security services of the shipyard which the navy provides the majority of funding for. prior to the security [speaker not understood] agreement being entered into but in anticipation of future community property transfer, the agency conducted a solicitation in 2000 and selected mccoy's patrol services to provide security services at the shipyard. services scope includes front gate access control 24 hours a day 7 days a week, along with ship wide hourly roving patrol on the overnight shift. reporting duties associated with the contract including the reporting of any disturbances to the authorities and ocii and the developer and the preparation of daily, monthly, and vehicle reports and logs. the contract that we are extending today expires december 31st, 2013 and it is at the end of a five-year contract with an annual budget of just over $385,000. the 2003 phase 1dda required lennar to provide property management services at the shipyard through an interim lease which was executed in 2004. that interim lease required lennar to provide all the property management for ocii

provide. cation a four. star. way we need to provide financing with public and private education institutions and health care institutions that provide the best quality you know competition and we need to engage with social responsible business businesses and n.g.o.s and we need to count. fish and practices so where are all these measures so it's been a year and a half since the signed these decrees in may of two thousand and twelve why seal it . may be. the option you either do it in a way that causes negative response from the. it's all or nothing is done of course we can't achieve your task when we set out in this way with. too many delays and the people who are consumers of searches have not been able to see any tangible effects when we allocate a lot of finance finances but what. if we go this way we only increase the number of bureaucrats. and that's what's happening i'd like to point out like to draw the change leaders of the region. the federal authorities we need to. make unused dependents. assessment pro

provide use will with insight. gary:,y's witness is director for the center of consumer information and center of oversight for medicare and medicaid services. he is responsible for overseeing the health, insurance -- health insurance exchanges and other aspects of the law. mr. cohan we a great -- to cohan we appreciate you coming in. cohen, we appreciate you coming in. shape the opportunity to discuss the many benefits of the to smalle care act businesses and their employees. act isthe care transforming the insurance market, making it easier for them to find and him -- and purchase employee health plans. it is important to remember that the reforms that are in the affordable care act, some of which have you gone into effect and the remainder go into effect in the years beginning january 2014, are not limited to the shop. we have transformed the entire small-group market, whether the products are purchased inside the shop or outside the shop. i think there are sometimes some confusion that in order to benefit from

think, and i'll speak a little bit, if, the title is, about provider and provider networks we need to look at, this is not about us, right? it is about how do we get the maximum number of people the best personalized health care we possibly can and the practical reality is our large group employs 500 people. >> with all due respect, my question was, are medicare and medicaid reimbursement issues issues that the provider community were dealing with prior to the obamacare affordable care act ever becoming law, yes or no? . . >> this isn't about creating a new washington system to how to figure out how to pay people to provide care. this is much more broadly, about how do we establish policies to allow patients and families to remain in control of their health care and health care decisions. so -- >> so why did you guys bring up the reimbursement rates under medicare and medicaid as one of the reasons why there is this lack of adequacy of network -- >> i would say -- >> -- providers within some of the plans? >> i would say it is one of the reasons. >> okay. >> so it -- >> so if the congr

these services either should be provided by managed care health plans contracted with community based service providers or coordinated or purchased by so this next slide shows you the services we're talking about. home care care management adult day care medication management nutrition transportation social interaction protective services ombudsman services behavioral health and accessible and affordable housing so as we move into this new arena there's going to be a change some of the providers that we work with are going to be no longer giving their services or training for free, the health plans will have to purchase those services and provide them so it's a new day in that regard. >> >> another recommendation is an improved ihss program you might remember it's one of those services going to be moved into managed care the managed care plans will oversee the allocation of hours to providers this is a very dice dicey and controversial topic. so the department of adult services should take the lead into managed care i'm sure there's questions about this. i can't give all the answers b

, from a cable provider, from up to three wireless provider in over 90% of the markets, you can get it over the top through a voip provider. you have a number of options for voice telephone service. if you take video, it was video from broadcasters or cable, but today you can get video from a telephone company, you can get it from a satellite company, and you can get it over the top. in fact, netflix now has 30 million subscribers, 10 million subscribers more than the nation's largest cable company. so we have real intermodal competition. and in this ip environment, the goal should be to incent further investment to accelerate the kind of investment that will lead to greater capacity. and it shouldn't begin with the question of how to regulate. i think that the question needs to be what should be our objectives going forward, and how do we best accomplish those objectives, and what public policy should we adopt to do so? >> host: what could the fcc do or congress do then, in your view, that would decrease competition? >> guest: well, one of the things it could do to decrease competitio

and generally provides or wouldn't provide. it would seem that it would be appropriate to share.maybe situations where there's privileged material. >> what kind of privilege? executive? >> where there could be attorney-client privileged material, for kmampl, where there could be another way, though, of making sure that the committee was informed. so, for example, a white-paper type of approach instead of providing the actual deliberations with a summary of that. it's still true to the underlying reasoning. >> any other documents that aren't appropriate? >> i just really don't know the universe of documents that we could be talking about. >> as i said, wrapped up in the attorney client is wrapped up. >> and you don't think even if there's no attorney client relationship, that you're not entitled to deliberative documents? >> i think there can be situations in which deliberative documents, where there would be an attorney as part of the scenario, but deliberations without attorneys could be something that would be protected by the dlibl rative process privilege. but i think it's im

they need to be working in the mayor's office of hope to provide protections because san francisco is the city that supposedly knows how president david chiu: thank you very much. any others wishing to speak? is there any additional public comment? seeing none, public comment is closed. >> madam clerk. president david chiu: colleagues would anyone like to sever any of these items. i would like to sever item 50. if not, call the vote. speaker: [roll call vote taken] tang; mar, wiener, yee, avalos, breed, supervisor campos, there are 11 ayes. president david chiu: the resolutions are adopted. item 50. speaker: to support a moratorium in california. president david chiu: i would like to call a motion to continue this item to january 14th. i would like to give it a couple weeks. motion by supervisor avalos and second by supervisor ferrel. without objection this item will be continued to the 14th of january. madam clerk, any in -- memo rules. speaker: yes. # president david chiu: given this is a last meeting. i want to wish everyone a very happy holidays and want to thank the members of th

to provide. information provided a bank companies on the economic performance on their social. realities and so on we need to keep reading the. banking system from because the so called money won't bring. in shops like. the departed russian. partners must be protected by the government. schemes they were using sure. dictions it is. a widespread. technology worldwide and russia just come at it along with the other world economy said. we need to look at it now not only with private businesses but also with companies that are owned by the government or. by the government so there must be a comfort zone for executives in this area we know that they get big bonuses but we will never see will never see our economy prosper if we deprive those people of their benefits we need to have incentives plates we also need to have control and we have oversight which companies must develop their long term strategy as it says lay out their long term. responsibility in the way of their management but we also if you need to think of responsibility including. responsibility for you feel you need tho

this committee needs to provide the important checks and balances that would normally be provided in addition to the american public in those circumstances. i also think the department of justice plays a critical role providing legal advice to the agency. that advice is authoritative for the agency. were it to be confirmed, i would consider it my duty to make sure that the committees were informed of all intelligence activities conducted by cia, in particular committee understands legal basis for those activities. i would also be sure information provided to the department of justice and particularly to the office of legal counsel was accurate and timely and up to date. my experience since i've been back in the leadership of olc i've interacted many times with lawyers from the agency. my experience has been very positive in terms of feeling like we're always get at olc the information we need to give our advice if things change and that happens to be the case. i think olc advice is not useful to client agency. otherwise the client agency has an opinion but is addressing a different s

as you know su serves thousands of students and we provide opportunity. in the community every salesmen our multiple racial and body totally appreciates the varied experiences they've had at the park and eco center. etch semester i bring my standards there. i value the experiences they've had and knowledge gained from the expired education provided by the professors and students at the clinical college. i hope that you will take my support into consideration >> i'm elaine johnson i'm the director of bio link the advance center funded by national science foundation we provide technical support. we've been house defense attorneys at the continually of san francisco since 998 and have been developing skills based programs for our students where they could get wonderful jobs. many of our students have come from the bayview hirpts point area and have been working in a variety of life science careers one has a job at the man technical and has started a girl's club. beef about that very, very excited about the possibilities of adding certificates and stackable c

i was a participating provider with them. just like patients have trust in their doctors, patients have trust in the insurance company and i was one of them. the new plan rolled out. it took away my out-of-network benefits, which i might say i might be able to live with because under the high deductible plans, the in network adoptable was $2000 for an individual but the out-of- network was $3500. i was less likely, i must say, even in my position and certainly my staff to go to an out-of-network physician because the first dollar amounts would be hours to bear. being a responsible individual, you should take care of your bills. the new plan does not give out- of-network benefits to all small businesses. the affordable care act insurance does not allow for individuals out-of-network benefits. what a also noted when my new plan was developed was a very crafted a letter that implied even though i was going to have been in network plan presumably of the same level as my current plan, but only in network, it would now be called an

providers in over 90% of the markets. you can get over the top through a voip provider. have a number of options. if you take video, it was video from broadcasters are cable. today you can get it from the telephone company, a satellite company, and you can get over the top. netflix has 30 million subscribers, 10 million subscribers more than the nation's largest cable company. we have real intermodal competition. in the environment, the goal should be to incense further to accelerate the kind of investments that will lead to greater capacity. it should not begin with the question of how to regulate. i think the question needs to be , what should be our objectives going forward and how do we best andmplish those objectives what public policy should we adopt to do so? >> what could the fcc or congress do that would decrease competition? could do the things he is to continue to over regulate. one segment of the industry at the expense of investments. if you take our industry for example -- at the time of the 1996 act, we wer

amitay says correctly, protective services not providing the training they are obligated to provide in the contract. on the other hand, fps is not gaining the assurance that it needs that the contract guard companies themselves are providing the training that they are obligated to provide. they are not doing enough of the checks and certification. >> who is watching this? you're watching it? who within the chain of command, meaning the management of this, is making sure this is getting done? >> each region is investigatory process to assure themselves and do checks and do audits. some regions have not done it. some regions have not done it or any random fashion at all where they can gain assurance. when we have looked at what they have done, not only did we find our breaches in many cases of guards standing without the proper certifications, we found disparities between our reviewed and the review that fps had done as well. >> i think some of those disparities are disparities in the documentation. there are instances where the guards have received required training. they have their car

we have seen some of the provider issues with providers leaving the networks. two things there.they have either chosen the plans that continue to have those providers and their network or have reverted to the original medicare program where the proprietors are available to them. >> you have written extensively about medicare and the scientific studies must meet certain established standards to be accepted including the transparency and peer review and confidence levels to establish the validity. as a professional researcher i'm interested to hear your thoughts on a study which in my opinion the standards i believe there are many questions that we need to have answered before we can definitely say that the results have great meaning. would you agree that these are some of the questions we have answered before the validity of the conclusions as a result of mr. kaplan blank study? >> usually when you have a study they undergo the methods laid out. i didn't have time to do a thorough review of the study but both ie and a colleague looked at it quickly and the details that you would

under affordable care act providers need to be using electronic records so providers can easily share information across jurisdictions a as appropriate so that's one change that's certainly going to be happening and in addition to that so for example remote appointments with providers if you are not able to get there whether it's web based or phone based or something like that and to be honest i don't know about plans for current plans for expansion but that's something we address in the plan and seen as a promising opportunity really to increase access to vulnerable populations to make sure they get the care they need. >> great. colleagues any other questions? i think that there's so much information here i think it's just really impress ive and incredible and i want to thank you for all the work you have done and for the outreach and the reason why we had a 41 member task force is because we wanted to have every possible group and segment of the population represented in some way and i think you know we managed to do that but that also made it a lot more difficult to move this forwa

and generally provides or wouldn't provide. it would seem that it would be appropriate to share. maybe situations where there's privileged material. >> what kind of privilege? executive? >> where there could be attorney-client privileged material, for kmampl, where there could be another way, though, of making sure that the committee was informed. so, for example, a white-paper type of approach instead of providing the actual deliberations with a summary of that. it's still true to the underlying reasoning. >> any other documents that aren't appropriate? >> i just really don't know the universe of documents that we could be talking about. >> as i said, wrapped up in the attorney client is wrapped up. >> and you don't think even if there's no attorney client relationship, that you're not entitled to deliberative documents? >> i think there can be situations in which deliberative documents, where there would be an attorney as part of the scenario, but deliberations without attorneys could be something that would be protected by the dlibl rative process privilege. but i think it's i

i was a participating provider with them. just like patients have trust in the doctors patients have trust sometimes in their insurance company too and i was one of them. the new plan rolled out. it took away my out of network benefits, which i might say i might be able to live with because under the high deductible plan the n. network deductible is $2000 for an individual but the out of network was $3500. i was less likely i must say even in my position and certainly my staff to go to an out of network physician because those first dollar amounts would be ours to bear. being a responsible individual you should take care of your bills. the new plan does not give out of network benefits, not just just to me that to all small businesses. the affordable care act insurance does not ensure for individuals out of network benefits. what i also noted with my new plan that was developed was a very crafted letter that implied that even though i was going to happen in network plan presumed we have the same level as my current day plan b

the imf also provided funding and an unprecedented scale also on the head. and they've seen the torrens title. i think what you say balanced especially as pets they were working on with the fact that i've run a charity for disabled and the refugee children are friends. mason's kids. i studied with kids in the year two thousand and one prior to september eleven on because i was watching the news knows this is bombing in sydney. and i just like that and i was like wow we are creating an entire generation disabled people that no one knows what to do i felt the need to go back there in tucson. when i first went to work with the kids i had no idea why. i did. ii top twenty in the haitian refugee camp knew no one knew nothing and was thus like ok it's cabbage onion and do that. to those of you who have never been to a refugee camps is so porous that riding swimming attend this long to write down who is and kids. millions and millions of foreign hungry kids and i was going to be there for bringing them shoes and glasses and clothes and all the while protecting myse

more than a hundred san francisco residents provided input on the plan at these meetings. and i also want to thank all of the 41 members of this task force. the result of this work is a 182-page document that compiles a wealth of data and sets forth a series of recommendations that will help our city to continue to improve the health care needs -- health care access of our residents. if my colleagues have not seen the document, i would encourage you to take the time to actually read it and to see all the data that outlines the specific health care needs, not only city-wide, but neighborhood by neighborhood, and you will be amazed at what you learn about your individual district and the individual neighborhoods. next week this board will vote on a resolution that i've introduced approving the health care services master plan and i encourage you again to read this document. and my hope is that this document will be used by all the city agencies to inform decisions that clearly, you know, can benefit from the information that's provided and the recommendations that are out li

we provide family nights with cultural fun themes. we have an active committee that helps to determine the goals and objectives of the program biensz or based on the data. we have our student elected representative. provide expanded educational stunt with college tours to stanford and u.s. santa cruz. support parents and guardians to understand the positive and campfire them to help with the agriculture needs. and to help with the educational language. collaborates annual event and the wisdom of moving forward event >> and our dancipowwow. we collaborator with the american indian community to support the youth and families. we received consultant oppose at the schools. >> thank you very much. so along with our successes our changes are the indian education program which are a nonpriority and challenge is to have a permanent location. we need to set up our libraries and a sf d staff to access as well as other resources. the district needs to republic a report that identifies all the current list of american indian students. we have onl

according to the quality of care that they provide.medicare is that e.g. greater for these reforms. as such it includes a set of policies designed to make the medicare advantage system more efficient and to enhance the plan quality. alongside the physicians, hospital and other healthcare providers medicare advantage plans have been and should be playing an important role in the transformation. medicare advantage included in the aca are intended to secure the high-value care. in other words, better quality at a lower price. recent changes to m.a. by the aca have strengthened the program in addition to improving medicare's overall financial outlook the aca through added benefits they are a cost sharing and improved plan quality. for instance, the aca expand coverage for the preventive services and prohibits medicare advantage plans from charging the original medicare for renal dialysis, chemotherapy and skilled nursing facility stays and requires the plans spend 85% of the premiums and federal payments on the patient care. these and othe

and in 2011 we provided $11.5 million in charity care. and each year we provide $1.5 million in charity organizations. and we provide free surgeries at the hospital several times a year. next week we will be underwriting a sponsor at the auditorium. and meal on wheels, and enterprise for high school students. we have dozens of community partners. as part of process, we don't just give money but part is to be at the table. we have a program and administrators sitting on 70 nonprofits across the city. and one special project we have developed here in san francisco is sponsorship of community gardens. we have given grants to help with the installation and maintenance of 21 community gardens across san francisco and would love to see that number double in the next couple of years. to conclude, i want to say that kaiser permanente is invested in san francisco and update our facilities and build more to serve the community. if you have questions, i am joined by our capital project developer and a number from our team. >> thank you, why don't we

the 96 act provided that. we have filed for variance petitions and i think what we need to do is to have the fcc acknowledge that we are -- where consumers have choices for a service like voice telephone service, that does choices can be intermodal in nature, and so the commission needs to expand its thinking to not think in terms of simply wireline voice service but to think in terms of voice service and the competition for voice service. where consumers have multiple choices for voice service ,-com,-com ma then the commission should no longer engage in economic regulation of that service. >> guest: would you like to see some kind of maybe special committee at the fcc or some kind of task force review all of these regulations? is that the sort of thing you are looking for? >> guest: i think this is something the technology transition task force can take a look at. i think the appointment of jonathan sobel and will be inspiring. yes go he will be the new general counsel at the fcc, the fellow who you just ment

it provided what economists call "a public good"-- a good that has to be provided collectively or notl. i'm speaking of the flood control and navigation improvements made possible by the tva dams. these improvements were in the interests of society, but they would not have been in the interests of private businesses. the benefit of flood and navigaon control was spread over the entire region and not limited to a few paying customers. flood control protects thousands of people in the region and thousands more who may move in afr the dams are built. whether thousands or millions of people enjoy this benefit, the cost of providing it is unchanged. the problem with a public good like this is that it's extremely difficult to charge private consumers for benefits they receive. my neighbor decides to pay for flood control, but i do not. there is no way in which i can be excluded from the benefit of his flood control, just as i can't be excluded from the benefits of a nationwide polio vaccine program, or national defense. invasions of flood waters or foreign armies can be handled only in one

funding for this program was provided by... woman: can the art on this child's face tell you what is going on in his life? i'm a cat, and you're a dog. creativity is more than crayons, paint, and paste. how does a fish sound? creativity is the freest form of self-expression, and the creative process is more important than the finished product. and the father said, "it's dinnertime!" there is nothing more satisfying and fulfilling for children than to be able to express themselves openly, fully, freely. come inside the house! come inside the house! girl: ok, papa. hello. i'm joanne hendrick, author of the whole child and your guide to this video series. over the years, we've learned that the experiences children have during their first years of life can do so much to advance the development of their creativity. we'll observe children in a number of different centers-- head start, family day-care homes, university schools, and private child-care centers. the question is, what can we do as caregivers to help foster and reinforce y

and the essential community providers. the strong requirements include the following. i am going to this because the people in the panel before blamed the affordable care act for the reasons they may not be on a provider network but these are state guidelines, reasons why at the requirements, provide recovered person ratio by primary care, geographic accessibility, waiting times for appointments with participating providers, hours of operation, technological services available to serve the needs of people who require advanced care. so if there are concerns with a state about adequacy of provider networks who can consumers go to and what actions can states take to address those concerns? >> you are right lee raising that the affordable care act actually establishes requirements for network adequacy and in many areas of the lot it leaves it to the state to enforce those requirements and we need attention to them, legitimate requirements. does fall to the insurance commissioner in the state, states have different degrees of w

waiver of these payments does provide the housing authority with additional resources to address our enormous challenging needs to maintain our properties and provide services to our low income residents. i am happy to answer any questions that you may have. >> thank you very much. colleagues any questions? okay. mr. rose can we go to the budget analyst report please. >> yes mr. chairman. members of the committee on page 10 of the report which was indicated by the department the proposed payment in lieu of taxes to the san francisco housing authority for the period listed totals about 12.1 million that is shown in table one of page of our report. under the cooperative agreement outstanding payments are not subject to interest or penalties. we point out on page 11 of the report out of 10 housing authority surveyed throughout the country four obtained waiveers for payments to remove taxes and others made payments to local government entities. just to clarify our recommendation in the management audit report the housing authority indicated they wanted a waiver and we said it has to be b

they can be child care providers so our clients can go out and work. >> we found more and more women of child bearing age come down with cancer and they have kids and the kids were having a horrible time and parents were having a horrible time. how do parents tell their kids they may not be here? what we do is provide a place and the material and support and then they figure out their own truth, what it means to them. i see the behavior change in front of my eyes. maybe they have never been able to go out of boundaries, their lives have been so rigid to sort of expressing that makes tremendous changes. because we did what we did, it is now sort of a nationwide model. >> i think you would be surprised if you come to these clinics. many of them i think would be your neighbors if you knew that. often times we just don't discuss that. we treat husband and wife and they bring in their kids or we treat the grandparents and then the next generation. there are people who come in who need treatment for their heart disease or for their diabetes or their high blood pressure or their cholesterol

haislmaier, sums dates have much stronger requirements for general providers and community providers. .. as in many areas of the law, it leaves it to the state for forces requirements. and it does thought to the insurance commissioner of the state and the states have different degrees of willingness and ability to address that and we are not seeing that effort in that regard, and we need to attend to it. >> you have decades of experience in assessing the health care system, and we hope to have you on this panel and here you are. one of the most critical features of a portable correct is the expansion of medicaid eligibility to millions of low-income adults. prior to the aca, it was restricted primarily to the low income children and people with disabilities and seniors. most were not eligible according to a study by kaiser family foundation. and only about 30% of adults had this in 2012. under the aca, medicare eligibility was expanded to cover all nonelderly adults, including 130% of the federal poverty level. and then face down this by 2020. >> that is correct. >> despite this, as m

we have a senior administrative analyst who oversees the services provided for women, and three re-- four rehabilitative services coordinators who coordinate the programming inside the jails. in addition, we spend -- we have budgeted $70,000 for professional services which include translation for people who don't -- who need translation to other languages, and subscriptions for items such as legal books that go into the inmates' library. we also spend $540,000 on the in-jail programs, among which is the very popular one family program which provides parenting classes and contact visiting for parents -- for children whose parents are incarcerated in the jail system. and we also spend $56,000 on materials and supplies, the largest item which is a video conferencing system which allows inmates who are at cj5 to communicate with their defenders downtown and to participate in a legal -- participate in their legal defense. we've had a number of requests from members of the board to allocate funds towards phone cards to reduce the cost of calls to inmates who are making calls. and, so, by c

it does come as a surprise. >> this is a mandate to where it provides health insurance to provide tosome in my note others. >> what criteria would you use? >> with job retention tiffin by the industry. >> different industries have different types of retirement plans and health benefits. >> when people save more companies will drop their health care plans? i don't know what facts or empirical data or research will drive anyone to conclude that companies will drop health insurance because when we hold hearings here, one of the issues that companies and small business bring to us is to find skilled workers for a bright ayrshire in order to retain those skilled workers, if you provide health care as the package job offer, if they would be more than willing to come to your company. >> before i yield back there is no balance but the atp national employment report which measures private employment says small businesses led the way with job creation in one had to choose thousand jobs in november. thank you. estimate there is never enough jobs so i would like more jobs. we will cut it down to

providers, payers, and policymakers. also, the affordable care act coverage, which really starts to hit later in the decade. they are seen as pushing providers forward and making the more interesting in reform of provider payments. also, i think that the new thinking about federalism has gridlocked grants for a long time. now, there seems to be thinking on both sides that we can use a shared savings approach. -- thethe key obstacles rudimentary state. innovative payment approaches. this is very early in the game. there are concerns that i mentioned before about second- generation. we need it soon. there is also a lack of readiness and many providers to succeed under reform payment approaches. another obstacle is the importance of consistency in payment approaches by payers. payments, there has to be some degree of coordination between what medicare and medicaid are doing and what the private payers are doing. there is a fascinating article ago, aboutm a month succeeding. subject to incentives. i think that the traditiona

funding for this program is provided by... narrator: the human species is engaging in a vast global experiment in climate change. each day, more greenhouse gases are being added to the atmosphere with unknown consequences. clues for what the future may hold are frozen deep within ice on the world's highest mountains. lonnie thompson and his team have been risking their lives for over three decades, drilling into mountain glaciers -- ice that has remained frozen for thousands of years. the ice cores they retrieve contain a perfectly preserved record of the earth's past climate. looking toward the future, chris field has created a time machine in a northern california grassland. the jasper ridge global change experiment is subjecting an entire ecosystem to the predicted climate conditions possible 50 to 75 years in the future. both research programs -- one looking into the past and the other toward the future -- will ultimately provide us with better ways to predict and cope with earth's changing climate. [ wind whipping ] man:

incentives they would receive with employer-provided coverage where there is tax incentives to provide health care coverage. let's deal with these frivolous lawsuits. that reduces the costs. so i appreciate the fact that one of my colleagues joined me on the floor and is going to continue this discussion but i want to go back to where we started. it doesn't have to be this way. what we're doing here in the united states senate by taking away the rights of the minority is not going to help us with regard to getting better judges. it didn't help us in terms of cramming obamacare through with 51 votes rather than the normal 60 that should have been required. it doesn't help for us to now continue down this track of a government one size fits all approach to health care. we've heard the stories, we see what's happening and we haven't hit most americans yet because they get their coverage from their employer. instead let's work together. let's provide more choice. let's reduce the cost. let's ensure that everybody has access to health care that works for them and their families. if we do th