national captioning institute] [captions copyright national cable satellite corp. 2009] .

but there has to be movement on all sides. to recognize that it is better for us to act than to talk. better for us to choose action over inaction, the future over the past, and with courage and faith, i believe that we can meet our responsibilities to our people and the future of our planet. >> president obama spoke at the climate change conference in copenhagen about 20 minutes ago saying not doing anything about climate change is unacceptable. and that's what we want to talk with you about this first half-hour on "washington journal," how important is the climate change conference in your view? you can see divided by affiliation, call on the line most appropriate to you.

host: please allow 30 days in between your calls. c-span wj is our twitter address. journal@c-span.org is our email address. joining us from copenhagen is our correspondent for the associated press. mr. boren steyn since president obama landed we've been getting reports that his entire schedule has changed and he's been conducting several meetings. what's going on? guest: well we are running at least two hours late, because for more than two hours the president and 19 other world leaders have been meeting, and from what i've been told, they themselves are trying to write an agreement. forgetting about their underlynx who have been spending two weeks, they are now taking it in their own hands.

but so far, and it's still so far, they are having the same luck the others have had, in other words, not so good. >> and they are not having luck with what? >> i wish i knew. i'm not in on the meeting. guest: there are three main issues that are sticking right now. one is just how much cuts in emissions? greenhouse gases, how much will they cut? and how will they make sure they do what they say they will do? that one's starting to make some movement. and the third one is money. financing from the rich countries, which have produced most of the greenhouseb(páqj that caused most of the global warming to the smaller ones that have more of the harm than the rich countries do. we're talking $10 billion a year in the short term and $100 billion a year after 2020 and

that's not just from one country but from many countries. host: seth borenstein, a lot of the talk has been about country, can you describe what that means? guest: i think it means different things to different parties which is one reason they are not in agreement. once the once china says we are going to cut by this much percent the rest of the world wants to know how do we know you're really cutting by that much percent and can we go in and check? that's the issue countries like china and india say rolves around. sovereignty. and the u.s. is likely the watching a satellite that by chance, and this was not planned, could do this.

they tried this in february. and the satellite fell spot oaks instead of going into the air. so that would help but there was still a sense of you have to have an agreement to trust each other. host: mr. borenstein, you mentioned china. the french president sarkozy criticized china on the front page of the financial times all eyes on u.s. and china in race against the clock for climate deal. besides the transparency issue, are there other issues with china? >> oh, yes. the other big issue with china is how much emissions will they produce? china is the number one producer of carbon pollution right now. they passed the united states a couple years back. because they are considereded -- they, under the old article, do not have to cap their emissions.

they are allowed to -- by g.d.p., gross domestic product. but if their economy grows like it has been,ñrñi incredibly ove the past few years, even though they stay we'll cut emissions by 45%. that means they can dramatically increase emissions because their economy is increasing. so the issue is just how much emissions -- how much pollution can they put out when that's still a good question? and then the other question say for the united states, you know, we are actually now starting to reduce emissions, but it's not as much as the rest of the world wants us to reduce emissions and we're number two. >> how much of this is a developed world versus an underdeveloped world issue? >> it's an awful lot. what this is is a giant puzzle. and there are several different interlocking problems, and one of them. and it's sort of the underlying

problem is it's the developed world vs. the underdeveloped world and china somehow manages to be on both sides. sometimes with the developed world, sometimes with the developing world. and that's part of the issue. host: and finally, mr. borenstein, what's the schedule for mr. obama the rest of the day, and what will you be covering? guest: well, schedule for president obama the rers of the day is he's going to be meeting more with letters and at 3:00 a.m. copenhagen time which was 9:00 p.m. washington time, this whole session and meeting of negotiateors was supposed to come back and gavel in an agreement. well, first of all, everything is running two hours late, second of all, as of now, there is no agreement to gavel in and sign and celebrate. so what i've been told is he will be leaving the end of the

day here. well, what happens next, we don't know. i mean, would he stay if they are close? we don't know. would they just leave it to someone else? everything is changing here. that's the key thing to -- right now, in an hour, it might all be moot. host: seth borenstein science correspondent for the associated press, thank you, very much. now on to your calls, how important do you think this climate change conference is? our first call from mary in austin, texas on our democrats line. caller: i believe this is very important for our world to do this. i am dismayed that developed countries have been so reluctant to help out the developing countries. we must do something for our children and our grandchildren. and the succeeding generations

to come or there will be no world. host: from baltimore, asar on our independent line. please go ahead. caller: i wanted to quote adolph hitler this morning, because this climate change thing reminds me of what he once said where he said when you want to lie, you lie big, because even if the lie can be refuted by a child, a big lie is hard to challenge i@uu1%9ñ and so if you look at the climate issue and the scientists that were manipulating the facts, that's exactly what they had in mind. now the u.s. is in a paying position and i'm going to link it to health care, is in the same position stahlen in russia was in in 1960 where you could not mention your master's name. and before that in the biological which a vicks, you

could not mention his name, you could not say stahlen is my oppresser. in america humans change roles at who is the oppress of and who is the nation but in the united states the jews were on the central banks and health care officials -- host: sir what does this have to do with climate change? all right, we're just going to move on. democrats, climate change how important is this summit in your view? caller: it'sñi that god created man with a responsibilityñiçó t manage, to care for, to take care of the environment. essentially the first responsibility given to man was to take care of the garden of eden. and i definitely see a parallel between that responsibility and essentially what we are -- what they are trying to do in copenhagen these days. i think president obama is on the right track.

i think the world needs to take stock of itself, and go back to that original mandate given to us by god, and i think because i'm a religious leader, a christian minister of the gospel, and i feel that it is not just our human responsibility, but it's a spiritual responsibility.ñi we are part of nature, and essentially our leaders have to take that mandate from us. take that responsibility from god and return to that place where god has created us. host: thank you, pastor, for that. here is a little bit more from president obama, and he spoke about a half an hour ago. >> as the world's largest economy, and as the world's second largest emitter. america bears our responsibility to address climate change.

and we intend to meet that responsibility. that's why we renewed our leadership within international climate change negotiations. that's why we worked with other nations to face that to phase out fossil fuel subsidies and taken bold action at home by making restoreible -- by putting our people to work, increasing efficiency in our homes around buildings. by pursuing comprehensive legislation to transform to a clean energy economy. these mitigation actions are ambitious and we are taking them not simply to meet global responsibilities. we are convinceed -- we are convinced, as some of you may be convinced that changing the way we produce and use energy is essential to america's economic future. that it will create millions of new jobs, power new industries,

keep up competitors, and spark new innovation. host: and in a column in the financial times this morning by andrew ward, the old world -- is melting away as robert zoellick walked almost unnoticed through the center in copenhagen it seemed like the old world order was being turned on its head. here's a symbol blending anonymously into the crowd at an international conference described by some as the most important since the second world war. fast forward to yesterday and a stream of newly arrived dignitaryies from far-flung countries walked through the the same austere hallway with scrums of journalists snapping questions in their wake and it's true the biggest buds to date surrounding hillary clinton u.s. secretary of state -- proved that the u.s. is no longer the only show in town. the grandstanding helped

extinguish any idealistic if you are version instead of the worldcoming together to save the plan tet name-calling between rich and poor countries has prevail. mark, how important is this climate change conference? caller: this is going to be pretty refreshing for republicans. it's basically this -- if you're living on an iceburg and it's melting, you don't ignore it. we see that the frost is melting, and we see that the ice sheets are pulling back. these are facts. and it doesn't matter who is doing it. it's happening. so if we do not do anything about it, i see that people are starting to hire their scientists now to refute that it's us doing it. it doesn't matter if the human race is doing it or not. it's happening.

and if we don't just try to reverse it or slow it down, i saw a map of florida in about 15 years if the meth thain starts to be released at a certain point of no return. west virginia is doing to be the new coastal line if we -- if people do not be attentive to this, and that's all i really wanted to say. it's not a democrat or republican or u.s. or china thing. it is not a greenland thing, it's all of us in this boat, and only a fool will not put their finger in the dike if they see the dike leaking. >> host: good morning. republican line? caller: there is no offender big enough to fill the hole if climate change is occurring. outside of man's control. and i hope that we nail down

the science a lot better than we have. thank you, very much.ñr host: syril inçó lincoln, california, is on our line, how important is climate change the conference in your view? caller: basically i think we're rearranging the deck chairs on the titanic. i tend to agree with dr. james lovelock that the planet -- and if you've never had dr. lovelock on, i strongly suggest you do it. his theory is well accepted by most scientists, and dr. lovelock says basically the planet is already going into a heating moat mode, and the co 2 is jst adding to it. and we really ought to be concentrating on how the human race is going to survive this

change. because in his estimation, we're going to be called down from 8 billion to 1 billion humans on the planet after this heating hits its stride. host: michigan, nelly, good morning. caller: good morning. i just want to agee with the caller, because i believe it's very important that climate that we do something about it. and that it is you know, very important, because everybody is concerned. and should be. but i think the president is right, and i think he's on the right track. host: thank you. from the "wall street journal," counts on private funding to curb co 2, much of the money to help poor nations deal with climate change tentatively endorsed by the u.s. would be put up by private companies and

investors, not taxpayers according to a senior obama administration someone familiar with the program, but whether it materializes, a bevy of business people are attending the copenhagen talks, looking for changes in climate policy that they believe will open avenues from private toove profit to carbon reducing projects in the world. independents you are on. caller: i don't think it's important at all. host: why? caller: i think it's the biggest scam in history. this is a plan of the united nations to steal sovereignty and have international law over superceding over the u.s. constitution. i think it's a big money-making scam and if we sign this treaty, we're going to lose our

sonchty and there are still other scientists refuting it that don't have a voice and i think it's a crying shame. host: from "usa today" this morning they do a q & a article. how much do the u.s. and others should how much should they cut emissions? president obama wants to cut by 17% by 2020 compared to levels in twie, a goal he says would involve a major shift towards cleaner energy sources and the u.s. goals are not ambitious enough. dallas, moore on our republican line. go ahead with your comments. caller: oh, hello? host: yes. caller: i'm just trying to say that we shouldn't base all our economies on the theory. host: all right. we're going to have to move on. caller: please turn down the

volume of your phone when you get on. there's a delay otherwise it brings the program to a grinding halt. david, norfolk, virginia, hi. caller: how are you doing? i really believe that we're in trouble, and the sooner we do things about global warming, the better. the biggest problem that i can -- that i believe is happening that i can see is overpopulation. and you've got these nitwits going around promoting population, like the catholic church with their anti-contra crept i was and all that jazz. that's our real problem is overpopulation, and yes, global warming is real. and we've got melting glashese and ice caps to prove it. and anybody who can't look at it and tell something's wrong is an idiot. host: roger in dallas. independent line, you're on

c-span. caller: yes. the panic and the hi stairya that's being generated about global warming is at best based on unproven science and perhaps just even a pack of lies. we're going to ruin the u.s. economy just to satisfy the fears of people, when we -- when there's no proven science underneath it. i know that everybody says that it is proven. but it's not proven. we know that from the emails that have come to light and other information that we're getting. so let's not panic and do something that could ruin the united states economy for the future. host: can i ask you a question, roger, do you think that individual efforts that we all could make would be a positive

thing to do to lesson our emissions? caller: well, i -- certainly if you just want to lesson your emissions, but global warming, new york city used to be underneath a mile of ice. so climate change is not something that is suddenly happening in our generation and it never happened before and couldn't possibly happen in -- unless mankind were causing it to happen. so you could reduce carbon dioxide, the carbon emissions and still not keep the planet from warming or cooling as it feels intended to do by nature. host: thanks for calling in this morning. brian from maryland republican, what do you think? caller: hi. thanks for c-span. i basically feel like it doesn't matter. whether the humans are the cause of the problem or not and

whether the warming is just because the sun is putting out energy, i think we should still do what we can to reduce our emissions and pollutants. and we just shouldn't cripple our economy in the process. we've -- we are responsible for any of the warming that's been happening for perhaps 100-200 years. no sense in trying to turn it around in one or two. we should just try to be as official as we can and reduce pollution and try to go to these summits to try to get china to do the same, but i don't think we should spend a lot of money doing it. host: a tweet, you could spend a million billion and still not change nature. from new orleans is clipper, is clifford. democrat. caller: good morning. thanks for having me. major: what do you think? caller: iñ;think this is the biggest thing since tobacco was

clasminkr cigarettes doesn't cause cancer. remember thbdñ host: what do you mean by that? caller: i mean during the bush administration do you know how much exxon and those companies were paying out to have scientists say that climate change was not real? they spent over $20 million in advertisement campaigns to create the myth that climate change did not exist. and now we're getting to the real heart of it. it's a black swan that we finally found out is not going anywhere. and we have to pay the piper. climate change is real. and we have to work on it now. it's not going anywhere. we know the economy's bad. but if we don't do it now, it will catch-up with us.

host: pap, texas, jon, how important is the climate change in your view? caller: it's important. and i'm fearing that something is not going to happen because a lot of rich countries are entrenched but one of the main points was a lot of the people who deny climate change are the same people it seems like a lot of conservatives who don't believe in science period, they don't believe in evolution and they are not going to trust scientists anyway. so coming from them, it doesn't sound genuine when they don't believe in the science of evolution, which is as plain and simple and most people, most scientists should believe in it. but i think what's happening now is that the rich countries don't want to help the poorer countries who are trying to develop, and that they are so entrenched that they don't want to give any ground, and what

i'm seeing in the talks is it seems like the rich countries are just not -- they are not acting in good faith. especially the u.s. and china. and, but i think that we need to accept scientific con census and discount those on the right who just -- they don't believe in science. host: how closely have you been following what's going on in copenhagen? has this been an interest to you? caller: not particularly. actually, global warming isn't number one on my radar necessarily, i do think the economy is more important. but as a lot 06 people say, you hear that often, that the global warming is not something that just the general public is that upset about. they are upset about the jobs. but i have been watching. naomi klein and other people i've heard talk about giving

rep rations to several countries around a lot of the talk sort of out of the main stream about what the third-world countries and a lot of the poorer nations are trying to push on to the summit, but are not being really listened to, and the rich countries like the u.s. and china, the more powerful and economically prosperous countrys are dominating the conversation. host: kathy in massachusetts, republican. caller: yes. i was going to -- a joke but about five years ago i remember the u.n. said let's send scientists to tell us what they think about global warming and i read 70% of the time they received these letters and bother to send them back but the u.n. said all the scientists sent the letters back saying they believed in it but didn't bott err to talk

about the scientists who didn't bother to send anything back. so to me, when i heard that and then heard nothing else again about it, i heard this one story about it, and then nothing, right away i thought something's up here. why are they not talking about all the scientist that is didn't bother to write back about it. so i knew this was a joke from the very beginning and when i hear about green, i always think money. this is about money. al gore, the business leaders now over there, they are going to spend $100 billion to help this, no. they are not spending it to help anybody. they are spending it to help themselves. people are going to get rich off of this. nobody cares about all these poor countries. they are looking to make a buck for themselves. if they want to help people, we have plenty of people in this country that need help. these poor countries, let them go to work and try to figure something out. i'm sorry, this country needs help now.

host: paula in west palm beach, florida, is on our democrat's line, the importance of the climate change conference in your view. caller: i think it's very important and a lot of these deniers need to study and read find out more information. because they are getting all their information from fox news, which is not accurate. and have taken drills into the -- , anytime the co 2 level in the air rises, the temperature goes up. that's a known fact. we know that if we left it to nature and never put co 2 in the air right now the earth should be getting cooler not warmer. these. people don't realize the co 2 being released in the a year is making the air warmer and it's man made. this is even with the burning of the forests and that's that

releases co 2 and that's by man doing that also. so these people need to understand that man is the problem. and it will create jobs if we switch from oil to greener energy. and it would solve the problems. host: row zhan in gardner, new york emails in, president obama's speech on climate change was right in line with every speech he has made to date. empty words. martinsburg, west virginia, michael is an independent and what do you think about the climate change conference? caller: it's very important. it's obvious whether or not the world is going ahead around changing its differences, is with whether -- it's because of of us or doing it on its own, nonetheless, we are sharing our form of pollution with the world. i believe it's whether it's the united states or any country it's time to take a step forward. one of us needs to go ahead and

get in line to go ahead and start gathering more people to start bringing the world to a greener era. i believe if the united states goes ahead and takes our steps forward, more countries will follow along. it's obviously a long-term plan. i'm young. i have a lot of friends that are young. i know we are interested in changeing the world to a greener environment. and i believe that we can go ahead and convince the rest of the dwrouth carry on what we're trying to achieve. jobs will come from it. host: do you think individual effort is important anytime? and if so, what do you do? caller: i believe individual effort is very important. me, myself, i know i'm studying up on skines and things of that nature. i'm more motivated to go ahead and try to share any of, you know, my efforts to give back to the world.

host: all right. thank you for calling in this morning. well, as you probably well know the senate is still involved with their health care debate. and we want to get up to date on it with the managing editor of congressional quarterly. where is the senate when it comes to health care? guest: well, day turns to night turns to day again, and it seems like they don't move very forward, but the action is clearly off the floor. harry reid, the majority leader is trying to cut deals with a number of outliars who are with holding their vote. not so much for the bill itself but procedural votes to let the bill come up for a vote. as a result he is in a series of negotiations trying to get to that magical number of 60. sort of the same situation the democratic leadership has faced for nearly a month now, and until then we don't quite know but it looks like there will be

-- drama will come to a close christmas eve after they overcome what is expected to be a bunch of republican hurdles thrown up. host: what is going to happen today? guest: basically today we're in a period called post closure. what happens is around 1:00 this morning they voted to limit debate on a fiscal 2010 spending bill. and it's not just money for the pentagon in this bill but a bunch of expiring programs. programs that would continue, for example, unemployment and health care benefits that were part of the economic stimulus package that was enacted in february, so under senate rules they've agreed to limit the debate. and they expect a vote on this spending package maybe 7:30 a.m. saturday if the republicans decide to use all of the 30 hours of post closure time they are allotted.

once that's done, they can try to turn back to health care, which is the elephant, you know, in the room. and basically, if senator reid that the point feels he has the votes to try to limit debate on that, he will do so and file a series of motions and pose a manager's amendment that will make some major changes to the original bill he offered in early december, and we'll see what happens. host: do you expect the senate to be in session all weekend? >> uh, yeah. guest: that's almost for sure. they have 20 dispense with this pentagon spending bill, because the funding kind of expires on midnight saturday. they could of course if they can't agree on this particular bill with the all the add-jans they could pass a continued resolution but they have to do something otherwise the pentagon goes in shutdown mode, and i don't think either party wants that to happen. so early next week, i guess the third consecutive weekend they

will be in session and that debate just kind of goes on drip-by-drip-by-drip but the action is not so much on the floor but off the floor as reid tries to negotiate a compromise and get this number one legislative priority of the democrats done. host: two issues in the papers this morning, br mr. bettelheim. a lot are calling what's going on right now a liberal mute any with regards to the health care bill by the senate majority leader, and two, the republicans may call the bluff. the bluff of the majority leader about a christmas vote. guest: right. well, in a lot of health care debates we've covered over the years in washington, there's always this sort of procedure wall -- it's funny that so many people thought the democrats had supreme power when they got 60 votes in the senate. but senate rules require that

you need 60 votes just to get past the filibusters. in effect what it's done is it's made every senator in the democratic caucus fight and if one of them decides to peel off or withhold his or her support, they have incredible leverage. so reid finds himself in a real procedural bind and republicans know that and they are trying to run the clock and force him to abandon this effort this year. the republicans likely their support with the health care bringing it to a vote. they feel they are not given enough time to read the -- so you have this sort of standoff. and at the same time the clock is running. reid had set a christmas decline -- deadline to get this work done and it's really crunch time. tever next three or four days.

adriel bettelheim, as always we appreciate you giving us the update of what's going on in the senate and particularly health care. >> thank you. host: the organization move on.org has been critical of senator lieberman and his position on health care. and in fact, they have used that as a fundraising tool. this is the video they put out to help raise money and to criticize senator lieberman, and after we show you this video, we will be right back with elisa hold of move on.org. >> public option. yeah. whoo hoo! public option. >> how about a trigger? >> that -- >> let me think about that for a second. hmm. filibuster. ok. no public option, no trigger, but how about that medicare

expansion you supported three months ago? >> yes. i -- boy, i would rather see all health care reform die than cave to the demands or my constituents, and by the way, i've got some demands of my own people, yeah. i'd like to be senator for life. >> uh. >> i would like my name inserted into the pledge of allegiance wrilt said flag before. >> yeah. ok. >> and i want a pony. >> i'd like to be french and taller. >> i'm not sure we can actually make you taller. >> do you really want health care reform to fail? i give. >> we'll find a way to make you taller, joe. >> consider it done. >> so you'll vote for it? >> yes. definitely, unless i decide not to in which case you're kind of screwed all over again. that's what's going to happen. >> call 202-456-1111, joe

lieberman can only hold america hostage if we let him. obama, -- >> boy, i haven't had this many people know what i am going to do in a long time. host: elisa from moveon.org has this been a successful campaign? guest: we have tapped into some advice ral anger that one senator who is not even a democrat anymore can hold the spire country hostage because of his personal whims. host: how much money have you raised? guest: over $48 million in an hour, which is an indication of how frustrated people are and senators who want to -- and

want senators to stand up to joe lieberman. host: what is the purpose of raising this money? guest: to showñi there will be real political accountability for senator lieberman or anyone else who hold it is country essentially hostage to his own personal whims. he's got 86% of the democratic faith and the majority of americans who believe that the best way to stolve health care crisis is to include a health option. this is what lieberman did in the underlying vote and one man has said, mmm, i don't feel like it. and the country's not going to put up with that. so it means pulling in connecticut and running ads there and nationally just to show his behavior will not be tolerated and we need a democratic party that works for the democratic people. host: the wall street journal and others have this -- angry

liberals inch fward a mute any that on the liberal side of the specktrum their anger at the majority leader because of the lack of the public health option. guest: well, i think what we are seeing is a genuine frustration and anger out there and in the country that we have compromised enough. the senate version of the public insurance options was already a compromise and many people feelçó the public option is already a compromise from the favored option that bernie sanders and others on the house side like anthony wiener continue to promote. so so we comp mindsed. -- conference mized. we have worked day in and day out for months to get a bill out that we believe serves the interest of the american people and we see it gunned down day-by-day by a few that want their personal whims.

host: do you believe the superzort guest: we do believe there are other options. we are listening to not just dr. doom but others that say that a bill that actually serves the american people is the most important thing. you can do things to reconciliation. that you could not otherwise do. yes, that the senators that are using the threat of the filibuster not be given all of the power, and in fact sherry brown said it we have compromised enough. it is time for them to compromise. host: were howard deans comments helpful or hurtful to the health care debate guest: i think they were giving voice to millions of americans feeling frustration and to that extent it was absolutely helpful. we are hearing from members every day who feel they have

lost their voice and they worked hard through the elections to elect this congress and president and worked for months straight to see a health care reform bill come through congress and feel like they have lost their voice in these last few days and howard dean is speaking for them. host: ilyse hogue from moveon.org. on our democrats line go ahead. caller: good morning. i am pretty upset with the loss of the public option on the health care bill, too. for the last 17-20 years, i've lost more and more of my health coverage to where right now it's more partial health coverage and if someone in my family gets sick we go in debt because it only pays for 70% of it. and just like the lady from

moveon.org is not just about electing a president. and everybody wanted the freedom, the choice and the liberty to choose a public option if we wanted it. and one thing that at least in the public relations war where we're trying to twins the american people how important this is is that these commercial health care are the ones that brought this on themselves. they monopolized the whole health care industry. guest: i appreciate everything the caller said but the one thing i would take issue is with the fact that we failed the public -- reuters showed an 86% of the democratic faith. so the majority of the country believe that the best way to break the strangal hold is of the private insurance agency is through the public option and not only don't we solve the

health care crisis but we rescue depressing the base of the hold in 2010 if they see senator lieberman gets his way over what 80% of democrats want. host: do you think there's a tie between senator lieberman and connecticut and the health care industry? guest: i think it's obvious and quite clear. look, i don't purport to know what snoort lieberman's motivations are. it could be his connection to the pharmaceutical industry or angry at the liberal base who tried to oust him but the people who will fay for it are those like the caller. host: fort worth, texas, you're on with ilse from moveon.org. caller: i'm questioning her motives. looks to me like blaverage

lincoln stood in front of it first. i told people she said it's like 150 years because the -- defied the supreme court and said when they said a black slave wasn't a person, we -- he said that they were. but now blaverage says a baby's not a person. so i think it depends on how you look at it, which person stood in the way of things. guest: well, certainly, there have been a lot of different senators who have expressed different views of pieces of point we've seen nothing but senator lieberman grandstanding. his own proposal for medicare expansion is what he turned around and wants to be stripped in order usher his support. host: senator nelson holds up health bill according to this article with the abortion issue.

guest: we're deeply concerned about the direction of this. our membership was very upset about this. and the house, senator nelson is following suit in the senate.ñi i think this could throw the health care debate into further disarray. but at the same time, i will say that when the rest of the senate sees senator lieberman getting everything he wants by withholding his vote, there is no motivation for them not to do the same for them on their personal tech issues and that's where you get into a race for the bottom not actually governingñr where the majority why we need to hold senator lieberman accountable for his actions. host: you're on with eilyse hogue from moveon.org. caller: one, praise god that lieberman is in opposition to this bill and i hope he remains is to. additionally i've been calling

my senators, and when i spoke to the folks at specter's office they indicated their poll that is pennsylvania at a minimum is not in favor of this bill. his polls indicate so, and his folks told me that just yesterday. additionally, host: what's your question,? caller: where in the u.s. constitution does it provide for the american government to force citizens to purchase any sort of -- in addition and like health care. there is nothing in the constitution that can provide for them to force me to purchase anything and then penalize me for not doing it. guest: you know, we're hearing a lot of discussion of the mandates right now. both from the left and the right and it's interesting. i mean, one of the things we believe is of course it's critical that every citizen has health insurance, and that what you had with the public option was the ability to buy into a

plan that would not profit and was actually going to bring down the cost and increase competition of the insurance sthri, and without that you've got a bill that provides an entire new client base for private insurance, which is making people angry. host: ilyse, the ad we showed people the puppet muppet, how did you put that together? >> oh, that was really -- we did that quite quickly and we did it because we were in such a sad situation that people actually need to laugh a little bit in order have some can a that are sis to come back for the fight. and i think it reaches that goal. it's just the beginning. it was a quick little very creative thing we did with some friends. host: did you do it here? guest: we did it in new york with some friends from puppet masters. it is the first definite campaign for real

accountability. of course that is not our campaign but it allows people to say look at the ridiculousness of the situation. we can't afford to let it go on. host: who is the voice of senator lieberman? >> i don't know. it was an actor. host: you're on with the zeam's line. caller: yes.ñinúpì(lc@&c+ i was calling toñi say you know i'm from a republican state, # but i think it's flawed. it's flawed from the sayingçó elections comingçó up, think they are trying to get back in the majority and they areñr slowing downçó the proces do that. guest: yes. i mean, i'm certainly with the caller. we've seen nothing but obstruction nism from the republican party since day one went to president obama's

coming into office. and at the the same time the republicans do benefit from the democrats not being able to get on the same page, so that's where we fail at times, the republican base is shrinking. the republicans are in the minority in both chambers so really bipartisanship at this point is getting all the democrats on the same page and hat as long as we allow one person like senator lieberman toçó hold the entire nation hostage.çó caller: good morning.çó i guess i'm a little disturbed by the comments about holding senator lieberman accountable. the constitution allows for senators to hold objections on principal grounds. and a bill cannot be forced through by reconciliation. that's just the process for the budget bill. senators by the nature of the constitution have a right to hold things up.

and if they can't gain consensus i think that shows some deficient as is in the bill. if you want to limit the debate. it's a slipry slope. do we close off debates altogether or -- the democrats did the same thing and i don't really your organization complaining about similar stall tactics. guest: you mean , the senators certainly are doing as they are allowed to. and the base is allowed to absolutely hold them accountable. that's why we hold elections every 2-4-6 years so there are individuals who have impact nationally and we believe in this case senator lieberman is one of them, and when your actions have a national impact, you can expect national repercussions. major: a twitter, what demographics of your

organization's in my opinion? guest: we have about 5 million members. we don't do demographics. we talk to our members all the time, every week. and we have votes every year about what we should focus on and what i will tell you is health care is by far and away the most important issues that our members have ever acted on outside of the presidential elections. we seen more enthusiasm, longer from all 5 million members than we have on any other issue ever in the history of the organization. host: and you're celebrating your fifth anniversary? guest: 10th. host: i knew it was a round number. you're on the line? caller: i'm glad senator lieberman is doing what he's doing, slowing this thing down. i haven't heard this lady say one thing about the fact that

60% of the american people don't want this thing to go through. and it's because they don't want socialism running their health care. they do want some changes, but they don't want these changes. and you know, probably hard for her to accept that. but this is not a socialist country. it's a democratic country, a capitalist country. guest: yes. you know, we -- what we are hearing across the country is that people are tired of profit-driven private insurance companies throwing hard-working american families into bankruptcy due to medical costs. people cannot get care. and the most important thing that this bill should do is break the strangal hold that the insurance company has over everyday american lives. and in order to do that, we need an option that people can buy into that is not profit-driven. and it's common place and all other the world, and we'll get there.

host: kevin leonard tweets in. demonstrates have -- guest: it's true. i mean, we have enormous representation from all over the country, and it's something that we're actually quite proud of. and that's why we believe that democrats need to govern from the place of con census from where the majority of registered democrats across the country want to see us go. and that certainly is true of the public option where 86% of the democrats nationwide want to see the public option. what that doesn't mean putting in a big tent is allowing one person to sort of take that tent down and take it where he wants to go and set up shop there. and that's what we're seeing in this case. host: may be early to predict this but do you see moveon.org being involved in the

primaries? guest: we don't have specific plans but i will tell you there is frustration among our members that one person whether it's in the senate or house is derailing what the majority of democrats want and it's certainly a tool we've used before and we'll use it again. we are progressive democrats. we will work to elect other progressive democrats. and we believe we can do that and still be with the majority. host: is it fair when people compare your view from moveon.org to the tea party members on the right? guest: you know i think we're just seeing the tea party people emerge. the biggest difference i see is moveon.org members are actually representative of what most main stream america warrants. we want every individual covered for health care. we want a job that works for main street not wall street and

helping hard-working american families. what we do see in the tea party members is they are representing a fringe of what the american people want. so they are loud but they are small and not likely to recruit many more people, because they are just their agenda is not what the country wants. host: how did you get involved? guest: i've been doing this kind of work for a long time mostly because i feel like the ethic of moveon is all we need to do is kind of lower the barrier of industry for ordinary people to participate and the political in the political process and i love getting to do what i do. host: kathy, you are on. caller: senator joe lieberman says he's a democrat. i don't believe that. but he supports israel and i am not anti-semitic.

i am for israel but we give money to israel vmry year, and they have health care from the cradle to the grave. now why aren't we, in america, allowed the same things? host: taking that, are you supportive of europe's health care coverage? guest: i mean, i think what we have seen in all these countries around the world is there are models where the government can actually level the playing field so every citizen is assured of coverage and we need to find something that works for our country but that's been proven can work and our american citizens deserve the same as canadian or french citizens. we care about our people too. host: jim tweets in. wouldn't it be easier around cheaper to regulate insurance companies rather than creating a public plan? guest: we are absolutely in

favor of that but fundamentally what we need is to break the absolute strangal hold that this industry has over american lives and the best way to do that is to lower costs and increase competition by having a public option. 40eu7 here's how do i mail you a check without giving you myçó personal information? maybe he's gone online and you ask questions? guest: there is an address on line if you look at the donation page where you can mail us a donation. and thank you, anthony. that's nice. host: you're the last call for ilyse from moveon.org. caller: i was wondering if we quit giving tax money to these organization that is she represents as far as her and acorn and all the pet projects that all the senators take back to their state and just stop that, we would have enough money to take care of the people that doesn't that want to buy a television but not

their health care. guest: we're so proud that we're actually all member-funded. our average donation is $42. we have 5 million members and our members contribute to the projects we work on because they are in the best interest of the american people. host: no government funding? guest: none whatsoever. host: what is the best place to get ahold of you? guest: www.moveon.org. host: thank you for spending time with us on the "washington journal." up next we continue our discussion with the republican from oklahoma. but first here's news from c-span radio. . .

>> south korea's defense ministry says that nothing critical was stolen, but they are investigating whether north korea may have been behind another incident of computer hacking. the ministry says that the attackers stole a document on u.s. and south korean military plans in the case of a war on the korean peninsula. and more hackers calling themselves the iranian cyber- army are claiming responsibility for briefly blocking access to twitter. users trying to reach the service were instead directed to a web page with the claim of responsibility. there is no evidence that the hackers are actually linked to

iran twitter says the problem has been fixed and it is investigating. those are some of the latest headlines on c-span radio. >> "washington journal" continues. host: on your screen is senator tom coburn, republican of oklahoma. there is a dana milbank column in "the washington post." "senators may be home for christmas only in their dreams." would you be here for christmas? guest: rather not be, but that is up to the majority leader. as far as i'm concerned, we are in a little bit of a charade right now. host: senator debbie stabenow, a democrat from michigan, was on the senate floor yesterday, and here is what she had to say. >> out of 40 weeks we have been in session here, 36 of those weeks we have at filibuster's, or stalling tactics, objections

to amendments, objections to bills being put on the floor. that means that only four weeks out of the entire year we have been in this tuition were republicans have not been saying no -- in a situation where republicans have not been saying no, have not been stalling on things that are incredibly important. guest: i do not know if the numbers are right. probably the characterization is certainly wrong. most bills, without offering amendments. just like we have had the health care bill, we have had 10 about amendments considered in two weeks on a 10,000-page bill -- on a two dozen-page bill. -- 2000-page bill. there is nothing wrong with the word no. it is a word washington needs to hear. know what we're stealing 43 cents out of every dollar we spend this year -- no one we are stealing 43 cents out of every dollar we spend this year from

our grandchildren. no to socialism at every turn and more government, bigger government, less efficient government, less effective government. there is nothing wrong with that word. that is a healthy work, especially given the fact that a child born today and their parents 20 years from now will each 0 $1,113,000 on the interest of everything. we have on mount the opportunities in this country, we have created -- unwound the opportunities and it this country, we have created a debtor's nation for our children, and in the last year when the country that is zero inflation and we have increased 12%, plus 35% directly to these agencies from the stimulus bill. we are now 40-some percent increase year over year.

no is a wonderful word. with the bills they have put up and the things they are trying to pass, the vast majority of americans don't want it. they recognize that we cannot afford the government we have today. host: what was your purpose in calling for the meeting of the health care bill yesterday? guest: actually, it was the day before. host: day before, sorry about that. guest: first of all, bernie sanders is a very intellectually honest person. he has the courage of his convictions. i wanted to see -- i wanted americans to see what this was like. when this is finally passed, their ultimate goal is bernie sanders. they will not say that publicly. everybody knows that the american people don't want the government's standing between them and their doctor. we have got that already in terms of rationing of medicare. the purpose was to make sure

that people get to see the contrast. the other purpose was to delay as long as possible this bill so that we don't saddle the americans with another $2.50 trillion worth of government over the next 10 years. host: senator coburn, are you still a practicing physician? guest: i am. host: are you still delivering babies? guest: i am not. is the first year i have not been paid increase malpractice insurance. -- i have not been. increased malpractice insurance. host: let's get to our calls for senator tom coburn. marietta, california, howard of the republican line. caller: thank you, thank you. senator, i just enjoy it as amended of your -- just enjoy every minute of your debate on the senate floor. guest: well, you are up awful

early. caller: i am retired. to avoid yard work, i try to get a little time. the point i want to make, and then i had a question about senate procedure. but the point i want to make to our liberal friends that if they'd spend the time to watch you, if they are retired or unemployed, and had the opportunity to watch you bring amendments to the floor, more time than not, first of all, these bills are out of priority. there are certain things we need to do, and there are certain things we would like to do. that is number one at. no. 2, explain how you are going to pay for it. i heard a figure the other day, yesterday, i believe, that if you took our debt, the unfunded mandates, which you might have to explain to some of our liberal friends, the family thdebt per family in the united

states is $400,000. guest: $400,000 -- $380,000 per person. that is not including where it will be 20 years from now as the unfunded liabilities go up. we passed a bill out of the judiciary committee yesterday and i voted against it, because it increases spending on something that is not the federal government's role by $4.5 billion over the next five years. we keep passing bills and spending money that we don't have to cover things that the constitution says is truly state's rights. state's obligations. host: senate procedure -- we had a good discussion with our viewers yesterday about whether or not the 60-to vote threshold -- 60-vote threshold is vital, whether one senator ought to be able to, in essence, hold

something. do you perceive any change in senate procedure, or to think it is billed correctly? guest: well, i think that the assumption that some have of a hold -- i use holds all the time. let's pass an amendment on it and be able to vote publicly. 90% of the of the thing they did, they did they did add three unanimous consent and the american people -- 90% of everything they did, they did late at night with unanimous consent and the american people cannot get to see the debate. i disagree with passing the bill without having a debate and having an amendment. that has nothing to do with stopping the bill. it has to do with educating the american people. one of the biggest problems is that they don't get to hear a thing because we pass things by

unanimous consent, saying we wonder% agreed. if you read the constitution -- we 100 percent agreed. either this is the rule book or is not. a hold is nothing more than saying put it in the light of day, let's have to pay, let's have an amendment. quite often they don't -- have a debate, have an amendment. quite often they don't want to do that. host: nancy, cademocrats. caller: i am a small business owner, and the cost of health insurance is strangling my business. we can add to increases in salaries or anything to it but my real concern that i would like to point out to all the listeners and you and your constituents is that we pay you folks, our senators and congress, approximately three times what the average american makes, and then we take a 75% of

the cost of your health care, and you have the option of maybe nine plants. i really think that you should be obligated to only by what your constituents at home have, just like i in new hampshire's only have access to new hampshire options. if you have to pay for it and have limited options, he would realize this is a crisis in our country. our congress and senators are royalty, and i think it is terrible. guest: in the market on the health bill, passed an amendment that says that whenever public option plan we have -- we cachalot choice of 285 plans. -- we actually have a choice of 285 plans. host: who is covered under your plan? guest: my wife and i. host: 4 $800. would you consider a cadillac plan? guest: it will be a cadillac

plan by 2011, 2012, as the cost goes up. we discovered that the people who run fehpb, as the rates increased last year and a the government were higher than the rates outside. but i want to go back to her point. senator john cornyn -- with medicating such poor outcomes compared to private care, -- medicaid be in such poor outcomes compared to private care, we ought to go to medicate. the government now controls 60% of health care. if you look at when the hyper inflation started with health care, it started with government programs. if you look at where we're going based on the curve, our premiums are going to rise faster, not

slower, if we pass the present bill. that is not really fair to senator reid because we do not know what thea.uk present bills dead. we know the bill heat -- we do not know what the present bill is yet. we know what the bill is on the floor. cost is what to nice people access. but in the name of cost, -- cost is what denies people access, but in the name of cost, we ought to go after what is bad. the proposals we have seen have gone after what is good in the name of fixing it. when you put a bill up that has 70 new government programs that will require 20,000 new federal employees, 1600 -- the secretary is going to read the regulation -- write the regulation -- that is the last thing we need, more rules and guidelines.

host: as an ob/gyn -- guest: family ob -- host: thank you -- you probably don't deal with a lot of medicare patients. guest: only about 40% of my practice was obstetrics. 60% was kids to grandmothers. host: would you charge different rates for a medicare patient and a private -- guest: against the law. here is what the federal law says -- you cannot give your services away free to medicare. if you do, if you have to give every other medicare patient free care. you can build what everyone for medicare, but they will only pay you a fixed price -- bill whatever you want for medicare, but they will only pay a fixed price. if you go to a hospital er, you pay a c- -- the

highest dollar they got. host: as a doctor, can you provide him with a price list like buying a car? guest: starting to happen. there was one guy i know of, a friend of mine, who stopped taking all insurance, medicare and medicaid, and has three prices in his office. he says, "i am a practicing the best medicine i've ever practiced, because now i can truly listen to my patient and give them the attention they need." he has cut the overhead out, and his prices -- the conference of a physical with the test and everything is about $600 -- the comprehensive physical with the test and everything is about $600. but it is a lot of this visit, it is 200 -- it is a lot office visit, it is 200.

but the time you go in and sit down and talk to your doctor, the average time before they interrupt you, because they want to hurry up and get to the next patient, is about seven seconds now. that is taking away from what we know is the best practice of medicine. every man school student is taught -- every medical student is caught this -- if you listen to your patient, they will tell you what is wrong. doctors are hardly in listening anymore, because they have to get to the next patient. the order tests that people don't need and walked out of the room and then they have the test. we are moving to a practicing doctor that relies on technology rather than at the skill of the practice of medicine. it is going to cause us great harm. it is causing us great harm. host: next call for senator coper, jacksonville, florida, william, independent. caller: good morning.

i like a short statement and then ask the senator question. -- i would like to make a short statement and then ask the senator in question. i am a 72-year-old disabled veteran. i have 28 appointments this year. yesterday, i had my second colonoscopy. the only reason i think i'm alive today is because the doctor i have. i love her like the air i breathe. at the teabag movement i heard you make a statement criticizing all government insurance, medicare, medicaid, military, everything. believe me, you really got me when you started criticizing the va. will you right now publicly apologize to all of our -- especially the disabled veterans -- for criticizing a system that we think is the best in the

world? guest: no, i will apologize, because what i said is what i believe it. i am so -- i won't apologize, because what i said is what i believe. i'm sorry you don't agree with it. where do you want to put your family? where do you think the best there is? i am all for va care, and in certain areas, the va is far superior to anything else. but it is highly inefficient. what we should do to veterans is give them a card and let them go wherever they on, rather than say that you have health care and if it is a good va clinic, a great, but if it is not, you don't have a choice. if you want of the hospital, great. if you want to get it down the road at a general hospital or anywhere you want, if you have ed ourountry, we ought to give you a choice. there are many fine doctors in the system. but government-run programs, the

outcomes are not as good. you can look to the literature anywhere you want. the outcomes are not as good. host: pennsylvania, and joyce, republican, you are on with senator tom coburn. caller: good morning, thank you for taking my call. guest: good morning. caller: there was a question asked earlier of a representative from moveon.org. she did not answer is, and then there was banter about the lieberman act. the question is what is the constitutional authority to mandate buying a product, health insurance, and putting a criminal penalties on that product if you don't purchase it? what is the constitutional party that allows congress to pass that kind of law? i have not heard an answer for any -- answer from anyone. our legal staff handles that.

guest: i can give her an answer. there is absolutely no constitutional authority to do that. there is not even a constitutional authority for a lot of what we do in washington. we have expanded it enumerated powers far beyond what we can afford, and we have gotten almost to the point where the government is doing everything at the federal level and taking away the rights and privileges at the state level because we have preempted -- i heard the previous guest said that the goal is for everybody in america to be insured. that should not be the goal. the goal is to make sure that everybody can have access to health care and has the capability so that they can access health care in a way that is not detrimental to their long-term health. in other words, finances should not keep you from being able to get there, but at the same time, a lot of people in this country, and under the harry reid's bill out there now, most young people will not have insurance, because we will see the rates double on them and they are held here and

they will say, "i don't want health insurance," and that will drive rates up for the 40-to-64- year-old group. why would you to spit at 7 harford $50 a year and six -- what wouldn't you just pay the $750 a year and save the $5,000? host: 1 was the last time you had a conversation with harry reid? guest: they're not interested. we have had a lot of ideas. there is no question that there is a strong majority in both houses, but the difference is that what to the american people want on health care? they want us to solve -- they want us to solve the problems. i want us to solve the problems. the way to fix it is to not put the government in charge.

the way to fix it is to create incentives for outcomes and availability of care. i have no problems with eliminating pre-existing illnesses. we actually did it in our bill. but the question is do you have a government-assisted program or a patient-centered program? that is my problem with most of these plans. as our caller asked, we are going to mandate that you have to buy something and in this country? that mandate will never stand the test of a constitutional challenge. you are going to build a health- care bill on that, the constitutional challenge causes that to fall, what happens? there was a wonderful study on looking at the excess and waste in health care. we spend $2.40 trillion. they say anywhere from $600 billion sit to $800 billion a

year is pure waste, as a practicing physician, i absolutely believe that. treating things that we should not be treating, tests we are ordering from a defense of basis or a conflict of interest, fraud, which they say it is up to $200 billion a year -- i know it is at least $100 billion -- the lack of coordination of care. we have more than enough money in health care today to give everybody aaa health care, if, in fact, we can create and allow forces to create an efficiency and effectiveness. you mentioned earlier about talking about liability. they said that defensive medicine practices are well over $125 billion, the fourth or fifth source that i have seen on that already in the last two years and in terms of that quantity of costs. i admit -- i guarantee, and

ordered tests that you don't need, but i need. it is a lot of today. host: have you ever been sued? guest: yes, once. host: what happened? guest: it got thrown out of court. 90% of suits never even get to court. they are not settled. they are withdrawn because they are speeches. -- they are specious you spend money with lawyers or you pay a fine. of the remaining 10%, 89% undecided -- the little over 1% -- 89% are decided -- a little over 1% of the cases are legitimate a lot of the people who should begin competition are not. remember, when they do, they only get about 40%.

the rest of it gets consumed in hefty fees for trial lawyers and expenses. there are ways we can figure that out. we can do that a whole lot cheaper. but there is nothing -- we have not addressed that question at all on health care. host: professor at the university of virginia -medical school. we will talk to her at about 9:15 a.m. eastern time. chris, you are on with senator coburn. caller: i am a lifelong democrat, but i actually agree with senator coburn. i think that what we need to do is stop the process right now and work towards -- i think that senator sanders' plan is what we need, because the whole idea of president obama's proclamation

was that we would give health care to people who need it. what are we having a whole entire system for people who already have insurance? guest: i think he makes a good 0.34 $2.50 trillion, -- he makes a good point. for $2.50 trillion, and half of them we will put in medicaid, which has a substandard outcome, and half the doctors in this country won't take, we ought to create access. there is a lot of ways to do that. everything is focused on the politics of health care right now, and the senators are getting tired and they're kind of at each other's throats over things that normally it would not be at each other's throats. what we ought to do is really fix the real problems in health care. the real problem in health care is cost.

if we can get rid of half of the wasted money in health care, which could by everybody cadillac plan. -- we could be wuy everybody a cadillac plan. we could actually change this. if we created transparency and accountability, what we would do is force competition, and the good doctors would give more patients -- and the bad doctors would not -- why is it that the bad doctors are the only ones who know who the bad doctors are? there is no transparency. we ought to have metrics out there so that people can make a decision, not just on word of mouth or bedside manner or personality. you could have a great personality and a terrible

outcomes, and we ought to be able to see that. there ought to be transparency and in terms of price, availability to help people, the ability to buy insurance -- if you one competition in this country, a loud entrance to be sold across state lines, -- allow insurance to be sold across state lines. in most of the states, you cannot do that. if i'm 55 years of age and i am not on medicare, why should i be paying for ob coverage? markets will work if we allow them. we don't have a big enough group of indemnification to create competition, and the whole address, and to -- the whole interests come into account. in four countries, if an insurance company has been cherry picking -- i am not going

to pick the six folks -- the capital is transferred to the people who are taking care of sick folks. you go to management of chronic disease instead of somebody who does not take care of chronic disease, and you do that through an economic incentive. if you will not take care of sick people, we will make sure that companies that are are getting rid generated. -- getting the enumerated. there is a good opportunity to fix things like not practice reform -- a number -- six things like malpractice reform and a number of other things. we need to reform medicaid. it is tough to put people in a program that has less-than- stellar outcomes and thus not give them a choice of whatever care they want.

host: let's look at the political process. let's say something passes before christmas, or on christmas eve, as currently planned, what is next? guest: it is my understanding, from what our leader has said, that that would go to the house and that it would not be a conference committee. the house would vote up or down on a. -- up or down on it. host: prediction on that? it becomes law? guest: if the president signs it. host: 1 was the last time you talked to president obama? guest: last weekend. he called me. my mother had passed away, so he called me to offer his condolences. i tried to write him every week or two, and encourage him.

nobody has a tougher job than he does. host: did you do the same with president bush? guest: no, i did not have a good relationship with president bush. host: you have a better one with president obama? guest: 0, by far. we came together in the senate. we are very opposed on issues, but he is a wonderful man. host: why did you not have a good relationship with president bush? guest: i was critical of him with the spending and government. he is a terrific man, too. but i didñi not really spend tie with him. host: did you talk health care with president obama? guest:xd yes. host: okay. we will leave it there. if you want to add to that -- guest:ñr we all have to address

those who brought us to the party. if this bill passes, he will have pleased -- he will of pleased a lot who brought him to the dance. we have some ideas that we could in fact, the other -- we could in fact come together -- i think that the president followed this advice -- i did not give this to him ahead of time, i feel guilty that i did not -- when he can to speak to the joint session of congress on health care, what he should have said is that "we cannot pass major pieces of legislation unless we go to the middle of america," and i am not in the middle, i am a very conservative senator, but take

the middle of the group and build a consensus. had he truly drawn together, like he wanted to do, i believe he wanted to do that, we would see a much different bill, and you would not see the partisan rancor, the clashing that we are seeing now, and we would be a long ways towards fixing health care permit it would not have had a public -- towards fixing health care. it would not have had a public plan. as a physician, we need to fix health care but we do not need to -- the prescription i would give is that we do not need to spend more money. we need to make sure we are spending goes to places where it does most good, and that is not happening. host: keeping senator akaka in just a few more minutes. we will take a few -- senator coburn just a few more minutes. we will take a few calls quickly. since it was, you with us? -- st. louis, you with us?

caller: good morning, senator. guest: good morning. caller: i wanted to ask the senator about the health care bill, i was wondering why the republican party did not bring a bill to the floor. guest: that is a great question. four bills offered by republicans. i would have loved to have our bill -- the management of the floor was to start down a road that is different. the payson street act, which you can see on-line, -ío patient's choice act, which can see on- line -- the ideas behind that are well incorporated in upper bill. -- in every bill.

would you have is a limited time and limited number of amendments. we have filed hours, but they don't want to vote on how -- hours. filed -- filed ours, but they do not want to vote on hoours. we have a 2500-page bill with 10 republican amendments that will impact 1/6 of our economy. we should of had an open, free for all amendment process. host: will we see you on the floor this weekend? guest: yes, you will. host: will you call again for the meeting of the bill? can you do that? -- the reading of the bill? can you do that? guest: probably not. i'm kind of at odds with the parliamentarians, because

they thought the president answered superseded -- they found a precedent that superseded -- the call they made on wednesday marked the changes that -- markedly changes that precedent. i'm a pretty good student with my staff of the rule book, and they were going to change it, he should have an obligation to tell everybody was going to change it. but that is water under the bridge. even -- here is what is going to happen -- christmas some time, we are going to foot the bill, if he has the votes. -- we are going to vote on the bill, if he has the votes. he does not have the votes yet. host: last call for senator coburn. caller: i have just a couple comments. it concerns me that we have men

fighting for our freedom, and yet on the health care bill -- i was born and cap and at government health care what i was born, -- born handicapped and at government health care when i was born, and i was denied a lot of things -- i had a brother who died because medicare denied him some treatments he needed. i fight not to be on disability so that i can have my own health care plan so that i can make sure i have the health care that i need. i am wondering why the government has the right to go into private enterprise. where will it stop after health care, number one? and number two, why don't i have the right to vote on this, if we are a free country? guest: we are a free country but

a constitutional republic. your vote is going to be cast on this issue by your representative in the house and your two senators from utah in the senate. i am not sure her point was -- she is trying thatnot to get a her option. that is a fair criticism of government programs. people on medicare are having trouble finding their primary- care doctor. we have a shortage in medicare now and we will have this big group. you pay into medicare and your employer pays into medicare. very few people are not going to opt for the medicare coverage. but they are going to find fewer and fewer doctors. what we have to do -- the scary

thing for our kids, peter, is the unfunded liabilities associated with medicare. what you're talking about, and your previous guest did not mention, is the standard of living in the countries that have bad health care -- signet -- have the that healthcare is significantly lower in standard of living. rather than stealing the trillion dollars, we ought to be putting trillion dollars into it. the consequence of that is a lower standard of living, 30%, because that is the differential. her point, government health care is not necessarily efficient. the reason it is not efficient because they russation. you have to look at the national institute of comparative effectiveness, the medicare advisory commission, and the u.s. preventive health services task force, which is referenced in that harry reid bill as

amended in what we will and will not do. rationing is coming if we pass this bill. host: near oklahoma colleague, senator inhofe, is in copenhagen. thoughts on copenhagen? guest: not a lot. i have personally reviewed a lot of the science. i'm a skeptic when it comes to anthropogenic causes of global warming. that is me personally as a scientist. the exaggerated claims. i think we ought to do everything we can to be green that makes economic sense, but i don't believe we have a catastrophe around the corner, i don't think we ought to cost our country millions and millions of jobs based on some signs that truly is not settled, even though they want to say is -- some science that surely is not settled, even though they want to say it is settled.

what do families get out of it? nothing that they can measure. with the living dead, tax increases, -- the looming debt, tax increases, which the world currency markets will force to happen, there is no reason for us to lose more jobs and tax the american people at a greater rate than what we are now. host: ben bernanke, up for senate reconfirmation. how will you vote? guest: i will vote for him. the economic present as we were sitting on. -- economic press of this we were sitting down was perhaps the most dangerous time -- precipice we were sitting on was perhaps the most dangerous time since the depression. but not like a lot of the things we were voting for, but the restoration of confidence, and particularly mr. bernanke did a good job.

he is not in anybody's political camp, and he has the best interest of the country and our economy and standard of living at heart. host: death of oral roberts. guest: very influential man. marks the passing at oklahoma history, because that is where his ministry was centered. through his legacy, a lot of people were impacted positively. a tribute to a guy who stood up for what he believed. host: finally, a tweet -- guest: good question. stupidity, one. when i was in the house, i was not here very long for president bush, but in the 1990's, the patient's bill of rights, as co-sponsor that.

-- i co-sponsored that. the first two years of this year, which of the a lot more. -- first two years i was here, we should have done a lot more. host: senator tom coburn, thank you for being here. we are going to continue our discussion on health care. this is kimberley strassel's column in "the wall street journal." she calls the health care package political suicide. that is what we will discuss after this. >> he was not an imposing figure, a giant of this time, but he was the nominee of the time his party was populated by

big figures. >> in his new biography of james capel, robert merry looks at the life -- james capel, proper mary looks at the life and times of the -- james k. polk, robert. look to the life and times of the president. >> on "after words," greg mortenson. get the entire schedule on booktv.org. >> "washington journal" continues. xdhost: you saw the promotion fr book tv this weekend. the senate is going to be in, so you will lose some book to be on c-span2 this weekend. -- lose some book tv on c-

span2 this weekend. but news organizations have put together the list of what they think are the best nonfiction books of 2009. you can find those lists at the website, booktv.org, right there in the center. you can see what the different organizations have put together as the best nonfiction books of 2009. we have a lot of them at the book tv website. we have covered a lot of the events on these books. you will be able to do a search at the top of the page, and you can search and watched some of these best of 2009 books. especially with the senate again interrupting book tv this weekend, we apologize for that, but we will keep you updated via twitter and on the air, and we will put up notices and let you know when the tv will be on. this is kimberley strassel's

column in "the wall street journal." "the president is demanding that his party unilaterally enact one of the most unpopular and complex pieces of social legislation in history. in the process, he may be sacrificing democrats' chances at creating a sustainable majority. slowly, slowly, the democrats held agenda is turning into a political suicide pact. congressional members have been dragged along by momentum, a threat, by bright, but mostly but the white house's siren song that it would be worse to not pass the bill that would be to pass one. that ever were true, it is not today." political suicide pact -- we want to get your reaction to "the wall street journal's"use

of that phrase. in half an hour, we will be joined by a professor from the university of for jenna medical school. we will become -- university of virginia medical school. we will talk about medical malpractice. we want to get your thoughts on health care and whether you think it is a political suicide pact. chicago, mark, independent. caller: well, i'm honored. i do not think it is suicide. something is better than nothing. host: why is that? caller: i was going to call the senator from oklahoma, but the republicans -- everyone should be covered with health care. no one should be denied coverage. coverage should be affordable for everyone.

it has to be worked out. it is sad that we don't have health care for so many americans. the rest of us have to pay exorbitant fees for inferior care compared to some other countries. they should pass something and build on that. host: ohio, john, republican. caller: yes, sir, thank you for accepting my call. i'm a 20-plus-year veteran, and while i was laying in the hospital in 1961, general curtis lemay came in and said they had captured communistic docume, and the gist of the documents was as follows -- we will not fight you, we will buy you, if you from within the ripple -- the fee to from within within your political system, the educational system.

that has all come to pass through our representatives need to the -- that has all come to pass. our representatives need to look in the mirror. i listened to your gentlemman from oklahoma, and he is so far out in left field that he could not even catch the ball if it was thrown to him. thank you very much for receiving the call. host: we were talking earlier about books and books available from book tv. we got this tweet -- both of those books are available for viewing at booktv.org.

steve, a democrat, you are on. caller: good morning. i would like to make a comment on the health-care debate. the park or the defendant plans are going to be stripped away -- park where the advantage plans are going to be stripped away. i'm a democrat, but i think those advantage plans are a blessing for those with income that cannot afford to supplemental plans. i'm very concerned that this is when to hurt medicare -- this is going to hurt medicare. host: are you a member of medicare advantage? caller: yes, sir. host: what is the extent, in your viewpoint? -- what is the advantage, in your viewpoint? caller: with the plan, i can afford health care.

people with a median income cannot afford, with disability, and it is a shame that they're not working on part b down the road. i think it needs to be reformed. i am a democrat and i voted for president obama, but this time i think that the bill needs to be sent back and worked on. host: how long have you been retired? have you been overall happy with medicare? caller: i have been happy with the advantage plans for about 3 or four years. host: what did you do before you retire? caller: i work for a factory and the company sold out and i got my attention -- got my attention. we were a car company. i worked there about 30 years and then i got my pension and

disability. the medicare a fetish plan has been a blessing to us. -- medicare advantage plan has been a blessing to us. in kentucky, you cannot find a supplemental plan that will accept a medicare beneficiary. host: steve, long island -- joe, independent. caller: interesting comments by the senator. i would have to agree with him. i think republicans are acting stupidly. this whole health care situation has become a political football, and i guess it is going to be a problem for democrats, but republicans should not be posting. they really missed the opportunity when they had the power to put together a plan that would work and fix the system, and instead, they just went ahead and continue their own little other in their own

nest, i guess. now we have a political situation on something that is of vital importance to america, we are going to wind up with something that i do not think will be good for the american people. i'm very disappointed. i used to be a republican, and i am now an independent, i will not vote for a republican or democrat in any upcoming election. until they grow up and start taking responsibility for the country, and the job that they have, i just cannot give them my vote. i'm looking for an independent candidate. host: front page of "the washington times close with this morning, "100,000 earmarks is 2700 miles off target when he earmarkeded $100,000 in taxpayer

spending for the jamestown library, representative james clyburn meant for it to go to the library in jamestown, south carolina. but congress ended up designating the money for jinta -- for jamestown, california, 2700 miles away and a town that does not even have a library. the library is just one of more than 5000 earmarks and pork barrel spending projects totaling $3.9 billion, inside the report accompanying the catch-all spending bill congress sent to president obama this week. mr. obama signed the bill wednesday, violating his own pledge to allow the public five days to comment on bills." south dakota. caller: senator dorgan had an

amendment for the health care bill that would allow us people to get our drugs for many other country -- get our drugs from any other country as long as they were fba-approved. how in the world could 48 senators vote against that? host: why do you support that? caller: we get our drugs 10 times cheaper out of canada right now. host: to you go to canada and buy drugs? caller: sure. host: chicago, a democrat. caller: i do agree with the democrats passing health care bill. there is a lot of good things. just the fact that they will end discrimination against women because they pay 40% higher in premiums and then men, and expanding health care for children, there is a lot of

things in the bill. there is much more good in the bill versus the bad. as far as tom coburn, he has no credibility. he has stood on the floor and said the people are going to die. and kimberley in "the wall street journal," she does nothing but-obama. i like c-span, but reading newspaper it -- does nothing but bash obama. i like c-span, but reading these newspapers -- [unintelligible] why wouldn't you want to get health care --ñr if they don't o it, it won't get done. if they cannot do it with obama in the administration, they will

never get it done. have a great day. host:ñr gerry, independent. health care as political suicide. caller: good morning, c-span. i just think -- i am an independent, have never been involved in politics before. me and my wife voted for barack . i am extremely disappointed. i'm disappointed in the administration. i'm a minority. my life is latino. -- my wife is latino. we voted for change. and the democrats have 60 seats. the republicans will do whatever they have to do. they have 40 seats. they have 60 seats, with two independents. i'm disappointed. barack obama has sat on his

butt, and he does not have the backbone to get out there and get this thing done. he lets people like joe lieberman, who needs to be recalled -- he has disgraced the senate. i am disappointed. my wife is disappointed. i am disappointed. and i will not vote for him in 2012. if this bill does not have the public option, if this fails, this is one of the main cornerstone is that i voted for barack obama, and if this bill fails, he does not have my vote, he does not have my wife's vote, ñihe does not have any democra's boat that i know of. host: what did you do in dallas? caller: me and my wife run a

medical field. my wife works for a very large company. they don't give health care there to the employees. this is one of the reasons we fought so hard. i am disappointed. i don't care what the republicans do. the democrats don't have a backbone. they have none. this is one of the main things that the minority public this disgrace about with the democrats. host: maryland, republican, good morning. caller: good morning. i want to talk about history and hindsight 20/20. when nixon was president, he had chip, and kennedy did not go along -- he regretted not going along with nixon. ñiwe would have health insurance that nixon wanted in the 1970's. host: our next caller, what do

you think of health care? is it political suicide? caller: yes, it is political suicide for both parties. most of the democrats -- i don't believe they are democrats any more. they are phonies. they are republicans who have been calling themselves democrats. they want to charge us -- they want to charge they want to charge people, they want to tax anybody who has a medical plan, they want to tax us and they want people to force people to pay for forced medical insurance. it is suicide for both sides. you need somebody in there like kucinich who, during the primaries, the iowa debate wore

all about health care, run by the health-care industry, the iowa debate kucinich wasn't allowed in the debates because he was the only one for single payer universal health care not for profit. >> -- host: from "the washington times" james traficant, colorful, recently released from prison said thursday he is proud of being an ex-con and may try to run again for a seat in congress. mr. traficant, elected to nine terms from youngstown, ohio, before he was expelled said he will circulate petitions in three house districts. he did not specify which but the three closest to his hometown are all held by democrats. buffalo, n.y., gregg on the independent mind. >> good morning, peter, how were

you? then i ask you about what you are doing with this twitter and -- host: what do you mean? caller: this is a call-in show, you ask people to wait 30 days, but it seems to me the folks twittering getting on every day, the same five, six, 10 people. how is that fair? if you have a 30-day rule how you have a free for all calls -- free for all? american hero gets on every day with his comments. guest: you know, you are right. the fact we have rotated hosts out here, i don't know who has tweeted in the last three or four days and i come out and read the ones that rise of to the taught. so, you got an absolute point. and in fact, we are still debating on how to handle that

because it isn't fair. it is easier with the phones, but you're right, you have made a great point. and you are gone. ok. thanks. kathleen, ariz., -- arizona. political suicide pact? the health care bill. i happen to be an american who doesn't have health care right now but the lastçó thingñr i was for the rest of the country to pay for my health care. i was brought up to believe that in thisñi country, you could std on your own two feet. i don't mind helping people truly in need. but it is ridiculous. they will break the country. it is turning into cuba or venezuela, i think that is where chavez's, anytime the government gets involved it is a mess. i'm going to a third world

country in february for a medical mission, and i can't get a hepatitis a shot because they are all out. my father wants to get a flu shot and he can get them because it is all out. it goes to show you want the government gets involved in anything it makes a mess out of it. i am so dead set against that. i think it is the biggest mistake -- plus, i want you to comment on what that senator from minnesota said to joe lieberman on the floor of the senate. that is how it is getting. it turns into some kind of country i don't even recognize. host: let us show you the exchange between senator franken, in the chair presiding over the senate, and senator lieberman. >> for 10 minutes. >> i wonder if i can ask unanimous consent for just an additional moment. >> in my capacitor -- capacity as senator of minnesota, i object. >> really?

ok. don't take it personally. >> that is on the floor of the senate. newark, ohio, george, a democrat. health care as political suicide according to kemberly -- of "the wall street journal." do you agree? george? we've got to move on. joe, oceanside, n.y., independent, what do you think? caller: good morning. from the prison i am looking at. i was watching harry reid on tv and there was this look on his face. there is this look of desperation. the last election, the two democratic governors are voted out. americans are catching on. they are fed up. obama, who i happen to like, and wanted bush and cheney out, he has not created the 3 million jobs that he ran on, he has not brought our troops home from the middle east, that he ran on.

matter of fact, he sent more troops. now he's got to come up with something because the elections are one year from now and have to say they gave us something even if it is two three aspirants for every american couple. there are going to pass this regardless of what it says because they have to have something on the resume to say look how good we are at governing. wheat pass this bill. -- we pass this bill. host: china's government censors take in fresh aim of the internet, rolling new measures that limit the citizen's ability to set up a personal website and view hugs -- hundreds of website offering films, video games, and other forms of entertainment. the authorities say the stricter controls are intended to protect children from pornography, eliminate piracy of films, television shows, make it harder to perpetuate scams. but the measures also appear devise to enhance the already strict control of any political

opposition. under the new controls more than 700 website have been shut down, including many that offer free movies, television dramas, music download. b t china, which recorded at least 250,000 visitors daily, was among them. china's largest files sherry site must obtain a licence or face possible shutdown as well, according to news media reports. it said this year china has blocked facebook, twitter, youtube, and thousands of other website. the next call on health care as a political suicide pact, fort worth, texas, edith, republican. caller: good morning, peter. i think we are running into a major problem because you have exposed millions of new people sitting at home to what congress used to do behind-the-scenes. where everything is behind closed doors. as of the public has no concept

of what was going on. last year we sat and watched. i was able to see dr. cockburn -- coburn and here the republicans and listen to the comments we make. one of the problems we have is if you have not been watching for the last year,ñr the very first thing the republican majority or minority said was that, if you say something and of time the public will believe it. -- not *, the public will believe it. what they have done very well, they have just said the exact same thing for the last year. and they keep saying they are putting in amendments. the amendments are actually back door and amendments to kill the bill by sending it back through

the process. people have died over this year. because of no health care. host: thank you for." , edith. indiana, steve, democrats appeared of a cup i'm opposed to what i'm hearing about the plan as it -- caller: i'm opposed to what i am hearing right now, that it is mandatory. i have insurance through my employer. as long as i have the option through my employer i will take appeared for someone unemployed, saying you have to buy mcdonnell's every day. these companies are so profitable i don't think it is really fair. i was in favor of public option, i am in favor of universal health care. i think it is a right. it should be a right and not a privilege. your first caller made the comment we need health care affordable and available to everyone and it doesn't sound like this will provide that.

host: st. louis, john, independent line. audit, i wanted to make a comment about a couple of things. the article in "the wall street journal." i think the political suicide will backfire on the republicans actually. a lot of people voted for this change and reform. and they are just obstructing everything they can. look how many bills were passed in the senate this short time obama has been president. it is appalling. the way politics is going now, it is not for the people. it is for the politicians and big business and i think it is wrong and i think that is what is going to come back and haunt the republican party. hopefully so. i wanted to make a comment about tom coburn, talking about all the wasted money spent, public dollars wasted in washington. well, i think his salary for him

and his staff is probably some of the biggest waste of dollars in washington right now. host: what do you do in st. louis? john, what do you do? we will never know. columbia, tenessee, a republican. caller: merry christmas to you and all the staff at c-span, i appreciate what you are doing for the american citizen. all three branches of our government, and i just wish that the american citizen can be sitting where you are right now. in a way you are giving us the opportunity. just about everyone i have heard on your program this morning, at telling some what the truth. they are telling just like it is about what the republicans are doing. i'm calling as a republican and this gentleman just on was a republican.

it is forcing suicide for this nation. our nation is going to fall. if we don't get behind these democratic representatives and senators, which i called both lamar alexander and bob corker from tennessee, i called all eight of my representatives as well and i try very hard to let them know this is very important. this is either going to turn our nation around or we are going downhill and there is no stopping us. we are going to be looking at our enemies and our enemies are going to be saying this nation is right for the picking and only because the morale of the people are devastated because we do not have leadership in our nation and we sure don't have the rights of our citizens. thank you very much and god bless america. host: 25 for watching.

bethlehem, pennsylvania. caller: of socialism was taken out and therefore i am against it. maybe weñi should start over oro reconciliation. when i studied history many years ago i recall in this constitution it says when there is a tie in the senate the vice president breaks the vote. what happened to that? those days don't count anymore, i guess. the other thing, it was the constitutional for george bush to give those trillions of dollars to the banks? what they have done is socialized the losses and privatized all the gains. as far as senator tom coburn, apparently he did not hear the lady from new hampshire when she said she would go out of business shortly if we don't get some sort of national health care, where her employees would be protected. that is a small business. think of general motors, chrysler, ford will have to pay money to employees and their

foreign competitors don't have to pay that. just an outrage. the other point, was coburn is concerned why didn't republicans do something they have total power for eight years -- maybe the last year and a half they didn't, they have total power and it did nothing about medical care and the said it is because we were stupid but it is definitely true they are stupid but the real reason is they are the agents for the insurance companies. host: orlando, michael, independent. you know the rules, go ahead. caller: to live for taking my call. i think the most important thing right now is the people of this country. the senate and house have a tendency, especially with something this portion of this magnitude, to take the time, and we want them to do it right but also in consideration of their political power and how long they will be in power.

i think it would be unethicalñr to play with such an immense bill, to not take into consideration the people they serve. all i have to say. god bless america. host: 45 minutes left in " washington journal" this morning. health care half-truths', too many mints, not enough reality. carolyn engelhard is the co- author and she joins us next from charlottesville, virginia. after this news update. >> a u.s. official speaking on condition of anonymity says talks between president obama and chinese premier wen jiabao moved a step forward toward a possible agreement. after meeting nearly an hour in copenhagen both leaders directed their negotiators to work on a possible deal. china has been criticized door and the summit for not offering stronger carbon emissions

targets and resisting international monitoring. more on the exchange in the senate between independent senator joseph lieberman and minnesota democratic senator al franken. speaking earlier on minnesota public radio, mr. franken said he was only following orders to keep the health care debate moving when he cut off joe lieberman's speech saying that majority leader harry reid had instructed him and others taking their turns presiding over the senate yesterday to hold speakers to 10 minutes. intelligence officials say a suspected u.s. drone missile strike killed three militants in pakistan's travel. medaaf afghan border. it was the third such attack in the past 25 -- 24 hours in area of north waziristan. are arriving earlier in afghanistan today, admiral mike mullen, chairman of the joint chiefs of staff, told a group of enlisted troops he is confident the country will hold elections march 7 and the u.s. drawdown will begin on schedule that

month. the election was postponed from january but admiral mullen said that will not change u.s. plants. an update on the auto industry. general motors said it would wind down saab operations after talks of a deal collapsed. those are some of the latest headlines on c-span rating. >> "washington journal" continues. host: "healthcare half-truths'" is the book and carolyn engelhard is the author. she joins us from charlottesville, virginia. how do you define medical malpractice? guest: good morning. well, medical malpractice has to do with the practice of medicine, and when there is a medicalñi error, when there is n injury, when there is a misfortune, that it ultimately becomes litigated so it has to do with medicine as well as our judicial system.

host: could you walk us through perhaps a typical case or a case of medical malpractice that might give us an idea of how it has developed and how it works? guest: welcome i am not a lawyer. i teach health policy so i tend to look at these things in a more global view. but certainly if you read the literature there are lots of cases where a patient has been given the wrong dosage of the right drug and it ends up putting them into an adverse situation. they later discovered that it was a mistake. the way the system currently works right now is, patients usually don't have access to what happens. if there is a threat of liability, it tends to be silenced. patients become scared, mistrustful, and at that point

that they usually seek legal counsel and then from there it just goes to the legal system. host: in your research, is medical malpractice expensive? as medical malpractice costs the u.s. a lot of money? -- has medical malpractice costs the u.s. a lot of money? guest: it cost the u.s. about $10 billion a year? is that a lot of money? less than one-half of 1% 1 what we spend on health care in this country. the average award is about $263,000, but the average award of the most expensive awards is closer to $1.2 million. only about 4% of all awards go to judgments. the rest is settled. if so, yes, it is expensive. $10 billion is a lot of money but in a scheme of things out

of our $2.50 trillion health care system, it is a fairly small amount. ghost: in your book you go through what you called myths about health care and medical malpractice. one of those myths is that tort reform of medical malpractice would keep health care affordable. why is that a myth? guest: well, it is a myth because tort reform in and of itself doesn't touch the other problems in our health-care system that drive up costs. so, the medical malpractice system currently as it stands really serves nobody. everybody knows it is in trouble. everybody knows it doesn't work, it does not work for patients because fewer than 2% of patients who are injured actually sue, and if they do so and received an award they

receive less than 50%, usually less than 40% of the award. it doesn't work for positions because it increases defensive medicine, it creates shot a wedge between patients and physicians and it does not work for health care system either because it doesn't do anything to change this system where the errors occur. no physician goes to work every morning saying, i'm going to harm my patient today. but we have a system that is full of land mines, if you will, of mistakes that can happen. and if you penalize orçó punish one individual physician and don't change the system in which he or she works, the next physician who walked into what will also run the risk of creating an adverse events. host: professor, how the medical mac -- malpractice develop in the u.s. and is it unique in the world? guest: we are certainly much more litigious than other countries, that is for sure.

how did it develop? i am not a historian, either, but in the late 1900's -- in the late 1800's, early 1900's, medicine became much more professionalized. it became ore.-based, disease- focused, and physicians started developing what we might call a standard practice patterns. once that happens, patients that could take action against physicians who seemed to not to conform with the practice patterns. and so, it began in that way. physicians learn, like anybody else would insurance risk, that the best way to insure against that is to pool resources, pull your risk over a large pool, and they did that. things when pretty smoothly for the positions -- they self- governing fairly well. they protected themselves in

court. judgments in their favor. then in the late -- 1960's when there was civil unrest and all different social institutions were being challenged, patients were suing doctors more. you actually were able to do a lot more in medicine these days, finally. the jury award started going up very much. so that became a period of great basilica will -- disequilibrium in medical malpractice. then in the 1970's with the recession, some of the health insurers were unable to rely on their investment portfolios to sort of protect them against the risk. only 25% of the premium for medical malpractice is based on medical experience. so, it insures look toward their investment portfolios and

other kinds of revenue sources to spread that risk and during the recession the return on their investments lord, and because of that, many of them exited the market, premiums went up, there was less competition, and so physicians felt that very keenly and called it a malpractice crisis. if we had three of those in the last century and they have all predictably followed a recession. the most recent one was in the early 2000's, and it ended around 2006. as of last year, 93% of all carriers, and now practice insurance premiums were stable. caller: hoshost: the medical mue system seems to be a fight between doctors and trial lawyers. is that fair to say that? guest: i think it is absolutely

fair. doctors believe medical malpractice is the result -- the problems that surround it are the result of greedy lawyers and a runaway jury is and trial lawyers think it is because insurance companies make risky investments and price their product below market value and get in trouble and exit the market. the truth lies somewhere in the middle of that. we do know that jury trials are very non standardized. you could at the medical malpractice case in one sitting that is almost identical to another city and the jury determination would be different. so, it does seem to be that way. the trial lawyers contend it is an american right to have your day in court, a way to keep physicians accountable. and physicians feel there are

many, many frivolous lawsuits that come forward that do not justify going into the legal system and it tends to be kind of a standoff. host: does the system in your view work, and doesn't need to be changed? guest: i think it absolutely needs to be changed. i do not think it works. i think almost everybody involved in this system, perhaps with the exception of the trial lawyers, no it has to change. and the reason it has to change is because, as i mentioned before, 10 times more patients are harmed than ever bring suit. and it creates in this culture of silence. when physicians feel threatened, when they are afraid that their patients are going to sue, what they do is practice defensive medicine, they do more tests than they need to do, which drives up health care -- health care cost and creates more risk for patients because any

invasive procedure carries risks. if -- and it creates fundamentally a problem in that it erodes the patient-physician and shipped -- relationship. the art of medicine and the science of medicine. the science is very important. it is unclear -- incredibly important that this movement called evidence based madison be allowed to mature and physicians -- physicians practice based on evidence and held accountable but there is also the art of medicine and it has to do between the relationship between patients and physicians. patients are sick, they are vulnerable. they are forced to trust. trust is and a central component to the therapeutic relationship. if you build this adversarial were mistrustful environment between patients and physicians, you will not have a good medicine. you will not have that in central relationship. thirdly, the reason it doesn't work -- and this is very important -- it does nothing to

change the culture of our health-care system. 100,000 people die every year in our hospitals because of medical errors. we have almost 2 million adverse drug evens. you know, hospitals are in many cases -- and i worked for an academic health system so we have a teaching hospital. -- but it is a complex, a chaotic environment fraught with potential problems. and people are working very hard -- very hard to make it more transparent, to put in checklist's, to have higher quality, metrics to measure quality, and we just can't do that. we can't do it successfully if we don't know what is going on that is wrong. if we don't know when the mistakes happen. we need a feedback loop that will tell us how we can change systems to make it safer for patients. physicians need the permission to be able to be more transparent and to be able to report those errors and mistakes

and adverse events without worrying that they are going to be dragged into court and sue because when you think you are going to be dragged into court and sue, what do you do? you shut up, you go silent, and that is not going to help improve our health care system over all. host: carolyn engelhard is a professor at the university of virginia school of medicine. she is also the co-author of this book "healthcare half truths. come -- "health care half truths." it is the lexicon of the current health care debate. we thought we would dig a little deeper and talk about this issue with her. we put the numbers up on the screen/political affiliation. i want to point out with a fourth line set up for health care professionals to talk about this issue.

host: chapel hill, north carolina. larry, independent. caller: good morning. i have been in the middle of a lawsuit now since 1993. host: a medical lawsuit? caller: my son was injured by a vaccine and i was suspicious. and the doctor, a neurologist who teaches at -- teaches at brown university said it would be impossible. to make a long story as short as possible, i hired two f b i agents to investigate -- host: 2 many little details. who has your lawyer sued. caller: i told the doctor what happened and he said he would testify for my son -- host: have you hired a lawyer?

where is the case currently? caller: the case was thrown out because i only have 36 months to figure it out. host: tell you what. professor carolyn engelhard, can you comment about lawsuits with vaccines and maybe general comments about what he had to say without getting into the specifics? guest: right, there have been a lot of lawsuits because of vaccines, and i don't know exactly lares situation appeared -- situation. but there is a belief among a community of people that vaccines caused optimism because of the composition of the vaccines, -- causeautism -- cause autism. most scientific studies the not believe there is a link between vaccines and autism. i don't know if that is the case with his son.

but the brink of a good point and it ties in with the medical malpractice discussion because part of the reason we see this roller coaster premium with malpractice, which takes us into what we call these crisis areas, have to do with the the fact that very often the judgment, the payoffs take four, five, six years. larry has been dealing with this much longer than that. but we call it a very long tail. so if you are an insurance company, malpractice insurer, and and you know you are carrying potentially these payouts forward, then you have to keep raising your premiums because in case you have to pay them out. that influence is the premium structure and makes them go up. what is different than other insurance products. host: larry called on north carolina. according to a map you have in this book, north carolina is a

state that has no damage caps. is a medical malpractice a state issue, a federal issue? guest: it's a state issue. physicians are sued at the state level. over 30 states have some caps on what we call noneconomic damages, pain and suffering. twice under the bush administration house of representatives passed a bill for tort reform that would place a national cap on medical malpractice. each of those times it did not make it out of the senate. mostly -- and the debate goes back to what we talked about earlier. trial lawyers believe very strongly that patients who are harmed shouldn't have an artificial cap put on what they should get out of the settlement.

so, it is a state issue. states have very different caps. california was the first in the 1970's. they have a $250,000 cap and georgia has half a million dollar cap. i think va is now as 2 million. it varies from state to state but most states do have a cap. host: there are four states in deep blue -- indiana, nebraska, louisiana, new mexico. what is their status? total damages cap is what you have as the key for them. what does that mean? guest: it just means they have a cap on all damages, which is economic as well as pain and suffering. economic damages has to do with, if you are injured, and you can't work, the court determines what you would have made if you have been able to work the rest

of your life. those are called economic damages and those are factored into the settlement. then pain and suffering, non- economic, which has to do with the hardship, a motion and psychological borne by the accident. and some states have what are called. -- punitive damages, that has to do with the negligence that is part of the claim. the states that have caps on all mean they have an upper cap that goes across all three of those domains. host: what is pain and suffering when you talk about it in a legal aspect? guest: you know, i am afraid i cannot comment on that sense i am not a lawyer. it has to do with things that are not quantifiable by income. what you are expected to make. but imagine that -- this is one of the scenarios brought up against caps. supposing you are a housewife or

a father -- suppose you are a stay at home parent raising small children and you have an accident, you are harmed by the medical system. and you go to court and your economic damages are based on what you will make the rest of your life or over a period of years until you can gain a full functional status. but you have no income. you have no outside income because at this time in your life you are home with your kids. this means essentially you would get no restitution. unless you had some sort of pain and suffering that talked about the emotional damage, that talked about how you have to replace the care you would have to provide for your children, housekeeping, cooking, whenever. those are the kinds of things that go beyond just simple economic damages. host: next call from professor carolyn engelhard.

croft and, maryland. jonathan, republican. caller: i just wanted to say that i think some kind of medical malpractice is obviously necessary. it keeps a level of due diligence and prudence in the medical fields. i just wanted to make a comment about the current health care situation we are in now. i would advise everyone listening that congress is not going to change anything. if you want change, stop paying your premiums. if you want reform, take your money out -- banking reform. that is all i have to say. host: professor, any comment? guest: thanks, jonathan. i would like to make some comments. as i mentioned earlier, i think everybody does believe that the medical malpractice system has to change. i think everyone also recognizes

there needs to be accountability within the system and responsibility for when bad things happen. ithere is a movement in this country to move away from a punitive adversarial system towards a system of more transparency and disclosure. the two bills right now in congress, in health care reform -- house reform bill and the senate bill -- there is language to provide incentives or rewards to states who try out a demonstration programs in some of these alternative models in medical malpractice. some of these models include things like health courts where you have an administrative judge who does this all the time, look at the suit, the lawsuit. they have experts who are not paid by the defense and the plaintiff but who were called

in to provide expert opinion on the ability of the case. and there would be a pay scale or a range of what would be paid out by medical error, negligence, or whatever the accident was. that is one of the ideas. another idea is what we call safe harbors. that is, if physicians document they followed, practice guidelines that are nationally accepted, they would receive liability protection. the other is called disclosure with compensation. that is when something happens, it would be investigated. if it is found to be an adverse event that was preventable, it would be disclosed to the patient with a form of compensation offered for economic damages and out popped

in damages. these are being tried all across the country right now with some success. the university of michigan uses that in their hospital, and in one year alone they saved $2 million and have -- cut their litigation in half. these are out there that can be tried. interestingly senator obama, now president obama, when he was senator along with senator clinton co-sponsored a bill to advance these kind of alternative models. it never made it out of the house. this is a discussion the nation is having about medical malpractice. host: john in illinois. you are on. caller: i apologize going off that subject a little bit. i want to know if you have a comment on the numbers that came out, about 60% of americans

don't want health care change at all. it is hard to meet to believe given our biggest employer of the united states, wal-mart. i lived in a college town and i have spoken to college students who are afraid when they graduate about health care. if you have any comments, i would appreciate. host: anything you want to comment, professor? guest: sure, this is my bread and butter work, teaching health policy of about health care reform. thank you, john, for calling. you know, most americans do want health care reform. for the last 30 years every survey we have had, americans say they believe all americans should have access to basic, decent health care. they think it is a crime 46 million americans do not have health insurance.

and very few people like their health insurance companies. everybody knows there is a problem. where we are now in the process is exactly where we were when the clintons tried it -- we are a little farther now than there early 1990's but the process is the same, and that is when you get down into the details, when you get down into the weeds, when people start thinking about how is this really going to affect me personally, me and my family, since most americans, 83%, have insurance and many americans are fairly satisfied with what they have, they get scared. they think that what is happening in washington is going to make our life worse. that they are going to have higher taxes, the help insurance they have -- excuse me, the health insurance they have later it will not be as good as what they have now. they are leery about subsidizing the health care for the uninsured. we have a very strong if those

of individual responsibility in this country. so we are caught in this bind right now where it is very complicated, there are lots of details. you know, making comprehensive legislation in this country is very debacle for a variety of reasons and when people get scared -- very difficult for a variety of reasons and when people get scared, maybe the devil i know is better than the devil i don't. but it is truly, truly clear that most americans understand that our health care system is wade toole expense of and that we should be able to find a way to offer health care to every american. host: next four professor carolyn engelhard is robert, of women to the screen, a retired lawyer from booker raton, florida. please go ahead, robert. are you with us? nope, he is gone. story -- sorry about that.

arizona, frank, republican. please, go ahead. caller: this health care debate and all that and consensus. why don't you set a cap on the attorney fees? not on the compensation for the patient? host: carolyn engelhard? guest: i think a lot of the attorneys work on a contingency basis, so it is a percentage of the award. i suppose you could put a cap on the attorneys' fees. i would question whether or not there is precedent for that. do we put a cap on other professionals fees? do we put a cap on how much physicians can charge? we do indirectly through a reimbursement system but we don't put a cap on how much physicians make. so it just doesn't seem -- i

understand the frustration, frank, but it doesn't seem very american and my guess most americans would say, people ought to be able to make what they can make, that is an all- american value, capitalism at its best. host: carolyn engelhard, before you came on we were talking to senator tom coburn from oklahoma. he said he is not delivering babies this year because his medical malpractice insurance would have cost him $80,000. at the first time he has not done that. is it typical for physicians to pay that kind of money for malpractice insurance? guest: obstetrician's paid more than many other bonds -- many other specialties, because they carry a higher risk. everybody in this country of course once a perfect baby. -- wants a perfect baby. it is very sad and a tragedy when there are accidents at birth.

obstetricians have a higher malpractice premium. some of the other sub specialties are less than that. this is one of the reasons why physicians more and more are going to work for large, integrated practices and hospitals because oftentimes those larger institutions will pay for their malpractice insurance. the solo practitioner, small group practitioner suffers the most with regard to that. host: the next call for carolyn engelhard, david, a nurse. caller: good morning. thank you for taking my call. i want to ask professor carolyn engelhard, i have over 20 years experience working in private insurance quality improvement, government positions involving quality improvement and oversight, hospital quality improvement working for the joint commission. i wanted to ask two things.

does dr. carolyn engelhard believe that in light of this plethora of people and agencies working in quality improvement throughout the country -- and this has been going on many years -- and in light of the national practitioner data bank, have any of these things really been effective in addressing the kinds of adverse statistics that the professor quoted pet -- quota? host: before that, do you care reliability insurance as a nurse? caller: when i am working clinically, i do. but when i worked in hospital quality improvement departments and private insurance quality improvement, i have not. only if i'm working in a direct clinical position. host: thank you. professor? guest: hi, david. thanks for your call. it is a really good question. when i teach, i have a slide

when i teach my lecture on quality, that i call the zen of quality. you remember that expression, if a tree falls in the forest and nobody hears it, does it make a sound? sort of the same for quality improvement. if we keep working towards it and working towards it and nothing seems to change, is anything happening? i know that there are lots of people working very hard on it. don berwick, many people nationally are working with hospitals to develop guidelines and check list and we have seen some improvement, particularly with things like infection rates, catheters in the i see you, and things like that. -- icu and things like this. generally speaking, there isn't a lot of improvement. in fact, the national agency that measures quality actually

says that, you know, we are getting slightly worse every year. partly it that is because we have a sticker and sicker and sicker people going into the hospital. we have more and more medical equipment and technology that we are using. so we are increasing the probability of quality problems. we have a long way to go. there are a lot of people working on this. and i think if we could do something in this medical malpractice every now where we move away from this culture of silence and the blame game and moved towards transparency, disclosure, reporting -- not blaming individuals, fixing systems, then i think we could improve quality a lot faster. host: about 10 minutes left with our guest carolyn engelhard, the author of "healthcare half-

truths'." who is your co-author? guest: a physician, a pediatric cardiologists and former dean of our school of medicine and currently the vice-president and provost at the university of virginia. host: missouri, carol, you are on with carolyn engelhard. caller: i was wondering, are the charges in the state left to the people with the malpractice reform has caps? and my other thing is, if not, isn't it ironic that we are worried about what doctors have to pay for insurance when nobody cares what people have to pay for insurance? host: professor? guest: no, the individual's health insurance is not determined on whether or not there are caps. i would say that in the states

where there are caps, the premiums for malpractice tend to be slightly lower, and there is some evidence -- although there are lots of studies that contradict each other, that states with caps -- it changes practice patterns slightly. we are talking about 0.2%, the cbo came out this fall and said. it is important, i think, that listeners understand that what we do know is that states that have caps, it still doesn't mean they necessarily reduce defensive medicine. we have lots of data that suggest that states that have caps spend just as much money in medicaid. -- medicare as states that don't have caps. one would expect if you have caps you would have much less defensive medicine, physicians doing less because they were afraid of being sued, but that is not what we see.

so, that is part of the reason why just having caps will save us a lot of money. the cbo came out in october and said it if we had a national cap it would save $11 billion a year. that is one-half of 1%. that is because of all of the other reasons we spend money in our health-care system. host: carolyn engelhard, what are some of the major areas of lawsuits of medical malpractice lawsuits besides ob? guest: surgery, anesthesia, emergency medicine. those are the areas, things that our procedure intensive or where there is high risk. we know there are a lot of suits -- this scare's physicians a lot.

three years down the road someone is diagnosed with cancer and they come back to the position and say, you know that and our eye you didn't give me or that ct scan you didn't give me three years ago might have picked it up and we might have been able to treat it earlier. that is why we see the explosion in imaging. just this week is that it came out and talked about the dangers of too many ct scans. the radiation exposure and how that leads to unnecessary cancers in our population. so, those specialties that our procedure driven, that use a lot imaging, and where it is high risk, where things can go wrong like and as these young and obstetrics. host: kingsport, tennessee. finroa, a retired nurse. caller: first of all, i am

impressed with her because it seems to be no political agenda and the type of person she is. but i would like to ask her opinion. as a nurse, several years ago in 1990 i was mutilated in a minor who will ligation and off of work six months. i started a lawsuit. most of the positions i worked with, they read my paper work and said there is no way i could lose. anyway i found out during the process -- of course, it did not get anywhere because the hospital i was injured at was owned by a hospital corporation. i would like that opinion because i found out during that time that if you sue and you were a patient in a hospital, that a hospital goes on record and that lawsuit, even if the

hospital is not claimed in that suit, they go on record so the hospital does everything they can to prevent you from getting the paperwork and getting the truth about what happened because they will go on record even though they are not part of the suit. host: carolyn engelhard, any response? guest: thank you, and i want to thank you for your kind words and i thank you if you buy our book because we appreciate that very much and i hope you enjoy reading that if you get it. i am sorry about your injury. and i am sorry about your experience. i think it is a good example of what is wrong in our health-care system with regard to medical malpractice. one of the double-edged swords of quality improvement is that we now have a web sites where people can go and check out

hospitals, and in some cases, even physicians, to look at whether lawsuits have been brought against them, quality scores with regard to mortality and survival, those kinds of things, that makes physicians and hospitals very nervous, of course. i think that is one of the things you've discovered. i think your example is why we need to change the system. if you are able to go into it and administrative judge environment, administrative court, where they had experts testifying that had no relationship to the hospital or to the position that performed your procedure, but could just look at the records and look at what happened, then the judgment might be different and certainly i would hope it would be more standardized and consistent across the country.

i encourage you to stay involved and to advocate for change because you know better than anyone how horrible the system is, both from the beginning, when you are injured, to finding a lawyer to take your case, trying to get to the legal system. it is very hard for patients to do that. so i hope you will be an advocate for change and acting your case is a good example of why we need change. again, i hope you're ok. thanks for calling. host: carolyn engelhard, has a research shown that physicians stay out of certain types of medicine because of medical malpractice threats, or don't locate somewhere because of those threats? guest: yes. i think when we are in these medical malpractice * there are certain states -- the last one, the one in the early 2000's, there were certain states harmed more than others or experience did more than others.

nevada, west virginia, pennsylvania, and in those states, particularly in some high risk specialties like ob, you found physicians leaving the state. i do think it had a trickle- down. i teach medical students and i work with residents and i do think one liability exposure factors into what they go into professionally. that and salary, of course. so, yes, i think it does have an influence on what special two and up going in. host: ohio, tobin, a republican. caller: the biggest problem i see if she seems to be pushing toward having the quote independent juries or individuals who are not attached to the system. how did these people know

anything about medical decisions? a jury could be full of individual citizens who know nothing about hospitals and doctors, what is required in anesthesia, but they feel so bad that somebody has died, they feel so bad that a child has died they don't realize the child was probably still gone from the get go from something the mother did -- host: we've got the point. carolyn engelhard. guest:well, first of all, thank you for your call. you brought up an important issue, and that is these kinds of cases can be very emotional. they can be sensationalized. it is sort of an american right, we believe, to have a jury of our peers that we can learn about the facts of the case, that we can be educated, that we can listen to