being spent in that environment that might well be wasted. that is not the biggest cost. the biggest cost in the medical malpractice tort arena is that as a system of health care, we do not have a systematize activity, we lose a lot of learning capability through these malpractice suits. it can destroy careers of individuals who have made mistakes. because of that, individuals tend to protect themselves by doing more tests than might otherwise. in addition, when the mistake happens, everyone goes to cover, it's quiet. we do not share it. when an airline has a problem, the employees are required to report near misses within 24 or 48 hours, so and engineering

group can study it and distribute the information throughout the airline industry as quickly as they can, which could take several months. in health care, in which 98,000 people a year or hurt by medical errors along, some people say is less and that or double, the point is, is more than one airplane crash three-year period 98,000 people is about 1747 crashing every 1.5 days. we would never tolerate that. in our environment, because of the malpractice tort and berman, there is no reporting, no mechanism we can learn. -- malpractice tort environment. we do not distribute this. this is the biggest problem

because of the tort environment. i am not saying get rid of malpractice. i am saying create a safety reporting mechanism where people can report errors in near misses that others can analyze and understand. in exchange for that, there is a safe harbor where you go into an arbitration environment, where patients actually get the payments they deserve, but we at least learn something out of this as we go forward. right now, we lose a huge opportunity. >> this comes from a patient from chicago, illinois. he says he was treated last april and spent over three weeks at the rochester clinic this spring. on the reform mail advocates for health care, when everyone with this basic coverage be able to get treatment at the mayo clinic without its five dozen dollar deposit or $80,000 copiague --

$5,000 -- $5,000 deposit or $2,000 in copiague. >> it depends on what the insurance companies to. the answer is yes. we do not have any contracts with insurance companies that require patients to come to us. they are coming of their own choice. we would really like to see a reform so anyone can come to the mayo clinic who needs our top of care. i'm hoping to reform will be able to answer the questions and that we get rid of some of those problems. >> what is the ratio of highest to lowest doctor salaries at mail? how does it compare with the country at large? are changes necessary to track

primary-care physicians question marks the ratio is about 2 to 1, roughly. it is in that ballpark. the fact of the matter is that what we do in our organization, we do a market assessment of organizations that are like us. that is our said our salaries, and around the 8% range of the benchmark organizations that are like us -- 80%. we tend to pay our primary care and pediatrics a little more than they would get otherwise, and we tend to pay our higher pay people a little less than they would get otherwise, so it is compressed in the middle. the competitive marketplace is driving things up.

overall, our salaries are a little bit lower. i think the country -- we have a large primary-care practice. we are in another 65 communities in iowa, minnesota, and wisconsin. we are providing local, primary, secondary, and tertiary care right in the community with groups of doctors and hospitals. it is a challenge to attract those folks, but it is a harder challenge to get people to go into medical school and come out with an interest in going into primary care. clearly, there has to be more

respect and more recognition of the value of primary care as we go forward. >> this comes from a psychiatrist who is paid to spend 30 minutes at a minimum with the patient, talking to them about their health. how can this be provided as a primary care service? >> at our institution, when a new patient comes in, are physicians will schedule one hour to spin with the patients -- to spend with the patient. there is no limit on how long they can spend. follow-up visits are routinely about a half-hour. we feel that the most valuable thing that physicians can do when they are relating to patients in the outpatient setting is to have adequate time to sit down and talk to them, get to know really what their problems are in their concerns.

it is frequently not their condition. it is recalling something around the condition that is related to it, and to spend time getting to know the families and understand what their desires are. our ability to protect that has been under threat ever since price controls went into medicare in 1983. we are fighting very hard to protect it. time with patients is where the real value is generated. we schedule our routine primary care in the same category. >> we are almost out of time. we have a couple of important matters to take care of. first of all, let me remind our members of future speakers. on september 28, ken burns, the documentary filmmaker will be here to discuss his new production and national parks. on october 8, john potter, the postmaster general of the u.s. postal service will give us the

state of play at the postal service. on november 13, chick like founder and chairman and his son will address the luncheon. it is a father and son team discussing their companies unprecedented sales growth in a struggling economy. i would like to present our guest with the much coveted national press club mug. [laughter] >> thank you very much. [applause] after point out that for dr. cortese, that is the third in a series of months they have gotten. had the best measure precision outcomes for end of life care? >> the best measure for that is to ask the family how they feel

things went at the end of life. this is a very difficult time for everyone. some of our results show that we are pretty efficient in in a block here. all i can say is, we do not do anything -- we are efficient with the end of life care. what we do is just get to know the family. our physicians understand a problem and get to know the patient. we do what seems to make sense for them, because our core value truly is, the needs of the patient come first. what ends up happening is we in of having those people in the hospital fewer days in their final two years of live, in the icy youth year days, fewer procedures and surgery. -- in the icu. we in up with a lower cost

scenario. however, you have to ask the family if they were satisfied. did they really get what they wanted? i would say in time, the most important measure for everyone to have is going to be the service components of what we do for people and begin to ask questions, what do people really want? >> thank you. i would like to thank you for coming today. i would also like to thank staff members for organizing today's lunch. also thanks to the national press club library for its research. the video archive of today's luncheon is provided by our broadcast operations center. our events are available for free download on itunes as well as our website. non-members may purchase transcripts, audio and videotapes by calling or e-mail

in us. for more information about the national press club, please visit our web site. i thank you very much. we are adjourned. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> what is marked on health-care legislation expected to be like in the upcoming week? >> you can make the case that the built will really be written in the markup that starts on tuesday. you will see amendments on issues such as the public auctiooption, and from the repun side, we will see amendments to strip down the cost of the bill, abortion and immigration issues. >> who is likely to offer the

amendment? sinter rockefeller it says you has a whole bunch of them. center chuck grassley on the republican side is going to take the lead for the republicans. >> one is been the reaction so far from fellow democrats and republicans and from the general public in general republic. >> republicans did not like it all. some felt it did not go far enough to help the uninsured and the biddle -- middleclass. the business community had some complaints, but i liked it more than the bills that have seen from the democrats. it may be too soon to seesay how the public at large ticket. >> there have been weeks and weeks of talks.

one dissenter wrestling not seem to have support? >> the structure of all the reform bills is too liberal for them. they see a potent political issue here. they think it could be a winner for them in the next round of elections. on a smaller scale, there are issues with the republicans that they could not come to terms with, the overall cost of the bill, whether abortion services will be covered, whether illegal immigrants would be involved. >> one is to continue to say he believes he will be added in the end? >> senator baucus seems to believe american politics is the point where everyone recognizes the health care system cannot stay the way it is, and ultimately when it comes time to cast a vote, people will not want to be on the wrong side of history. >> how is the bill likely to be paid for? >> a tax on health insurance --

there is a concern because will trickle down to employees, making their health insurance more expensive. it reduces medicare spending over a 18-20 years time frame. >> what will you be watching most closely as the bill makes its way through this legislative stage? >> a lot of the success of this depends on whether democrats are willing to move toward the middle where senator baucus has framed out this bill in order to get behind it. whether democrats on the finance committee can come together on a consensus on a bill that can move out, because ultimately they may never have many republicans on board.

>> thank you for your time. >> it has been announced that the senate finance committee will hold an open executive session to begin work on their health care legislation this tuesday. live coverage of the markup begins at 9:00 a.m. eastern on c-span. >> up next, the values of our town, all on health care. then, first lady michelle obama talks about health care legislation. after that, our look at u.s. healthcare will continue with dr. cortese, president and ceo of the mayo clinic. >> sunday, a forum with former president jimmy carter at the carter center in atlanta. he and his wife talk about the center's current help and foreign policy programs and take questions from the audience.

>> what are your thoughts regarding the recent outburst unrepresented joe wilson of south carolina during president obama's recent address to the joint session of congress? do you recall a similar event in your political career? >> i am going to be frank with you all. i think it is based on racism. [applause] there is an inherent feeling among many people in this country that an african-american ought not to be president. and ought not to be given the same respect as if he were white. this has permeated politics ever since i have been bob bennett, back in the 1960's. not only in the south, but also -- since i have been involved in it -- throughout the nation.

>> we will show you that entire event sunday at 6:00 party in 9: 30 p.m. eastern. now, a health-care town hall. this is part of an event the group called the value of voters summit. we will hear from republican members of congress and later speeches by mitch mcconnell and house minority whip erick kanter. this is about nine minutes. but let's bring on our health care panel, moderated by a senior vice president or your representative values before congress on a variety of issues such as education policy, tax reform, fight based initiatives, and the sanctity of marriage. he has a long history in local and national campaigns as a political, legal, and legislative analyst. he is a frequent guest on many talk shows and radio shows

around the country. his works have appeared throughout the country in major news outlets including "the new york times," and forbes magazine. coming now to moderate our health care town hall, which pleased welcome tom mccleskey. [applause] >> or you always get? that is good to hear. are you all feelings stimulated? this is the audience participation part. are you all feelings stimulated? first off, how was asked to allay any fears. if you are looking for the death panel, you need to go up to rem 3200 and ask for nancy pelosi. -- go up to room 3200.

we have seen democracy in action, and it is just beautiful. it is great that we can bring that to you here today. first, the ground rules. i have been worn by nancy pelosi that some of you are an unruly mob. if anybody acts up, we have union thugs to kneecapping. if anybody here is from a corn, i need to ask you not to buy a bodies fingers off -- did not bite anybody's finger off. i have to tell you, i have the greatest job in the world. not only every day do i get to work in the same halls as daniel webster, john quincy adams, henry clay, the late great henry

hyde, i also get to work with their successors, many of whom are here today. please keep your questions to health care. if you would like to make a statement, they will show you where to make them out in the hall. anyone who violates the rules will have to watch "dancing with the stars" with tom delay twice. first i would like to introduce the congressman from the ford district of new jersey, congressman chris smith. [applause] congressman smith not only represent his district admirably, he also is probably

the successor to henry hyde, and a very worthy successor. women around the world can look to him to be safe from sex trafficking and other abuses. [applause] next on the panel is representative tom price from the sixth district of georgia. [applause] he is not only the head of the republican study committee, a group of conservative members on capitol hill, he also has introduced a total health care reform package that addresses the physical and social needs that will that really need. our last speaker is represented michelle bodman from the sixth

district of minnesota. -- michele bachmann. when she was in the state legislature, we also shared the same honor that keep algren -- keith ealdorman named as of the worst person in the world. we are born to start off with remarks first from congressman chris smith. -- going to start all. >> welcome to everybody, and i am so glad to be here with so many committed people who care so deeply about the direction that our country is taking. right now we are in a very

serious crisis, as we all know. i have been in the pro-life movement for 37 years. i have been in congress for 29 years. i have cochaired a bipartisan caucus for the last 27 years. never in all those years have i been more concerned, and i know you share that, about the abortion promotion coming out of the white house. the culture of debt promoted by barack obama, by his secretary of state and his cabinet, and by appointees is outrageous and unconscionable. the unborn child and his or her mother or more at risk now than ever since roe versus wade itself.

the current health care debate is the point of contact, the place where we have to stand firm to ensure that we do not see any further diminution of protection for the unborn child, but on the other side of that coin, receive no further expansion of the culture of death. i do believe that obamacare represents the greatest threat since roe versus wade itself. that are going for it all. they are using an enormous amount of deception, misdirection, saying one thing over here while doing the opposite over there. the abortion-rights organizations have been playing this game, using code words like reproductive health and reproductive rights interchangeably with abortion, trying to deceive america about what they are really about.

we know that if obamacare becomes law, approximately one- third abortions will occur, at a time when there has been a steady, persistent decline in the killing of unborn children and the wounding of their mothers, and it's time when the trend line is going in our direction in all areas, including among young people who increasingly identified as a prologue. even the gallup poll, which often ask the question in a way that it elicits the worst possible outcome for ourselves, it is saying america is pro- life. against all that, the abortionist have teamed up with barack obama, the abortion president, to try to force you and i to coerce uni to compel every american to subsidize abortion in this healthcare plan. when the president said

seemingly airtight rhetoric the other nine, that under our plan, no federal dollars will be used to fund abortion, those boards were demonstrably false an extraordinarily misleading. [applause] i say that with profound sadness that the president would get on such a stage with all america and many in the world looking on and make that kind of false statement. it is unconscionable. we know that the plan that was marked up in the house of representatives, three committees of the house, and dr. price did a magnificent job in fighting for what and other important aspects of health care reform, we know for a fact that

when they talk about the hyde amendment somehow covering the public auction and the affordability credits, to brand new programs, that is just not so. the hyde amendment covers medicaid funding for abortion. it covers those items contained within the department of health and human services appropriations bill. what obamacare would establish is to brand new programs. one would provide up for the 400% of poverty, so those after medicaid would get affordability credits on a declining scale based on their ability to pay to buy health insurance. the language could not be more clear that secretary sibelius' or any hhs secretary would have clear authority to improves -- impose abortion on demand. is right there in black and white.

that is public funding for abortion. we see very clearly the public plan, the affordability credits will expand the opportunities to destroy children, will create additional venues. every state jurisdiction will have to have a plan that has abortion in it in the private sector. a majority of counties in this y have no abortionists. there are no longer in business. the business of dismembering and chemically poisoned unborn increasingly offensive to health-care providers, and i want none of it. that would change if obamacare becomes law.

later this evening i will be in new jersey at a forum focused on the culture of life. martin luther king's niece will be there. she will be the headliner, and i'm looking forward to your her speak. every time she speaks, i am inspired and encouraged. here is a woman, a civil rights leader in her own right, who had two abortions. now she is passionately pro- life. now she says how can my uncle, how can the dream survive of inclusion if we murder the children? she speaks out and says that we need a society that reaches out to post abortive women and six opportunities for reconciliation. we know the studies clearly show women who have had abortions are

more prone to clinical depression that other abuses including suicide. we know that prematurity -- another study just came out of canada. 35% increase in prematurity and low birthweight. abortion is bad for women. it hurts women and exploits them. and it destroys children. more luther king's niece calls each and everyone of us, and i'm talking as well to those people who are in the middle who may hear this for some other means, dr. king calls out and says stop the enabling of this gross exploitation of women in this terrible killing of unborn children by dismemberment and by

chemical poisoning. abortion is not health care. [applause] >> good morning. my name is tom price. i'm privileged to chair the republican study committee and serve on this panel with rep chris smith. did you notice chris did all that without a teleprompter? [applause] michele said i just stole our line. this is a town hall, right? i'm proud to be in a room full of patriots. [applause]

we have incredible challenges before us as a nation. as a physician, health care is front and center in one of the most major issues that we must confront as a nation. as a physician, i have looked at the democrat bills. i have read most of them, including the 1000 plus page monstrosity. i am here to tell you that if there were medical treatment, that would be guilty of malpractice. we are currently confronted with the farthest reach of government in decades. this debate we are having about health care right now is really not about health care. it is about freedom and principal. we live in the greatest nation in the history of the world. we have that honor and the

blessing because we have stuck to principal. one would think that when we were challenged with significant problems, we would embrace fundamental american principle. instead, now we have a group that is running in the opposite direction. i'm want to talk about principles in health care this morning. big about what your principles are. -- think about what your principles are. everybody has principles in health care. most folks have the top three, affordability, accessibility, and quality. i add three to those. i at responsiveness, innovation, so we have the greatest health care in the world and continues to do so, and finally, choices.

you need to be at issue is who is treating you, where you are being treated, what kind of treatment you receive and when. those are my six principles. what every years are, they may be part of those are something completely different -- what ever yours are. what ever they are, none of them are improved by the intervention of the federal government. [applause] so what are the solutions? i have charged our members with coming up with positive, upbeat, optimistic solutions that embrace fundamental american principles. does exist for every single challenge we face. we have offered a bill that solves the challenge of the uninsured by giving them tax

deductions, tax equity for the purchase of insurance, so that every american has the financial incentive to purchase health insurance. we solved the insurance challenge of portability and pre-existing problems. you ought not lose your insurance if you change or lose your job or if you have an injury or an illness that strikes you or your family. you can do that not by putting the government in charge, but by making robust pulling mechanisms to get the purchasing power of millions. as a principal, we have to write into law that patients and families and doctors are the ones making medical decisions, not the federal government. [applause]

h.r. 3400 addresses the issue of lawsuit abuse. we have to solve the challenge of lawsuit abuse. it does so in a way that allows for individuals to have appropriate redress, but that things are hard before individuals to know what it means to take care of patients. we can do all those things without raising your taxes by one penny. [applause] h.r. 3400 is the bill. google republican study committee. if your interesting -- interested in stopping the government takeover of health care, come to petitionpelosi.com. i cannot thank you enough for the work that each and everyone of you do every single day. samuel adams said it does not take a majority to prevail, but

an irate and charles's minority, king on setting brush fires of freedom in the minds of men. i am honored to help reset those brush fires of freedom. god bless you. [applause] >> midmorning, everyone. it is so unfair to have to follow these two great guys. there is no one who has worked more than chris smith to champion the culture of live. he has been a great leader for all of us. dr. tom price, who has been five years in congress but is now the head of the republican study committee, the conservative are other republicans in congress. what an honor to have him here as well. i am grateful to be their little sister, so to speak. it is an honor, and i want to

put a little caveat in before i give you my remarks. i want to talk about what you have seen happen on the acorn issued this week. it was a housing and urban development bill. yesterday we took about in the house to it defined the acorn. our colleague offered a motion to defund acorn. a housing bill in the senate, an education bill in the house. how are these two bills going to come together to actually defund acorn? as we stand here today, it has yet to be defunded of one dime. nothing has happened. recognize that our president was a former attorney for project

of. he has it within his power to direct the housing and urban development department to stop grants now if he wants to to acorn. these are the calls we need to make to our members of congress, senate, and my health, and demand no political gamesmanship. do not try to make yourself look good. really do something. we do not like the promotion of child prostitution and illegal aliens coming into our country. stop it now. will you do that? [applause] you are a very intelligent group, so i know you will figure this out. on the back of what tom price said about positive solutions, it really is insulting when we hear the republicans do not have positive solutions.

we have all sorts of positive solutions. that may give you a positive solution that is very easy to understand. we have 1018 pages of the democrats' plan, and we heard the president in his speech last week tell us there were some large details that had not been worked out yet in his plan. some large details that just trust me, we will get it right. pass the bill, and we will take care of the rest. one of which is your taxes going up in january, and health-care benefits do not start until three or four years from now. were you aware of that provision in the bill? you start paying taxes right away and we will see about getting additional health-care three or four years down the road. rather than the federal government owning your health care, rather than your employer owning your health care, you on

your health care, just like you on your car insurance in your house insurance, you on your own health care. the new can band together with whomever you want, maybe teachers, farmers, realtors, maybe like a credit union. you bind it together in a geographic area so you have purchasing power. you bind together with you every want to purchase health care, the new bid to purchase whatever level of insurance coverage -- then you get to purchase whatever you want anywhere you want. today, the federal government gives a partial monopoly to insurance companies in every state in the country. did you know that? this is something the federal government can get rid of, and it cost no tax money. so you on your health care. you bind together with to

everyone for purchasing power. then we let you use tax-free money you have set aside to buy it. over and above you can deduct on your income tax return, and then we have true lawsuit reform. that's all 95% of our health care problems, and we have not spent federal tax money to do it. it is called freedom. that is the route we want to go. thank you so much. we look forward to your questions. [applause] >> this is change can believe in. there are three microphones set up in this hallway. i would ask that you lineup and behave like gentlemen and treat everybody with the respect we deserve.

>> what can be done to make certain that lawsuit reform is included? the yellow car we have did not mention that issue. as long as doctors are terrified of ordering expensive test, the affordability factor of health care will always be an issue, regardless of what other reforms are included. >> i would say noticeably absent from one is making its way through the house and senate is tort reform. back in ronald reagan's presidency, there was a well- founded attorney general's report that recommended capping pain and suffering and having a sliding scale for attorneys' fees, particularly the incentive to bring a frivolous lawsuits, which drives up the premiums that dr. price and others have to pay, which is driving them

out of health care in certain specialties. in republican party, which was offered bills that passed in the house of representatives that would have capped pain and suffering a $250,000 and what happened a lid on these excessive fees. there ought to be the ability to sue, but it needs to be reasonable. unfortunately, is nowhere to be found. >> the imperative for lawsuit abuse reform is not just the cost of the malpractice insurance for physicians and for hospitals. it is primarily the cost of defensive medicine. those are the tests and examinations and procedures that your physician performs in order to make certain he or she is absolutely certain that have done everything they can to make a diagnosis or to treat

something, so that if they find themselves in a court of law, they are able to say to the jury, i have done everything i could. that adds hundreds of millions in costs. the answer is acorn. look what has happened of the last week. the american people understood and they raised their voices and said stop this madness. the senate passed a bill to stop it and the house passed a bill to stop it. that was done without a major media markets even paying attention to it. [applause] the solution once again will not come from washington. it will come from america. when the american people demanded, then it will happen. >> is an issue whose time has come. again, trust but verify. the president talked about how

he was directing kathleen sibelius to implement a pilot program on tort reform. we have already had a pilot program called the state of texas. they did a wonderful job of lawsuit reform and actually some medical costs come down. we know it works, but the proof is in the legislation. the president made no mention that he was actually going to include the tort reform in the legislation, unless it is worse on a sheet of paper that goes into the bill, it is not going to happen. it means nothing if it does not actually defund acorn. it means nothing it will not actually result in tort reform.

put your money where your mouth is. but the language in the health- care bill, and then we will believe it. i am a former federal trial warrior, and i believe in for reform. -- former federal crile lawyer. -- former federal trial lawyer. >> i heard the term monopoly used. how do you overcome the mandate in certain states which i think protect the regionalization of mandating coverage is? there is sex change surgery that is mandated in certain states but not other states. contracts negotiated in that state are cheaper than they would be -- how do we overcome

that? >> i believe minnesota is the state that is the no. 1 state for mandates. you cannot buy an insurance policy in minnesota unless all those mandates are filled, which drives up the cost of health care. if we would remove this federal law that creates these private monopolies, then states would be competing with each other. if you have a high level of mandates in one state and local level and another, people would be ample to buy an insurance policy from the state with the low level of mandate. some states may decide to have zero mandates, you can sell what their insurance policy want. if that is the case, the origination of insurance policies in the state will probably skyrocket. that is called competition, free enterprise. that is something michael more

does not know much about. why not try that option before 8 $2 trillion monstrosity destroys the greatest health system there has ever been in the world? [applause] >> i must play the devil's advocate with this question for dr. price. we are asked to sign this yellow card that says there shall be no denial of medical treatment based on age, disability, or quality of life. i am a physician just like you, dr. price. an unseen people over the age of 90 receive coronary artery bypass grafts that are predicted to add two or three months of life to the patient, at a cost of $50,000 to $100,000, and i have also seen a lot of patients with terminal cancer and

advanced alzheimer's disease but on chronic hemodialysis, the artificial kidney, against ordinary conjure indications of the nephrology profession. how do you deal with that? is there supposed to rationing in some of those cases or not? >> it gets to the fundamental issue and the fundamental principle of who ought to be making decisions about health care treatments. the fact of the matter is that the decisions about what kind of treatment you receive or i received or anyone receives ought to be between patients and families and doctors only. [applause] how does that relate to this question, and why do these things happen? i suggest that these kind of treatments happen not necessarily because the patient or the doctor wants it, but because of the system in which we find ourselves, where each of

them feel that is the only option that ahathey have. the doctors believe they have to offer every possible kind of treatment, so they will not be sued. you sit down with the family as a caring and compassionate physician and say these are the options available to us, these are the pros and cons, and let the family and the patient and physician together make that decision without the threat of somebody over their head. [applause] >> that leads to my question. i am a father with a daughter who has special medical needs. i have a health savings account that my family likes.

i would be interested in a comment on that. more specifically, under obamacare, when i still be ample to take my daughter the 2.5 hours one way that we go to see the specialist we want outside of our health-care network the the to give her the best coverage confined if obamacare is rammed through by democrats? >> it gets to the specifics of what it means for you and your family. the honest answer to is, we do not know, given the current bill, because it provides so much power to individuals who are defined in the bill like the health choices commissioner. those kind of answers are not readily available through the bill itself, which is why you have to get back to the principle of who ought to be making these decisions.

we should never see the decision made by the federal government. that is a wrong principle, and that is where we ought to be, so that you have a comfort and confidence that whatever happens with washington's decision making, that you still retain the opportunity and that privilege and that right for you to be able to make those medical decisions. >> given the constitutional intent originally, what are we even considering any involvement in health care at all in any form from the national government? [applause] >> a lot of people are asking that question. what we have seen transpire in the last few months is the resurgence of a fidelity to the

constitution of the united states. people are reading our great founding documents, understanding that congress has enumerated limited powers. you can turn that document upside-down and inside out. there is nothing about running health care in that document. part of the reason why we are at this so-called crisis is because government spends about 47 cents of every dollar on health care. government has come so far entry into the area of health care that they are the big dog in the room now. what we want to do is try to change that model so that you on more of your health care, you have more choices and control over what you want and what you need to have down the road in the future. so you are exactly right. that is the debate we need to have. have the executive, congress,

and supreme court acted within their constitutional limitations? we would not have the current problems we have in our country. [applause] >> there is a role, but it must be limited in carefully prescribed. medicare and medicaid to provide a very valuable service. senior citizens, and medicare events allows the private sector insurance to be much more involved in the management of the care of our senior citizens and those who are disabled, but what we are so concerned about is that obamacare is reckless. i chair for different caucuses, including the alzheimer's caucus, the optimism caucus, and i am very concerned about a

government bureaucrat becoming a co-manager on the course of care and the dollars expended in the ability to limit and get a negative adverse consequence is there in neon lights. look at canada and the united kingdom and other places where the outcomes for cancer and a myriad of other diseases and disabilities are far less than the united states. the private sector plays a valuable role. we need to have a mix like medicare, but it needs to be very carefully established. this new expansion, which will quickly lead to socialize care -- two-thirds of those on private health insurance will be dumped into the public option. that is about 140 million people who already have private health insurance who could lose it under obamacare.

>> waste, fraud, and abuse in medicaid and medicare is not new. this is not a question. when i do not understand is why this administration has waited nine months into their administration to address this, and only then as part of their efforts to contain the cost of their proposal. my question is, medical malpractice lawsuits cost millions. they add millions of dollars to the cost of health care. i do not understand, and maybe someone can answer this question, why the democrats have not addressed this in their reform proposal? >> i think howard dean said it best when he said that the reason we are not dealing with

liability is because we do not want to take on the trial lawyers. that is what he said. he made it very clear. he said it was a political calculation on their part. there are too big constituent groups that democrats believe but them into power, the unions and trial lawyers, mostly personal injury lawyers, and they are not going to offend them. the rationale is political, and the american people know that and understand that. they are gaining greater confidence and standing up and saying this cannot be solved without lawsuit abuse reform. >> consider the same people who put together medicare, who put together a system where president obama said it has literally hundreds of billions of dollars in waste, fraud, and abuse, these are the people we are going to put in charge of expanding the system to all the

rest of us. for a bar% of american people who already have health insurance -- 85%, we are going to destroy what they have to be able to expand additional care to the other 15%. we are going to destroy something that works for eight hours% of the people to mandate that another big thing% have it -- it works for 85% of the people. why not just extract the waste, fraud, and abuse? why not just pull that out and start from there? [applause] >> the house committee on veterans affairs oversees the largest integrated health-care network in the world.

and oversight hearings and probes, we always defined in the waste, fraud, and abuse. the biggest -- in no way will the savings be a crew that something if we just throw that were around like a slogan. dr. price is absolutely right about defensive medicine. that is causing waste, maybe not fraud and abuse, but waste, and toward reform is the quickest way to lessen that waste. [applause] . .

need to work in order to make certain that one branch of government doesn't exceed its bounds. and that's where we are right now and it's why the american people have such anger and concern, because they don't see any checks and balances here in washington. so the speaker can headlong move as rapidly as she wants on whatever issue she wants again as long as she can keep her folks in line. if there's no check in the executive branch because we've got no confidence there would be any veto out of this  administration on anything that resembled a violation of the

constitution, then the redress is through the courts and we both know that takes a significant length of time as well as an uncertain outcome given many of the courts we have right now. so the fact of the matter is the check and balance we have right now is the best check and balance and that's the american people so when the nern people rise up as i believe they will over the coming 14 months and say once again, time-out, this is not the direction in which we believe this nation ought to be heading, we're going to institute appropriate checks and balances come november 2010. [applause] >> there's an economist from arizona state university who did a study and he said that prior to the inception of bail out nation, in other words, less than one year ago, 100% of private business profits were private but since the inception of bailout nation, he has calculated that with all of the

government takeovers and the current mentality that rules washington, d.c., 30% of private business profits are now owned or controlled by the federal government. if president obama and the liberals that dominate the united states congress have their way, an additional 18% of private wealth created in the health care industry will be owned or controlled by the federal government, which will be 48% of private business profits. that doesn't include the vote that we took yesterday in the house of representatives where the united states house voted to do away with all private lending for school student loans and instead it's now the public option. so remember, 30 years ago all student loans were private. and then congress put in a public option for student loans. as of yesterday, congress said we don't want anymore private loans, we want only government

opt. so yesterday your congress took a nationalization or a takeover, government takeover of all student loans. that's the direction we're in. and we haven't even yet passed the government, the federal government taking over the energy industry with the climate change bill. when that happens, then what would that percentage be? this is very serious what's happened in the last year. the government takeover of private business profits. that's why you see the pulse of the american people so uncertain. they're not just making this up. these aren't hordes acting irrationally. these are very common sense decisions people are making because they realize we are losing something precious at a speed never before seen in this country. [applause] >> i would just add that with -- if you want to see change in washington you've got to make the change. one thing, if i can just shill

for one second we have a path reception tonight to make sure that congresspeople like these three who are representing the nation in congress, not people like nancy pelosi -- you can get information on that at the registration desk. >> it's been said that the main road block to the legislation in the house are the blue dog democrats. i actually happen to think it's the pro-life democrats. i also read on a pro-life blog a while ago that steny hoyer was apoplectically reaming the pro-life democrats after a vote not long ago. are you all confident that the pro-life democrats are not going to have their arms twisted by nancy pelosi? and what are you republicans doing to voice solidarity with them? i think if there is any group in the congress that needs our

prayers right now it's those courageous pro-life democrats. >> one question. barlt stupak from 3467 -- -- michigan has been absolutely valiant and brave and courageous and very smart. he and joe pitts, who is also a republican on the energy and commerce committee crafted an amendment that would take abortion out completely from obamacare and their amendment initially won in the committee, amazingly, only to have a parliamentary maneuver pulled, a couple of arms were twisted and they were able to on the pro-abortion side eke out a very small, narrow victory and on what's known as the caps amendment, a very, very pro-abortion amendment. i agree with the questioner, property-life democrats and there are fewer now than there were when we went through this

trial with hillarycare and they too during that difficult time were magnificent, standing there with an amendment saying that we will not be part of the greatest expansion of abortion in the united states history since roe versus wade. so bart stupak and jim oberstar from minnesota and others have signed letters to the speaker and to the president saying that they will not vote for obamacare unless all of the pro life problems, the pro-abortion problems have been rectified. and your call for prayer, bart is a very principled law maker and a man who is, i can tell you because we know what it's like behind the scenes. what we see in front of the scenes is bad enough but he is not well liked by certain elements of the democratic coalition so he needs our prayers. he needs our support and many he is a very, very courageous man and i greatly admire him. so thank you for that question.

>> let me take just one minute if i may. i would be remiss if i didn't say that the opportunity the blue dogs have to finally show some back bone is because of the unan i amity of the republicans in the congress standing united against this remarkable government takeover of health care. it is imperative to remember that every single blue dog voted for nancy pelosi to be speaker of the house. you've got to remember that because that's the individual that sets the agenda for the house of representatives. we have begged and cajoled and prayed for and lifted the blue dogs up and at every single turn our hopes have been dashed so i hope that the prayers of this room and the nation will give them the for the i tude and courage to finally stand up to their leadership and say no more will we allow this travesty to go on. >> we're running a little short

on time. we'll try to do a rapid-fire round here. >> under the obamacare, what is the fate of our health savings accounts and also with the republican plan's alternatives, how would that affect the health savings accounts? >> under 3200, the bill in the house of representatives, after a five-year period of time all health insurance in this nation would have to fit a very specific set of sts about which health savings accounts won comply. so health savings accounts, flexible savings accounts, high deductible accounts would not only be unavailable, they would be illegal. that's the consequence of 3200. the senate bill is not as specific and we'll see how it moves forward but the goal of these individuals, make no mistake, the goal is to have the federal golf. taking over health care in this nation.

>> there is really only one question we have to ask ourselves on any of these health care bills -- who will have more control over health care? will it be government or will it be yourself? that's all you have to ask on any of these bills. who will enjoy the control. i just want to mention one of our colleagues, kevin brady from texas, put together a great graphic. you can go to gop.gov or any of our web sites. it's a graphic that shows the new bureaucracies that would be created under obama care. put your spouse, elderly parents, your kids on one side and the doctor on this side, the surgery you need, the drugs you need, the medical devices you need and think that you have to fight through 53 different bureaucracies to get to the goal of health care. that's obamacare and also reck it is the i.r.s. who will be enforcing this system under obamacare.

how do you like them apples? the i.r.s. would be your enforcement mechanism. so very simple -- who will have more control, you or the federal government? >> i think you just got their attention. >> frank morelli from new jersey. and wellington, florida. may i say thank you for your service, riment smith because -- [applause] -- -- finding a pro-life republican in new jersey is like finding a jew in damascus. it's not safe. but i came down here to talk to you, representative price. i want a job but i don't want any pay for it and can i help you? in fact our daughter and son-in-law moved to georgia. i looked you up and both you and michelle balkmann are on my new web site. i'm not going to give it because this is not a commercial but i've been

practicing for 40 years as a trial lawyer. i'm retired. i have nothing to do. i want something to do. i went down to georgia and i melt judge dawson jackson and he swore me in and i came down there to georgia because i want to helpup. >> god bless you. thank you. you're very kind. >> hey, i need more help in minnesota, so come up to me! >> come back to jersey. >> it's warmer in geament >> we'll sign you up. just google republican study committee or the web site. thank you ever so much. >> yes, my question is really about the democrats right now and their willingness to go this alone and strong-arm this program through without any bipartisanship. if they get this through, how do we roll this back in 2010 and 2012? >> again, the checks and

balances are the american people and so i believe if they strong-arm it through. if they rahm it through, what will happen is that the american people will not only allow the house of representatives to be led by responsible republicans and make other -- certain that we move the nation in the correction -- correct direction, the senate will be run by republicans as well. the answer is twofold. once we have the appropriate checks and balances in congress we have a great opportunity to sit down with president obama and say we're happy to talk about whatever issues you would like to talk about but first we need to repeal the disaster and tyranny that you passed last session. [applause] >> i'm afraid we only have time for one question. right here in the middle? >> thank you. i'm very ashamed but i had three abortions.

and i wanted to say that having an abortion is a downward spiral. i started drinking and doing drugs after the abortions. which led to a car accident in 1977. and i wanted to know what i can do now. >> you are so beautiful.

my dear, beautiful friend, you already have. you have told the world and that's the beautiful story for every woman. there is forgiveness. there is a way forward and there is life after. thank you for being willing to share your story. >> god bless you. >> we love you very much. thank you. >> i would like to thank all of you and also thank our distinguished guests. who would have thought, three politicians on a panel and we ended up on time. kind of. but thank you all and god bless. >> keep fighting for freedom. ♪ there ain't no easy way out ♪

>> well, thank you very much, gill, it's a pleasure to be here this morning and i appreciate the opportunity and welcome to town all of you. it's great to be here with so many folks who cherish the values that make our nation great and who aren't afraid to say so. [applause] you know, it's not always easy. our friends on the left like to think that they're the party of inclusion, and yet we've seen time and time again how quickly they can turn on someone who expresses a different point of view. we've seen it with entertainers or sports figures who speak up about their beliefs. we've seen it happen in washington to qualified judicial nominees who believe the constitution means what it says. we've seen it with candidates for office who take an unpopular position and we're seeing it today in the debate

over health care. ordinary americans speaking their minds, dismissed and ridiculed by people in power. the reason they're doing this is clear -- because we're winning the argument. [applause] at town hall meetings across the country last month we saw the wisdom of ordinary americans and i know that many of you are in this room. you know who these protesters were because you were the people at those town halls. you were the people who were there asking the right questions, reminding your representatives what a true democracy is. you were the men and women who filled the mall here in the district to overflowing last saturday, surprising even -- [cheers and applause]

-- surprising even the strongest supporters of the event. you were the people who proved the politicians wrong what -- when she -- they said all this activism and unrest was crafted somehow in a board room down on k street. the grass roots activism isn't astroturf as they like to put it. it started at your kitchen tables and in your living rooms. it started out of a sense of urgency about the future and it was underwritten by you, an -- not a public relations firm here in washington. so why did you do it? why did you and millions of others travel to the mall or wait in lines at town halls from one end of the country to another in the august heat? because you believe as i do that there is something special about america. and you worry that we may be

one more bailout away, one more so-called reform away from losing our way as a nation of the people, for the people, and by the people. these worries have been building for a long time. even before last year's election. but they've reached a new level in recent months. as soon as democrats in congress decided to move forward with the health care plan that would put the government in charge of one sixth of our economy and would lead to the same kinds of denial, delay and rationing that we've seen in every single other country that's adopted a government-run health care system, the american people literally rose up. yet rather than address the legitimate concerns of all of you shall is organized left has attempted to dismiss you as cranks or scaremongers or worse. well, i've got a couple of questions for the white house and its allies in congress. if americans who like the care

they have can keep it under the democratic plan, then why did a democratic senator from florida come down to the senate floor this week to say he plans to fight hard to keep his constituents from getting kicked off their medicare plans? if the bill allows them to keep their coverage, then why is he fighting? and if the bull doesn't allow government-funded abortion, then why bonet -- won't our democratic friends allow a blanket prohibition on federal funds for abortion of any type in this bill? the fact is there are multiple avenues for government-funded abortion in these reform proposals either directly through a government-run plan or indirectly throughsubsidies to private plans. this is wrong. the vast majority of americans strongy oppose government-funded abortions, and on this important issue we

will keep up the pressure until your voices are heard. look, we know that most americans are common sense conservatives and that most of the people running our government in washington are not. that's why the legislation they propose so rarely does what its name suggests. i can't think of a better example than the employee free choice act. here's a bill that's meant to make it harder for workers to do what they want to do, to inhibit their freedom. on this important issue and on many others we've been calling their agenda what it is. the american people agree with us and we're starting to see the results. on health care we've had a simple message. the democratic plan costs too

much. it asks seniors and small businesses to pay for it and leads to a government takeover of health care where care is denied, delayed, and rationed. we've also put forward better ideas for reform such as getting rid of junk lawsuits against doctors and hospitals. [applause] promoting wellness and pro vention and giving individuals the same tax benefits big corporations get for buying health insurance. it's impossible to deny the crowds we saw in august or last week on the national mall, despite the best efforts of many in the mainstream media to dismiss the critics. today i can proudly tell you more importance -- americans now oppose the democratic plan than support it.

on national security, it's undeniable that we've been heard on national security. common sense conservativism has completely reshaped the debate on guantanamo. in january the administration said it would close guantanamo in a year, without ever providing any details about how to do it. republicans repeatedly asked the administration for answers and said it would be irresponsible to close guantanamo without a safe tornte -- alternative. and now the american people and even a vast majority of democrats agree with us and oppose closing guantanamo without a plan. on spending and debt, conservative impact in the debate over taxes and debt is also undeny abe. we told anyone who would listen that the administration was spending, taxing, and borrowing too much for the nation to

bear. in the first 50 days the administration's actions cost the american taxpayer, listen to this, in the first 50 days the administration's actions cost the american taxpayer more than iraq, afghanistan, and katrina combined. the budget that they proposed and passed doubles the national debt in five years and triples it in 10. the biggest golf. spending stree -- spree ever in the middle of a recession. we've hammered away at this wasteful spending and debt, and people are beginning to listen. they're worried about it and they're beginning to question the economic predictions they're hearing from the administration. the democrats have offered more spending, more taxes, more debt and unprecedented government control. we must not go in that direction. we must turn the tide. now our job is to keep our message loud and to keep --

keep it clear. that's where the family research council and concerned citizens everywhere come in. we need to multiply our voices in the public square. that takes work and the family research council has played a vital role in doing that work and showing americans that common sense conservatives offer the best solutions to the problems we face as a nation. when the american people hear the ideas and alternatives we're offering, they overwhelmingly support us. so the key is making sure our ideas and our messages are heard. and with your help, they will be and they must be. the stakes are too high. the consequences, too serious. too often in history we've seen howl the expansion of government can lead to the contracting of liberty. and that's why groups like the family research council are so important. you remind us that faith,

family, and freedom come first and that a nation that cherishes both will not lose its way. we cannot let a crippling debt, a weakened defense, or an ever-expanding government stifle the american dream. and i can tell you, ladies and gentlemen, with your help, we won't. thank you so much. [applause] ♪ >> all right. now coming is a popular five-term congressman representing the seventh district of the state of virginia. in december he was elected to serve as the republican whip. he holds a seat on the house

ways and means committee, which has direct jurisdiction over taxes, trade, social security, medicare, pretion -- prescription drugs for seniors, health care, and welfare reform. he's got a very important message for you this morning. he also serves as chairman of the congressional task force on terrorism and unconventional warfare. from the key battleground state of virginia, would you please almost -- welcome congressman eric kantor. [applause] ♪ from the east coast to the west coast ♪ ♪ down the dixie highway ♪ this is our country >> thank you. thank you very much for having me. it is a true honor to be here. first i'd like to thank you, though, for being here and for fighting on the front lines of

what we know is truly a battle for our democracy. i'm from virginia, where a story is often told of a baptist pastor who was urgently advising his congregation and he asked, "does everyone here want to go to heaven?" they said yes, pastor. he asked again, do you really want to go to heaven? they said yes, pastor. he said do you really want to go to heaven? and they all yelled yes, pastor. so he said stand up if you really want to go to heaven and so all the congregants stood up except for one man on the front row and the pastor looked atd him and said brother smith, don't you want to go to heaven? the guy said sure i do, pastor, about i was -- but i was kind

of afraid that you were getting a load together to go right now. well, my friends, we do need your help right now. [applause] the battle for our democracy is being fought today. this hour. in the hauls of -- halls of congress and throughout the 435 congressional districts across this country. we must win this battle to change the troubling course america is now on. let me spell it out, i think, in a little more detail as to why it's so important. if you'd go with me for a second and imagine a hospital room where a man is in bed with his family all around.

he's been in an induced coma for a year and the doctors are just beginning to wake him up. his eyes flutter and then open, and everyone cheers. he says, "i feel like i've missed so much. tell me, tell me what's going on in the world." and his wife says, "well, we're in a bad recession. our government owns the biggest car company and controls the banks. we're talking directly to north korea and iran while they develop nuclear weapons, and we're on our way to a government takeover of our health care system." "unbelievable," the man says. "i went into a coma in america and i wake up in sweden." can you relate? right now, millions of americans are waking up

realizing that they don't recognize their own country anymore. for more than 200 years we believed in limited government and now people in washington are seeking unlimited power. for more than 200 years we have believed in peace through strength. and now people in washington believe in fighting terror by talking. for more than 200 years we have believed in faith, freedom, and family, and now people in washington are tearing at our foundation and trying to replace it with the latest social whim or pseudo scientific theory. our foundation in america was built upon traditional values like the marriage of one man and one woman. [applause]

our values, our foundation in america was built upon the sanctity of all human life from fertilizeation till natural death. [applause] the left has whittled away at these values slowly but surely and now has majorities in both houses of congress and holds the white house. we've witnessed them striking down one pro-life protection after another, overturning the mexico city policy, reversing the conscience protections for pro-life health care professionals, to forcing you the taxpayer to fund the destruction of human life in the name of science. we have heard threats from the left in washington and beyond that they'll move to overturn

marriage protections currently in place, that they will force religious businesses to set aside their values in determining who they hire. the left is -- has also racked up the debt to every family at a frightening rate. they say if you want to measure your values, take a look at your register in your checkbook. well, if you looked at the nation's checkbook, it's a terrible picture of what we value. when we republicans were in charges -- charge the last eight years, we made the mistake of overspending and trying to buy support. it failed and the people fired us. [applause] but the democrats in nine short months have made us look like ebenezer scrooge on welfare. in just a few months they have doubled the projected national

debt and quadrupled the deficit. by the time they are done, we'll be paying $1 billion a day on debt service. the nation's credit card is maxed out to the tune of $483,000 per household. that's a bill 10 times the annual household income. some say it's like having a mortgage 10 times your income with no house to show for it. and as if that was not bad enough, our credit card company? communist china. here's one of the most important points though. the nation's fiscal policy and its family policy are two sides of the same coin. what's good for the long-term

economy is good for families. [applause] what's bad for the long-term economy is bad for families. if you look at the deriveation of the word "economy," it is household management. economic policy is managing our house well. ron ealed reagan was right -- the most important decisions in america are made around the kitchen table. and washington needs to make decisions based on the same values. but under the current leadership, nothing could be further from the truth. and here's the path that they and the left have taken. first, they mischaracterize the problem. then they overgovernmentalize a solution, trusting in programs rather than people. then they overpromise results, part of their sales pitch to

get us to take the plunge, and then when it doesn't work they overtax and overregular late to cover their mistake. as if just a little more money or a little more government is all we need to achieve nirvana. now, tonight at sundown begins one of the holiest periods of the jewish calendar. it begins with rosh hashana, literally meaning the head of the year. for jewish families it is a time of contemplation and introspection. we begin this period called the days of awe by examining the year gone by, looking back alt our relationships, our actions, and our attitudes to see where we may have sinned or where we could have done better. i would encourage all of us to do the same just for a moment. like the guy in the hospital awakening from his coma, we are

waking up in a country we barely recognize. unlimited government spending, social changes that undermine our morale foundation, unprecedented economic power grabs that threaten the very concept of freep enterprise. the future of the america that we know and love hangs in the balance. so our calling is to dedicate ourselves to the writing of a new future for america starting with the battles in the halls of congress and those that will rage in the 435 congressional districts just over a year from right now. in the book of other cleese yaft ess -- eccliastes, solomon

wrote, the race is not always to the swift nor the battle to the strong. we do know that the best way to win an argument is to begin by being right. we have the facts on our side. we know what's at stake. now we have to work hard and organize and fight in such a way that we can continue to prove that these facts and that these stakes are important to the rest of america. [applause] let me close with the words of president abraham lincoln, the founder of the republican party, a man who studied abraham, moses, and solomon. he said "the probability that we may fall in the struggle ought not to deter us from support of a cause that we

believe to be just." it shall not deter me. we believe that our cause is just. let us examine ourselves and make the necessary commitment to the struggle. the battle is great and the numbers work against us. if we fall, we fall. but we shall not he detered, for if we win, we win for the cause of faith, family, and freedom and the restoration of a nation that we all know and love. thank you all very, very much and god bless. ♪ from the east coast to the west coast ♪ ♪ down the dixie highway back home ♪ ♪ this is our country [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]

>> up next, first lady michelle obama takes about health care legislation. after that our look at u.s. health care continues with dr. cortese, president and c.e.o. of the mayo clinic. then a conversation with bertha lewis of acorn. tomorrow on america and the courts, u.s. solicitor general kagan talks about her work, her preparation for cases and her thoughts on cameras in the courts. and now first lady michelle obama joins the health care debate, calling for the passage of a bill this year. we will also hear from health secretary kathleen sebelius and the event includes three william -- women talking about their health care experiences.

it's about 50 minutes. >> good morning. all right, you guys are in the right mood. that's the mood we want today. all right. please be seated. good morning from the white house to all of you who are here and all of you who are watching us live streamed on white house.gov slash live. so any of who are twittering, please do. we are web streaming this live. my name is tina chen. in addition to being the

director of the office of public engagement i am very proud fob the executive director of the white house council on women and girls and on behalf of the council i really want to welcome you and thank you for coming to this event about heal reform and women. we're here to talk about the importance of health reform to women and their families because as the president indicated last week after decades, decades of talk about health care, now is the season for action. [applause] absolutely. you all those -- know this better than anyone because no one knows that better than women. it's women who so on experience what's broken about our health care system, whether it's insurance discrimination to the strain of unaffordable premiums to the strain of trying to take

care of spouses, partners, children, parents while trying to pay all the bills. those of up here especially know it because you represent organizations that help women and are health care professionals that are helping the women of america and many of you have already been speaking about why health care is important and we thank you for that. but we're here to ask you to redouble your efforts. it's time to get health reform passed now. so to do that we're really fortunate today to have three women who have come from across the country to share their individual stories because it's these stories that can illustrate better than any speech why we need health reform and we're joined by the woman who can speak most pourlly -- powerfully as a mother, daughter, a lawyer, and a medical center administrator, the first lady of the united states, michelle obama.

but to lead us off it's really my great pleasure and honor to introduce the person who's been a true leader for women and for health care all her career from the time of her election in 1995 to did, as kansas insurance commissioner to her election as governor of kansas to her leadership now as the secretary of health and human services. please welcome secretary kathleen sebelius. [applause] >> thank you. good morning, everybody. thank you tina for that nice introduction. i'm happen -- delighted to have a chance to be here with the first lady. we got to spend a lot of time on the campaign trail together and talking to women like our wonderful three women today about the stories of their life struggles to try and figure out

affordable health care. so it's -- i don't get to see you as much now. got a few other little things going on. but this passion about making sure we have affordable, available health care for all americans is one that i know the first lady hasn't lost. this is an exciting time, as tina said. we are closer to health insurance reform than ever before in the history of this country and it's one of the reasons that the battle lines are getting a little tougher. if victory was not so close, people would be a little calmer who are on the other side but the heat is on because the congress continues to move forward. the president continues to be focused on this and the legislative process is actually underway. there's a message coming through laud -- louder and clearer from americans every day, that the only option that

guarantees costs and more americans losing coverage, the only option that does nothing to improve the quality of care, the only option that's truly unacceptable is the status quo. that's clear to people across this country. [applause] former president ronald reagan used to say that the status quo is just latin for the mess we're in and he was absolutely right. but let me tell you a little bit about what the status quo looks like, particularly it looks like for women. insurance companies can continue to charge women 50, 75%, sometimes 100% more than their male colleagues for exactly the same premiums. insurance companies in states across this country can deny coverage to women who have had

a c-section or are victims of domestic violence because those are preexisting conditions. if you develop breast cancer, insurance companies can take away your coverage just because you forgot to declare a case of acne. that's a real story that happened to a woman here in the united states just within the past couple of years. a system that treats women like that is unconscionable, and lots of folks across america are saying we're tired of waiting, we need a change right now, this should never happen again in the united states of america. and the president has proposed a strong and reasonable plan to fix what's wrong with our heelt -- health insurance system. you will hear more about his proposals from the first lady. but the real is we need your help. being here today is an important step, but what's more

important is to reach out to your friends and neighbors, reach out to your p.t.o. list and your contacts, reach out to your kids in states around the country and acquaintances that you have and tell them that we are on the verge of making history in this country. we are on the verge of turning an important page. 44 years ago we were here with medicare. think about a country where seniors went into their later years without any assurance that they would have their bills paid for or get the treatment they need. it's unimaginable that we would go back to those days, but that's what the situation is like for millions and millions of americans and we have the opportunity to take the next big step forward to make sure all americans have affordable, available health care and with your heap -- help and support and your voices it will happen. week -- we can do this.

we can pass health insurance reform this year and i want to thank you for the hard work you've done, but roll up your sleeves. we're close to the finish line, but the house and senate need to continue to move ahead. we need to get a bill to president obama's desk this fall that he can sign and make the change that all americans are waiting for. so thank you very much. [applause] thank you, secretary sebelius. and now i'd like to bring up three really brave women who i'd like to personally thank for coming here today and taking the step to come forward and share their story withup. debby traft from ohio, easter spencer from washington, d.c. and roxie griffin from kansas city, missouri. debby?

>> good morning and before i get started this is going to be the only light-hearted part of my talk today that you will hear. as every mother that's here today and every grandmother knows, today's football friday and in a lot of parts of the united states it was football thursday because of the holiday. i'd like to apologize to my 15-year-old sophomore son, danny, who is a member of the high school marching band, to coach ramsey and the nationally ranked elder high school football team. sorry, guys, it's a rite of friday passage. . guys, it's friday night. go, you panthers, go. chili after the game. as i said that will be the only

light-hearted part of my talk today you will hear. i'm debi trauth from cincinnati, ohio and i have over 25 years of working in the health care industry. working for insurance companies, managed care companies and for a large hospital care organization. i never in my life thought that my life would turn into sleepless nights worrying over paying health care bills, now worrying about paying my health care premiums. i worked in the health care industry. five years ago i lost my best friend and my husband, roger, to colon cancer. an -- on halloween 2000 he got his diagnosis and his prognosis that he was given four to six weeks to live. i was a working mother at the time, with a first grader. i refused to give in and believe what i was told by a cat scan and by an oncologist. with the love and hard work of a great oncologist that i

managed to convince he was wrong i was given three and a half additional years with my husband. we thought we had good insurance. that is, until every person in this room goes home and reads your benefit book and read how your catastrophic benefits read for chemotherapy. when my husband died i was left with over $100,000 in co-insurance for those years of chemotherapy procedures and hospitalizations. i was able to use my knowledge of the health care industry to get to negotiate down those bills and i was able to pay those bills with what little life insurance my husband left me. i was able to pay because he left me some life insurance money. he was of the age where people were told don't be insurance poor. i was left with very little money from his life insurance policy. i'm speaking out today and i risk having his charts pulled

from the hospitals and from his providers for another audit to look for unbilled charges and again being rebilled. the harassing phone calls and the nightmare to live all over again. but my story doesn't end there. while working for a large hospital system i fell on vacation and broke my right wrist. before and after i had surgery i was placed on light duty. the light duty benefit was for 12 months. my hand surgeon wanted me to have three more months of rehabilitation because i broke my lunate bone in my wrist. i was not granted those three months and i was terminated. i began to pay my insurance via cobra. cobra has written in that your employer can add in an additional amount of premium, which in my case was up to 13%. for 18 months i paid those additional premiums.

during the time i had off while i was unemployed i enjoyed spending time with my son, who was still grieving for his father, and i enjoyed spending time with my mother and my aging mother-in-law i was taking care of at the time but as my cobra was beginning to expire,, and the economy was spiraling down, i found myself having to find individual coverage. of i was denied by three carriers. my son who happens to play a lot of sports, had a sprained ankle and two sinus infections and because of the grief i was going to, working 12-hour days and being a full-time mother to a grieving son, i had to go on anti-depressant medication for one year. just one year. because of that i was considered high risk. due to underwriting guidelines. i've also watched my late

mother-in-law struggle with medicare despite being in a managed care program in the late years of her life. i watch my own mother today struggle with her health care questions and i've worked with elderly families and family members who i see them concerned as well but the real reason that i'm here today is every month i struggle to pay close to $1,000 a month for premiums for myself and my son. i am afraid and i am scared to go without health care coverage. next may i lose my social security survivor spouse benefit because my son turns 16. i have been using that to pay for our health care premiums because my son turns 16, i lose that benefit next year. for over 25 years i've worked in an industry and i've now become a victim of that industry. this is where my career, my life and i have given my heart to. if i'm unable to find employment that offers health care i don't have an answer for myself but my son will have coverage due to the late

senator kennedy's bill but there is nothing for me and i can't keep paying high-cost premiums and co-payments. this just can't -- isn't the answer. as a widow you learn to to anything and everything very quickly and very fast but this is one thing i can't fix by myself. i need help, and i need help now. thank you very much. [applause] >> good morning, everyone. my name is easter spencer and i'm here to tell my story. back in july we were, my partner and i were getting ready to go to a concert and i discovered a lump on my right nipple. i called my partner in and she assured me that everything would be ok. she says, honey, i'm going to put a call in the mart iner project to see if you can get a referal to get a mammo grafment

i went to get the mammogram and sonogram at the same time and they said it's a cyst that needed to be removed. unfortunately i don't have insurance at this time so i have to wait until open enrollment time on my job to get the insurance. i'm really scared because i don't know if it will grow bigger and more of my breast will need be to removed. i need help and i'm hoping someone out there will help me. thank you. [applause] >> hi, my name is roxie griffin. i'm a 52-year-old lung cancer and double breast cancer survivor. i've now had to file for bankruptcy due to my high co-payments through my insurance company which during my chemo and radiation totaled a little over $27,000. i'm a single person. it took my savings and what i

had. the rest ened up in the bankruptcy courts. now that the company i work for has changed to another company due to the height cost of premiums for them, and in doing that, of course we got less coverage in our insurance and they looked at me and told me that the policies are comparable. now with the new co-pays that i i have to pay and plus they're higher and plus i have to pay 10% of all the cost of all my bills, my co-pays would have been $101,000. instead of the $27,000. and i have a hard time seeing $27,000 and $101,000 being comparable in anybody's imagination. anyways i believe i'm alive today because of early detection and that is now a situation i have to forego. ity can't afford the routine

screenlings. they're too expensive. i have to make a choice to either keep a roof over my head or have the routine screenings. at this point i choose to keep a roof over my head. i think there's a huge populace of people like myself that i've tried to get other insurance. i'm not able to get it. the lung cancer, that's it. the breast cancer if i was 10 years out on that, they'd cover me but they will never cover me because of the lung cancer and i'm unemployable to a lot of places because of my preexisting conditions so i'm in a quandary in the fact that the only way i can get insurance is through my employer and i'm at their mercy of what kind of insurance coverage they want to carry. i just want to, just want people to realize there's a large popation in the country like myself that are in --

uninsureable, unemployable to other people and we have to accept what the insurance companies offer us. thank you, i appreciate your time. [applause] >> well, thank you, deb ifrlt, east. er, and roxie for those powerful stories and really for having the courage to come here and tell them to all of us and i hope this is a spark, the spur to move us all on to push this through to the end in these coming weeks because these are the women and there's thousands and thousands of women like debi, roxie and easter across the country who need health reform and need health reform now.

nosh they are stories that the first lady listens to and talked about for two years on the campaign trail. she reached out for women from coast to coast and informed her passion about this issue. i watched her in cities across the country be able to draw upon not only the life history of individuals, but their plight. that is part of the passionthat is part of the passion that propels this initiative for both the first lady and the president. michelle obama has been remarkable in her first eight months as first lady of the united states. she has been a role model,

wife, mother, of but the most famous and vegetable gardener in america. she is a great spokesperson for healthy living, healthy life styles, and olympic champion, the president's closest adviser, and an incredible role model for women and girls across america and across the world. i am pleased to call her my friend. the first lady of the united states, michelle obama. [applause] >> thank you all. please, sit. first of all, good morning. i am so thrilled to see so many of you here this morning at the

white house. welcome. that is including my good friend, dr. dorothy. [applause] she is always there. for the past eight months and before, if there was a big event, an important event, she finds a way to be here. she is my inspiration. it is wonderful to see you again today. thank you so much. [applause] thank you all for joining us today for the outstanding work you are doing every day on behalf of women and families across this country. i have to think archer ordinary secretary of health and human services -- i have to think -- thank our extraordinary. this includes pushing for health insurance reform and

preparing us for h121. pursuing cutting edge research to find treatments and cures for tomorrow. clearly this is not the easiest portfolio she could have. she is doing a terrific job and we're grateful for her leadership. i also want to think tina chen who you all know. [applause] she, too, is doing a fabulous job for our office of public engagements. she pulled together today's events. she is also a key figure had making sure we are all aware of what is going on. finally, i want to thank the three women behind me. [applause]

is not easy to come here and tell your stories. the stories are not new. at the stories are happening all over this country. -- these stories are happening all over the country for millions of women. for two years on the campaign trail, this is what i heard from women, that they were being crushed by the current structure of our health care. crushed. these stories that we hear today, and all of us if we're not experiencing it we know someone who is, these are the stories that remind us about what is at stake in this debate. this is really all that matters. this is why we're fighting so

hard for health insurance reform. at this is it. this is the face of the fight. this is why i would like to talk to you today. that is why i am here. that is why reform is so critical in this country, not tomorrow, not in a few years, but right now. people are hurting in this country right now. there's also a reason why i invited this particular group to talk today. there is a reason why we have invited the leaders not only from family advocacy groups and health care advocacy groups but from so many organizations that have been fighting for decades path for empowerment for women. when it comes to health care, as the secretary said and we all know, women play a unique and significantly increasing role in our families.

we know the pain because we are usually the ones dealing with that. eighth in 10 women, mothers, report their the ones responsible for choosing their children's doctor, getting them to their cat -- there catchups created many women find themselves doing the same thing for their spouses. [laughter] more than 10% of women in this country are currently caring for a sick or elderly relatives, often a parent. it could be a grandparent or a relative of some sort, but it is often a parent. the are making critical health- care decisions for those family members as well. in other words, being part of the sandwich generation is what we're now finding, raising kids

while caring for a sick or elderly parent, that is not just a work-family balance issue anymore. it is not just an economic issue any more. more and more is a health care issue. it is something that i have fought a great deal about as a mother. i will never forget the time eight years ago when sasha four months old and would not stop crying. she was not a crier so we knew something was wrong. we were able to take her to our pediatrician the next morning. he examined her and said something is wrong. we did not know what, but he told us that she could have meningitis. we were terrified. he said get to the emergency room right away. fortunately for us, things worked out. she is now the sasha that we

all know and love today who is causing me great excitement. [laughter] it is that moment in our lives, it flashes through my head every time we engage in the health insurance can't bridge a conversation. -- health insurance conversation. what would be done if we had not had health insurance? what would happen to that beautiful little girl if we had not been able to get to a pediatrician who was able to get us to an emergency room? the consequences, i cannot even imagine. she could have lost her hearing, her life if we have had to wait because of insurance. it was also fortunate that we had good insurance, right? if we had not had a good insurance like many of the panelists up here, we have -- we would have been saddled with

costs for covering the emergency room visit, her two days in the hospital. we would have still been paying off those bills. this issue is not something that i thought about as a mother. i think about it as a daughter. as many of you know, my daughter had -- my father had multiple sclerosis. he contracted it in his 20's. as you well know, my father was a rock. he got up and went to work every day. i find myself thinking, what would we have done as a family on the south side of chicago as my family had not had insurance? if he had not been able to cover for his treatments? what would it have done to him to think that his illness could have put his entire family into bankruptcy? what if he had lost his job, which for in he never did? what if they would have changed

in assurances, which fortunately never happened. we became one of the millions of american families who cannot get insurance because of a pre- existing conditions. and these are the thoughts that run through my mind as i watch this debate and hope that we get this right. let's be clear. women are not just this proportionally affected because of the issue. women are affected because of the jobs that we do in this economy. we all know that women are more likely to work part time or to work in small companies or businesses who do not provide any insurance at all. women are affected because, as we heard, in many states insurance companies still can still discriminate because of gender. this is still shocking to me. these are the facts that still

wake me up at night. women in this country have been denied coverage because of pre- existing conditions like having a c section or having had a baby. in some states, it is still illegal to deny a woman coverage because she has been the victim of domestic violence. in a recent study, it showed that 25 more women are charged up to 45% more for insurance than 25-year-old man for the exact same coverage. as the age goes up, you get to 40 and the disparity increases to 48%. 40% difference for women for the exact same coverage in this country. it is not just women without insurance. as we have heard and as we know who are affected. plenty of women have insurance, but it does not cover basic

women's health services like maternity care or preventive care like mammograms or pap smears which we all know we have to have. we cannot go without these basic services. many insurance policies do not even cover it. or policies cap the amount of coverage that you can receive or drops coverage when people get sick and they really need the care. maybe people have coverage, but they're worried about losing it if they lose their jobs or change jobs for the company changes insurance carriers. out of pocket costs get higher and higher. it is hard to be able to plan your monthly bills when you do not know what your premiums are going to be. a lot of people find they have to drop insurance because they can no longer afford it. many women are being charged more for health care coverage,

but as we all know women are earning less. women earned 78 cents on the $1 to a man. it is not exactly surprising when we hear statistics that more than 50% of women report putting off needed medical care simply because they cannot afford it. we have trouble putting ourselves first when we have the resources. just making the appointment when you have insurance to get your regular screenings, to take care of those bonuses, those bonds, launched, pains that we tend to ignore -- those bumps, lumps, pains. it is not surprising that so many millions of women around this country are simply going without insurance at all. the thing that we all know is that the current state, this current situation is unacceptable.

it is unacceptable. [applause] no one in this country should be treated that way. it is not fair. it is not right. these are hard-working people we're talking about, right? these are people who care about their kids, their lives, and the circumstances could happen to any of us. this is one of those there but for the grace of god go i. none of us are exempt ever. i think it is clear that health insurance reform and what it means for our families is very much a women's issue. it is very much a women's issue. and of a woman to achieve true equality for women, if that is our goal, if you want to ensure

women have opportunities they deserve, if that is our goal, if we want women to be able to care for their families and pursue things they could never imagine, then we have to reform the system. we have to reform the system. the status quo is unacceptable. it is holding women and families back. we know it. fortunately, that is exactly what my husband's plan proposes to do. it is important for us to understand some of the basic principles of that plan. if you do not have insurance now or you lose your insurance some point in the future, you can purchase affordable coverage through an insurance exchange. it will have a variety of options so you can compare prices and benefits. this is the approach that is used member of converse with

insurance. the thought is that it is good enough for members of congress, it should be good enough for the people who vote of them in. [applause] [applause] this is an important part of the plan. if you already have insurance and it seems there are a lot of people who worry they will lose what they have under this plan, if the arctic have insurance, it you are a set of the -- if you already have this insurance, you are set. you keep your insurance and doctors and you are blessed this plan put in place some basic rules of the road to protect you from the kind of abuses and practices that we have heard. insurance companies will never again be allowed to deny people like debbie and her son coverage

for pre-existing conditions. it is sound like a good thing. whether you have breast cancer or hypertension or even just a see section -- c-section, and none of that will be a reason to refuse you coverage under this plan that my husband is proposing. when you are fighting an illness, he believes they should not also have to be in the process of fighting the insurance companies at the same time. that is the basic idea. [applause] under this plan insurance companies will no longer be able to drop their coverage when you get too sick. or refuse to pay for the care you need for set a cap on the amount of coverage that you can get. it will limit how much they can charge for out-of-pocket expenses getting sick in this

country should not mean that you go bankrupt. that is a basic principle of this plan. finally, this plan will require insurance companies to cover basic preventive care. it seems simple. from routine checkups to mammograms to pap smears -- and this would come at no extra to charge to the patient. folks like roxy can get the chance to get the screening says she needs to save her life, because we already know that if we catch diseases like cancer early it is much less costly to treat and we might just be able to save some lives. we know this. under this plan, we can save lives and we can save money. it is not as good as medicine,

but it is good economics as well. i think this is a pretty reasonable plan. i do not know about you. [applause] i know many of you believe it is a good plan as well. i know that many of the groups that you represent believe that what we are doing here, this fight, is important. it is important to this country. it is important to women. it is important to families that we succeed fidel now more than ever -- succeed. and now more than ever, we need to act. in no longer can we sit by and watched the debate take on a life of its own. it is up to us to get involved.

what we have to remember is that now more than ever we have to channel our passions and to change -- into change. that is nothing they all have not done before. you all have been the driving force behind so many of our greatest health care achievements. whether it has been children's health insurance, funding breast cancer research, a stem cell research, to passing the family medical leave act, the folks in this room are the ones that made those phone calls. you wrote those letters. you knock on those doors. you made that happen. that is exactly what we need you to do today for health insurance reform. we are going to need to over the next few weeks to mobilize like you have never mobilized before. we need you to educate your members about what the plan

really is and what it is not. education is the key to understanding. it is going to take phone calls to explain to talk things through, to make sure that people understand not just what is at stake but what it all means. we know there will be all sorts of misconceptions about what the plan is and is not burda it is so important that to make sure that people know the facts and at least to make their decisions based on the truth about what this plan is and is not. we need to make your voice is heard right here in washington. you all know how to do that. it will not be easy. there are always folks who are afraid of a little change. we understand that. we talked about this all during the campaign. change is hard.

sometimes these that his " comic even if it is not right, feel comfortable because it is what we know. -- sometimes the status quo, even if it is not right, feels comfortable because it is what we know. there will always be folks who will want things to say just the way the are, to settle for the world as it is. we talked about that so much. this is one of those times. i am here today, standing before you, as the first lady of the united states because you all did not settle for the world as it is. [applause] you refused to settle.

as a result of many of your efforts, as a young girl i was able to train in ways it and never could have imagined, that my mother and grandmother could never have imagined thanks to so many of you, i am raising the jake imagines. thanks to you i am raising two beautiful young women that are going to be think so different about their place in the world because of the work that you have them. health care reform is part of that movement. health insurance reform is the next step. we are going to need you all. focused and clear, picking up the phones, writing your congressman and women, and making this something that is the highest priority for all of us. we can make sure that every

family in this country can move forward as we hope that they can. they do not have to worry about whether they can insure themselves. they do that have to worry but whether their kids are going to break an arm. if that is what kids do. and they break stuff. i am grateful for all of you in the work that you have done and for what i know that we can do together over the next several weeks. we have to be fired up and what? >> ready to go. >> the little fired up and ready to go. thank you so much. god bless you all. god bless america. [applause]

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>> and now a different perspective on health care, from president and ceo of the mayo clinic. he talks about affordability and how quality care can be delivered. from the national press club, this is about one hour. >> thank you. we should let her keep going. shoes on a roll. she was covered all the key messages. i am here to talk about the changing health-care activity in america. the one to speak a little bit about ideas and concepts and strongly urge our elected officials to collaborate and

work together to get the support and work done for all to us as people in the united states in the the free more -- united states. the framework shows healthcare in the united states is in trouble. we are in a bit of trouble. we have been watching medicare have some problems. we are also realizing that from the standpoint of measurable outcomes, we are not necessarily getting on average throughout the country what we are paying for. we have heard several presidents say those exact words. this time we are getting close to trying to tackle that. what we are here to talk about today is coming at this from the viewpoint of what is surely the best for the patients. what is really best for people?

what is best for each of you and the audience? we are talking russell made different stake holders from the place. -- about so many different stake holders around the place. we can design a system to help us attain that as we go forward but of where what to what happened in the last month with all the mud and things that were going on in the meetings. take a breath and say that refocused a bit on the fact that we want high-quality, affordable health care for all people in the night it states but a what might that look like? some of you might have been here the last time i spoke. i asked the three questions. i will ask them again.

it depends on how you into these questions. who would like to be hospitalized tomorrow even it is the best hospital in the world? nobody raised their hands. who would like to be sick tomorrow? who would like to be patient by someone who is endorsed? again, i see no pants. when you answer those questions as know, you begin to rethink about what is happening in the health care in non system so that we turn it into a system that helps you obtain the answers that to ask for. saying that really changes the trend. hospitals are no longer the center of the universal health care delivery. they are very important. they urge as part of the peace.

you can even make an argument that the more hospitals we have and the more beds we open up, the system is failing. i want to talk a little bit about what he said. the first is the peace that has to do with health insurance reform and health care reform. -- it is what i call healthcare delivery reform. their two separate concept but equally important. but take the easy part first produced the easy part is health insurance reform. i hope you are laughing. you know how difficult it is to do this, but believe me, it is the easy part dealing with

getting people injured. we have heard it -- insured. we occurred about insurance for all. we strongly support health insurance reform at the mayo clinic. we have a story come to us from one of our patients who attended one of the meetings in chicago recently. it is a story -- about a graduate student from bloomingdale, ill. and shia congenital heart disease. she still does. she underwent operations as a child. there was some recommended follow up that she needed . this denial of a valuation was there. after some hassling, she wanted to go to a facility.

insurance companies to not cover that. that is one concept about health insurance. the second was, during college, she lost her parents' insurance coverage. she was a full-time student with no insurance. have we heard that story before? the third lesson that she summarized is that as an adult, she could not get coverage. we have all heard that before. right there there are three or four examples of a problem of keeping people injured in the night this is. the new york times had an article about a woman who is

covered by medicare because she had renal failure and had been on dialysis and have had to transplants that had failed. it the lesson here is shoe is now getting ready for her thread -- she was now getting ready for a third transplant. the drugs that are used after the transplant were only covered for three years. that is medicare. it makes you wonder if it is much cheaper to cover the drug than it is for a transplant she is coming up to her third transplant. that is not make sense either. when we look at examples of how to save, let's look at the patient's viewpoint. there are ways to solve every one of these examples. i am here to say we need to do this. we need to make sure we have the uninsured and underinsured having access to affordable and portable health insurance. the mayo clinic's position on

this is that we would be viewing the idea of insurance as a mandate. everybody should have it. i know people do not like the word mandate. let's change that word. but if everybody insured. do not want to argue but the issue. people need to get to a stable condition more people have insurance and they do not have to go broke over it and be concerned about lack of access to good insurance. we feel individuals should own their own insurance. it is portable. if they can take it wherever they need to go. they are not locked into a job because of that insurance. i think they really should own it so that employment status this not really produce the double whammy of losing a job and losing your health

insurance. -- or the fact that you are reluctant to change your job because you might lapse with no insurance for three or six months. we think the insurance should go with the person. we think employers should continue -- could continue by buying insurance for the employees they like -- if they like. we are not proponents of an employer mandate. certainly employers could compete by offering them health insurance as part of the package. it is up to them to make a decision. we think insurers should take all comers despite of status. that is at the front of the line with the ideas that are being discussed here in washington about health insurance reform. that seems to be the front state of this.

there is a cigna began role for government. the role for government is a thunder, a body that helps people be able to afford insurance with a sliding scale subsidies. there is another potential role and that is to regulate the insurance industry to foster competition. is a basically the key components of what we are suggesting that we should be looking for. a lot of people talk about an idea of a public plan or not a public plan. i do not know people are talking about yet. i still have trouble understanding what a public plan it means. for my personal viewpoint, a public plan i hear being discussed that is owned by the public is a co off of some kind. -- co-op of some kind that is what i see.

the citizens own it and control it. if what we mean is a government run plan, that is another story. if we are talking about a government-run plan, i am not sure what people are talking about there. are they talking about medicare or medicaid or military system or a va system or tr andi-care? -- tri-care? are talking about extending another program for children? are we talking but the federal employee health care plan? the federal government has a whole bunch on its shelf to pick from i have not heard anybody committing. it is hard to take a position

for or against the public plan until we know exactly what it will be. however, our advice is that we tend to favor a federal employee like model. there is an exchange, patients can select from a wide range of plants where there is greeting in scaling regarding quality. the drugs are covered. they can choose with government subsidies would get a basic product or buy up. that link a little closer to what another bill had indicated a couple of years ago. that the bill is still floating around out there. i cannot -- i do not understand enough to know if it is good or bad for the country. we do need to move forward to

insurance reform. we support that and all the efforts better going on now to move toward insurance reform by the house, senate, and white house. we are trying to support it. i want to shift to the hard part. want to get everybody injured, insured, and all we have is everybody in shirt and that delivery system. it does not mean it is a good plan. when we look at the second component, it is the idea of high quality affordable healthcare the recall by you. -- that we call value. that is compared to related to the amount of money we spend it

to get that. that is the value equation. we should be looking for high- value health care in the united states. i consider what i just described what health reform is all about. what do we really mean by health care reform is the health care delivery reform so we are getting care if it helps keep us out to the hospital, it keeps us healthy, it keeps as working, it keeps us in school. it may help prevent people who have chronic illnesses or conditions from suffering. how do we do that? this is the hardest part. it is the aim to provide these great outcomes. currently, there is a significant amount of regional variation in the outcomes and safety service compared to the

cost throughout the united states. we have all heard this a lot. there are attempts to explain the variations. when we look at the variation, it is predominantly driven by the different amounts of things that are done to us as patients. how many days are we in the hospital? how many tests do we actually get? it varies widely for similar conditions. it makes you wonder. when we look at the regions of the country that you produce high-value care, and their many of them -- and there are many of them, there has been some work done to figure out some of the common characteristics among those institutions, among those regions, among the states to get high-quality care.

i will list a few of the common characteristics. there tends to be a higher level of a cultural focus on the needs of the patient. there is more patient centered thinking going on in those organizations or in states that have created a better environment of caring for people. their focus more on the patient. there tends to be a higher level of engagement in taking care of people. that is a general statement. there tends to be a much higher level of teamwork and collaboration in deciding medical decisions for patients. there tends to be a much higher

couple of coordinated care. teams are the integration component and coordination is how they manage the patient themselves. coordinated care is a key component. there tend to be a higher rate of sharing of medical records and information from one place to another. there is a fair bit more connectivity about information then there is elsewhere. many have connectivity, he tend to have conductivity of knowledge. people are able to make better decisions. there is a definite higher level of the use of what we call a science of health care delivery. we bring it system engineering in to the way we take care people.

we began to systematically but that the way patients afloat through. how do we eliminate waste? had we standardize certain properties? there are some common features should be posturing in the countries of this can happen. here is a personal story about my mother. she died in the year 2000. 12 years before, she of problems with a fever of unknown origin. that went on for a year or two. then it reached a hit on one sunday morning. she called me. she woke up and she was blind in one eye. we have a very clear -- temporal arteritis predict it is an inflammation of blood vessels for the tucson physician that afternoon. surest -- blood vessels. she saw a physician that

afternoon and received a diagnosis ins. use the act a year or so of steroids to can we often your fine. she never could get off. she had significant problems including her heart. she had osteoporosis. she had multiple problems. for about six years, she was seeing seven different doctors. each one was not coordinated with each other. for the last two or three years, she was going into the local hospital roughly once a month for a day or two, going to the e.r.. all the physicians will trickle in and fine tune into the. there is no follow up. there is not a way to the continuity of care. my brother-in-law was the

cardiologists on the staff. between my brother-in-law and myself, we cannot get her into credit scored in the care with irresponsible position. -- get hurt coordinated care with a responsible position. a rheumatologist have to say pulmonary doctor. for the last six years of her life, she was hospitalized once a month before she dies. she is able to work with the nurses and call them quite frequently and get fine-tuning. she rarely came to our clinic. it was a whole new life. she was interacting with people. i have worked at the mayo clinic 40 years. i was stunned to see how good

her care was. i do not believe we can do it that well. we did not work at it. it was just the way we did it. the saddest part of all, you know how much we got paid? 0. medicare is not pay unless to go in the hospital. we cannot design a model of care to reproduce this as a business model. this has to change. this is what i mean by the science of health care delivery. we have some people sitting here at a table and had similar experiences about integrated care. that is why they are here. they have a big interest in this kind of a problem. there are several places in the country that have coordinated care. there are places that do this. i singer, scott white in texas,

i can go on. as far as cities grow, there are cities that do this. granted junction, san francisco, wisconsin. they are competing. they are providing really could care. there are states that do this that produce high-value care. iowa, hawaiian, utah, new hampshire, vermont. wisconsin, nebraska, wrote islands, both dakotas. when we think about what we can learn in the country, there are examples. what is going on in these places that are producing care? the bad news is it does not pay

if you do it. that is the problem. it does not pay. in the instances are not aligned. we make more money the sicker you all are. the more time you are in the hospital, we make more money. this has to change. my mother's example is a perfect one, because it was less expense for hire by you care. we cannot build a business model to make that work. in a fee-for-service environment like medicare, they are able to do this. for the whole country, we need to come up a way of physicians can make this work. week of focus on what is really high-value care. -- we can focus on what is

really high body care. incandescent bulbs might last several months. it the fluorescent wall may cost five times as more to begin with but in mass -- but it may last 10 years. we are seeing patients ought to be involved in making that decision. there has to weigh -- there has to be a way to build that in the system. we are looking at congress. they are making some suggestions in the house and in the senate on how to focus on value. there are several good suggestions on both sides and all five or six of the bills that are out there. but will come out of this is not clear. whatever comes out, it has to have something that moves the

country. the mayo clinic recommends that we look at medicare as the largest insurance company that is currently run by congress and let's start the value for medicare. let's begin there. we do not need an act of congress to do that. let's paid for by you in medicare. our recommendation has been let set a goal that in three years medicare is paying for body. in those three years, but create a process for redefine what we mean by value -- let us create a process where we define what we mean by body. let us starting transparent about where everybody is. you might say that is an overwhelming task. we can switch 3-5 medical

conditions. adobe high blood pressure -- that will be high blood pressure and heart disease. if we throw in three or five most expensive procedures, what are those? if we just did that, and focused on 86 or 10 conditions we can define the outcomes. safety, easy to measure. service, patient satisfaction already. the outcomes already exist.

age, the national quality forum has these sorts of things available. we have the iom in that regard. there are a number of groups. we begin to pay for it least those. what we are asking for is the vision to say that we want to get there in a reasonable amount of time. we think that right now, we have this big chasm to crossover. this chasm is people insured and getting value in the health delivery system. you can't really cross a 20 foot chasm in a couple of 10 foot jumps. we have to come to grips with both. we have to say now, and three years, we expect to be paying for value. we have got to get there and make the commitment to that. we think that lawmakers are on the right step and the right direction. we continue to give our

directions about what patients might want out of care as we look to the future. i will stop there and take some questions. [applause] ok -- >> ok, you did not list minnesota. what should the state where you are based do differently. >> we are in that list, i just didn't listed. we can do more. to be quick -- we have providers that provide excellent care for several groups in minneapolis and the rochester area. we can do more to interconnect and distribute the knowledge that we have learned together. we already do it fairly well. to do it in a formal way that is efficient, electronic, and we have a name for it. with a program we are developing to make this work.

how do we connect all of this? there's a group in the country that has taken this on from the public domain. it is called the national coalition for health information. it is being launched. people are beginning to hear about it. >> mail has pushed for higher care and burst into rates. how do expect health care reform to affect those rates? >> we have not really pushed for higher rates. when we look at the way payments are made, there is been a consistent pattern for the last several years to continually reduce the payment rates by fixing the prices in such a way that we are not keeping up with inflation. what we're saying is, we understand that may have happened. make the reduction, not across the board,