answering emails and using health i.t. effectively, using nurse practitioners, allied health professionals, implementing wellness programs whatever it takes for their beneficiaries to get better health outcomes and lower costs. this is part of most of the healthcare reform proposals that are being considered right now. and again, focuses on accountablity for costs across diverse practices and it's designed to be compatible with other reforms things like paying for health i.t. or care coordination, bundled payments, things that are considered part of healthcare reform can help move in this direction of getting to what we really want, accountability and payment based on better outcomes and lower costs. and this can be done through multistakeholder collaborations as well. there are a number of these going on around the country. i'll mention those briefly in just a second. but the idea is as patrick was saying there's some things that are best to collaborate on and other areas that are best to compete on.

meaningful use of health i.t. is being discussed now, and put a big emphasis on getting demonstrated impact on performance measures and on quality of care. having some abilities to compare these benchmark trends to impact over time, so either having a control group or having a benchmark prediction that can be tracked against actual performance of this accountable care collaboration, having a savings threshold above which savings shared. and then again having a quality and efficient component as well. so these kind of steps are being done now. they are being considered in legislation related to medicare that would get medicare i think the much-needed ability to get important quality and cost measures quickly for their beneficiary so that the impact of reforms like these can be evaluated much more quickly and can be potentially an important part of achieving meaningful health care reform. thank you all very much. [applause] >> thank you, mark, for sharing your perspectives. now it's my pleasure to introduce uwe rein

the fact if we could facilitate health of i.t. that in and of itself would be a goal line in the situation where i have this letter from senator kohl addressed to senator kennedy, enzi, bachus and senator grassley. so, i would recommend we not vote on the colburn amendment but referred to the judiciary committee. and with admonition, with the admonition that we really are supportive of the policy roles outlined in the committee. >> mr. chairman, my comment would be if we come through that legislation all the provisions outside of the scope of the committee i think it would be a lot smaller than it is so i suggest we then go through the bill, find those provisions outside the scope of the committee and eliminate them as soon as possible. >> senator mccain, there's only one committee without bumping against and that is the finance committee. >> there are numerous provisions outside the scope of the committee and i would be glad to identify them to the chairman. >> i don't want to get into that. the fact is they view this as judiciar

already made investments and health i.t., that's information technology, electronic medical records that will reduce medical errors, save lives, save money, and still ensure privacy. we also need to invest in prevention, in wells in programs to help americans liver longer and healthier lives. [applause] but the real cost savings will come from changing the incentives of a system that automatically equates expensive care with better care. we've got to move from addressing -- we've got to address flaws that increase profits but don't actually increase the quality of care for patients. we have to ask why places like kiss jer health systems in rural pennsylvania or inor mountain health in salt lake city can offer high quality care at costs well below average but other places in america can't. we need to identify the best

i would say the implementation of health i.t. will be a significant enhancement factor for providers who often don't want to be isolated but with health i.t., can be in frequent consultation with specialists and colleagues in various parts of the country and various parts of the state so they are not in isolated practices. so there are a number of features that are not only in this discussion draft, but in the bills that you previously passed that i think really help to address the workforce issue. >> thank you very much. >> thank you. >> i yield back. >> thank you. we now go to mr. burgess. >> thank you, mr. chairman. ma dm secretary i'm in the broom closet behind the kid's table which is where they keep me on this committee. during your -- and welcome to our committee this morning. during your confirmation hearing before the senate, i believe the statement was made, you said if confirmed i'll not only be an eager partner to work with congress, but that i understand bipartisanship. is that a reasonable fact similar lee of the te

it is their health i.t. carper go rabid then as keeping all the health i.t. ars, we will have the record of this retreat and an updated file on i.t. but they will carry their own card. they also have the option of doing it through local health or some other mechanism that we don't know will come to market now, but what it does come instead of putting this large burden in the middle of the healthcare center, it creates in uses technology with which to utilize things that are already proven out there. and so we enabled that. if used correctly the patient's savings on this could be billions and billions of dollars every year. it would also give us better and more timely information. one of the biggest problems we have as physicians to care for multiple patient's to see multiple doctors is getting the information from the other doctor. it will be right there in your card. the legislation would provide a charter for treating member owned, independent health record bank accounts that are operated in a cooperative institution for the medical information wedded here t

we still haven't done a good job in terms of broad band expansion, whether it's health i.t. information or just people being able to have the ability to have these new protchalkts have not reached rural america. and i know something about it because i was on the energy and commerce committee and we worked a lot on the telecom subcommittee and know that's something that will help enpower so many of our citizenry. if they have acsession it cuts down on other incidentles. sand going back to green jobs, cutting our dependency on foreign oil. making sure we can retool and retrain workers. and hopefully those jobs will stay in america and be a sustaining crotch of new jobs that will help -- crop of new jobs to help people say in the middle class. >> on behalf of the los angeles times and steve of the cleveland plain dealer thanks for joining us on "newsmakers". >> thank you. >> as we continue the kferings, let me follow conversation, let me follow up to your question on california. what are you sensing and what role does labor have in >> the administration is really retsents. that

health i.t. is important as well was mentioned. i think a public plan option is the way to go and i'll ask dr. hacker about that in a second, dealing with catastrophic costs clearly that's something we have to deal with it, there's no doubt about it. and i could go on and on. i do want to pick up on the regional and geographic disparities question. i'm from iowa which may not surprise why i want to pick up on that. iowa as maybe everyone on the panel, maybe everyone not is consistently ranked at or near the top in terms of outcomes and deficiency, quality of service, all the rest. we're among the best if not the best. yet iowa and not just iowa but there are a number of states that rank high in terms of outcomes but rank low in terms of reimbursement rates. i want to ask any of you here to offer any remarks that you might with respect to the current bill and whether it really gets at that issue or not. and what we might be able to do to really remedy some of those geographic disparity that is we see. in particular, i think mr. poll

first, the purchase of health i.t. equipment. and we looked forward to standards for intraoperablity. [applause] and we thank you for the investment in comparative effectiveness research to enhance quality medical care. [applause] in your budget, you used realistic numbers about the cost of treating medicare patients and you charted a course to replace the senseless medicare physician payment formula and you're the first president to do it and we thank you for that. [cheers and applause] you've recognized that medical liability concerns contribute to rising health care costs and we appreciate your interest addressing this problem. it is critical to the physicians of this country. [applause] friends, i've had the opportunity to meet president obama at the white house and i can attest to his willingness to listen and to engage. his focus on heather care reform and the polite of the uninsured -- health care reform and the plight of the uninsured takes a courageous spirited and wise judgment and we're grateful for hits leadership. so

and it covered health i.t. and the way that that can save costs in health. and just yesterday i got a book from senator daschle, information cure, solving the health care crisis systematically through integrated health care management. i read that last night. it has a lot of good points in it. some of which we have not put in the bill yet, particularly dealing within ing aggregating information. it reaped benefits. we have found some common threads there. but we have neverin aggregateed that so somebody might have something similar that is affecting them. each of the registers that we have are separate registers. but there is the possibility of integrating that information and aggregating it and coming up with new solutions for prevention and that's would cut costs. but i'm afraid we'll be on a much more limited basis raising expectations for people while we raise cost instead of lower costs. so i was hopeful and i'm still hopeful that we will take the time to get it right. but the bill we're marking up today is a bill that we were kind of excluded from havi

i.t. all loveless are basing our estimates on a really splendid paper and health affairs play jack hadley, and who are the others, you probably know them by heart i shouldn't put you on the spot, but they were a bunch of urban institute crowds basically employees and this is a super study the way they did it and everyone uses it as a benchmark and they started out singing if you took fully private insured people in 2008 and looked what was spent on their name, it was $3,900. and if you took similar, the same demographic makeup, similar people who were uninsured, we spent, what, something like 18 -- 1700. so about 43%. so what if we argue we are not rationing that is just a joke. that is rationing unless you say the whole difference was waste we must have already been rationing. so basically what jack hadley and colleagues to basically say we have to top this off. if we insure than they behave like the others 3900, and i think that in the end because some people were uninsured the whole year only part of the year what they come up with it will add about 122 billion to health spending in 200

health i.t., electronic medical records. i think the republican party would agree we need to go in that direction. to equalize the tax treatment of a health care benefit. those who work for an employer gets a very nice tax exclusion that covers outstanding health care and many cases it includes prescription drug benefit but if somebody isn't working for a larger employer or is the sole proprietor or certainly if they are out of work, they have to go into the individual market, pay higher rates because they don't have the delusion affect the would have on a lot of lives covered, and they get no tax break. that's not fair so we clearly need to equalize that. there are just so many things that hopefully we will have time in the show to talk about, because we, too, we are not in the party of no, we clearly understand that our system could be better, should be better. is the greatest system in the world. most people are happy with health care and we certainly don't want to throw the baby out with the bathwater. >> host: question f

taking on their payments now that are for reporting on quality of payment coming for not just having health i.t. in your office or in your hospital but actually demonstrating that your using it to improve care. so there's steps already happening in this direction and i think the chance of legislation passing will take major further steps in this direction and medicare this year is 100%. there's a lot behind it and medicare legislation as i said before is going to pass this year. >> great. >> add to what mark said it's changed what's happened the past two years as far as people's interest and coming together on payment reform and how important. and certainly some of the changes to fix up the existing fee-for-service system won't take very long to do. and i think -- i think the more ambitious change as market is saying there will be steps towards them, but i think it is going to be many years before we get to the point they have reached their potential and fact we had an impact on cost in the aggregate. >> there's another part to the question which is for pat. how will aamc be treated in the driv

it means health i.t., it means prevention. all these things are the starting point, i think, for reform and i've said very clearly, if any bill arrives from congress that is not controlling cost, that's not a bill i can support. it's going to have to control costs. it's going to have to be paid for. so there's been a lot of talk about well, $1 trillion price tag. what i've said is, if we're going to spend that much money then it's going to be largely funded through reallocating dollars that are already in the health care system but aren't being spent well. if we're spending $177 billion over 10 years to subsidize insurance companies under medicare advantage when there's no showing that people are healthier using that program than the regular medicare program, well, that's not a good deal for taxpayers and we're going to take that money and use it to provide better carat a cheaper cost to the american people. so that's point number one. number two, while we are in the process of dealing with the cost issue, i think it's also wi

part of bipartisan health care reform there is an emphasis on getting better information for using health i.t. to developing better evidence on what works for a particular patients of what kind of policies work best for decision making. those are important policy steps but in themselves are not going to be enough. they are enablers and not going to be enough and so all of this emphasis hearing today on reforming payments to providers and moving toward paying for what we really want, better health, lower-cost as opposed to fee-for-service is also extremely important. a third key element is consumers and involving patients to been a reform and we talked about that as well. i've heard about that in the last presentation and you can think of the reforms being considered on coverage sitting in the school as well. insurance market reforms make sure everyone has access to a range of choices and competition among health plans based on each patient better and not by selecting healthier individuals. we talk about the insurance market reforms. tax reforms and things like having the health insurance excl

savings in the system, we are for health i.t. if there is a transparency savings in the system, we are for it. i think all of those things will ultimately save money, whether the majority can convince the c.b.o. to score those or not is something we will be interested in seeing. but we will have a significantly lower price tag thand there are four or five different places to go and efficiencies in the system and competitive marketplace are two that nobody is really talking about to the extent they deserve to be talked about. >> people are talking about [inaudible] is that on the table? >> it is certainly not part of our plan. and i can't tell whether it is part of the democrats' plan. mr. mccain talked about it. mr. obama said he would never if go there and angle he is there. mr. rangel said it was not be part of their plan and now i think it is. i don't think it is necessary to tax that benefit. i think it is helpful to give employees more knowledge of how it is used. we have a marketplace now but it is not the kind of competiti

there will have an opportunity to get in a health care career or i.t. career or an entirely different area, but to make sure there are capabilities that they will achieve and the hubble to it the education and training. if they have to be mobile, they will get the opportunity and there will be a job at the end of the day. >> getting back to the auto industry, general motors has just filed for bankruptcy. chrysler is in bankruptcy. one area where there is potential large job losses is the cutbacks and the dealerships that chrysler and gm have announced. last week i was in a hearing with a number of senators really grilling executives from chrysler and gm about the dealership closings. they plan to close about tutsis and dealers, terminate their franchise agreements, -- will they be pushed to ease back on the leadership closings or at least extend the timetable for the dealers to get rid of their inventory? >> it is a very pressing situation. people are losing their jobs, no doubt about it. those kinds of decisions will have to be made between chrysler an

so that's $500 million and $250 million that will also be issued in health care careers and also in i.t. >> why is it taking so long to get the stimulus money out? you mentioned grant solstation. is there a way to get this money out quicker as it's progresses? what are some of the complications in getting this money out? >> a lot has to do with making sure that the appropriate guidance and guidelines are followed and that states are notified. in many ways it's working out a contract tull agreements with the different states too to make sure that they understand what our guidelines are and just two weeks ago we issued our guidelines. so it does take time. but i would say that this is the first time i've seen the amount of money coming out so quickly. it will be coming out quickly. in terms of you've got to remember, he just signed this piece of legislation in february, so this is kind of a rapid response, i would say, according to what you've seen in the past. at least in terms of what i've seen in the last eight years. >> hie has a chrysler stamping plant that will use roughly 1200 jobs

and additionally, we were doing health care simplification, so we could involve a little bit of medical i.t., so when you roll into a hospital, god forbid, after an accident. when they pull up your name and pull up your identification, they're able to identify who you are and your health care records. the military has been doing this for years. on our military identification card, we have the medical technology to pull up my medical records. if i rode into a hospital or a v.a. facility or a military hospital, on my card, they would scan it in and my complete medical history would come up. and on that, you would be able to tell what type of treatments you haand that is going to cost hospitals less because they won't run the battery of tests to see if this person is a difficult betic because they know what sa john doe's medical history. it's something we ought to explore for americans so they can have quick access to medical records. ms. pingree: i think it's one of the reasons why earlier this year we went along with the president's proposal and invested so much on health information technol

i.t. attractively, using nurse practitioners and well as programs whenever it takes for their beneficiaries to get better health outcomes of our cost. this is part of a most of the health care reform proposals being considered right now and focuses on accountability for the evers practice organizational and market settings and assign to be compatible with other reforms, and things like pay for health it and on all payments can help move in this direction of getting to what we really want accountability and payment on better outcomes a lower-cost and this can be done through multi stakeholder collaboration's as well. there are in number of is going on around the country and i'll mention those briefly but the idea is as bad triclosan there are some things to collaborate on to compete on to the extent possible to get multiple stakeholders to commit to the same kinds of quality measures that providers believe in and patience can believe and and can help them get better value for their spending. multistate colder collaboration can support these accountable care activities. having consistent quality measures can also

health care. the other thing you do not want to overlook is efficiencies in the system. let's see if the democrats can get the score. if there is an i.t. savings in the system, we are for that. if there is a transparency savings, we're for that. i think all of those things will save money. whether the majority can convince the cbo to score those is something we will be interested in, but we will have a significantly lower price tag and there are four, five different places to go. inefficiencies in the system and competitive marketplace are two nobody is talking about to the extent i think they deserve to be talked about. yes? >> senator mccain talked about tax and health care. >> that is not part of our plan. we cannot tell if it is part of the democrats' plan or not. mr. mccain talked about, mr. obama said he would never go there, and he apparently is there now. charlie rangel said it would never be part of their plan, and now it may be. i think it is helpful to give employees more input into how the benefit is used. that one thing helps create a more competitive marketplace. the marketplace does not control costs, or people under 65

health institutions of the government. that's a reflection of the fact that the cutting edge of the economy is becoming more biology-based. that includes computers, the internet, satellites, most of the rest of the i.t. revolution that finally exploded in the late '90s in a tech bubble but also much else. civilian aircraft, advanced machine tools, pharmaceuticals, biotechnology, and a lot more. the crucial role of the state in economic development should be kept in mind when we read these days dire warnings about government intervention in the financial system after private management has once again driven it to ruins. at this time an unusually severe crisis and one that harms the rich, not just the poor so it merits concern. it's also worth recalling that large state intervention of the economy is nothing new. on the contrary, it's always been a central factor in economic development. there's no time to review it here. but the history is quite instructive. these state-guided modes of economic development require considerable deceit in a society where the public can't be controlled by force. so people can't be told that the advanced economy relies heavily on the principle that the population pays th