you have an i.t. system, that it is an i.t. system that is working to the maximum effect. we all know that i.t. can work, but we know it is not going to do a lot of good with the buzz words of e-prescribing and doctor, you know, supported-protocols and all of that stuff, it is not going to do well@@@@@@@ @ '@ '''$h >> who picks up that it was only three of the five? how do you measure whether your system is working up to speed? who is going to be testing to make sure that you were doing the job in terms of getting the most efficiency out of your information technology systems? >> i think each company owns that for their own i.t fair. areas. >> that is the problem. you cannot have all of these

proprietary systems out there. everyone thinks they have the new-age thing going. they all have different systems for trying to do this process more efficiently here, this process here. we do not have standards. we have basic mattress for clinical care. his process here, when we don't have standards. we have basic metrics for clinical care, but where are the metrics for making sure that you are going to do the best administratively. we can do all of the protocols in the world when you come into the e.r. and say, wash your hands, get this glove, get that glove and cooperate this way and which want this person to be treated so they don't get an treated so they don't get an infect know, is what are you doing to standardize so that no matter what i.t. system or health system, we know that you all are doing, you know, not your own proprietary thing, but whatever proprietary thing is doing, it

is good housekeeping seal of approval proprietary system that is squeezing out every bit of waste and duplication and redundancy that is out there. how do we know that it is really going to be working to the best effect that it is supposed to be? >> the gentleman's time has expired, but one of the witnesses may respond, if they care to. anyone? i think that mr. kennedy raised some important points and the follow-up discussion that staff has with the panel, we will explore that. thank you, mr. kennedy. we are now going to go to round two of questions. just a little bit of housekeeping here. in the last round of questions, i'd asked mr. richards for information about his town hall meetings. you know about all of our town hall meetings, and we want to know about yours, and so you have internal town hall meetings and the audiotapes as well as

copies of all the meetings and memoranda of the meetings and actions decided on the meetings and you will hear from us in a for mamal way, but we want you know that we will be looking for that information announced from chair here. >> will the chairman yield? >> the chair will yield. >> one quick question, we don't know if these others have the types of materials and i am wondering if the chairman is planning to inquire? >> we will at mr. cummings' request that we will ask so we are not singling you out mr. richards, we will ask everybody to produce the same information. you may not call them town hall meetings, but we will try to find out what it is to try to organize the troops on the issue of cost reduction. thank you, mr. chairman. >> i thank the gentleman. and now -- >> mr. kennedy? >> in response to the questions that i asked if all of them could get back to me on actual

tangible recommendations as i pointed out to what we can do to standardize incentives for them to have widespread standard of adoption of i.t. to incentivize these standards. >> mr. kennedy, this is not solely an investigative committee, and we also look for recommendations as to how the existing system can be improved. so, along as we this system, i would imagine that you, ladies and gentlemen, have some good ideas, so thank you, mr. kennedy. mrs. farrell, let's talk about aetna. neat is the third largest for profit insurer according to "fortune" magazine, but the current management returned your company to profitability by shedding members. you made bigger profits with fewer premium payers, isn't that true? >> are you referring to back in the late 1990s and early 2000s?

>> that you have made, and there is a point at which you shed some members, and the profits started to go up? >> there was a point in our history where we were as an enterprise not profitable, and one of the reasons, the big reason why we were not profitable is that we had underestimated medical costs. >> oh, i'm sure. >> that is exactly the point. so how much customers did you have to lose in order to return to profitability? >> i don't recall, it was not looked at in terms of how many members we had to lose, but looked at in terms of what is the underlying rate of medical cost and how do we price appropriately there? >> "forbes" magazine said about $8 million and we will put na in the record. does that have an estimate of how much medical expenses the company avoided by shedding those policy holders?

>> i don't believe it was looked at that way, but relative to the underlying medical costs. >> well, can you determine for us, and look at the internal memoranda at your actuarials and you should be able to figure out how much money you saved by shedding 8 million policy holders. >> i can look at that and provide that information to you. >> i would appreciate it, because almost all of those 8 million people received their health insurance through employers and they lost their aetna health insurance when aetna raised the prices of the group plan beyond what the employers could pay. isn't that true? >> i would say if they left us, it was beyond that which they thought it was a reasonable premium, yes. >> and your ceo has spoken publicly about the significant investment in sophisticated technology and he started at the start of his leadership that the i.t. investments helped aetna identify employers for repricing. so i'm wondering, could you tell

the subcommittee if aetna picks employers to shed by for example the type of occupation workers performed? >> no, that is not the way that we would do that? >> the age in the plan, the age of the workers? >> so, you are asking about the underwriting practices? >> and do you -- does your i.t. system identify people by age, and do you pick employers to shed by the age of the workers in the plan? >> our i.t. system does not identify people by age. the way it works is that an employer will provide us with a list of their employees, and along with that list would be other requirements in order to understand write each one of those. >> can it identify how long someone has been in the system? >> it would identify how long they have been a member at

aetna, yes. >> okay. do you pick employers to shed by claims' histories of the workers in the plants such as frequency of emergency room visits or clusters of disease like cancer. >> could you repeat the question? >> i'm trying to explore how employers get shed. do you look at claims histories of workers in a plan? for example, if someone visits an emergency room frequently or is there a number of people with cancers or do you make decisions based on some of those principles? are any of those programmed into the information technology? >> no. we never drop a member, because of an increase in their medical costs. >> so, do you have -- like some will be a report that will be just spit out that says, uh-huh, cluster of diseases here, cancer, high cost, out. >> no. >> that does not happen. >> it does not happen.

>> and you don't screen by location or zip codes for whether there might be -- or do you? do you screen by locations or zip code? >> one of the ways we price our business is to look at geography, because there are significant cost variations by geography across the united states today. >> are those cost variations determined by among other things epidemiological factors? >> they are determined by looking at the underlying costs by geography and there can be significant variations just towns away from one another, and that is one of the things that we look at. >> my time has expired on this round, but what i would like to do, ms. farrell, so we can better understand the relationship between your information technology and how it serves as a tool for decision-making, if you could provide this subcommittee with a narrative so that we can come to

an understanding of the relationship between the data that you gather and the way it is used as a tool for your decision-making with respect to your customers and whether they will continue to have policies. this would do shedding, recisions, and even -- and any use of information technology that would be used to shed any of those 8 million customers. and you know, since we are trying to be fair to each and every one of you, this subcommittee is going to ask each and every one of you by letter to provide that information. the information technology that you have, and how does it help, you know, does it help you to decide which customers to shed, and how does it do that? okay. my time has expired. we are going to go to mr. schock

and you have five minutes. you may proceed. >> thank you, mr. chairman, and i guess in response to some of the concerns raised i would only say that, you know, i think that most of us agree or at least i agree with the comments that were made earlier that health care premium costs are a function of reimbursement rates, and so, it is disingenuous to compare a government plan to private plan when a private plan cannot control for costs and a government plan can. in other words, in a truly static system where all reimbursement rates are set at a medicare or medicaid reimbursement level, the system then would be forced to control their costs either by reducing quality or reducing options. i think that for those of us who share the concern of the movement towards a single-payer

system, it is clearly focused on the quality of the care that the patient will receive and continuing the progress that this country and this health care system has made over those countries with a different plan in in terms of the innovation and technology here in the country. ki only speak to my experience prior to being in the congress which is the state legislature in illinois and i witnessed firsthand what happened in illinois under then rob blagojevich's health care proposal which was all kids, which did similar to what the majority wants to do here, which is basically offer health care, a government plan for all kids in the state of illinois regardless of income. i saw firsthand in my legislative office individuals who had children insured, individuals who were dually employed by an employer who

offered a private health care plan and who opted for savings of anywhere from $50 to $70 a month to take their child out of the private plan and enroll them in the all kids medicaid reimbursement level health care plan. now, it did two things. number one, i had a very poor legislative district, 40,000 voters and 20,000 of them on food stamps. the people living in poverty who otherwise had access to their care, their access dried up and went away. today, there is not a dentist in the city of peoria, illinois, that will take an all kids' patient. second, it ballooned the deficit within the state of illinois' medicaid program, all kids program, a wnld renow nine months late in the reimbursement levels and i throw this out as a case in point example and mic

microcosm in the country where we have tried competition against private insured, and second, and to that point, i don't buy the concept that the solution to greater quality, greater access and lower costs is the government. to that point though, i think we need to do a better job of providing if we understand that we are trying to control costs, and if everyone accepts the fact that health care premiums rising are making it more difficult for businesses to provide health insurance, for individuals to provide health insurance, how do we lower the health care premium cost? well, then we have to lower the request for services. >> how do we reduce the cost? if i have a plan that is provided to me as an individual or by my employer -- there has

been a lot of talk about health insurance compared to automobile insurance. the biggest difference i see an automobile insurance is that if mike targets in iraq, i'm going to go around and get two or 3 estimates. that is not because i will pay out of pocket. it is because when i turn in my automobile expenses, like insurance rates will go up. that connection does not seem to be in the mind of the patient as he or she accesses the health care system. what tools can you in the insurance industry give to consumers? how can we look at reforming the way that people buy health care? not the premium, but the actual service. i understand you couldn't do that with emergency care. i live a relatively large city of 150,000 people. a lot of places offer mris.

location charges a different rate. that information is not readily available to me as a consumer. that is part and parcel of doing a better job of controlling the costs that drive up health care premiums. what are you doing now? what could we be doing to give the tools to consumers? you doing now and what could we be doing to give those tools better to consumers? >> the gentleman's time has expired, but the witnesses can answer the question. go ahead. >> congressman, i can answer that for my company wellpointe, several years we embarked on a journey to increase the transparency so that consumers more easily compare the prices of commonly-used services within their geographic area, because you are right. there is a large disparity between an mri in one part of the city and another part of the city and a cost for commonly

knee replacements in one part of the city versus others, so we created anthem care compare which is a website to analyze the top 40 elective type procedures and a member can go into the website and type in the zip code and it will identify different providers in the area and the costs associated that would be charged by the different facilities for those areas, plus we try and tie in as much quality, public quality available information available to the members so that if you are considering having your knee replaced at a certain facility, and how often do they do that procedure and what are the success race and the readmission rate for that. we have rold have rolled it outf the markets across the country and now providing that service to many blue cross blue shield plans across the country. that is one example of how to increase the transparency.

>> congressman, you mentioned mris which is a great example because in some geographies the cost of an mri can vary by 100% or more. at cigna we have provided the cost of mris on the website so individuals can go to look it up. the vast majority of a health care providers who work with us allows us to do that and there are some who did not allows to show the transparency, but the vast majority do. it does help. the other thing i would say, and along the lines of tools, that you need to provide the incentives to individuals and i think that one of the cigna's customers is safeway and they are a marvelous example of a company that has worked with cigna both to increase the cost and quality transparency, because it is not just cost, but quality varies as well among their employees so they can get the right care, get it at the most efficient price. they also send people for appropriate behaviors whether it is not using tobacco or

exercising, because at the end of the day, for safeway, if you have a healthier employer, it is also going to be a lower cost employer. -- lower cost employee. >> i thank mr. schock for his presence here. if you is followf -up questions make sure you put them in writing and we will support them. you brought up that issue and i want to, as chair, point out that when you brought up the issue of car insurance, and compared to health insurance, i mean, that is like one of the debates right now. and just what occurs to me is that if you wrecked your car, you can get a new car. if you wreck your health, you're dead.

you know, unless you believe in reincarnation. mr. schock, thank you. the chair recognizes mr. cummings. >> you know, as i was sitting here listening to you all, i was saying to myself. boy, they sound real nice. i mean, it sounds like everything rosy and it is amazing the people who sat here yesterday. made us -- said some things that i thought were very damaging to the what you all do everyday. i am not talking about you all individually, of course. and the thing i guess that i'm just sort of wondering about and they made a big deal of this whole denial of claims.

i specifically asked them the question about whether they felt that things were worse or better since the clintons tried to get through health care reform, and they said that they were far worse. we are guard to denial of claims. and so, mrs. farrell, i am going to go to you, because for one reason, because you have said something that interested me. you had talked a little bit earlier about claims that there were no, there was no one, that only -- well, maybe it was several of you said that only doctors deny claims. is that right? so you all are telling me that there are no other non-medical people who make decisions that a person cannot get a certain

treatment paid for. is that what you are telling many e >> just to clarify. what i said is that there are no medical decisions or no medical denials that are made by somebody who is not a physician. you can deny a claim for a non-medical reason, and that decision can be made obviously by a nonclinician. >> and so i take it that those kinds of decisions made everyday by nonmedical people? >> nonmedical decisions, yes, can be made by nonmedical people. but if it is medical-related, it is made by a physician. >> and so, a claim, and a claim is for service, and i want to make sure that the definitions are right again, this is for services already rendered. a claim is for -- i see you shaking your head, mr. bloems that right? >> we are as a group struggling with the definition of denial of a claim is. to me, when i cited what the survey said on about us, a claim -- there are basically three kinds of claims.

and the first kind has been really enunciated here which is when you get a duplicate claim and rendered service, as you said and then get a claim and then another claim comes in and you have probably paid the first one. in the denial rate in the numbers of the 5.4 and the 8.7 that medicare part b has, in those claims the biggest cause is duplicate claims, and the next kind of claim is for experimental or investigational which there was no preauthorization which was discussed earlier. and the last kind is where the employer has through the policy terms decided we are not going to cover that kind of a claim, that kind of process. that kind of a procedure. now, the other thing that we are struggling when you are asking questions, i believe you are also talking about coverage determination whether people have coverage in advance of when

services are covered. >> okay. i got to ask you this. i understand that a person can have the treatment preauthorized and get a preauthorization number and get treatment and still, the payment for that same procedure may be denied. is that true? >> in a coverage determination, there is an initial decision made about whether this procedure is covered. that in our company like in the case of ms. farrell's case, that is done on a denial of coverage for medical reasons is only done by a licensed board certified medical director. >> and so, none of you all then nobody up here has anyone who denies a person treatment? in other words, that is -- in other words, how many of you all deny folks any of you do, have

people who you give bonuses to or give financial incentive for denial of treatment? nobody. >> right. i answered before, neither, none. >> none. okay. i just think that -- i think that the based upon the testimony that we got yesterday, the testimony was clear that there are many, many instances that where insurance companies are basically intentionally and maybe coverage, if you want to call it coverage or claims or whatever holding back decisions and literally waiting for certain things to happen and sadly in some instances, death, and then, and the person is denied one way or another. so, as the chairman says, here, the difference of an automobile, the person dies. that's sad, sad situation. >> the chair recognizes mr.

conyers and you may proceed for five more minutes. >> thank you for your generosity, mr. kucinich. ms. farrell, are you aware of the report from health care for america now on july 15th, that reported that profits at the ten largest publicly traded insurance companies rose 428% from 2000-2007? >> i am not aware of this specific report that you are referencing, but aetna's profits for every dollar we take in, we pay about and make about five cents in profit and pay about 84 cents in medical claims. >> what about you mr. richards? >> i am not aware of that

report. if you look at global profits, cigna makes about $1.66 per customer per month. mr. sassi, have you ever heard the statement? >> i am not aware of the report either. >> ms. reitan? >> i have not heard of it. we arewould not be in it. >> i have seen that report in the newspaper. i believe it is somewhat deceptive in the way that it is framed. there has been an enormous amount of growth among the top companies. it is simply adding up the crgross profit of companies as they grow. there's a greater amount of gross profit in those companies

than 10 years ago. that does not mean that profits have grown per member, per unit of business, customer. one does not necessarily flow from the other. >> mr. bloom, do you know about this? >> i am not familiar with the statement, but let me comment on my company. >> i do not want you to comment on your company. you are not familiar with the statement? >> i am not familiar with the study or the statement. >> how long have you been in the business? >> i have been at my company since the beginning of 2001. >> have you ever heard of health care for american now? >> no, i have not. >> let me ask you this question. are you familiar with the recent study of the american medical association that 94% of the

insurance markets in the united states are highly concentrated? you are not familiar? >> i am not familiar generally with those statistics. it is not an unfamiliar statistic in terms of some markets do not have a lot of competition while other markets have quite a bit. >> the protest this finding of the -- do you protest this finding of the ama? i do not know enough about it to protest it. >> let's go down the line. ms. farrell, i know that you have heard of this. >> i am not aware of that. >> you have never heard of it? >> mr. richards? >> no, mr. congressman. >> has anybody ever heard of it?

has anybody ever heard of the ama? >> yes. >> all right. let me ask you about this. have you ever heard the statement that has been made public and to my knowledge has never been contested that the 10 largest companies and health insurance, the ceo's and stations total $118.6 million. it is an average of $11.9 million percy of. let's say some time. has anybody ever heard that before? nobody. do you want a citation for it?

not particularly. ok. let me ask you this. not particularly. okay. all right. let me ask you this, miss farrell, what is your annual compensation per year? >> my annual compensation is something that is very private to me and something that i would be happy to submit -- >> wait a minute. you don't want to tell me? is that what you are saying? >> i consider my compensation to be very private. i would be happy to submit it to the committee in writing. >> but you don't want to say it publicly? >> no, because i consider it to be private. >> before you came, we asked the witnesses to submit information about their compensation in writing. it's a choose not to answer at this committee meeting, but they

will present it to us in writing. >> okay. >> we can still get that information. >> that's fair. does anybody here -- i've never had a hearing where six executives of health insurance were all on the same panel. this is a new experience for me. do any of you want to tell me what your annual compensation is for the record without having to submit it in write iing? >> if the witnesses care to respond, you can do that. if you don't, we certainly want you to submit it in writing. >> what do you want to tell me. >> i make $728,000 in salary. >> okay, i appreciate that. what do you want to tell me mr. bloom. >> mine is $545,000 a year. it's a matter of public record.

>> sure. i thank you for that. what do you want to tell me mr. sassi? >> i'd be happy to provide it in writing, but i consider it a privacy issue and i would be happy to submit it in writing. >> okay. >> if -- before we go to mr. kennedy, i just want it understood that you have agreed to submit this information to the committee as long as we have that agreement, that's fine. you can choose to answer the question now or in writing. it's really your choice. >> i just, to yield just to be happy, john was bringing up a point, i think folks hereofiously working as -- in a field that's perfectly legal and

set up by our society to earn what they are doing. nothing wrong with that. i think what is wrong is the gentleman is trying to point out is last year, the head of cigna earned $11 million. now, if you are going to talk about where that money is coming from, it's coming from denied claims. the head of the united health group earned $9.4 million. these are public records. you don't have to ask anybody here. they are nice -- i'm sure they love to be called senior executives. frankly, i think they hope to be senior executives with those kind of pay scales. they are not, i'm sure, at that level yet. the point is the industry is allowing for these kinds of exorbitant pay at the very top that beg the question, it's an allowable industry in your country. we need to know, kind of what is

this a matter of where the dollars are coming from when people are paying the premiums and getting rejected for health care. i'd appreciate the questions you are asking, i also understood the fact these individuals here have every right to say and do what they are doing -- >> mr. kennedy, if i may. his time is expired. however, we will now go to you mr. kennedy, if you want to yield anytime back to him. you can proceed for five minutes and we're going to go one more round after that, then be done. >> okay. i'd like to go back to the whole idea of how -- if insurance has thus far not gotten around to figuring out ways to help the

government or society change reimbursement reform. if we had known for years our system is upsidedown, all we pay for is sick care rather than health care, if there are simple ways for us to keep people from being frequent fliers in our emergency rooms, if we just did x, y and z and that would lessen the pressure on you to charge your customers exorbitant premiums, then why haven't you, in your industry, taken upon yourself to be the biggest advocates for insurance reform over the last 20 years? furthermore, what i don't get is back home, like most of my businesses for the most part are passive when it comes to their

insurance premiums. they let their insurance carriers dictate to them, here is your premium this year. it's the insurance companies that work for the company they are subscribing for. they have been hired to do their policies for. so, i just don't, for the life of me understand why if it's in the interest of their clients to reduce premium costs why insurers in this country haven't been at the forefront of the health care debate saying listen, here are the ways we can restructure the health care market based upon a capitalistic system where by it pays to have better care at reduced costs. that's what i can't figure out, mr. chairman. if it's really about making money, we know there's plenty of money to be made. why can't they build a better mouse trap to make money and

also save money? and give us the answers? you know, we're just trying to do what i think is consistent with what they are trying to do. that's lower cost and build quality. they are the experts. they are in the private sector. why aren't they giving it to us? why do i have to sit up here and ask about things that i am not that educated about because my staff person puts it in front of me and they are going to promise to put it to me on value based streamlining and engineering. it can't apply to health care. all of these kind of thing that is we are going to have to put in law to enforce insurance companys to bring their costs down. what do we have to put that into law? i'm sure they don't want to be regulated more than they are.

tell us why. we are being pressured to bring the deficit down. we have an enormous deficit that's going to swallow up our money. taxpayers are going crazy. they are getting on our tail for having a big deficit. health care is one of the biggest nuts we have going forward. help us. one way or another money is going to have to be streamlined. it's going to be done at the expense of our consumers, which we don't want or efficiently with quality in mind so people don't get their health care cut because we haven't been on the forefront of making the right decisions that help their continue in a more sufficient way. maybe you could comment on why you don't think you have ahead of the game in terms of getting better reinforcement. why does the government have to do all the incentivizing for

health. why haven't you been out there for years doing this stuff? >> congressman, i would love to respond to your question. first of all, there are things we can do personally. at cigna, we do things to improve the health of our custome customers. for instance, we have a gaps and care program. we monitor to see if they are getting the care they need. somebody who had a heart attack, we outreach the individual's doctor and the individual and say shouldn't this person be on a beta-blocker because for most people, it's appropriate. if they don't take the drug, they are likely to have another heart attack. we are actually increasing pharmaceutical claims for the better health of the individual. it's something we can do and do

do today. relative to the payment reform question, again, cigna is working with a variety of health care professionals. i referenced hitchcock in new hampshire. we are working with five other entities in the country for payment reform. we have a patient center where primary doctor coordinates the care. it's a complex system. if somebody is sick, they have a lot of different doctors. having a primary care person look at the care is very important. a lot of primary care doctors can't afford to do that because of the rates medicare pays them. it's tough to do that. the medical home is a promising pilot we are trying where we are paying extra money to allow them the time to coordinate the care. i think there are things we can do individually and in partnership with health care professionals and things it

government needs to help on as well. cigna and the industry have supported reforms for a variety of things we have mentioned at the committee today. we need government to work with us to help reform as well. we look forward to working with you. >> my point is it works. why are we piloting it? we are doing it because we are slow walking something that works. it's been demonstrated again and again. it makes so much common sense. it's like the trigger thing. we are doing what's inevitable, but it's going to take an extra four or five years before we take it to scale because there's too many financial interests we are going to have to tiptoe around to get it implemented. if you stood up and said hey, we know medical homes are about making more efficient, giving

the dock and gate keeper more time. 80% of the dollars spent >> we are slowing down because there is this inertia. everybody is trying to protect their piece of the turf. you would not have that insurance were more proactive. it is in your interest to be more proactive. at the end of the day, we are going to hit the wall. when we hit the wall, everyone well off will be fine. the people in the middle and at the bottom are the ones that will get hurt. >> the gentleman's time expired quite a while ago. i think everyone in this room and watching knows how important what you just said is. i'm wondering if there's any response. does the industry care to respond to what mr. kennedy said? in a way, he is providing a wake-up call. does anyone care to respond? mr. kennedy, we're going to have

one more round after this. then we will wrap it up. does anyone want to respond to mr. kennedy? >> chairman cozenagkucinich, wee submitted $500 million in potential savings. that is over. of time from 2010 until 2019. we will support that as part of the record. -- it was $540 billion. >> ok, that would be helpful. anyone who wants to submit similar information, we appreciate you doing that. as the go to the final round of questions here, i am sure the insurance company executives

here recognize that everything has changed with respect to health care in america. you are facing a totally new environment than when you started your careers in health care. 47 million people are uninsured. another 50 million are under insured. many people are losing everything they have because they cannot afford to pay their hospital bills. many of those people had insurance. today, we are talking about this business model. what we also have to understand -- we appreciate being here but we also have an understanding of your position and political power. let me give you an example. the insurance companies are so powerful that you were able to take hr676, medicare for all,

right off the table at the beginning of the discussion. right at the beginning of the discussion. for either party. both parties, took it off the table. 85 members of congress that signed on to it. we drafted it. 86, thank you. but, the point is, that you are able to exert your opinion. it lashes with your business model. we understand that you are very influential here. based on your influence, we are seeing the so-called public option that would provide competition. we understand you feel it wouldn't be productive. based on your influence, the public option looks like it's

going to be very difficult to get into a final bill. of course, the industry has had an influence on shaping triggers and co-ops. what mr. kennedy had to say is so important. where his comments lead to is that you should be thinking about the fact that the business model you have could end up being -- could end up killing the goose that laid your golden egg. you may be reaching an end point as to how much medical loss ratio you can go before people start to say what's going on he here. how far can your executives go making millions of dollars a year while people's claims are being denied. you say there's no connection, but the public make as connection.

look at where we are headed towards. this is where your presence here is not a small matter. we could very well be headed toward a condition where health care reform in america is really more of a continuation of insurance care where by the 30 million people would be covered by hr-3200. without a public option, 30 million people would be pushing private plans. they have to choose among private plans. if they don't do that, they could be penalized. it's extraordinary. but, with that kind of power, i would hope you start to think about a different model of

business as social responsibility. i'm not lecturing you here, i'm just sharing some thoughts. the insurance industry, because of changes in the global climate is due to take an enormous hit, coastal areas over the next 40 years, there are areas we should be working together. but, on health care, you may eventually want to think about what it's going to be like when you wind down your health care products. i think, sooner or later, whether it's this decade or another decade, you are moving toward a position where people are under insured, deductibles are going to be out of the reach of more and more americans and they are going to put it on you. you know that. so, you know, i didn't call you in front of the committee to embarrass you, it's not my intention at all.

we need information about how your business model works. we understand, you are not charitable organizations. it's not why you were formed. you're responsible to shareholders. if your ratio changes, wall street punishes you, too. is this business model sufficient to provide health care to the american people? there's a collision here. you happen to be at a time and place where the collision is happening. i'm going to ask a final question as i wrap up my time here. yesterday, we received testimony from aaron ackley of montana. aaron's father, william, his obituary is part of the record. he had a request for a bone marrow transplant. it was denied coverage on four

occasions. it caused a delay in cancer treatment. he ended up die frg the cancer. aaron told this committee he had been enrolled in medicare. had he been enrolled in medicare, he would have received his bone marrow transplant right away. government run medicare provides health to senior citizens, standardized forms, a minimum cost. a fraction of yours. i'd like to go down the line and answer this question. isn't it true that your reason for not adopting the medicare standards as your own is that you could not deny payment for expensive treatments like the one i referred to.

mr. collins? >> i can't answer that. i'm not familiar with the medicare guidelines. >> like him, i am not familiar -- >> miss farrell. >> i'm not familiar, either. >> nor myself. >> our chief medical officer used to be the chief medical officer of cms. had he been here, i'm sure he could have answered it. >> i'm glad you are here because i got a chance to ask about your town hall meetings and i'm really interest ed in that. >> i have the same problem everyone else mentioned, one of our chief medical officers could have answered that question. >> see, i mean, you know -- you may not be as familiar with the medicare standards, i'll accept that answer. but i think you understand why i asked the question.

we are trying to get to the genesis of the business model here. how do you make money? many americans believe insurance companies make money not providing health care. your first obligation is to the stockholders, shareholders, then you have an obligation down the ro road. you have to have an obligation. you pay. you have a good batting average. mr. conyers, do you have five more minutes for questions? >> i'm so nearly exhausted, i hardly have anything else to say. but to thank you for this meeting and to thank our witnesses for holding up. but, you know, it's been made public that the american medical association sort of come out for the obama approach.

you all have heard about that? have you? no? yes, no? okay. you don't know if ama is with obama or not. what about your companies? have your companies said anything one way or the other about obama's strategy of health reform? anybody? you don't know. >> congressman, cigna came out as others in the industry and supported many aspects of the president's plan. >> okay. let me put it more delicately. are there parts of the obama hr-3200 approach that you are -- that your company is for and other parts you may not be in

full accord with? is that fair enough? everybody shakes their head. there are parts you can go along with and some parts, obviously public option is not one of your favorite parts of the bill, where ever it may appear. there may be other things. but there are things you like. >> there are many things we like, yes. >> pardon? >> there are many things we like. >> well, thank you. let me ask you about the baucus bill. you got a reaction. did he make a little impression on you or somewhat favorable? how does that resinate with your company -- >> congressman, from csigma's

standpoint, we are still reviewing the details of that bill. >> yeah, but, so am i. we all got the news at the same time. it's been on television, newspapers, commentators, doctors. come on. i mean, how long do you have to -- how much study do you -- >> there's no legislative language that's been shared yet. we are studying what's been released. >> really? >> that's my understanding, yes. >> but, he's been preaching about his bill and copying headlines all over the place. you say there's been nothing specif specific. there's a bill out. it's got the chairman of the finance committee in the senate. well, i tell you what, could you -- i know you have a lot of

assignments coming here today. could you let me know when you -- when your companies have examined it sufficiently to let me know what you think of it? okay. all right. thank you very much. now, >> we had testimony in the judiciary committee from doctors that there were 1 million medical bankruptcy's ies in the united states caused by medical bills. ever hear of that? nobody has heard of that. ok. well, i cannot ask you to

comment on that. let's do it hypothetically. if you heard and learned about that, with that cast some concern on neyou about the problems that individuals are going through when the largest cause of individual bankruptcies in the intended states -- in the united states are due to medical bills that people could not afford. you would be concerned? may i send you some things? you are sending us a lot of things. may i send you more information about that subject? ok. thank you, mr. chairman, for your generosity. >> congressman kennedy, you may proceed for 5 minutes. >> thank you for holding the hearing. thank you for your patience this

afternoon. i am looking forward to getting responses to the questions i asked earlier. i would ask all of you if you would give me an affirmative in terms of working with my office in closing a loophole that appeared in last year's mental health and addiction. t act bill. we applied it to all insurers for all mental health benefits. it seems as though college students health insurance plans do not have the -- is not applicable to college students' health care plans because students are not technically employees of the university. the bill talks about this as covering employee-based health insurance plans. see the wrinkle there? as a result, the students are not considered employees.

they are not subject to the requirement for perigee. because suicide amongst kids is the third largest cause of death, i would ask all of you now, would you be willing to work with me to close that loophole in the health bill with language that insures that kids who needed the most get that coverage as mandated under the wellstone-diminish minici. to build. . parody bill. >> cigna supported the bill and would be happy to work with you to close the loophole. >> that would be great.

william gardner and my office, if you would be in touch with him. we want to make sure it's facilitated in the bill so the kids don't get disrupted in their health insurance coverage. obviously, i had a lot of other things. things. e sure you tidy that up. thank you, mr. chairman. >> thank you very much mr. kennedy and mr. conniers for remaining. this has been a hearing of the domestic policies subcommittee of the oversight and government reform committee. we have gone over three hours now and the witnesses have been much appreciated in your presence there. the title of today's hearing, between you and your doctor, the private health insurance

beaurocracy. i feel as mr. kennedy implied, we barely scratched the surface here. i hope the witnesses understand and hope you feel that this committee treated you fairly. there's no browbeating here or trick questions, no attempt to try to force you to give an answer over something that you are not ready to do at this moment. that's the way we are going to continue to proceed. we are fact finding investigative and going to try to get information from the industry so we can understand your business model better. while i try to conduct the hearings in an impartial way, away from the hearings, i'm a strong advocate with the bill i wrote with john conniers. i don't let it interfere with the conduct of the meeting. i want you to put your point on the record.

while you are treat ed fairly here, we are hopeful that you are going to treat the american people fairly. i think as we move forward, this issue of awareness, we're going to send you information. it's a time we can become more aware of the business model and why we have great concerns and why there's a national movement to move away from the model you spent your life building. so, it's a great time for this debate in the country. health care ends up being a flash point. you know this. people losing their jobs, homes, retirement security, investments and you are right at the point where it's a flash point. so, let's see if there is a way we can find to best serve the american people. it's why we are in congress and i hope it's what you will conclude as a good purpose to be in business.

i'm congressman dennis kucinich. this committee stands adjourned. >> what are your thoughts regarding other recent outburst by representative joe wilson during president obama's recent address to the joint session of congress? do recall a similar event during your political career? >> i am going to be honest with you all. it is based on racism. [applause]

there are many who feel that an african-american on not to be president and ought not received the same deal of respect. not only in the south, but in many places throughout the nation. >> we will assure you that entire event today at 6:30 p.m. and 9:30 p.m. eastern and pacific on c-span. >> president obama held a campaign-style rally on thursday to promote his health-care plan. this took place at the university of maryland at college park. it is about 40 minutes.

>> hello maryland. thank you. thank you. thank you, college park.

it is good to be back at the university of maryland. [applause] i want to begin by wishing you good luck. [applause] maybe i'll even rubbed his nose before i leave. [applause] we have a number of extraordinary elected officials who are here. i just want to introduce them real quick. your governor o'malley is in the house. [applause] the two outstanding senators from maryland, barbara mikulski and in bed in gardner are in the house -- and the been gardner are in the house. [applause]

one of the finest leaders we have in the congress, anywheres in the house. -- benny hoyer is in the house. [applause] lt. gov. anthony brown is here. [applause] mayor stephen brahmas here. [applause] congressman don edwards is here. [applause] -- congresswoman donna edwards is here. [applause] congressman chris van hull anen.

and to your president of the uterus to come up thank you very much. [applause] -- and to your president of the university, thank you very much. [applause] whom? [applause] the last time i was here, it was at the end of a very long and a very tough campaign. and in that campaign, i promise to be a president that -- you guys can sit down, by the way. [laughter] [applause] in that campaign, i promised to

be a president that i woulwouldt just clean up past crises or to just stand still. i promised to be a present that would build a better future, who would move this nation forward, who would ensure that this generation, your generation, has the same chances and the same opportunities that our parents gave us. that is what i am here to do. that is why i ran for president of the united states of america. [applause] i ran for president because of people like her. did she not do a great job with the introduction next [applause] -- with the introduction? [applause] part of that promise is a clean

energy revolution that affects our planet, up? arab security, agreed in jobs of the future right here in the united states of america part of it is giving every citizen the education they need to compete with every worker in the world, just like you're getting right here at the university of maryland. today, we are on the cusp to take another step forward toward fulfilling that promise. a few miles from here, the house of representatives will soon be voting on a plan that will finally make the student loan process simpler and more affordable for millions of americans. [applause] this plan would end the billions upon billions of dollars in unwarranted subsidies that we

had to banks and financial institutions, money that does not do anything to make your loan any cheaper. we will use it to strengthen programs and purchase loans to make part -- to make college more affordable. [applause] and we will simplify the financial aid form to make it easier for you to apply for help. [applause] these are reforms that have been talked about for years. but they're always blocked by special interests and lobbyists. because you voted for change in november, we are going to bring change in the house representatives today. [applause] and then we will take this battle for america's students

and in america's working families to the senate. and then i intend to sign the bill into law because that is the change you worked for. if that is the change you voted for. that is the change you deserve. [applause] but terps, we cannot stop there. there are still those in washington who are resistant to change. there are more willing to defend the status quo than address the concerns of the american people. [boo-hooining] >> what can i say? they are still out there. we're trying to address the issue of this generation. that issue is the issue of health care reform.

when you're young, this is not always an issue that you have a the top of your mind. you think your vulnerable. that is our thought. >> i love you. >> i love you back. [applause] >> i am sure that some of you wonder why the college requires that all students have health insurance this semester. here's why. every day, the one in three adults -- the one in three young adults that do not have health insurance are one accident or one illness away from bankruptcy. imagine what would have happened to regular she did not have health insurance. nearly half of these young people have trouble paying their medical bills. nearly 40% are in debt because of it. think about adding the did you

already have for college, on top of that another $20,000 or $30,000 or $50,000 or $60,000 just because you get sick. some of these americans do not get insurance because they feel young and healthy. but some work part time or at businesses that do not offer health insurance. it is too expensive to buy coverage on your own. even if you do have coverage, insurance companies can drop it or water it down when you're sick and need it the most. or they can decide that they will not pay the full cost of your care and make you pay the rest of it out of your pocket, even if it is thousands upon thousands of dollars. if that is why one-third of all young adults, even those with insurance, have trouble paying their medical bills. that is why one-fourth of young adults are paying off medical bills. we have heard some horror stories during the course of this debate. a young father i meant in colorado has a child who was

diagnosed with severe hemophilia when he was born he has health insurance, but because they have a cap on their coverage, the father was left frantically to find another option or face thousands of dollars in debt. another woman was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. [crowd groaning] >> what is going on? you're ok. [applause] i want everybody to understand this. you had a young woman who was

diagnosed with cancer. because she had a case of acne that the insurance companies said they had to declare, they said they would not cover her. but the time her insurance was reinstated, her breast cancer had more than doubled in size. these stories are hard braking. they are wrong. nobody in america should be treated that way. -- these stories are heartbreaking. they are wrong. nobody in america should be treated that way. [cheers and applause] >> at its core, that is what this issue is about.

health care is about more than the details of a policy. it is about what kind of country you want to be. young people, it is about what kind of country want to be. we're the only nation on earth that leaves millions of people without health insurance. we spend more than any other country on earth and we're not any healthier for it. this is about the country you want your children to grow up in. a lot of you here today and a lot of people across the country give their time and their effort to this campaign. you believe that america can still do great things. [cheers and applause] >> you believe that in this country, we do not fear the future. we shape the future. [cheers and applause]

we do not feed on division and anger. we feed on hope and possibility. that is what america is about. this is what we are called to a firm right now. [cheers and applause] it has been nearly a century since teddy roosevelt first call for health care reform. our failure to get it done year after year and decade after decade has placed a burden on families and businesses and taxpayers that we can no longer sustain. i may not be the first president to take up health care reform. but i am determined to be the last with your help. [cheers and applause]

>> we will get this done. the good news is that we're no closer to reform and we have ever after debating this issue for the better part of the year, there is no agreement in congress for about 80% of what needs to be done. four committees and five committees have completed their work. the finance committee put out its own bill yesterday. each bill has its strengths and there are a lot of similarities between them. hospitals and seniors groups and businesses -- doctors and nurses, most importantly, are supporting this. do we have medical students in the house? [cheers and applause] the people that are most

enthusiastic about health care reform are the barre medical professionals who have firsthand knowledge about how badly we need in this in the system. [applause] not pay attention to folks who sending false messages. pay attention to the nurses and doctors. i think it is fine not that we have heard constructive criticism about these issues all over the last several months. this is a big deal. this is our democracy works. nobody has all the right answers. we'll have a stake at getting this done. that is why i will embrace all good ideas wherever they come from we already have. too often, during this important

debate, we have also seen the same kind of partisan skipped spectacle. to many use this to score a short-term political points rather than working thitherto faced -- working together to take this challenge. i've heard some say kill obama- care. when you ask them what their solution is, it amounts to the same old same old, the same status quo and more uninsured and less security than we have ever had. it is more of the same. i will not except the status quo solution. not this time, not now. the time for bickering is over. the time for games have passed.

now is the season for action. now is the time to deliver health care reform for the future. [cheers and applause] but here's what you need to know about our plan appeared for those who have health it -- about our plan. for those who have health insurance, you will have better coverage. this will slow the growth of health-care costs for families, businesses, and government. if you already have health insurance, nothing in this plan will require you to change would do that. it will make the interest to have worked better for you. under this plan, -- listen up young people. under this plan, if your parents have health insurance and your

on-air policy, you'll automatically be able to keep your policy until your 26 years old. [jews and applause] -- -- [cheers and applause] one of the ideas on the table is to protect you if you get seriously ill. it will be against the law for insurance companies to deny you coverage because of pre-existing conditions. [cheers and applause] you just heard a racial story. she is ok right now. she is a lot -- you just heard rachel's story. she is ok right now. right now, she is having trouble

getting insurance. under the bill we sign, she will be able to get coverage. when i sign this bill, it will be against the law before insurance companies to drop you when you get sick, when you need it the most. they will no longer be able to place an arbitrary cap. we will place a limit on how much you can be charged for out- of-pocket expenses. in the united states, nobody should go broke because they get sick. [cheers and applause] insurance companies will be required to cover with no extra charge routine checkups. there is no reason that we should be catching treatable illnesses or diseases before they get worse. that saves money and save lives. if you do not have health insurance.

the second part of this plan will offer you quality, affordable sources. if you look -- if you lose your job or change jobs, you will be able to get coverage. if you start your own business, you will still be able to get coverage. we will do this by creating a marketplace where individuals and small businesses will be able to shop for an affordable health insurance plan that works for you. that is how i and everyone in congress gets health insurance. you should have the same thing that congress has. [cheers and applause] i have also said that one of the options in the insurance exchange should be a public insurance option. [cheers and applause]

let me be clear. it would only be an option. no one would be forced to choose it appeared no one with health insurance would be affected by it. but it will provide more choice and competition and put pressure on private insurance to make their policies affordable. think about it. some folks say that it is a government takeover of health care. we have public universities and private universities. nobody says that we are taking over private colleges. we're giving students a choice. you should have a choice the same way in your health care. [applause] the only way this plan works is if everybody fulfills their responsibility, not just government, not just insurance

companies, but employees and individuals. our plan will make sure that insurance is affordable for everybody. we will also said that everybody needs to get insurance. if there are affordable option than people do not sign up, then the rest of us pay for somebody else's expensive emergency room care. that is not fair. [applause] improving our system works if everybody takes responsibility and americans are ready to take that responsibility. [cheers and applause] a lot of you may be asking, it sounds pretty, but how are you going to pay for it to? how do we make sure it does not add to the deficit for the next generation? here's what you need to know. first, i will not sign a bill that adds one dime to our deficit, either now or in the future. [applause]

part of the reason i faced a $1 trillion plus deficit when i walked into the white house is because to many initiatives in the past decade were not paid for, from the iraq war to the tax breaks for the wealthy. i will not make the same mistakes on health care. [cheers and applause] second, we have estimated that most of it can be paid with funds in the existing health care. right now, too much of the hard earned savings that we use on health care does not make you healthier. without taking any money from the medicare trust fund that gives the benefits to your grandparents' -- they depend on it for their health care -- we're going to eliminate waste and fraud and subsidies to insurance companies that have

profits but do not do anything to make seniors healthy. some of my republican colleagues also support reforming malpractice costs. i don't think this is a silver bullet. but i want to explore the idea. i have directed my secretary of health and human services to move forward with programs that will help us put patients' safety first while allowing doctors to focus on practicing medicine instead of defending against lawsuits. [cheers and applause. i am going to seek common ground in the weeks ahead. if you come to me with a series of serious proposals, my door is always open. but i will not waste time with those who make the calculation that it is better to kill health

reform than to improve our health care system. [cheers and applause] i will not stand by while special-interest do the same old tricks to keep things exactly the way they are. i said last week at the speech of the joint sessions, if you misrepresent what is an airplane, we will call you out. [applause] we will call you out -- if you misrepresent what is in our plan, we will call you out. we will call you out. [applause] this is one they spread -- this is when they spread rumors. that is what they always do. that is why i need your help whe. when i was running for president, i never said that things would be easy.

it is hard. it is always hard. civil rights was hard. getting women the right to vote, that was hard. [applause] making sure that social security was there for our seniors, that was hard. [applause] getting medicare in place, that was hard. [applause] i know that there are doubts that creep into people's minds. i know that there's a tendency during tough times for folks to turn on each other and get mad and get angry. but our history tells us that each and every time we face a choice between the easy road and the steepest road to climb, the hard road that leads to something better, we take the higher road. [applause] that is hell americans are. we refuse to stand still. we always want to move forward. and that germany does not start at washington, d.c. it begins right here at college park.

it begins at campuses like this one. [applause] -- and that the journey does not start at washington, d.c. young people are determined to take this nation's destiny into their own hands. some of you remember during the campaign we had a slogan, "fired up." not everybody knows how this story came about. i am good to tell it again. [-- i am going to tell it again. [cheers and applause] this was early in the campaign when none of you knew how to pronoun's my name. [laughter] i had to go down to a lana -- to at lana -- to atlanta.

i was sitting next to a state rep. i told her, i need your endorsement. she said, i will give you my endorsement if you come to mind hometown, greenwood, south carolina. i had had a glass of wine. i said, fine. [laughter] come to find out that the greenwood is an hour and half from everyplace else. it is in the middle of nowhere. about a month later, i am back in greenville. i am tired and sleepy. i had been campaigning for two weeks straight. then i get a tap on my shoulder. my staff says we have to be in

the car at 6:30 a.m. tomorrow morning. i said, why? because we have to go to green would like you promised. -- greenwood like you promised. the next morning, i felt terrible. i was dragging. i felt like a college student. [laughter] [cheers and applause] i felt like i was back in college and do not want to wake up. i felt like i was staying up late doing who knows what. [laughter] i know. i remember how you all are. i feel -- i am exhausted. i go to the curtains to get some sunlight. it is pouring outside. it was miserable. i open up a newspaper and there

is a bad story about me in the new york times. i go downstairs and my umbrella busts open. by the time i get in the car, i am wet and sleepy and mad. and we started driving. and we're driving and we're driving and we are driving a and then i realize we have to drive an hour and a half back. finally the lead affected greenwood. although you do not you are in greenwood right away. [laughter] but there was a little park district building. we get inside. after the long drive, there are only about 20 people there. [laughter] and they're all kind of damp and they do not look all that excited to see me. and they do not know how to pronounce my name be there. [laughter] i am shaking hands. how you do?

nice to meet you. suddenly i hear this voice behind me. fired up! i am startled. but everybody around me thinks it is normal. and then some says, ready to go! and i see this woman and she is about 5 feet, 5 feet 2 inches. she is just like she just came from church. she had a big church had. [laughter] -- a big church happt. come to find out that this is a city councilwoman from greenwood. it turns out that she also moonlights as a private detective. [laughter] story. at any event the chigoes to, a

football game, city council meeting, -- at any event that she goes to, a football game, city council meeting, she says fire it up. ready to go. and i realize i am being upstaged by this woman. [laughter] i asked my staff, what is going on here? when it is -- when is it going to stop? and they just shrug their shoulders. they do not know but after a minute, suddenly i realized i'm feeling kind of fired up. [laughter] [applause] i'm feeling like i am ready to go. [applause] so i started joining in the chant. for the rest of the day, wherever we went, i would say to myself, are you fired up? i am fired appeared are you

ready to go? i am ready to go. -- i am fired up. are you ready to go? i am ready to go. it just goes to show you that one voice can change too. if it can change the room, it can change the city. if it can change the city, it can change the state. if they can change the state, in chains in the nation. if it can change the nation, it can change the world. we will change the world with your voice. we need the voice of the young people that transformed this nation. i need your voice. so i want to note, are you fired up? >> fired up. >> ready to go? >> fired up. >> ready to go.

let's go change the world. thank you. [cheers and applause] ♪

♪

>> in 1971, as a new york times reporter, neil sheehan received the top pentagon papers. he won the pulitzer prize for "a bright shining lie." this weekend, he will discuss his latest. q&a is tonight on c-span. >> house republicans spoke with reporters on thursday about their ideas on health care legislation speakers include tom price and mike pence. this is just over 30 minutes.

welcome. this is a discussion we welcome. we hope to find areas of agreement with the president to enact positive health reform. however, our whole effort has been hindered by the president's recurring inaccurate statements that republicans have no plans for health reform. whether the president is being disingenuous or whether he is misinformed, we do not know. but we have come here to say today that republicans have held -- have plans for health reform, that the status quo is unacceptable we have plans to put patients and doctors in

charge. we have plans that we believe the american people support and we want to work with the administration on reform. you have heard the president said that he seeks bipartisanship, that his door is open to republicans on this important issue. as republicans that seat health care reform, we can tell you that those pledges have rung hollow. we have asked to work together and we have been denied at every opportunity. but we are not deterred. today, we're here to put forth a positive vision for health care reform. no less than three dozen health- care reforms have been introduced by republicans this year. while each bill is unique, there are all based on the fundamental principle that patients and doctors should be making decisions on their health care. we think that patients should be in control of the system. while the president says that it is his way or the highway, we said that there is another way,

a better way. we hope the president will recognize that and work with us to find that common ground. i am honored to be joined by a number of colleagues who will talk about their specific pieces of legislation. we look forward to your you have a good cross-section of the very best minds in the congress of the united states. i am honored to be standing with these colleagues. the american people want health care reform. it would lower the cost of health care insurance and lower the cost of health care in the long term. what is becoming increasingly clear is that the american

people do not want government- run health insurance that will cost millions of americans to lose the health insurance that they have, cost hundreds of billions of dollars in higher taxes and lead to a government takeover of health care. the good news for the american people is that there is plenty of good alternatives to government-run insurance. to those who say that the republicans have no ideas and no proposals, i responsibly by seeinsaying go to gop.gov. you can see the various proposals. you can read the extraordinary work of the leaders in congress, let tom price, paul ryan, bob

goleta, marshall blackburn, just to name a few. mr. president, there are alternatives to a government takeover of health care. the american people are rejecting the liberal government approach. we encouraged this administration to join us in a fresh dialogue about those alternatives. >> thank you so much. the gentleman from wisconsin, mr. ryan has been working on this issue for the truly yours. >> is a for literally years -- has been working on this issue for literally years. >> they want to see congress

fixing what is wrong with health-care. we have shown, proven, and demonstrated the various bills that you can have universal access to affordable health care coverage for everyone in america without having the government take the system over, without a brand new tax increases and trillions of dollars in new spending. we already spend more than 2 1/2 times per person on health care than any other country. we spend plenty of money in america on health care. let's spend that money more efficiently and more effectively and let's do it anyway for the patient is the nucleus of the system, where the driving decision-making force is the patient and the doctor, not a bureaucrat. we do not want an insurance bureaucrats dictating these

things and we do not want government. that's doing this. -- and we do not want beer and bureaucrats doing this. at the beginning and at the end of the day, it really comes down to where the power goes. who gets the power? we are proposing anthat the powr should go to the patients with choosing their insurance and make providers, hospitals up, doctors, insurance companies compete with each other for our business, so that we, the patients, are the nucleus of this system. that is what we're asking the president to consider. i just have to tell you that the biggest fiscal crisis in

america, the fact that their debt is going up so high is because of health care spending. if we make in the government the single or primary spender of health care, the only way to solve our fiscal crisis, the only way to solve our debt problem is to have the government be in the position of having to ration care. that is not to we are as americans. that is not the road we want to go down in america. what we are proving with these bills is that it is unnecessary and that it is unavoidable. we want to put the patient back in the center. we want to work with the president to do this. unfortunately, our overtures and offerings of ideas and alternatives have been rejected time and again. that is why you have one party- rule trying to jam through a bill that puts the government in charge of our health-care system. we think that is wrong and we think there are better alternatives. >> the breadth of ideas across our conference is white. there's not a single individual

on the republican side that believes that the status quo is acceptable. >> i spent august in 40 illinois cities where this is the number- one topic. when i got home from active duty in afghanistan, charlie and i began working on a reform package. we put together the medical rights and reform act which has three main goals. first, congress shall make no law interfere with decisions that you have made with your doctor. secondly, defensive medicine reform -- you can do health care reform in the congress without lawsuit reform. also, there would be fully

digital records that belong to the patient. and the finer -- the final pillar is insurance reform. americans should be allowed to buy from any state in the union. congress should give the same tax break to individuals that it is to employers when they buy health insurance for themselves or their families. we are seeking to repeat the success is of some states and avoid the failures of others. the smoking whole of health insurance in america is the state of new jersey. there is no lawsuit reform. it costs about $500 to ensure one person in that state. the vested in the unit is california, rock and rolling lawsuit reform. they have cut their costs to half of new jersey. now i would like to introduce john shattuck, the leadiner in

health care reform in arizona. >> trust me, you do not look old. the president said, and i am glad he said, he said, point blank, if you come to meet with a serious set of proposals, i will be there to listen. that is a great offer. i unfortunately, that has not been true at this point in time. i worked in health care since i got here in 1995. i have written more health care reform proposal and any member in congress. i began writing the patient's bill of rights back then veered i wrote some of charlie norwood. i wrote some with tom coburn. i have written a bill which addresses the number-one concern that the white house is using right now to sell its proposal. the president said in his address the other night that the proof we need health care

reform, and he says it is proof that we need a government-run plan, is that, in many states, as much as 75% of the people in that state who by from the individual market only has five plants to choose from. in at least one state, 95% of the people have only five plans for get their plan from only five companies. welcome to the discussion, mr. president. i offered a bill three years ago to address this issue. it is a bill called the improving health care for all americans act. it would allow you to buy health care, a health care plan offered in one state, which was then brought to an offered for sale in all 49 other states. you just heard about new jersey. that bill came out of new jersey. people in new jersey had learned that the cost of health care in new jersey was five times as

high as the cost of health care plan in neighboring pennsylvania. they discover that they're going to the same doctors and the same hospitals and paying five times as much. people were shopping with their feet. it recently committing insurance fraud. they would go to their brother- in-law or cousin who lived across in pennsylvania. their policy for the same family of people was one-fifth as expensive. let me apply from your address. i will get the same coverage. i will go to the same doctors and hospitals and pay one-fifth as much. mr. president, the idea of increasing competition for individual insurance policies is out there. it has been out there for a least three years in the bill i wrote. unfortunately, i was not invited to the white house to discuss that. neither was anyone else invited to the white house to discuss that issue.

the ranking member on health care of the commerce committee with primary jurisdiction not invited to participate in any of the drafting of the house side. i have an interstate commerce bill that would bring down the cost of health care in the individual market. i also have a bill called the improving health care for all americans act. it has different ideas. it has ideas that i would argue are a sears set of proposals. but the president has not been interested in those ideas so far. let's talk about where there is agreement and what we could be doing. every single republican bill appear, every single one, every republican bill addresses to critical issues. we all believe that pre-existing

conditions -- they should not be allowed to deny care. every proposal embraces universal coverage. if there is no agreement -- if there is no disagreement there, then why fix it? we believe in getting people involved, like everywhere else in our economy, will solve the problem. you put the patients first annual drive the cost down and quality up. we have different avenues for doing that. i believe that if you have an employer plenty like it, you should be able to keep it. the use and also have the option of not taking it and buying your own plan. but the other side is not willing to discuss those options. it is time to have a positive

bipartisan discussion. my bill lays out exactly how we can bring down the cost of health care in america by letting people get more involved. my colleagues on the other side of the aisle say that wellness is critical. but if somebody else is paying the tab for your health care, unit you -- you're not motivated to care for your wellness. .

>> i had six town hall meetings over the course of august. i would hold the bill up and say for 1017 pages, i defy anyone to say it is to find one word on the issue of medical liability reform. every american understands that liability reform is an essential component of overhauling the american health-care system, but the bill we have been dealing with is silent. i've been working on a proposal. we have legislation that will address this serious issue. it was mentioned about pennsylvania, about how we compare to new jersey, favorably on health insurance a few years ago. we did not compare very well on medical liability issues. in my state, we have had hospitals that have stopped delivering babies.

we have had trauma operations shut down. we have been a crisis state for very long time. we have medical schools beebe medical center said only deliver babies just for that purpose of teaching residents. what we propose is legislation that will deal with issues to stop the deep pocket madness. instead of long some, you want to pay them out over time. emergency room protection. we want to make sure that those physicians providing care during the most difficult of times are protected. they are providing a federally mandated services. they should be treated as federal employees. is the right thing to do. this is about access to health care as well. we are concerned about costs, to be sure, making sure the people

are protected with pete -- pre- existing conditions. at the same time, people need access. if people cannot delivered their babies, we have failed the american people. that is what our proposal is about. that is what we are doing. these are positive changes. the american people support us. that is what i have to say. >> charlie, thank you very much. that is a great segue into what i wanted to discuss in regard to medical liability. first of all, let me say that it is a pleasure to join with my republican colleagues. the republican party of know is spelled k-n-o-w.

there are at least 35 individual bills on health care. charlie then just talked about, medical liability. you look at this poster and the pledge of the president as recently as last week to open his door and to listen to suggestions from any and all, both republicans and democrats. i heard him speak to the american medical association back in june about the need for medical liability reform. he said it once again last week in a joint session of congress when he was speaking to the nation about the need for medical liability reform. ladies and gentlemen, utah about a silver bullet in regard to healthcare reform. the rand corp. estimates that medical liability reform could save as much as $120 billion a year. i have a specific bill, 1086,

the health act of 2009, that addresses a lot of things that my good friend from pennsylvania just talked about in regard to medical liability reform. the most important of which is a cap on non economic pain and suffering awards, which was modeled after the bill passed in california back in the late 1970's. it works. it brings down the cost of liability premiums so that i like today, you do not have one in seven ob/gyn's quitting their practice. this savings will allow us to believe that $500 billion in the medicare system that we are about to take away from medicare advantage and hospice and in disproportionate share, hospitals. does not require us to raise taxes by $800 billion a year,

killing 5 million additional jobs across this country. the republican party has lots of ideas, and we look forward to sharing those with the president. we need to do this on a bipartisan basis. maybe there are some components of my bill that will have to change. i am willing to do that, but at least give us the opportunity to talk about it, because we need health care reform. we all agree with that. we need health insurance reform. we need to bring health insurance to more people and make it more affordable. we can do that, but we do not have to throw the baby out with the bath water in the process. >> because of our early votes today, we had some folks had to the airport, so there are a number of other folks who wanted to be with us today. let me close by saying, if you

think about the principles of the american people as they relate to health care, where there it is accessibility or affordability or quality or responsiveness of the system or choices that patients ought to have, any of those principles, none of them improved by the further intervention of the federal government. what you hear is a breath of ideas, a positive proposal lucian's that we put on the table -- a positive proposal of solutions that we put on the table. we can do so in a way that respects the system that the american people have come to love and appreciate and desire. we look forward to meeting with you, mr. president. we are at your beck and call, so all you have to do is give us a call, and we look forward to discussing this issue and others as we move forward. with that, we are happy to take some questions.

>> water the price tags on these bills? >> the one that has over 40 co- sponsors from the republican study committee is h.r. 3400. it gives folks insured through system of tax deductions and tax credits. it makes it so that patients and families in their positions are making medical decisions. it's also liability challenge without raising taxes by one penny, through savings in the system and liability system, making sure it is not done for bureaucrats, and by making health reform a priority in this nation by gaining savings elsewhere. you do not have to tax the american people and you do not have to slash medicare in order to pay for it.

we provide for 1% decrease in on discretionary spending over a period of 10 years. there are some estimates that the practice of defensive medicine costs about $300 billion a year, so there will be huge savings. >> [inaudible] >> our plan is paid for, and it runs about $600 billion, somewhere in that range, which is deficit neutral and does not raise taxes or/care. >> we are not having our scores given to us. we have not been able to get scores.

we know how to write these bills and replicate scoring, so we are confident we have written are bills in a way that is tax neutral. >> this is a devil's advocacy question. you mention malpractice a number of times. i feel like you guys are not willing to support any of their proposals. a few examples, the public option. [inaudible] ophiolite democrats might think you guys are not willing to come

towards them -- i feel like democrats think you are not willing to come for them. >> the notion that we would concede on anything that leads to the government takeover of health care is not acceptable to us. it is not just the government's auctio option. if the government is defining what every health insurance policy -- what kind of care is allowed by rationing, that is a government takeover of medicine. the kinds of things we do agree about, health information technology, electronic medical records, incentivizing those things, wellness and prevention programs, certainly there is a lot of room for agreement. if they are unwilling to come off of their desire to put the government between patients and doctors, then yes, we are not interested in conceding that, because we do not believe the

american people want that. >> to a certain degree, you are saying that republicans have not played it cool way. there are three issues, universal coverage, pre-existing conditions, and cost control. on universal coverage and pre- existing conditions, republicans are saying we are ready to go. we are already to embrace dealing with pre-existing conditions and saying under our structure, no american with a pre-existing condition or chronic illness goes bankrupt or fails to get help from the government to pay for that extraordinary costs. on universal coverage, three years ago you would have said no republican would support universal coverage. every single one of us. on two of the three biggest issues, we are already there. perhaps we should have held us

back and use them as bargaining chips, but those are huge concessions. the notion that we now have to give more to get tort reform, i don't think so. >> last week, mr. kantor said you guys see eye to eye on pre- existing conditions and portability. [inaudible] >> we do not believe that any american on to lose their insurance if they change jobs or lose their job. we believe it is important to provide for a system that allows the patients the ability to select the insurance that he or she desires, not that the government chooses for them. they need to be able to pool with millions of other americans across the land so they are not left out in the individual market. for each and every challenge we

have in health care, there is a positive, patient centered solution that we have put forward in various degrees and our bills. >> my bill, improving health care for all americans act, recognizes the fact that at least 60 present site of all americans currently get their health care from their employer. as you just pointed out, their employer picks the plan, and if they leave their employer, they did not have portable insurance. they have lost their coverage. my sister is a breast cancer survivor. she worked for a school district. she had gone to another school district, she might have been able to get coverage. if she left and had to buy her own coverage, she would have been left out. my bill says that if you have employer provided care and you like, you keep your care and you keep the tax exclusion. if you do not like your employer provided care, you can go out and i a policy of your selection, either in the

individual market or in an enhanced group market. you on that policy, and -- you own that policy, and it is portable. i think that is the ultimate in portability, individual ownership. >> one thing that is so important about patient ownership. a situation with a young person, and many of these uninsured are young people, they are 20- somethings, straight out of high school, their first job, have a lot of expenses and cannot afford health insurance unless it is a high deductible, low premium policy. that is probably the kind of policy i would recommend to them. that they do have insurance --

over a 15-year period that have very few claims, obviously the insurance company is making a profit off them. but they get sick and lose their job, there ought to be some guarantee to give them the same rates, and that would be possible if they own to that policy. what tom and john are talking about is so important. this is one area of insurance reform that we clearly could save a lot of money for the public. >> that we encourage you to go to gop.gov. we have offered over 30 different pieces of legislation to address this. thank you. when we have made requests both

formally and informally, we got a very polite thank you. thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> jeffrey young, what is the senate finance committee's markup expected to be like during the upcoming week? >> you could make the case that the bill will really be written in the market, which starts on tuesday. >> what kind of amendments can we anticipate? >> issues such as the government-run plan, to increase the tax incentives and tax credits for individuals and small businesses, and from the republican side, and then is to

strip down the costs of the bill, medical liability reform, immigration issues. >> who is likely to offer the amendments? >> center rockefeller has made it clear that he has a bunch of them. senator chuck grassley, the ranking member of the committee from iowa, will take the lead for the republicans. >> what has been the reaction so far from fellow democrats and republicans, and reaction from the general republic -- from the general public to max baucus's draft bill? >> republicans did not like it at all. a lot of democrats thought it did not go far enough to help the uninsured and middle-class. the business community had some complaints, but they liked it more than the other bills that have seen from democrats this year. i think it is too soon to say how the public at large will

take it, because it is pretty complicated stuff. >> there have been weeks and months of talks. what is senator baucus not appear to have any republican support? >> republican party at large has decided the structure of all these bills is generally too liberal for them. they think the public is not ready for something this big. on a smaller scale, there are some issues that senator baucus was negotiating with and could not come to terms with, the overall cost of the bill, whether abortion services will be covered, whether illegal immigrants will get enrolled, sticking points that could hold up any number of issues. >> why does he continue to say he believes he will get it in the end? >> he seems to fundamentally believe that american politics is at a point where everyone recognizes that the health care system cannot stay the way it is, and ultimately when it comes

time to cast a vote, people will not want to be on the wrong side of history. >> how is the bill likely to be paid for? >> it comes from a tax on health insurance companies that sell very expensive plans. a lot of them are concerned that tax will in a trickling down to employees, making health insurance more expensive. the bill also assesses fees to a variety of medical providers and reduces medicare spending over a 20 year time period. >> what will you be watching most closely as the bill makes its way through this legislative stage? >> a lot of the success of this legislation depends on whether democrats are willing to move towards the middle where senator baucus has rained out this bill in order to get behind it, whether democrats on the finance committee are able to come together on a consensus for a

bill that can move out. ultimately, they may never have any republicans on board, or no more than a couple. >> thank you for your time bit >> the senate finance committee holds an open executive session tuesday to begin work on their health care legislation. live coverage begins at 9:00 eastern on c-span. this week, congressman michael turner discusses defense issues, including president obama's decision to cancel plans for a defense missile shield in eastern europe. "newsmakers," today at 6:00 p.m. eastern, here on c-span. >> the discussion now on president obama and the news of the week. from today's "washington journal," this is about 55 minutes. >> there is a cartoon today that

shows president obama of the food network. he is preparing something, either an omelette or pancakes, and the caption is a couple sitting on the couch. "is there channel he isn't on?" moore is one of our guests. he is going to be on five networks this morning, what is his goal? >> pushing -- guest: pushing the health care initiative. i do think that he is suffering from overexposure. i think that people are getting a little tired of seeing him on television day after day. it is interesting, the more that he talks about an issue, the less that the public approves of it. the public wants this " to

succeed. -- wants this to succeed. host:k, -- kevin baker, obama to hit sunday talk show circuit, five appearances facing the familiar issue of overexposure. there is that word. can a president be overexpose? oguest: talk about one of the greatest non issues of our time. before the problem was that he was not out in front on this issue, now he is overexpose? as i recall, his poll numbers for health care went up after

addressing congress. i do not think that this is a problem at all. host: this is a round table. for democrats, 202-737-0002. for republicans, 202-737-0001. for independents, 202-628-0205. up in new york city, kevin baker, one of the contributing editors for "harpers." here at the table is stephen moore with "the wall street journal." the reason we wanted to peer you together is that you have had interesting writings lately on president obama and herbert hoover. mr. baker, you can see this shot of the president here in a herbert hoover-esque collar. "the best and brightest blow it

again. " what are you saying here? guest: like herbert hoover, barack obama was ahead on seeing the various crises we had to deal with, but was not able to detach himself from the conventional wisdom of the politics of the time. host: why he -- why has he not been able to detach himself? oguest: it is a very markemuch t of him. a professional attachment to the people, barack obama probably too much respects the sort of people that built the current wall street, built the current american economy, feeling that things just need some tweaking.

a more dramatic change is necessary. guest: like herbert hoover, he is advocating trade relationships changing. let's hope that he does not turn out like herbert hoover. it is clear that what was the trigger point for the great depression was the infamous tariff on over 2000 good throughout the american economy. it was the trigger for the stock market crash. you need a president that is free trade. congress is always going to protect their parochial district. southerners protecting agriculture. if you do not have a president that is pro-free trade, you will have a problem with the trading

system. one out of every three jobs in the united states is a result of export. host: the health-care debate on capitol hill, we know how strenuous and has been for the president and others along the way, in "the new york times" they are talking about 500 amendments floating around out there. what is it going to take for the president to get what he wants. what do you think that he wants at this point? guest: not sure what he wants. remember, the wall street crash was before that tariff. i am not sure that the president knows what he wants at this point. going into the debate it was about controlling costs. now he feels the public option can be discarded, apparently,

from the mixed signals he is giving us. i am not sure what is going to come from this. one of his problems is that he has been to free in letting everyone in congress have a say. the congressional leadership is so confused, it has led to chaos. host: let's take a short look at a piece on the president on the joints health care reform session -- on the joint session of congress on health care reform. >> added up, we will be spending less than we have spent on the iraq and afghanistan war is, less than the tax cuts for the wealthiest few americans that congress passed at the beginning of this administration. [applause]

most of these costs will be paid for with money already being spent, but spent badly in the existing health care system. the plan will not add to our deficit. the middle-class will have greater security, not higher taxes. if we can swallow health-care costs by one-tenth of 1% each year we will actually reduce the deficit by $4 trillion over the long term. host: here is the editorial from "the washington post." "there are flaws in the max baucus plan. " where you want to see this go? like guest: to set the record straight, kevin has it wrong on the smo