. $30,000 per person except for federal medicare. el patch thome was $75 million. quite remarkable. if we don't address that type of issue, because of defensive medicine and so forth, we should talk about that. >> if you read that article which was very impressive, you find a culture of excess with respect to the provision of care. if the way this is going to go, once in a generation time when the congress gets it right and the congress gets it white -- right with respect to the aspects that have been discussed, and the time is created for those implementation activities to take place. that becomes the critical time for us to the mental health advocates, not so much now, knock on wood. perry is going to be included. we still have to keep the pressure on with respect to reforms, then that creates a playing field for change. it seems to me the issue of wellness and prevention becomes the sweet spot for the mental health community. these reforms are probably not going to go to critical changes in the high end safety net for the mental health delivery system that states -- they is opera

medicare. if the federal government did not move for medicare our seniors would not have had affordable health care coverage. our disabled population would not have had affordable health care coverage. i don't know of a single member of this body who is suggesting we repeal medicare. and that's a public insurance option. a public insurance option does not have the government interfere with your selection of doctors. the doctors are private. the hospitals are private. we are talking about how we collect and pay for the bills. and medicare has worked very well. as tri care for our military community. we want to build on that experience. the main reason that we want a public insurance option is to keep down costs. that's our main reason. we know that medicare advantage -- this is a private insurance option within medicare. well, i'm for a private insurance option in medicare but what i oppose is giving, costing the taxpayers more money because of that. and we know that medicare advantage costs between 12% to 17% more for every senior that enrolls in the private insurance option. the congressional

. $745 million to settle civil charges that it systematically defrauded medicare/medicaid and other federally-funded health care programs. later that year, hca agreed to pay criminal charges and fines of $90 million. and finally in 2003, hca agreed to pay $631 million more in civil fines and a total of $7.1 billion. tenant health care corporation, 2003, they paid $54 million in fines to settle allegations of two doctors working in reading, california to, perform unnecessary cardiac procedures on patients in the interest of profits. imagine that. cardiac surgery in order to make money when that surgery was not necessary. 2006, tenant agreed to pay $725 million in cash in order to resolve claims that defrauded the federal government overbilling medicare claims over a six-year period. and on and on and on it goes. so, when we hear, and mr. chairman, i would ask unanimous consent to enter this information into the record. >> without objection. so ordered. >> now, mr. president, i got a little bit tired of hearing how the government can't do anything. government can't do anything. well, you know what, wh

if we fail to act, federal spending on medicare and medicaid will grow by an amount almost equal to the amount our government currently spends on our nation's defense. it will eventually grow larger than what ever government spends on anything else today. it is a scenario that will swamp our federal and state budgets and impose a vicious choice of either on presidents tax hikes or overwhelming deficits or drastic cuts in our federal and state budgets. to say it as plainly as i can, health care is the single most important thing we can do for america's long-term fiscal health. that is a fact. [applause] the truth is, most people know it is a fact. as clear as it is that our system badly needs reform, reform is not inevitable. there is a sense out there among some and perhaps some members who are gathered here today that as bad as our current system may be, and it is pretty bad, the devil we know is better than the devil we do not. there is a fear of change. a worried that we may lose, what works about our health care system while trying to fix what does not. i am here to tell you that i

medicare, medicaid and other federally funded health care programs. later that year they agreed to pay criminal fines of around $95 million. finally, and 2003, hca agreed to pay $631 million more in civil fines, total of 1.7 million. tenant healthcare corporation, 203 -- in 2003 paid allegations for to doctors that performed on necessary cardiac procedures on patients in the interest of profits. imagine that. cardiac surgery in order to make money when the surgery was not necessary. 2006, ten and agreed to pay 725 million in cash in order to resolve claims that defrauded the federal government over billing medicare claims during a six year period. and on and on and on it goes. so when we hear -- and mr. chairman, i would ask an analyst consent to enter this information into the record -- >> without objected, so ordered. >> i got a little tired hearing about how the government can't do anything. government can't do anything. well you know what? what you're seeing many years is a systemic record on the part of private insurance companies, private drug c

and also, after the medicare program, these tax rules which are upwards of $250 billion a year, mr. president, they amount to the biggest federal health care program. in other words, medicare, number one, federal health tax rules number two. now prominent democrats and prominent republicans just in the last few weeks have said that these rules don't make sense. for example, for colleagues on our side of the aisle looking at some of the progressives who have called for reform just in the last couple of weeks, robert reich, the former secretary of labor, certainly one of the leading progressive thinkers in our country, has talked about the regressivity of thaous rules, how they disproportionately favor the most affluent. bob green stein, head of the center for budget priorities is of the same view. both of those reflect the comments of individuals who are progressive. suffice it to say, a number of conservatives have spoken out against these rules as well. milton freedman, going back to a hraepblgdary conservative, began to speak out -- back to a legendary conservative, began to speak out against these rules some time ago. we oug

provides health care in a variety of ways to low-income americans who are not eligible for medicare. the federal government pays 60% of the cost, the states pay the rest. 58 million americans are trapped in medicaid. it's the only place of any significant size where we don't have competition in our health care system. think of the elephant in the room. it was my experience as governor -- i believe it is for most governors -- that it is not only an administrative mess with substandard care -- the medicaid program -- but its costs have spiraled out of control, threatening the viability of public universities and community colleges because there's no money left for the states to support them. here's what would happen in tennessee to the ken -- if the kennedy bill passed according to state of tennessee's medicaid director. our state costs would go up $572 million if we increased coverage to 150% of federal poverty. if the fed pays for this, the fed's costs would be $106 billion. i mean the federal budget paying for it. because the federal budget pays two-thirds, the state one-third. if the state has

safeguards when it comes to the use of research in federal healthcare programs. medicare and medicaid should not be allowed to create automatic links to any single study. these programs need to be open, transparent, and thorough in how they use patient centered research. nothing should be done behind closed doors without public input. we should not build walls around the research. we should not bar any federal program from using it in responsible and transparentive way. many patient groups see the value, indeed, the need for this type of research. let's take prostate cancer. men with prostate cancer have a choice among three common treatments. surgery, radiation and chemotherapy. each approach yields different outcomes in terms of survival and quality of life. some areas of the country tend to use one approach. some use other approaches. and some of these are more costly and less effective than the others. comparative effectiveness research would compare the clinical outcomes of each approach in a systemic way. that way doctors and patients would have more information by

medicare. you can pay for it out of your own pocket, you can come up with other options. but we spend 16 percent of the federal budget to give people a choice, making a huge people -- different lots of americans. there is no gun in your head. caller: medicare has to be my primary and by private insurer has to be my secondary and now medicare is gatekeeper for united healthcare and instead of getting the test that i need before preventative maintenance, i have to wait a year for a prostate exam, concerns about pet scans and cats can't ping allowable and my wife had lung cancer -- guest: i would strongly recommend. you have great people in new jersey. i strongly recommend you talk to your member of congress about being forced to wait a year for a prostate exam. let me go back to my comments, objective data by independent sources that evaluates the costs of health care and looks at the outcomes in terms of how long people live. the rates of various diseases, how procedures people -- people " look and compare community to community. the objective evidence is that the overall costs and oregon are no war and the out

but the federal government did create medicare. medicare which now serves 40 million americans, disabled, and old, and does a very, very good of job of doing that. i look forward to the date we are going to continue to have. the speaker pro tempore: the gentleman's time has expired. the chair recognizes the gentleman from california, mr. mcclintock, for five minutes. mr. mcclintock: thank you. madam speaker, if the gentleman from kentucky wants to know why republicans oppose the government takeover of our health care system, i would invite him to consult the many, many refugees from canada and britain who have come here to america to get their health care because they simply can't survive with bureaucrats telling them what treatments they'll get and what they'll get them. the republicans are proposing to bring within the reach of every american family a basic health plan that they will own, that they can change if it fails to suit them, and that they will hold wherever they work and under whatever circumstances they work. madam spe

treatment decisions by prohibiting the federal government from using the results of comparative effectiveness research, i.e., cer, to deny coverage under medicare or any other federal health program. in addition, it requires that cer conducted account for differences in the treatment responses and preferences of individual patients. these prohibitions are required because current law does not prohibit the government from using the $1.1 billion awarded to cer in the stimulus package for cost containment and to achieve cost savings. along with other goals. neither do the cer provisions in the bill before us today. now we have all heard the horror stories of the united kingdom's national institute for health and clinical excellence. the acronym for that is n.i.c.e., and it's not very nice. delaying or denying access to cancer drugs and requiring seniors to go blind in one eye before approving treatment to access for macular degeneration, this is a real thing, it actually happens. we need this, it seems to me, to safeguard, to guarantee that this scenario will not happen in american medicine. i want to make it very clear this amendment does not pro

medicare, not' penny -- not a penny set against it, is bearing down on us. as the president told the a.m.a. earlier this week, if we fail to act, federal spending on medicaid and medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. in fact, it will event ually grow larger than -- eventually grow larger than what our government spends on anything else today. it's a scenario that will swamp our federal and state budgets and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets. mr. president, question only avoid that vicious choice by reforming the health care system. we are committed to making sure that every american has health insurance coverage, but meaningful reform will take more than that think of it this way. if you had a boat out in the ocean and people overboard around it in danger of drowning, surely you would try to bring them all into the boat. but if the boat itself was sinking, if the boat itself was on fire, surely you would know that had you to do more than ju

medicare and medicaid will rise sharply over time. we will go to the next figure. this picture -- the dash line shows the projected path of combined federal and state spending on medicare and medicaid. our projections show these expenditures, which are currently about 6% of gdp, will rise to 15% of gdp by 2014. in the absence of tremendous increases in taxes or reductions and other types of government spending, this trend applies a devastating and frankly unsustainable rise in the federal budget deficit. another trend that is to crucial to be ignored is the rise in the number of americans without health insurers. currently, 46 million people in the united states are uninsured. in the absence of reform, the next picture, this number will rise to 72 million. this is an 24. this is an increase of 26 million people over the next 30 years. the president has emphasized that providing quality insurance for all americans is a key reform. for all those who have insurance, the president has promised that if you like your doctor you can keep it. the president and congress are also proposing methods to make the existing system work better for all fam

making treatment decisions by prohibiting the federal government from using the results of comparative effectiveness research, cer, to deny coverage under medicare or any other federal health program. it requires that cer be accountable for the treatment responses and preferences of individual patients. these provisions are required because current law does not prohibit the government from using the $1.1 billion awarded in the stimulus package for cost containment and to achieve cost savings but th. neither do the bills before us today. we've all heard the stories of the united kingdom national institute for health and clinical excellence, the acronym for that is nice. still lying access and requiring seniors to go blind in one ad says before approving treatment -- this is a real thing. it actually happens. we need a safeguard to guarantee that this scenario will not happen in american medicine. i want to make it very clear that this amendment does not prohibit cer. i would never do that. i would never stand against medical advancement. we need cer. it is not interfere with the fda. i would never prevent the fda from fulfilling its mission of in

which will consist of the -- the president has laid out $600 billion in savings in federal health care spending, medicare and medicaid, improving efficiency, improving quality in those programs as well as some additional revenues that will be designed to provide an opportunity for health care for all americans that will begin to emphasize quality of care, your relationship with your doctor as opposed to simply quantity of services that are sometimes mindlessly done without any regard with what's really best for the whole patient. this is a small initial investment to improve the health care for all americans, make more affordable options available for all americans, make it possible for americans who can't get health care at all now to get health care for themselves and families. when you see ceos scoring because at $1 trillion or above, do those numbers correlated with your thinking and seeing in the administration? guest: there will be preliminary pieces of legislation that are emerging from various congressional committees that are working very hard to write legislation that will bring down costs and

in the washington stree"thewall streett the unfundefund obligations of e federal government today -- these are things like medicare, social security, veterans benefits, pension guarantees that we have -- rivals or gets close to $100 trillion of unfunded obligations existing on the part of the federal government today. that number seems high to me, but i know if you look at medicare and a couple of other ones we're looking ago nearly $60 trillion in that category. and to give some perspective, the total economy is $14 trillion or thereabouts. this is irresponsible to the highest degree, and it is irresponsible to future generations, and it's time we put a mechanism in place for us to deal with it. i urge my colleagues to join us in cosponsoring this bill. i'm submitting it now to the desk with 20 cosponsors. this is an idea whose time has come. i want to thank my colleagues, and i'd yield the floor. a senator: mr. president? the presiding officer: the senator from maryland. mr. cardin: mr. president, i ask unanimous consent to be able to speak as if in morning business. the presiding officer: without objection. m

for the new public plan, the uniform federal rules that currently apply to medicare would prevail. this does not create a. the public plan, many assume the employer system is opposing the carry plan. that is not the case. there are proper and the proposals on reforming the health-care system. there are important roles for the government to play. public plans are resentful to help the lowest income individuals where the employer base plan may not be the best plan. the government can facilitate and regulate the system where people can select from a variety of different competing private plans such as the role of the government to operate these exchanges. people can select among different private plans. the concern about the public plan option emerges from decades of concerns about massive cost shifts. the government says the reimbursement rates, other purchasers pay more. there is no cost saving and chief. it is moved from one player to another. my time is up. i was going to get to the part of the bill that i like. it will not take very long. the public plan -- if they will operate b

medicare. there isn't any federal government program that truly comes in on budget on time anymore. it's because of the way we purchase. the cheap is -- the forces that allocate the resources in health care. we've got more money than we need in health care right now what we need to do is have the forces competitive. ask yourself why we have $5 billion a year just in fraud on durable medical equipment through medicare. why? because the system. because it's a government -- it's designed to be defrauded. we spend all of this money trying to chase those dollars. if there were real transparency in the market, people wouldn't buy x wheelchair for this when they could buy x wheel chair for this. we have one case from florida, your state, that was sold so many times they collected $5 million on one wheelchair and never delivered the wheelchair. this came out of dade county, florida. so the point is, who is best designed to decide what you want, where you want it, and who you want to get it? you are. and if there's an economic incentive associated with that, with you and that you never allow

because you don't get the benefit of the bulk purchasing that federal government does through medicaid or medicare or insurance companies do through similar programs. so she finally one night decides the pain is just so unbelievable she can't stand it anymore. so she goes to the emergency room. she gets to the emergency room too late to save her foot. she has a foot infection that has gotten so bad she has to have it amputated. that for her is a life changing event. her life is never going to be the same. she's never going to be the same person, same mother. she'll have to deal with the disability for the rest of her life just because she didn't have the money or the coverage to get some simple antibiotics that would have treated that foot infection. that doesn't make sense in the richest country in the world, but think about it from the cost perspective. i don't know how much that surgery cost, but it's in the thousands of dollars i'm sure. she didn't have the money to pay for it. maybe she got billed for it. but probably more than likely it got just sort of sucked into the unreimbursable costs b

states and those areas where our elderly population resigns medicare by farm the most costly and largest and most rapidly growing the federal health-care programs is failing our seniors and disabled population every day when it comes to the primary-care so we know we've got a reform for medicare and ultimately bring down the costs of the medicare programs and that is said to be at the heart of what we do with this legislation. i think our success and failure is going to depend on reining in it the royal spending within the medicare program. in alaska we're in a situation now where our doctors are turning away on a daily basis medicare patients. there are being forced to pay out a pocket for their medical whether other choices for those all together and this is not a situation that is acceptable. we made that promise to them, we told them that you pay into the system and you will receive benefits and yet that care is not there. in a bridge which is the state's largest city and of every 75 in general practice doctors only 13 are accepting medicare peer know these are statistics that just simply don't work and what happens is

accessibility already in many of the programs the federal government has a hand in accessibility is decreasing including medicare. affordability, all of the programs have overrun their cost estimates by sometimes 100 times. so there's no way the federal government can keep a hand on the cost of anything. quality i would suggest respectfully that the quality of health care has provided a federal government gets involved it's worse, not better. responsiveness and innovation, federal government, you make the decision i am not sure the federal government has anything to do with responsiveness and innovation in anything it does. and choice is clearly the federal government need to make choices. so there are positive solutions we have put on the table and will put on the table and they involve making certain patients and families along with doctors are able to make health care decisions making certain individuals have an opportunity to be able to afford and purchase the coverage of their choice, not the government's choice but there ridgway's and that they own and control their health coverage and health policy so tha

accessibility, already in any of the programs that the federal government has a and in, access sblet decreasing, including in medicare. affordability, sometimes 100 times increasing. quality, i would suggest respectfully that the quality of health care that is provided when the federal government gets involved gets worse, not better. responsiveness and innovation. federal government, you make the decision. i'm not sure that the federal government has anything to do with it in anything that it does. haven't seen it. choices clearly the federal government -- so there are positive solutions that we have put on the table land put on the table and they involve making patients and their families along with dock trors able to make health care decisions. -- doctors are able to make health care decisions. and they they own and control their health coverage and policy so that the dynamic between insurance companies and patients becomes one that is responsive. the insurance company has to be responsive to individuals. there is a patient-centered way to do it and government-centered way to do it. we believe patient-centered is t

we know, as i mentioned that medicare is expanding radically in its cost burden to the federal government. we than by the year 2020, 2035, 18% of the gdp will essentially be absorbed by medicare, medicaid and social security and social security really isn't a driver in this. it's medicare. we than we're looking at a health care system where the cost of health care goes up to 20% by the year 2020 and 20% of gdp and that's not sustainable under any economy because it basically absorbs the entire productivity of the nation. so we have to get this under control from a standpoint of fiscal health and we have to get it under control from the standpoint of making americans insured. what's been the republican role in this effort? well, we have put forward the substantive initiatives. there are three or four major plans that are pending. >> we believe very strongly that all americans should have insurance, and it should be an insurance that's meaningful so that nobody is wiped out by a medical event or a physical event that causes them great injury. if someone in your family experiences some terri

federal government says that is fine. we will pay you this much. with regard to medicareone of the reasons i think the overwhelming majority of seniors on medicare also have supplemental policies is because of the limited benefits available in a russian government system. we believe it is in the best interests of taxpayers -- in a rationed government system. we believe it is in the best interest for taxpayers not to do that. >> and you hear taxpayers say i wish we did not have medicare to hear low income people saying i wish we don't have medicaid? >> no. i have the occasional senior tell me they would like to be a conscientious objector. until we have as much gray hair as i do, you don't realize you don't have a choice. he reached the age of enrollment and you are enrolled. so people want us to support the systems and have supported the systems, but they also recognize that we are running a two trillion dollars annual deficit this year. we have doubled the national debt under the last administration and scheduled to triple the national debt in the next 10 years. most ame

federal budget was defense. social security was 15%, medicare had yet to be enacted. by 2007 defense spending 20% of the budget while social security makes up 21% and medicare makes up 16% and it is rising at an alarming rate. the u.s. has a commitment to health care almost double any country in the world from the standpoint of the overall cost. it is unsustainable. we can do a much better job but it can't just be by spending money. mr. chairman, the national health care anti-fraud association organization of 100 private insurers, public agencies estimates 60 billion, about 3% of the total annual health care spending is lost to fraud every year. but the figure is considered conservative by the new england journal of medicine. 2008 government why proper payments cost the united states treasury $72 billion or 4% of the total outlay for related programs. medicaid had an estimated improper payment rate of 10.5% or $18.6 billion for the federal share of medicaid expenditures. the highest rate of any federal program. and it is my belief that in the second half of the legisl

federal government default insurance program. what they will do eventually is cut reimbursement to our providers who are already cut to the bone on medicare, medicaid programs. at lot of the democrats, very powerful democrats in the house where i serve, what this government to fall plan to look like medicare. goodness gracious, that is the last thing that i would want to see any health-care plan look like, medicare. we have lots of problems in that program. we do not want to duplicate them. host: let me follow-up on that point. you also said that you do not have to go any further than vermont, where howard dean served as the state executive in his push for health care. you call that in fear and said that his wife was one of the victims of what you@@@@ i believe howard dean's wife, she's a family practitioner in vermont. dr. steinberg is surname. i had a conversation with her. she dropped out of the medicaid program. because the reimbursement rates were not sufficient to keep her doors open, to provide health- insurance thoron own employees. so, you start talking about reforming the system and covering more people, but if you are reimbursi

government is spending too much of your money, consider this: your state and federal governments spend about $60 billion every year on medicare and medicaid payments for health problems related to tobacco: medicare and medicaid, $60 billion a year. and that is related to tobacco diseases and conditions. so it's not just a health crisis, it's an economic crisis. one that we cannot afford. we can't afford to spend $60 billion of medicare and medicaid money on tobacco-related problems. and still if that weren't bad enough, mr. president, about 500,000 people die every year as a result of their smoking or, i guess, in some instances, someone else's smoking. these deaths from lung cancer, emphasis seem and many other conditions -- emphysema and many other conditions related to tobacco, such as heart disease which is made worse by tobacco -- name any disease, mr. president, and it's a rare one that tobacco doesn't make it worse. but it's so preventable. this bill aims to ease the pain and prevent others from going through it. the dangers of smoking are hardly breaking news. we've known about it for decades. we know about it and we'

we don't reimburse the federal government for telemedicine, we don't do it in medicare or medicaid even though we have got around the country's these incubators and community health centers that are doing telemedicine for chronic heart disease and now we're remotely they can check some of these low levels and began to adjust their medication so they don't end up in the emergency room in a three day stay to adjust their madison. my point is understand and don't question what is trying to do but i'm not sure that he gets step one. want to begin to get people educated, covered and rolled that we will have a better feel for whether the back end in need sizable amounts of money. emily will find that the system will, in fact, that these people in a better position house why this and ultimately into the right incentives are there for the individual meeting competitive market where premiums go down because you're healthier that is the incentive and the the individuals in this country make. >> senator sanders will. >> will begin by picking up on a point as an observer raise and i entering 60 mil

medicare and medicaid is driving costs and yet we are going to increase medicaid to 133% of federal poverty level. i have an article here from a group that points out that when you have increased medicare and medicaid, for the private insurance companies, it drives the cost of. it is a hydraulic effect. he pushed down here and it pushes up here. one question i have is, how are we going to control medicaid we are increasing the reimbursement levels and we are increasing the eligibility? that is just across purposing. secondly, next tuesday morning, i'm going to be tree lots and medicaid patients in a public hospital in louisiana. i've done for 20 years. i do not think a single one of them would say it is a patient center. i frankly did not see much over the weekend that said patients center. we are using that rhetoric. as a guy that has been spending 20 years addressing it, i've not seen it. even the advocates admit that there are a lot of obstacles to be instituted. bundling is an improvement. i wonder how we are going to save money by using the state power to drive down the provider reimbu

for the government, growing costs of medicare and medicaid is the biggest threat to our federal deficit -- > social security, bigger than all the investments we have made so far, so if they are worried about it -- if you're worried about spending and deficits, you need to be worried about the cost of health care. we have the most expensive health-care system in the world -- bar none. we spend almost 50% more per person on health care then the next most expensive nation. 50% more, but here is the thing. we are not any healthier for it. we do not necessarily have better outcomes. even within our own country there are a lot of faces -- places where we spend less on health care but actually have higher quality than places where we spend more, and it turns out green bay is a good example. right here in green bay, you get more quality out of fewer health-care dollars than any other kennedys across this country. and this is something to be proud of. -- than many other places across this country. and this is something to be proud of. [applause] use them less, but across the country, spending on

governors association said increasing the federal poverty level to 150% would increase the cost to $360 billion over ten years in all the states, increases in medicare reimbursement would bring that total to $500 billion in all the states. that's on top of the $1 trillion that the congressional budget office has said that senator kennedy's bill already costs. one of the effects on this is it would absolutely destroy our public colleges and universities across the country. it's already damaging them because governors and legislators are finding they barely have enough money to keep up with increasing medicaid costs. they have nothing left for colleges, universities. and so the quality of the universities goes down and the tuition at the universities goes up. finally senators serving as governor of their home states trying to manage an expanded medicaid program would find that most of the people -- maybe a majority debaters would find a hard time getting service. today 40% of doctors nationally don't provide full service to medicaid patients because of the low reimbursement rates. so, mr. president any version of the bill we're considering will explod

for the government, the growing cost of medicare and medicaid is the biggest threat to our federal deficit. bigger than social security, bigger than all the investments that we've made so far. so if you're worried about spending and you're worried about deaf sits, you need to be worried about the cost of health care. we have the most expensive health care system in the world. bar none. we spend almost 50% more per person on health care than the next most expensive nation. 50% more. but here's the thing, green bay. we're not any healthier for it. we don't necessarily have better outcomes. even within our own country there are a lot of places where we spend less on health care but have higher quality than places where we spend more. and it turns out green bay is a good example. right here in green bay you get more quality out of fewer health care dollars than many other communities across this country. this is something to be proud of. [applause] that's something to be proud of. you spend less, you have higher quality here in green bay than in many parts of the country. but across the countr

two seniors who are on medicare and to the rest of the population. the federal government will be able to dictate its care. we have not provided that same protection for any other carrier in the country. that is what air legislation that would do. mr. president, the final thing i would like to discuss is the notion that we could have a government-run insurance plan and that somehow that would be helpful for americans. stop and think for a moment. a government auction would be the federal government making decisions about care. well you may decide that it is a lot cheaper because the federal government can subsidize the insurance plan, the government will be deciding what kind of coverage you get. this is one of the areas we are concerned about in using this comparative effectiveness research. the so-called public auction in order to keep costs down could end up rationing care. that is ok if it is merely an option. even if it is cheaper, i do not want this. if a health-care consulting group says that unfortunately, because private employers are likely to dump the

federal government, not affordability. all of the cost overruns that occurred in the systems run by the government, medicare, medicaid, indian health service, the veterans' health care certainly not quality when you see the limitation of care that is imposed by the federal government responsiveness and innovation in the same sentence as the federal government is rarely used and rightly so and then choices, choices are always limited by governmental intervention and to the end of the costs which i think is an incredibly important to address. dr. gratzer, would you comment what is included in our estimation of health care costs that may not be included in other asian destinations of their health care costs? >> well, let me -- dr. price, i fully agree with your comments. with regard to what is american medicine do that one wouldn't find elsewhere in the world, research and development would be a great example of that. there is more spent at one facility in the united states anderson on research and development and the reason the entire country of canada. america is the leader in medical technology to solomon and implementation.

meanwhile, medicare and medicaid pose one of the greatest threats to our federal deficit and could leave our children with a mountain of debt that they cannot pay. we cannot continue down this path. i don't accept a future where americans forego health care because they can't pay for it. and more and more families g without coverage at all. and i don't accept a future where american business is hurt and our government goes broke. we have a

and it seemed like medicare gave us the most headaches, not the least reimbursement been second to least, reimbursement and there was an enormous cost shift going on when the federal government was involved and now you have the access issue trying to get physicians that will take medicare patients. i don't want to see us create a government-run system that mirrors one that's not sustainable right now. and you know as well as i do, some of the goofy rules in medicare that drive seniors to the hospital to get, you know, an injection when they should be able to get it at home, telemedicine is a great thing but if you're a provider and you're on the other end of telemedicine you don't get reimbursed under medicare so there's a disincentive, irrespective of this debate, that we could do to improve medicare. >> thanks for your generosity on time. >> let me remind mens. we mentioned this earlier but i wanted you to know that the secretary has to leave at 12:00. now, of course, we'll have written questions for many members including those that have already spoken and those who have not to follow-up and she'll get back to us. >> mr. chairman? >> yes. >> could we ask the se

thrust on to the mercy of the federal government which has a program called social security which is regrettably going bankrupt and will probably be by the year 2019 or so. medicare as we know it will be bankrupt within a few years after that the social security will be bankrupt. so we are relying on the federal government to pick up the tab yet we don't have money in the retirement accounts to take care of us. it will be a terrible shock. people were using a technique if i can use that term of saving money under what was called a 401(k). or a 403(b) program where they set aside a certain small amount the employer generally speaking matches the small amount and over the years that begins to grow. it became the savings vehicle of all of the baby boomers. and then came the recent recession and they have founded the 401(k) savings vehicles have lost about 50% of the value when the market went down. people were faced with devastating losses and the fear gripping america was probable. people were not only losing their retirement savings but also beginning to lose their jobs. we have laid off 78 million people in the united states and it is hurting all over the board.

and apply it to the rest of our health care, to seniors who are on medicare and to the rest of the population to the extent the federal government will be able to dictate its care. we have not provided that same protection for any other care in the country, and that's what our legislation, the patients' act, would do. mr. president, the final thing that i'd like to discuss here is the notion that we can have a government-run insurance plan and that somehow that will be healthy for americans. stop and think for a moment. a government-run option, a government option, as it's called, would be the federal government making decisions about care. so while you may decide that it's a lot cheaper because the federal government can subsidize the insurance plan, the government will actually be deciding what kind of coverage you get. this is one of the areas that we're concerned about in using this comparati

and consumer groups to barrier programs including medicare, medicaid, schip, ryan white, a grandson of the public health service act and other federal laws regarding policies and procedures to eliminate fraud, waste and abuse under such programs. such commission shall review such programs for two years following the date of enactment and provide a report with recommendations to congress within three years. not heavy lifting, mr. chairman, going after waste, fraud and abuse and making sure that providers of school based programs live up to state law. we've got a lot of work to do and i hope mr. chairman that we take our time doing its. i'm not sure that that will be the process that we follow, but i think it is a prescription that we should. i think the chairman and thank the members for their indulgence as i had the opportunity to fully that the frustrations but the truth is we have only one shot at this. there are many things that we do up here with a change in administration and a change in the makeup of congress reverses a mistake and it all goes away. drastically change health care and you are talking about a generational change

we can do short of, madam speaker, turning this over to the federal government, to run what -- amtrak, the post office or indeed the medicare program. and i don't think that's what people really want and expect. we can do better than that. and there are a number of issues in particular that we can talk about in detail if we had more than just an hour, madam speaker. but clearly, this idea of electronic medical records, i think, is a way of trying to save money. i think the money we put in the stimulus package, $19 billion to provide grants. i've got a piece of legislation that would help physicians purchase hardware and software and a maintenance program that is specialty specific, whether it was my specialty of ob-gyn or general practice or surgery program produced by a company in my district called greenway, where you have as part of that electronic medical record program, you have all the things set up of best practices that are developed not by a government bureaucrat, madam speaker, but by that very specialty group, those men and women, those leaders of that specialty society that want to do what is best and they want