harkin: thank you, madam president. madam president, i have 10 unanimous consent requests for committees to meet during today's session of the senate. theft apriewl of the majority and minority leaders. i ask unanimous consent that these requests be agreed to and that these requests be printed in the record. the presiding officer: without objection. a senator: mr. president? the presiding officer: the senate agrees to the preamble of the resolution, without objection. mr. cornyn: madam president. the presiding officer: the senator from texas. mr. cornyn: madam president, i'd like to turn to another important topic, and that is the pending confirmation of judge sonia sotomayor to be associate justice of the united states supreme court. like many senators, i've had the opportunity to visit with judge sotomayor in my office and, of course, congratulated her on this great honor. and i further pledged to her that she would receive a fair and dignified confirmation proceeding. unfortunately, that has not always been the case

we'll have a recorded vote on harkin number two. >> senator dodd? >> aye. >> senator harkin? senator mccull ski. >> aye. >> senator binghamman? >> aye by proxy. >> senator murray. >> aye by proxy. >> senator reid? >> eye by proxy. >> senator sappeders? senator brown? senator casey? >> aye by proxy. >> senator haguen? >> aye by proxy. >> senator murphy? >> senator whitehouse. >> senator enzi? >> no. >> senator gray? >> aye by proxy. >> senator bier? >> senator anderson? >> aye by proxy. >> senator mccain? >> aye by proxy. >> senator hatch? >> aye by proxy. >> senator coburn? >> aye by proxy. >> senator kennedy? >> aye by proxy. >> the vote is 13 ayes, 10 neys. >> the amendment is agreed to. >> thank you, mr. chairman. and, you know, you kint of sit back and listen to the colleagues on both sides and i think you said it senator enzi. we're all in agreement on it about 80% of what we're talking about is always in the details. but the goal is certainly there when we talk about prevention. we all recognize this will be integral to whatever plan we put forward. and the hope truly i

and, i think the senator harkin for his attention to this. there are a couple of areas where we think prevention, the pressure prevention and a healthy lifestyle can be incentivize. and, especially in the area of hipaa we think the federal government disincentivizes bergen the area of the ability for people to pay cash rewards for folks who live healthier lifestyles we think there's this incentive in our system and we believe this bill in its present structure and i understand may be going through some mutation, moving during-- for direction of a healthy lifestyle and to allow communities of employees to participate in programs which basically give them the opportunity to live a healthy lifestyle and be rewarded in doing that. so, as the senator was saying there are groupings of amendments. there is certainly one grouping of amendments that i consider to be very important and i know many of my colleagues to. there is also a number of other issues in here. the issue of this preventive fund, i think the technical budget issues that the center i

we combined the two and senator harkin as well. i'll ask unanimous consent that burr amendment number 3 as modified be agreed to. all those without objection so agree. one more, tom? >> yeah. i've got to find it. >> sure. go ahead. >> go ahead. >> sorry. i'm going to bump in front of my colleague here for what i hope will will be a quick amendment. this is my amendment number 10. this is as it relates to the right choices program, and as the language is drafted now now, the eligibility requirement is that the individual is 350% at the fpl, federal poverty level. i'm proposing that in an effort to deal with the costs of the bill that we have in front of us that we replace it with federal eligibility requirement of 200% of the federal poverty level. the amendment also includes that one of the criteria for eligibility be that the individual must have a chronic disease condition. and i recognize that that may be a negotiable proposal here. we are looking at this right choices program. it's been scored at $15.2 billion over ten years. i

. >> thank you very much and i will turn to senator harkin and then open up from eminence. >> thank you very much. there is a lot of what senator enzi said that i agree with. when it comes to prevention and wellness we have a scatter gun approach. we don't really have any real structures to this that are delineated by the people that no one works. we don't have any real guide posts out there. that is what we're trying to do in this bill, and this title is to add some form and structure to its, not in a way of telling people what they can and can't do, but to make it easier to be healthy. to change the system and structure so that people find there are more incentives by not telling people what they can and can't do. as i said yesterday i repeat for emphasis sick when dr. andrew wiles said the human body wants to be healthy, it is in our dna to be healthy but we have corrected all the structures that make it difficult to be healthy so it is hard to be healthy and easy to be unhealthy. we need to kind of change that around. i would say to my friend from wyoming that we have to entities in

senator harkin's new language is that cbo will have to score $80 billion. so when it is scored it will be scored as an $ 0 billion. it will be scored as 80 billion. >> over ten years. >> right. >> mr. chairman? >> so to complete the point. the piece we have is the 5 billion or the right choices program and just to take that and if it is $80 billion over ten years, that's the right choice, that's 5 billion per year over the first three years. this program sounds to me like exactly the sort of common sense that we'd want to have. we know that there are few diseases that create 75% of the costs in the health care system. we also know that a lot of those costs are tied to the uninsured because their diseases progress significantly with little prevention, little disease management. so this section says, hey, since we know the uninsured are a major source of expenses and not to mention significant source of loss of quality of life for american citizens, let's take, while we're getting affordable, accessible healthcare for all americans in the time that intervenes

harkin: madam president? the presiding officer: the senator from iowa. mr. harkin: madam president, the clerk just read for the first time ever in this body what we should have done a long time ago. an apology for slavery and the jim-crow laws which for a century after emancipation deprived millions of americans their basic human rights, equal justice under law and equal opportunities. today the senate will unanimously make that apology. i, first of all, want to thank my friend, senator sam brownback, for all of his hard work and over the last couple of years working together to get this finally to this point. i can't thank him enough. he wouldn't give up and stuck in there all the time working to make sure that this day would come. and i thank him profusely for his help in this effort. i also want to publicly thank congressman steve cohen on the house side, who is the leader of this resolution that they will be passing soon over there. john quincy adams once remarked our country began existence by the universal emancipation of man from the thralldom of man.

senator harkin is trying to do. the winning a revolutionary change in the way we do with prevention in this country and it is not going to simply be with employers. some are doing and break john but, on the other hand, there are some for a dozen different reasons, there are cutting back and eliminating the private health insurance providing to their work and we're seeing more of that. one of the important provisions and was senator harkin is trying to do is dealing with school based health care. sure we want people to get educated on the job appear and i would argue that a better place to get education about disease prevention is in school and i think we should put a great emphasis on school based health care which is what we're doing here and other areas so the bottom line is if we're serious about trying to keep americans healthier in trying to save money and think prevention is the way to go in and think this bill begins of the revolution we need in changing the paradigm puebla. >> senator greg. >> i don't thank

i mean, there's a disparate levels of funding and support for these activities that the harkin proposal has included. if we apply a standard that says if there's any funding presently going on that that program would be exempt and/or excluded from any additional support seems to be, in a sense, overreaching. i say that respectfully. but the whole goal here is to provide additional resources, particularly in the areas where chronic illness are costing us so much in terms of health care. that's 75% of the health care dollar is consumed by chronic illness. obesity. school-based programs that deal with oral health. oral heelt being one i mentioned as well as in other areas that have been addressed. i think to say if any money is being spent on that you're out because it's duplication is going further than we want to do. i understand those who oppose us providing any direct funding in these areas. i disagree with that conclusion. but i understand that point. >> well, i'll take a voice vote on this. >> all those in favor of the hatch amendment say aye. >> aye. >> those opposed no. >> the nos

>> aye. >> senator harkin? aye?>> it was aye. >> senator mi cull ski. >> aye. >> senator murray. >> aye. by proxy. >> senator reed? senator brown? senator casey? >> aye. >> senator haguen. >> senator murkley. senator enzi? >> aye by proxy. >> senator alexander? >> aye. >> senator burr? senator isakson? senator mccain? >> aye by proxy. >> senator coburn? >> no. >> senator roberts? >> aye by proxy. >> chairman kennedy? >> aye by proxy. i want to recommend that all future amendments be offered by senator sanders. very good, senator. lamar alexander, you're up. >> thanks, mr. chairman. i have an amendment to title three, section 311. the purpose of it is to make sure that the right choices program which is in that title doesn't require the states to spend any money on it, and this is a relatively small item, probably, but i would like to make a larger point in making my proposal, if i could say just a word about it. >> certainly. >> we have talked a lot here about cost and usually the cost is described in terms of cost

kim i senator harkin, maybe we should just adjourn and startup again, i would be glad to be here at 230. >> you will be first up. >> so we move to the senate caucus room? >> we are moving from here to the senate caucus room at 2:30 p.m. this afternoon. >> mr. acting chairman. i know my quality comes up and i just wonder if the staff's could work during the break in this area. i have four amendments on an administration supplication come into are duplicative, there are two amendments to strike an outrage had to senator and see. 24 of comparative effectiveness. i would debate all 24 but i wonder if we could come down to just kind of a scrub and make sure that are not duplicative and. to jesse not to stifle in any way debate or accretive solutions and i will also be ready to take some, senator rakowski and the indian tribes commenting, our stuff that we're doing with senator gregg. >> i am sure our staffs would be happy to work on this and when we're talking about more time that is what we're talking about, we have and have the time to scrub to those to see what could be done and was dupli

and senator harkin have talked many times. i wish i could go to cdc and remind them that prevention is part of their name. this provides them a tremendous amount of money. this does not force cdc to do anything with prevention except spend a tremendous amount of money. but we can't be assured it has any -- i realize i'm getting close to home here. excuse me, $6.4 billion annually to carry out their mission. well, $6.4 billion. why do we still have prevention problems? is it going to change when we get the budget to $ billion annually? or $10 billion annually or $20 billion annually? we have no matrix design to figure out when we've been successful. and the truth is that we're doing a good job of duplicating efforts that are already in place that don't work. and the argument that we're making -- i think it's wrong -- is that if we just put more money in it, these programs will work. and i will tell you, in fact, every example we've had of success of prevention and wellness and disease management doesn't have anything to do with

. >> thank you chairman harkin and senator cochran and members of the committee. i want to thank you for the impartation to come and discuss the 2010 budget and for a start by thanking you for your hard work gang leadership on a fulbright the of health issues. we certainly face great challenges in the country today and i look forward to working with you to tackle those challenges together. health reform is one of the issues i know that is front and center and the senate and house right now and i think that there is great agreement, we can't continue with the status quo. the president is committed to health reform. we have seen businesses and governments and families and providers come together two of knowledge that the crushing costs are influencing families bottom line, the competitiveness of our businesses and we have got to find a way to deliver higher quality healthcare for all americans. i do agree with you senator, that prevention and wellness are a central component of that transformational health policy and some of those building blocks as you say, have al

>> no. >> senator harkin? >> no. >> senator mikulski?>> no. >> senator binghampton. >> no by proxy. >> senator murray? i'm sorry? senator reid? senator sanders? >> no by proxy. >> senator brown? senator casey? senator hagen? senator murkley? senator whitehouse? >> senator gregg? >> aye. >> senator also expander? >> aye by proxy. >> senator isakson? >> aye by proxy. >> senator mccain? >> aye by proxy. >> senator hatch. >> aye. >> senator roberts? >> aye by proxy. >> chairman kennedy? >> no by proxy. >> the vote is ten ayes, 13 nays. >> the amendment is defeated. senator murkley. >> thank you. i'm pleased to offer murkley amendment number one. this is po focussed on facilitating the ability of mothers to continue breast feeding after they go back to work. there are two fundamental reasons that this is very important. the first is that a very high percentage of mothers are working. and the second is breast feeding is of huge value to the health of our children. so let me address those points in just a little bit more detail. currently 72% o

senator harkin wouldn't settle for anything less for most of the decade. i guess it isn't entirely true. occasionally he settled for 3 billion. but if you take a look at the cost of living in just meant inflation rate about 3.3%, thatn i would urge you to take another look. we want to stay within our budget. i would appreciate it if you took another look at that. the $10 billion that was added in the stimulus package brought an enormous wave of excitement. scientists. and i think we have to maintain the growth rate. we talked about cutting down the cost health care. what better way of the cost factor than to prevent government and during the purple of time when senator harkin had his way increasing from 12 to $30 billion on the death rate -- >> we imminent, i was a ranking member then. i was ranking member of that time. >> come to think of that he didn't have all that much to do with it. [laughter] but on a serious note we use to trade gavels with frequency but on to the serious note, the death rate from strokes went down, from heart disease, improvements

i think probably senator harkin heard it and that's why he's leaving. i expressed my discontent with the process, the cost and substance of this bill. marvelous speech. i know that i am not alone in this sentiment as the american people it seems to me start to realize what is actually in this legislation, despite the goal so eloquently put by me colleagues to my left. and you're right. on process, my republican colleagues and i recently made very reasonable requests from the chairman and finance committees as well as senator dodd who has done a very good job in serving in senator kennedy's absence. these requests appeared in a letter, my letter, i wrote it, which every republican member of the finance add health education and labor and pension committees signed. every republican. hard to get every republican to sign anything. in that letter, we asked the chairman to release the complete details of their plans to reform health care. we asked them to do so in a timely manner to allow us time to read and understand the policies to get reactions from our co

i want to thank senator harkin, senator brownback for their leadership on this issue. i urge my colleagues to join as we seek to write the next chapter in our history, to move forward not only saying we apologize for slavery but moving forward to make sure remnants of discrimination of any kind is removed from this great nation of ours. thank you, madam president. i yield the floor. a senator: madam president? the presiding officer: the senator from new hampshire. splays mean: madam president, i ask unanimous consent to speak as if in morning business. the presiding officer: without objection. mrs. shaheen: thank you. a senator: will the senator yield? the presiding officer: the senator from california. [inaudible] mrs. boxer: i would wonder if she could expand her request and say upon finishing if i could have just about five minutes. mrs. shaheen: i'm delighted to do that for the -- my colleague from california. the presiding officer: without objection. mrs. boxer: thank you. the presiding officer: the senator from delaware. [inaudible] the presiding officer: the sen

again, -- >> we have been over this before and as it will senator harkin about the cardiologists and why i don't get more people -- i said notwithstanding provision of this title, all programs authorized by this title shall fund programs to obtain only primary care providers and that i just worry about saying that, the reimbursement levels, but i don't want to be at a point where we clearly excluded where we come out of this by saying i measure pediatrics but even the odd pediatrics i would not want the department of health and human services and managing all this to interpret markup that we did not appreciate specialization and that is where the pendulum stores sweeping and reviews ms. a balance between the program number of special sessions and primary care. >> mr. chairman, i hope you'll at recognize because i think we have a way to solve it. >> i'm going to go to bernie sanders and then you can max mr. chairman, let me just before you go to a vote to say that everybody recognizes there is primary care problem, but that is not the only issue we have in providing health care. if we

and i have to say that i am pleased that senator kennedy has delegated this committee to do and tom harkin and who i have worked with him very strongly on the health and other and barbara mikulski worked on the american action everybody on this committee. this is a committee that this war to help people in america and i came to for the first for years we got into some scraps and we have been scrapping all these years we developed a great love for each other and frankly i pray for him everyday and wish him well and we do miss them. there are so many bills to put together that he is a master legislator. in answer you in some of the others in this committee. this committee does build good leadership because of the myriad programs -- the largest authorizing committee and the congress and was a privilege for me to chair the 21981 and 1987. lme take some time today and not be too long and take a few minutes to talk about them affordable health choice act. first and foremost the may make this point again even though concern to summon a broken record very reforming our health care system to insure

. >> can we vote on harkin 4? >> a voice vote. >> all nose in favor of harkin number 4, say aye. >> aye. >> those opposed say no. >> the ayes appear to have it. >> i have an additional amendment i want to offer. >> all right. then we'll go back. >> i didn't actually offer an amendment. i was -- >> that's true. >> go ahead with senator binghaman. >> i have one i hope doesn't take very long. this is amendment number one. it provides for modernization of our national disease surveillance system. amendment was developed in close collaboration with the council of state and territorial epidemiologists. it's been endorsed as standalone legislation by a lot of different health ground, incl e including the american public health association, american society of microbiology, infectious diseases society of america, the center for infectious disease research and policy. the national public health information coalition and the society for health care epidemiology of america. at the current time, many parts of the local, state

as i understood it earlier, we had a similar debate, senator harkin made the point and identified several a areas where specifically the states were specifically mentioned. as to the importance of their involvement in getting back to the commission to make sure that at the national level, the point that tom coburn makes and i this think we all agree on, that there's a fear that this can be sort of decided on mt. olympus, disregarding what's occurring in our respective states and the diversity that exists across the country. from connecticut and oklahoma. different needs. different climactic conditions. all sorts of things that can result in a different set of priorities. tom's fear that is this commission will disregard what the states are doing in this regard. our answer is that -- >> i would say to the senator the okay opposite would occur. what we're going to look to, i assume with the commission, is for the states themselves to work with us to tell us, here's where our shortages are. here's an information-gathering commission. then at the federal level we can make sure what we're doin

senator harkin, i thank him as well. we don't have to go into evening and finish up 40 minutes, half hour. >> we're going to finish this now? okay, good. tomorrow we'll begin on wo workforce. that will be the goal. >> want you to go ahead, mike. start talking about it. >> i've been informed that i'm number 80, that that is kind of included in the burr amendment. >> okay. adopted? so we can drop number 80? >> yes. >> number 80 is gone. 80 is withdrawn. is this enzi 80? >> yes. okay. so i'd offer enzi amendment 50. >> enzi amendment 50. i have 51. >> while that is being passed out, i would say that is to ensure that the secretary conducts workplace wellness evaluations in publicly funded programs before evaluating the privately-funded programs. i'm not sure why we are having cdc evaluate programs outside of the government when we haven't evaluated the ones in the government, so this would ensure that we would have evaluated our own programs before we starts a cessing the value of the impact of the privately conducted progr

have some extraordinary members of congress here on stage, senator dodd, senator bourbon, senator harkinative waxman, rep christiansen, and rep platz, all who did a big part to move this legislation forward. [applause] i want to thank all of them. there are three members of congress that i have to especially thank, representative waxman, representative dodd, -- senator dodd, and most importantly, senator ted kennedy who cannot be here today. [applause] and the legislation i am signing today represents a change that has been decades in the making. since the middle of the last century, we have known about the deadly effects of tobacco products. more than 400,000 americans now die of tobacco related illnesses each year, making it the leading cause of preventable deaths in the united states. more than 8 million americans suffer from at least one serious illness caused by smoking. these health problems caused us all more than $100 billion a year. what is even worse are the effects on our children. one out of every five children in our country are now current smokers by the time believe high s

and with that we will go to senator harkin has the senate agreement for two amendments we have reached agreement on already. >> i will refer to senator gregg since he is ranking member on the budget committee looks at these scores for us, and would give us comments on where we are to date, and where we are going. >> good. >> well -- i appreciate the chairman's decision not to go forward the class act because we don't have joint tax and of course we don't have jurisdiction over the tax section, but it is important to put in con text the cbo's score in context, because what the class act is creating is a brand new entitlement and brand new major entitlement for long-term health care and yes over the first ten years, it is logical to score positively, because premiums will come in and people who are able to take advantage of the long-term care coverage will not have moved into long term care facilities over the first ten years, the majority of them. so it is very unlikely that there is a significant drawdown on that account, but if you go outside of the ten-year window and you look ta 40-

i would harkin this group and this commission to take a good look at why the institute of medicine is and what it does. they pulled together national experts. there were able to publish an unbiased, non partisan view. one thing that it highlighted was confidence and health care. i certainly have a tremendous amount of respect for teachers. one of the other pieces of data that you can certainly read from is the report and the importance of concordance between groups in terms of understanding particular patients. here is where we get to the heart of cultural competency. understanding the patient and being able to understand the patient. that could be a hispanic patient or a russian patient. it is about understanding the cultural background of that patient. when we are talking about cultural compensate, i think we are focused on race and ethnicity. this is about understanding that patient. as a position, really e. kgs are important. patients' care more when you care more about them. dr. sullivan spoke about the workforce data. it there is this idea that we train a workforce that is refle

senator tom harkin has a big effort going on to look at ways to encourage more of this prevention and wellness, and healthy living. host: we have an e-mail that is asking us to do a program on who promotes the myths about canadian health care. we have focused on that issue. we will do so again. thank you for the suggestion. the next call is from tennessee . caller: i am amazed at the people who want someone else to pay for something that they want. tell me one program the government has ever run that they have not run into the ground. medicare is broke. tencare in tennessee is broken. it has corruption and abuse. all of their drug dealers get their drugs from tencare. tell me one thing the government does. people want single pair. they tried to get around it by calling it a public plan. they are playing with words. people want someone working to pay for their medicare. guest: it has been a little while since i have been down to tennessee to take a look dat tencare. i'm not aware of the latest with the program. it has gone through some difficulties. on medicare, i hear these complaints

yet two of our nation's most female pilots, jacklin cochran and nancy harkin love, persevered and continued to lobby for the ability to use their exceptional skills in service of our country. as the nation mobilized it became clear there were not enough male pilots in the country to fight the war and man the home front. as the iconic rosie the riveter began to build her tanks and planes, the army set up two squadrons of women pilots to assist in the war effort. in 1942 mrs. love became the commanding officer of the ferry squadron in new castle, delaware, which ferre ideaed planes around the country from factories to airbases. not long after that, cochran became commanding officer of the 319th women's flying training detachment in houston, texas, which provided basic flight instruction for the army air forces. on august 5, 1942 -- 1943, the squadrons were combined to form the women's air force service pilots. over 25,000 women applied to become pilots and only some 1,900 were selected for training. of these almost 1,100 eventually earned their wings, many in the hometown of sweet water, texa

we will do that and then go to senator harkin has to it eminence we haven't reached agreement on in areas already. >> i will defer to senator greg this is his ranking member on the budget committee looks at the scores for us and would give probably some comments where we are today where we are going. >> well, i appreciate the chairman's decision not to go forward because we don't have a joint tax and don't have jurisdiction over the tax section it but it's important but the context of the cbo scoring in context. context, because what the class act is creating is a brand new entitlement and brand new

i also obviously want to recognize chairman harkin on the agriculture committee for the longstanding work on derivatives issues and i look forward to having both committees coordinate closely as we work to provide transparency and reduce the risk of the financial sector. this week we find ourselves more focused than ever on the important work of merchandising and outdated regulatory system for goeth call this hearing to explore one of the key aspects of such reforms. to modernize regulation of the over-the-counter derivatives market and the institutions that participate in these markets. both exchange rate and over-the-counter markets have grown extremely rapidly over the past decade. and tillie recent downturn of the economic markets, every category of derivatives show almost a decade of extreme growth, in many cases more than tripling or quadrupling trading values according to data compiled by the data resource service. between 20,002,008 the number of contracts traded on exchanges rose by 425% and the total notional amount of over-the-counter contracts of standing rose by 522% ove

caller: tom harkin and danny davis introduce a bill simultaneously dealing with long-term care to remove the institutional bias so that people can receive care at home at 1/3 the cost. i am wondering if you're a person from "the political -- i am wondering if your person from "of the politico" can talk about if we can get this 12-year-old choice act through. we have the baby boomers coming, and we're not even ready for them. host: ashburn, virginia, laurie, on our democrats line. caller: hi. i had an opportunity to listen to the president's speech to the ama yesterday, and he said distinctly that he was not going to advocate a single-payer system but a choice like we have in the federal government, of care providers and insurers. but when i get my insurance statement for my yearly checkup with my primary care physician and i see the insurance companies have negotiated, my primary care physician gets less for my yearly checkup than my mechanic does when i take my car in for service? i think there's something wrong with my health system, and i am not sure how we're going to retain the high

but let me turn to senator mikulski and thank her immensely for the job that tom harkin and jeff bingamanand patty murray have done all along with others in developing these ideas and quality prevention coverage as well as workforce issues. i'm going to ask senator mikulski to lead the debate on this and we recognize her. >> thank you very much senator dodd and good morning to all of my colleagues here this morning we are taking up title to, the quality section. and after that i believe senator dodd it wants to proceed and prevention. these two titles go hand-in-hand and even interface with each other. once you hear the conversation we've had over the last several days has been related to the cost of health care. there is no doubt that it is skyrocketing. in we see as to all public health policy experts that the issues of equality and prevention could in the long term until late reduce the cost of health care while it increases health outcomes. in my area we focused on those issues, five big issues that were readily agreed upon by all as drivers with their needs to be improving in quality

you are going to hear from tom harkin shortly as it goes to the issue how do we get people to change lifestyles. you've spoken about this in the past how that may be the critical piece in the long-term implications bringing down costs and improving quality of health in the country so i think there is again one of those moments there is a great sharing of common principles in this bill. things we ought to be built to achieve and to and i can't say with all the details of the amendment but i think some concepts the ones we all embrace and share i think striking the whole section is where it gets an easy because there are very valuable sections senator mikulski has included that are important that go to the heart of what we are trying to achieve, so i would oppose the amendment but again, as barbara mikulski said there is an appreciation as a medical background and it's important to hear when you had to say. >> mr. chairman if i might, just one point is the process is causes an amendment like this. we are told here's a bill. i would much rather have gone through the bill piecemeal, but

i strongly support congresswoman rosa delauro's bill, senator tom harkin's bill. we need to get that because it will change how we respond to the stimulus. we need a range of tools. i was giving a talk at google and went into the cafeteria and it was striking. there is either a red, yellow or green sign right in your face and i will tell you it has a real affect. red means eat small amount for taste, yellow, each a moderate amount common dream as much as you want. i was in charge of regulating food and i tell you it had a major affect on me. we have to change how we proceed stimulus and we have to have greater disclosure. we have to change -- we don't stop with just manual labor. what is served in the schools, with the vending machines -- parents, it's so hard you try as hard as you can and the kids are being stimulated with fat, sugar and salt. they have to change how we regulate advertising manual labor is a key step changing how we perceive the product. >> thank you very much. >> thank you. >> good afternoon. a quick question despite your comments on rules we c

let me turn to senator harkin. >> thank you very much, mr. chairman. first, i want to salute our committee chair, senator kennedy, for his tireless and relentless and courageous leadership across many, many years, and advocating for a comprehensive health reform for america. we are going to get it done this year. i also want to compliment and thank senator dodd for stepping in to provide his great leadership and commitment to getting a progressive and affordable and quality and c comprehensive health reform bill accomplished this session. we all know what the goals are. affordable and high quality health care, reduced costs for families, government and businesses and protect people's choice of doctors and hospital and insurance plans, but there is one goal, i believe, that is overarching over everything and it's the goal that i really believe enjoyed strong bipartisan support on this committee, strong bipartisan support in the senate and the house and is supported by the great majority of american people and that goal is to re-create america as a genui

senator harkin. >> thank you, mr. chairman. first i want to respond to senator gregg. i just listened to what you said the president wanted to accomplish. there is one way to accomplish that and that is to a single payer national insurance health program. very simple. >> if you want to bring that forward. why don't you bring that forward? we need to bring forward senator coburn's proposal and my proposal and we'll be working off product that gets where you want to go, where i want to @í@% overcharged subscribers and taxpayers an estimated $4.4 billion, that has to be factor into our thinking process around here and how we are building this system up. we do what we can around here. while i have long been a supporter of a single payer, my record is clear on this going back to the early '90s, that that was the simplest, strayed forward way to do things. i probably recognize there aren't the votes for that. that doesn't mean we shouldn't talk about it and let the american people know what it would mean to have a single payer type of a system in this country. i think people

working with the other side as well on a number of amendments that we hope when you get through senator harkin, we'll be ready to accept a number of amendments as well. we're working with them. >> the intention is to go after prevention go to workforce and then the areas of fraud and abuse section. those other ones before we get back to the coverage issue which is the issue is the more serious division as to where we are as po opposed to language. >> there's one thing i need to say. congratulations on your 10th anniversary. [ applause ] >> that's not my anniversary in the senate, that's my wedding anniversary. and i asked jackie whether or not she would like to spend the evening talking cbo numbers. i think we'll go to dinner instead. she's here and my two daughters are here as well. came this afternoon. wonderful friends from iowa. >> let's have a shout out for the dodd girls. [ applause ] >> all right. senator coburn, you had an amendment? no. who we looking at? no. >> senator coburn had an amendment. >> tom, do you have an amendment. >> waiting on the resolution. >> waiting on that resoluti

. >> also, we believe that as senator harkin has stated that there must be a major emphasis on the initiative of prevention and wellness and healthy lifestyle, but we believe the way you do it is the way it's been -- or most of the bills on our side that have been propose side by promoting incentives for people to pursue healthier lifestyles. this is a country where money makes a difference and if you give people a an incentive to live a healthier lifestyle, it has been shown that in instances they will, and in the instances of major employers such as safeway and they have been the case. we will reward you for going to a gym. we will reward you for having screenings that will identify potential serious diseases early. we will financially reward you for living a healthier lifestyle and yet this bill contracts that availability. contracts that availability for employers. it essentially says there can be no differential between what an insurer pays for someone who lives a healthy lifestyle and an insuree who doesn't. it makes sense, of course. we should be expanding that differential which is no

i think tom harkin has told the story several times over the last two weeks we have been together about that part to position. cardiologists and iowa where it sank while our people lawyers to prepare in the answer said if you pay primary-care physicians what you pay me you have a lot more in primary care -- a pretty honest answer why we're not giving people for the reimbursement rates are what the profession pays. so my inclination and another will be a lot of amendments in the area we are talking about for the of our consideration to including senator mikulski is but i am supporting what senator murray is doing now because it will solve the problem. senator coburn is right, it's not good to solve the problem but it is still a major piece of this at least a significant piece of what the financial burdens of like that have influence on decisions he met alan brinkley said, i think it is a very good thing that we all seem to be on the same page. nco lot of disagreement in understanding there is a crisis and we have to move toward in a number of the runways. i mentioned for the record the b

i think senator harkin pointed out despite my friend from oklahoma's description of the bill as the president has drafted, the states are paramount and are considerations in this. and that's intention, all of us, to make sure that's the case. let's move on. do you want a roll call vote on this? rr'@ @ kák @ @ @ @ @ n @ @ @/ are agreed on by both sides and i would ask unanimous consent that they be approved. >> i ask by consent those two amendments be agreed to without objection. they are agreed to. that now brings to about 25 of those amendments have been either agreed to or we've disposed of. senator binghamton? >> thank you very much, mr. chairman. i wanted to bring up bing ha hafr -- binghamton amendment number two. this is to train health care professionals in existing, in a matter that emtzs team-based service, emergency preparedness and response.s team-based service, emergency preparedness and response.ms team-based service, emergency preparedness and response.ps team-based service, emergency preparedness and response.hs team-based service, emergency preparedness and response.as team-b

so senator harkin's intention, his heart is pure. but will it be efficient?name me one efficient, effective federal government pral thograme set up you. name one that's efficient and effective. a pilot is effective when we put him if an f-18. but is the pentagon efficient? no. and we have that all across the federal government. so if our answer is we've got the answer and we're going to tell everybody else how to do it, ki promise you right now we're goinging to fail it. of and i don't think we should fail. it's too important. we have big problems in health care, and we immediate to come together based on what the real facts are out ñç?ñ well, guess who ends up you caring for most of the -- out the 4,000 babies i delivered, 2,500 of them have been medicaid. but what happens is that shifts down and so what we promise in terms of care and coverage is just a promise. it's hollow. because they don't get equal coverage. they don't get the same care. they don't get the same attention. yet we've promised it to them, but we don't deliver it. the reason we don't deliv

senator harkin. >> thank you, mr. chairman. first i want to respond to senator gregg. i just listened to what you said the president wanted to accomplish. there is one way to accomplish that and that is to a single payer national insurance health program. very simple. >> if you want to bring that forward. why don't you bring that forward? we need to bring forward senator coburn's proposal and my proposal and we'll be working off product that gets where you want to go, where i want to go. this product we are working off today does not accomplish what a single payer would accomplish. >> i say to my friend i'm sure we'll have a chance to vote on it on the senate floor, one way or the oefrmt other. i want to say to senator sanders, thank you very much what you just brought to this committee. we have to have a dose of realism once in a while as to what we are talking about here. when you pointed out that the inspector yen vorted that 80% of the insurance companies participating in medicare part d overcharged subscribers and taxpayers an estimated $4.4 billion, that has to b

. >> senator harkin. >> no. by proxy. >> senator mi cull ski. >> no. >> senator hingeeman. >> no by proxy. >> senator reed? >> no by proxy. >> senator brown? >> no by proxy. >> senator casey? >> no. >> senator hagan? >> no by proxy. >> senator berkeley? >> no. >> senator whitehouse? >> no. >> senator enzi? >> aye. >> senator gregg? >> aye. >> senator alexander? >> aye. >> senator burr? >> aye by proxy. >> senator mccain? senator hatch? senator murkowski. senator roberts? >> the senator is recorded. senator, would you like to be voted as aye? >> chairman kennedy? >> no by proxy. >> 14 ayes -- or no, 11 ayes, 14 noes. >> the amendment is not agreed to. senator murray? >> mr. chairman, we are now ready to accept murkowski number 23 as modified. ask unanimous consent it be accepted. >> any objections to senator murkowski number 23 as modified? without objection, the amendment is agreed to. next up? >> mr. chairman, we have a meeting. >> do you have a meeting. maybe it's just as wise at this juncture. my view would b

in many ways i kind of wish it could harkin back to the old days but in the old days we didn't have the medical miracles we have. in my hometown of 300 people, small little town, we did have a doctor. he came as a young man and stayed until he died. and he provided health care. there was no medicare. he just provided health care to anybody that needed health care. if they couldn't pay him he would take chickens, a hog, or a side of beef. if he was on a ranch or farm and delivered a baby and they didn't have any money, and if somebody had money, he would charge them a little extra for the people that couldn't pay and he just administered his own health care system but they we couldn't look inside the human body, we didn't have the miracle medicines through the n.i.h. and pharma and others allowing us to stay out of acute care bed. we didn't have all of those things. so now health care has become much, much, much more complicated and for some, according to the new yorker magazine article which i commend to everybody, when we have decided to make health care a "business proposition" so tha

senator harkin. >> thank you. i ask unanimous consent but before i do that i just want to respond first of all to senator gregg. you know, somebody just said the president wanted to accomplish. there is one way to accomplish and that is a single payer national health insurance program. peery simple. >> if you want to bring that forward obviously senator sanders agrees why don't you bring that forward and we can bring forward senator coburn's proposal or my proposal and then we will at least be working off product which gets where you want to go, where i want to go, different philosophies but this product we are working on today does not accomplish what single payer would accomplish. >> i say to my friend i am sure we have if chance to vote on the senate floor when we were the other. but i also want to say to my friend senator sanders, thank you for when you pointed out that the inspector general reported 80% of insurance companies participating in medicare part d overcharged subscribers and tax payers and estimate

>> senator harkin. thank you, mr.chairman, for the leadership, especially on this issue that i think really is the heart and soul of what we are going to do on health reform. if we don't, if we don't move aggressively, comprehensively on prevention and wellness, everything else we do is not really going to matter very much. we are just going to be spending a lot of money on sick care. so i think that what we have done today is taken a great step forward in shifting, and it is not going to happen overnight, and we all know that. it is not going to happen over night, and we have had good amendments from the republican side that came into focus, and that is what is good about the open mark-ups that we were able to resolve some of the issues and as you said move ahead. i thank you for your leadership on this and cracking the whip on us and keeping us here at the table all day. i thank all of my colleagues for all of their help on this, and i, too, join in thanking the staff on the great work on this. i think that this pre

. >> senator harkin? >> no. >> senator -- who is next? >> has she been called? >> harkin. >> i said no. >> senator mikulski. >> no by proxy. >> senator freedman? >> no by proxy. >> senator mury? >> no. >> senator reed? >> senator sandberg? >> no by proxy. >> senator casey? >> no. >> senator berkeley? >> no. >> senator whitehouse? >> no. >> senator enzi? >> aye. >> senator alexander? >> aye by proxy. >> senator byrd? >> aye by proxy. >> senator isaacson? >> aye by approximatey? >> senator mccain? >> aye by proxy. >> senator hatch? >> aye by proxy. >> senator coburn? >> aye. >> senator roberts. >> aye. >> senator kennedy? >> no by proxy. >> ten ayes. it appears to be nay. the amendment is not agreed to. here's where we are and senator coburn is leaving. i was hoping to get done by tomorrow midday, but we're going to finish, so i -- i don't want to keep people in the evenings if we can't consider amendments, but i don't know -- we have the fraud and abuse section now to go to and about -- >> there are eight people here, mr. chairman? we have eight, i know, and i th