paradigm because we have proven the bureaucracy in washington does a good a good job of managing the medicare system for the medicaid system. waste fraud and abuse and incentives for people to live healthy lifestyles and that the medicare system has mess of this events were held late lifestyles so setting up a billion dollar a year annual fund noir without any oversight basically ends up being secretary/ms. nilsson's this emmy this bill and the cbo's for this bill as costing $2.3 trillion when fully implemented over 10 years and not pay ford and the bill is anibal to score the most expensive part which is going to be the employer mandate and a public plan. so this bill is headed to a 3 trillion to $4 trillion pricetag front page and added to the event and there is no reason to aggravate that with another $80 billion basically walking around here and it just doesn't make any sense. if you want to create incentives in the public sector to changing the medicare rolls for people to pursue a healthy livestock i have a number of amendments to accomplish that and to simply throw a bunch of money on the tab

medicare. every person who picks private insurance costs the system money. the congressional budget office, a nonpartisan objective scorekeeper here says the medicare advantage premium we pay over what we would pay if they were fee-for-service costs the system $150 billion over 10 years. so the public option is not only to offer choice to the people of our country between a plan they want, that's available to them, whether it's a private plan or public plan. remember, the providers are going to be private. it is not who provides the benefits but who pays for it, who puts the plan together, the save the system money. part-d, this is no public option in part-d. many of us raised that issue back then that they would have saved taxpayer money and saved medicare money if we at least tried to keep the private insurance company honest by having a public plan that we know what is being charged in paying for prescription drugs. most of it is the cost of medicine. why can't we have transparency? why do we have to pay the high overhead without the competition of a model

the limitation of care under medicare system i know very well and firsthand as a physician practicing under that system, and medicare limits the ability of physicians to care for patients in a remarkable number of ways. so i would join the chairman and hoping that we would have a very thoughtful, sober, reflective, honest debate and discussion. and if we do that, i have great faith we will come up with a system that will reflect the ideals of americans. >> i thank the gentleman. and i would just conclude with this comment. an american president stood up and said that the country needed a law to be sure that every person had access to quality health care and health insurance. and he said that if we did not take steps to achieve that objective, that the economy of the country would suffer greatly, and more importantly individuals and families would suffer greatly. that president was harry truman, and his words were repeated by various other presidents since then. in 1971, richard nixon proposed a system of universal health care through an employer mandate. icy chairman conyers shaking h

one is a total single heyer nationalized health care system, medicare for all. one would be a private system for all, which is what we on the republican side back. and the other is a public and private system that are competing with one another. . i really watch with great interest to my colleagues on the other side talk about how this could be a great deal, a great success, where you have a public system that's competing with a private system and somehow that's going to drive costs and prices down and we're going to get a dividend from that. well, what i would do is point out to my colleagues, let's look at medicare today and medicaid as well. both government-run systems. both of them are running out of money rapidly. the budgets are exploding and expanding and they are living off the fat of the private system. today we know, in fact a recent survey, a study came out showing that the average subscriber to private insurance spends an extra $1,000 a year to support the medicare and medicaid system. we also know that a lot of that support comes by way of the uninsu

system. the government already takes out medicare taxes and stuff on the check. i do not see why it would be such a big deal to take out an extra $20 for someone who wanted that type of insurance. the other idea -- they want more basic insurance. that is just what medicare is. if they wanted something like aarp, people in their 50s could get the supplemental. host: thank you for the call. a story in "the washington post" president obama welcome to todd gay patrons. the president saw to assure guessed that he had not abandoned the issues important to them. next is a caller from miami. caller: i am calling from miami and i want the world to know what is happening in honduras. i have been happening -- i want everybody to know that what is going on in honduras right now is beneficial for the country. it was not a coup. it was a judicial order followed by the military. it was backed by congress. it was backed by the attorney general. all of the population is happy with what is going on in honduras. the images you guys see on tv is not a representation of what is reall

the private clinics, is not available under the one government program we have in america, the medicare system. we have also, a veterans care system but under medicare there is no alternative. you can't have private care. if you are on medicare and you go to a doctor that serves medicare patients it is against the law for him to treat you and then just champion you individually for that. under medicare it is either medicare or no care, that's the law. i know because i tried to get it changed. we tried to get something called private contracting, the same as in canada, we troyed to get that for medicare so -- we tried to get that for medicare so if you were not satisfied with medicare and you wanted to speed it up and you could find a doctor who could do it, whatever amount he would charge you had the right to do that. no, what congress did was to say, and this is in the middle of the night in a conference committee, you can't do that. only if a doctor says, in advance, i will treat no government patient, no medicare patients, for at least two years, is he able to provide that care to you. so w

but medicare was the people who had worked all their lives to put money into the system. so that when they got to be 65 -- i am 71, by the way. but before i became 71 i was under 65 -- when i went to the clinic i had to pay the doctor -- get this -- the doctor before i could see him. i think the fee was $40. i am not sure. anyway, but when i got to beat 65, then i came into the medicare system and that took care of that, ok? guest: yes, and medicare still provides care for the elderly. you are in directly touching on an importance point which is that in fact people have been paying into medicare their whole working lives and expecting it to be there when they retire. but what has happened is because health-care costs have risen so dramatically, so much more than expected, the money is not there in the medicare trust fund to provide health care for the elderly. that is why we need comprehensive health care reform. the president spoke yesterday about savings within the government program, but it this is in the context of a more comprehensive proposal to stop, lower the rate

all of the cost overruns that occurred in the systems run by the government, medicare, medicaid, indian health service, the veterans' health care certainly not quality when you see the limitation of care that is imposed by the federal government responsiveness and innovation in the same sentence as the federal government is rarely used and rightly so and then choices, choices are always limited by governmental intervention and to the end of the costs which i think is an incredibly important to address. dr. gratzer, would you comment what is included in our estimation of health care costs that may not be included in other asian destinations of their health care costs? >> well, let me -- dr. price, i fully agree with your comments. with regard to what is american medicine do that one wouldn't find elsewhere in the world, research and development would be a great example of that. there is more spent at one facility in the united states anderson on research and development and the reason the entire country of canada. america is the leader in medical technology to solomon and implementation.

too much of the medicare system is driven right now by the number of times a provider touches a patient, not necessarily what happens at the end of the day. so the system you described, which not only would provide for a coordinated strategy, which is really what we need to occur throughout the country, but also save money, it makes sense to provide those incentives to providers. >> great. thank you for your service. >> sure. >> thank you for being here. >> thank you, mr. markey. miss christiansen? >> thank you, mr. chairman. i guess there is some benefit, i guess, at least in this instance, to being a delegate. and not having to go to vote. welcome, madam secretary. good to see you. last week we had some very good conversations on health disparities. but i note that at least in reading your testimony, because i had to step out both in the senate and here, there was very little, if any, reference made to this very important issue that by itself, results in close to 100,000 premature preventible deaths every year. i hope you'll work to make sure your entire department is sensitive to thi

to bring that kind of a system to a national level steers the heck out of me. i happen to me on medicare and frankly i do not like the idea i was forced to take medicare -- guest: you are not forced. there is no law that forces you to take medicare. you can pay for it out of your own pocket, you can come up with other options. but we spend 16 percent of the federal budget to give people a choice, making a huge people -- different lots of americans. there is no gun in your head. caller: medicare has to be my primary and by private insurer has to be my secondary and now medicare is gatekeeper for united healthcare and instead of getting the test that i need before preventative maintenance, i have to wait a year for a prostate exam, concerns about pet scans and cats can't ping allowable and my wife had lung cancer -- guest: i would strongly recommend. you have great people in new jersey. i strongly recommend you talk to your member of congress about being forced to wait a year for a prostate exam. let me go back to my comments, objective data by independent sources that evaluates the costs

medicare's propped up by the privately insured as it is and still on a course for bankruptcy. within 10 years. our president says he can make a government-run system lower cost. then why hasn't anybody been able to do that with medicare in 50 years? creating a public option like medicare will progressively increase private insurance cost due to cost shifting and eventually drive private insurers out of business. besides the damage it would do to the private sector, the government does not have the money to pay the $1.6 trillion price tag. as a physician i say we need to reform to bring down cost and increase access to private insurance. we do not need the government in the exam room. i yield back. the speaker pro tempore: for what purpose does the gentleman from oregon rise? mr. defazio: to address the house for one minute. the speaker pro tempore: the gentleman is recognized. mr. defazio: ure peaans have had a market-based cap and trade system and it has failed. the last recorded year $60 billion in trades, that is added cost, and higher greenhouse gas emissions. now the house of representatives wants to bring thature peaian system here to the un

illness or manageable illnesses that cost less, obviously we're reducing the pressure on the medicare system. so the question for me obviously that i'm raising is, and i think they are legitimate issues. the author of this section will be the first to tell you why we need the accountability and i appreciate john mccain's amendment. we need to find out whether or not these things are going to work. anyone who tells you with absolute certainty they are, is not being candid. because we don't know. we think -- these make some sense, we want to try them. but obviously if they do work, the pressure on medicare is tremendously positive. so i would respectfully oppose the amounts for the reasons, not because i disagree at all with the goals and the determination to deal with these two questions and you've outlined it well in terms of what we're looking at. the cost to society down the road if we don't. and so -- that's right. >> let me comment, one additional comment if i might. you know, take $8 billion a year and figure out what we could do with that in terms of -- just the $8 billion for infrastr

people who have medicare will have that available to them and they will even have it better medicare system. we are going to take substantial steps to phase out the dawn of holt, the so-called dawn of hold that people face when they are pharmaceutical costs are too great. we are going to address one of the major concerns of physicians around this country and that is that we are going to permanently reformed the unfair physician payment cuts under current law. we are going to fix the sustainable growth rate or the str. six, we are making major investments in the workforce, making sure physicians and nurses and other health providers are available to meet patients' needs. there's an even stronger network of community health centers that will be available as well. and finally, we are going to enhance prevention and wellness programs. they are absolutely essential to a true healthcare reform, so we are sharing coverage of preventive benefits and investing in the major community prevention initiatives. we are now ready to proceed. this legislation, and i want to stress this, is important for the

remain for many private payers, who are not using drg's, either the old system or the new updated medicare system but they are paying on the basis of per diems and discouldn'ted charges. so for privately insured patients, the incentives for hospitals are still there. now, physician procedures involving new technology are more profitable for physicians than evaluation and management services. now there are two aspects to this and this is getting into a little bit of detail. the medicare fee schedule is calibrated so that a big component of it is the physician work or really the time, effort, intensity that physicians personally put into the services and the other major components is what we call the technical or the facility or the practice expense component. ba

remain for many private payers who are not using drg either the old system or the new updated medicare system but they are paying on the basis of per diem for discounted charges and so this for privately insured patients the incentives for hospitals are still there now physician procedures involving new technology are more profitable for physicians ban evaluation and management services. now there are two aspects of this and this is getting into a little bit of detail. the medicare fee schedule is calibrated to the big component is the officious -- decision work that physicians personally put in to the services and fielder major component is what we call the technical office of the or practice expense component basically payment for the rent, service technicians, nurses, staff and providing the service. the biggest distortions are actually on the technical side. these patterns are not -- were not intended by payers. let me talk about the responses. and this to me as someone who has been conducting visits since 1995, i received a change and providers as far as much a greater responsiveness to

if we want to cut costs and grayned debt and extending medicare like system to everyone in america isctly the wrong prescription. we need to make medicare itself solvents and find ways to improve the current healthcare system. one way to do that is to implement reforms that we know will save money. we could start with ann on this prevention programs that encourage people to quit smoking and control their weight. it is no mystery that smoking and obesity are leading causes of the chronic diseases that are driving up healthcare costs. and finding ways to reduce these illnesses would also reduce costs. we should allow employers to create incentives for workers to adopt healthier lifestyles. we should also encourage the same kind of robust competition in health insurance and health insurance market that has worked so well in medicare prescription drug benefit part d. we can enact a long-overdue reforms to our nation's medical liability laws. for too long the threat of frivolous lawsuits has caused insurance premiums for doctors to skyrocket. doctors then passed these higher costs on to pa

medicare. why? because the system. because it's a government -- it's designed to be defrauded. we spend all of this money trying to chase those dollars. if there were real transparency in the market, people wouldn't buy x wheelchair for this when they could buy x wheel chair for this. we have one case from florida, your state, that was sold so many times they collected $5 million on one wheelchair and never delivered the wheelchair. this came out of dade county, florida. so the point is, who is best designed to decide what you want, where you want it, and who you want to get it? you are. and if there's an economic incentive associated with that, with you and that you never allow some bureaucrat, whether it's insurance or the government to get between you and the provider. you're going to make the best decision for your economic and your health interest. one other point that has to be discussed is we don't spend money on prevention in government programs. and the only way we truly get out of the health care dilemma we're in is to prevent the chronic disease that we're seeing tod

system. then there is a single para britcom lot of people have proposed that we have medicare for all or canadian-style single payer system. i myself do not think that is the best system. it is very hard to provide a single payer system for 300 million americans there has not been one organizational structure that 300 million people anywhere in the world there are other difficulties and i will mention two of them one of the problems is they'll lock him of the four service delivery system where they pay doctors to do more and more. that is not a very good system for improving the quality of care or organizing more coordinated care. second, as we have seen with medicare it is very difficult to have the effective cost control under the system because of political pressure. fell last seven proposals does not have a very elegant name. i have now becoming to call the social insurance that is unrelated from the employment system market is actually the proposal i want to elaborate. the proposal that the professor from health economics at stanford and i like to refer as the original three horsemen one of the th

the draft that is a broken medicare physician payment system and prevents cuts that are scheduled under current law from going into effect. the draft takes the steps necessary to fix the shortage of primary-care practitioners and addresses and other providers. finally, at the drafting chores that people have a choice. a choice of doctors, benefit packages, and a choice among insurance plans. this approach builds on what works and fixes what is broken and make sure that people have choices that are pragmatic. it will produce the results of the nation's health care system so desperately need. it will lower costs, broader coverage, and better quality. today we will continue on a journey that began over 100 years ago to provide health insurance for all americans. some of our greatest presidents of the 20th century, teddy roosevelt, franklin roosevelt, and harry truman, or advocate for health insurance for all americans. president clinton fought hard for the administration proposal. those initiatives may have failed, but the hope that inspired them was never defeated. the time has finally co

host: here is an editorial that talks about how congress should use the medicare part b system as theodel going forward. he says it is an enormous success, cheaper than expected, and popular with singers. the problem is ideology. it is based on competition among private insurance plans. democrats are determined to run reform on government-run plant. he writes that private insurance companies are competing for customers and offering them tauruses. seniors can switch plans once per year. our next call is from tallahassee on the independent line. caller: good morning. i basically believe the best way to take care of any medical insurance is for government to get the heck out of the wood. government is the problem, not the solution. -- to get the heck out of the way. national means our country, universal means " we'll pay for everyone else who does nothing. i do not like universal at all. government-mending is the problem. it is better private. i work in telecommunications. i do not have any interest. i take care of myself. i get my check ups and take care of my own business. i do not app

and we have a medicare payment system that says, if you're a medical student you graduating in this countryu don't want to go into primary care because there's a 300% payment differential versus you spending another year or two in training, you'll make 300% more. so only the most altruistic of our physicians go into primary care. it's obviously not about money because they could be an engineer and make twice as much with less time and a lot less school debt. i would just ask my colleagues, as we walk down this, i agree to walk with you, to truly fix the problem. senator and i have a totally different look at cost comparative eblcompar comparative effectiveness. i'll tell you the other reason i think health care in this country is pretty good and good for my medicaid patients and good for patients with no health insurance. because when somebody gets cancer, most of the time we get them well. most of the time we get them well. some fall through the cracks. that's true. but as a two-time cancer survivor, i think this health care is pretty damn good. i think it's pretty dang good. i have atrial

system like that called for in h.r. 746. anything else would either increase costs or decrease coverage inevitably. medicare is a single payer system with low overhead cost, but it uses the same profit oriented providers as the same system so its cost of rising almost as rapidly. setting up a medicare-like program to compete with private insurers is advocated by the president would have the same problem. and also not realize the administrative savings of a true single payer system. i also worry that the insurance industry would use its clout to under fund the public program and make it a dumping ground for the sickest costliest patience creaming off the profitable ones for themselves. i'm aware phasing out the private insurance industry would mean a loss of jobs but i believe the job loss in that sector would be more than offset by job gains in the rest of the economy which would no longer be saddled with exhort and costs of an industry that offers almost nothing of value. thank you and i look forward to your questions. >> thank you very much. [applause] i think that each of the four of you validated our op

a lot of things you saw in texas has been referred to, based on a reimbursement system perpetuated by medicare. i am 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

medicare patients. i don't want to see us create a government-run system that mirrors one that's not sustainable right now. and you know as well as i do, some of the goofy rules in medicare that drive seniors to the hospital to get, you know, an injection when they should be able to get it at home, telemedicine is a great thing but if you're a provider and you're on the other end of telemedicine you don't get reimbursed under medicare so there's a disincentive, irrespective of this debate, that we could do to improve medicare. >> thanks for your generosity on time. >> let me remind mens. we mentioned this earlier but i wanted you to know that the secretary has to leave at 12:00. now, of course, we'll have written questions for many members including those that have already spoken and those who have not to follow-up and she'll get back to us. >> mr. chairman? >> yes. >> could we ask the secretary if show could have those answers back by july 6th? i think that would give about a week? >> normally we submit the questions within ten days. so that would -- i'm triing to figure in out here. if you all agree to

medicare coverage. nine out of 10. we have a broken doctor payments system and medicare that has to be fixed every year so seniors can continueo get care from doctors. this year alone this broken for mccall's for the more than 20 percent cut. i can keep going on but the point here is simple. washington is not the answer as much as i love my colleagues on the other side, you love washington too much. i love it too and not that much. and i think it is not the answer. i think is a problem. the supporters of the baruah plan as these facts so they're trying in their approach by claiming that the government plan is simply competing with the private-sector on a so-called global plainfield. this rehash on us that for some of the free-market plans to compete with this government run a plans always creates a not level playing field and tubes competition. the medicare program provides an important lesson here and as a political compromise medicare was set up in 1965 to pay doctors and hospitals the same rates as a private sector. faced with rising budget pressures congress quickly abandon this level playing build approach and an active

medicare coverage. nine out of 10 of them. we have a broken doctor payment system in medicare that has to be fixed every yr so seniors can continue to get care. this year alone this broken formula calls for a more than 20% cut. i can keep going, but the point here is simple. washington and a government-run plan is not the answer. talk about creating problems. the supporters of the government plan, they know these facts, so they are trying a different approach by claiming that the government plan is simply competeing with the private sector on a so-called level playing field. give me a break. history has shown us that forcing free-market plans to compete with these government-run programs always -- always creates an unlevel playing field and dooms true competition. the medicare program once again provides an important lesson, as a political compromise medicare was set up in 1965 to pay doctors an hospitals the same rates as the private sector. faced with rising budget pressures, congress quickly abandoned this level-playing field approach and enacted price limits fo

because we have a health care system, medicare that provides health insurance for everybody over 65. there are polls and gaps in coverage in medicare, the premiums can be pretty hard for some to reach. the co-pay and deductible can be a problem. overall people know when they have medicare, they are pretty well darned taken care of and that is not the case for people under 65. i came it the floor tonight for a few more moments, mr. president, as i was listening to senator sanders talk so eloquently to share a couple of stories. sherry in albany, ohio, she is not medicare eligible, she is forced to consider borrowing from the equity in her home to pay her $1,070 premium through cobra. she had a job. she lost her job. she has to pay the employer and employee side to pay for her health insurance. that's the way cobra works. a good program, but a bit of a cruel hoax, if you lose your job, it is pretty hard to pay your premium and your employer's premium at the same time. she's considering borrowing against her house to pay for her health insurance for cobra for 18 months, she will get a l

years in social work in nursing homes, hospitals, assisted living, and i worked with medicare and medicaid in the v.a. system. it is terrible. people have a terrible time with it. you have to employ two or three people to try to get reimbursement from medicare, to argue with medicaid. i worry that a national health- care system run by the government is going to be another problem like that. i saw my doctor recently, my heart doctor. i saw him for 10 minutes and it cost me $92. that is part of the problem with health care. host: also, what do you think congress is going to vote on? guest: i would say to sandy, if you talk to most physicians, they will tell you that dealing with the private and insurance companies is a lot worse than dealing with medicare or dealthe v.a. in terms of paying $92, citing issues doing pretty well. i have heard stories of people coming out with a bill of $1,000. that deals with reimbursement rates among other things. in many ways, we're not putting enough money into primary health-care. too many doctors are going into specialty care. the conclusions of doctors and specialty care is

it is also worth noting that while there is no intention in this public plan to have medicare for all system, the virtues of having met system are cheap by having a competitor in the market in this exchange that embodies those values, putting patients before profits, making sure people have broad coverage and making sure the focus is improving care and innovating overtime. >> that sense of competition may eventually bring some sense back to the premiums, usage of private companies, why don't we initially require that we get into the exchange or whatever you're going to call it, why shouldn't they have to meet some particular level as the consumer that we have to spend a certain number of premium dollars on direct medical care? >> there is a medical loss ratio standard. >> i know who put it there. do you agree that it ought to be there? it is that a rather low number. >> it may sound very low but as you well know, many insurance companies spend less than 85% of their income on care. even within medicare advantage plans, there are many cases where they are spending 82% or 83% of their spending

medicare. it's a system we know. and in particular the existing health provider network so that public plan can truly compete in the private market and lower costs for all americans. mr. speaker, health care must be accessible in order to be accessible to americans living in both rural and urban areas, it must be be accepted by providers t has to have doctors. i' concerned the initial version does not provide the provider infrastructure already in place for medicare. we know it, we can use it. this is a serious oversight that needs to be revisited. mr. speaker, i know we can meet the challenge for health care for all americans. a uniquely american plan unparalleled in quality, low cost, and real choice. let's do that. the speaker pro tempore: for what purpose does the gentleman from michigan rise? >> to address the house for one minute. the speaker pro tempore: so granted. >> mr. speaker, a growing number of americans are concerned about the future of capitalism in this country. the current economic recession has ope

medicare reform. simply turning the system over to the government, i think, will not solve this problem and without addressing medicare reform, we'll leave many seniors without quality health care coverage. let me real quickly, if i might, mr. chairman, secretary, you quote your testimony -- in your testimony that reform will guarantee choice of doctors and health plans. no american should be forced to give up the doctor they trust or the plan they like. if you like your current health care, indeed you can keep it. do i take it from your testimony that you mean all americans will be able to keep the health plan that they like, including the 11 million seniors who get their medicare from medicare advantage? >> well, sir, i certainly hope so. the proposal to stop overpaying for medicare advantage is one that is included in the president's cost savings after years of examination, there are no enhance the benefits and they're being paid at about 14% higher a rate than other programs. as you know, the center for medicare services has proposed that there be fewer plans this year because of the proliferation of plan

medicare. people would never be able to choose from this system. it is too complicated. turns out not complicated at all. about 79% of the american people think it costs too much. principle it is fairly ingested depoo into the system are important. transparency, liability reform. better reporting. better use of technology. more importantly, a bigger marketplace. where people actually have to get out and compete in a marketplace where your employer may be able toll provide you with the insurance -- to provide you with the insurance that they have been provide yog you but may be able to make an equally -- directed by you purchase of insurance somewhere else. the bigger the marketplace the more likely people are going to have the care they need and the more likely the price is going to be reflective of a marketplace driven price where people -- where they are competitive with the price and care. one of the reasons part d works so well is that 100% of the people in that edition of prescription drugs to medicare, 100% of the people in that system know they can change their pr

president's's plan and proposal will be done by transferring money within the health-care system from medicare, on wasteful spending, and so on. we are talking about the final 1/3. he has proposed a plan that would keep with the promise he has made to cap deductions for the wealthiest americans on their taxes. host: was there any change of message from the candidate obama in september, 2008, and presently? guest: they are trying to maine -- remain consistent on taxes. we have to see what comes out of these bills. there may have been all lawson there but it is a wait and see thing. guest: the administration is stuck in a box to try to figure how to pay for health reform. they have to figure out where the money will come from. the administration is large it looking to congress to resolve its of the ideas that are coming from congress would involve some of these tax increase that the administration is not willing to take a firm position on. they want to let congress debated, figure out how to pay for, and then present the proposal. host: in the first five months, has this been the pattern of this

i came to a conclusion not too long ago that medicare would be a good public health care system since that is the way we are going. i want to know how it is going to change when the whole nation is on it. right now i pay $106 per month for medicare insurance, $38.40 for prescriptions, and $199 for supplemental insurance. that comes to $4,100 per year. what are you going to do with a family of four or five? are they going to pay the same amount? who is going to supplement that? is it going to be the government, or is it going to be be paid higher prices? guest: you're a smart cookie. you have got this down. i agree. medicare is not perfect. but it does have the benefit of being pretty easy to understand for the most part. the payments are pretty easy. you do not lose the insurance if you get sick. i do not know if the whole nation is going to be on medicare. i do believe that a significant proportion will be, if we get the bill out of the house. i believe a significant amount of people will choose their private health insurance. i think that is their right. i do not think the whole nat

system. you have medicare. does medicare have problems? it sure does, but the administration cost of medicare is a fraction of what private health insurance costs are. it runs more smoothly. the goal that we have is to create a simplified system. the complexity of the current system has to do with insurance companies, among other things, cherry picking. you are a good guy to cover. on the other hand, if you're 50 years old and had a cancer operation, we do not want to cover you at all because we will lose money on new. -- we will lose money on you. it becomes a complicated process. we have to say as a nation, we are all in this together. we're all going to get coverage. we're going to put more money into disease prevention. we are going to put more money into primary care. 60 million americans today, 20% of our country, do not have access to a doctor on a regular basis. what happens to those people? when they get sick, they go to the emergency room but very expensive care, or they got into the hospital when they get sick and that is very e

medicare. we than we're looking at a health care system where the cost of health care goes up to 20% by the year 2020 and 20% of gdp and that's not sustainable under any economy because it basically absorbs the entire productivity of the nation. so we have to get this under control from a standpoint of fiscal health and we have to get it under control from the standpoint of making americans insured. what's been the republican role in this effort? well, we have put forward the substantive initiatives. there are three or four major plans that are pending. >> we believe very strongly that all americans should have insurance, and it should be an insurance that's meaningful so that nobody is wiped out by a medical event or a physical event that causes them great injury. if someone in your family experiences some terrible cancer or is in a terrible car accident that should not threaten your financial wherewithal as a family. >> also, we believe that as senator harkin has stated that there must be a major emphasis on the initiative of prevention and wellness and healthy lifestyle, but we believe the wa

we need to be able to do rapid cycle testing of the way to do that so that we're not in the system where medicare once a year makes set rates and so forth. we need a more -- we need a more flexible and nimble approach that really 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

expense under the president's plan would be done by transferring money within the health-care system for medicare, on wasteful spending, giveaways to the insurance and drug companies, and so on. we're talking about the final third. he has proposed a plan that would be in keeping with his promise, to cap deductions for the wealthiest americans. host: was there any change of message from the candidate to the elected president? guest: i think they are trying to remain at least somewhat consistent. we will have to wait and see what comes out of the bill is to see if they can stick to it. guest: a think the administration is that, trying to figure had to pay for health care reform. it is estimated around $1.60 trillion. trying to figure or will come from is one of the difficult challenges. the administration marshall looks to congress to resolve it. -- is largely looking to congress. some are not taking a firm position. they are waiting to see what the best ideas are. host: in the first five months has that been the pattern? guest: i think so. obama came into office with large goals and has said to th

outlining what we have talked about here which is restructuring aspects of medicare and medicaid that are inefficient in the system, particularly, i think the biggest example was medicare plans that are -- pay private insurers extra money to do what they already should be doing in the form of a middle man payment. i think the president will in short order out line additional ways that efficiency can be brought to the system in achievable and score will savings -- scorable savings that will enhance the robust downpayment he has outlined. >> what is the shortfall? >> i do not know that -- obviously, some of that scoring will be dependent on the parameters of what plan is adopted. you heard the president talking about the fact that there should be some basic elements in health care -- a health care plan. it is hard to figure the final scoring number out. the president in short order will be even more specific than he has been. as you mentioned, $600 billion in achievable savings, this will even more enhance the down payment. >> when is he going to do that? you talked about that yesterday. when is he going to do that?

outlining what we have talked about here, which is restructuring aspects of medicare and medicaid that are inefficient in the systemparticularly, i think, the biggest example was medicare plans that pay private insurers extra money to do what they already should be doing in the form of sort of a middle man payment. i think the president will in very short order outlining additional ways -- outline additional ways in which efficiency can be brought to the system with achievable savings and even in a greater way enhance the already robust down payment. >> any idea of what it would be? what is the shortfall? >> obviously, some of that scoring will largely be dependent on the parameters, the parameters of what plan is adopted. i think you have heard the president talk about that there should be some basic elements in a health-care plan, and so, it is sort of hard to figure the final score number out. i think the president in short order will be even more is specific than he has already been. it was mentioned essex and dollars billion in scordatura and achievable savings -- it was already mentioned $600 billion in scora

medicare. people would never be the jews in the system because it is it too complicated.urns out it is not complicated at all. in fairness, i think 79% of american people think it cost too much. i think market principles for early injected into the system are important. transparency, liability reform, better reporting, better use of technology, but more important a big marketplace where people actually have to get out and compete, a marketplace where your employer, for instance, may be able to provide you with the insurance at work that they have been providing you but they also might be able to make an equally tax protected purchase of insurance somewhere else. the bigger the marketplace, the more likely people are going to like wth

system. the idea is that medicare ought to be able to get the best price available. they ought to be able to do good shopping for their customers. that is the general idea behind competitive bidding. i do anticipate there will be more of that in the coming years. host: one of our tweets wants the url for your blog. guest: washingtonpost.com/healthcare caller: i was really offended when clinton compared us to cars when talking about insurance. you have a choice about having a car. you do not have a choice about being born. i believe it is unconstitutional to force people. in massachusetts, a large percentage of the population is having a hard time paying these premiums. i was injured a few years ago. i paid my bill in cash with a credit card. i paid it off and got a discount. the number one concern at the hospital has to change. they were concerned that i did not have health care instead of that i was suffering from severe burns. doctors should be trained not to care about the paychecks. then we will see the proper care. it cannot be through an insurance company. i wa

system. just look at medicare. if the federal government did not move for medicare our seniors would not have had affordable health care coverage. our disabled population would not have had affordable health care coverage. i don't know of a single member of this body who is suggesting we repeal medicare. and that's a public insurance option. a public insurance option does not have the government interfere with your selection of doctors. the doctors are private. the hospitals are private. we are talking about how we collect and pay for the bills. and medicare has worked very well. as tri care for our military community. we want to build on that experience. the main reason that we want a public insurance option is to keep down costs. that's our main reason. we know that medicare advantage -- this is a private insurance option within medicare. well, i'm for a private insurance option in medicare but what i oppose is giving, costing the taxpayers more money because of that. and we know that medicare advantage costs bet

our system was working very well. the medicare prescription plan was witten verbatim by the pharmaceutical companies. host: we will get a response to that. this tweet, "for bobbins are so correct, why do they need to smear the public option -- if republicans are so correct, why do they need to smear the public option?" guest: with this last point, the public option, i really think it is unnecessary. if you have a connector not unlike what was done in the state of massachusetts and the state of california, and you have the individual insurance companies, the private market, competing in that connector, then clearly you will get the best value, the best price, and hopefully the best medical care. it was actually 2003, mma, medicare modernization act, and i was a member of congress and did support that bill. a signature part of it was medicare, part d, the prescription coverage option. the democratic majority said this was not going to work unless we had a public auction, a public plan, the federal government negotiating down the pri

system. right now medicare would work beautifully if there were no doubt in it, kicking people out of hospitals in two days and then readmitting him and gudgeon the costs. it is really bad. the second thing -- and gauging the cost. use nurse practitioners, pay doctors medical school. you do this by every year the practice and take away their debt. host: are you still practicing nurse? caller: 08 yes, i worked in nursing homes and have worked in every area. public health, and the public health department in the city of chicago. it worked beautifully in the head clinics. it was dismantled along with everything in chicago. ronald reagan was treated by trauma centers and then he closed them. we have enough money to give it to public health science. host: delaware on our independent line. caller: i pretty much agree with that nurse even though i am a basic secretary in the health- care industry. we have an aging population and we need to have long-term care and hospice care, dental care, it needs to be all inclusive. the current model does not work. it is crazy. host: how you pay for? caller: i'm on

efficient health insurance system available. that is medicare. that is a no brainer. >> thanks for your call. their lead story has to do with the former state employees. a washington couple charged with spying for the cuban government lived double lives. >> also in this story, alicia stanton becoming the first african american woman to be or contained a rabbi. she is scheduled to resume leadership in north carolina in august. coming up on our line for democrats. go ahead. >> i think congress needs to pass a law that would separate the bad ones off social security and ssi that are misusing the system by being a drug pusher on it. could you reduce social security and ssi by promoving the dope pushers. >> in new york. go a head. >> yes, sir. and having to pay taxes on health benefits. my husband is not yet on medicare even working people having to pay taxes on the health benefits. is this part of the bill they are working on? i zont think this is fair to people. >> thank you for your call and all the people who have called in. on wednesday, the reag

of single payer and frankly i am glad that they have procreating a new one size fits all systems based on medicare is a recipe for disaster would balloon the deficit and add to our mounting debt will drive down medical innovation and rationing care while empowering bureaucrats. of my friends on the other side of the i/o have not included republicans in their deliberations. i have been following them closely in the news. the latest reports indicate they could formally unveiled their legislation as early as next week while the proposal reported does not include a single player scheme it seems highly likely we will see a government run option and i use that word with trepidation because it seems clear any government run the option is to undercut the private the structure of the market. maybe today is appropriate after all democrats are serious about putting the government-run option in their plan and that is designed to crowd out the private sector them the reality is we are only a few steps away from a single payer system. how else can we explain the urgency with which this hearing was scheduled? co