tax extensions and told california hospital association today uc fees could go up as high as $25,000 a year if forced to cut another $15 billion in spending. >> this is not free f you want to have the fire department there, this costs money. investing in a great university costs money. that is where we are. >> brown says he'll resort to painful cuts if the legislature pro fuse -- refuses to put his proposals on the ballot. >> more jobs left california for texas. and there is a delegation headed to the lone star state to figure out how it's luring company as way from california. >> costa mesa based tickets.com announced it's shutting down it's call center. a texas firm's software will handle jobs 125 californians

>> i can respond briefly and say that california hospital association does not condone any fraudulentactivity among hospitals in california. we will let the facts speak to the case. we do not represent sutter. we do not represent them legally and we are not taking a position and legally. we do not know the facts. the facts will come out in the judicial system. supervisor campos: i agree with that. we have to allow the court proceedings take place, but we, as policy-makers, are being asked to make important decisions. one of the things that the complaint points out is a certain type of agreement, or agreements, between sutter and the insurance companies -- this is what the complaint says. "contains provisions which prevent health-care insurers, referred to as payers in the agreement, from challenging the reasonableness of the sutter hospital bill." this is accomplished through audit policies. these policies provide that question an opinion regarding medical necessity, reasonable of charges and the propriety of providers's usual and customary practices are beyond the scope of an audit a

luke's hospital, and the senior vice president for health policy of the california hospital association, and dr. glenn melnick. maybe if you could come up to the table, and then, the need to speak, you can come up, but thank you very much. >> thank you. good morning. i am the senior adviser at the pacific business group on health, and i'm here to talk about the effects of market consolidation on hospital costs and quality in the city and region and around us. first, a quick word about who we are. we are located in san francisco. we have been around for 20-plus years. we are a coalition of large employers that is trying to improve the quality of health care and women help care cost increases. we are in the same quandary that you are, and i certainly do not then be your task. our members spend $12 billion a year providing health coverage for about 3 million individuals. they are purchasers of health care just like you are. mr. chairman, use of me on this slide, but here it is in pictorial form. we have all paid close attention to the article that came out in open " l.a. times" last month,

california hospital association represents all the hospitals in california, a broad range of hospitals, general acute-care facilities, stand-alone rehab sites, investor-owned, not-for- profit, public hospitals, safety net hospitals, urban, metro, the full gamut. so we are pleased to talk about some of the drivers impacting the issues you are talking about today. what i want to do in this first chart is -- picture these two bars as being dollar bills. if we look at 1980 how the dollar was separated, hospitals accounted for 43% of that dollar bill. we can look at the other sectors of health care that have taken their portion. when we move to 2009, you can see the shrinkage in what hospitals have consumed as part of the dollar. you can see other areas where it has grown, specifically, other, including administrative costs, prescription drugs, and other things. an important dynameter know, and i think will be concluded -- included in my later slides, this shows the trend over the last 10 years of the increase in spending for hospitals, but comparatively to other factors within the industry

governor brown has begun to layout the consequences of not approving tax extensions and told california hospital associationcould go up as high as $25,000 a year if forced to cut another $15 billion in spending. >> this is not free f you want to have the fire department there, this costs money. investing in a great university costs money. that is where we are. >> brown says he'll resort to painful cuts if the legislature pro fuse -- refuses to put his proposals on the ballot. >> more jobs left california for texas. and there is a delegation headed to the lone star state to figure out how it's luring company as way from california. >> costa mesa based tickets.com announced it's shutting down it's call center. a texas firm's software will handle jobs 125 californians did. >> i will go to timbakt fu. it will put people back to work. >> there is a bipartisan group to texas to find out why the lone star state is adding more jobs than california adding that texas added jobs from 2008 to 1010 -- 2010. >> if we don't get into the game and realize golden goose is being slain in california we're going to have to pay

the system -- the speaker from the hospital association point of the california has the lowest costs in the country. that is because we are the highest managed care population in the country. kaiser in northern california, when you look at those counties in terms of how much was spent -- kaiser insures about one of every three people. that is what helps drive our costs down. i'm going to focus on the two types of hmo's we have because they reflect the different incentives for hospitals generate revenue. the health service system actually pays the claims and premiums for the city plan. when you go to the doctor, we pay the doctor bill. again, only 10% of our membership is there. the rest is divided pretty equally between kaiser and blue shield. those are two different kinds of hmo's. one is a staff model and the other is a non-staff model. in kaiser, there are no fee-for- service costs unless someone is getting care out of the network. there is no incentive to do more to generate more revenue for the hospital. what you see is what you get. in a non-staff model hmo and in our case, blu

hospital. that is no longer the aspect of my work. i do continue work through the brain injury association of california which i brought with me certificates which i can hand to you to share with the supervisors. and have also been featured in several publications and tv news representing my personal experiences, having been 10 years ago a survivor of a pedestrian collision in san francisco of which i effectively described to you when i came before you in summer 2006 in the rules committee then. you see an effective need in our city -- i see an effective need in our city, the need for seniors and the cost of medical services through me --dcal. the cost for prevention is much smaller. for those in physical and mental needs, be it seniors and people with disabilities, the effective areas that i know of and i agree of district six, district one and the marina boulevard and the development of dorrel drive and the compounding affect of the extension of the f line through your district will increase pedestrian -- [inaudible] and the stoplights, the pedestrian signals in that area need improvement. i also have witnessed not in person but have see