of a 80 billion build structures and there is no way in there to get the kids incentivize to use thetructures here and i'm not sure how saint ides of fact that, but they're all nice things we like to buy the right to have and can be shot already in stimulus, but they are not, definitely not hill ready. they're not something that is going to cause the people to do those things right away. there are other ways we can get people to read better foods with a meal act and have them to get exercise but that is with some incentive. there is a lot of equipment out there not being used toward and we could make that more available and smoking we did something and i said it was an adequate but the best we were going to do and i am pleased that we're able to do that but that is not what a billion is about and 80 billion is rather unspecified. there were more specified the things talking about like getting people to stop eating bad foods and salty foods and of those things incidentally burger king right now has a sign on the counter where you go to order and says, if you hold the cheese and hold t

directing money for infrastructure that we haven't said we're going to put the dollars there to incentivize people to use. you know with pittany bowes. we're living in the moment. my one big vice is eating a star crunch with a glass of mitting at night. the point is if i learned that because my bmi is elevated and i continue to do that, i'm going to have diabetes, and if i have diabetes, here's what that means for me, all these things in terms of changing my lifestyle.r screened. so the goal is, i'm with you all on wanting to create a prevention environment, and create an expectation that individuals need to be responsible, but the first thing you've got to do is be educated about it. i'm interested in us using what dr. cooper has down in texas, exercise and what that means. i don't know if you've seen el paso school system. for 12 years they had an exercise program in it. 6 their drug usage is down about 30%, their dropout rate is down about 25% rate. their graduation rate is way up. their grades are way up, their testing is way up and their college attendance is way up. through -- and it can all be dir

they are apparently proving to some character flaw that says on like the rest of us the need to be specially incentivized to treat their employe year's interest fairly. most of us in this society are able to go along without that. that is up to them and their shareholders but it shouldn't be done in a way that incentivizes to much risk and i fink is irascible that is happened in the past. i do differ with the administration and is the eternal and if we strengthen the compensation committee's we will do better. i agree with what they're trying to achieve and their statement of goals. i have less confidence than they that we will be able to find compensation committees that will have the independence so i would go further. but we do agree on the goals and with the administration on say on pay and i would simply say this is the first in the senate hearings that will lead the committee and i hope to begin marking up in a month a set of financial regulations that we will have to the floor of the house before we adjourn for the summer that will put in place rules that your life from the message we've learned f

apparently a pleasantly pleading to some character flaw that says unlike the rest of us they need to be specially incentivized to treat their employers interest fairly. most of us in this society are able to go home without that. that's up to them and their shareholders. but it should not be done in a way that incentivizes too much risk. and i think it is irrefutable that that has happened in the past. i do differ with the administration in that hopes springs eternal and that seems that if we strengthen the compensation committees we will do better. i agree with what they are trying to achieve there. i agree with that statement a goal. i have less confidence in me that they will be able to find compensation committees among these boards that have the independence. i would go somewhat further. we do agree on the goals and we do agree with the administration on say on pay, and i would say to say this, this is the first of the senate hearings that will leave this committee i hope to bring begin marking up in a month a set of financial regulations that i hope we will have before the house before we adjourned for

but there's a whole lot of difference between incentivizing good behavior and allowing us to control cost by having the government stepped between a patient and their doctor and i think we have to have a clearer provision. if we are not bring to have it what it says by default you admit you want cms to control the cost, so it is either we do or we don't and we are dancing around words here, but the fact of the matter is before we allow cms to ration care or not and that is the whole intent either we put a provision strong and say no, we don't want cms to stand between the patient and doctor or yes, we are going to allow quick and i think center roberts first offer a clear prohibition that cms will not practice medicine, and i might relate eyeball to repeat the stories about in the medicare and all of 1965 here is what they said, exact language you had originally. nothing shall be construed to exercise any supervision or control on the practice of medicine. guess what? we are not paying attention to that right now. that's why we need a clear prohibition is because the cms is practicin

practices, things that we can learn, but there's a whole lot of difference between incentivizing good behavior and allowing us to control costs by having the government step between a patient and their doctor, and i think we have to have a clear prohibition. if we're not going to have it, what it says is by default you want cms to control the cost. so it's either we do or we don't. we're dancing around words here, but the fact of the matter is we'll allow cms to ration care or we're not and that's the whole antenna. so either we put a prohibition that's strong or say no, we don't want cms to stand between the patient and the doctor or yes, we're going to allow it, and i think senator roberts' first offer, a clear prohibition that cms will not practice medicine, and i might just relate, i won't repeat the stories, but the medicare law in 1965, here's what they said. exact language you had originally. nothing in this title should be con strued or allow any employee to have supervision or control over the practice of medicine. guess what? we're not paying attention to that right now. that's why we need a clear p

put it in infrastructure for prevention and a way to get there which some people will use, but if you don't incentivize them, they won't utilize the $8 billion they'll spend on infrastructure every year, they're never going to do it. >> mr. chairman? >> senator casey. >> one comment on the discussion. it's important we understand what this prevention policy will result in, but in terms of the cost question which is critically important to the american people, i think what we'relying out of the discussion, i know my colleagues will disagree with this, but if you want to talk about cost over time, let's focus on another cost. giving people tax cuts. we've had a long discussion about that, but i don't know what we got for that. eight years of giving very wealthy people tax cuts and when this administration came in the door the economy was in the ditch, okay? so if we're going so if we're going to talk about $8 billion and $8 billion every year over ten years, that's important to discuss that. but i'm still waiting to hear what we got for giving wealthy people tax cuts year after year after year hundreds a

this moves us in the wrong direction. we need to incentivize the private sector, but yet we are expanding the federal government that will crowd out the private sector and stifle innovation and entrepreneurship. the american people are watching us. they expect their government to do exactly what they have done, cut the waste and tighten their belts. that is the message i have heard all across our district and from families who are experiencing unemployment and small businesses who have had to shut their doors. this congress continues to spend and spend and spend. rather than taking steps to improve the economy to create jobs for the 14 million unemployed americans, we are giving a better deal to the 2.7 million people who are already employed in the federal sector. this is the wrong message to send and i encourage my colleagues to vote against this legislation. i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from massachusetts. mr. lynch: i would like to yield at this time three minutes to the chairman

incentivize better behavior both in terms of prevention and wellness but also incentivize economic choice. the military has given us some. but i think the military is far from where -- what i would like to have for our military. i would like for military families to be able to go wherever they want and choose the provider that they want and nobody say here's the list. and i agree that there ought to be some economic skin in the game for every decision you make in health care as far as purchasing. but at the same time there ought to be transparency in terms of quality and price. we don't have price transparency and we don't have quality transparency. fact is, the doctors know who the bad doctors are but everybody else disnltd. why should that be? why should you not be able to have transparency in terms of being able to judge the quality of the provider that's giving you some very significant care for you and your family. host: we have an e-mailer who asked about hospitals saying how your play would impact hospitals. they say i would like to know how the republican mantra of everybody has access is any different? if

while we are incentivizing those alternatives, to make sure we are science-based as opposed to politically based, which is what got us corn-based ethanol, which is a disaster, and, secondly, we recognize that we need all the answers for a while here. importantly if we have climate change and have a hubris to the weekend control god's world, elisse would and would honestly and straightforwardly the term -- instead of trying to manipulate. host: "the financial times" april 2009, you called the president's focus and carbon dioxide histrionic and maniacal. why? guest: up to the reason for that -- what was left out is there was no discussion about what appeared clean water is a much bigger issue to the world and co2 emissions, although i think mandates co2 emissions certainly need to be controlled. my view is from my sense of science. i work in a world where we look at rocks better to hundred million years old. our scientists and engineers trying to find god's bounty of oil and gas for 100 years and we know that there have been periods of time in the earth where we had much higher magnitudes of co2, much warmer temperatur

build into the system here and obviously for lack of a better and incentivizing employee but where rican is a look across the range of ages use can they think about this as well in terms of how women make a difference so when we talk about people getting out into what they're doing in terms of visible exercise that is a mandate requires investment in this area with an anyone suggest going to work perfectly in will be out government functions. we know there are dangers associated with this but deeply concerned that if we didn't make these investments were wounded or incentivizing people's personal behavior and responsibilities we're going to come up short of that going and actually changing lifestyles and getting people to reduce the cost. our system is entirely dependent upon people showing up in a doctor's office or hospital to get well. that is entire system here and we're fundamentally trying to alter that and incentivize the system this is you don't show up at the doctor's office. it is safe fundamental alteration of how we have been conducting health care and to achieve that goal of 90 make that shift, how do we move thi

incentivized to engage in higher risk behavior. that's what economists who look at the model tell us when they fret about what we're doing here. in the context of systemic risk regulation, do we run the risk of distorting market by labeling those institutions too big too fail as such and more effective to focus on potentially high risk activities in the market instead, rather than a set of large financial firms, mr. spence? >> is that directed to me? >> yes,sir. >> we agree with you. we think that systemic risk regulator, not a question of labeling companies too big too fail but determining in advance and preventing companies to become too bill to fail. >> thank you. my last question goes to mr. skinner, because mr. skinner, you've spoken at length on the need to establish a federal presence on insurance in the united states as well as the problems e.u. regulators have run into when trying to negotiate with the various state insurance commissioners. there appears to be a consensus that something should be done in this regard. to what degree remains obviously questionable. when is an office of insurance information just an offi

directors of the largest work force in the nation, it's incumbent of us to let them know how we see them, to recognize them, to incentivize them, to recruit the very best and brightest people in this nation and to retain them. and how do we do that? by leading in terms of the benefits that other large corporations provide. we should be leading by example. but the reality is that other large work forces oftentimes provide better benefits than the federal government. we need to be in the leadership. this enables us to catch up. we recognize these employees by doing things that are tangible. and this is a tangible benefit. second reason is that we recognize that the most important time in anyone's life are those first few weeks after birth, where a parent has the opportunity to nurture, where the child can bond, where the child's brain can be stimulated and the child can understand they will grow up in a secure and safe environment. i very much thank my good friend. and i would hope that those who are in kind of knee-jerk opposition to this legislation would reconsider because mr. wolf perhaps expressed it best, these are th

if nuclear energy cannot be safely used and there's no way to store it we should look for other ways and incentivize other ways in order to make energy. the fact is, by whipping out fear and hysteria about cap and trade and coming up with clever slogans which i'm not even going to repeat, the fact is that we're simply clay -- delaying the inevitable which is the gradual acidification of our oceans, the acceleration of melting of solar -- of our ice caps, of expansion of desert, of loss of species of animals and plants, of intensification of hurricanes and all these very serious problems. the scientists all agree, the only people who don't want to listen to science don't agree and, yes, we have some of them here. the fact is, addressing carbon emissions, addressing global warming, is not going to hurt our economy, it's going to actually bring jobs. it's not going to hurt our farm economy and it certainly is not going to be the devastating thing that some people on the other side of the aisle claim that it is. the fact is, tonight i just want to talk to people who know that global warming and the acid

what they are saying is you've got to incentivize quality and cost for a payment system and you've got to be sent to fisa over utilization by not using a tax law which encourages over utilization. and yet, as i look at this proposal, there is nothing that addresses those points made by cbo as the way you start to bend the cost curve as is becoming the nomenclature of the time. interestingly enough, the president has sent to us a series of suggestions how you could best do the reimbursement issue side. they represent -- three digit $50 billion of potential reductions in the cost of health care and none of them are included in this bill. granted some of them deal with medicare but still it would have been -- they should have been at least sort of statement or overarching commentary the injustices where we can go to get savings and i haven't heard any great enthusiasm from the other side of the aisle for any of the president's proposals in this area. he has proposed we incorporate productivity adjustments and medicare payments that we reduce subsidies for hospitals for treating the uninsured, that we adopt medpac recommendations for pay

that if we do a better job of incentivizing reimbursement for a delivery system, medical providers, doctors, nurses, all the many health care practitioners are so important to us, unless we make sure that they are -- they have the reimbursement, they have the tools to be able to provide the care in the right settings in the community to help us have the information we need to have the right medical advice to work with us to be healthier. at the end of the day, our hope, i believe, is not only that we will extend coverage, not only that we will contain costs, not only that we'll improve quality, but at the end of the day, americans will be healthier. and if americans are healthier, we will in fact contain costs and be able to afford to make sure that we have no child in america without health coverage we don't have families who are bankrupt as a result, families who aren't worried because they have a member of the family with chronic disease and can't get insurance, if they can't act responsibly, that's something we want to do it's a goal the president has set out and a goal many of us have worked on. i look forward to standing on this floor and having the oppo

used to teach courses on the advance directive. a lot of decisions need to be made. whenever we do to incentivize and encourage people to fill these out, it really helps the physicians that i have dealt with you also have to be competent at the time that to actually execute one of these things. that might preclude any sort of mandate of a requirement. in looking at, you have to take that into consideration. >> what you are suggesting is more of an opportunity that is presented to people to do it than requiring them. >> sure. who wants to pay copays for three years? >> if the chair would allow us to work on this? >> absolutely. >> i will direct staff. >> i saw connie walking in. that is right. you know a lot about this area. i am directing you to sit down -- >> jurisdiction. we have jurisdiction over local communities. -- we have jurisdiction over local communities. that is where a lot of elderly people often go. >> senator roberts, you said you had an amendment that was ready. are you ready? >> yes. >> white. to let us know what it is? >> number one --it is robert number one. i will take it right

together and other things i think all of us share, democrats and republicans and as americans, is the idea if we are going to talk about energy we have to incentivize business and industry and the engineers and our universities to develop the science and to develop the entrepreneurship and give the tax incentives for investment for that type of energy in the united states. and to build the equipment here in the united states. there's no reason. it cost as lot of money to ship fragile mirrors over from germany. we can build it here. we can build it better. and probably export it and compete with the rest of the world. i think that's a pretty exciting opportunity. there are so many other areas. in my district off the coast of florida. most of you heard of the gulf stream. that's that perpetual current, 365 days a year, runs up and down, north of the -- along the east coast. right now one of our local

offer no risk you ought to incentivize them and this has been statements i made for a long time so even the risk-based approach can be modified somewhat. is there a way to give us a better handle? fifty you have better numbers that support this discussion draft at $375 million actually means $374 million worth of ability to inspect? >> regrettably i don't believe the 375 million will cover the cost of inspecting on the schedule outlined in the bill. actually would need considerably more source is to do that. we know based on estimates that very, we know domestic inspections, cost, a little over $9,000, national inspections are probably threefold higher, and the number of facilities requiring inspection and are very, very large numbering in the hundreds of thousands. >> my time is expired and i apologize. i would just say there will be skeptics that say okay we have 375 million on a fee schedule that will not go to inspection. it will go to other aspects of the fda would it help provide and if i can and on this because the chairman mentioned this once again that there has been negotiation with the republican colleagues. i would call them

use of testing, mis-classifications. this is one of the ways in which we seriously waste valuable health-care resources, and the reason we do it is because the system incentivizes it. we have a system unlike any other in any advanced nation where the system actually rewards you for these kinds of extra testing. now, this isn't an attack on the medical profession because one of the things you will find is that there are parts of the country that engage in this kind of excessive, inefficient over- usage, and there are parts of the country that don't. one of the things you will hear director peter orszag here -- say is the mayo clinic. it has one of the best and most cost-efficient records on precisely this constellation of measures. so, doctors know how to provide efficient care. but the system incentivizes wasteful inefficient care, and that is key to our reform. host: finally, mr. bernstein, a different topic before and let you go. lead editorial this morning in "the financial times," "and escape to soon for u.s. banks." letting banks out of tar is premature. the 10 have to demonstrate they can raise funds without guarantees. the temperature tenement -- put liq

us in that direction. 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 is tried to address, because it was a very creative and unique hybrid, what open with a pandora's box budget wise but now b