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

the point is, we can do a lot of things to 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

. >> well, in some ways you answered your own question. because i think that the more we are incentivizing high-quality primary care, prevention, wellness, management of chronic illnesses. and one of the things that it turns out is that about 20% of the patients account for 80% of the care and the costs of the healthcare system. and if we can get somebody first of all who its overweight to lose weight so that they don't become diabetic we save tons of money. even after they've 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 prorate the costs for a counselor to call the diabetic on a regular basis to make sure they're taking their meds. and as a consequence, we don't pay $30,000 for a foot amputation. all right? so there are all sorts of -- [applause] >> -- all sorts of ways that i think that we want to improve care. and that helps us manage risk. now, people are still going to get sick. and going to still be really catastrophic costs. and there have been a lot of ideas floated around in congress or the

we don't want to do that in a way that's going to incentivize employers to say, well, you know what, i'll just stop offering health care coverage and all my employees can go into the plan. that is not what this is about. and we don't want to add one more financial burden to half of the small businesses in the country, the ones i'm talking about that are already unable to afford health care. we don't want to add to their financial burden. we recognize that this is a very complicated issue and it's going to be very difficult to achieve these goals. mr. murphy: mr. altmire, we spend so much time with our business community, our chambers of commerce when we are back home and when they come visit us down here, that we know what the reality is out there. that these folks that right now can't afford to give health care to their employees desperately want to do that. they want to do it first because it's the right thing. they are members of their community like anybody else is. they want to be able to provide health care to their employees whether they have two employees or 40 employees. tha

wellness differential. 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

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

employees found out is 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

program, it's about how do we most effectively get that government program to incentivize the management of chronic disease, wellness and prevention, and i don't think what we're doing -- i don't know whether it will work or not, but i can tell you it's not efficient. it isn't going to be efficient because we've missed the one connection that causes people to change their behavior. and that's economic. it's an economic incentive, and we can -- greed does conquer difficulties. it does conquer difficulties. innovation comes from it. people will act in their own self-interest. 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

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 this 300 million people in our country and the coming generations and a chronic illnesses. with and we do what we can to move that shift to the juan assigned. it is a herculean investment and anybody tells you it is fine to produce the results doesn't know they're talking about. it is hard to do this but absence of trying to do but i guarantee without it will fail. when so i'll be the first to admit i don't of this is going to work or not. and what we don't now have incentivize individual the now predict what the outcome here and which represent and i see no indication that the costs will decline or that the numbers of uninsured are going to go away as we wish them to appear in this is a bad we are taking a chance and all of us need to admit that but doing nothing about this absolutely guarantees an out

are no doctors there, particularly primary care doctors that we want to incentivize to treat the sick but also to enhance wellness. we need more and more doctors like that, and you are paying them less and less, and the best and brightest are not going to go into medicine, and they are certainly not going into those specialties that we are most in need of. host: by the way, howard dean is out with the new book and will join us tomorrow. paul is on the phone from fort leavenworth, kansas. caller: how're you doing, congressman? i am a retired army veteran and i am pleased with my health care system. thank you for keeping that cost look for our veterans. it is good to know we have it. my point is, we were told that tarp had to be expedited, the stimulus bill had to be expedited. now we're being told that his health care reform has to be pushed through quickly to leverage the political capital of democrats. i am very concerned with the government spending that, if the bill gets passed through quickly without thorough analysis and debate, that we will have issues with runaway inflation. just like any government progra

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 again some people struggle. some have when shuler issues or genetic problems. it

well, we want to be fair here, though. that's our goal of the bill. we want to incentivizerenewable, this green energy revolution should be every where not just in certain parts of the country. so we need to find a way then to make sure that we don't invoke this kind of consequence that undermines economic development in states that have incredible resources indigenous to them. and that's a real difficult problem here and something we have to work through. i apologize to everyone. i really could spend a whole afternoon with you, and next week i might spend an afternoon with each one of you in working out this issue because we have to be fair. we have a bigger vision. every state can play a role here. there is a row for everyone. we have to make sure that we winter to the east coast the things that are theirs, and so forth to the rest of the areas. even as you were saying, you represent a 75% of the land mass in the united states. there is an ocean mass as well that is also up there. excuse me? that is what i am saying to you. i want to make sure they are able to go out into

wellness. something that everyone can agree has to be an important component. 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 wee

but ujs we know, unless we incentivize through economic means, we're not going to get large participation in that. so that's the end of my sh peel. >> well, again, there are different sections to this title. one of them is the community transformation grants. again, we have to remember when we're talking about prevention and wellness, it's not just clinically based. senator coburn thinks i think because of his training more about the clinical aspect of it. that's fine. there's other parts. the there's the school base. we've talked about that. there's the workplace base, some of it being done here, some of it being done by the finance committee. there's also the community based. the trust for america's health, as i mentioned earlier, came out with this report and findings last year that they funded that showed that there is a big cost benefit ratio to community proven community-based wellness programs that communities engage in. not every one of them are obviously beneficial. that's why we take a look at them. that's why we have these demonstration grants in there. and that's why this is i think a part of this excuse my using this word ho

well below the national average. these are all islands of excellence. we need to make a standard in our health-care system. 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 t

know there's discussion about wellness programs for prevention, we've 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

well below the national average. these are all islands of excellence, and we need to make the standard in our health care system. so replicating best practices, incentivizingxcellent, closing costs disparities, any legislation sent to 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