effectiveness research in order to ration care. so i think that -- i hope that our colleagues would view this legislation as an important step that we can take. let me just give you a couple of the examples that i said i could provide. there's a fellow by the name of rocky fernandez, a kidney cancer patient in britain. he was given two tphopbgts live when the cancer spread to his lungs. his doctor wanted to spraoeub a drug, a new drug for advanced kidney cancer but the british government said no. he and thousands of other cancer patients protested the british government's decision. this is what you'd have to do, i gather. the government ultimately reversed its decision and, fortunately, he was able to begin taking the drug. but the british health authorities knew this wasn't the end. more costly life-extending drugs would become available, patients would demand access to the drugs, and the government would be faced with increasingly difficult decisions. so faced with a finite pot of resources, the british health authorities decided

that is a euphemism for rationing health care. the president himself has talked about this, not in those specific terms, but in a recent interview he said, what i think the government can do effectively is be an honest broker and assessing treatment options. if it the government is going to be a broker in treatment options, that is a euphemism of deciding what it will and will not pay for. what you can get and what you cannot. a former u.s. senator and at one point candidate for hhs secretary talked about this. he and knowledge that doctors and patients might resent any encroachment on their ability to use the treatments. he called for the same kind of body in his book that would allocate treatments based upon this kind of cost research. there are many other steps have spoken about it as well. this the sun go down so well in countries that have tried it like great britain and canada. i will quote one other individual that has talked about this. a professor at the harvard business school said that the comparative effectiveness stim

that is why the ration care in great britain. it goes on, the quality, quantitative adjusted life year, the method helps as measured these factors so we can compare different treatments for the same in different conditions. this is the idea of how many extra months of years of life of reasonable quality person might be-- gain andy goes on to conclude, each drug is considered on a case-by-case basis. generally however if the treatment costs more than 20 to 30,000 pounds for quality adjusted life year then it would not be cut considered cost-effective and they don't give it to you. we have many, many examples of people in great britain that are denied care because the government has decided that the cost of the treatment is more than your quality adjusted life year. this is adjusted for aids so the older you get, the more the treatment, or even though the treatment may cost less you are less likely to get it because of your age. think about that for a moment. something cost $20,000 in the united states and you were 65 years of age

if you don't think rationing is out there right now and we're not rationing care and doctors are making decisions to not serve patients, you know, go out there in the real world ask take a look. and that's why we have a specialty hospital. i can't afford it. and you will save a lot of money by medicare and the president said he would cut medicare and simply because, you know, the doctors won't offer it. and if that ain't rationing, i'm not country. >> the counteroffer. mr. chairman, what is the pending order? >> the pending order of business would be -- i believe -- >> the roberts amendment. the roberts amendment. let me just say, senator, we've had a good debate about this and discussion going back and forth and unfortunately, we haven't resolved this despite the fact that this is some common points of interest in all of this, but this is -- to move the process along and we'll have to come back to it and i realize there are a whole host of amendments that i hope you can clean up by this and over the evening we weren't able to come to the understanding that would allow me to agree on la

it if you look any country that has government health care they rationed. the way they ration is a run of money because governments always overpromise everything, so everyone has talked about they underpay doctors. if you are a doctor who is underpaid, will you say this is the career i want into more of this? you will do less so we have a more limited access all the time so the best example is we talked about is medicaid. how many doctors want to take medicaid? one and three reimbursements, it is a hassle factor so we have ration health care, we will continue to have rationing health care of the more government involved in the system. i would ask everybody to take the time, this is 28 and a half minutes, watch this, get on our website and look at the different interviews and talk to people in other countries, don't rely on us but talk to people and tell everybody the problem with government health care that your kids and daughters and son in paris will not get the same health care they get today. thank you very much. samantha website? >> you can get on the

if you don't think rationing is out there right now and we are not rationing care and doctors are making decisions not to serve patients, if you know, go up there in the real world and take a look. that is why we have special the hospitals. that is why we have the special the hospital, like a sheep. the factors they know i'm not going to put up with it, i can't afford it so they don't treat medicare. now take this to the logic conclusion, you are going to save a lot of money with medicare. the president says he's going to cut medicare simply because the doctors won't offer it. if that ain't rationing, i am not country. >> is there objection to-- to the counteroffer? then, mr. chairman-- >> the pending order of business would be, i believe-- >> it is the roberts amendment. >> let me just say, senator, this has been a good debate and obviously and fortunately we have to resolve this. there are some common points of interest and all of this, but to move the process along, we will have to come back to a. i realize their whole host of amendments. i hope we can clean up by this and eventually

allocation of treatments is another way of saying rationing. you decide which treatments to allocate and which ones not to. this is the way it's done in great britain and canada. they don't have enough money to pay for all the health care physicians prescribe, and so they delay some of the care until it's not needed anymore or the person dies, or they deny it. for example, one of the policies was not to prescribe a -- well, the doctor prescribes the drug, but not to fill the prescription for an eye condition until the patient was blind in one eye. and then you could get the drug. americans don't want that. they don't want to have to suffer in that way when the medicines are available to treat them. and what the government agency in great britain has said is, look, we don't have enough money to give you all the care that your doctor says you need. we're going to have to make tough choices. we understand that won't please everyone. but there is no other way to use the limited dollars that we have to provide this free care to everybody within the

we are not going to have united states rationing in united. -- we are not going to of rationing in the united states. conservatives were against medicare. we got medicare passed under lyndon johnson with almost no republican support. they thought it every step of the way. here we are and medicare is the difference between whether seniors are dying in droves or whether they get recendays and h care. you have to put these conservative ideas aside. they get told what to say by a very high-priced political consultant paid what they say is not show. -- what they say is not so.

i saw absolute rationing of health care. we had four hospitals in london. if you visited other hospitals in london, you could see how pathetic the facilities were and talk to parents and see how they didn't get care. one of the first things we did this year is put together a documentary and we hired -- you can get a copy outside. if you don't get a copy, just e-mail me. what we did is we hired jean randall, an anchor from cnn who had gone freelance. he talked to patients and doctors. i'll give you quick stories. a 19-year-old girl says she's in college, it's time to get a pap smear test. they get in the united states and most countries after earlier two years after sexually active or 18 years old. she goes to the primary care doctor, says no, the government says you don't get it until you're 20. then they say the government just changed the law until you're 25. she goes back at 23, she's got cervical cancer and she has a year to live. she's 25 years old now. another example, a doctor, an oncologist, he'll tell you, you can get a copy of this on the website,

i rationing, it's used all the time and it's not offensive. we're not for health rationing, we're for driving down the costs and deliver affordable health care and by frightening people by talking about rationing does not contribute to the debate. all in favor say aye. >> ask tour a roll call. >> clerk will call the vote. >> no. >> no by proxy. >> no. >> no by proxy. >> no. >> no. >>> senator brown. >> no. >> senator casey. >> no. >> senator occasikagen. >> no, by proxy. >> senator murphy. >> no. >> senator whitehouse? >> no. >> senator enzi. >> aye. >> senator staalexander. >> aye by proxy. >> senator bird. >> aye by proxy. >> senator mccain? >> 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

nobody wants their healthcare rationed by somebody here in washington dc.would also require that comparative effectiveness research account for differences in the preference of patients and their treatment response to personalize medicine and something called genomics. genomics is the breakdown of the genes in the body into all of the difference elements, which make as unique as individuals and what genomics research focuses on is what exactly is it in your gene composition, the human genome that might be different from someone else's. that means a person lies treatment would work for you where is it might not work for someone else and they are actually finding that they can tailor specific drugs to treat specific genes in such a way that, if they know your human composition they can find a way to treat your condition, say a cancer, potentially slightly differently than they would treat somebody else is cancer, whether the dosage of the medicine or in a specific kind of medicine or however it might be, the point being that not everyone is the same. effect w

where the banking system operates on a much slower to much lower capacity where credit is much more rationed and it's going to be a much slower. so the question i would leave you with is as we look back at the story of jpmorgan, the story of credit innovation which parts of the innovation can we actually preserve and which parts can we throw out. is there a way we can actually take the original ideas about financial innovation that were developed in the 1990's and keep them for the good or is it the case all complex finances bad. i think looking back at real-life human beings and how they've tried to develop those ideas offers one way of showing that it didn't have to be like this. and so i hope that for the future it will provide a pointer of not just a terrible mistakes that the banking industry's made but also some ways we can, try to control going forward. thank you and i would like to take any questions that you can speak eight at me. >> there have been a new complacency it seems to me in the credit derivatives markets. it's going to be exchanged trade, it will become more transparent.

[laughter] there's been a lot of talk about rationing and during the war, people have rations. imagine during wartime if one out of six americans who are getting rations during a critical period when the war, imagine if one out of 61 of able to get rations and they just starved. well, one of six americans starving for health care, 50 million americans can't get any health care at all. now, dr. gratzer, you tried to make the case for rationing in canada worse than it is in the u.s.. do you know what statistics canada and a lot to the u.s. census says the wait time is across canada for elective surgery? >> why don't you inform us. >> it's four weeks. >> why does canada say to the wheat time for diagnostic imaging like mri? >> i can tell you the government recently looked at that -- >> it's three weeks. >> how many uninsured are there in canada? >> probably relatively few. >> non-or view. how many bankruptcies or there in canada? >> it depends how you define the -- >> notte or view. cunego without care due to high costs due to health insurance companies? >> am i allowed to answer

and it's going to be -- it's going to be basically a blueprint for rationing health care. maybe i'm wrong. maybe i have just been through all of these experiences and think that there's, you know, things there that aren't there. i don't think so. and i don't see any problem if it is duplicative. where has it been said that congress can't be duplicative in trying to protect patient's choice. i appreciate the comments from my friend from maryland. >> all right. no further debate on the amendment. all those in favor of the -- >> i'd like a roll call vote. >> the clerk will call the roll. >> senator dodd? >> no. >> senator -- >> no, by proxy. >> senator mikulski. >> no. >> senator bingaman. >> no, by proex. >> senator murray. >> no, by proxy. >> senator reed. >> no. >> senator sanders. >> no. >> senator brown. >> -- >> senator casey. >> no. >> senator higgens. >> no, by proxy. >> senator murphy. >> no. >> senator whitehouse. >> no. >> senator enzi? >> aye. >> senator greg. >> aye by proxy. >> senator alexander. >> aye by proxy. >> senator burress. >> aye by proxy. >> senator m

not only would this exponentially increase the cost for the taxpayer but also further ration hlth care. the administration expressed desire for public insurance, public insurance plan that would directly compete with private health insurance plans. employers will see this as a cost avoidance and moved there in peace and costs from their own pocket book and bank account to the tax payers. we have seen this already in schip. how will we pay for this as a nation? have you accounted for the enrollment beyond just today's uninsured? further, public insurance accounts for about 40% of the health care coverage while private insurance covers about 60% of it. we know that the reimbursement rates are much lower than the actual cost when it comes to the public portion. in kansas the experiencing from 25% to 70% below cost on reimbursement rates and it's not one entity alone. its hospitals, clinics, and physicians. they try to make ends meet by shifting cost from the private insurance payments to cover the shortfalls and the public from the insurance. today in kansas one-third of the physicians wi

and a rationalization of the companies' respective a value streams. i conclude by encouraging our witness to engage in open dialogue with members of the committee about the matters that i have just mentioned. the honest disclosure of today's hearings is necessary to restoring the semblance of public trust in the plans were restructured. so thank you mr. chairman, thank you to our panel, and i yield back the balance of my time. >> thank you, mr. dingell. mr. barton. >> thank you mr. chairman. i want to thank you and chairman waxman for holding this hearing and thank you personally for agreeing to let mr. frank backer who is a dealer in my district testify and also thank you for being willing to put a statement in the record of congressman allowed to read to isn't a member of the committee but has asked to sit on the diocese and you indicated you except unanimous consent to allow his statement into the record so i appreciate all of those courtesies. in mr. chairman, i have a prepared statement and i will submit for the record. but i want to just kind of

and that's why rationing is wrong, and that's why question as are wrong. because in fact they eliminate the very power of the individual -- question as are wrong. this -- quotas are wrong. >> this lead us to some profound commitmes. having judges that understand that america that has driven god from the public square will no longer be the america that has extended freedom and prosperity for 400 years. understand that individual rights and responsibilities are at the heart of our system, that there are no quotas and no group identities in the american system. understanding that at cape henry, where english-speaking settlers first came, they erected a cross as their first act in order to thank god for having gotten across the atlantic. understanding that at jamestown, our first permanent settlement, they established the principle "if you do the do not work you will not eat" not for the poor but for the air rest toe cats. it was at the heart of our wealth forereform in 1986. it is our most successful conservative program in the modern times. 65%% of the peopl

both in -- at their expense in the form of cost and rationed care. so a question for the program is: how much will it cost? who is going to pay it? another question: what's going to be the effect on seniors who are in medicare? do they have anything to worry about? my answer do that is, absolutely, because some of the conversation has to do with "reforming" the way our seniors get their cost. we haven't heard much about the exact price of government-run health care. but we know the cost will be extremely high and we won't spend enough to ensure that all americans get the care they need. so when we talk about beginning to be more concerned about the cost than quality of care as the institute in bin that i quoted just said, we get into a situation where we are going to be having to ration care and that is something that neither our seniors nor families with coverage today want at all. we need a real marketplace of openings. and choice. and freedom. they should be guiding principles for the reform we all want. i reiterate, republicans and democrats want

that was the-- of the bank said you had all these reasons why do you were not behaving rationally. there were structural incentives. then you get the situation where all the banks are competing fiercely to grab a slice of the market and none of them not only stopped to build up their the structure but nor did they want to spend any money because that is going to hit their peak and al, their bonuses nor did they won two-- so there isn't enough situation, there's a case where there is a rational self healing mechanism to get everyone to invest collectively. it wasn't until the fed stepped in and said listen, let's try and get everyone around the table and work out a solution. they began to do that. they could do that and they did it with a degree of success but it was in some ways pretty late in the day. they could do that in a case of credit derivatives with the settlement problems but it was tangible and it was stated, and if you like there was an issue where everyone agreed. no one quite knew how to act. was clear that market forces alone was not solving it but you get the banks o

is a bear minimum that we should do to prevent rationing of care. our bill, incidentally, is endorsed by the american medical association. mr. president, government-run and rationed approaches have caused much pain to people in other countries. for example, in an article for the "manhattan institute city journal" it was written of the long waits that canadians endure for any procedure or diagnostic test. seniors who lay on stretchers for five days in a hospital waiting room. a three-year wait list for a hernia operation, a two-year delay for sleep apnea treatment, a year-long delay for hip replacement and so on. it's one thing for washington it take over car companies, getting it wrong there usually won't lead to life or death problems. but it's an entirely different matter to allow washington to go into business as the nation's health care provider. who's going to protect you when they get it wrong? who are you going to appeal to? in his health car speeches president obama has stressed if you like your current health care, you can keep it. if you d

but there's a big difference between wanting to save money and rationing care and that is what we are talking about. rationing care because cms will use the information to limit the availability of new and advanced techniques to save people's lives, to extend their lives to increase the quality of their lives because it saves money. and that is what the state is all about. it is about whether cns kits to practice medicine. and the intent of the administration has stated is that they want cms to practice medicine and what that does is puts the government in between the patient and the doctor. it denies the art of medicine. i readily admit we don't do as good as we should be doing in terms of practice protocols, best practices, things we can learn. but there's a whole lot of difference between incentivizing good behavior and allowing us to control cost by having the government stepped between a patient and their doctor and i think we have to have a clearer provision. if we are not bring to have it what it says by default you admit you want cms to control the cost, so it is either we do

care like the system in -- delays, denies, and rations care like the system in new zealand. health care decisions left to doctors and patients not remote bureaucrats. but that is what we can expect if we have a government-run health care system. >> thank you. today i would like to talk about a bill that we introduced. a companion bill will also be introduced. the number of the bill is 1259. it is called the patient act. -- patients's act. the idea is to focus on health care as it relates to patients. it should be patient-centered. nothing should come between the position and the patient. we are concerned that there is something that is being done that needs to

rationing will hinder access. as i said, my colleague from illinois, the distinguished majority assistant leader says that you can actually find some examples in the united states where there are long wait times. if that is true -- and i don't doubt what he said -- that's not good. it's bad. we should try to fix that. so we don't have wait times. we shouldn't justify having more weight times on the fact that we already have some -- having more wait times on the fact that we already have some. the fact there are some people in america who have to wait, therefore we should make it possible for everybody in america who has to wait. we should be like canada or great britain. that's not the answer. if we have wait times here, we should stop it, not say we might as well be like canada or great britain. americans do not deserve or want health care that forces them into government bureaucracy with its labyrinth of complex rules and regulations. think about the hassles of dealing with the i.r.s. or the department of motor

roosevelt did in 1941 and do a thing called rationing? it seems all of you are afraid of that word, rationing. i don't know why everybody in this country cannot get along on 7 gallons a week for their registered automobiles. i can do that and pay to dollars and 50 cents a gallon and be happy, but if you want more than that, you pay $10 a gallon. don't make me pay for your bad behavior and bad driving practices. i don't think it is fair and i think you people are missing the boat with this cap and trade. the vehicles on the road are making most of the pollution. you have to start restricting the amount of gasoline you put in them. guest: first of all, i strongly disagree with your assertion is rationing something we should look at. rationing was tried in the 1970's, and you saw what led to. lines at the pump when jimmy carter literally limited people's ability to buy gasoline and you can only buy on a survey based on your license plate. people changing license plates day today so they can buy gasoline. this is america, this is not russia,

it's not rational to have an efficient market and, of course, the buzzword for the free-market group was efficiency. the problem was

or not rationing in political terms and that came down to a cost analysis will not be included in the clinical effectiveness research. some members of the congress especially in the senate and also in the house where ferrell the dow be used to ration the cost and analysis and i made it clear that no this is a clinical attractiveness. clinically this procedure and is this a job and is in this medical device, is a better than the other or not? i am fond of this planning how fda reviews a drug application, it looks only to see whether it is safe and doesn't work and compares it with a placebo, not against any other drug and i think we need to do a comparison here, not just drug and medical devices but also procedures to see which is more attractive and so have much more evidence based evidence in america based more on value and reimbursement, based more on quality and value than volume. and i think that we will be able to get this included in the health care reform as comparative effectiveness research or fred as we want to call it as long as you make it clear there is no cost benefit an

you must -- we must already have been rationing.o basically what jack hadley and colleagues do, basically say we have to top this off, you know, if we insured them they'd behave like the others, it'd be 3900 and i think in the end, because some people weren't insured the whole year, only part of the year, what they come up with, it would add about $122 billion to health spending in 2008 had we had everyone insured. that's it. and i think no one has fought with this number at all. it's the -- it's the gold standard we all use. so if you now use this and would say, okay, supposing we had full coverage in 2010, that would probably add $150 billion to national health spending, maybe. and the government would maybe pay $125 billion of that. some of it might still be coursed out of the people under a mandate. but that would grow. i had let it grow only at 5%, which i already assumed everything president obama is dreaming of would have come to pass. in fact, probably none of it will, but i just want to be nice. so here -- that's $1.57 tril

not rationing in political terms. and that came down to the cost benefit analysis will not be included in a clinical effectiveness research. and some members of the congress especially in the senate also in the house were fearful that would be used to ration the cost benefit analysis. and i made it very clear, no, this is clinical effectiveness. clinically does this procedure, does this drug, you know, medical device -- is it better than the other or not? i'm fond of explaining how fda now refs a drug application looks only to see whether it's safe and did it work. and it compares it with a placebo and not against another drug. we need to do a comparison not just drugs but medical procedures and we have much more evidence-based medicine in america and based more on value and reimbursement is based more on quality than volume. and i think that we'll be able to get this included in healthcare reform as comparative effectiveness research, fred, we want to call it -- as long as we make it clear that there's no cost benefi

so you have all these reasons why they weren't behaving rationally. there was distortions and incentives. and the situation where all the banks are competing furiously to try to grab a slice of the new market and none of them not only want to stop to build up their infrastructure but nor do they want to spend any money because that will hit their p & l and their bonuses and there isn't in that situation -- it isn't a case that there's a rational self-healing mechanism to get everyone to invest collectively. it actually wasn't until tim geithner stepped in, let's get earn around the table and they began to do that. now, they could do that and they did it with a degree of success but it was actually in some ways pretty late in the day -- they could do that in the case of on the credit derivatives with the supplement problems because it was tangible and if you like there was an issue where everyone agreed it was a problem. no one quite knew how to act. it was clear that free market forces alone wasn't solving it but you'd get the banks around the table.

america was reduced by bad policy, bad politicians, and bad government to rationing gasoline. my good friend pointed out he was only 13 at the time every morning, his father would give him a screwdriver to go out back and change the license plate so the car that needed gas had the right license plate. if you learn that a government rationing led 13-year olds to change license plates, you are a conservative. if you conclude that what we needed was license plate police at every gas station, you are a liberal. it is that straightforward. we have been here before. replacing the rule of law with special interest deals and bankruptcy does not work. having a 31-year-old to take time off to did -- to redesign the auto industry will not work. he is a symbol of the arrogance and lack of realism of this administration. [applause] heading off a corn and other groups will not work. you can't have capitalism on the way up and socialism on the way down. you are going to choose one of the other. i pick capitalism because it has been the most productive, most prosperous, highest quality of lif

and you would articulate a rational explanation for that different treatment as what? >> as the need for the counties in the precincts to have the flexibility to allow elections to work. the fact is in pine county where there may be one street called main. in minneapolis there maybe 20 streets that have main. so in minneapolis you may need a different standard for whether or not it says mainstreet, maine avenue, main boulevard. whether it has a directional -- >> is there evidence in the record to support this rational explanation that you're offering now? spivak there isn't a. the trial court found that there is difference of technology, different personnel and resources were among the differences that justified the difference interpretation that counties brought and personnel brought to being satisfied and i point this court to that operative word. if you read the statute, what it says is that the election judge must be satisfied these requirements were met. and that term satisfied obviously connotes that there is going to be some measure of discretion involved, some

that is rationing unless you say the whole difference was waste we must have already been rationing. so basically what jack hadley and colleagues to basically say we have to top this off. if we insure than they behave like the others 3900, and i think that in the end because some people were uninsured the whole year only part of the year what they come up with it will add about 122 billion to health spending in 2008 had we had everyone insured. and i think no one has fought with this number at all. as the gold standard we all use. so if you now use this i would say okay suppose we had full coverage in 2010 that would probably add 150 billion to national health spending may be. and the government what may be paid 125 billion of that because some of it might still be coerced out of the people under a mandate. but that would grow. i had let this grow here at only 5%, which as i already assumed everything president obama is dreaming of what have come to pass. in fact, probably none of it will but i just. [laughter] secure that's 1.57 trillion. very close to the 6 billion the cbo, 1.6 tri

i'm curious if you think the private insurance companies currently delay, the not, or ration care about. if if so, how to change the system in order to make some of the reforms and get the results republicans have been talking about? >> great question. at the end of the day, nothing is more important to you and your family, maybe except freedom, then the health of your family. if your doctor says you need a procedure or treatment, you want to do everything you can to get it and you do not want it to lay. the first part of your question is, is that done by insurance companies today? a few years ago, there was legislation call the patient's bill of rights. the was a concern that hmo's were trying to construct to much to care they allowed their members to receive. doctors were getting exercised, patients were getting exercised about it. congress started considering ways to make the hmo's take care of people i timely basis. it finally transpired that they made the changes themselves. we never passed the patient's bill of rights because they were formed themselves. patients don't want anybod

of our health care system and talking about how democratic plans would delay care, deny care, or rationare. i'm curious if you think the private insurance system or prithe insurance companies currently do delay, deny, or ration care at all. and, if so, how you would change the private insurance system in order to make some of the reforms, get some of the results republicans are talking about. >> great question. because at the end of the day, nothing is more important to you and your family maybe except freedom than the health of your family. and if your doctor says you need a procedure or a treatment, you want to do everything you can to get that and you don't want it delayed. now, the first part of your question was, is that sometimes done by insurance companies today? remember a few years ago when there was legislation that there waws lot of support for called the patients' bill of rights. there was a concern that h.m.o.s were trying to constrict too much the care that they allowed their members, their inshurds to receive. doctors were getting caper sized about it. so congress started

rationing care is something that happens every day. it is done by private insurers could get between a doctor and their patient and decide which practices can be met, which procedures can be paid for, what prescriptions. i think this is an opportunity to make sure that we have more patient-centered care and we follow the articles that work. >> thank you, mr. chairman. madam secretary, i introduced legislation with then congressman rahm emanuel, and congressman chris smith from new jersey, called the independence at home act, and the bill created a medicare pilot project focused on improving the coordination of care and reducing costs for the vulnerable medicare beneficiaries, those with multiple severe chronic conditions, such as alzheimer's, als, parkinson's and other complex debilitating diseases who also need help with two or more activities of daily living, such as dressing, feeding, et cetera. cbo has reported that 5% of medicare beneficiaries account for 43% of overall medicare spending, and cms has noted that approximately 20% o

henderson claimed in a tv interview that there were economic rational and no one's aware of it. how they were determined. so what exactly silent rational for shutting a dealership like the one in maine i had a conversation with a dealership heartbreaking conversation. had one of the most thoroughly trained workforces, highest customer service index in the state and according to general motors they could no longer maintain a productive business relationship. why? this is a business that's been in partnership with general motors for 80 years. third-generation. and g.m. asked this dealer to pack up and relocate and now they are targeted for closure. due in part to that relocation. this is a dealership that has served an area of more than 100,000 people sold more than 2 million in parts and confidently several popular here's the in the entire county will go from multiple g.m. dealerships to absolutely none leaving geographic areas without any dealers, without customers having to rely on providing, getting the service that they depend upon, having to drive 100 miles or mohr for servi

pinkberry, and rationally building up infrastructure to process or settle dealing with the prospects. in credit derivatives they grow to explosion and that no single bank had time once it realized it was going to be successful to invest in infrastructure and the trading desk inside banks certainly had time or incentive to impasse because that was also a problem and the back of the skies in the bank so you have all these reasons why you are behaving rationally, structural incentives and distortions and then you have a situation where all the banks are competing to try and grab a new market and none of them want to stop to build up their infrastructure but nor do they want to spend any money because that will have their pm el and bonuses nor do they want to lose investors. so there isn't in that situation in case with there is a rational selling mechanism to get everyone to invest collectively. it wasn't until geithner said it was try and get everyone and around a table and worked as some had a solution and began to do that. now they can do that and they did it with a degree of success

sounds pretty rational to me. if the borrower is getting such a sweet deal, surely the lender, his commercial banker was acting irrational and giving him alone. but the world of commercial banking has changed dramatically last 25 years. banks today don't sell loans they make. they securitized them and sell them upstream to big principal investors like pension funds, sovereign governments, municipalities and insurance companies. the commercial banker has few rational reasons to care about the quality of the loan that he's created. if it defaults he won't lose anything. we now know that some of these banks did indeed position some of the toxic waste on their own balance sheets. and their losses turned out to be huge, excuse me. large enough to bankrupt many firms. sounds pretty stupid, doesn't it? but what if i told you the same banks were making tens if not hundreds of billions of dollars in profit from their mortgage operations and bank managers had seen their bonuses increase from less than a million dollars a ye

fourth coming plan from democratic leaders will make health care more expensive, limit treatments, ration care and put bureaucrats in charge of medical decisions rather than patients and doctors. that amounts to a government takeover of health care and it will hurt rather than help middle-class families across our country. the administration likes to say they can expand health care and lower costs at the same time, but i think that's just simply nonsense. you can't add millions of americans to the government health care rules and reduce costs unless government takes control of medical decisions, rations care and limits treatment, all of which will reduce quality and undermine the care that americans have come to expect. republicans believe there is a better way. led by roy blunt, the health care solutions group is crafting a plan that will ensure access to affordable quality health care for every american regardless of preexisting conditions. this plan will protect americans from being forced into a new government run plan that raises taxes, rations care and eliminates coverage for more t

i've spoken about the trouble with health care rationing, so today i would like to talk about the cost of a new washington-run health care system. the administration often argues we need washington-run health care to help the economy. but washington bureaucracy and economic growth are not phrases that tend to have a positive correlation. is it realistic to think that adding millions of people to a new government-run health insurance system will somehow save money or help the economy? as "wall street journal" he had toerlzed about the so-called public plan -- and i quote -- "in that kind of work, costs will climb even higher as far more people use free care and federal spending will reach epic levels. end of quote. one wag kweupd if you think health care is expensive now, just wait till it's free. in fact, the first estimate from the nonpartisan congressional budget office shows that just a portion of the democratic plan will cover only one-third of the uninsured, will cost over $1 trillion. $1 trillion to cover 16 million more people. that's for one part of the proposed plan. i think t

and in that regard, then, you see rationing. you can have the best government program in the world, the best government card in the world and it can guarantee all swords of things. but if you can't provide a doctor that really provides it or a home health care provider that will provide that or any provider that will provide that, well, where are you? second, i'd like to see provided the cost estimates from the congressional budget office and the joint tax committee. just let us know how much all of this is going to cost. that's extremely important. we're hearing anything, $1 trillion to $2 trillion. then lastly, how will it be paid for? i know we're into an era now where basically we have the printing presses rolling. we have an economic recovery act and we have many facets of that. we have the stimulus, we had the omnibus. we had the president's budget. and we had tarp. and we had four different other acronyms under tarp. and we didn't worry too much about the pay fors and who was going to pay for it. we let the printing press

he said a government plan where care is denied, delayed, and rationed. well, those are fighting words because nobody wants their coverage denied. they don't want to wait in a long line for surgery, and they don't want to believe they're victims of rationing when it's important for them to have medical care given to them. the language that we hear from the other side of the aisle is language we're all-too familiar with. the miracle of the internet is that people can come up with a written document now and just by pressing a button or clicking a mouse, they can send that document to lots of different people. well, a couple of months ago there is a republican strategist named frank luntz who wrote a 28-page memo to give to republican senators on how to defeat health care. and doctor -- he calls himself doctor, dr. luntz said that whatever they come up with, here is the way to beat it. so he had not seen the health care reform plan that president obama might support or the democrats might produce. but he says this is how we stop them from passing anything, h

it simply doesn't make -- there is no economic rational. i don't know where your economic rational is, but it certainly didn't find itself in maine. >> couple of comments. first in terms of our coverage of rural areas and smaller towns in the u.s., when we're done with this process, we'll have between 1500 and 1600 dealers in those towns. we will be by far and away still the broadest distribution system for general motor vehicles in small towns. >> i guess it is all relative, but that's not going to be true in maine, okay? you've got, you know, loyal customers and you got loyal dealers. so the fact that it is relative broadly speaking isn't going to help the situation in maine looking at the map. and that's what this is all about. >> sure. >> and looking at where you're doing it, some of, you know, even the more prosperous counties, that you're concentrating one dealer and, you know, the most populated area, and city, largest city, and some don't have any -- some of the counties don't have any, and that's a wide stretch of geography just in