the liability that comes when there is a claim when there is health care provided. that's the differences. i have watched this verbiage get confused over the immigration debate over the last few years, too. i made the point then that you wouldn't -- in fact to the white house at the time, that they couldn't get past the idea that they were proposing amnesty. they tried to redefine amnesty and the american people didn't buy it. . the american people are not going to buy it. they know the difference between health insurance and health care. and they like to know where it is because they know their very lives are at stake and they don't want to stand in line. i know i have a chart here that scribes the quality of american -- describes the quality of american health care. and this is the survival rate of cancer patients compared to different regions. so here's prostate cancer, breast cancer, there's two good indicators that are there. if you look at the united states, our survival rates are at the top. compared it to- in both prostate and breast cancer, and then when you see the -- what should i call it? burgdy here, that's canadian. canadian's survival rates are substantially higher, especially for prostate, than they are for europe or england. europe and england are down. canada's up, u.s. is better than canadian. it's also the case when you look at breast cancer, only it's not so stark. the difference between europe and england in the united states. i look at this and i think, how can canada be so close to the united states with survival rates of cancer? we have the best survival rates here, by the way. how can canada be so close? could some of it be that because canada is so close, mr. speaker? could it be that canadians come from canada down into detroit to get their cancer treatment? could it be that their coming down to the mayo clinic in minnesota to get their cancer treatment? could that be one of the reasons why their survival rates are better in canada as compared to the other countries that have a socialized medicine program? but make no mistake, mr. speaker, this is socialized medicine. it's the government writing the rules, it's taking away your freedom. you can't own your health insurance policy the way you own it today. the government will interfere and intervene and will write new rules. when the president says that you get to keep your plan if you like it, well, i guess maybe if you're working for a company, you may get to keep your plan if you don't like it. but when wal-mart makes a decision as they did a couple of weeks ago that they would endorse an employer-mandated health insurance plan, that should tell us something. why would wal-mart do that? they insure about 52% of their people, their competition ensures about 46% of theirs. so there's a little push there exetively. but surely they have to think that the health insurance for their employees is going to be cheaper if it's under a public plan. and so when the president says, if you like your insurance plan you get to keep it, what does he say if wal-mart, for example, should decide that they're going to drop all of their private insurance carriers and policies and go over onto the public plan? doesn't wal-mart or any employer have the option to shift? if we offer, if we offer people a public plan over here in this had chart, it's the president's position that a company can't switch? is it he saying to a company that's providing health insurance to their employs -- employees, if your employees like these plans you have to keep it? is he saying that to the descendents of sam wallet snn i don't think so. they'll make that decision, it may be a moral decision for a will the low of employers as well. but the president cannot guarantee that you get to keep your health insurance plan. that decision will be made by the employer if he provides it and if you're an individual that owns your own plan, that plan will still have to qualify to be sold in the united states of america. if will not be legal to sell health insurance in america unless you comply under this circle with the qualified health benefits plans. the rules of which will be written by the health insurance czar. 31 different agencies there. there's a lot of freedom that's lost, a lot of lines will be created, a lot of freedom will be lost, some lives will be lost, and we know that people die in line. mr. speaker, i have a couple of subjects that i wanted to address when i came here tonight and i wanted to take this little moment and, while the chair of the judiciary committee was here, and ask, as we've had many of these discussions and dialogues, if he'd be open to a little colloquy, i make the point to mr. conyers that if mr. conyers would be open to a little colloquy i would make the point to mr. conyers that today, today the government reform committee released a report on acorn. and i have read the executive report on acorn and from my perspective, if the 82 pages of report that's released support the statements made in that executive summary, it has -- it is earthshaking for me to read all the implications of that. so i know that you've had some real interest in looking into acorn to examine the propriety of the operations they have, the very breadth of all the corporations that are affiliated and i would just inquire if the gentleman's had an opportunity to read the executive summary of the government reform report at this point? mr. conyers: if the gentleman will yield, i haven't read it yet. but i will be reviewing it tomorrow and i'll be prepared to discuss this with him next week. mr. king: and reclaiming my time, i thank the gentleman for that commitment and i look forward to having that dialogue. it's something, you know, i've been very concerned about for many months and i know that the chairman of the judiciary committee has take an real interest in this and this is real evidence as i understand it, real definitive evidence that's now in the congressional record, in a composite form, hopefully the chairman and his committee staff could take a real thorough look at this and either produce a response to the evidence that's there or, i would be very interesting in opening up hearings so we could examine acorn. would the chairman have any inclination what he might do at this point? mr. conyers: not until i've examined the document the gentleman's referred to. mr. king: reclaiming my time, i thank the chairman for his indulgence in this. again, i appreciate it's late at night here and john conyers is here engaging in this health care debate and paying attention to the things that matter and i did intend to bring up the acorn issue at this point. so it wasn't an injection into the dialogue and if the gentleman had further points i'd be happy to yield. mr. conyers: i don't have any -- i haven't seen the report that you've reviewed. but i'll be happy to look at it next week and we're in dialogue, we see each other every day that we're in session and i'll be delighted to discuss it with you . mr. king: reclaiming my time, i thank the chairman again for his indulgence and attention to the matter. and i will at this point then move on to that subject matter. unless the gentleman from texas came to speak on health care and health insurance, i would be happy to yield. mr. gohmert: i appreciate my friend from iowa yielding. that is something i did want to mention. because i'm still so deeply disturbed by the fact that this congress would be censored where we did not have the freedom to debate when that ability is what gave us this country, is what started this country. and if you go to the speaker's website you'll find all kinds of references that are clearly political and clearly demeaning it to republicans and yet i don't know of any republican that has said that she needs to personally pay for her website since it's political and yet here we find out today that we're not allowed to use the term government-run health care because that is considered political and demeaning to the democrats' plan and therefore if we're going to put that in any cords then we have to personally pay for it -- correspondent then we have to personally pay for it. we can't do like the democrats who send out all this mail trashing republicans, some of it valid a few years ago, that we were overspending. and so i thought perhaps the silver lining would be when they got the majority they'd do what they said and cut spending but it's gone the other direction. but nonetheless then the chart, as i'm sure my friend from iowa has pointed out, that has these 31 different new created entities, we're not allowed to put that, we're told, on our website, otherwise we'll have to pay for the website. we're not allowed to send that out in any literature because the fact of the business is that might educate people on just what it is that's going on here. but we were told we have to use the term public option rather than government-run health care. john carter was told that today, that if he was going to use the term government-run health care he'd have to pay for his mailout. he couldn't use franking to do so. he would have to use the term public option. it is so outrageous that in this body we're being censored by people who have made a living out of being political. it is just outrageous. and i've got too many friends on the other side of the aisle that i can't believe would condone that kind of conduct. because they should have the freedom to criticize any republican plan. we should have the freedom to criticize any republican plan. and we both should have the freedom to criticize, you know, the democratic plan. that's supposed to be constitutional. and yet we're told we can't use political demeaning terms to their health care plan. well, i'm telling you, it is socialized medicine on its way, it is nationalized health care, it is the government's effort to take over your body because, you know, i've got three daughters, my friend knows, and, you know, while somebody is under my roof and i'm paying their health care bills then i feel like i've got the right to tell them, you need to eat better, you need to do this, you shouldn't do that. you know, because i'm paying to their health care bill and if they're going to run it up doing something then i have a right to have some injection and control over that. that's what this is about. i've said it months ago that what we're running into this in this body is the g.r.e. the government running everything. and that's what taking over health care, once the government has this government-run program, let's face it, you cannot in the private sector compete with a government, especially a federal government, program. because it can run in the red. and it can count on being funded by the government. you can't compete with that if you're in private business because you can't run in the red. you've got to run in the black. or you go bankrupt. well, you it used to be you went bankrupt unless the government wants to run in and bail you out because you're good buddies with people in the government. but, nonetheless, i talked today, this morning, with a lady from tyler and i love her delightful british accent because she's originally from england and she had called wanting to speak with me, really needing to speak with me about health care. and she told me that her mother died of cancer and she herself was later to found to have breast cancer and that if she had been under the system her mother was, she would have died. but she's alive because she was in the united states and is a citizen here and her mother's dead because her mother was in england and she didn't get the kind of care she would have here in america that sue got. i don't want people dying like that unnecessarily. and the government has to put you on lists and i might yield to my friend from iowa, you have quoted the president on that town hall in response -- i see my friend shaking i had head -- his head. this was, pam stern was on the town hall meeting with the president and talked about her mother that she's now 105, but over five years ago her doctor said that he couldn't do anymore to help her unless she had a pacemaker but she's nearly 100 years old. and the doctor felt like, her doctor, that she ought to get a pacemaker. everybody was in favor of it. except her arythmia specialist who had never met her. so her doctor said, he needs to meet you because that's going to be worth 1,000 words. so he makes an appointment with the arythmia specialist. he meets pam stern's mother and he realizes, and according to pam, that because he saw her and her joy of life then he said he was indeed going to go forward with the pacemaker because this woman had a real zeal for life and was enjoying life and doing well. and so she went on and asked about his plan. and was wondering what treatment someone elderly could have and asked this basically, outside the medical criteria for prolonging life for someone who is elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life, or is it just a medical cutoff at a certain age? and the president, and i went online earlier this morning and watched this on youtube and typed it up myself, and went back and forth to make sure i got everything right, i let out two or three uhs, but anyway, and we're not going to solve every difficult problem in end of life care. a lot of that is going to have to be -- we as a culture and as a society starting to make better decisions within our own families and, and, for ourselves. . i got to pause here. she's 105, she got a pacemaker five years ago, and her quality of life is exleapt. how does she need to make better decisions in her family? her family is supposed to tell her you can't have a pacemaker because it's time for to you roll over and die? the president goes on. he says, but what we can do is make sure that at least some of the waste that exists in the system that's not making anybody's mom better, that is loading up on additional tests or drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what, maybe this isn't going to help. maybe you're better off not having the surgery. but taking a painkiller, unquote. the woman got a pacemaker and has had a wonderful quality of life, a zeal and joy for life, and according to this president, maybe what we should have told her, you don't need a pacemaker. you need a painkiller. it is just unconscionable. we value life more than that in this contry. what grieves me most, i heard on the news, i don't know if it's true, aarp is now endorsing this. if they are then at some point, bless their hearts, they are going to owe their members an apology because if we go to this proposed plan that supposedly on the news they said today they were endorsing the president's plan, then the people who will be hurt dramatically will be the seniors. they'll go on lists like sue's mother did in england and they'll die. because that's what will happen. that's how you keep a socialized medicine plan from going broke. you put people on long lists. they stay there. and then they die. mr. king: reclaiming my time. i would add to this that in this bill there's also language in there that sets up government counselors to go and see the family and talk to the children of people who are aging and presumably to counsel them on hospice care and end of life decisions and so to avoid the costs of taking care of people when they get older. this is going to be an economic equation that's going to be counseled by people who will end up -- they'll go to college to learn how to do this. they'll get a government check, a check from the federal government, to go and visit the children of our senior citizens and perhaps our senior citizens and counsel them in why a pacemaker is not a good option why pain pills are a good option instead. this is -- this changes our values. when i think about the president answering that question with recommending a prescription for pain pills, even after the fact, what kind of arrogance does it take for an individual who, let me just say, has no medical training, has not examined the patient, just simply tosses out a prescription because he's president of the united states. that is a very high degree of self-confidence and that is very much an understatement on my part. i'd illustrate also what happens with the health insurance when you see the private health insurance plans that get crowded into the qualified health benefits plan competing against the publix, they will have set up under this bill a very similar scenario what they had when the federal government decided to get into the flood insurance business. now you can look across the country and try to buy a private flood insurance plan and all you can find on the market is a federal flood insurance plan, because the federal plan crowded out the private plans and crowded it out because they didn't charge premiums that reflected the risk. and the result is the federal flood insurance plan is $18 billion in the red. they have starved out all the competition. the government as a monopoly on flood insurance, they set the premiums and the taxpayers in america are subsidizing the flood insurance for other americans to the tune of $18 billion. that's the deficit. when government gets in this business, we lose those automatic checks and balances that come with competition. we lose the human nature of dealing with people individually . i don't want to be in these decisions, these end of life decisions. i don't want to write the rules for that. i wouldn't think that a president would want to make such a prescription of take the pain pills, old age is terminal. take a pain pill until it's over. that's what i hear he prescribed for this lady. i yield to the gentleman. mr. gohmert: my friend from iowa is exactly right. his words exactly were -- like my friend from iowa said, this is after the fact. after we know it helped. he still says that at least we can let the doctors know and your mom know that you know what, maybe this isn't going to help. maybe you're better off not having the surgery. but taking a painkiller. let me also point out, the president is a very smart individual. well educated. extremely articulate. obviously very good and persuasive. but he won't be the one making the decisions. it will be some bureaucrat who is not as smart as the president. that's where this is going. and i have shared on this floor before about a gentleman from canada i talked to whose father died in the last year or so whose father was on a list to get a bypass surgery for two years. and some bureaucrat kept moving people in front of his father. i thought it was a crime to move up the list in canada. he said it is to pay somebody to move you up, but it's not a crime n. fact it's required the government has bureaucrats in little cubicles somewhere, they are not near as smart as president obama, who read these things, look at this stuff, let's move this guy in front of his father. and they kept moving people in frovent him for two years and he died because the bureaucrat was wrong. his father really did need the surgery. so it's scary enough that the president would say about a woman who had successful pacemaker surgery five years ago that, you know what, maybe we just should have said to her you are better off without the surgery. take a painkiller. imagine somebody not even as smart as he is making those decisions for you. this is really dangerous stuff before us. if i might add one more thing. some people say that this debate over health care is all about politics. and i just want to say. if this debate over health care were really just about politics, the smartest thing that my friend from iowa and i could do is sit back and say nothing. and let this bill pass, not point out all the dangerous stuff in this thing. the life ending stuff in ts thing. the freedom-ending stuff in it. just sit back and not say anything because what would happen is the bill will pass, if we didn't stand up against it, and didn't let people in america know how bad it is, so they didn't inform their -- just sit back and let america find out how many freedoms are taken away, how many loved ones they lose because they are in this system, and the american public, i believe, would be so irate they would turn out the democratic majority for at least two or three more generations. they would be so irate. that's the political side of it. but the factual side is, this is so bad, we care so deeply because we know where this goes. i saw socialized medicine in the soviet union as an exchange student there. i want this. i know how it goes. i don't -- i would rather stay in the minority and be free of in kind of government intervention that ends lives and takes money for abortions and takes money to have people take a painkiller and die instead of having the pacemaker they need. i would rather do that and stay in the minority than have people endure this kind of plan. that's politics. if we were smart politically, we wouldn't point out all the problems. we would just go home and let america find out and put us in the majority permanently. mr. king: reclaiming my time. i completely agree with the gentleman, the judge from texas, in that statement. this is a horrible policy for america. i would put it out this way. this is the hillary care plan. this is 1993, hillary care. the flow chart i think sunk hillary care. the chart that scared the american people and mobilized them to ring the phones off the hook then and to run ads and raise the resistance because they did not want to have a government-run plan that took away their freedom. that's hillary care. this is obamacare. if you hated hillary care, you can't like obamacare. this flow chart, this one, the black and white hillary care flow chart, was devastating to a national health care agenda. can i say, a government-run health care program? can i say that about the old one i wonder? i wonder if this one was mailed off by frank mail. i wonder if the people in charge then in 1993 had ruled that there wasn't freedom of speech on the part of members of congress. i will bet that this chart went into all kinds of envelopes and got spread all the way across america and people opened it up and stuck it on the magnets on the refrigerator and thought what are they doing in washington, d.c.? we didn't send them to grow a big government program. and they rejected it. that was the end of the momentum of the clinton presidency then when hillary care went down. and now we have obamacare and the censoring of this. first ever all i want to make this point that i don't need -- show this chart and send it to my constituents. they already know what we are going into. they know that my vote on this and my effort on this thing is pretty well settled. i have said for years that i'm going to oppose any national health care plan. no amount of logic is going to change the minds of the people over on this side of the aisle. they have come to a political conclusion, a conclusion that they are going to ban together and they are going to pass something that president obama will sign and he'll sign most anything as long ast says that it's got the public health plan in it, if it happens the public health plan in it, it will starve out the private and we will have what all of them -- almost all of them have said from the beginning, they want a single payer plan, a government plan. they don't believe in private health insurance. they don't believe in the best health care system of the world. they do believe in censoring, but the american people cannot be be censored. we have internet. we have twitter. we have -- this kind of a chart can be forwarded all over this country. by tomorrow morning it could be in every computer if the american people just decided they wanted to make sure you could see it. you can't understand this health care program if you read the print. if you look at this chart on your screen, you will pick up the phone and the american people will be scared enough, i think, to jam the phone lines again and fill the offices. i yield to the gentleman from texas. mr. gohmert: i realize the gentleman's time is going to expire at 11:30. i wanted -- this is about freedom, life, pursuit of happiness. this is about freedom and life. the book "liberty and tyranny" so many tremendous quotes. i want to make this final comment. president raping, quotes in the book, said, quote, freedom is never more than one generation away from extinction. we didn't pass it to our children in the bloodstream. it must be fought for, protected, and handed on for them to do the same. or one day we will spend our sunset years telling our children and our children's children what it was once like in the united states where men were free. unquote. that's why we are here fighting. i yield back. mr. king: when men were free. reclaiming my time and concluding. i want to conclude however appropriate it was the statement made by the gentleman from texas, that when the president says if you like your health insurance plan, you can keep it. here is what the bill actually says, section 102, by the end of the five-year period a. group health plan must meet the minimum benefits required under section 121. that's that qualified plan i talked about. no plan is going to be the same in five years as it is today. if you like your health insurance plan that you have, as john shadegg said, get ready to lose it or rise up and defend your freedom. with that, mr. speaker, i yield back the balance of my time. the speaker pro tempore: does the gentleman have a motion? mr. king: mr. speaker, i move the house do now adjourn. the speaker pro tempore: the question is on the motion to adjourn. so many as are in favor say aye. those opposed, no. the aye vs. it. the motion is agreed to. accordingly, the house stands accordingly, the house stands adjourned until 9:00 a.m. >> $40 billion less -- and there will take on funding for labor, health and human services, and education department. live coverage at 9:00 a.m. eastern here on c-span. >> over the next three hours, several of today's events about health care legislation. first, it is president obama at a town hall meeting in ohio. in an hour, house speaker nancy pelosi. after that, a forum on health care hosted by house republicans. >> this weekend, using candid humor, author harry stein talks about how his life was changed after crossing the political spectrum. >> president obama was in ohio today for a town hall meeting on health care legislation. he was at shaker heights high school for one hour. [applause] >> hello, everybody. [cheers and applause] thank you. please, everybody have a seat. thank you. hello. [cheers] hello, shaker heights. hello, ohio. it is great to be here there are a couple of quick acknowledgments to make. please give rick a round of applause for his introduction. [applause] some special guests that we have got -- first of all, the governor of ohio is in the house. [applause] your state treasurer is here. [applause] your secretary of state is here. [applause] the mayor of the great city of cleveland is here, frank jackson [applause] ] shaker heights mayor is here. [applause] the shaker heights school superintendent is here. [applause] not here but a couple of my favorite people, congresswoman and sharon brown on out here today. they had to do work in washington. it is good to be back in the great state of ohio. [applause] i know there are those that like to report on the back and forth in washington, but my only concern is the people that sent us to washington, the family feeling the pain of this recession, the folks that i have met that have lost jobs, savings, and health insurance, but have not lost hope. the citizens that defied the cynics and the skeptics, that went to the polls to demand change. change was the cause of my campaign, it was the cause of my presidency. when my admonition came into office, we were facing the worst economy since the great depression. we were losing an average of 700,000 jobs per month. hundreds of thousands of people from ohio felt that pain firsthand. our financial system was on the verge of collapse, meaning families and small businesses could not get the credit they need. experts were warning that there was a serious chance that our economy could slip into a depression. because of the action we took in those first weeks, we have been able to pull our economy back from the brink. now that the most immediate danger has passed, there are some who question those steps. let me report to you exactly what we have done. we passed a two-year recovery act that meant an immediate tax cut for 95% of americans and small businesses. [applause] 95%. it extended unemployment insurance and health coverage for those who lost their jobs in this recession. [applause] it provided emergency assistance to states like ohio to prevent deeper layoffs of police officers, firefighters, teachers, and other essentials personnel. [applause] at the same time, we took steps to keep the banking system from collapsing, to get credit flowing again, and to help responsible homeowners hurt by falling home prices to stay in their homes. the second phase, we are now investing in projects to upgrade roads and bridges, ports, water systems, and in schools, clean energy initiatives throughout ohio and across the country, projects that are creating good jobs and bring lasting improvements to our country. there is no doubt that the steps we have taken have helped stave off much deeper disaster and even greater job loss. they have saved and help create jobs and have begun to put the brakes on this devastating recession. i know that for the millions of americans who are looking for work, for those who are struggling, full recovery cannot come soon enough. i hear from you at town hall meetings like this, i read your letters, stories i hear are the first thing that i think about in the morning in the last thing that think about at night. they are the focus of my attention every waking minute of every day. it took us years to get into this mess and it will take more than a few months to dig our way out of it. [applause] but i will promise you this. we will get there. it will do everything in our power to get our people back to work. [inaudible] i love you back. [cheers and applause] we also have to do more than just rescue this economy from recession. we need to address the fundamental problems that have allowed this crisis to happen in the first place, otherwise we would be guilty to the same short-term thinking that got us into this mess. that is what washington has done for decades. now is the time to rebuild this economy stronger than before. strong enough to compete in the 21st century, strong enough to avoid the waves of boom and bust that have time and time again unleashed a torrent of misfortune across families across the country. that is what we are building a new energy economy that will unleash the potential and create millions of new jobs, helping to end our dependence on foreign oil. [applause] we are transforming our education system, from cradle to college, said this nation has the best educated work force on the planet. [applause] we are pursuing health insurance reform so that every american has access to quality, affordable health care insurance. [applause] i want to talk about health care for just a second. how one to be clear. reform is not just about the nearly 46 million americans without health insurance. i realize that with all the charges and criticism being thrown out there in washington, many americans are maybe wondering how my family or my business stands to benefit. what is in this for me? folks are asking that. if you have health insurance, the reform we are proposing would give you more security. you just heard rick's story. reform will keep the government out of your health care decisions, keeping you the option if you are happy with your coverage. and that will keep the insurance companies out of your health care decisions, too. [applause] by stopping insurers from cherry picking who they cover and holding the insurers to a higher standard for what they cover. [applause] you will have to worry about receiving a surprise built in the mail because we will limit the amount of your insurance company can force you to pay out of your own pocket. [applause] you would have to worry about pre-existing conditions because -- [applause] never again will anyone in america be denied coverage because of a previous illness or injury. [applause] you will have to worry about losing coverage if you lose or leave your job because every american who needs insurance will have access to affordable plans through the health insurance exchange, a marketplace where insurance companies will compete to cover you, not to deny you coverage. [applause] if you run a small business, and you are looking to provide insurance for your employees, you will be able to choose a plan through this exchange as well. i have heard from owners across the -- across from america trying to do the right thing but choices are becoming more limited. now, if you are a taxpayer concerned about deficits, i want you to understand that i am concerned about deficits, too, because in the eight years before i came into office, washington inactive it to large tax cuts primarily for the wealthiest americans, added to medicare, funded two wars, all without paying for it. [applause] they did not pay for it. the national debt doubled. we were handed a $1.30 trillion deficit when we walked in the door. one we had to add in the short term to deal with this financial crisis. now, i have to tell you, i have to say that folks have a lot of nerve who helped us get into this fiscal hole and then going around trying to talk about fiscal responsibility. [applause] i am a little surprised that people don't have a little more shame. [laughter] about having created a mass and then try to point fingers, but that is another topic. because, the truth is, by and now president. [cheers and applause] and i am -- and i am responsible, and together, we have to restore a sense of responsibility in washington. we did -- we have to do what businesses and families do, to cut out the things we don't need. that is why i have pledged i will not sign health care reform if that reform ads even one dime to our deficit over the next decade, and i mean what i say. [applause] now, we have estimated that two- thirds the cost of reform to bring health care security to every american can actually be paid for by reallocating money that is already in the system, what is being wasted in federal health-care programs. let me repeat what i just said. about two-thirds of health care reform can be paid for by not new revenues or tax hikes but just with taking money that is not being spent wisely and moving it that make people healthier. that includes -- we spend more than $100 billion in unwarranted subsidies that go to insurance companies as a part of medicare, subsidies that do nothing to improve care. we ought to take that money and use it to actually treat people and cover people, not to lined pockets of insurers. [applause] i am pleased congress has embraced these proposals. while they are currently working through proposals to finance the remaining costs, i continue to insist that health care reform not be paid for on the back of middle-class families. [applause] now, in addition to making sure that this plan does not add to the deficit in the short term, the bill i son must also slow the growth of health care costs while improving care in the long run. i just came from the cleveland clinic where i toward the cardiac surgery unit, met some of the doctors who are achieving the incredible results for their patients. there is important work being done there as well as the university hospitals and metro health. [applause] the cleveland clinic has one of the best health information technology systems in the country. they can track patients and their progress, the conceive what treatments work and which ones are unnecessary. they can provide better care for patients. they do not have to duplicate tests because it is all online. they can help patients manage diseases by coordinating with doctors and nurses, both in the hospital and in the community. here is the remarkable thing. they actually have some of the lowest costs for the best care. that is the interesting thing about our health care system. often, the better care produces lower, not higher, expenses, because better care leads to fewer errors and money and lives. you or your doctor do not have to fill out the same form a dozen times. medical professionals are free to treat people, not just illnesses. patients are provided preventive care early, like mammograms and physicals, to avert more expensive treatment later. that is why our proposals include a variety of reforms that would say both money and improve care that is why the nation's largest organization representing doctors and nurses have embraced our plan. our proposals would change the incentives so doctors are free to give patients the best care, not the most expensive care. when to create an independent group who are empowered to eliminate waste and inefficiency in medical care, a proposal that would save more money. our proposals would improve the quality of care for our seniors, save them thousands of dollars off of prescription drugs, which is also why aarp has endorsed our efforts as well. [applause] the fact is, lowering costs is the center for families and businesses here in ohio and all across the country. take the ohio example. premiums have risen nearly nine times faster than wages. as we meet today, we are seeing double-digit rate increases on insurance premiums all over america. there are reports of insurers raising rates 28% in california. 23% in the conn. 56% increase in michigan. if we don't act, these hikes will be a preview of coming attractions. that is a future you can't afford. that is a feature that america cannot afford. we spend one of every $6 in america on health care, and that is set to triple in the next decade. small businesses struggle to cover workers while competing with large businesses. large businesses struggle to cover workers while competing in the global economy. we will never know the full cost of dreams put on hold. so, ohio, that is why we seek reform. we have forged a consensus that has never before been reached in this country. senators and representatives in five committees are working on legislation and three have already produced a bill. health-care providers have agreed to do their part. hospitals have agreed to bring down costs. the drug companies have agreed to make prescription drugs more affordable for seniors. the american nurses association representing millions of nurses who know our health-care system best, they have announced their support for the reform. [applause] we have never been closer to achieving quality, affordable health care for all americans. at the same time, there are those that would seek to delay. is that the air-conditioned? [laughter] that's good. it is a little warm. [cheers and applause] you can still hear me though. we had one republican strategist who told his party that even though they may want to compromise, it is better politics to go for the kill. another senator said defeating health care reform is about breaking me, when it is really the american people who are being broken by rising costs and declining coverage. [applause] of the republican party chair is seeking to stall our efforts went as far to say that health insurance reform was happening too soon. first of all, let me be clear. if there is not a deadline in washington, nothing happens. nothing ever happens. we just heard today that we may not be able to get the bill out of the senate by the end of august or the beginning of august. that is ok. i just want people to keep on working. just keep working. [applause] i want the bill to get out of the committees and then i want that bill to go to the floor, and then i want that bill to be reconciled between the house and senate and then i want to sign a bill. and i wanted done by the end of this year. i want it done by the fall. [applause] whenever i hear people say it is happening too soon, i think that is odd. we've been talking about health care reform since the days of harry truman. how can it be too soon? i do not think it is too soon for the families who have seen their premiums rise faster than wages year after year. it is not fair for the businesses. it is not too soon for taxpayers asked to close a widening deficits that stemmed from higher costs, costs that threaten to leave our children with a mountain of debt. reform may be coming too soon for those in washington but is not too soon for the american people. [applause] we can get this done. we can get this done. people keep on saying this is really hard. what do you keep on taking it on? we were reminded earlier this week when americans and people around the world marked the 40th anniversary of the moment that the astronauts of apollo 11 walked on the surface of the moon. it was the realization of a goal that president kennedy said a decade earlier. there were times where people said this is foolish, impossible. but president kennedy understood and the american people set about proving what this nation is capable of. those who are seeing our failure to address stubborn problems as a sign that our best days are behind us, that we lost our sense of purpose. i believe that this generation, like generations past, stand ready to divide the skeptics and the naysayers, that we can once again some in this american spirit, we can rescue our economy, we can rebuild its stronger than before, we can achieve quality, affordable health care for every single american. that is what we are called upon to do. that is what we will do with your help, ohio. [cheers and applause] all right. thank you. all right. this is the fun part. i am going to take off my jacket, guys. it is a little hot. all right. now, here is how this is going to work. there are really no rules. there are no pre-programmed questions. all of you have to do is -- first of all, everybody should sit down. [laughter] the second thing is, i am going to call on as many people as we can during the time that we have. just to make sure it is fair, i am going to call on girl, boy, girl, boy. try to keep the question brief. we will try to get through as many as we can print introduce yourself if you don't mind. there are people in the audience with microphones. ask the question so everybody can hear you. ok? this young lady right there in the colorful blouses. > hello. good afternoon, mr. president. thank you for taking my question. my name is norma goodman. my question is twofold. it appears that your plan has the health-care industry funding your health care reform. i think you just alluded to that a little. it poses a concern for me. i am the owner of the medicare certified agency. my agency invited you to come visit. [laughter] your proposed budget includes drastic cuts to reimbursement. i feel that that threatens -- you were shaking your head no. >> i don't think so. i should point out, the home care industry has actually endorsed this reform effort in their moving forward. go ahead and finish your question. >> that is my concern, that your budget proposal has lined up recommendations, several cuts for the next several years that will amount to, i don't know, $13 billion or so. >> let me just respond. the medpac idea is to have health care experts and doctors to down and figure out how they can to improve medicare, how to make it more cost efficient. it is not an exercise in just cutting reimbursement rates. in some cases, we may need higher rates for certain aspects. i think home care actually becomes cost efficient in many cases rather than institutional care. in rural communities, there are certain areas where doctors aren't reimbursed at an adequate level, so you are seeing too many doctors leave those communities. so what we do want to make sure of, though, is that we are in -- we are incentivizing smart things. for example, right now, that the hospital is reimbursed for the number of tests that it does, then that may not give them much of an incentive to make it efficient. once you take the first test, you end up having it sent around to everybody so you do not have to take more tests. right now, the way the system is set up, you don't have that incentive to have the one test and then use information technology to distribute it throughout the system. those of a kind of changes that we want to make. we think that the more that we are encouraging efficient, smart care, that is going to be good for providers, good for patients, and frees up more money so that we in some cases can provide higher reimbursements for folks who are not getting efficient reimbursements. it is using the dollars that we are spending more wisely than how we are spending them right now. thank you. . . in early fall, they will come back and vote on the bill. i have not talked to him today. my attitude is that i want to get it right. i also want to get it done promptly. as long as i see folks working diligently and consistently, and then i am comfortable with the moving this process forward that billed as much consensus as possible. what i do not want is to delay for the sake of delay. delayed because people are worried about making tough decisions. that is what i do not want to see. if people are legitimately working out of problems, and some art of, this is a bit system. it is complicated. i have no problem. if i think people are really working through these difficult issues and making sure we get it right. i do not want a delay is because of politics i have to tell you that sometimes delays in washington occur because just do not want to do anything that they think may be controversial. you know what? that is not how america has made progress in the past. medicare was controversial. social security was controversial. people accused franklin and franklin delano roosevelt of being a socialist because he wanted to set a date system to make seniors more secure. going to the moon was controversial. at some point of we are going to move the country forward, we cannot be afforded to change a system that we know is broken. -- we cannot afford to change a system that we know is broken. that lady who is waiting at me. -- waving at me. >> thank you very much i and the director of community relatives in cleveland. i represent a group called senior boys. we sent a report out with signatures to our congressional members asking their support of medicare. my question is about medicare. there is the doughnut hole in particular. 3.4 million seniors have altered the doughnut hole on the annual basis. this represents about one-for seniors and participate in the program. one thing has fallen into the hole is that they have to make choices about whether or not they take their medication. they break their pills and half. they make decisions about buying medication or purchasing through. my question to you is will you support legislation that is cringing -- currently being introduced to close the doughnut hole of the next several years? >> i am going to do more than that for you. and our health care reform proposal, we have already extracted concessions from the pharmaceutical industry that we know will right away fill up half that total. they have put a billion dollars on the table. for those of you do not know the doughnut hole is, the way medicare works is it helps you pay for your prescription drugs until you hit a certain ceiling and level and then suddenly the subsidies just go away. you have to pay out-of-pocket expenses of several more thousands of dollars until you get to the point where health kicks and again. that is what the call of a doughnut hole. -- that is why they call it a doughnut hole. one thing we can do 3 form is to make sure that we are moving to close the doughnut hole. that is a commitment that will be contained in its health care reform bill that we get past. this young man right here. we will get a young guy in here. >> i am going to be a junior in high school. but question is, for students, how can we get this passed? >> i appreciate that. i like that. i very much appreciate that as a junior in high school you are still thinking about this. usually leon people think they are indestructible -- use a young people think they are indestructible. a high portion of the uninsured are actually young people, for to give the after they graduate from college and have not received a job yet that provide health care. they are very vulnerable if, heaven forbid, something happens to them. there have been a couple of ideas that we have talked about. for example, extending the insurance apparent making companies keep kids on the insurance until they are 25. that would help a lot. the question you ask is how can you help get it done. make sure you are persuading your parents if they are not already convinced. mom is right there. she is already on board. activism right now in calling your congress people, calling your senator, making sure they know it is important, that is something everything -- everyone here in needs to do. and they are hearing from the other side. all those votes were out there today. they are saying we cannot afford it and this is socialism. all the folks who are getting talking on the radio and the cable news shows. i have to say, and they have an effect on member of congress. they need to hear from folks who are saying in a very common- sense way that this is something we can do. it is going to be paid for. it is not going to add to the deficit. it will control the deficit over the long term. young people should particularly be concerned about that. if inflation keeps going up at the rate that it is, you will not, when your generation is running things, will not be able to afford anything else in the federal budget. medicare and medicaid will consume all our federal dollars. that is the huge problem. the last thing i want to emphasize to people, when you contact your senators and your member of congress, make sure to make this a personal testimony. tell your story about why you are concerned. sometimes these debates is so abstract and i have to remind people that i did a story about a woman you contracts cancer and selling at only she worrying about her cancer but she is also worrying about the hundred thousand dollars worth of unpaid medical bills that she is having to deal with and her family cannot afford. i hear from people who say, i have always worked hard. i've always done well. i have a good job. i love my job to start my business. i cannot get health insurance because of a pre-existing condition. i'm one to have to close of my business and go back to doing something where i can get health insurance. everybody knows those stories. one thing that emphasized yesterday that people do not think about enough is if all the money is being eaten up in premiums, even if your employer is paying for it, guess what? that means that employer has less money to give you a raise. you wonder why for the last 10 that year's wages and incomes have been flat. on average, people are not in a race. why is that? part of it is because it has all been taken up in increase health care costs, even if the companies are profitable. the group to understand as best as folks who are members of unions. -- the groups to understand this best are folks who are members of unions for know even if your . they cannot afford to raise the hourly wage because look at what happened to my health care rate. your whole negotiation and of being how much more of a health care burden are you going to have to carry when he thought the benefits were already locked in. that is why reform is so important, even if you have health insurance. it is taking money out of your pocket and leading a lot of people in very dire straits. ok? young lady right here. there is a gentle man that is coming with a microphone. >> hello, mr. president. i have a question. the republicans and some democrats want to pass health care benefits. do think lower enterprise plans would pay $1,500 at the age of 24? the $200 at age 50. almost $10,000 at age 64 the same plan. for a female employee, it would cost $3,300 at age 24 and $6,400 at age 50. family plans are more. a tax credit can only benefit those who make enough money to use a tax credit. most people do not need a tax credit. how would you make the taxing of benefits equitable to older and the millworkers? -- female workers? >> let me make sure i understand your question. in terms of taxing benefits, and i said i oppose the taxing of health care benefits for people that are you receiving. i'm not supportive of that proposal. there is being discussed in the senate finance committee the fact that some folks have cadillac plans, meaning -- to give you an example, the average member of congress has a plan somewhere 30,000 or 14,000. it is somewhere in that range. that is a pretty good plan. what the senate finance committee has been saying is that maybe when you get to a $25,000 plan, one that is a lot more expensive and fancier than the one that even congress has, maybe at that time what you should do is start to cap the exclusion and deduction that is available. that is so we are discouraging these really fancy plans that end of driving up costs. that is the debate that has been taken place. i have not signed on to that approach. i think it is a legitimate debate to have. what i have said is the idea that you just described, which is that you'd actually provide and eliminate the tax deduction that employers get for providing you with help insurance, because a lot of employers would stop providing health insurance. >> let's see. this young man right here. he has a bow tie on. he looked very sharp. you can use my microphone. >> hello. i am a junior high it senior class president. [applause] my question is from early. you said you want to extend the age for health care. we see that many states have extended to 26 and 30. at 29 we are still the main percentage of people who do not have it. my question to you is, exactly how can we guarantee this? >> keep in mind, one way of dealing with this is having health insurance reform so that young people are covered under their parents' plan was there in that transition time for a college to a job. anybody under the plan that we proposed and actually are seeing a consensus in congress about, anybody would be eligible to go ahead and get help insurance through what we are calling this exchange with subsidies that would help from the federal government it cannot afford it. use of fields to help insurance even if you are 20 or 21 or 22. as long as you are eligible financially. if your lebron and james, he does not need a subsidy from the government. assuming you quality -- qualify with your income, regardless of age, you then be eligible to go ahead and buy health insurance for this exchange. that is the whole idea, that we are creating a system where anybody who does not have health insurance is able to go and look up and see these choices. this exchange had a lot of aoptions, if that is what you prefer. you can choose the plan that you believe works best for you. we would then help you be able to purchase that insurance. any insurer who is in the exchange would have to abide by certain rules like you cannot exclude people for pre-existing conditions. it cannot stop you if you get too sick. we cannot lose insurance if you change jobs. we would be reform the -- reforming the insurance industry. it is the young ladies turn. i neglected way up there. that young lady is standing up right there. no, no, i know you are excited. i was pointing at her. [laughter] i love you too, though. right there. you, yes. >> thank you mr. president. i am and are in a the cleaving -- cleveland committee of reach. we serve the uninsured and are doing some great things there. this is a counselor also. she works of me. my question is, and health care reform, are there going to be provisions for insurance companies to get paid for providing health education and health promotion for their people as well as more help with mental health services. there is a huge deficit there. >> i have long been a supporter of mental health services as part of a package. i think that is important. i really want to focus on in addition what you just mentioned, which was prevention of this can make such a huge difference. i was meeting with some of the officers here at the cleveland clinic. they are all sitting in the front. they are very serious skies to do outstanding work. one thing that is exciting is the they are also linked up with all these family clinics. one of the things that a clinic and a family physician can do is focus on preventable diseases. making sure you are helping someone with a nutritionist to keep their weight down before they get diabetes as opposed to paying for surgery for a put invitation -- foot amputation. if there had diabetes, a counselor to make sure they are maintaining the regiment to keep their diabetes under control. that is cost-efficient. the problem is right now that a lot of the health system does not reimburse and incentivize that kind of preventive work. what we want to do is absolutely in this reform package, there will be reimbursement for prevention and wellness and we are going to make sure that those are the things that do not require out of pket costs for the patient so that they are not been discouraged from using it and they are being encouraged to use it. that all the difference in the world. how much time do we have? ok, i have time, i am sorry, for one more question. one more question. i have to say, i apologize up front. i'm going to go with another young person. this young man right there. he has a jacket on. he is looking very sharp. thank you for dressing up, guy. you have the boat tie and jacket. i did not just that good when i was your age. >> i am 14 years old. how can you reassure americans that your health care proposal is it too much too fast? >> i think that is a great question. that is a great question. [applause] first of all, on i do think that sometimes people get the idea -- you know i, i have said, let's get this done by august. what i was referring to is, let's get the bills voted out to the house and senate by august. as a means to have to come back in the fall and reconcile the differences between the senate bill and the house bill, had a new bill, it would go back to the house again to be voted on and then finally come to my desk. our target date is to get this done by the fall. that is the bottom line. keep in mind that even if we got it done in the fall most of these changes would be phased in over several years. it is not as if you are going to wake up tomorrow and suddenly the health-care system has all changed. we are going to phase this in any intelligent and deliberate way. there are some changes that i think back to take effect pretty quickly. making sure that we are reducing progression -- prescription drugs for seniors. we should not have to wait a long time for that. we should not have to wait in long time to make sure people to not lose their insurance because of pre-existing conditions. there are some things we can start implementing that need to be dumb. is it too much? i do not think it is too much. it is only too much by the standards of washington politics today. that is basically that anything just becomes a big table of who is up and who is down and to its advantage and who is not. the lobbyists are all scurrying around. i am working with people pretty hard on capitol hill. this is not too much. what we are talking about is not strapping the existing health care system. all we are saying is if you have health insurance you can keep it. if you do not have health insurance you can now afford to buy it with some help. if you have health insurance year when to reform the insurance industry so that it can still make a profit. it can still offer good services to its patients -- its customers. it cannot engage in some of these rules that basically have them collecting a lot of premiums and not wanting to pay out what people really need it. what we want to do -- here is what is complicated. changing the delivery systems so that we actually start getting more quality for less money. that is going to take some time. it is not going to happen overnight. the reason i visited the cleveland clinic is because they have been able to drive down costs more than any other health care system out there while maintaining some of the highest quality. when i asked, how did you go about doing it? they started this thing in it 1921. what they have done is, for example, doctors who are part of the clinic get paid a salary instead of being paid a fee for service. that makes it easier for them to make some of these changes, because people do not think they are losing money. they just know they are getting a salary. that is not maybe the thing that every doctor is going to want to do. there are other ways we can take that same approach for this are thinking in terms of what is needed for the patient and making sure they are getting reimbursed for what is good for the patient and they do not have to worry about what the government is saying or what the insurance companies saying ended the year 12 -- and worried there going to get reimbursed. most of all who are doctors or nurses did not get into it to fill out forms. they got into a to make people feel better and heal the sick. that is what we want to free them up to do, but it will take a little time to get there. stay on your members of congress. keep up the heat. we have to get this done. thank you. love you. by. -- bye. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] ♪ ♪ ♪ ♪ >> more about health care legislation from nancy pelosi. she spoke with reporters for 15 minutes. >> good morning. think he for your patience. we have a briefing on the h1n1 flu virus by the secretary of h ss, homeland security, the president advisor and homeland security, and the secretary of education. it is very viable information for us to pass on to our colleagues. that has change our schedule this morning. throughout the week, americans have come to capitol hill. you have met with some of them. they talked about why we need to have health care reform and why we need to have it sooner rather than later. we occurred from doctors and nurses about keeping insurance companies out of health care decisions. we have heard from americans facing crushing debt on what how one diagnosis or phone call or accident has threatened to kill them. people have been denied coverage because they were trapped in a job. what we want is to change all of that. we want americans to be able to start businesses, to change jobs, to become self employed. we want them not to have pre- existing medical conditions governing whether they get medical insurance or not. it is a pretty exciting time. nevada us have for our entire careers to get to this. we have a few issues that we are going to result. i believe in the next 48-hours. we are on schedule. the american people need it. the president has spoken very eloquently. i believe the toward force last night about why it is important to go forward is important to individuals, and businesses, families, our economy. this is probably the single most important initiative we can take to turn our economy around. the dynamism that will spring from deliberation -- for not being job blocked for reduced to poverty because of it. we are building momentum. more than 130 national organizations have expressed support. that includes a may come and a r p all the way to the ymca -- that includes the ama, and the aarp, all the way to the ymca. we are on schedule. we will be able to give a wonderful gift to the american people. a gift of confidence, peace of mind, as a move toward a healthier america. it'll make their families help the year and give them economic security. with that, i will take questions. >> there have been some disagreement as of late between the senate and house. you propose a surtax to pay for health-care reform. that is not a very popular idea in the senate. they want to take a big-dollar infrastructure bill. -- a $500,000 -- a $500 billion infrastructure bill. what are we seeing here? a diversion between the two? >> we are seeing the legislative process. and we say how proud i am of what happened in the house yesterday. this was very dramatic for us. for four years, they have been advocating for pay-go. george miller was pushing this 30 years ago. this is the organizing principle of the blue dots. this has been a priority on both sides. we are very proud of what happened here yesterday. we are very proud of the fact that the president of united states is committed to signing legislation. we made it the role of the house and we became the majority. yesterday we moved to make the law of the land. we always have differences. we will work them out in terms of how the health care reform bill is paid for. eventually, we will have a transportation bill. it is just a question if we take in smaller or bigger doses. i like to see it in a bitter dose. if the house wants to start with the 18 months, that will have to be made. we will have a bill. it will create jobs. this is a different of timing, not of the direction that is used to create the deficit. >> are you worried that they are using money as an excuse? >> on the other side? >> they have a very interesting healthcare. >> all i know is that there are forces out there who do not want to see health insurance reforms in our country i tried to prepare my colleagues for an onslaught of their efforts to deceive this effort. you've heard some manifestations of their message by some members of congress here. i will not repeat them. the fact is on these issues we have three issues, education, health care, and energy, which are the pillars of the president's to turn the economy around. in each of those cases, agents of the status quo are wanting not to make the change that is necessary to reduce the deficit, create jobs, and make the feature better. we are prepared for that onslaught. >> other leaders are trying to influence it. >> i'm just not -- familiar to any who have supported health care reform. i do not even know what you are talking about. there is a newcomer. let's welcome him here. >> you voted very strongly a few years ago about the credit tax, saying that there should be to statutes representing. [unintelligible] hoyer said the voting right is not dead. this will be a step in the right direction. the city could do it by suspension. what is the reason for the delay? had he spoken to chairman to move this bill, which would give it some representation? >> let me again reiterate my strong support for the district of columbia in the capital. the priority for us right now is for the district of columbia, it is immoral that they did not have a full -- that they do not have a full vote on the floor of the house. they want to put the statue bill forward. they look for to working with her today. >> you think that should be done? >> i do. our priority at the moment is of course the health care. we have a full agenda here. specific to the district of columbia, we just came through our appropriations bill. we had some success to make some progress on respecting the district of columbia. we want to get to be a vote. -- get the vote. it the murders and assaults into the forward, he has my wholehearted support. -- if the chairman wants to put it forward, he has my wholehearted support. >> [unintelligible] do you believe that kind of -- are you going to support the deal? >> i am not following you. i have been totally consumed with healthcare. i'm not aware of the bill that came to the committee. >> could you elaborate on your contention on the survey that you have the votes? >> i am more confident than ever. when we work out some the differences that we have, it will be very apparent to everyone that the momentum is there when the bill is ready. it will go to the floor. we will win. >> the blue dogs they do not have the votes. >> i do not intend to get on a discussion on that. i stand by my statement. i'm not addressing anybody else's. >> this morning it is one the most contentious meetings on health care. he suggested they postpone or cancel the august recess and suggested -- >> i guess it depends on your perspective. i thought it was a very invigorating meeting. it was one where we invited members in terms of some of the issues and timing as we go forward. it was pretty exciting. there was definitely a sentence in the meeting that members wanted to get it done before the break. that was reflected in what mr. cliburn said. we will take the bill to the floor when it is ready. when it is ready, we will have the votes to pass it. i do not know that we would even have to stay any longer than our regular scheduled departure. if the bill is ready, and knew the american people have the need. what is important is not whether the meeting was exciting or whether we stay or not. what is important is the american people need health care reform. they need to be able to say they have a pre-existing condition and changed jobs or start a business that they are able to get health care. the need to remove the insurance company from between them and their doctors. the need to be able to have confidence and peace of mind. if we do not act, the cost will be higher, the waste will be greater, and the health will be worse, and we will have accomplished nothing. we are having a very small conversation about whether we leave a few days sooner or later. >> if the house these the street without taking the boat, the momentum will be gone for this -- the house least next week without taking the vote, the momentum will be gone. democrats abandon us of of doing this. they will lose momentum on this? >> i've not afraid of august. it is a month. what i am interested in is the sooner the better to pass health care for the american people. 1400 people lose their health insurance a day. this is a major issue and of great relevance to the american people. you are here at the time we are having a very lively debate. the differences are between democrats and republicans, parties, and regions. the differences will be resolved in decisions will be made. we will be able to honor the president's timetable to get this bill done as soon as it is ready. we will do the best possible job. this must work. we must take the time to listen to our colleagues we have -- colleagues. we have. >do not you fill excited to be part of this historic momentous thing? it has been the '60s and medicare was passed and since the 30's that this initiative began. harry truman even talk about how important it was to get this accomplished. now we will. >> some the most liberal members of your caucus expressed concern about the efforts. do you risk, because the blue dogs and those factions have been saying we need to do some things and change it, are you concerned about possibly losing boats on the other side from the congressional black caucus as to go through this? >> no, i believe we will reach consensus. 1c decisions are made, everyone understand what this was in the interest of furthering -- getting as close to our goals to getting affordable and quality healthcare for all americans. this is very big. when we are here in washington, some of these questions are very small. this is a very big initiative. i believe that the numbers will resolve their differences -- members will resolve their differences soon. we will be prepared to move forward. we will be the most significant -- it will be the most significant fact that most of us will ever have been part of passing. mr. dingell was there. i say most of us. there is at least one exception. thank you very much. >> our coverage of the health- care debate continues in a few moments with a forum hosted by house republicans. in a little less than two hours, president obama is in ohio for a town hall meeting on health care. after that, we will be air nancy pelosi's weekly news conference. -- re-air nancy pelosi's weekly news conference. >> robert gibbs will take your questions about the first six months of the obama administration. we will look at the automobile industry, health care, and economy with sherrod brown of ohio. nudie gingrich discusses the republican party and the 2010 election. >> now a discussion on health care legislation, posted by house republicans, including the experiences of doctors and patients of other countries. this is a little more than 1.5 hours. >> that sounds like it is working to me. let's get started. it may be a coincidence that the boats came at the only time that any health care discussion was being held today, because they canceled a marked on the bill that was going to happen in the energy and commerce committee. we will assume that is a coincidence and try to work around the coincidental nature of us having to run back and forth a little bit for the votes to going on. let me welcome to the healthcare solutions hearing. we are pleased to have this pen with us today. as i said early, dr. carol is joining us from great britain on the telephone. our group was formed six months ago at the request of our leader john boehner. the ranking members from the budget committee, work force committee, energy and commerce committee have been active for many of our -- and many of our members have been involved. two dozen of us have worked hard to send the system in a better direction. it is very fair to say that this health care solutions group was to create a system where people have more access and more competition and that creates both better price and more patient satisfaction with a real focus on the doctor/patient relationship. more access and more competition that creates both better price and more patient satisfaction, but writ real focus on the doctor/patient relationship. beyond that, i'd say that we are here today to really talk about what might happen if you wind up with a government competitor that eventually becomes the only competitor and our panel is a panel that has real experience with that, both in terms of medical tourism, personal health challenges and economic impact both in canada and in great britain. let me go next to others for some brief opening statements. dr. begin gri if you're ready, we'll see if we can make these mikes workt right way. >> yourses have had a go off first. >> i turn mine off first. is yours on? >> is this on? i believe it is. well, surprise, surprise. so mr. chairman, thank you very much. and of course this health care working group that, as chairman blunt has described that we've been working together, the group of about two dozen of us. as he point out, the ranking members of the three respective committees of jurisdiction, education and labor, energy and commerce and ways and means. we have number of physician members. i happen to be one of the physician members and a member of the energy and commerce committee and the health subcommittee, so we bring a lot of talent, experience to the issue. we clearly feel that health care reform is needed and our system, while it is the best health care system in the world, is not perfect. and we ought to always strive for perfection. that's what we have done in this committee as we have worked tirelessly to present the republican alternative to health care reform that doesn't turn it over lock, stock and barrel, throwing the baby out with the bath water i like to say, to the federal government. we are for insurance reform. we are for delivery reform, not necessarily babies. but the delivery of health care in general. we clearly feel that liability reform, expanding electronic medical records, giving everybody access to health care creating high risk pools, equalizing the tax treatment, i could go on and on and on, but there are other members of the panel that are more expert on some of those areas than i am. but i've been proud to work with this group. i think we have got a great plan, if just given the opportunity to sit down with the democratic majority and with the president, i think we could show them how to fix this system and fix it right. i really welcome the panelists and look forward to hearing their testimony and asking them some questions. >> let's go next to our whip, mr. cantor. >> thank you. i want to just commend you, roy, for having this panel today. because i think it is very important that we respond to the many questions that the american people have with regard to what a government health care plan would mean for their families. and as we know, there are many people across the country that are very, very uncomfortable with the rush to get something done if we don't get it right. health care obviously is important to every man, woman and child in this country. and frankly, as we saw last night with the president's press conference, there are still a lot of unanswered questions as far as his plan is concerned and that which is making its way through congress. the reality is right now as it stands there is a bipartisan majority against the bill, which creates a government health care plan. and a lot -- the reason, i think, for a lot of that opposition has do with the uncertainty around what government health care has produced in other countries. and what that would mean for the ability of american families to continue to access the kind of care, the quality of care the timeliness of care that they have become ud to or that many that have health care have become used to so. i look forward to this hearing and i want to welcome the panelists and thank them very much for being here. >> let's go to mr. klein who's the ranking member on our workforce committee. joining us today. >> i don't think this microphone is working. oh, it is working now. thank you very much, mr. chairman. i want to thank the panel iists for being here. it's particularly gratifying to have an expert all the way from the united kingdom who is willing to stay with us on the phone. let me just say very brief ly, e looked at this bill, it was 1,018 page after it was 852 page, then the amendment was 1, 1,042 pages. there are some very, very troubling concerns. we in education and labor marked up this bill, tried to amend this bill starting at 10:00 one morning going straight through until 6:00 the next morning. a very healthy debate as my friend dr. gingrey said, we had three physicians on the republican side and i can telling you that they were engaged an we were have happy to stay gauged if we could fix this bill. our concerns are enormous. this legislation creates a new federal bureaucracy and with a new commissioner, you can only think of as a high commissioner because it's enormously powerful position to fundamentally, i believe, wreck the delivery of health care in this country. so i'm just delighted to be here. i applaud the work of my colleagues and looking forward to the testimony of our witnesses. i'll yield back. >> dr. fleming. >> okay. thank you. yes. thank you, mr. chairman. i just want to say briefly that there are three fundamental problems with the takeover, the government takeover of this health plan. one is cost despite what our president says, despite what members of the other side of the aisle says. every analysis that has credibility including the cbo says the cost will go up for years and in fact in the out years it will go up infinitely. bureaucracy stepping between the patient and the physician, a psyche kred sacred relationship. it's tremendously bureaucratic. we may hear more examples of that today from other countries. and finally, a big concern, despite where you may be on pro-choice or pro-life, this ploisd taxpayer fund abortions which 69% of the american people are against. so we have some very fundamental flaws with this plan and quite honestly despite what you hear democrats say, every single republican is not for the status quo. we are for true health care reform. common sense health care reform. not nonsense health care reform. >> paul ryan. >> hi, i'm paul ryan. ranking member of the budget committee and also serves on the ways and means committee which marked this bill up last friday morning. a couple of cost points i think ought to be made give than we're here to learn from experiences from other country has have done this. number one, the congressal budget office is telling us that not only is this bill not paid for in the first tenor use, it the has $239 billion deficit. i expect the majority will close that but they're telling us that costs grow at 8% a year and offsets grow at 5% a year, what that means is congress is on the verge of creating a new entitlement which will be unfunded. a new unfund liability on top of the ones we already have, medica medicare and med. the reason i point those is it's very important if the government is to earthly take over the rest of the health care sector. they're telling us that with the health care option, two out of three americans will lose the private coverage they have and be dumped onto the public plan in about three years because of the cost shifting that curse. if the public plan underpays providers as they do, typically 20% on the hospitals and physicians. what will happen is they will overcharge on private plans. this will precipitate an enormous dumping onto the public plan whereby the public plan option inevitably becomes a government-run monopoly. and under that signed kend of a system with huge cost eck explosion. a $38 trillion unfunded@@@@@@@ , that is one of the reasons why they need to compare it, witches how we will design -- which is how it will be paid in reimbursed for providers. we are very fearful that instead of addressing the problems that we want to address in healthcare, cost, accessibility, making sure people can get affordable health insurance, we believe we can fix those problems with of the government taking over, new taxes, and spending. the past this bill is on it is going to put this in a position where bureaucrats will have to make of the cutter decisions. . . tant bureaucrats will have to ma make cookie cutter decisions on how medicine is to be practiced in america if we're ever going to deal with the cost explosion just right around the corner and the fear is that will take the doctor/patient relationship out and replace it with bureaucratic dictates who do not know the uniqueness of a particular patient's ailments. inevitably, rationing, i know that's a dirty word, must inevitably occur. that's why it's valuable we don't rush this to the floor which is being done next week that we patiently look at this and learn from the experiences of other countries as to what this road looks like that our new government is trying to put us down. that's why i'm excited to hear the input we're going it get from our witnesses. >> mr. whitman. >> mr. whitman. >> r. chairman. it's an honor and privilege to be here today as part of this group and to these have these fine folks before us to testify today. as you've heard the common theme amongst this is solutions to health care and the solutions rest in reducing cost. that's the bottom line. and you've heard a lot of different aspect about where the problems are with this bill and where it does not reduce costs. we hear from the governor's conference about their concerns about increasing costs of medica medicaid. they are deeply concerned about the unfunded mandate, also the congressional budget office speaks to the unsustainability of this bill passed 2012. also the mayo clinic points out the problems with the bill and its sustainability. as we see, we want good workable solutions that get to the basic issue at hand and that is controlling costs within this system. at 17% of gdp going to health care costs and that rate growing at 1% a year, everybody in this congress realizes what the issue is. it's cost and containing costs. secondly, what you heard is also about making sure that we maintain the integrity of the patient provider relationship and that is also critical in whatever comes out of this body to make sure that we maintain that that's where the most efficient decision making takes place is between the patient and provider. we must preserve that and do all we can to reduce costs f we do that we create a sustainable system of health care in the united states. the current path we're on is not sustainable. the bill currently before us is z not create that sustainability and it interferes with a patient/provider relationship so we are here to make sure we can achieve those two goals in our efforts and hopefully we'll find folks object other side of the aisle willing to work with us in getting that accomplished. again, thank you so much, mr. chairman, for being a part of this today. >> thank you, rob. is this -- we're going to struggle with this for a will. first of all, let me mention some of the things i want it say here which is to reiterate that the choices are not the choices that the president laid out last night. the president has been an expert at creating the straw man, you can either do what he wants to do or we can do nothing. nobody on the solutions group and my belief is nobody in the republican side of the aisle in the house believes that we couldn't make this system better. and in facting we're proposing plans and ideas and legislation that would create access for everyone to the system regardless of pre-existing conditions that would create more choice and more competition, choice and competition will have more impact on price than anything else. and has been said several times, we're also convinced if you have a government provider, every outside study that is objective on this indicates that you won't be able to keep what you have even if you like it. another thing we constantly hear from the president is if you like what you have, you can keep it. but believe me, if 114 or 125 million of the 160 or 180 million who get their insurance at work go to the new subsidized government plan, what you like won't be there anymore and at cost will go up. it will just -- those things will disappear and then you have governmen government-run health care. and we want to have some discussion about that today. we have three witnesses with us and one witness on the phone with us from the unite the kingdom. so four witnesses to testify, four witnesses to ask questions of. i'm struggling a little bit to decide the exact best way to do that. but since i don't think we've gone to the second vote yet, i'm going to go ahead and introduce shona holmes. shona has traveled from canada to be with us today. she was diagnosed a few years ago, with a brain tumor and because of the system in canada, she was told it would be months before she would see a neurologist in canada. fortunately, if you live in canada, you're not too far from the united states and in her case you're not too far from the mayo clinic and she was able to go there and receive treatment and shona, we appreciate the personal effort you've made to be here today an we look forward to your testimony. >> can i figure this out? >> i don't know. i think mine is on. somebody is going it have to -- >> hello? >> yes, there you go. >> thank you very much. >> sorry about the mike problem. >> no problem. i feel strongly that if we don't start talking to each other in the same language that the truth is going to get lost in the translation of this debate. it has always been my view and my message that both canadians and americans have so many miss conceptions about each other's current health care system i have chose to become involved to all right patient's point of view from the miss conceptions using my personal experience from both sides of the border. i left canada for diagnosis in the united states because i could not access diagnosis in a timely manner with specialists for my condition which was becoming fwrarvly worrisome. this is often the part of wait times ig by studies an improvement within our health care system. at least one in six people in ontario are without a family doct doctor. that is the gateway to your care and to specialists. out of 33 million people in canada which is the same population as the state of california, we have 5 million people that are without access to a family doctor. i was fortunate enough to have a family doctor. one that cared for me very deeply. she was unable to expedite the tests we needed, nor the specialists, the diagnostic testing, the imaging, the blood testing and some of which weren't even provided under our governme government-run health care. one simple blood test could have saved me grief and expense that's not even available in canada. not because we can't do the test, it is a simple blood draw. but because the government mandates the lab hours. i required a test at 11:00 p.m. at night and the government closes at 7:00. within one week, i received a complete comprehensive diagnosis from two former kanacanadian dos who now work at the mayo clinic in arizona. the most amazing part of my story, issie ooh file is that both of doctors recommend i go home. for this surgery and for follow-up testing. as we now knew what the issue was that i should have been able to be treated rapidly through our free health care or government-run services. confident that i was armed with the information required to be triaged to the emergency list, this was sadly not the case. i was to find out many months later that doctors in canada are not required to take other doctors' reports. the doctor i saw refused to review my record, read the diagnosis and worse yet, personally declined a call from the mayo clinic doctor himself as he frantically contacted him with updates on my condition. sadly, stories like mine are not a rare case. as some are trying to discredit me by saying our country is using the united states on a regular basis to help out with emergencies when we arise, we are lacking the resources to sort them out ourselves. as recently as two weeks ago, two premature babies were born in one of the largest teaching hospitals in my cities and there were no facilities available for them. one was sent to buffalo, new york. while the other was sent to ottawa, some seven hours away. the month that i came to the u.s., 26 people were with the cross the border for brain surgery due to a lack of neurosurgeons. i can count story after story in this discussion, but the most compel thing to me was the other day when i spoke to the border guard reported to me the must bes daily of people that are crossing the border from canada to the united states for cancer treatment, mris and other emergency treatment. and he wondered why people in the u.s. were glorifying the canadian system. we have government websites that post targeted goals for wait times in our areas. as well as the average wait time and sadly, we are never near target. lost in the language is coverage. the basics that americans have complained to me about not being covered is not covered in our government plan. things like prescription medicine, eye exams, unless you're referred to an ophthalmologist and the wait times to see ophthalmologists are up to one year. hearing tests, and even things like a cast on your leg if how is break it. the doctor tending your injuries will be paid for his services but you would be out of pocket for the cast, the crutches, the physiotherapy and ambulance ride to that hospital. i'm saddened by the glib attitude that if it didn't happen to me, that it can't be true. canadians are terribly proud of our health care because we fear what we have been raised to believe what america is like. no insurance coverage is very different from no access to care. nor the ability to step out of the system and take care of yourself and/or your family without being fined. to leave your country to get treatment in a timely manner alone tells the tale of too much government control. i have yet to meet an american who boasts about the health care in both the medicare process all right in place in the u.s. or your va hospitals. sadly many of those stories only mirror our whole system. this debate seems to polarize people. it's polarizing points and worse, it's polarizing professionals. when i watched president obama give his peach the other day and he spoke about being surrounding by nurses because they didn't choose the profession to get rich it drummed into me what the problem was. this is unfair to assume that the driving costs of health care lay on the backs of only one specific field of individual, be it doctors, the medical profession, pharmaceutical companies, the insurance industry or patients themselves. this is irresponsible. canada, with our, quote, free health care, battles the exact same suffering, the exact same issues under socialized medicine. health care is expensive. our only way to control costs is not through competition, not through choice, but with more taxes or rationed services. everyone wants and deserves health care. they weren't affordable health care but most importantly they want accessible health care. this is the lesson that i've learned in the past few years. looking back, i chose what kind of canadian statistic i would become. i mitigated my own damages. i came to the united states and i saw [captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] he has been a physician with the national health service in the u.k. for the last 37 years. he is the author of numerous books and papers. doctor, we are glad you are with us and look forward to your testimony. you're with us. >> a pleasure, thank you very much. i think i circulated a little preamb preamble, the problem is not unique to any country. all developed countries are struggling with new technology and aging populations. medical inflation is now running medical inflation is now running at@@@@@ @ @ @ @ @ @ @ @ @ @ @ @ no one is uninsured, and that is a fact. the difficulty is that politicians are playing with the health service. it is inevitable to have a government-run health service that is essentially run by the politicians. they are looking for ways to score votes. in small areas to change hospital configurations, consultations, politicians making statements to encourage people to vote, and, similarly, a nationally, in terms of policies, certain cancers become more important, because there are political. breast cancer is more important. if you are irrational provider of the service -- if you are a rational provider of the service, in health care, especially government-run services, there are really five- health . services, first of all you get huge bureaucratic -- nhs is the larger single employer in the whole of europe. the second problem, and when you've got a large workforce that's bureaucratically structured there's tremendous resistance to change. if you look at other consumers like the shopping malls, it has changed dramatically in both countries over the years. our health care system remains almost exactly as it was 30 years ago. the the second problem is what i call the value equation. the competition that you've heard about earlier this morning, price in competition drives value. i would define value as the quality of the care together with access to that care of patient, canada had to wait several months if you wait in the canadian system. so if the quality goes up and the access goes up and costs go down, the value goes up. that's the driver in any consumer industry service industry. operation is et up to compete and those that provide better value as judged by the end user, those that provide poor value close down. that dynamic incurs every exception of government-run health care. the third one i mentioned is inevitable. we've seen it both in our conservatives and with our labor, a lot going on in health service. it is one of the most important issues to people how health care is going to be provided. politicians struggle to find ways to solve it. and one way -- and of course, the issues as we've heard from you, the consumption of gdp potential is massive. then the fourth problem is a delicate one. that's the majority of health that goes to our senior citizens and i'm nearly there, so i'll be one of them very soon. older people tend to people little tax. on a tax only basis, you're asking the older people who now have all this wonderf futechnol to get it at cost to younger people that will have to pay more tax. more tax to pay for the health care wishes of aging health consumers. inhe ha that is a huge political problem. then the last problem with a government-run service, is you've got to ration it, it's the only way to do it. we sort of do it here through an organization the national institute of clinical excellence. the problem with nice, its value judgments are not agreed by everybody. so we use a cost for quality, and if you try to calculate that, there are all sorts of arguments about the calculation n my area, cancer, going through a rapid surge of new technology, how do you know whether they are giving new drug for cancer is a better health intervention than doing something for mentally handicapped children. that's impossible to put into single numbers. trying to get in conclusion some sort of system that allows the benefits of universality which the nhs certainly does and allows choice in competition to move through is clearly to me the way we go through. but what i do admire about what you're doing, both you and the democrats, you seem to have a greater realism of -- we tend not to have that here. but it's coming in the next three to five years, i guess because of the increase cost of health care and the fact that new technology will keep coming at us and solving the problem today doesn't mean it's going to be solved two years. still new technology that people know about. thank you very much. >> doctor, if you can stay with us, we have two more witnesses, then i'm sure we'll have questions for you as well. >> let's go to richard baker, founded timely medical alternatives. it's an organization that sends thousands of canadians to the united states for a surgical procedures. he's become one of leading spokespeople for a free market reform in the canadian single payer health care system. he's appeared off and on radio and television to discussion health care reform and made a considerable effort to be here today. thank you, richard. >> well,t was working. >> how about now? >> yes, working now. >> mr. chairman, ladies and gentlemen, my name is richard baker and six years ago i founded an organization to help canadians who are on long medical waiting lists to get timely care in u.s. hospitals. now currently there are over 3 quarters of a million canadians waiting for surgeries which americans routinely get in days. in some parts of canada, the waiting time for an mri, for instance, a very routine test, the wait is over one year to get an mri. a basic diagnostic image. the canadian supreme court admitted that people are dying on waiting lists in canada right across the country. over the years, my organization has sent well over 500 canadians to the u.s. and rewe refer to the u.s. as canada's health care system of last resort. if you are dying, if you cannot get care, there is always the option to go to the u.s. two years ago, building on our success and our experience i founded north america surgery, offers deeply discounted surgery procedures for uninsured americans. in the course of this works we have saved the lives of six of our fellow canadians and never had the opportunity to work with -- i will tell you some of our other clients whose stories i believe are compelling. we helped an 8-year-old girl who had a message cranial infection. she was on a 15-month waiting list in canada to have the most simple of surgeries. she needed drains put in the ears to drain off the infection and needed her ton sills out and add noids out. this is the simplest surgery yet she was on a 15-month wait after having gone deaf in january of 2004. couldn't hear her teacher or participate in school. >> in month nine of the 15-month wait, we sent her to a surgeon in seattle. and told her father had she waited for the 15 months she was asked to wait in canada, she would be dead. he said, never mind her hearing, he said my job now is to try to save her life. happily, this surgeon did save her life. this little girl lost all of her hearing in one ear and half of the hearing in the other and her wants of drain tubes in her ears and ton sills and adenoids. another one, his family doctor would have estimated it would have seven and a half months from the time he collapsed on the street until the time he got his surmgry, that included a 4.5 month wait for the mri to confirm the diagnosis of a brain tumor. we sent him down to buffalo, new york where he had a ma lilignan tumor removed and compressed seven and a half months into four and a half weeks. he had his first hearing in court yesterday. he's gone to supreme court and suing the canadian government for violation of his charter rights, specifically the charter right of security of person. it would be ironic if just as canada appears to be going more to the right on health care delivery, the u.s. would be copying the canadian system and going to the left. it would be very ironic. our client in british columbia was told by her vascular surgeon that she had two, maybe three weeks to live due to a blocked artery. starving to death. she could not digest her food. lost 40 pounds. -- is that another vote? >> i don't know what that is. that's another disruption. >> surely surgery was planned in british colombia, on the table being prepped for the surgery whether the word came down that all elective surgeries were to be canceled for the day. this is a routine procedure, they don't have sufficient beds. had she her surgery, they wouldn't have had beds. they don't have nurses to tend to the patients in the bed. shirley waited. her second surgery the following week was canceled. her surgeon said get in touch with timely medical alternatives. they will help you to get care in the u.s. next day, shirley was at an excellent hospital down in bellingham, washington, where she was told you were hanging by a thread. you had less than a week to live and saved her life. shirley went back -- this is an important part. she went back to canada. went to the government, said i would like to have my money back please. why would we give your money back? because there's an implied contract, i've been driving a school bus all my life. paid crushing taxes all my life. the implication being when i needed health care it would be there for me. i want my money and the minister of health said your decision to leave the jurisdiction was an elective decision. your application is denied. now, this brings up an important point. by the way, shirley's response to that comment was the only thing elective about my decision to go to the u.s. was i elected to keep on living. that was a great quote. you will hear from proponents of single payer health care there is anecdotal evidence that in canada some elective surgeries are sometimes postponed. the implication is that mrs. smith's planned tummy tuck had to be postponed. you need to know elective medical procedures in canada is any condition which does not immediately threaten life or limb. give an example. if you're hit by a bus in canada, you get immediate and competent care. that's an emergency situation. if, though, you were hit by a bus six years ago and you you might not be able to function, but it is an elective surgery. again, there are three quarters of 1 million canadians waiting for elective medical procedures, and one of those is our clients from vancouver. a person needs a major spinal surgery. he is only 15 years old. he needs a lumbar fusion. she herself needed the same surgery when she was 15. she did not get it. by the time she was 28, she could not pick up her two babies, and she could not pull down a job. she was walking with a walker. she was addicted to morphine, and worst of all, in my view, she had to walk around all day in diapers, age 28, a mother of two, walking around in diapers. she said to her surgeon, "when can i get my surgery?" and he said, "well, you are too young to get a spinal fusion. too young." she was too young to get spinal surgery. there were so many others waiting ahead. "i am sorry, there are too many hundreds of people waiting ahead of you. plus, you have not yet suffered long enough." i want you to remember that phrase, "you have not yet suffered long enough." 828 daschle mother of two in diapers and addicted to morphine -- a 28-year-old mother of two. when she was 31, three years later, she finally got her surgery. she came to us two weeks ago to help her get surgery for her son, who has the same familial condition. she told us she would pay anything. she would mortgage her home. she would sell her home. she would do anything to avoid having him go through the same suffering that she went through. we will be sending her son to an excellent position in sioux falls, s.d., for surgery in the next couple of weeks -- to an excellent physician. excellent physician in south dakota for the surgery in the next couple of weeks. you'll hear from prominent canadians on the left of the political spectrum about how wonderful canadian health care system. jack lay ton, the leader in canada, recently came to washington to tell you folks how wonderful the canadian health care system is. why would he do this? why would he care? here's why he came. the only reason canadians put up with the dysfunctional health care system is the fact that the government tells him that ours, the canadian system is the best health care system in the world. however, when canadian citizens are willing to pay to get timely care in the u.s., even though it's free in canada, people begin to question the government's propaganda. it's inconsistent they would pay to go to the u.s. if they have the best health care system already. why would they come to the u.s.? now, if the canadian and american governments can arrange things so that both countries have single payer health care, then the freedom train that my company operates for canadians will have no place to send our canadian clients. that's why i'm here today. americans need to know the truth about the strength and weaknesses of both health care system and with six years of experience working in both systems, i have, i think a unique insight into the subject. you will hear from the u.s. congressional leaders that we have the doctors on our side. i work closely with 60 u.s. doctors. i have not talked to a single doctor, not one, who believes that single payer health care system is the answer. certainly the association of american physicians and surgeons is four square against the single care plan. now, i noticed the title of today's discussion is health care solutions. so far all i've been doing is talking about solution that simply will not work or cannot work. interestingly, you should know that our organization able to negotiate pricing for canadian clients at prices significantly below the customary prices charged to american citizens. quick example, hit replacement cost uninsured people 43,500, american insurance companies get a break. they don't pay 43,500. they pay 24,000. our canadian clients pay 18,000. we get far better prices than the insurance companies do. a believe this is a free market solution in part to the perceived health care crisis in america. mr. whitman earlier stated that the solutions rest with reductions in cost. i have been able to find a way for my clients to reduce those costs dramatically. now, in conclusion, as you americans work to create new laws, to govern the delivery of health care in your country, you should know that the canada health act in my country has caused more pain, caused more suffering and has caused more death than any other piece of domestic legislation in the history of canada. i thank you. >> thank you, mr. baker. let's go next to karen kerr again, and listen to her testimony and then we'll go quickly to some questions. >> thank you. >> am i on? >> i am on. let me thank all of you members of the house republican health care solutions group for hosting this event today and for inviting small business to be a part of the discussion. i feel i don't have to go in too much detail with all of you about the challenges faced by small business owners regarding the epic struggle to provide and keep health coverage for their employees or for themselves. this is certainly been a long-term problem for small business owners as you know. the central issue being cost. that is, high cost and rising costs. even in the best of times these rising costs have hurt business growth and hiring opportunities and competitiveness. certainly during this tough economic period, it has been an extraordinary challenge. for the people that do not provide insurance and want to and cannot afford to, it goes without saying, economic conditions have exacerbated their situation. many small businesses are in survival mode. they are cutting expenses and cutting hours and cutting jobs and doing what they can with very limited resources to keep new business. like many americans, the economic confidence is rather gloomy. a late june discover small business watch survey found 59% of small business owners rated the economy as poor. 30% rated it as fair and only 8% rated it as good or excellent. 57% believe economic conditions are getsing worse and 49% see conditions for their own business getting worse. these numbers and this lack of confidence do not bode well for the economy. given these tough economic conditions and the important role small businesses play in our economy, you would thing th think lawmakers what do whatever possible. that's what our members heard when congress started down the path of health care reform. namely that cost of coverage will decrease for small business owners under the current legislation. but unfortunately, that is not the case. hr 3200. the affordable health choices act is not an affordable plan for small business. in fact, the financing appears to fall most heavily on small business owners. new taxes and mandates and penalties and regulations that will raise costs. this is not what small business owners need when many are struggling to survive. the mandate requiring employers to provide insurance, acceptable coverage as defined by the federal government or pay a penalty would drive up costs and kill jobs. the sur tax doesn't make sense and we need the entrepreneurs to invest in businesses to keep employees in a payroll. we are in a recession and the economy and private sector needs its capital. we need to keep capital in the hands of productive business owners. with the government defining what is acceptable coverage, we're very concerned this would drive health insurance costs higher for many small businesses. an acceptable benefits plan will likely include new man dated services and other provisions not included in some current plan which means costs will increase. we're very concerned about the overall regulatory impliance cost in the bill. you can read this bill and not acknowledge that it is a regulatory monster. complying with hr 3200, will be costly. they will develop a system to track whether they are providing insurance and making considerations as well as the proper proportion amount and paying the correct penalty tax and the exchange if you don't offer insurance and the list goes on and on. none of this is going to lower cost for business. as we know the cost of regulation falls disproportionately, more burdensome for some business. small business owners december sfratly want reform. they've been leading the parade for reform but it has to be small business friendly and has to lower cost and it has to produce reasonably priced coverage and more choices of plans for small business owners and their employees. small business owners can lead us out of the current recession, but that will not happen if they are covered with costly new man dates and penalties and unfortunately that is the direction of the legislation that is moving through the house as we speak. and it certainly is not a plan that small business owners can afford. thank you. >> thank you, karen. what i would like to do now, i think we can go until 2:00 and what we'll do is give each member five minutes to ask questions. we'll watch that clock sincee don't have a clock in front of us, i may tap the gavel if i need to, but we'll try to do this in the order the members came to the hearing. mr. klein, mr. herger, mr. camp, mrs. brown, mr. jenkins and cassidy and if there's any time or questions left, i'll be last. mr. klein, do you want to start? >> thank you, mr. chairman, i think the microphone is actually working. i want to thank the witnesses. they've been absolutely tremendous. i'm from minnesota so, of course, canada is neighboring. and we foresee anecdotal evidence all the time of canadians coming to minnesota because we have a mayo clinic there too. i'm not sure why you travel all the way to arizona -- that's all right. but we have a mayo clinic in rochester minnesota that is world famous. and you chose to come to a mayo clinic, you could have chosen several hospitals in other states and mr. baker has given examples of hospitals around the country where canadians have gone. you did that because you needed to, you had to and you could. you could do it. i think that the phrase that i think it was mr. baker said that the u.s. is the canadian system of last resort, a place you can go. so i'll start with you mrs. holmes, if i could. if the united states were to adopt a system like canada has with a government-run health plan that operates like that, do you think that the mayo clinic in rochester and others would still be able to provide services for you and other canadians? >> well, i'm not sure that that would continue to happen. i think that it would -- i don't see where the need would be on either side. and what i think is that if americans then needed a place to run, if your facilities are now completely bogged down and backed up and near the system of which we have, would canadians be able to then turn around and be able to help americans that couldn't get any help. and i think that we would become neighbors with the same problem and no solutions. >> thank you, i'm not sure how the microphone switching back and forth is going to work. i think this one is working again now. mr. baker, you did leave us with some thoughtful and terrifying quotes. the quote of the doctor to lynn of quote, you have not suffered long enough, i wonder how one determines when one has suffered long enough. and of course, we are very much afraid if you have a bureaucracy making that determination that you will have many people suffering for a very, very long time. let me move very quickly again, mr. baker. you're providing a service, your entrepreneuri entrepreneurial, have a program here, see a need and canadians are being referred to you by concerned physicians that say i've got to get help for my patient. >> that's correct. >> you're providing a service. and i've heard as we're trying to catch up on what the canadian system does, the canadian government may actually try to create something that would compete with your services. >> well, if they did create something, i've said many times that i feel blessed in operating my business that my major competitor is the government. because who cannot succeed in business if their only competitor is the government and listen, my competitor offers the same product i do but they don't charge for it. it's absolutely free. i charge for my service and yet people still come to me. what kind of an indictment is that of our system if people willingly pay for a product, a service that's free and in their own -- i think it's pretty clear indictment. and then talking to our colleagues and talking to businesses back in minnesota that the small businesses, the small-business owners, the employees there, and those who started to look at this, they realized that the bill payer here is going to be overwhelmingly placed in the hands of small businesses, and so, ma'am, you gave some very good testimony. what is it you would say from the small-business perspective? what is it that small businesses really want to have happen here? what do they want in the way of fixing health care? >> well, it is very obvious. they want their health-insurance costs to go down or at least to stabilize. those who do not provide insurance either for themselves or their employees want access to affordable coverage. and i think there are solutions that have moved through the congress previously and that have been proposed that will help them do that. i mean, certainly, there is the pooling that has moved through the congress previously that would allow small-business owners to pool as a group and leverage their numbers so that they can negotiate better prices and have more choice of plans. s a group and leverage numbers to negotiate better prices and have more choice of plans. there is on the tax side there are tax credits that can be offered both to individuals and business owners. the tax code can be fixed for the self-employed with respect to tax parrity. we can open up the health insurance market on a nationwide business. some are locked into the insurance market and it is very expensive in some states, new york and new jersey where they have excessive mandates. and that is a barrier to coverage for many business owners. so certainly have a nationwide market, a true nationwide marketplace, not something run by the government, i think that makes total sense. more choice, more competition and i think some very simple targeted reforms without taking over the whole system and making small business owners pay for it. so -- >> thank you, you sound just like a member of the republican health care solutions group. those are the exactly the discussions we've been having. thank you very much. i yield back. >> thank you. excuse us, these are government-run microphone systems so -- all right. thank you for your patience. we just received very recent analysis of hr 3200 which is a bill we're probably voting on next week. and the analysis to make decisions customerize treatments for patients with respect to reimbursements and not just waiting lines, we got a good idea of that, but the concern that we have under this system where the public option becomes the only option, we've already created this institute of creative effectiveness to determine what care is reimbursed or is not. meaning it decides the treatments that can be given to patients. how does that work in canada. >> well it works in canada in this fashion, not only is access to medical care rationed but access to the medications and the techniques involved in the care are rationed. we go back to my client who we sent to belling ham, washington for her blocked artery. had she had that surgery in canada, she would have had a an arterial bypass. she was emaciated and debill tated. her surgeon told her later, had she got the surgery in canada, she likely would not have survived it. when she went to bellingham, she had a stinting procedure, far safer and far easier and quicker. why is it not offered in canada? because a stint, costs, i don't know, a thousand dollars, it's cheaper to do the bypass procedure. so that is one way that the customized system is affected. another excellent example is an access to drugs. there are evidently 25 pharmaceuticals which are deemed to be effective for treating cancer. depending on which province you have, you may or may not have access to them. in british columbicolumbia, we of 25. hopefully if you come down with cancer, your particular type is receptive by one of those 23. what if you live in prince edward island, they only approve one out of the 25. you would have to be very lucky to have cancer that was treatable by that one drug. but what if you had cancer that required one of other 24? you would be just out of luck. >> that's exactly what our concern is, which is physicians ought to be able to have the maximum amount of freedom to customize and taylor the care per the particular need of their patient. each patient is different and he'll ailment is unique, if we set standards by government body, the uniqueness of that patient is completely disregarded. cookie cutter, standard based medicine. it's all cost driven, not therapy driven. so, is it five minutes up already? >> it is. >> i guess i've been gavelled. >> doctor, we remember you're there too. >> there we are. well, i wanted to direct my first question to the -- not to the doctor but the gentleman, mr. baker, who was just spoke about. you made a comment, mr. baker, i want to -- this is not a question pertaining to this comment, but you said who cannot succeed in business if their only competition is the government. and i think that was in reference to the fact that you weren't worried about competing what the government your business and your business model and your plan and your entrepreneurship and how well you've done. american success story, i can tell you who would not be able to succeed in this country competing with the federal government. no insurance company, no private insurance company that offered a health care product could win and succeed against the federal government if they were not only competing but setting the rules they were on the playing field but also a referee. that's a real problem with this situation with a public plan, a government default plan. and i'm sure my colleagues have talked about that in the time that i had to be away from the panel. but that's -- you may want to comment on that. but, you know, in regarding your patient, shirley healy, you talked about the need for the stint and what she went through because of what i would like to call and i think you described as rationing, when we had our first mark-up energy and commerce the other night in regard to hr 3200, the america's affordable health choices act of 2009, i asked the chairman and i asked my colleagues if they were as concerned as i was about the possibility of the government making medical decisions and literally with all of this comparative effectiveness research council taking the decision-making out of the hands of the physician, taking the art -- not just the science but the art away from the practitioner of that act, and so what i want to ask you is, if we go to this system as those 1100 pages now describe, without some significant changes and that becomes law in this country, what do you see for your business in regard to trying to get them access to care and out of that long queue and not be rationed out of the health care system? >> there are other countries who offer health care. isn't a week that goes by we're not contacted by hospitals in india and pakistan and bangladesh and phillipines and thailand. i don't want to be sending my clients offshore. there are risks inherent to traveling to these countries. i have faith, however and i hope it's not misplaced, that while we canadians tend to go to the end of the line willingly and without grum bling, i don't see americans doing that. i have a higher regard to the american resistance being pushed around and remain kstd that there's going to be a way that people want timely delivery of health care that one way or the other they will work out a way to deal with the doctors. i would like to thing the american spirit is more -- or less willing to roll over and play dead. >> let me reclaim my time because i know we're getting short of time and the chairman is just giving me the signal. i think that the answer is if i could just xpound on your answer a little bit, that you certainly won't be able to send them to the united states any more because if we adopt this system the same kind of problems they are trying to get away from, they will inherit when they get to their shores. i yield back. if we have a second round, i have a small business question for you. >> thank you, doctor. >> thank you mr. chairman, and thank you for your line of questioning. we appreciate that. i would like to ask a question of mrs. kerrigan. we know there is a mass shift in programs like medicare and medicaid and private shushs plans, private insurance plans essentially subsidize the under payments of government programs and according to a study by the act wear ral firm, this cost shifts results in people with private insurance s paying an average of $1,788 more out-of-pocket every year. do you think this would change under the government plan option proposed by the house bill and wouldn't the government plan simply place further pressure on private insurance and employers leading to even more and more people dropping employer coverage to selects the government plan? >> in short, yes. with respect to the government option, the government is going to set the rules of the game. certainly they'll have a competitive advantage. they'll give themselves a regulatory advantage, and it will crowd out private insurance. more companies will leave the market and more individuals will end up in the government plan. so, again, if government sets the rules of the game, the competitive game, it's going to be to their advantage. and what that means is that there's going to be few erin surers and more people going into the government option. i share your concern and your appraisal of what i see happening we also have similar stories in the u.k. and europe, and ms. holmes, i know that you have similar concerns, so, again, i thank you. the good news is that the american public, the american people and the american voters, are becoming more and more aware, and as they are of what is being overnight in these 1100-page-document health-care

Related Keywords

New York , United States , Canada , Nevada , Texas , Cleveland , Ohio , Vancouver , British Columbia , Minnesota , California , Mayo Clinic In Rochester , Russia , Michigan , Washington , District Of Columbia , Pakistan , United Kingdom , Ottawa , Ontario , Sioux Falls , South Dakota , Arizona , Bangladesh , India , Thailand , New Jersey , Prince Edward Island , Heights School , Iowa , Town Hall , Capitol Hill , Americans , America , Canadian , Britain , Canadians , Soviet , British , American , Frank Jackson , Robert Gibbs , Shirley Healy , Sharon Brown , John Carter , Nancy Pelosi , Richard Baker , George Miller , John Conyers , Harry Truman , Shona Holmes , Franklin Delano Roosevelt , Sherrod Brown , John Boehner , Harry Stein , Norma Goodman , Karen Kerr , Paul Ryan ,