it wasn't just a question of incentivizing by providing vacation time are lower-cost and that actually build facilities in that place some in addition to a lifestyle change they invested the money in a wellness center where so they could take did manage of the incentives on site. not everyone can do that but i think tom harkin is suggesting with his proposal over 10 years which is a fraction of health-care cost is to 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

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

ask safeway, ask pitney bowes, when they start incentivizing chronic assessment and they lower the cost of participation, guess what happened? they went from 80% to 20%. >> greed didn't actually conker this time around. >> i'd be happy to go into this debate. i'd be happy to see that as many at this table as well. we set up and we are responsible for the majority of that. we allowed greed to run amok, i agree, it did solve of the difficulty of loaning the mortgage loans. we certainly loaned a lot of money to people that couldn't afford it. i want to go back to what richard burr said. if we don't design something that incentivizes people to utilize whatever program we put up and you all are in charge and you're going to ride it, but if we don't have the incentives for them to utilize it, it will be highly inefficient, and the second point i'd make is all throughout this bill there's not transparency once and there's not a metric anywhere to say what are we doing and what will we do? >> the transparency and accountability and metric, that's a good point, but tom harkin has a good answer.

so, it was the moment of some import and again i think the combination of incentivizing behavior for individuals to assume responsibility for their own health condition as well as the efforts that can be made in the larger context, to promote his efforts at thinker going to produce the results were looking forward to so i look forward to the discussion. >> mr. chairman, one other thing, it is just the old-- problem with cbo, but we have got good data out there from companies. we have safeway, pitney bowes, to name two of the big ones. smaller ones that i have come to know that have only maybe two or 300 employees, some may be less than that but have then remarkable things and they can show the savings. for some reason cbo can't seem to give us the score on that. >> safeways said the other day, mr. bird said the other day, the ceo of safeway, with an obese person that works at safeway, for every 1 pound of weight they lose as a reduction of $50 a year in premium costs with the 38,000 people that they are presently covering with their healthcare plan. one example of where come and agai

we need to incentivize prevention. pay doctors for prevengsz, pay primary care so we get more doctor going back into primary care. host: connecticut for senator tom coburn on our independent line. guest: good morning. caller: yes, good morning. thanks for taking my call. i just wanted to make a comment. i've been unemployed now, been over a year, and went through, you know, all of my employer's $700-plus cobra plan for medical which has been exhausted now. i have been collecting unemployment with please i can't. i do not -- want to seem ungrateful but i have been informed that i am receiving too much money collecting in order to receive medical from the state, medicaid plan. because i do have medical conditions that, you know, that i'm desperately in need of medical attention. i don't even know where to turn. you know, it's either collect and pay most of my bills, you know, just general housing, utilities, and put food on the table or maybe cut that in half and get the medicaid plan until i find a job. then i wouldn't

we believe that the market should be put into action so that people can save money and be incentivized to put some of that money in their pocket if they don't spend it by the end of theay. number three, we don't believe that health care decisions should be made by insurance companies, h.m.o.'s or washington bureaucrats. number four, we believe there should be less frivolous lawsuits. we certainly want to protect the tort laws in america but we conet want frivolous lawsuits. number five, we believe the patient-doctor relationship should be preserved and that we should not have a british, canadian or german-style centralized government planning where the doctor-patient relationship is destroyed and, mr. speaker, i yield back. thank you. . the speaker pro tempore: the gentleman from kansas. >> mr. speaker, i ask unanimous consent to address the house for one minute.

not saying the private system is any better, they followed suit and have done the same thing, incentivizing more care, not cost-effective care. there are examples of private plans that do a pretty good job. current >> i would like to focus on the self-employed which we talked about in his testimony. can you tell us about louise hardaway who was quoted $13,000 a month? i want to ask you to confirm what i think is true, her situation is not created by government, by government option programs or mandates. the self-employed are completely exposed to the marketplace with absolutely no protection under prior hippo laws in both states, in the regulatory protection. that group needs help. isn't that correct, mr. arensmeyer? >> that is correct, it is growing as part of the twenty-first century high-tech economy. you're absolutely right. the system could not be worse than it is working for them, directly or impeding economic growth. >> i am trying to decipher where the chamber is. at the end of your statement you talk about the chamber, time to reform insurance markets but you danced around the ques

the costs aren't going to go down unless we incentivize the management of chronic disease.y won't go down but continue to rise because disease prevention is the way to get out of this. and unless you this bill has that for the primary focus, the sustainability of it, getting out of this problem, we won't cut the 7.2% inflation rate in health care, especially with the demographics of people aging. you know, sheltering children, as bob casey said, that's important. we just modified schip and rejected a senate amendment that would have covered all of those kids and not raised taxes at all. yet we've got 16 million kids out there today that are eligible for schip and medicaid and they're not on the roll. why? because we're not listening to the patient. we're not listening to what we're doing wrong and we're getting ready to make the same mistake again. 16 million of them. so why are e.r.s loaded with kids with an ear infection when they're already medicaid-eligible? because we haven't oversighted and neither have the states in terms of enrolling those people to where they have

seen some very good models, some larger employers and insurance companies are working harder to incentivize people to eat right, exercise, prevent some of these conditions from worsening. but clearly we have a long way to go and we have much work to do to make sure we help folks with chronic diseases be able to be healthier to get better to not have the disease get any worse and of course in that process, it'll save them money and it'll save all of us the high cost of taking care of patients. any of us who ever visited a renal dialysis cent every know if we can do more to make sure that somebody who, for example, is early diagnosis of diabetic, follows the prescribed treatment, does try to eat right, exercise, really take care of themselves and gets good, consistent health care, and can prevent themselves from becoming more seriously ill and of course going into any kind of renal failure and needing renal dialysis would save them much problem and save us all a lot of the cost involved. just a few more numbers, i think they're telling. chronic conditions cost american businesses nearly $1 tr

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 from the most recent crisis and as i said we are here now because of concern over the amount of compensation but fundamentally because we think the incentive structure has contributed to success of risk-taking. t

prevention, will miss, and early health, suddenly, incentivizing providers through fair and proper payments to adopt in best practices, and reforming public programs to rudolf fraud. here's a little bit of representative jim mcdermott's op-ed. it's as we must address and comprehensive reform is an overall primary care in this country from how we recruit and train doctors. the pyramid has to be turned right side up with a solid and broad base that is built upon primary care moving up to the specialty practices. primary care is the key to reforming health care in america. here is a democrat from new york, senator charles schumer. in many areas of the country, one or two insurers have struggled on the entire market producing cost of premiums and health care decisions that may not always serve the best interests of the patient. this is why public health insurance plan is critical, to ensure the greatest amount of choice possible for consumers and provided least one option that is patient, not profit focus. host: john, an independent, you are on the line. caller: one dollar -- isn't that a great

now, the problem is more and more what our healthcare system is doing is it's incentivizing each doctor individually to say "how many tests can i perform? because the more tests i perform the more i get paid." and it may not even be a conscious decision on the part of the doctor. it's just that the medical system starts getting in bad habits. and it's driven from a business mentality instead of a mentality of how do we make patients better. and so what you've got it -- [applause] >> -- what you've got is a situation where for example the mayo clinic in rochester, minnesota is famous for some of the best quality and some of the lowest costs. people are healthier coming out of there, they do great. and then you've got places -- there's a counsel in mccal up, texas, where costs are actually a third higher than they are at mayo but the outcomes are worse. so the key for us is to figure out how do we take all the good ideas in a mayo clinic and spread them all across the country so that that becomes the dominant culture for providing healthcare? that's going to take some time. it involves ch

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

i think that the more we are incentivizing high-quality primary care, prevention, wellness, management of chronic illnesses -- it turns out that about 20% of the patients account for 80% of the care and cost of the health-care system. if we can get somebody, first of all, who is overweight to lose weight so they do not become diabetic, we save tons of money. even after they have become diabetic, if we are working with them to manage their regimen of treatments in a steady way, then it might cost us $150 when you break the costs for a counselor to call the diabetic on a regular basis to make sure they are taking their methods. as a consequence, we do not pay $30,000 for a foot invitation. so there are all sorts of ways -- for a foot amputation. there are all sorts of ways to improve footca health care, andt helps us manage risk. people will still get sick, and there will still be catastrophic costs. there have been a lot of ideas floating around in congress for ways that we can help to underwrite some of the catastrophic care that takes place that would help lower premiums. i am open to

more and more what arse -- what our system is doing is incentivizing each doctor individually to see how many tests they can perform because the more tests they perform, the more they get paid. it may not even be a conscious decision on the part of the doctor. it is just that the system gets into bad habits and it is driven from a business mentality instead of a mentality of making patients better. so, what we have have [applause] we have a situation where the clinic in rochester, minn., it is famous for some of the best quality and lowest costs. people are healthier coming out of there and do great. then there is a town in mcallen, texas, where costs are 1/3 higher but the outcomes are worse. the key for us is to figure out how do we take all the good ideas from this one clinic and spread them all across the country so that it becomes the dominant culture for providing health care. that is going to take some time. it involves changing how we reimburses doctors, doctors forming teams and working in more cooperative way, and that is a slow, laborious project. here is the bottom line.

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 liquidity guarantee program however remains available to them, in effect, subsidized by the government but freed from rules on compensation and hiring, they can approach staff and business from competitors still in tarp. guest: an interesting thing, a couple of weeks ago i was out here talking to the media and folks said, why won't you let these people get out of the tarp and now we are criticized from all how come you are letting its people get out? the deal is very simple. the stress tests evaluated how exposed these banks were to worsening economic conditions and what they needed to do to get their balance sheets in order. that had to do with raising the type of capital called common eq

it will get worse unless we incentivize people to have healthier behaviors. we can have these free-market principles in health care, have a healthier country, do it for less money, and not bankrupt or for the bankrupt our children and grandchildren with spending more than $1 trillion. we can do it if we have republican principles at the forefront. the next issue, the president introduced to supreme court nominee. it is good that we take this very seriously and give it some intellectual paul. -- intellectual thought. we need to talk about what the philosophy should be of someone on the supreme court. i do not believe it should be somebody who actually makes laws. the founders produced the greatest political doctrine in the history of the world. one of the reasons we are so blessed is because of the u.s. constitution and the vision that the founders put down paper. they said if you want to change it, here is how you change it. they did not say supreme court, you can change it because you believe the world should be at a different place. that put an amendment pr

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 the summer that will put in place rules about the ride from the message we have learned from the most recent crisis. as i said, we are here not because of concern over the amount of compensation in general, but fu

the application does not incentivize the question of these options are in fact it strongly penalizes the introduction. these are all good reasons to prevent ba-aa from going ahead. the support of this alliance have to resort to other arguments to prevent the regulars with a normally would prevent. the current economic melee is no reason for antitrust immunity through. ba and american had helped to see the avocation approved by the end of last year and yet this would have represented a dereliction of duty by the regulators to rigorously asked back the long term impact of a ba-aa tie up. not to provide special protection from the immediate challenges of economic cycle. what would the ba-aa monster monopoly be like when the economy recovers? antitrust laws should not be ignored during an economic downturn for good reason. because when the economy recovers competition and consumers would be faced with a permanently changed the market. that would be unsustainable, and consumers, the intended beneficiaries of competition laws would be the biggest losers. of course, there's an element of se

and that's the incentivizer here. we could never come up with all the lists of the myriad of list of things you might want to do to make people participate? a lifestyle that was better for them. and it might actually vary state to state. the northeast you might have a different wellness program than you'd have in arizona simply because of the physical ability to use the outdoors. so, i mean, i don't think we want to get into minutia here. we want to set it up to create the incentive for wellness to be a large part of employers' ability to say to people. if you get the prescreening, if you join a gym, if you get your -- if you do -- if you stop smoking, you're going to benefit. and that's going to benefit the price of the insurance for the entire company n that's what's going to drive the decision on the program. they're not going to put in place wellness programs and give them no return in the reduction of insurance premiums. i guess we'll get to talk about this again. >> i want to instruct the staffs here to really w

the application does not incentivize the creation of new service options, in fact it strongly penalizes the introduction of price competition. these are all good reasons to prevent the b.a./a.a. from going ahead. supporters of this alliance have to resort to other arguments to permit what they would normally prevent. the current economic male last is no justification for regulators to let the application for antitrust immunity through. b.a. and american had hoped to see the application approved by the end of last year. yet this would have represented a der lick shown of duties by the regulators to vigorously access the long-term impact of the tieup on competition, not to provide special protection from the immediate challenges of the economic cycle. what would be the b.a./a.a. monitor monday nol poly be like when the economy recovers? antitrust laws should not be ignored during an economic downturn for good reason. when the economy recovers, competition and consumers will be faced with a permanently-changed market. that would be unsustainable and consumers, the intended beneficiaries of

we have a serious problem it will get worse and worse unless we incentivize people to have healthierehaviors. we can have the free market principles in health care with a healthier country and do it for less money and not bankrupt once again our children and grandchildren with spending with the president says $1,000,000,000,000.02 make sure that they ensure the uninsured. we can do a for less if we have republican principles of the forefront. the next issue you may have heard the president introduced the supreme court nominee. it is good that we take this very seriously and give it some intellectual thought that this is something we take seriously. but we need to talk about what the philosophy should be of somebody on the supreme court. i don't believe it should be somebody who actually makes laws. the founders produced the greatest political document in the history of the world. it is truly, one of the reasons we're so blessed as the country because of the united states constitution and the vision of the founders put down on paper. guess what? they said if you want to change it here

they're incentivizing wellness. and that's what we have to have as a exoan yentd of any plan that -- component of any plan that we put forward. host: texas, good morning. our independent line. caller: good morning. host: good morning. you're on. guest: good morning. caller: good morning. i've been listening to the republican's argument about the h.m.o. system for four years. it's been a failure for four years. i think we can all agree on that. guest: i agree. caller: one of your comments about not having a single payer system -- and i am on medicare and i love it. it's socialism. would you define socialism for me, please? guest: i'm not sure i said medicare was socialism i may have. i certainly may have in the past. socialism is when you take from those and give to somebody else on a plan with the government at the central area managing the system. medicare works. but we can't afford it. we've got a $38 trillion. your medicare right now is being paid for by the tax that are going to fall on your children and grandch

incentivized to flood the market with predatory loan products such as subprime mortgages. for financial gain and increased systemic risk. as a result of this increased systemic risk, the american taxpayer has been asked to bail out financial institutions through liquidity tools, such as the capital purchase program and turn asset-backed securities, or tal. that money is not a gift but regular alone for about. as such require certain protections. one of these protections is special master who will place transparency into the system so the public and shareholders are properly informed. to the extent bonus compensation poses a systemic risk, get to merit some limits. i think our witnesses today for having the guts to frame a discussion on which bonus compensation limit may be appropriate to rein in systemic risk. with that said i do not believe noncriminal recipient should have their salaries capped by the president or the congress. thank you, mr. chairman. i yield back the balance of my time. >> one minute, mr. moore? one minute. i apologize. mr. campbell for one minute. >>

for that reason, i have introduced the rewarding achievement and incentivizing successful employees, or raise act, h.r. 2732. it will allow working union members to escape the false choice between collective bargaining and individual reward that our outdated labor laws have forced upon them. senator vitter has introduced similar bill in the senate. under the raise act, union members would retain all of the collective bargaining rights under current law and employers would be bound to the wages and benefits schedules negotiated under those laws. in addition to the floor established by the union contract, employees could add bonuses for -- employers could add bonuses for those workers who go the extra mile combining the benefits of collective bargaining with the rewards of individual achievement. years ago admiral grace hooper observed that in all of her years in the united states navy she had determined that the greatest impediment to human progress is the phrase, but we have always done it this way. that's the only answer we have heard so far in opposition to this simple reform, and

the answer is we do have standards and we have other bills in congress to incentivize the building of green homes, particularly in h.u.d. homes. there's a bill winding through congress now and the author of this is congressman perlmutter from colorado. that bill called the green act, a very good bill. another important part of the bill is reduced carbon emissions from major u.s. sources by 17% by 2020 and over 20%. complementary measures such as investments and preventing tropical deforestation. now again, this is an important piece of the puzzle. the united states needs to do its part. i hear people from the other side of the aisle say, china and india? what about china and india? what about other places? if america sets a mark down there that we are going to cut our carbon emissions, that sends a possible signal and enhances our ability to our neighbors around the world and say you have to cut yours, too. america is leading out there in front and doing the right thing not simply saying we are going to change our carbon emissions when other countries change theirs. the united states

we explore -- there are not many countries doing that anymore because we have not incentivize them. we spend about $1 billion a year to find new resources. we have the deepest performing platform in gulf of mexico, cleaner-burning natural gas and a footprint about the size of this building environmentally. to create that kind of supply, 1.5 percent of all natural gas demand in the country, would require a solar panels over all of washington, d.c., and more and two states work of windfarms. it tells you about the scale and intensity of the hydrocarbon fuels we have use for 50 or 100 years. we have to be careful as we transition that we understand the environmental footprint are alternatives. what disturbs me a bit is forcing people to be proposing solar power, the same people who shot down putting solar power and the mojave desert. if we cannot put in the mojave desert, we are in trouble because no one i know wanted in the back yard. how will we get this wonderful answer if people who are fighting traditional fuels are also fighting the citing of the alternative fuels? host: kathleen

we have to incentivize doctors and hospitals and our health care system more generally to keep people healthy. to keep them out of the system. to not wait until the last minute. until the situation develops that the gentleman talks about. just think about one disease which in western pennsylvania where i'm from is in near epidemic proportions and that's diabetes. which in some cases is preventable. some cases it's not. but for every individual that you can put on a program of wellness and prevent diabetes from taking place, or at minimum delay the onset, you are changing that person's life for the better. you are making a material difference in the life of that person and their family, but you're also in a more global sense saving money for the health care system and you take that one person times the entire country and the entire group of people who you can delay the onset for not just diabetes but any affliction which they may later get in life, you can prevent injuries if you keep people healthy. the weekend warriors and so forth, joint injuries, arthritis, the onset. these are ver

what is so important is if you have the patient and the doctor in charge of their care, you incentivize quality, make sure the doctor has the timely information through electronic medical records. those are things we are not doing. look at other clinic the mayo clinic, university of pittsburgh medical center, ones that are focused on we're going to change the quality of care you see the costs go down. that's part after the -- part of the focus we need to have. with that, i yield back to my colleague. mr. kirk: i want to talk about some solutions we're going to put forward. what's lost in the debate is we agree with the president we should lower cost. we agree we should expand health care. we think we have a better way. many times in the partisan debate, people can say we have no alternative. so we've spent about 90% of our time coming up with that alternative. we want to make sure that we guarantee the rights of each patient in the doctor-patient relationship so you or a loved one in your family is allowed to carry out the decisions made by you and your doctor, and not be interfered wit

and so if you can incentivize a huge number of people that are currently not getting screenings, are not, you know, just doing the nurse coaching that's available. a lot of very simple steps that really over the long run will be much more from a preventative nature. i think that's what we're talking about here. if we go from 20% to 30%, then i think that's more of an incenti incentive. it's not to ever punish anybody who either has diabetes or has other chronic diseases because, one if they get the screenings, if they go and do all the procedures that are required, be sure they check their blood sugar, be sure they do all those things, then hopefully, they, too, would be able to qualify. but the overall amount isn't going to go up for somebody else. i mean, it's not like if it goes to 30%, somebody else is

and we need a lot of things to either suggest to or to incentivize or to mandate that the health care providers do. but in the end result, if that person is sick, they're going to have to see a doctor and they're going to have to see a nurse and they're going to have to see some health care provider. so in the end result, we better at least be doing something that the providers say, yes, this makes common sense or you're going to see either one of two things. you're going to see a political revolt. and they say, no, we're not going to go down that road. or else you're going to see a continuation and rationing where providers say, no, i'm not going to take part anymore in the medicare program because i'm not getting reimbursed up to cost. and in that regard, then, you see rationing. you can have the best government program in the world, the best government card in the world and it can guarantee all swords of things. but if you can't provide a doctor that really provides it or a home health care provider that will provide that or any provider that will provide that, well, where are you?

little has been done to incentivize a new nuclear production. nuclear power is safe and emission free. what it does is inadequate considering the overall goal of this bill. there is no framework for an international agreement on climate change in this bill. this framework -- framework -- my district will lose thousands of jobs to countries like india and china if this legislation is passed. i oppose this bill and urge my colleagues to do the same. i yield back. >> gentleman from michigan. recognized for two minutes. >> without a job -- without objection, so ordered. >> climate change policy is a moral imperative. . action is a vital part of our legacy to the nation and to our children and grandchildren. we must ensure that the energy industry is not placed at a competitive disadvantage by nations that have not made a similar commitment to reduce greenhouse gases. after discussions between energy and commerce committee's , and the administration, we have developed a reasonable proof -- provisions that involve the president and congress in taking

that if you do believe in wallace and prevention, this -- in a wellness and prevention, this is incentivize. 248 of the 300 or so it took up the plan. what do you think? >> i would like to do more research to see if that is a common experience. i am trying to see but plan is more popular with the help the and the affluent. one of the things is if you are bored about the employers dropping their coverage, that goes too much of our discussion of how important employers share the responsibility. >> they did not drop coverage but allowed the government plan which did not play the providers but only two-thirds costs. i'd like to know how many people will lose theirs. i want to know is will you provide all of this other care comes in, who will provide it? we do not have enough nurses and doctors in america. we have more doctors retiring in the next 10 years. i am sorry my time is up. >> thank you. you have given me great confidence that we are on our way to doing something very reasonable. thank you for your leadership. i have a short question and then a larger discussion. choice. we are assuming

if we can incentivize people to maintain healthy lifestyles, that will be important for this portion of our bill. host: out what time might we see details? guest: we are in the midst of drafting these details and to legislative language, and we talked about the scoring. it is difficult. in our system, the gym -- the majority get their bills scored first. so it will take time because we are at the end of the waiting line, but over the summer we will be coming out with these provisions, certainly. host: thank you. representative dave camp, republican from michigan, ranking member of the house ways and means committee. after another short break, we will talk about foreign policy with brad sherman of california. we will talk about iran and take calls. be right back. >> coming up shortly, rhyme emmanuel speaks to the democratic leadership committee. the senate health committee meets this morning to consider and make changes to health care legislation is -- legislation. that is 10:00 a.m. eastern on c- span 3, and both the mets are also online at c-span.org. right now, look for our redesig

replicating best practices, incentivizing excellence, closing cost disparities, any legislation sent to my desk that does not achieve these goals in my mind does not earned the title of reform. my signature on a bill is not enough. i need your help, doctors. to most americans, you are the health care system. americans, and i include myself and michele and our kids in this, we do would you tell us to do. [laughter] that is all we do. we listen to you and trust you. that is why i will listen to you and work with you to pursue reform that works for you. [applause] together, we take all of these steps, i am convinced we can bring spending down and quality up. we can save billions of dollars in health-care costs and make our system work better for patients and doctors alike. when we align the interests of patients and doctors, we will be in a good place. i recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulders for fear of lawsuits. [applause] i recognize that. do not get to get excited yet. -- too excited yet. [ap

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 now. and then you will not have to listen to me. >> is this an alphabe

i think whatever we do to incentivize and encourage people to fill these out, it really helps, i think, the physicians that i have dealt with but you also have to remember, you have to be competent at the time that you actually execute one of these things. so that might preclude any sort of mandate of a requirement. so i think in looking at it, you certainly have to take that into consideration but i do think if you can be more instead of the stick, a carrot approach would

think you should go after risky individuals pompano that in essence 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

there is little to incentivize a new nuclear production despite the fact that nuclear power is safe and emission free. what little it does is grossly inadequate considering the overall goal of the bill. there is no framework for an international agreement on climate change. in the absence of such framework, my district can count on losing thousands of jobs to countries like india and china. i oppose this bill and urge my colleagues to do the same. >> she yells back her time. michigan? >> action on climate change is a policy indeed a moral imperative. prompt action is a vital part of our legacy to the nation and our children and grandchildren. as we act, we must ensure that the u.s. energy industry are not placed at a competitive disadvantage by nations to of not made a similar commitment to reduce greenhouse gases. after discussions between energy and commerce and the ministration, we have developed reasonable and effective provisions which involve the president and congress in taking action no more than necessary to insure this important legislation is neutral for energy intensive and

we're only going to be able to do 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

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

matches the quality improvement efforts that are being done around the country and rewards those and incentivize those. i know that in the senate health bill i was admiring some of the things that they did that were beginning steps to do this but sensible kind of things like we're going to pay a physician's office extra money if they do follow-up on hospital discharges. this is a huge problem. it costs us an enormous amount of money. it's very simple to solve but the current system we have has nobody responsible for that. well, why not pay a little bit extra money to save some money? so i think this is -- this is one big point. the other thing i would just say is i really think that with the advented of a public plan, we're going to see a much more responsive public system to payment rates because it is not going to be just the elderly or just the poor. if we mainstream public insurance i think we're going to get a much more responsive public insurance system all the way around. >> okay. thank you. did you want to say anything, mr. pollack? >> i would just add to that that i think the more move

part securely -- the special your primary care doctors, who we want to incentivize. we want to encourage people to stay healthy. we want more doctors like that. you are paying them less and less. the best and brightest are not going to go into medicine. guest: it is interesting that two of the doctors on the program -- the republican doctors and i are at such odds. dr. coburn has a different point of view. he is very conservative and by not. dr. gingrey is quite wrong. my wife is named judith, not elizabeth. good thing he is in congress because i would hate to see what he would do to patients. caller: how come none of the democrats or any republicans are calling -- i believe in talking to people in the health-care industry. illegal aliens cost us $300 on $1,000. who is going to address the situation? guest: the numbers are not right, but the problem is right. we do not pay 30% of our health care costs for undocumented people. here's the dilemma. if you are a doctor and somebody comes to you, you have taken an oath to do the best you can to get them well and get them

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 uninsu

so replicating best practices, incentivizing excellent, closing costs disparities, any legislation sento my desk that does not -- that does not achieve these goals in my mind does not earn the title of reform. but my signature on a bill is not enough. i need your help, doctors. because to most americans you are the health care system. the fact is americans, and i include myself, michelle and our kids in this, we just do what you tell us to do. [laughter] >> that's what we do. we listen to you. we trust you. that's why i will listen to you and work with you to pursue reform that works for you. [applause] >> together, if we take all these steps, i am convinced we can bring spending down, bring quality up. we can save hundreds of millions of dollars on health care costs are making our health care system work better for patients and for doctors alike. and when we align the interests of patients and doctors, then we're going to to be in a good place. now, i recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulders for f

competitive advantages to companies in a have implicit backing of the taxpayers and they would be 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 s