more than 8 million people have hsas. and, with all due deference the gentleman from california, i don't think we are here to cast judgment against those who believe that an hsa is appropriate for them or their family. in fact, the increasing number of people purchasing hsas is reflective of the fact that they can have some backstop, that a cot strofk coverage is something that allows them some sense of health care security, and economic security. and to sit here and say we have heard sea many stories of people being duped and buying things they thought they didn't know they were buying, that answer irrelevant point, mr. chairman. these individuals, either we're going to apply the law and trust the regulators and allow them to promulgated the proper regulation so there is transparency in these products and then allow the mark place to work -- marketplace to work, mr. chairman i urge adoption of this amendment. >> all in favor kate by saying aye. opposed. >> opposition -- the amendment fails. clerk call the role. >> mr. st

they can get a credit to fund their hsa. there is something called patient directed health spending in which you prepay a position to take care of your primary and preventive services needs. this is already being done. it is not theoretical like an account of their organization. there are organizations that do this. let me give you a scenario. the clerical worker gets 10 of her friends, maybe her entire church, to sign up with a particular physician. they prepay. that position has to manage their costs. they are paying $50 a month, but if they do not like that physician, they can transfer to another. therefore, the physicians are incentivized to take care of them. on the west coast, they provide basic labs, some generics, x- rays, the whole thing to keep the patient group happy. i do think there could be a credit given to the folks who are below a certain income level to find that patient directed health spending account that they could then move. the advantage of the program is you are cutting out the administrative costs a

i made a simple request of the gentleman from michigan -- i wanted to support his idea of the hsa but wanted to be treated like all other insurance plans competing. and i don't think it ought to have a separate special treatment, i don't want hsa saying they don't have to cover benefits like maternity care, prescription drugs, i don't want hsa to say that they could deny coverage for people with pre-existing medical conditions. were allowed insurers to charge cancer patients more for this insurance. this is a form of insurance by should not be treated as an of insurance that is so special that they can do all the things we're trying to stop insurance companies from doing. now offered to take your eminence if you work with me in new to nine the willingness to even more for me, i can support your amendments. >> the difference between working with us and completely changing the locus of the amendments to man quick changes of this of the amendments. >> i am asking a question, would a change of the lotus of your amendments to allow hsa plans and not allow them when they compete to be was t

in charge we passed the availability of what were called health opportunity accounts, essentially an hsa for patients on medicaid. it wasn't a requirement but states could be allowed the flexibility to set up an account for their medicaid population. they would place dollars into the account over which the patient would have discretionary control for health care expenditures. if they were not all used, a portion would stay with the patient. i know from my experience in practice, when i first started up i would see patients who were on medicaid who would have a tough time paying their medical bills. but it wasn't always going to be like that. they would get a job and the next thing you know they were on a reliable health insurance. but to allow them to begin to build toward that in those years while they were just getting started and they relied on a program like medicaid, a very powerful tool to put in the hands of people. and then the other aspect of things, you look at the rate of growth of the cost of regular indemty insurance, the high option p.p.o., about 7% a year. medicare and med

where is the hsas? where is the interstate insurance competition that would have brought down costs. >> politicians have made it illegal. i can't buy from out-of-state because new york has crazy rules that say i have to pay for acupuncture and mid-wives and who knows what? it would be more of a market if you could at least buy out-of-state. obama tonight, i read his opening statement, abc sent it to me will say insurance companies should have less freedom. >> see that, robert reich, less freedom. >> every one of the bills now coming out of congress would create more competition and would create exchanges in which consumers can get more and better information about what they're paying and what they're getting for what they're paying, that's what they're paying, you free marketers and i'm a free market going out to be celebrating these exchanges and celebrating the fact there will be a public option, let me underscore the word "option." it would actually put pressure on the private insurers. >> i'm sorry,

i think i have a blue cross/blue shield like plan, but i could have an hsa plan and not pay so much. that's the other thing. when you start

. >> host: am i right in this case the eco barons in this case, do hsa -- this is a trade-off between the environment and profiting from the new developments the bill or are they synergistic effect for the -- of the can preserve nature will they be able to get a higher price for the homes they build because it will be beautiful? >> guest: well, this has fractured the environmental movement in california because you have a number of very dedicated prominent environmental groups that send let's make this deal. we will take the 90% because it's better than nothing because if we fight and go to court and lose maybe we will lose everything and i didn't know this was going to happen when i started the book but as it happens the organizational profile and "eco barons," and i name everyone in the center for biological diversity, owl hooters we talked about earlier, they're still on the steel fighting -- they are old school. well, their position is that even with the amount of land being observed it's not enough to make up for the damage that will be done to nature and endangered species so it

hsa reform, health savings accounts. we should be able to pay our premiums from savings accounts. individuals should have the same kind of tax deduction as businesses do. big business ought to be able to get its claims information from insurance companies so they can compete their insurance. i could go on and on. there are a myriad of specific proposals that we support and they would all have one thing in common. they would either provide greater access or reduce costs, and they wouldn't interfere with the coverage that most americans have and like. >> so, senator, i guess the bottom line question -- the chairman, senator max baucus, and the ranking member, chuck grassley, do you think with the long list of things you just mentioned, that there is a bill that can come out of senate finance that is a compromise? >> i sincerely doubt it, because none of the things that i just talked about have been accepted by the democrats. president obama as a senator voted against most of the things i just mentioned. those are all good ideas. they're republican ideas and our colleagues have voted

the very proposals i was talking about of interstate commerce, personal deduck table built, using hsas to pay for a premium, small business health plan. he voted against all of these things, wolf, which leads me to believe that it is not health insurance he wants people to have but government control. >> there is some concern among some national republicans that the party, your party, is becoming a sort of a southern base. that's where the republicans have their stronghold. george voinovich, your republican colleague from ohio, is telling the "columbus dispatch" this. "we got too many jim demints i and tom coburns. it is the southerners. they get on tv and go err, err. people hear them, these people, they are southerners, the party is being taken over by southerners." i wonder what you want to say to senator george voinovich. >> well, he is apparently very frustrated. he has decided not to run again and i don't mind him taking out his frustrations on me, but the fact is if you look at the southerners, a lot of our elected leadership, like lee mar alexander, john cornyn, these folks are

>> a doctor, a 70-year-old doctor, who said to me the best thing you did in health care was pass hsas, which have engaged patience like i have never seen in ment