to charge medpac with this kind of responsibility.it would change very much the nature of medpac, and you know, i think paul rightly said it would be great to have somebody that wasn't subject to political pressure make these kinds of decisions. but as soon as you have some buddies make these kind of decisions, inevitably it will be subject to political pressure. and what medpac has done over the years is make recommendations to congress about payment updates for medicare and payment reform and other issues with respect to medicare or and congress has taken some of them, recommendations, has not taken others. interestingly enough by my count, three quarters of the cost-saving measures that that the president has put forward in his $900 billion have been medpac recommendations in one form or another. what i would think would be more appropriate way to go and one difference between germany i believe in most of the other european countries and us, is that they have a budget for health. anha

resistance to doing things like competitive bidding on durable medical the claimant or things that medpac recommended have gone nowhere. is there a new mood on capitol hill, a different understanding of the necessity of doing some of these cost savings things? >> yes. let me answer that in 2 ways. yes, there's widespread appreciation that the reform must be at least deficit neutral and contain costs savings and there is a surprising recognition, a significant recognition that a change in the process would be beneficial. senator baucus has spoken about the fact that he doesn't feel, both because of understandable, real lobbying pressure and because of the technical nature of the medical analyses that need to be done, the finance committee might not be the ideal location for deciding upon the reimbursement rate for durable medical the equipment. as one of the motivations for the proposal we have put

forward, to take the medpac recommendations and rather having them sit on a shelf somewhere, have them protected under a fast-track procedure, voted up or down as a package and considered within a limited period of time so that they become much more relevant, irrelevant to some degree, but much more relevant to the decision making process. >> the u.s. senate is about to start the day. first, general speeches resume at 10:30 eastern, leadership hoping to make progress on tobacco regulation bill, a vote to advance the measures scheduled for 11:30 eastern this morning. the senate majority leader hoping to have a final vote tomorrow morning, the house is in in about a half an hour and 10:00 eastern on c-span. now live senate coverage on c-span2. the chaplain: let us pray. ene chaplain: let us pray. gracious god, to whom all thoughts are revealed and all desires known, we pray for this large senate family. lord, you know the secret needs of each person on capitol hill, those who are hurting, or feel frustrated, discouraged, or exhausted. you know who has stopped loving and those who are exp

medicare payments that we reduce subsidies for hospitals for treating the uninsured, that we adopt medpac recommendations for payment skilled nursing facilities and long-term care facilities and they are interesting ideas and i would ask an analyst consent they be included in the record. >> without objection. >> this gets to the question of a couple of specific points in the bill which i think have to be highlighted because the concerns are so critical. the first is this a medical advisory council. this has for those of us here in 1994 this is -- this is deja vu all over again. this is hillary carob loss. this is the elite of the elite deciding how everybody is going to get health care in this country. this is you set up a group of folks in washington who are going to unilaterally decide what type of health coverage people are going to get across the country. and its it really is the center of the bill when it comes to top-down centralized management of health care. it is some of us are concerned about the slippery slope to single payer. this is a greased slide to a single single-payer. i

and also in cannes private insurance with medpac. well, we know what happened in the 90's. it didn't turn out well but now we have a chance in the 21st century. so we have tried every time to come up with new ideas. they have served the public well. they often have requirements and refinements that this is the time where we close the gap and build on what we know we can do. public and private options, a public auction that holds the private options accountable so we don't have to depend upon the background of the state legislature or be worried about the philosophy of the governor and to the point as a state insurance commissioner. that is why i am for public auction. but i believe we have no option not to do anything the time is now. the need is compelling. i don't sit here represented interest or institutions. though i represent some pretty terrific ones and ih, fda in my state, daughter of space agencies in my state where those bureaucrats we got to look out i've got a nobel prize winners who work for the federal government and i also have water men and farmers so i am h

we really need sort of a medpac for nine years, we continually recommended that payment for primary caree boosted, those for specialty care be reduced, and that this would then take, you know, many, many years to redress the imbalance that now exists in the relative supplies of those two food groups of physicians. and so i think we want to approach this with a good deal of caution. >> that is a buzz kill. >> bob, i don't disagree with you. it's going to be challenging for our market to move the global payments as far along as we are. so i understand that's going to be even more challenging for markets that aren't as advanced in that regard. so we're not underestimatingle challenge that's here but your cost is a good one but it underscores there isn't one answer out of legislation and one simple way to do this for the whole country. people are in different places. and we need to encourage the various models to grow so that we can see what are the best things to be done in a variety of places. >> i know uwe -- >> this reminds me there was a study years ago when quebec introduced universal

that package will be evaluated by medpac and by the eo and then we'll go on a fast-track basis to the floors of the appropriate committees and then the floors of congress for an up or down vote. and if the vote is down, then there's some kind of automatic mechanisms that will cut provider payments or increase premiums or whatever to bring the discipline that you didn't have before. . . i would like to thank everyone for coming and i would really like to thank the panelists for their time. i would like to offer a round of applause. [applause] the purple sheed norpac was an evaluation. if you could fill that out and slides will be on our web site, www.nihcm.org. thank you. [inaudible conversations] [inaudible conversations] >> it is the last thing congress before the july 4th recess. the house gavel then this morning to complete work on the 2010 anterior environment spending bill for ago that legislation providing $32 billion for the interior department, epa, u.s. forest service and related programs. also today climate change measure that aims to restrict emissions of greenhouse gases w

according to the june 2008 medpac report, an attendant of fisheries have to get additional benefits beyondheir 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 continue to 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 hosp