i gather there's some room and i'll let senator mikulski address the issue herself. but i gather there is some room and possibility of agreement on some of these ideas that haven't arrived yet but nonetheless, we're getting closer to it. on the issues involving long-term services and support, fraud and abuse, i really encourage our staffs and members to be working to see if we can't achieve some understanding in those areas as well as we move forward. we'll reconvene again on monday on this issue. assuming we're complete, we'll work on the quality section as well as the prevention areas. we'll move into these other matters. in the meantime, i mentioned we might have an opportunity to meet with our former leaders that have produced a paper themselves, senator daschle, senator dole, senator baker and senator mitchell. we might set up a breakfast meeting for members to meet with them to have a discussion about their various ideas, which could be helpful. that may be in the middle of next week some time. obviously i'll chat with mike about that in terms of timing. let me

senator mikulski, you have any additional amendments you want to propose?>> there were amendments to be as suggested to him by senator greg on improving data collection which i know we would also recommend that we could proceed on. >> mr. chairman, if you would indulge me there are two elements we have worked on with senator mikulski incentive it in a stabenow like to move to an amendment which hasn't worked out. >> wait, there are amendments. you had a greg amendment nine related to share in decision making and you had greg an amendment 10 related to data collection. >> those are agreed to. we will just except those only get a quorum and now an offer the brennan and 35. >> can we hand out? and as soon as one more member shows up we will cover these amendments that have already been discussed. >> what page? >> which title is this? >> it goes to title to generally, title three anti-war generally. >> it is the gao review of the activities of those titles. >> we now -- and to have 10 or 12 here? we only have 10. we're still missing people. >> i can talk about

i ask unanimous consent that both mikulski and dodd be accepted. >> is there objection? >> okay. >> okay. all those n favor say aye. >> those agreements are agreed to? >> yes, they are. >> i understand the first amendment, senator jack reed -- >> senator, let me apologize, we need 12 members to adopt amendments and eight in order to have a discussion. we have to wait until some show up. >> we'll lay the votes aside. >> we can't do a unanimous consent unless we have eight. >> we need 12. >> i got it. i've been to those kind of meetings. perhaps we could proceed to the discussion on senator reed's. >> thank you, mr. chairman and senator mikulski, i would offer an amendment to section 218, this is on behalf of myself and the senator for their cooperation and thoughtfulness and asked the consent that senator hatch be offered as a co-sponsor. >> no objection. >> this is the amendment that goes to the drug fact box which is shown by researchers to give consumers significantly better information, more understandable information recently fdas risk communication unanimously recom

. >> let me turn if i can't senator mikulski. why don't we take care of those and reach some agreement. >> by the way we have got a quorum of 12th so let us go into the executive session if i can for a few moments with my colleagues to return to the affordable health choices act in a moment. kathy martinez is the assistant secretary for the disability, kathy is the nominee for the administration for aging department of health and human services. i want to thank chairman kennedy and remember mike enzi for their work on the nominations. >> i have comments i will put in the record it's been clear on our side. >> all of those in favor say aye, the ayes appear to have it and the nominees are confirmed by the committee. they will be reported. let me go back if i can to senator mikulski about amendments that have been cleared. >> thank you, mr. chairman. i want to say to the committee we had a good day yesterday. we accepted 17 amendments, and very few from our side, but as the other side of the aisle offered suggestions and we could ei

. >> senator mikulski. >> let's go to the actual amendment, not what a aspect of it does or may be an interesting idea or whenever. if you go to the front page of the colburn amendment, it says strike subtitle be of title to and insert the following. so he strikes the entire section with a title deed which goes to the patient safety research center, community health teams, trauma system reform and others and eliminates the agency with health research quality so that is what this amendment does. it strikes and inserts essentially an i.t. package. so that's number one. i think that our quality section had a lot of work and it should stand. second, during the course of the deliberations are held six hearings on quality. six hearings on quality and we wanted them to be bipartisan but hardly any members of the party showed up except the last two. so all this stuff now of information technology and so on is coming brand new. i don't dispute but if you want to be in the game and shot to play and part of the play was to participate at hearings and where there was innovation to also try to sug

senator mikulski agrees with your point. i was wondering if he news of the muck the word that i did not know. -- if he knows of something about the word that i did not know. >> that is different than this. >> of the important idea is that we are not going to fix the liability. we are still going to increase the cost. >> the issue guidelines exist. this exists in every court of law. guidelines would be suggesting that if you did not follow the guidelines --the issue you raised is, are you mandating so

senator mikulski, your better listen to this. i used a fig are that was below both of us. i used a figure that was below both of us. what about these folks. should they get a knee replacement, hip replacement and that person said well maybe not. now that sounds like that can't happen in the system we're trying to construct today, but i'm telling you, it can. that's why i've introduced the bill. i've gone on way to long. i appreciate the patience and indulgence of my colleague. >> thank you, senator. senator mikulski. >> first of all, let me just say that this amendment offered by the senator from kansas is unnecessary. if you go -- because we get into this cost. we get into this repetitive word and it goes over very well with focus groups, but it has no rationale here. if you go to page 323 of the actual bill, where it says incorporation, we absolutely prohibit that this -- anything related to the center for health outcomes, otherwise known as comparative effectiveness, that there shall not be construed as mandates for payment, coverage or treatment. it is in the bill. pag

i would submit that to you and senator mikulski.hank you for your consideration. >> one brief comment, mr. chairman. i have appreciated dr. coburn's insights in the house and here and have enjoyed hearing his comments. i want to just take off on something senator mikulski said about using the word bureaucrat. i don't have a lot of federal employees in my state relative to some other states, but we use the word bureau crass in discussing and dehumanizing and delegitimizing decisions we don't so often use the word bureaucrat talking about insurance company automotonss or lower level people or whatever denying care. from the view point of comparative effectiveness, they're denying care based on -- not denying care. they are basing questions based on legitimate scientific evidence when it's insurance companies, private experience companies, bureaucrats that might be denying care based on profit. so i just hope that we are a little more careful in words we use to describe human beings that work in these agencies or that work in insurance

>> senator mikulski, have you finished, ma'am? >> senator roberts? >> well, thank you, senator mikulski, thank you for your willingness to work with us and thanks to the staff to try to get some -- some kind of understanding about this where we could agree on it. i think we have -- if you have counter language, i think we have counter-counter language, but we'll see where we go. i'm not concerned and, i can't speak to doctor coburn, but i think he would agree about the center being prohibited from mandating. my concern is prohibiting the cms from using information to mandate doctors' decisions and treatment, and if i might, a mandate is not the same thing as a prohibition. a mandate means to force or bond. the language on page 323 are says that the reports and the center for health outcomes research and evaluate lgz which we'll be conducted the needed. comparative, effectiveness ask research and you can't inform doctors. that mandate says it does not preclude coverage and treatment. you have the other language -- >> on the bottom. the very last line.

chairman, i would like to echo senator mikulski's concerns about the amendment. i appreciate senator hatch's interest and concern in the area. obviously enormously distinguished lawyer, one of legal luminaries of his home state but i would urge my colleagues to oppose this particular amendment for three reasons. first, this is the health care reform bill. and it seems to me to be an awkward platform from which to drill into an area that is con signed enormously to the discretion of our judges. it would be a colossal intrusion into the judicial arena. the admissibility of evidence in a particular case is a determination that is very much the province of the trial judge. it is reviewed to an abusive discretion standard and highly unusual for anyone by stat constitute to try to intrude, it is one of core aspects of a judge's control of his on her own courtroom and of the trial of a case before them. i think it's a very poor -- i think we should vote against it for that reason alone. second, these medical malpractice cases reinvolve around expert temperaturstimony ar

senator mikulski and and i dr. coburn as well had a very lively discussion about the intent of this language. senator mikulski said that the intent of the language was to keep the right to make treatment decisions with the doctor and the patient, not with the government. i certainly agree with that. and senator mikulski has worked long and hard on this bill and i respect her for that. she is a good expleeg a good friend -- good colleague and a good friend, and i agree with this intent. but as i pointed out to the senator, the language in the kennedy-dodd bill does not accomplish our common intent.

center mikulski -- senator mikulski, you need to listen to this. i use to figure it was below both of us. i said, what about these folks, should they get a knee replacement? that person said, maybe not. that sounds like that cannot happen in the system that we are trying to construct. i am telling you, it can. that is why i introduced this bill. i have run on way too long. i appreciate the indulgence of the chairman and my colleagues. >> thank you. senator mikulski. >> first of all, let me just say that this amendment offered by the senator from kansas -- if you go -- we get into this repetitive wording. it goes well with focus groups, but it has no rationale here. if you go to page 323 of the actual bill, where it says in corp. -- incorporation, it prohibits anything related to the center for health outcomes, otherwise known as comparative and effectiveness. there shall not be construed as mandates for payments coverage for treatment. it is in the bill. this is page 323, line five through seven. please, take a look at it. tell me about that. we sa

for the purposes of senator mikulski. there is nothing that precludes a 64-year-old who walks in for that 90 day period and says i want you to do everything to keep me alive you possibly can. that is a medical directive. two, part d medicare, we have a requirement, you have to decide which plan you're going to be on. it's a decision that we're asking every person that's gone on medicare to make, and we go further. we say if you won't make a decision, we're going to put a 10% penalty on you. that's going to accrue for every year you don't pick a part d supplier. and to the chair's comments, i would only ask staff to look at page 101 of the base text. specifically, the small business verification. i don't believe that this is a technical conforming language to interweave this into something else. this is basically a new dictate and therefore, we do get into finance committee's jurisdiction. >> all right. okay. senator hagan? >> thanks, mr. chairman. i used to serve on the ethics committee of a large vet hospital and we deal

>> aye by proxy. >> senator mikulski? >> aye by proxy. >> senator kennedy? >> no, by proxy. >> i thank the clerk. further amendments, senator robert, you had an amendment you wanted to raise or senator enzi. >> i have one i would like to discuss based on what we discussed over the weekend. that would be enzi amendment number 2. >> clerk will distribute that amendment list. >> this is something i've been working on with ç9> there is reasonable ability for people to get paid quickly but there needs to be protection for the doctors to make sure they stay in the field. we have come up with an award of grants for states for the of the plot -- for the development of alternatives to the current litigation. this is an experimental area where they can do some different things. it would promote a reduction in health care errors by allowing patients safety data related to disputes be collected by patient safety organizations to improve the quality of health care. errors by providing data to be collect and analyzed by patient safety organizations to improve the quality

. >> senator mikulski. >> mr. chairman i want to comment and then i know senator whitehouse also wants to. first of all, i just want to assure the gentleman from oklahoma, who comes to this table with a great deal of clinical experience, and has always had his patience first. so, i appreciate him and i appreciate all physicians. when i looked at the issue of comparative effectiveness, there were going to be two things that i, as we looked at it from experience of other countries and even from learned groups and foundations here. one was the shelp not shackled a physician, and interject government into the practicing room. that a physician brings experience, brings scientific training, brings dedication, and assumes risk and liability in that room. so, we made sure that what we had in our legislation would in no way interfere with who is in charge in that room when that doctors talking to the patient. the second argument that this raised was stifling innovation, and what we were also told there is, if you follow th

. >> senator mikulski? >> aye by proxy. >> senator kennedy? >> no, by proxy. >> i thank the clerk. further amendments, senator robert, you had an amendment you wanted to raise or senator enzi. >> i have one i would like to discuss based on what we discussed over the weekend. that would be enzi amendment number 2. >> clerk will distribute that amendment list. >> this is something i've been working on with senator bachus for a long time and he and i have agreed on a bill and it gets into the same area of liability. we need to make sure that there's some reasonable about the for people that have been injured to get paid and to get paid quickly, but there also needs to be some protection for the doctors to make sure they stay in the field. so we've come up with an award of grants to the states development implementation and evaluation of alternatives to the current tort litigation. this is that experimental area where they can do some different things and we've actually suggested a number of things that would fit into this area where it would develop an alternative to the current tort

senator mikulski, how are you? i hope would be this afternoon that we could try to complete whatever-- where you want to sit. to try to complete the quality piece of the could this afternoon. we have it voted 5:30 annika could spend the next couple of hours and get through title to it would be great and start title iii tomorrow which is the prevention section and to work on that through tomorrow, and with the remaining sections dealing with the workforce, fraud and abuse of long-term care. every piece we are working on there are scored numbers for. we thought we would have cbo numbers back today. we don't yet have them john. i know you were interested in the subject matter but we hope to get them by early tomorrow. i am not going to go near the sections that we don't have scored but they will stick with the sections that we do have scored numbers, to allow us to complete those sections and to move forward. at wanted to say to all members my intention would be this week to work in the evenings, and hopefully we comp

>> no. >> the clerk will call the roll. >> senator dodd. >> no. >> no by proxy. >> senator mikulski.>> snow. >> senator bingasman. >> no senator brown. >> no, senator casey? >> no. >> senator hagen? >> no by proxy. >> senator enzi. >> aye. >> senator gregg. >> aye. >> senator bird. >> aye by proxy. >> senator mccain. >> aye by proxy. >> senator coburn? >> aye by proxy. >> 13 nos and ten yays. >> 13-10 was the vote. the subject is open to further amendment. i think senator hatch has number 8. we adopted an amendment before you arrived. we adopted a hatch amendment while you weren't here? >> no, that's a blessing. we're on number eight. >> am i on -- >> you're up, sir. >> we included your chiropractor immunity -- >> that means a lot. that means a lot. i'll call amendment number 8 on comparative ektiveness research. the purpose of the amendment, to summarize -- >> which number is this? >> number eight. number eight. >> staff will please distribute the amendment if it hasn't been already. >> okay. >> go ahead, orrin. >> thank you, mr. chairman. the purpose is to prohibt the use of compar

we have got to provide the kind of best practices that senator mikulski has come up with intersection in terms of comparative effectiveness and we have got to do the same thing with wellness and prevention also. mr. chairman, thank you very much. i would be ready to go any time you are but i will tell you what. since they are working together to try to get these centers together, these groupings together, he would probably wise we are not going on this evening and if we could reduce them down or the staff can reduce them down that saved us from joiner around here. >> i am strongly encouraging that. i think he may have resolved 50 of them in 30 more on the cusp of being resolved. that is a sizable hunk and if you could do even more up bringing them together. there's a lot of them that are very similar so there may be an opportunity to group them so we end up having a healthy, full frauded debate about a couple of provisions i know very much, just on the comments earlier that we heard early on at the opening statements. i think judd gregg maid, either there are one of recessions have so

. >> senator mikulski. >> no by proxy. >> senator murray. >> no. >> senator reese. >> no by proxy. >> senator sanders. >> no. >> senator brown. >> no by proxy. >> senator casey. >> no. >> senator jenkins. >> no. >> senator berkeley. >> no. >> senator whitehouse. >> no. >> senator encely. >> aye. >> senator greggg. >> no. >> senator alexander. >> [ inaudible ]. >> senator mccain. >> [ inaudible ]. >> senator hatch. >> no by proxy. >> senator mutuali in in ing -- >> no by proxy. >> test eign ayes, 13 nays. >> number 72. >> coburn amendment number 72. >> mr. chairman? since we decided we didn't like my idea of sending it all back to states, what this is is a compromise that says, perhaps we would allow hersa to contract in the states for states to put all -- funnel all their stuff into their three most areas of acute short aage. all we're saying with this is, whatever the title is that we've got, whatever we do, this allows hersa to form a contract with the state to funnel all these monies into their three or more acute shortages. we still get money into the state but we add some flexibi

and tom harkin and who i have worked with him very strongly on the health and other and barbara mikulski worked on the american action everybody on this committee. this is a committee that this war to help people in america and i came to for the first for years we got into some scraps and we have been scrapping all these years we developed a great love for each other and frankly i pray for him everyday and wish him well and we do miss them. there are so many bills to put together that he is a master legislator. in answer you in some of the others in this committee. this committee does build good leadership because of the myriad programs -- the largest authorizing committee and the congress and was a privilege for me to chair the 21981 and 1987. lme take some time today and not be too long and take a few minutes to talk about them affordable health choice act. first and foremost the may make this point again even though concern to summon a broken record very reforming our health care system to insure every american has access to affordable health care is not a republican or democrat issue

pushing under your leadership going to get there and i want to thank you, senator harkin and senator mikulski and senator bingaman who spent time on this and especially our staff who really have worked hard to get us to the point that we can now begin this markup process. there's a lot of work ahead of us, absolutely. and by delaying it, that's not an option mr. chairman. the line is not an option. i am frankly a little disappointed with the town from the other side this morning of doom and gloom. mr. chairman, i go home every weekend to washington state and i hear from my constituents, i will tell your the doom and gloom is coming in is in people who don't have access to adequate health care today who are so afraid not going to sit down at this markup and start working our way to a process that makes their lives better. i just met a woman a few weeks ago in my home states, owns a small business, her name is molly moon and she opened up an ice-cream shop. shoes and her late 20s and hired 20 young people to work for her. and she is successful and opening up a second shot. she said to me, i am

i was proud to work alongside with senator mikulski and senator webb and former senator john warner last year to pass the federal safety improvement act signed into law in october of 2008. this law authorizes $1.5 billion over 10 years in federal funds for metro's governing washington metropolitan area transit authority matched dollar for dollar by local jurisdictions. for capital improvement. the technical details of the arrangement are nearly complete and when done, metro will finally have the dedicated funding sources. i compliment the states of virginia, maryland and the district for passing the necessary legislation. earlier this year as a regional delegation along with our new colleague, senator mark warner, we requested the appropriations committee provide the first $150 million. while this is a substantial down payment it's not nearly enough to fulfill all of metro rail's obligations. at the time of the bill's passage metro had a list of ready to go totaling about $530 million and $11 billion in funding needs over the next decade. yesterday, i joined with my colleagues from maryl

. >> senator mikulski? >> no. >> senator bingerman? >> pass on that for a moment. >> senator murray? senator reid? >> aye. is that correct? >> senator sanders? >> aye by proxy. >> senator brown? >> aye. >> senator casey? >> aye. >> senator hagen? >> no. >> senator enzi? >> know. >> senator gregg? >> no. >> senator alexander? >> no by proxy. >> senator byrd? >> no by proxy. >> senator mccain? >> aye by proxy. >> senator coburn? senator roberts? >> no. >> aye by proxy. >> did senator coburn vote? has he voted? >> no . >> senator bingham votes no by proxy. >> senator sanders, did you get that? >> yes. >> did you get that? all right. >> vote is ten ayes. >> it is not agreed to. all i can say is my nose counting was correct. >> it sure was. where are we here at this point now? are there any additional amendments? >> mr. chairman? >> senator casey. >> i just wanted to get back to the fraud and abuse section for a couple of moments. i know senator enzi had some comments before. we were dealing with senator mccain's amendment so i wanted to ju

chairman, can i also -- can i senator mikulski. >> mr. chairman, i too am a strong advocate of consumer opportunity but i have to be up here for consumer protection and what i want to put in here is not my health had but i had as a member of intelligence committee and also my hands as they a proofreader for commerce justice and the funding for the fbi. we are in a tremendous risk coming into this country of counterfeit drugs and we know from a variety of sources including the mafia run over of exploiting yes. this is real and serious. i'm not showing any of the drug companies so i really have to insist on a certification from the secretary on a safety. i can only do as a matter of really good conscience. i wonder consumers to get the best deal. out of love for them to be able to imports inexpensive prices, but everything i know from both classified and unclassified briefing this i really would have enormous amount of anxiety over voting for this month as constructed. >> mr. chairman senator roberts can back out like to echo an associate w

senator mikulski. >> thank you very much, mr. chairman. well, this bill has just been accused of being somewhere another combination between goldberg and karl marx. however, our current system is a combination of adam smith, darth vader and the invasion of the body snatchers. [laughter] i like our plan better. [laughter] >> do i look like a body snatcher? [laughter] >> don't ask that question. >> but mr. president, this isn't the place -- this is really a historic meeting and when i got up this morning to come here i was really excited to join with our colleagues on both sides of the aisle where would i consider a rendezvous with destiny. this country, our great country has struggled for decades on how we could ensure a health safety net for all americans. this bill isn't the first time that we have looked at this matter. it has been a struggle over many years and i come to this table as someone who through her graduate training and social work has been both a student and a teacher and college teacher when the history of social welfare in

couple of these were as modified but i will ask consent that the amendments as identified by senator mikulski be considered. without objection, so ordered. the amendments are adopted. that includes the seven we did this morning, so that's about 20 amendments. there were 59 introduced originally but we're moving on this. granted, it's not luke skywalker speed, senator roberts, as you mentioned earlier today, but we're moving here. pretty good pace. we have a vote that's just started and i will be -- in fact, i entertain another amendment to at least be offered and we can start for a few minutes the conversation, then come back after the vote. >> isakson number one. >> johnny? >> thank you, mr. chairman. i think there's a copy, everybody has a copy. >> good job. thank you. >> this amendment simply requires that upon signing up and becoming eligible for medicare, that every recipient will show proof of having exercised an advance directive legal in the state either by statute or by previous court cases. an advance directive is basically a durable power of attorney that directs physicians, hospit

i also know senator children, feinstein, mikulski, locks her and very well be speaking or may have already in the next few weeks on this nominee as will many of my colleagues but all i appreciate this, mr. president and we are excited for this upcoming hearing and glad we are able to be here as ambassadors of truth. thank you, high-yield the floor. >>> the senate continues work on a health care bill. this is the sixth day the senate health committee has led to mark up its legislation. they are one of a number of congressional -- [inaudible conversations] >> the committee will come to order. >> i thank my colleagues for being here. let me turn to senator enzi for offering the first amendment. >> mr. chairman, i call amendment 55 and this amendment strikes section 421 which modifies the student loan rates -- you still can't hear me? i thought they fixed that while we were on break. is that better? i called amendment 55 which strikes section 421 which modifiers student loan rates for medical profession guidelines and the purpose of this amendment is to -- there are changes being suggested tha

we have a system that i know senator mikulski and i and senator dodd and worked on to reform fda to make sure we're getting drugs through quickly but the end of the day has a process where safety is critical because when ours go into a drug store they need to know it is the gold standard. so i haven't had chance to look at the mccain eminence. i want to take everyone's word is the same language but i have some concerns and out ask senator brown, it has been dropped

. >> senator mikulski? >> no. >> senator binghampton. >> no by proxy. >> senator murray? i'm sorry?senator reid? senator sanders? >> no by proxy. >> senator brown? senator casey? senator hagen? senator murkley? senator whitehouse? >> senator gregg? >> aye. >> senator also expander? >> aye by proxy. >> senator isakson? >> aye by proxy. >> senator mccain? >> aye by proxy. >> senator hatch. >> aye. >> senator roberts? >> aye by proxy. >> chairman kennedy? >> no by proxy. >> the vote is ten ayes, 13 nays. >> the amendment is defeated. senator murkley. >> thank you. i'm pleased to offer murkley amendment number one. this is po focussed on facilitating the ability of mothers to continue breast feeding after they go back to work. there are two fundamental reasons that this is very important. the first is that a very high percentage of mothers are working. and the second is breast feeding is of huge value to the health of our children. so let me address those points in just a little bit more detail. currently 72% of mothers work full time. the fastest growing segment of the u.s. workforce i

of amendments in the area we are talking about for the of our consideration to including senator mikulski is but i am supporting what senator murray is doing now because it will solve the problem. senator coburn is right, it's not good to solve the problem but it is still a major piece of this at least a significant piece of what the financial burdens of like that have influence on decisions he met alan brinkley said, i think it is a very good thing that we all seem to be on the same page. nco lot of disagreement in understanding there is a crisis and we have to move toward in a number of the runways. i mentioned for the record the best of my understanding in terms of debt forgiveness for example of for every four applicants for a national health service program and that is a federal program that reduce debt fort those that go into primary care, only one is accepted in. so i think we are in agreement that we have to approach this problem in a number of different ways and i hope we all agree we are not one to solve the crisis until we address primary health care. it is a huge issue. >> mr.

senator mikulski of that -- had that prescription bottle from iraq of all places. it is a very real threat. my modification -- but since i missed the deadline on the amendments -- but again i thought we would do this under the coverage section. that my deadline on that would be next week. it simply says, this act shall become effective only if the secretary certifies to the congress that the implementation of it will pose no additional risk to the public's health and safety and result in a signal the direction of the cost of coverage products to the american consumer. a significant reduction in the cost of covered products to the american consumer. it's that section a that is absolutely essential if i'm going to support this amendment, although i know exactly what the senator from arizona is trying to do. i respect that. i don't mean to throw a clinker in here or be a johnny-come-lately, but i did want to share the concern of the senator from maryland. i would like to ask the chairman some guidance here. i know senator mccain is busy in the armed services committee

initiatives and i trust although i must say the point senator mikulski has made on the issue is compelling and obviously sitting here dealing with kickbacks sharing the information with those physicians practicing in the hospital. what i prefer to do is take this tomorrow morning to consult with senator kohl dealing with the matter and if there is some -- he says in his letter he didn't want this considered without being i think the word is out to be considered -- >> consulted. >> consulted which is a different answer than he would oppose it and to me when a colleague has to be consulted on the chair as a committee that's where they take a pause and breath and inquiry and so i would like to recommend at the moment like this i clearly want to finish up this title that we withhold on this one until we have a chance to consult or talk herb kohl. >> i make the point that the start antitrust commission lies on the finance committee of the judiciary. it was written by the finance committee and promulgated by the finance committee. i am not sure, i am not sure it went through the judiciary commit

i think senator mikulski's question. i thought as we were sitting around talking about this. the safeways, the starbucks, the costcos, the connecticut pitney-bowes. a lot of wonderful examples of very well run corporations that do a lot. obviously, thousands of businesses out there. so and so says i have a wellness program. what is your wellness precinct? what your doing? i think we want to have some standard other than a declaration as a standard. that's why having a step back before you rush to the 50% and someone just declaring it to be such that you have some ability to make a judgment. and what's a smaller employer as opposed to a -- you have a whole facility. pitney-bowes has facilities on site for its employees. not every employer than do that. but they may have a different idea of a wellness program that will serve their employees in a way that would allow them to encourage that kind of behavior. i think we want to have some taking a step back, other than just branding something being a wellness program. but i'm very encouraged by this program. i think we can really d

mean, we've worked on intensively on this legislation per say with what senator arkin is doing and mikulski and senator murray on each section. but we've been working intensively for months and years on these issues. we know these issues. we know how to discuss them, by and large how they're going to work. let's wait -- people say we shouldn't do health care now because the economy is so bad. but then when the economy is good, we shouldn't do health care because the economy is good. senator dodd, i think, has done this masterfully when, you know, certainly not hurrying anything through their amendments, not hurrying anybody through their opens statements. i sat through a lot of opening statements in the house committee and i never quite heard such a marathon length of opening statements as we saw the other day. and senator dodd sat there as the chairman and did that right. and more importantly is the 14,000 people a day that lose health insurance. we don't want to rush this, but we're working very methodically and fairly and we need to do it. >> someone pointed out the other day, if all of

and senator mikulski agreed to consider the suggestion last night and i appreciate that. but, today, when the help committee reconvened our markup, senator mikulski and the majority refused to accept my language and offered counter language that would basically put us back to square one doing nothing to protecting patients and doctors from government agency interfering in their treatment decisions. when i asked why my language was unacceptable, which i thought was acceptable for much when we left yesterday, i was told that the decision to say my language was not acceptable was based on concerns by -- quote -- "washington policy experts." and i said, who's that? which "washington policy expert" said my language was not acceptable. and when pressed on which "policy experts" we learned that the directive had come straight down if the white house. now, why would the white house be so concerned about prohibiting federal government from using comparative effective research to restrict payments to doctors or to direct doctors to follow specific treatment orders? why would the wh

senator mikulski we thank you. we're getting to ten of your title to this bill. you've done a tremendous job. i want to thank you and your staff for tremendous effort to write such a very thoughtful and thorough title on the quality provisions. we're all very grateful to you. >> yes. >> this shall not beÑ/Ñ/Ñ7ññññ;

. >> senator mikulski. >> no by proxy. >> senator freedman? >> no by proxy. >> senator mury? >> no. >> senator reed? >> senator sandberg? >> no by proxy. >> senator casey? >> no. >> senator berkeley? >> no. >> senator whitehouse? >> no. >> senator enzi? >> aye. >> senator alexander? >> aye by proxy. >> senator byrd? >> aye by proxy. >> senator isaacson? >> aye by approximatey? >> senator mccain? >> aye by proxy. >> senator hatch? >> aye by proxy. >> senator coburn? >> aye. >> senator roberts. >> aye. >> senator kennedy? >> no by proxy. >> ten ayes. it appears to be nay. the amendment is not agreed to. here's where we are and senator coburn is leaving. i was hoping to get done by tomorrow midday, but we're going to finish, so i -- i don't want to keep people in the evenings if we can't consider amendments, but i don't know -- we have the fraud and abuse section now to go to and about -- >> there are eight people here, mr. chairman? we have eight, i know, and i think we ought to keep working at the thing. >> do it. >> i don't have amendments. do we have amendments? >> mr. chair