so now you fast-forward to today where, whether you have a high-deductible plan or you're in a ppo, theuctible is still probably pretty high, and the consumer is paying first dollar coverage. rebates don't really work well in that environment. so i think there are a lot of reasons employers don't like rebates. i think part of it is it's a very con voluntavoluted approac to lower drug costs, from their perspective. the difference between gross and net in terms of what somebody could pay versus what the net price could be. there's got to be a more simplified approach to how you manage costs, and actually the rebate structure can also prevent some other drugs from coming into the market because of rebates, procedure and the like. so there is a lot of flexibility in#t this market that is not j about pbms or manufacturers or dribt to distribu distributers. >> it seems there would be an opportunity for a processor that would not play games and would play straight with their clients. why doesn't that exist? >> you have some more pbms coming into the market that are more transparent. but when

so, an hmo and a ppo are the primary plans in our area.eferred provider organization, which typically allows you to go wherever your insurance company is contracted with. for a lot of people, it's very important for them to stay with the same doctor and also their local hospital. so, that is something i have them consider. an hmo is a health-maintenance organization, which you choose a medical group, so you have to stay within that group. we're lucky living in the bay area to have so many great doctors and facilities to be able to go to. we have such great specialists. i've been here for nine years, and i've seen a lot of growth, a lot of change, and it's been so positive. >> well, hello, dear. >> hello. >> we're back. >> i think it is important to have an advocate when you're choosing a health-insurance plan, especially with alice and joe with medicare. what happens is, when you turn 65, you get a lot of mail. you get a lot of insurance companies contacting you, and that's fine, but each one of them is trying to sell their plan. our servi

. >> i would say regardless of high deductible plans, a regular ppo plan, you don't have financial incentive once you get past your out-of-pocket maximum high-cost claims are a major driver overall, especially pharmacy in many respects, becoming high-cost claims. if you look at million-dollar drugs that are emerging whether it is a combination of the cost of the drug or administration of the drug uc this coming together of claims as a common category. i think employers are concerned how you manage high-cost pharmacy drugs. that is one of the elements in that mix of high-cost claims but cancer is another category related to drugs but also in general a high cost claim category that growth and centers of excellence you are seeing is a way employers get at these. cancer centers of excellence seeing growth at 30% to 40%. really again trying to steer people to the best place they can go for care, another way to get a high cost claim. all right. other questions? going once. going twice. all right, thank you all very much. .. and we have a full three days of authors and books for you this labor day

we've also put beside the bills that we talked about, we put people in a ppo prepared to deploy order. only about a 24 hour string that we have them on to respond and we have been all over the nation. ready to respond with the full capability and capacity of the department of defense that will be to be applied here and this is a microcosm of that in the sense that these are portions we are bringing forward. these are forces that have been brought forward under the agreements between these days to bring that capability forward that we know we have great rescue capability within those three units . >> stand over for now they will be moved forward. >> brian brown, cnn. >> you can you talk about preserving the needs of the area? >> you have an overall number of how many assets have been relocated to the high concentration of military facilities in the carolinas, do you have an overall number of how much has been relocated? >> it would be a moving target in the self that moved early, now and we will be bringing them back in a manner as well but we can update on the movements of that number

write the opinion saying that his military commission prosecution is unconstitutional, violates ex-ppoles. you will never have a nominee ruling that way. why did i rule for someone who had been involved in the september 11th? because the law compelled it. justice kennedy showed us in the texas versus johnson case. we don't make decisions based on who people are or their policy preferences or the moment. we base decisions on the law. justice kennedy's example of independence is something that i have tried to follow. and it means you are not a pro -- as i said yesterday, not a pro plaintiff, pro defense, pro prosecution or pro defense judge. i'm a pro law judge. that is part of being an independent judge is ruling for the party no matter who they are so long as the party is right. if you walk into my courtroom and you have the better legal afrgt arguments, you will win. >> i think you answered my next question based upon what you said about homdon, but there are probably other examples, you don't need to go into detail, but you have -- >> [ yelling ]. >> -- president bush a pointed you.

the state of texas does have some protections, i believe, while for patients who are in hmo's, not ppo's and i was a little shocked to see that in your graph. for example, use an in-network hospital, and they receive a bill for an out-of-network anesthesiologist or pathology, i think that is well worthwhile. you would be limited on the out-of-pocket. that is well worthwhile, exploring that. sen. cassidy: i pulled this from your testimony. the cataract surgery fees, tenfold difference between the low and the high. mr. kampine: correct. sen. cassidy: and it seems principle facility fees. mr. kampine: correct. sen. cassidy: it is quite remarkable. one thing that i had a conversation this morning with somebody, and although medicare is beyond the scope of this committee, still it is worthwhile considering, what if we made it passable for m.a. plans to share savings with beneficiaries who sign up for medicare if the beneficiary chooses a lower-cost facility? making sure we have information on infections and quality and everything else that everyone else spoke to. for example, a hip replacemen

they do have some protections i believe for patients in hmos come and not ppos and i was little shockedto see a red to see a red that was in your graph. that's something that needs to be addressed. for example, in an end network hospital if you end up with a balanced bill for an out-of-network, you are limited and is well worth while. >> my next chart. >> i pull the south florida cataract surgery fees 10 fold difference the low and high. and it seems principally facility fees. >> correct. >> it is amazing from less than 2000 operated 12 dozen is quite remarkable. now, one thing that i had a conversation this morning, thank you -- conversation this morning with somebody. although medicare's jan discovered this committee, still worthwhile considering, what if we made it possible for plans to share savings with beneficiaries to sign up for medicare if the beneficiary chooses a lower-cost facility. making sure that she has the information on infections and quality in everything else that everyone else hope to peter example of a hip replacement quite remarkable. what are your thoughts about