the next for you about is medicare advantage. it is a private medicare plan to provide different benefits that usually do not have these gaps. host: why is there a deductible , $1,000.68? jake -- $1,0068. guest: it is not intended to cover every dollar. is more like if you hit a certain threshold it will cover these expenses. lower income people have medicaid instead. their 7 million seniors who have dual coverage. medicaid also provides supplemental coverage. so, the issue is that for people who are notpo poor, this should cover some of the cost. the idea was to make sure that the beneficiary has some sense of sharing the costs. and also to keep the cost down. host: what is the theory behind after 60 days of big co-pay kicks in? guest: a lot of it was cost. in 1965 the program was originally projected to be $3 billion per year. this year is $470 billion. so, the issue is largely because. hospitalization is pretty high. very few seniors see the deductibles. the issue was cost. there's times the legislation was passed to cut some c

medicare is a federal program. no, medicare provides something and some of you are old enough to remember when senior citizens have a lot of trouble getting health care coverage in america. medicare in 1965 was a program put in place by that president and a different congress over a lot of opposition. i was a young man in 1964. i was a high-school debater. and a topic that year was, does medicare equal socialized medicine? that was the national debate topic and i had to debate both sides of it. do we regret that we instituted medicare? i do not. it has saved a lot of senior citizens from going into penury and has provided quality health care for millions of americans, and we need to make sure that it will be there for the next generation as well. that is how i am going to look at it. as i said, i am not committed to any particular bill but i am sure committed to making sure that we build on the system that we have. we're not trying to change it, and we're not going to federalized healthcare in america. but the feder

how you can accept medicare? is medicare socialism? >> i'm not sure you want me to answer the question, lawrence. >> is medicare socialism. >> no one is suggesting that. >> is medicare socialism? can you say yes or no? >> of course not. >> it's not socialism? tell me why it's -- because it's old it's not socialism? because it was done in the '60s. >> lawrence, i think -- you illustrate -- for your listeners, you are illustrating why msnbc's viewership is in the tank. you don't allow the people you're interviewing to answer. lawrence this is why katie and everybody else is going to facebook, why listen to msnbc when you don't let the people you're interviewing answer the question. >> i don't want you to spin your time here. i want you to get serious. >> i am trying to get serious. you are trying to change the subject, my friend. >> let's delete the over 65 part of medicare and make it available to everyone. what's your argument against that. >> no one has ever suggested repealing medicare or -- >> why not? they're both socialistic progra

medicare is 20, medicaid is 7. private insurance is 50. so when you think about who pays for doctors and who pays for hospitals, most of the money comes from a private source, and medicare and medicaid make up the different percentages. now one thing you should know about public payment rates, in case you don't. is that two-thirds of all hospitals, two-thirds, have a negative medicare margin. medicaid pays differently and less than medicare. in general. so our public payers are not what you'd call wildly generous. both pay less than private payers an of course this is one of big controversies that is role, but it's a very serious fact. private payers pay a heck of a lot more per patient relative to cost than do medicare and medicaid. i'll close with a reminder of what this debate is about. what i'm showing you here is that basically, 35% of our population in poverty is uninsured. medicaid takes care of some of the poor, not all. and some of the poor, believe it or not, actually have employer but 35% are uninsured. they represent 36.5% of th

the average payment in that county toward medicare is very different. it is $11,000 a year. year. that is the traditional medicare program on top of that coming you can buy an additional private not related to medicare supplemental. is a confusing enough? or you can stay independent across or anna -- aetna, i want to buy your plan. the government is one to pay $11,000, they are likely playing aetna of thousand dollars. if you say, how does it happen? the numbers of people in managed care were dropping because the payments were too low. we were trying to make it more attractive for a few years. some technical errors were made in the drafting of it. some were paid more. it is not that the plants make our money. hmos are regulated and they make 85% profit by the regulator. -- a 5% profit by the regulator. it is difficult for congress to fix this because seniors are happy. they get lower premiums and more benefits. there is a great debate on how much should we cut medicare at the damage payment. -- medicare advantage payment. one person has a reaction that is unfavorable. the ho

>> there is no cap on medicare. there is on social security. medicare is now not capped. e social security cap fica bill -- that is social security taxation. as we reach -- social security is now in good physical shape. begin to start have to have a problem in late 2013. there will be a need to do some adjustments than -- in late 2013. -- 2030. there will be some -- there is some free-setting mechanism in here, part of it going back to what the doctor mentioned before. there is an effort in this bill to create attractiveness of becoming a primary care physician. there is a problem with compensation of primary-care physicians. we have a special issue in massachusetts by the way. health care is important because it is a service that people get and as an industry. it contains big employers. in the hospitals in general, it in the greater boston area, they are very important for the state's balance of payments. people come from all of the world to get care and spend money in massachusetts. we also have a burgeoning medical products industry, which is a high-tech industry less l

the medicare is running out of money. you're a patient you want to pay an extra $50 to your doctor to get seen quicker, medicare denies that right to patients. also, if you want to leave the medicare program, as jat just said, you are de-- as the gentleman just said, you are trapped in that program and there's no competition. finally, medicare wants to institute called pay for performance that wants to pay doctors for meeting certain government cree with the medicare with the medicaid supplemental because medicare pays 53% of my costs so i lose money every time i take those patients. basically, why is medicare denying patients the benefits they expect and why won't they -- host: what is your practice? caller: i do trauma call. the system needs to change. and we cannot have more government control. it's breaking the economy. and in the end the rights will be denied fishtse and there are rationing boards being set up. host: tom scully. guest: the more you have rational debates. i'd like to see health reform pass this year.

medicare part d is no great -- medicare part a and b basically shoves you, unless you have a great employeres you to buying private health insurance which is not always a good deal for seniors. host: do you agree with that, mr. vladeck? guest: no. it's a substantially better deal, the medigap plans. i can't resist because tom has a couple times mentioned for part c plans run ploss ratios about 86% which is to say that of every dollar the government pays them 86% goes to pay for medical benefits. the medical loss ratio in traditional medicare part a and b is about 96%. so it's that 10% that comes off the top in the private plans that's the source of concern to many people. in terms of what bin fisharies of the program are getting for the 10%. it's clearly what the insurance companies are getting. it's much less what the government or the beneficiaries are getting for them. host: ken, 65 and older, you're on. caller: i got three little things to make. pardon? host: please go ahead. caller: i go to a specialist every three months and he charges $220 for an office visit. medicare pays him $88.0

would you have voted for or against medicare? >> it is not spinning. >> would you have voted for or against medicare? >> in 1935 social security was set up as a safety net as a last resort. >> it still is. >> therefore, of course it was there for people who -- my father, who grew up in the depression, my dad told me without those safety nets, john, people just died. and that's unacceptable. >> that's right, enacted by democratic presidents over the opposition of republicans like you -- >> i know, your heroes, lawrence. i know that. >> was fdr wrong to enact social security or not? >> i just told you, lawrence, if i were here in 1935, the very limited scope of social security as it was designed as a safety net of last resort, of course i would have supported that. >> how would you have voted in 1965 on medicare? >> in 1965 -- i voted against, in fact, lawrence -- i wasn't here in '65 but i did vote against the medicare prescription drug bill. i voted against farm bills -- >> would you have voted against the invention of social security by

and health reform is not going to fix that or medicare. will only fix it as a nation, as we grow up and decide that it's a public responsibility to ensure the health care professionals. host: allen is a health care professional. what do you do? caller: thank you for taking the call, i have over 40 years of experience. i joined h.i. p. of new york, as a pre-paid private system. back then all the doctors were sal ride. -- salaried. and prior to medicare, it had problems because patients had to wait months to see doctors in some cases. and this is the model for the single payer that i am really against. but going back to medicare, the insurance companies to me need to be addressed. now the federal health care benefit program has all insurance companies go through an accreditation process. this is a process where they are evaluated. not all insurance companies can sell to federal employees because they don't meet their standards. this is one of the best cost controls we could have. and also other measures to bring down the cost. i had one perso

medicare is 20, medicaid is 7. private insurance is 50. so when you think about who pays for doctors and who pays for hospitals, most of the money comes from a private source, and medicare and medicaid make up the different percentages. now one thing you should know about public payment rates, in case you don't. is that two-thirds of all hospitals, two-thirds, have a negative medicare margin. medicaid pays differently and less than medicare. in general. so our public payers are not what you'd call wildly generous. both pay less than private payers an of course this is one of big controversies that is role, but it's a very serious fact. private payers pay a heck of a lot more per patient relative to cost than do medicare and medicaid. i'll close with a reminder of what this debate is about. what i'm showing you here is that basically, 35% of our population in poverty is uninsured. medicaid takes care of some of the poor, not all. and some of the poor, believe it or not, actually have employer but 35% are uninsured. they represent 36.5% of th

medicare is 20, medicaid is 7. private insurance is 50. when you think about who pays for dtors and who pays for hospitals, most of the money comes from a private source, and medicare a medicaid make up the different percentages. now one thing yoshould know about public payment rates, in case you don't. is that two-thirds of all hospitals, two-thirds, have a negative medicare margin. medicaid pays differently and less than medicare. in general. so our public payers are not what you'd call wildly generous. both pay less than private payers an of course this is one of big controversies that is role, but it's a vy serious fact. private payers pay a hk of a lot more per patient relative to cost than do medicarend mediid. i' close with a reminder of what this debate is about. what i'm showing you here is th basically, 35% of our population in poverty is uninsured. medicaid takes care of some of the poor, not all. and some of the poor, believe it or not, actually have employer but 35% are uninsured. they represent 36.5% of the uninsured. ok. and

medicare celebrating its 44th birthday this week with more fraud charges. is it time to fix medicare first before we embark on this new system? >> are you kidding? you have to. this is like saying we'll redo the state rooms on a cruise ship. when the motor doesn't work, there's holes all in the boat. if they can't run medicare, they can't run a national health organization either. you have $60 billion in fraud, doctors ordering tests people don't need because they're scared of being sued without some type of medical fraud reform this thing falls apart. >> the numbers are astounding. the fraud allegations run into the hundreds of billions of dollars. in terms of just medicare. >> that's true. and medicare needs to be cleaned up and fixed. but i don't think it's an and/or. i think part of the whole health care reform or national health plan will include fixing medicare. in the boat analogy, you do need to paint the whole boat at one time if you don't want to be able to put the boat out of service for such a long period of time. i think it needs to be fixed toget

medicare has no network. host: if somebody isa member of park city, do they have recourse with medicare? -- if somebody is a member of medicare part c, do they have recourse? guest: they have recourse with the private insurer but essentially, they can go to medicare. host: can you drop out of medicare part c if you joined and want to go back to a and b? guest: only once a year. it was modeled after diem -- federal employees benefit plan. there are two months a year where seniors get brochures and can shop the plans. in the fall, like federal employees, they get the brochures and make their choices at the end of the year and they can change them once a year. there are exceptions to that but generally, you can also change in the spring but you cannot change of you were involved in job benefits. host: 45 people -- 45 million people in the medicare system right now? 22% of them are in medicare part c? guest: some kind of private health plan, yes. about 50% are in hmos. -- there are 15% in hmos. \ there are a number of companies that

this is not medicare dollars. this is not health plan dollars.is is their personal family savings. so when you talk to family members -- now, you know, when patients die, of course, we try to ask people as they're going through these illnesses what they want and what the experience is like for them and how can we improve it. but part of what matters in the way we care for patients at the end of life is the memories that are left behind. and the way to find that out is to ask the families. so family members tell us this is what they want. they want their loved one's wishes to be honored. they want to be included in the decision process. they want -- and those are the two things, by the way, that the legislation that susan put up there addresses. a way of getting -- the patient to tell the doctor that information. the rest of this is what good pallative care and good hospice programs can do. personal care needs, practical help, honest information -- i can't tell you how many times in many studies and actually in patient interactions that i've had w

medicare is not -- reimbursement. medicare is not working efficiently. it would be nice if it were true. >> ben, the numbers speak for themselves. we're talking about the dealers dropping out of cash for clunkers. look at doctors anecdotally who will no longer take medicare. you have more than a quarter of medicare recipients who have trouble finding a primary care physician. only half the physicians take medicaid. we're just beginning to see doctors not accepting government insurance, particularly if we get more of it. >> also, i mean, you're saying that the cash for clunkers is new, but wouldn't this new health care reform, wouldn't that be new as well? women have the same sort of assumptions. i don't see how -- there is not a loft dots to connect. there is one dot. they messed us up. they didn't know how much it was going to cost the first time. they thought a billion was good. they misjudged that. >> charles, there is a process already in place that pays the doctors. you're right, i used the wrong word with efficiency. it does work. the doctors do ul

benefits, but save money overall and will actually increase the life expectancy of the medicare trust fund, which is in deep trouble if we do not do something. as he said, money does not grow on trees. we are actually trying to preserve medicare and make people healthier in the process. all right. [applause] young lady in the back, there. right there. >> good afternoon. my name is sarah landry. i am a single mother of two children and a university student. i have son that suffers from many disabilities. he is disabled for the rest of his life, she is 11 years old and suffers from autism, he is not verbal, if he suffers from extremely hard-to-control epilepsy, and he is diabetic. he has been sick with these elements since he was nine months of -- old. what with this reform would happen with this coverage? >> first of all, thank you for sharing your story. you are a heroic mother. so we are grateful to you. your son is lucky. [applause] if your son already qualifies for medicaid, he will continue to qualify for medicaid. so it would not have an impact on his benefit levels and ability to get the care

this next comment is about medicare part d. est: it is the prescription drug benefit that was added to the medicare program in 2003. host: this your rights -- -- this viewer writes -- guest: well, i do not think that aarp supported the coverage gap. at the time there were only willing to put so many dollars into providing that drug benefit. one of the ways they go with that was by the architecture of a program which provided for the coverage gap which we believe is a serious flaw that needs to be closed. host: here is another question about it. guest: it is interesting you raise that. it was offered as an amendment in the energy and commerce committee showed before the house left for the august recess, and it is a provision we strongly support. that is something we believe ought to be in the final package. host: kentucky, on the republican line. caller: i would like to make a comment about medicare and insurance. i do not appreciate our president to get on the air and say that he will let us keep our insurance that we have. you

constantly. >> all right. >> constantly interfering. >> medicare -- i'm sorry, which isnterfering? >> medicare never interferes. if anything, medicare is too permissive. there's too many things they allow they should not. they should tight en it up. private insurance tells me what hospital, what laboratory, what meditation, whether i can admit the patient, whether i can't admit the patient. it's incredible. >> but the argument is, as you know, doctor, that with government-run health care there would be great intrusion by the government and the government, you mentioned medicare, is 35% more expensive over the past 30-some-odd years than all of the other private programs combined per patient, so that's not a very likely model either. so what would be the two -- >> medicare is treating old people. medicare is treating old, sick people. great amounts of costs the last two years of one's life. it has to be more expensive. >> my question is what are the things you would like to see done, the top two requirements for successful health care reform? i know there are many more. j

medicare. [laughter] true story. and so, i think it is important for, particularly seniors who currently receive medicare, to understand that if we are able to get something right, like medicare, then there should be a little more confidence that maybe the government can have a role, not the dominant role, but a role in making sure the people are treated fairly when it comes to insurance. [applause] under our proposal, the majority of americans will still get eir health care from private insurers. all we want to do is make sure that private insurers are treating you fairly so that you are not buying something where you fail to read the fine print and the next thing you know, when you get sick, you have no coverage. we want to make sure that everybody has options. there has been talk about a public auction. this is where a lot of the idea of government takeover of health care comes from. all we want to do is set up a set of options so that if you do not have health insurance or you are underinsured, you can have the same deal that members

you said medicare is run by experts. to are these people? a program that is $39 a trillion in the red -- $39 trillion in the red. help from howard. i asked you to answer. you are my congressmen. howard dean is not my congressmen. >> all those in favor of getting rid of medicare, raise your hand. all those in favor of getting rid of medicare, raise your hand. thank you. [unintelligible shouting] >> answer the question. >> medicare is not in the red. [booing] we do not use general funds. it is true that we are going to run out of money sooner than social security because the cost of medical care is going up. i do not know anyone over the age of 65 who wants to give up their medicare. the reality is that medicare costs have gone up at a much slower rate than private insurance company cost and medicare use is 3% of the trust fund money for a ministry of costs, whereas in the private system is 30%. medicare is operating at much less cost. we need to figure out a way to pay for it. in the long run, this is one of the ways that we intend to do that.

they said-- and they have an argue in the fact that medicare is 11% a year already because of the great increase of demand and prescription benefit and so on. so the one hand he says don't worry, on the other says we have to cut medicare. >> i think he knows we have to cut medicare. medicare from the start has been unable to meet its promises. in 1965, they said that by 1970, that that would cost about 3.-- 3.1 billion dollars. it came in at 6.5. in 1967. they said by 1990 that it would cost 12 billion. it costs almost ten times that. so, you know, basically what happens when something is free, paid by the government, the demand is always going to outstrip supply and the only way to ration that is to have someone come in an arbitrator and this is too expensive, you can't have that and i think that seniors see that coming. >> and medicare rations in numerous ways, doesn't it? >> that's right. certain procedures that diagnostic, again, something called a virtual colonoscopy. >> and certain asthma medications, all sorts of restrictions on what type of care doctors are allowed to deliver or

to medicare advantage which is people over 65 to people over 65 you will find very similar satisfaction rates, in some cases higher satisfaction with medicare advantage. if you compare the specific co--population cohorts. if you look at the kinds of cost containment and quality improvements, none of the elements that we have introduced with physicians in a clabtive way, namely disease management, care coordination, paying for quality has been actually successfully introduced in medicare. g.a.o. did a study saying that imaging in medicare is rising, excess utilization in traditional medicare and they ought to adopt the techniques that private sector plans have. unfortunately another members of congress said don't incorporate those techniques. so government has a difficult time getting through the politics. during patient protection we brought health care costs, this is post the 93-94 period, we brought health care costs down to zero. and in some cases below zero. the message we got from politicians was that we were too aggressive in using utilization re

that's what medicare is. we have 50 million people in the medicare system, a veterans affairs system which is very good so we already have nationalized care. there's already another group of people of which senator frist was one, congress has a socialized health care. you get sick, go downstairs to the doctor, go to walter reed hospital. it's all government run. the question is, who's going to choose? my question is why can't we, given the successes of this national health care system, why can't we let more americans make their own choices? the truth is, not very many people will actually choose a public option. senator frist talked about the medicare part d which has been very successful. only 6% choose the public option there. but to have the public option, if you can't get into an insurance company, if they cut you off as unfortunately so many of them do, if you get sick, if you move, if you lose your job the public option is always there. a wonderful thing about medicare is they don't charge you any diffe

medicare is 20, medicaid is 7. private insurance is 50. so when you think about who pays for doctors and who pays for hospitals, most of the money comes from a private source, and medicare and medicaid make up the different percentages. now one thing you should know about public payment rates, in case you don't. is that two-thirds of all hospitals, two-thirds, have a negative medicare margin. medicaid pays differently and less than medicare. in general. so our public payers are not what you'd call wildly generous. both pay less than private payers an of course this is one of big controversies that is role, but it's a very serious fact. private payers pay a heck of a lot more per patient relative to cost than do medicare and medicaid. i'll close with a reminder of what this debate is about. what i'm showing you here is that basically, 35% of our population in poverty is uninsured. medicaid takes care of some of the poor, not all. and some of the poor, believe it or not, actually have employer but 35% are uninsured. they represent 36.5% of th

medicare is a federal program. dicare provides something, and some of you in this audience are old enough to remember when senior citizens have a lot of trouble getting health care coverage in america. medicare in 1965 was a program put in place by a different president and a different congress over lot of opposition. i was a young man in 1964, i high school debater. the topic that year was, does medicare equalize socialized medicine? that was the national topic and i had to debate both sides of it. do we regret that we instituted medicare? i do not. it has saved lives of senior citizens and has provided quality health care for millions of americans. we need to make sure that it will be there for the next generation as well. that is how i'm going to look at it. i am not committed to any particular bill, but i am committed to making sure that we do -- i agree with you -- we build on the system we have. we are not trying to change it. and we are not going to federalized healthcare in america. but we already have to --

medicare is a bit wasteful right now, but the medicare will not go away as mike knows it. >> here to e have something wonderful in the united states. the there's no place in the world you want to be if you get a rare diggs order, if you get cancer, have some freakish kind of injury. we can deal with that. in canada, for example, they're not good at that. they come here to get treated for that, people in canada, but they're really good at broken ankles, bad colds and the ow wees we take care of. how do we adjust our system to get what they have but not lose what we have, the best critical care in the world monopoly. >> sthast absolutely the trick. there is a reason rich saudi princes come to the united states for their medical care. it's great for those really difficult to attack big problems you describe. that's the trick. how do you keep that but try to do the other parts better? i'll give you an example. when a woman has a baby in england, she has a nurse coming to her every day to make sure she and that baby are doing okay. on a regular bay ses, she gets that visit. here a new mom

medicare. [laughter] true story. and so, i think it is important for, particularly seniors who currently receive medicare, to understand that if we are able to get something right, like medicare, then there should be a little more confidence that maybe the government can have a role, not the dominant role, but a role in making sure the people are treated fairly when it comes to insurance. [applause] under our proposal, the majority of americans will still get their health care from private insurers. all we want to do is make sure that private insurers are treating you fairly so that you are not buying something where you fail to read the fine print and the next thing you know, when you get sick, you have no coverage. we want to make sure that everybody has options. there has been talk about a public auction. this is where a lot of the idea of government takeover of health care comes from. all we want to do is set up a set of options so that if you do not have health insurance or you are underinsured, you can have the same deal that member

you're suing for your right personally to get out of medicare. is that the problem that seniors hate medicare and they want out? >> i didn't say that. i was talking to my minister the other day. my minister said, dick, i'm so fortunate i'm in medicare. i said, bless you, my friend, that you get to be in it if you chooseo be so. but give a government program and you let me choose to be in and choose to be out, that's generosity. if you force me in irrespective of my desires, that's tyranny. medicare's $46 million in the red with no idea how we're going to pay for it, why do we not let people who don't want to be in out? >> that's a -- this is a really important point. >> this defies logic. >> the anti-health care reform lobby thinks health care is tyranny. you said in 1995 that medicare is a program i would have no part of in a free world. you said in 2002, we're going to have to bite the bullet on social security and phase it out. >> it's exactly what i'm talking about. >> medicare -- >> this is your -- >> too the medicare law that was written -- >>

the answer is medicare. you of the one who said we have no [no audio] i think that is wrong and i cite medicare. the private insurance companies have thrived with medicare. i think they have been too generous with them. medicare has not put private insurance companies out of business. >> [no audio] >> after 44 years -- >> [no audio] >> yes, it is for people over 65. after 65, most people on medicare do not work. >> i want to thank you for coming tonight. [no audio] it is great that we have the opportunity for you to come down to express our democratic rights in this republican form of government to adjust our questions. in the interest of full disclosure, yes, i am the republican state committeeman from the district and the regional chair. i voted for president bush twice quite proudly. i am here as a constituent with a personal concern. i haven't read the health bill. i trust that you have substantially. >> don't wait for the movie. it is not coming. [laughter] >> i will agree, i think that some of the thing

so what we've proposed is not to reduce benefits, benefit on medicare would stay the same. it's not too ration. but what we are asking is that we eliminate some of the practices that are not making people healthy. example number one. subsidies to insurance companies under medicare amount to about $177 billion over 10 years. that is how much we think we could save by eliminating subsidies to insurance companies that are offering was called that your advantage. it doesn't help seniors anymore than regular medicare does. and so if we took that $177 billion, we're not making seniors worse off. we've got that money now, not only to strengthen the health care system overall, but potentially to cover more people. navigations companies don't like it, but it is the right things to do. let me give you another example of changes that we should make. right now when you go into the hospital, you get a procedure under medicare. if you end up having to come back to that hospital a week later because something went wrong, they didn't do it right, the hospital doesn't pay any penalty for tha

or medicaid or whatever. >> if medicare was such a great program to begin with, why is that having so much red ink. we are talking about expanding a nationalized medicare and that is going to help the deficit? not like medicare is running in the black right now. i don't get the argument from any perspective. >> let me give pat a second to respond, too. pat? >> i think the core issue as ease alluded to earlier are you need to reduce overconsumption and tax a benefit that people get. i have a cadillac healthcare plan and i don't pay a darn dime for it. that that is insanity. as toby mentioned that is one way to reduce a big distortion in the system. and if people what they consumed is tied to what they actually pay they will see the cost curve bend down. >> bottom line is, a government-run healthcare plan going add it to or reduce the deficit? >> dramatically increase the deficit over the next 100 years. >> and we have 37 trillion of unfunded liability. >> they brock the bank on medicare and medicaid already. >> we need to address the uninsured. if we don't do it now. it

medicare is basically a private system wh a government funding. an amendment was offered in every committee to have the members of congress and the staff in any government option as a mandate. if this is good enough for the american people, it's good enough for the politicians. in every committee, the democrats voted no. now, why is it they want to insist on a government-run system for people other than the congress, but the congress and their staff would be exempt? second, i think it's not intellectually not honest to suggest that sis going to be a matter of choice. we're talking about a specific bill. the way the bill in the house would work, if your company didn't offer any insurance, they would pay an 8% tax on their personnel costs. for most companies that would be a net savings of 3%, 4%, 5%. one estimate by lewin associates is 141 million americans will lose their private insurance and be pushed into a government plan. >> governor, had those systems taken ahold -- >> lewin associates is owned by a health insurance company. so let's -- cbo wh

and fans is more expensive than traditional medicare. i agree with much of what you said, is that you cannot compete the government. the government will not be able to adapt these wonderful techniques. why is there an argument there should not be a competitive argument. >> in terms of head-to-head? >> said that i could choose a public option. >> the last point that you made was very important. that is the last thing i did not comment on. on head-to-head bases, why is medicare cheaper? medicare is cheaper because it pays eighty-five cents on the dollar. if we continue to get ourselves that underpaying hospitals means cost containment, then that will put us on the path to ruin. that is why so many hospitals have stood up and said, if you pay as medicare rates, we're going to go bankrupt. we're going to dismantle the entire system. the question is, how do we back up and do the right thing and put together a policy that works, and frankly, can get past? there are key elements that can get past. medicare and manage, i would love to talk abou

what we have proposed is not to reduce benefits. benefits on medicare would stay the same. it is not to ration. we are asking to eliminate some of the practices that aren't making people healthier. example number one, subsidies to insurance companies under medicare amount to about $177 billion over ten years. that's how much we think we could save by eliminating subsidies to insurance companies that are offering what's called medicare advantage. it doesn't help seniors any more than regular medicare does. and so if we took that $177 billion, we're not making seniors worse off. we have that money now not only to strengthen the health care system overall but potentially to cover more people. now, the insurance companies don't like it but it's the right thing to do. let me give you another example of changes that we should make. right now, when you go into the hospital, you get a procedure under medicare. if you end up having to come back to that hospital a week later, because something went wrong, they didn't do it right, the hospital doesn't pay any penalty for that. they jus

. >> social security is bankrupt, medicare is bankrupt, the post office is bankrupt. how am i, as a proud american, going to trust you people to do the right thing? >> the initial cost is over $1 trillion for a down payment. my children and grandchildren are going to pay for this bill. >> reporter: some supporters of reform respond by saying health care costs are a huge part of the deficit problem, reform is necessary to tackle the issue. >> health care reform that brings down the growth rate of health care costs will help our children and grandchildren in affording health care and having less debt. >> reporter: the president makes that argument, too, and has made this promise. >> first of all, i said i won't sign a bill that adds to the deficit or the national debt. okay? so this will have to be paid for. >> reporter: but some budget hawks worry congress, so far in drafting the ledge slargs, is avoiding tough decisions on controlling costs. >> from what we're seeing so far, it doesn't look like they're tackling the real cost drivers of health care. and that means if

sean: medicare is rationed. ight now people are denied coverage. >> harry reid said that there will be public auction. it will be government run. rahm emanuel is very insightful and he said that the goal is not negotiable but the passes. . the-- the path is. this is government run health care. sean: what if the democrats go alone? what will happen? >> that will not work. i think it will go to the senate. sean: you think this is dead on arrival? this is the holy grail. >> that's right, we think of it as a human right. where the constitution does this say that we have a right to privacy? it has been interpreted. are you saying that we shouldn't be watching out and providing care? i have confidence in the government and private-sector. with to demonstrate the allergen trappers in pledge, we've trapped kimberly in this glass box... with all this dust. well, it's only dust. in that dust are allergens from pet dander and dust mites. eww! pledge with allergen trappers... traps up to 84% of allergens in dust. 84%? that's

by and large, medicare is a pretty popular program that is working well.ost: 1 article in the "new york times" talks about the state of health care, saying -- do you sense that? guest: certainly, at my meeting, it is evenly divided. there are lots of folks who are passionate advocate for reform. there are lots of others who have serious and grave reservations about the fine print in that reform. the generation that remembers the new deal is fading away, so we have to make a rational argument about why we cannot afford to continue down the path we are on. because it will not be sustainable for anybody. if you like your medicare today, which most recipients to, we want to make sure it is there for you tomorrow, as well as for you and your grandchildren. host: maryland. good morning, rita. caller: i just have a comment and a question. i am an independent and i have listened to a lot of obama. it is all about what both parties must do. certain people have interests and holdings, and in the meantime, we have insurance companies, and then the lay people suffer.

medicare socialism? can you say yes or no? is medicare socialism? >> of course not, it's a program that's been in place for many, many years. >> because it's old it's not socialism because it was done in the '60s. >> i think, lawrence -- for your listeners you're illustrating why msnbc's viewership is in the tank because you don't allow your people you're interviewing to answer questions. you know, lawrence, this is why katy and everybody else is going to facebook. everyone is going to the internet because why hisen to msnbc when you won't even let the people you're interviewing answer the question. >> yoment you to spin your time away. i want you to get serious, okay? >> i am serious, lawrence. you're not serious. you're trying to change the subject. >> if medicare is not socialism why don't we delete the over 65 part of medicare and make it available to everyone? what's your argument against that? >> no one has ever suggested repealing medicare or social security? >> why not? >> because if we're going to restore the country to the constitutional f

medicare. it's not to ration. what we are asking is that we eliminate some of the practices that aren't making people healthier. example number one. subsidies to insurance companies under medicare amount to about $177 billion over ten years. that's how much we think we could save by eliminating subsidies to insurance companies that are offering what's called medicare advantage. it doesn't help seniors any more than regular medicare does. and so if we took that $177 billion, we're not making seniors worse off, but we've got that money now not only to strengthen the health care system overall, but potentially to cover more people. now, the insurance companies don't like it. but it's the right thing to do. let me give you another example of changing that we should make. right now, when you go into the hospital, you get a procedure under medicare. if you end up having to come back to that hospital a week later because something went wrong, they didn't do it right, the hospital doesn't pay any penalty for that. they just get reimbursed for

that is half a trillion dollars. medicare advantage is at the top of that hit list and the top of that cut list. please know that. >> the president had town meetings in montana, north of wyoming, and then in colorado, south of wyoming and said that if you have a program you like, you can keep and in the same speech, he said we would eliminate medicare advantage which is to 10 million american citizens. i am sure there are people like you today -- we really have 3000 in wyoming -- when they put the program in place, it was intended for people in cities and people in rural communities. that is louisiana. i had the privilege to tour the newly opened new orleans state medical university medical area. it is stated the art. doctors around the world will come their to learn things about computer simulations surgery. i am an orthopedic surgeon. it is beautiful what they have therefore cardiologists and for general surgeons and four medical students, four nurses, positions, it is absolutely incredible. they also have a program to help