need more competition and selling of health care insurance. there are too a few choices out there for votes, and we've talked about this map that we have seen. we pass this out before to members of the committee. i think there's a big copy of it back here which shows all the market share of the two largest health plans by state. and you can see that there is very little competition in many of our states. we need more competition. that part is very obvious. .

the problem with doing something for two years around here, there are always opportunities to try to extend it. >> but then, if you are going with the two-year series, and the senator from north dakota says, "this will put all of my hospitals out of business, " he knows i have that feeling -- it is nonsense. medich year for two years is just a way to get this started, -- medicare it is for two years and is just a way to get started. you have to make a case to m&a that all of the hospital's debt shutdown in two years -- you have to make a case to me.

all of the hospitals get shut down. >> my preference would be not to have it tied to medicare. my preference would be to do more of what we try to do in the health committee, more of what i believe senator schumer is going to propose later, which is to leave the setting of rates that are provided for negotiation from the beginning of the program on, and i think that it be preferable, and then i think the public interest option is what senator conrad looked about, the co-op idea or insurance, senator nelson refer to as that. i think that also has promised. like i said, i think the most direct way to do it would be to set up a non-profit and tell them to go and negotiate rates with providers and compete. that is what we tried to do in

the health committee. i think it would make sense to do that here, and hopefully do it, but the overwhelming conclusion i have, that i reached, whatever of these options we wind up with, we will be improving the situation because we will be providing more choice, so i compliment the senator on offering his amendment, and i will stop with that. >> mr. chairman? >> senator schumer is next. >> well-heeled? >> senator bingaman, you have the floor. -- would you yields -- yield? >> yes. >> as abundantly clear, senator rockefeller is offering an amendment. i am not discussing my amendment right now. i am here discussing senator rockefeller's amendment, why i

support it, and let me just rece-- the basic idea year in should there be some kind of institutions and by the government's. if the nonprofits and of itself and spring up like grass, i think that would be a good idea. senator conrad has done a great job on this, and i support him, but that is for another day. there is very little competition in the marketplace. the chart that senator bingaman has referred to, is there. there is not much competition, and we all know the american way is to bring more competition, and my colleagues on the other side say leave it up to the private insurance industry to bring competition.

frankly, many of us do not believe it will happen. the reason so many of our markets are highly concentrated, not just insurance, but many of the large fields have very few competitors, and it is because it is in the shareholders' interests not to compete, particularly in price. we find it in industry after industry after industry, and we can all argue about how strenuous our antitrust policy should be to create more competition in the private field, but the bottom line is we know right now we do not have it, and the troubled health- care is that without competition, the prices keep coming up, and that is not -- my friend orrin hatch mentioned medicare prices are going up. they are. so is private-sector insurance, even at a greater rate, said the

increase in price is not the domain of the government or the demesne of the private sector. it is rampant in both, and i would say it relates to the structure of the market's -- markets. a, we do not have what the economists would call perfect knowledge. when your doctor tells you that you need a spectroscopy, you do not know if you need it or not, so that is fine. at the same time, you are not paying for it because we either have the government paying for it -- we are not all paying for it directly. we are paying for it indirectly. but you are not paying for tha'' because you're over 65 and are poor and that the government paying for it -- you're not paying for that spectroscopy. why do we have insurance and health care but not in so many other areas? that is because health is the

most important thing, which relates to god's greatest gift to each of us, which is life, and we all feared that the doctor but some point tell us that your husband, your wife, your brother, your sister needs this major operation, surgery, drugs, that costs $100,000, and we all feel we will not have it, so we all buy insurance in case that happens to us, hebut the combination of us not knowing what to do, we do not go to medical school, and we know when we buy a chevy versus a cadillac or when we buy a garden apartment versus a mcmansion, we know the difference, but we have no idea about health care by and large, and people said you can go on line 84 certain kinds of prescription drugs, but i do not know how to read an x-ray and go online and looking whatever i have got on there to see of this

particular operation, mri, or whatever, and you put that together, and the costs are going through the roof, and the number was imperative to us is to get those costs down, and i think every one of us would agree. i think every mineramoderate, l, conservative would agree. it is in the chairman -- chairman's modification. who is going to check costs on the doctor prescribes a this?

the insurance company. because the insurance companies was to say, hey. that is going to be too expensive, and it is not really necessary when a doctor who wants to maximize his or her income wants to go for it, and in good old adam smith economics, it would happen, because there'd be 25 insurance companies, and a couple of them would say, hey, i will veto that and have more customers by having lower rates, lower premiums, but it does not happen because of this chart, and, frankly, the bill does many good things. the chairman is right. but it does not get to the fundamental problem of concentration, those of us who support the public option support adding some real competition to the coagulated

and fundamentally anti- competitive insurance market. and i do not blame the insurance companies. their job is to protect their shareholders. that is what the president of the board is to do. that is not our job. our shareholders are our constituents, and so, we need a public option to create competition and to bring costs down. it is my belief nothing will do it better. we can put regulations on the insurance companies, but their natural inclination is to escape those regulations, because their job is to maximize their profits. the public option does not make a profit, whether it is rockefeller's idea or schumer's idea. that automatically brings it down by about 10% because that is about the average profitability. it is actually a bit higher.

and second, it does not have to go to market because if you need it, you will take it, but they do not have an imperative to maximize their profits. they just want to serve their members, their people, and so that saves another 10%, and that is 20 weren't there, and third, -- that is 20 right there, and third, when you have god forbid cancer, the natural inclination of the insurance company is going to be to say, ok. this is expensive. we had better check to see if it is covered in their policy, and they may find through some negligence or some oversight that not, and they say, hey, we do not have an obligation here. the implication of the profit would not do that. profit does a lot of things well. profit companies are more efficient. my guess is that a fourth problem is more efficient than a

not-for-profit, all things being equal -- my guess is that a for- profit is more efficient. so we have two different models, and frankly, nobody knows which one works best. there are some on the left, far left, who say it should be the government, and that is it, and, by the way, for 45 million americans, that is all it is. it is medicare by and large. some have medicare and manage, but for most, it is medicare, and then there are some on the right to say no government involvement, although again, in questions to my friend chuck grassley, there is a bit of the competition -- contradiction. you are so against the government, but half of the amendment said and for preserving medicare, -- half of the amendments here have been

preserving medicare. we hate the government plan, but we hate you because you're not preserving medicare enough. that is not fair, and it does not add up, and i think the american people will see that. but having said that, the ideal solution, at least in my opinion, is have both. have a public plan, and let it compete with the private plan. jay rockefeller does this and i do it, and we have some different interpretations, to make the playing field level. for the house, for instance, i think they tie up the medicare for good. try to make it level, and see which one prevails. the public option in both places will not get constant infusions of government money. that is where the argument is that it might go to single

payer. if it kept getting more government money every time it lost money, sure, they could set rates at the to%, but orrin hatch is right. we cannot afford that, so they get one infusion to get set up, and then with their different model, no profit, not too much marketing, but having the same basic rules that they face, they go after the market and provide the competition we have here. the cbo scores rockefeller savings at $50 billion. i would bet that that is conservative. i would bet it is more, but cbo is conservative, and we live with that in any way. -- in every way. similar ones have a little less savings but still sitting in savings, so we are giving people a choice. we are saving the government money. and we are not being ideological that says absolutely no public plan or absolutely no private plan.

it seems to me be fair and down the middle way to go. it is no wonder that 65% of all americans support, despite the massive propaganda that has been waged against this, 65% of all americans according to "the new york times" last monday, i think it is, support at public option, and it was not awarded in a slanted away -- it was not worded in a slanty way. so what is holding us back? the system is not working. we certainly want to put some rules and regulations on insurance, and we are doing in the bill, and i support them, but it may not be the ideal. it is not the ideal. it public option every day and in every way will compete and bring those costs down and serve

the public as opposed to simply the shareholders, and i would urge everyone on this side and everyone on that side to think about that. take off the ideological blinders and let's see what works for people. i am agnostic. i do not prefer the government. i do not preferred the private. -- i do not prefer the private. at the end of the day, it would sort of be like what we have with universities. when a family has a daughter or son who is a senior, they have to apply to college. no one forces them to go to one college or another, but in most states, probably every state, we have public universities and private universities. public universities are government-funded, the private universities are private funds, and each family has a choice, --

are privately funded, and i would say that they are better off because they have that choice. why do we not do the same to the area, the only area, where costs are going up even more, and that is health care? thank you, mr. chairman. >> mr. chairman, i might say that senator and some -- senator ensign is next to be addressed, and it is 2:45. i do not know if it is possible, -- and it is 12:35, and it would be progress to get a vote on the rockefeller remanent before lunch. -- rockefeller amendment before lunch. following debate, we will then

turn to the debate and vote on the schumer amendment. >> mr. chairman? >> yes? >> mr. chairman, i do not know if you announced this at the beginning of the meeting that you're going to do it, but on our side, we have some amendments that we want to offer, too, so when will we be able to offer those? >> a vote on the schumer amendment. >> did we agree ahead of time that there was going to be a schumer amendment and a rockefeller ramana? >> we did not agree ahead of time. -- rockefeller amendment. >> i certainly hope you keep to that, mr. chairman, because the two are symmetrical. >> we had some amendments. we can do two republican amendments after that if that is helpful.

i see senator kyl with a grin on his face. does that work, senator? you are recognized. >> thank you, mr. chairman. one interesting observation, we have heard a lot about how popular the public option is in all of the polls from the other side, but i think it is very interesting to note that if it were so popular, why are there so many democrats that have a problem with it? why is it causing your side so much consternation of not being able to be built through? i think it is because it is not possible -- not able to get the bill through? if you heard from your constituents the way we heard from our constituents, people are afraid of the, quote, "public option," and a print it in a quotquotes because many bee

it will lead to more government- dominated health care in the united states. i stick it is interesting that with the cbo -- i think it is interesting that what the cbo, later on, about one-quarter will go to the public option? is that about accurate? >> one-third of the 25 million that are expected to liberal. >> what percentage in the united states are not for-profit insurance plans today -- one- third of the 25 million are expected to mineral -- to enroll. a lot is offered by not-for- profit today. the profit motive senator rockefeller mentioned in his

opening statement today, i mean, that is what has been demonized all day today, the profit motive. 44% of the plans in the united states, and a lot of them are the dominant plants that have been held up in this chart today. 44% are not-for-profit -- and a lot of them are in the dominant plants. senator rockefeller said that after two years, the government is not going to be running his plan. who is going to be running a public option after two years? who is going to be running the public option after two years? >> i believe in the rockefeller amendment, there is an administrator. >> who does the administrator work for? is it the private sector, or is it the government? >> i believe is the federal government. i am not yielding yet.

the person running the plan works for the government, and yet, it is not a government-run plan. is that some of the logic i am hearing from the other side? you do not have to answer that. >> could i just ask a question of -- >> let me finish line. -- mine. it has been argued this is not a government plan. i just thought it was important. i will enter your question that you asked of senator grassley earlier. -- i will answer your question. one of the biggest problems is there is cost shifting is to the private sector. and there is no argument about that. 20% or 30 percent of the costs is what it is because the

government thinks is the prize, and we underpay what those market forces would normally dictate, and because of that, there is cost shifting, and the rest of america has their insurance rates go up, which makes it unaffordable for a lot of people, which makes a lot of people undershirts -- which raises the price for other people. either negotiating or fixing rates. there is going to be a cost shift that happens to everyone else, and that is why one group said that millions of americans will lose their insurance, because of this extra cost shift, and there will be even more cost shifting that will happen, and you'll end up with people losing their private health insurance, so you end up with more people on the government, and is a spiralling effect that could eventually destroy the private insurance market, which is why a lot of us believe we will end up with a single-payer type of system.

now, what is wrong with a single-payer type of system? first of all, i guess senator conrad was a pretty good spokesman for why the canadian system and the u.k. is not a good system, but let me go a little further on why they are not good systems. in canada, the control health- care costs. they spend about half per person what we do as far as their gdp. there gdp is about half of what we spend. we spend about 17% of the gdp, and they spend somewhere around 8%. the numbers are close. the way they do that is a cap the amount of money they are going to spend, and when you do that, you get a huge waiting times in canada. one out of three doctors in canada refer a patient to the united states, one out of three doctors. the quality of care in the united states is far superior.

as a matter of fact, the former canadian member of parliament opposed to any privatization of the canadian health care system, and after she led that debate in the parliament against a private health-care system, she was tragically struck with breast cancer, and very sad situation, obviously. where did she come to get her care? she came to the united states. she actually came to ucla to get her care begins you do not have the wait times, and, plus, you have a higher quality of care. we know the survival rates. do you have that chart yet? we will have this chart passed out. these are the five-year cancer survival rates, all malignancies, men and women, ok? c.b. red, white, and blue of the united states flag higher than the other flags?

this is comparing health care with health care, serious health care with serious health care. after five years, all malignancy's foremen in the united states, about a 66% cancer survival. in europe and in english, the survival rates are less than 50%. for women, it is about 63% in the united states, in the low 50% in england. we hear all of the time about -- senator conrad made the comparison, and i made the argument earlier. he was talking about preventable deaths. we hear that they have the same kinds or even better results, longevity and things like that. when you take into account cultural factors, the fact that we drive cars a lot more than any other country. we are much more mobile. if you take out an accidental deaths due to car accidents and

you take out a gun deaths, because we have -- we like our guns in the united states, and there are a lot more gun deaths. if you take those out and just as, we actually do better as far as survival rates. there are a lot of other cultural defense is in after taking into account, and that is why you have to compare health- care outcomes, not other factors. you need to adjust for the other factors soak the statistics can be fair. now, mr. chairman, this is an important debate because medicare, medicaid, the schip program, and this expansion, we are going more and more toward government-funded and eventually government-run health care in the united states. i do not believe that is the direction that we need to go. costs are a problem.

senator rockefeller pointed out that the cbo said this they would score $50 billion in savings. well, one of the most important parts of the bill -- we know it is not going to be in any of the bills, medical liability reform. we know no serious medical library reform will be in the bill, and that is a huge cost and united states. defensive medicine, huge lawsuit. we can bring down costs other ways than having government compete with the private sector. another point that i would make on costs is that i am going to bring up an amendment later, and it is healthy behaviors. well, if we get pretty good data out there with a significant number of employees that if you incentivize people who have healthy behaviors, you can save a lot of money in health-care costs, why would that not be a major part of the proposal? and yet, it is not in this proposal or in the chairman's

underlying market. we know there are ways to actually bring costs down without actually having the government run health care and without having the government compete with the private sector, so i think we should reject this amendment. when we get to the schumer amendment, we will have a little different argument but basically the same, and i believe this committee should reject both of those arguments. what i am very afraid of the as we go forward is even if we reject these amendments, we know where most of the house of representatives is right now, and that is they want a public option. they want the rockefeller m&a. that is why it is in the house bill, and we are afraid that no matter what the finance committee comes up with, when it goes to the floor, this bill will go to the left, and then when it goes to conference, it would shift radically to the left, and the debate will be over at that point, and it would just be, well, we have gone this

far. we have to pass this on." and then there will be no repealer of it. all you have to do is what happens to the british system. the british system was put in because of world war two, kind of an emergency think, and what happened with the emergency system? the british health-care system is the third largest employer in the world. it has millions of employees, more government bureaucrats than health care providers. that is what happens when you get government-run systems. bureaucracies grow. they add on. they protect. and then they become a constituency where they influence the political process where you can never repeal these kinds of systems. this is a slippery slope for us to go down. the public option is what most of us believe will lead to a government single-payer system in the future as we take over -- as the government takes over more and more of our health-care

system. thank you for your indulgence. >> senator? >> first, to the argument that a public plan is justified on the grounds that we have a manager government plant so it must be a good idea. a lot of experts disagree with this. let me quote, first of all, from a "the wall street journal" peace, on september 11, and they were talking about 13 different health care delivery organizations, including the mayo clinic, which said, and i am quoting, many suffering losses from treating medicare patients, and it said it these were expended -- expanded to those who do not have medicare, it would be unsustainable for even the eight -- nation's most efficient high-quality providers, eventually driving them out of the market. this is a point that senator bingaman made earlier. secondly, just to quote the president of the mayo clinic, he

said we think everybody should have insurance. when people start talking about the public plan, it was not quite -- clear what kind of public play we're talking about, and if a public plan looks like medicare, i think the country would go broke almost overnight, because medicare is already proposed to go broke between 2015 and 2017, so, mr. chairman, medicare is unsustainable under its present course, and these experts agree that a government- run option would likewise be unsustainable. i thought i heard the argument secondly that physicians actually support a public plan. in the event that there is any question about that, i would know that the american medical association does not. there was a piece earlier in "the new york times," and i would just quote here. the american medical association is letting congress know we will oppose creation of a government sponsored insurance plan.

they specifically point out one of the reasons for it, which has been alluded to here earlier. i am quoting again, the medical association said it cannot support a plan that m&a its physician participation, and i am quoting now from a doctor who was ahead of the ama until recently, a doctor, and she said they would be engaged in discussions but that they are absolutely are against mandatory physician participation in any position plan. now, the third point is that the public option, it is said, which create more competition. two factors about this. first of all, it will not. it will actually crowd out private plans, and that argument has been made. let me just cite a specific comment about that from the same new york times article that i submitted. these comments were actually submitted to the senate finance committee and then to the american -- and then, the american medical association said the following.

the ama does not believe this or not disabled individuals under age 65 is the best way to expand health-insurance coverage and lower costs. the introduction of in a public plan threatens to restrict patients' choice by driving out private insurers, which currently provide coverage for 7% of americans. in other words, rather than create more competition, there will be less competition because of the crowd of factor. and the second point i would like to make with respect to this as if, in fact, there is not enough competition in some other states, the first question should be asked, why is that so, and then, perhaps, address the reason, and there are two primary reasons. first of all, there are some states that primarily involved mandated insurance companies, which makes it very unproductive for private plans to compete in those states, and the obvious answer is for them to conform their process to some other states that do not have such

onerous mandates. the second is the small population and a lot of these states, so you have a smaller risk pool, and it simply is not possible to have a lot of ensures dividing up a small risk pool. this does not solve that problem with public option. republicans, however, have identified several proposals to meet the real reason why there is not as much competition in some states as there should be. i suggested fewer mandates. we talked about plans with higher risk pool -- this will obviously raise private premiums. this is what happens with medicare. when you use the medicare rates, someone has to be the difference between those rates and what it costs of medical providers to action to provide medical services.

there is one estimate that the hidden costs that the private plans pay to subsidize the cost of medicare and medicaid is $80.80 billion per year, and they conclude the bass meet -- this means average doctor spending is 1007 under $88 or about 10% more annually per family than it would be without this kind of cost shift, and that would simply be exacerbated if you have the public option with payments similar to medicare, so these are all very strong reasons to argue against or to suggest that we should not be supporting an amendment such as the rockefeller amendment or, frankly, any public plan that would have the deleterious effects that these experts that i quoted said that they would have. >> ok. i have to get my list of year. next. >> thank you, mr. chairman.

just so everyone knows, senators following. and i think that after we finish these, we will break for lunch, and it will be about 45-minute break, depending on how long you wish to speak. we will come back whenever that 45 minutes is done. you are recognized. >> i appreciate it. first, i want to thank senator rockefeller for his passion and this amendment, which i think is very, very important, and i do want to make a couple of comments, first responded to debate from colleagues. just to note, the chart that was held up on cancer survival rates, it is interesting that the response from great britain to this chart, which obviously they are the lowest of the three, mike richards from the u.k. department of health said many more lives could be saved if all countries where brought

up to the standards of norway, sweden, and finland, which goes to the earlier comparisons from senator conrad. i say this only that on this chart the way have done well, -- we may have done well, but there are many other countries doing better, and the good news on the chart about cancer which rose another important point, which is the foundation to this legislation, my understanding that in analyzing cancer rates, one of the reasons we do better in terms of life expectancy for men is that we have coverage for psa screening for men for prostate cancer, and that is a good thing, and the coverage in this legislation, a requirement, as it relates to prevention, and wellness and focusing on those items. i would also just say for the record, when we come out 20 seconds it infant mortality, and

we are behind honduras, in part, that is because we do not offer widely maternity care. just for the record, prenatal care, what is happening to babies in the first year of life, when of the reasons why this bill and the coverage we are talking about is so important. i think the real challenge for us, mr. chairman, is that we do not have one system that we are building on in order to make sure that small businesses and people that do not have insurance pecan be able to get insurance that they need, that they can afford, and that they can find. we basically have i think just about every system that senator conrad talked about. we have a system for our armed forces and for our veterans that is wholly government run, and the veterans administration has been the leader in electronic

medical records and in looking at health information technology and new quality measures, but that is a completely government- run system. then we have medicare, which is single-payer, a government-run system, which is different than the veterans administration. then we have employer-based care, and employers kick in, employees kicked in a piece, and most instead of a wage increase are getting health-care coverage, so we have different systems, which makes this a tough. this is a complicated issue because we are committed, the president is committed, i am committed, and we have all said that we want people to keep what they have, but what they have is involved in very different systems, said to me, when we look at how do we bring together and pool people in an exchange,

people do not have insurance, cannot find it, cannot afford it, how do we do that in a way that makes sense? to me, senator rockefeller as an actor schumer, these amendments have a grand compromise, because it says we're going to create a grid market. we're going to allow people to go into it the benefit of lower costs through negotiation in a big group and choose between private insurance companies, but they also can choose what a lot of people in america have, which is a public insurance choice, a public option. we have been told by cbo, who we all know is a conservative, that over time, about 25% of americans that do not have insurance today -- so it is not everyone. it is not decimating the entire private sector system.

if you go back and look at the debate on medicare, the very same arguments are used in the 1960's, that we could not have medicare for seniors because it would destroy the private market, it would destroy the private insurance system, and that is not what happened. the same arguments again. today. and yet, we hear from cbo that, in fact, they estimate over time, one out of four americans that do not have insurance today, they are not in medicare, they are not in the veterans administration, where one of our troops serving us in harm's way, they are not in an employers system, but these people through their inability to get a big prize as an individual going to an insurance company, that one out of four would choose a public option. i do not know what the fuss is all about. i mean, there is a lot of demagoguery about government,

which i find frankly, mr. chairman, very concerned, because we're all part of it. we have this great democracy that we all talk about and liberty and constitution, and yet, with the comes the requirement that we work together through government as well as the private sector to address the concerns of americans. and we know that the recent polling indicates about 60% of voters would like this choice. they may not take it. cbo claims their numbers, but they would like to have the choice. liberty, freedom, choice, people being able to make their own decisions. 73 percent of the doctors according to "the new england journal of medicine," 73% of medical doctors supported public option of some kind.

who would know better in terms of what is happening right now that doctors who are trying to work their way through the system? so in my judgment, when we look at the fact that people would like the option, physicians would like to see this happen, the factor b&o it saves $50 billion to taxpayers, we know from the independent commonwealth fund that over 10 years, through the whole system, they would estimate reforms that included public option would reduce spending nearly $3 trillion. over 10 years. those are big, big numbers. in my judgment, this is reasonable, rational when you get by all of the hyperbole. this is part of how we make sure the reforms in the bill work. we have tough insurance reforms in this bill.

we have important reforms to about somebody if they lose their job to know that they and their families will lose their insurance. we have ways to bring down costs over time that are incredibly important in this bill, but from my judgment, the way to make sure it is really affordable, it is really affordable for americans, is to make sure there is real competition and real choice. it has been done before. it should be done again, and, mr. chairman, to me, this feels the deal in terms of having a package it guarantees the american people that the new system will be able to deliver and what it is we all hope it will do. thank you, mr. chairman. >> thank you, senator. we want our recess for about 45 minutes. the list i of senators whishing to have recognition, these people, and i will recognize

whoever is here, when we resume at 1:45. we will be in recess until 1:45. 1:45. the meeting will come to order. before we recessed, various senators were speaking on the rockefeller amendment. the senators and include the is, senator bunning, senator kerrey, senator nelson, -- the senators included these. isc senator bunning is here. thank you, senator, for being here, and you are recognized.

>> there are a lot of charts being used quite frequently today, and i would like to call this chart before us market share of the two largest health plans by state, and i would like to bring it forward once again and explain the reason why. it states could at shoal -- sold insurance across state lines, they would all be like oklahoma. they would have many more insurance companies bidding for their business. so we would have much more competition i can tell you -- more competition. i can tell you in 1992, restrictive laws were passed in kentucky.

we had 48 competitive insurance companies in kentucky at that time. after the law passed in 1992, we had 1.5 insurance companies bidding on health care in kentucky. one was bluecross blueshield, and from bluecross blueshield, which at that time was non- profit, and just to have competition, we had a health care sponsored by the state, so we had one and what i call 1/2, health-care bidders. that is why i differ completely with senator rockefeller's position that the public option would create more health-care options.

if we would allow insurance companies to sell health care across state lines, we would have many, many more health-care companies bidding for business, not only in kentucky but all of the other 49 states, and we do not need a public option to do that. one of the other things that has been brought up quite frequently today is that 73% of the doctors are for this plan, and it was quoted in the journal of the american medical association. i hope everybody realizes that only 20% of the doctors in the united states of america belong to the american medical association. 20%. that means 80% do not belong. so if you get 73% of 20%, that

is the amount of doctors you might be talking about. that amounts to about 14% of all doctors in the united states. so i do not think it is a fair quote to say that 73% of all doctors in the united states are for a public option plan. and medicare has been mentioned quite frequently, that that is a given public option. absolutely. we all agree it is. we all agree it has been here since 1965. we all agree that it also over spends to the tune of having $37 trillion in underfunded liability.

$37 trillion. does anybody have any idea how much money that is proved -- that is proof $37 trillion? -- that is proof -- that is? since our national debt is approximately $12 trillion, but in 2017 or 2018, depending on who is counting the numbers, medicare will go, medicare part a, will go bankrupt, so unless we do something in this medical fix to take care of the bankruptcy, and there are arguments on both sides about what kind of fix we have on medicare, and i am not going to get into that discussion other than to say yes, medicare is

something we created in 1965. it services those over 65, or is supposed to, with health-care benefits, but there are a lot of people who do not trust medicare and will keep private insurance because they think private insurance is more reliable than medicare and pays the doctors and hospitals what they are supposed to get paid for the services they render. so i think it is very, very important for the people who are listening to understand that some of us feel that if we're going to pass this option for medicare improvement that the people in congress and their

staff and the people in the administration and their staff and the people in the judiciary and their staff should be governed by the same law. in other words, there should be an option that we are all covered under this same medical care that we are proposing for the american people and that there should not be all of these things that allow us a way out. if i heard one thing during august, why, senator, are you not including yourself in what is being proposed?

and i said, it is not my bill, but i will try to make that change when we go back and debate this bill, and as far as the public option is concerned, we on our side of the dialogue really feels strongly -- on our side of the aisle feel strongly about this. maybe in 2014 or 2013, depending on when it gets there. with 40 grandkids, i do not want them covered under the public option, and i do not ask them because some of them are not capable of even telling me what they want because they are very young and very uninformed, as i have heard it said that most of

the people who are in medich wrote shawn m&a game or medicare do not know what they're buying -- people who are medicare shoppers or medicaid shoppers, they do not know what they are buying. we are going to restrict what is available, just like canada does, just like england does, and i heard profits mentioned so many times today, that the profits of the health-care community and the insurers are just out of sight. well, as of the last quarter, and this is a chart that i would just show. i do not have those big chart. i have just little ones.

it shows that health-care plans make a profit of 3.3% in the last quarter. if we get to the beer companies down the road, they have a profit of 18%, and cigarette companies, 15.7%, wireless communication companies, a 11.5%, restaurants, 7.7%, waste management, soft drink companies, and the least of that group is health-care plans, which have a 3.3% profit margin, so if we want to make sure that we keep profits low for the health-care companies, we need to change a lot of things, including medicare and medicaid and make some changes that will make them more efficient and

more usable for those and make sure that our doctors are accepting those patients. what good is medicare and medicaid if doctors refuse to cover them? if all of a sudden, by luring the reimbursement rate to at 80% or 85% -- by lowering the reimbursement rate, it is below what they can get. obviously, they are making up the difference on private insurers, but that will not last that long. it is not going to last if we do not change what we are doing, so we on our side would like to see some significant changes in medicare and medicaid to make sure that we do get the

reimbursement that the doctors and hospitals deserve. that is why i am not for the current public option that has been put before us, and i thank the chairman. >> thank you, senator. senator? >> thank you, mr. chairman. i apologize for not being here right at the reconvening of the committee, and i do want to speak in support of senator rockefeller's amendment, but i want to ask a question first, which is we have had a lot of discussion about medicare and medicare rates as that it pertains to the way it is drafted, and it is my understanding that you would pay medicare rates based on current law, and in the underlying bill, a sitting senator rockefeller's amendment was adopted and the bill currently in modification would be adopted, but medicare rates would be very different than they are today, and senator

conrad's concern that people in his state would not be getting an adequate reimbursement would be changed under that formula. is that correct? >> that is correct under the senator amendment -- senator's amendment. the reimbursement rates are dramatically changed. >> and so, if you were from an efficient state that had an efficient, low-cost system with a good outcome, u.n. action be making more than you currently are today? so if you are from a state like senator conrad's, the chances are you would be making more money, and it would not be as exasperated of a problem as it is today? -- you would actually be making more than you currently are today? >> correct. >> not just in medicare