now to the hhs board, last week, supervisor elsbernd said it takes four votes. you read the language, the language only says a majority of the board. what is a majority? that is up to interpretation, and could be four members, three in one. i have been attending the health service board meetings for a number of years. i have never seen any conflict there or any vote dividing the act, elected over the non- elected. i do not see what the problem is. they have never explain what the problem is. when ed lee came around to it seiu in district 1, i told him not to pass off the retirees. well, he certainly has. the city did not have -- the unions did not want to meet with the retirees, make them part of the process. i suggest removing the supplemental colas and the issues about the health service for changes, starting over, why can summary from the city come out to the retirement board meeting and talk about these changes and say what the problem is? maybe we can work out these changes. commissioner kim: thank you. if he would like to speak for public comment on this i

host: we will hear from congressman ryan first and kathleen sebelius, hhs secretary, on the independent advisory boardwe simply give up 15 people the ability to unilaterally under pay providers, and we see where this is headed, what is going to end up happening is that providers are going to gut medicare. i don't know what you call that, but it is rationing under a different word. if you say, a provider, we will not pay anything close to what cost to provide the service, they will not provide the service. >> mr. chairman, first of all, ipab does not come into effect unless congress has not taken action. congress is in the driver's seat. ipab makes recommendations of the spending trends are on target -- >> it is a super majority vote to prevent that, though, correct? >> only if congress has not proceede -- preceded ipab. if congress has paid attention to the bottom line of medicare, ipab is a relevant and it never triggers in -- is irrelevant and never triggers in. guest: it is one of the big concerns. in the statute, it says that ipab is very constrained in what it may recommend, and that it may not r

host: we will hear from congressman ryan first and kathleen sebelius, hhs secretary, on the independent advisory board. >> if we simply give up 15 people the ability to unilaterally under pay providers, and we see where this is headed, what is going to end up happening is that providers are going to gut medicare. i don't know what you call that, but it is rationing under a different word. if you say, a provider, we will not pay anything close to what cost to provide the service, they will not provide the service. >> mr. chairman, first of all, ipab does not come into effect unless congress has not taken action. congress is in the driver's seat. ipab makes recommendations of the spending trends are on target -- >> it is a super majority vote to prevent that, though, correct? >> only if congress has not proceede -- preceded ipab. if congress has paid attention to the bottom line of medicare, ipab is a relevant and it never triggers in -- is irrelevant and never triggers in. guest: it is one of the big concerns. in the statute, it says that ipab is very constrained in what it may recommend, and that it m