even worse is the fine print of ipab. now, get this -- if kansans determine that they do not like the direction the ipab is taking, and many of us as well, and call for my office and every other office here in the senate to ask the senate to do something about it, ask me to do something about it, we in congress can overturn their decision, but it has to be by a certain margin. on the surface, this sounds okay until you realize the president will never support congress overturning the recommendation of this board, so he'll veto it, and overrieg a veto takes a two-thirds vote. that's 66 votes to overturn a decision by ipab. my colleagues have been changing the rules around here because they think 60 votes is too high a threshold. what are the chances of reaching 66 if an arbitrary decision is made by ipab with regards to medicare. but wait, there's more. if the secretary appoints a board unable to make a recommendation for cuts to medicare, then she gets the authority to make the decision of what to put. this president has

i don't want him worried about ipab. i don't want him worried about icbm-10. i don't want him worried about whether or not they met the requirements of the electronic medical record. i want him worried about me. and i want him concentrating on me. and so we put this big distraction out there because we know better than the market, than the trained professionals, and the arrogant assumption that we know better than the average american about what they need because we've already told them what they must buy. and we've told them if you don't buy what you must buy, here's the penalty. and thank goodness, the young people in this country have figured that out. which brings us back to the integrity of the statements of the president. what did he say? we've seen all sorts of rationalization. if you like your insurance now you got, you can keep it. is that right? right now for 5,800,000 and soon to be 15 million americans, that isn't true. they knew it wasn't true when they said it, but it sounded good. the second deceitful thing, if you like your doctor, you can keep

it is now called the independent payment advisory board, ipab. an entity that was set up that when it's kicked in, 16 members picked by the president, they will determine scope of coverage. it is not the congress of the united states. if we don't legislatively do something with their recommendation, it becomes law. it goes into effect. the bill would cut payments to medicare advantage plans by approximately $110 billion over ten years resulting in a less generous benefit packages and decreasing enrollment in medicare advantage plans by about 33%. 33% of seniors would lose their advantage plan. again, mr. president, this is 2009. this is not today. higher costs present in 3,000 pages said it would reduce cost. the chief actuary says that's not the case. mr. president, let me read a letter, a letter i got in the last couple of weeks from a lori perez, willow springs, north carolina. i'm a divorced mom of three. i receive insurance through my employer. my rate has increased $100 a month. this is a huge difference that will have to be budgeted by red

actually, the ipab that's supposed to be in existence, they say it's not going to be involved, and it doesn't have the power to determine what care can and not be given. can and not be given, but as i believe not only are the people on the panel with me saying but i think in the comments of the members implies that what the ipab can do is determine effectively how much you get paid for it. and if the payment for something drops to a point where you cannot stay in business or keep your doors open if you continue to provide it, less of it is going to be available. so i think it's a bit of semantics, and i think some of the words can cause division, but the ultimate reality and the ultimate goal of the independent payment advisory board if medicare expenditures go up faster than inflation or 1% above inflation is to reduce those costs. and they are going to go where the money is. .. certainly if my world taking care of number of fractures and acute injuries i don't have luxury of longstanding experience with patients and families. you need to be able to get data so families can get the b

ipab is the number one i'm concerned about. they are worried about the reimbursement your hospitals in indiana, my hospitals will get in kansas. that's why we are trying to do the doc fix. at any rate, we were in the help committee. i had three amendments. all three were defeated by a party-line vote. that markup sat on a -- i don't know where it is now. it's collecting dust. it then went to the finance committee. i had the same three amendments. i wanted to offer the amendments on the floor. we are going to have a lot of problems with these rationing boards making decisions as opposed to individual patients and their doctors, if they can find their doctor, if they can have their doctor, period. so it gets back again to regular order. it gets back in to respecting the minority rights. it gets back into protecting minority rights. had we had those, i think that this bill possibly could have been worked out. i now believe that this bill was proposed by those that really prefer national health insurance and this was the stalking h

i have always been confused by those who hate ipab and hate medicare vouchers. take a deep breath and step back. they are after the same thing. holding health spending per capita to something close to gdp growth per capita. there is a dispute over the growth of level of benefits. there is a difference in who bears the risk of failure. beneficiaries -- but there are way more and comment than the antagonist have admitted. our debates would be more honest and more productive if we analysts could help them to see the essential similarities in the indications of their proposals. the cadillac tax simply taxes the exclusion. there are examples of where they were nonstarters before anyone had heard of the security act, much less the aca. i agree with paul. i spoke with self-insured firms last june. their ceo clients already directed them. make sure that we do not pay the cadillac tax. six years before they come into being. that is a hugely perp -- and packed full provision. provision.ull judgedance can be fairly against objective standards. until then, we rest the same

only are the people on the panel with me saying, but in the context of the members imply can do isthe ipab determine how much you get paid for it. if the payment for something drops to a point where you cannot stay in business or keep your doors open if you continue to provide it, less will be available. i think it is a bit of semantics and i think some of the words can cause division, but the ultimate reality, the ultimate goal of the independent payment advisory board if payment care expenditures go up faster than inflation is to reduce those costs. they're going to go with the money is. they're going to go to the andsive patients with mf say we're going to pay a lot less. they're going to say that centers like uris are going to not make services available. that that fromme what you say is negative to the health care system. the question is how do we get the best health care to the mom who brings her child to me. >> the best health care we deserve. >> trying to get patients and families involved on multiple levels and try to make the best decision for them. ofmy world, taking care fractu

i have always been confused by those who hate ipab and love medicare vouchers. take a deep breath and step back. they are after the same thing. holding health spending per capita to something close to gdp growth per capita. there is a dispute over the growth of level of benefits. there is a difference in who bears the risk of failure. there are beneficiaries -- but there is way more in common than the antagonists have admitted. our debates would be more honest and more productive if we analysts could help them to see the essential similarities in the indications of their proposals. the cadillac tax simply taxes the exclusion. there are examples of where they were in favor of nonstarters before anyone had heard of the security act, much less the aca. i agree with paul. i spoke with self-insured firms last june. their ceo clients already directed them. make sure that we do not pay the cadillac tax. six years before they come into being. that is a hugely impactful provision. overall spending targets are possible only when the math is clear and performance can be fa

novack, what are your views on this ipab, i believe it's called, the independent payment advisory board? >> sure. as i mentioned earlier, i just think it's a serious area of concern. i don't think that for those of us -- and, actually, for most families -- that creating another new layer of bureaucracy that are making determinations about accessibility is a step in the right direction. i would add that i think there's actually fairly senate bipartisan opposition to the independent payment advisory board because of the way it's structured and how their decisions effectively have the ability to bypass congress. >> do you have evidence that competition and choice is a better way to increase value and reduce costs than government bureaucracy in experts? >> i think there's a fair amount of evidence that if we increase transparency, provide more information to patients that a lot of patients will make better decisions. that's also true on the physician side. and a lot of those solutions are a lot simpler and cost a lot less than the 2 .5 to $3 trillion we're p spending on the affordable care

i have always been confused by those who hate ipab and hate medicare vouchers. take a deep breath and step back. they are after the same thing. holding health spending per capita to something close to gdp growth per capita. there is a dispute over the growth of level of benefits. there is a difference in who bears the risk of failure. beneficiaries -- but there are way more and comment than the antagonist have admitted. our debates would be more honest and more productive if we analysts could help them to see the essential similarities in the indications of their proposals. the cadillac tax simply taxes the exclusion. there are examples of where they were nonstarters before anyone had heard of the security act, much less the aca. i agree with paul. i spoke with self-insured firms last june. their ceo clients already directed them. make sure that we do not pay the cadillac tax. six years before they come into being. that is a hugely perp -- and packed full provision. provision.ull judgedance can be fairly against objective standards. until then, we rest the same