the problem is, the costs are skyrocketing with our health care system. every family, every business, every individual in this country is impacted by the cost of health care. and not just with what you're paying directly for your health care costs. what your co-payment, premium, deductible is. but the cost of everything you buy in this country is higher because of health care costs. we use the example of an american-made car. $1,500 of the price of every car made in this country goes to health care costs. the health care corses of the workers who are involved in putting that car together. but it's more than that. it's every level of the supply chain. every segment. if you think about the company that manufacturers the good, the people that ship the good, the people who receive it and stock the shelfs and the people who sell it at every level, there's a component of cost that is increased because of health care costs of the company involved in that. every level of the supply chain. . every segment of our lives health care is a part of that. what we are try

the goal is to lower your costs and the cost for all americans. host: linda debose is from the white house office for a care reform. there is a tweed saying, ms. douglas, why does this radical plan have to be implemented during a recession? it will only add to inflationary pressures. guest: i would certainly quibble with the word "radical," but one of the reasons that we're doing this is because we are struggling in our countries. this is -- in our country. this is squeezing our businesses and making it difficult for them to compete globally and to compete with businesses that do not provide health insurance because they cannot afford those costs. they cannot hire more workers. one of the reasons we're having a difficult time digging out of this economic trouble that we are in right now is because there is the way, the burden of these high health care costs on all businesses in this country. we pay twice as muc for health care as any other country in the world. we do not necessarily have better outcomes, but we are spending a lot of money on healt

between 1 trillion to $2 trillion in costs the next year. let me ask you this, if it does cost between one or $2 trillion depending upon whether it is the kennedy bill or the bill being considered by the finance committee, what new taxes or savings would the administration recommend to make sure we don't add to the deficit? >> well, senator, as you probably know in the 2010 budget the president recommended about $630 billion worth of both savings and revenue enhancements. we've also suggested after reviewing the overall medicare programs that within the medicare program we think another to to $250 billion is possible in terms of savings. there is no question that the additional and enhanced efforts on fraud and abuse will generate some additional savings, and he has had a lively discussions with members of house and senate about their ideas for funding the remainder of the program, but i think the good faith effort by the president and it's a demonstrated in this budget moving forward to come in with a substantial investment in reform moving

that added to the cost. simultaneously, the overall economics began to fall out of the bottom as we saw new plants go by the wayside. it came to a point where it was not given that time, especially with the ridiculously high interest rates, it was not economical to build such a facility. it was a decision by the industry. from a public policy standpoint, president ford did it during the campaign. it was followed up on by president carter. he took it off officially. but president reagan came back three years later and said to have at it. but the economics have changed. >> by then, it was too late. >> it really comes down to price. >> i still blame jimmy carter. [laughter] thank you, senator. >> the other problem that seems to stand away is economics. what are we going to do to make sure that senator alexander's bill is actually implemented once enacted? how much is it going to cost? what will we have to do to the permitting and regulatory process? are we going to have to enact some litigation shortcuts so tha

so i think the cost number there is a myth. there are lots of arguments to support my position but one thing that always comes back to me is if you're going to say that in a situation where there's negligent or intentional conduct that leads to injury, serious injury, if you're going to say that you can have no, and i believe punitive damages help and i support them when a jury imposes them. but if you're going to say that you can only get, say, economic damages, you cannot get damages -- you cannot have punitive damages or damages for pain and suffering, what you're saying, for example, to -- let's say there's a woman who for a variety of reasons was not in the work force for a long time, didn't develop earning capacity because she was at home for many years and didn't work outside the home. what you're saying to her when you have these laws that are passed to limit her damages, because you don't have -- your earning capacity is limited, you're limited to what that capacity tells you. on top of that, you're not getting anythin

the cost shifting. i've heard it is about $100 per family that goes to paying for the cost of indigent care. is that about right? >> i would have to check the numbers. it is certainly substantial. >> thank you. >> can you say a word about the cost of covering prenatal care and early child comprehensive care? >> i think that certainly goes to mr. kaplan's point. in terms of preventive care that has a good pay off, i feel very strongly with the evidence suggesting prenatal and child care is crucial. >> the medicaid program has a program epsdt. are you familiar with that? it is a comprehensive set of benefits. it is -- is it essential that that same set of benefits, which includes preventive screening tests be available on all accounts? . . when we think about setting up a public auction, it will be able to put competitive pressure on private firms because there may be more administrative costs. >> is there much difference between the two? >> i believe it is substantial. >> the 25%-45%, is that the magnitu

the costs. the problem is they do not print money. they raise rates. the cost of electricity will go up dramatically. in my state of arizona, we got a letter from r utilities in response to a request, and they said that in the first year, the cost of electricity will go up at least 2% to 3%. the problem is that those costs going up are imposed upon you and i, and they damage the economy. as for whether carbon dioxide it is depleted? the john and said i in peach myself. i want to be reasonable about the issue, but the evidence seems to be -- in the rest of the world, skepticism about manmade carbon dioxide causing global warming is not just appearing in australia, where the article was written, but in japan, germany, and other places around the world. in the czech republic, only 11% of people believe carbon dioxide created by man is causing this problem. you heard a pretty good reputation of both sides of the debate. host: let's go to the democratic lonine. kay from minneapolis, minnesota. caller

a recent new yorker magazine article showcased the mayo clinic in the contests of health care's costs problem. according to an author, a physician, we're in a battle for the soul of american medicine. on one side is a fragmented volume-driven model that too often crosses into profiteering. there are good parts, believe me. i know this. i live in minnesota. we have to maintain those. but we have to fix this broken cost structure. on the other side, you see this model offered by mayo and other institutions across the country where doctors collaborate to provide the best, most efficient care for their parents. patient. on one side it is financially and morale unsustainable. on the other side is a new direction that promises to cub b costs and it is time to choose sides. for the sake of fiscal health and the sake of millions struggling to afford the care they need i urge my colleagues to choose the ladder. yesterday, i met with a bipartisan group of senators. i have to tell you i still have hope we're going to get this done. i have hope there will be bipartisan support for this. the thing

and the cost of the bill. oddly, that's the appropriate place where those conversations should be going on and i believe the committee established a feedback group now between us and the gao in terms of the cost of whatever title. however, let's talk about cost and what prevention and quality is. there are many things in here when you score the cost -- my father used to say, basrb, sometimes you have to spend money to make money. we have to save money to spend money. i didn't sit here while i was getting a manicure and wrote up five ideas on how to achieve quality. we had extensive hearings in terms of public experts in the area, number two the consensus in that area about what needed to be achieved, number three, estimated costs that it would be based on real life experiences. like the north carolina approach on medical homes. the management, the patient safety implementation, the checklist that was developed that saved michigan $200. we went and held extensive haegz and went to the public domain on the conse

at some of the lowest costs in the nation. we should learn from their successes and promote the best practices, not the most expensive ones. this week, i conveyed to congress my believe that any healthcare. that means, if you like the plan you have, keep it. if you like the doctor you have, keep it too. i have made it clear, we must develop a plan that doesn't add to the bunlet deficit. we will work with congress tofully cover the costs through rig rouse spending redugs. we'll eliminate weavet fraud and abuse and take offer -- take on healthcare costs. >> in the "washington post" it is written. >> michigan on our line for independents. good morning, mike. >> good morning. let me say this to the democratic congress. if you believe we are going to spend our money to support insurance companies, you people have lost your mind. i think democrats want to loose in the midterm elections. go ahead and come up with a healthcare that is provided by these hacks insurance company. if you figure out that $100 million people paid $100 a hea

that drives up the insurance costs. yes, it does, and insurance doesn't drive up the cost, but i was subject to a medical accidents and unless you died or you are severely in a,, you tried to sue them, you need money to sue the system. guest: ok. host: talk about medical malpractice. guest: i just want to make a reference, something coming out of europe, i do not see how that will relate to north american free trade agreement but i will try to circle back on what the caller mentioned because it is new territory for me. merkel malpractice is cited as one of the major -- medical malpractice decided as one of the major factors, but one article about a city in texas having the highest medicare costs and the nation, this little town. but compared to help pass so, in the same state with the same laws governing medical liability, had a wildly different cost. there are other drivers. in oregon, there are concerns that i heard from my friends in the medical profession about the impact that's medical liability has on their costs,

but the cost shift that takes place is the reason why an aspirin costs $10 when you go to the hospital. and it's very easy to demagogue this issue if you're in it for political reasons to say, here's what they want to do. they want to take your money and give it to those people who don't have health insurance. because 87% of americans in this country have health care. we spend a lot of time talking about those who don't. 87% of americans have health care. now they are in many cases one illness or injury away from losing everything. certainly one job loss away. and tens of millions of americans that have coverage live in fear of losing it for those very reasons. tens of millions more are underinsured. they have some coverage, but don't have what they need. and in many cases, the insurance companies have people, millions approximately two million people, that are employed in this country specifically to find a way if you are insured, to make sure that they can deny your claim. to red line you. to find a preexisting condition exclusion. to find a reason why they shouldn't have to pay your

, the highest energy users in america will get the highest increases in their costs. let's just say you're in the business of converting iron ore to iron and steel. let's just say you are in the business of converting natural gas to plastics or any other high-energy intensive operation or let's say you ar farmer and use a lot of diesel fuel and looking at 88 cents a gallon added on to by waxman-markey. all of these industries will see their costs go up. if you are generating electricity from burning coal, natural gas, fuel oil, for example, you will see the cost of that electricity go up. an m.i.t. professor did a study and calculated the overall dollars by waxman-markey and divided the number of house holds into it and the bottom line, increased average annual household costs for energy, $3,128 from waxman-markey's cap and tax bill. for every $5 collected for this cap and tax bill, only $1 goes into the treasury and the balance is consumed by the inefficiencies created. . this is an insidious tax, it will tax every glan of gas, every gallon of diesel fuel, every cup

the reality, of course, is the costs are not the same. we look at the cost of transmission to move power from west to east. there's significant cost involved. however, if that cost is ignored and everybody pays the same price regardless of how far it moves it changes the economics and, yes, dakota wind would then be more economic on that basis once the cost of transmission is ignored, then michigan or the east coast. we don't think that's the right way to look at it. >> one of the things that we're really trying to accomplish, obviously, in the waxman-markey bill is to generate renewable electricity and renewable energy jobs generally in all 50 states. so, mr. izzo has a plan to, along with many other people in new jersey to generate, you know, new renewable energy jobs that help with the employment in his company but in the state of new jersey as well. and we don't want to invoke the law of unintended consequences here and have a great revolution, have a standard that's imposed on new jersey and then not have the jobs created in new jers

the only reason doctors aren't delivering babies in those regions is because of the cost of the errors and omissions policies. believe me, the harm that's caused as a result of not having a doctor within a reasonable distance is -- far exceeds, i think, the anecdotal statements from the senator from rhode island. in addition, this doesn't cut off recovery. if it cut off recovery, the people of texas would have rejected it. the people of california would have rejected it. two of the largest states in this country are under this regime already. this simply creates an opportunity for the baby doctor to practice in a rural area. how many programs have we talked about today, 20 or 30 or 40 or 50? that have been directed at getting doctors, primary care doctors, into rural america or out of the cities where they're concentrated. probably couldn't do anything more constructive in that area than to allow doctors in those areas to be able to deliver babies. they're still going to have to pay an errors and omissions policy. they're still going to be subject to liability. liability's still there.

i presume that the cost of building a text message is twice the cost of carrying it. that would make the cost of text messaging to be 0.3 cents. this portion of analysis makes a strong assumption about billing costs. to sum up the cost of a text message is smaller than 1 cent based on testimony from at&t and verizon. it is likely to be swallowed and 0.3 cents based on my analysis. -- is likely to be smaller than 0.3 cents based on my analysis. i believe the only possible reason to raise the price per message would be if the amount of radio spectrum used by the traffic was so great as to cost [unintelligible] in this case the price increases would dampen [unintelligible] but the total worldwide traffic of 3.5 trillion text messages carried in 2008 account for the radio spectrum available to just a few hundred cell phone towers. i have estimated [unintelligible] however, in 2008 alone 300,000 were sold. so is unlikely that text message traffic is congesting the network. therefore, the price increases cannot be cost-justified. i have tried to answer the questions to the

the administrative cost of the federal government. they're not in their assessment because they can't figure it out yet. what is the effect on coverage. under current law, the number of non-elderly resident, those under age 65 with health insurance coverage will grow from 217 million in 2010 to 228 million in 2019 according to our estimates, the cbo's estimates. over the same period the number of non-elderly residents without health insurance at any given point in time will grow from approximately 50 million people to 54 million people. constituting about a 19% of the non-elderly population. because the medicare program covers nearly all legal residents over the age 65, our analysis has focused on the effects of the proposal on the nonelderly. >> let him go a little bit here. >> so they're saying that there will still be during the period somewhere in the range of 54 million potentially uninsured. according to preliminary analysis, once the proposal was fully implemented, the number of people who are uninsured would decline to 36 of t

average has to be to reduce the cost of health care and the rate of a growth and cost over the years because we are basing -- >> [inaudible] >> i do. we are facing an unsustainable situation in our federal budget which is jim and in large part by the cost of health care. we know that we have a approximately $38 trillion unfunded liability in the medicare accounts. another large amount of unreliability i think in the range of $10 trillion in the medicaid accounts and we also know that health care is not taking 17 percent of gdp headed toward 20% of gdp in the these numbers are simply not sustainable for our government coronation and thus one of the core elements of health care reform has been not only to get everybody covered which people on our side are totally committed to it and to give people quality health care which we are equally committed to put in the process develop proposals which reduce the cost of health care. and then bend at the curve has become the term to month and the cost curve. and the president called for banning the curve and i congratulate him for that. and of t

>> the reality is the cost about the same enemy look at the cost of transmission to move power from west to east there is significant cost involved however if that coast is ignored in everybody pays the same price regardless of how offered myths the changes the economics and yes decota wind would then be more economic on that basis once the cost of transmission is ignored, then michigan or the east coast. we don't think that is the right way to look at it. >> one of the things that we are trying to accomplish obviously in the waxman-markey bill is to generate renewable electricity and renewable energy jobs generally in all 50 states. so mr. izzo had the plan. along with many other people in new jersey, to generate new renewable energy jobs that help with the employment in his company but in the state of new jersey as well. and, we don't want to invoke the law of unintended consequences and have the standard imposed upon the jersey and not have the jobs created in new jersey especially if they have the richest renewable energy resources to write off their shore. mr. anguish. >> mr. chairm

interest of african americans, both legislatively and in the civil war, the extraordinary cost don't necessarily contribute to the better angels of our nature. i think we've got a long way to go to achieve that ideal of equality of opportunity in this country. but we've come a long way toward a more perfect une 81 and i think we always -- union. and i think we should acknowledge that. >> we'll be right back with our reporters. >> david, what political position are the republicans in right now? >> frustrated. they don't have the numbers. democrats in congress and for that matter the white house know they can get things done without them. there's very telling last week when senate majority leader harry reid was asked to in effect define bipartisanship on health care because for weeks we've heard that democrats want 70, 80 votes to pass health care because it's so broad and so all-encompassing. and senator reid said i'll consider it bipartisan if i can get three or four republicans. that's it. and after, democrats control 59 senate votes and i believe 258 house votes. touf check me on t

when it comes to the cost of our health care, the status quo is unsustainable. [applause] reform is not a luxury, it is a necessity. when i hear people say, well, why are you taking this on right now, you've got these other problems, i keep reminding people, i'd love to be able to defer these issues, but we can't. i know there's been much discussion about what reform would cost. rightly so. this is a test of whether we, democrats and republicans alike are serious about holding the line on new spending and restoring fiscal discipline. but let there be no doubt, the cost of inaction is greater. if we fail to act -- [applause] if we fail to act, and you know this because you see it in your own individual practice, if we fail to act, the roles of the uninsured will swell to include millions more americans, which will affect your practice. if we fail to act, one out of over $5 we earn will be spent on health care within a decade. in 30 years, it will be about one out of every $3, a trend that will mean lost jobs, lower take home pay, shuttered businesses and a lower

the growth rate of cost of time. the important thing is that it is not the only the queenie to do. there are other things like how we reward value over volume and changing the delivery system. wellness is one component. >> thank you. i have had concerns as we do know, there are some in the rural areas where it is difficult. part of the district i represent, my concern continually is access to a physician or to quality care. i am wondering, i'm getting ahead of things, but how are we going to insure that in towns and districts that there will be the opportunity for wellness and quality services? we do know there is a lack of quality or lack of any positions in general and many of the underserved districts. >> one of the very strong features of the tri-committee bill is that it does address these workforce issues. especially if we are going to move to a system or more people have coverage and more access to primary care, we need more physicians. these workforce issues are going to be important and something i know that

. -- 21 csi, we have seen as the nation the cost of a hot war, and the cost in terms of people, and blood and treasure. can you talk a little bit, is the key to it looking at the benefits of deterrence and how you put a price tag on that. >> absolutely. i think that there is no question that it is -- it is not -- and it's not just a cost issue, either. i mean, the need to do everything that we can to prevent war is more than a dollar value. it is this cost of human treasure. and so i believe you will see as an outcome of the qdr, the types of capabilities that will allow us to be more in the prevention regime, and that is why i feel quite good about the strategy that we have set, where we clearly articulated in our strategy, almost two years ago, that preventing wars is important as winning war. and why you you know -- the increased emphasis on things like maritime security regimes, where we can go in and work with friends and partners, to alleviate the type of activity, you know, transnational criminal activity that can produce those types of frictions that can then resulted in conflict.

the lowest cost. after decades, without major investment, the public service board has approved three major transmission projects from 2005 to 2008 with total projected capital over half a billion dollars. at the regional level, these without any transmission investme investment, more than 4 million has been placed in service and new england since 2002. despite the activity on the say the and regional level, they will provide broader transmission authority even though we're four years removed from the enactment of the policy act in 2005. epac gave backstop citing authority designated by the department of energy. not enough time has passed to determine whether this law needs to be revisited, but the congress addressing this issue is nevertheless, neru reese notally updated our transmission policy in anticipation of federal action. we believe that a bottom up state and regional driven approach is the most appropriate model going forward. while we are not convinced that the case has been made for federal

in discussing cost containment, i want to focus on the following of the growth rate of cost. this is the so-called curve of venting that can last for decades. slowing cost growth is quite separate than the efforts that we might take immediately to cut the level of government medical spending. this is crucial for paying for the expansion of coverage and other health care reforms in the short run. if we were thinking about the changes that will save it from the long run trends, and cost growth year after year is essential. many reforms are necessary to slow the growth rate of cost over time. the cea report focused on the importance of reform rather than the mechanics. the report does describe in broad terms the kind of changes that might be implemented. we discuss changes in payment systems, such as bundling of payments or hospital and pose hospital care. these are ways to reduce fragmentation and promote more effective and more efficient care. we emphasize the crucial role that investment and help the information technology and research on what works and what does not work cou

that's not bending the cost. you don't -- you don't control spending by radically increasing spending. on the issue of coverage keeping your own policy cbo says 15 million people will no longer have private insurance. so, to me why are we marking up a bill that doesn't meet the president's task and why would we even consider a section that's going to add $2 trillion of new unfunded liability to an already unsustainable relation of $60 trillion of unfunded liability? these are at the core of the questions we have on our side of the aisle. i appreciate the fact the chairman and members who've been having different sections have been very cooperative in taking technical changes and most of the amendments are technical and some are marginally substantive but on the core substantive issues, this bill fails on the presidents test. something has to be changed. first on the area of coverage, second the area of cost drivers and third the area how you make sure people don't lose their policy or else the standards which we

all the government plan does is shift the cost of every one who does not have that plan. doctors have seen that now read it these are not advocates for the insurance company but advocates for a competitive marketplace that works. one of the principles that we have is that we are not for a government takeover of health care because we think it drives people away from the coverage they have now. most americans really think the coverage they have now works pretty well for them. the have heard of reports, the discussions, they listened throughout the campaigns and they believe there is a problem, they just don't think the problem affects them. 82% of the american people think that their current health care coverage is either good or excellent. 83%. that is what you hear the president saying, as mrs. clinton started singing last year, if you like what you have, you can keep it because they know that people like what they have. it the truth is, under their plan will not be able to keep it because it will not be there anymore. the government will never compete fairly, so before

the services costs in the hundreds of dollars. the surgery-related to diseases not caught early are in the continues of thousands of dollars. it makes sense economically and president obama's right to invest in health information technology that will save money and also manage individuals' care in a more effective way. so there are a lot of ways to bring down the cost of health care but let me talk about one issue that has a lot of attention on this floor by some of my colleagues that seem to be opposing health care reform before we have a bill before us. that is the conversation about a public insurance option. mr. president, i'm somewhat bewildered by the discussion because i don't hear to many of my colleagues suggesting the medicare system should be done away with. the last time i checked medicare was a public insurance program. but let me differentiate because this point has been misled on the floor that within you is a government or option it doesn't mean the government provides the health care. it means it pays for the heal

, the costs rose. but the ability of the taxpayers to meet the rising costs was limited. what does the government do? it restricts care. it denies treatments. it denies service. it rations care. that's sort of a microcome. that's what happens in massachusetts and perhaps other western european countries or canada. i'm not here to either praise or condemn those systems. in western europe, the united kingdom, or anywhere else. they're different systems. people need to understand that. what happens in those systems when the costs continue to rise for health care and there aren't the tax dollars to meet the costs they deny care. i think we all know that -- we know that people are concerned about cures, not treatments. they want to be treated like human beings, not numbers. unfortunately, that can happen in those systems when off single payer system, take a number, wait for dialysis, wait for hip replacement if you can wait that long. if you're canadian, if you have the money, come across the border and get

pricing the cost of health insurance is going

that increases the cost to everyone of their health insurance policy and increases the cost of the doctor bills that we get, the hospital bills we get and indigent taxes. so if your family has health care, you pay at least $1,000 more than you would if all other families had health care n that letter i expressed my sincere thoasincerehope that republicank with us. i asked for their hope. i knew we would disagree at tiessments i told them i looked forward to working with them to help struggling americans. in had letter i especially asked our republican colleagues to focus on the concrete and critical crisis that affects children, families, and small businesses every day. a parent who cannot take a child to the doctor because insurance doesn't exist or is prohibitively expense six a family lives one accident or illness away from financial ruin. a small business that lays off employees because they can't afford skyrocketing health care premiums. we hear those stories every time we time we go home. i ask that letter that we used short and valuable time we have to work together rather than aga

the number-cruncher's about the cost issue -- and then sat fiveisfy the number crunchers about the cost issue, it would be on its way to passage. let's talk more about safety. when i was a young man, my generation was affected by the china syndrome. it was a motion picture that may or may not have had any scientific basis in fact. it was followed by three mile island. then there was chernobyl. a member of our panel was just murmuring "chernobyl" under his breath. i think we need to get that out there. talk about what can be done to make the american public feel good about the safety issue. if you can, be specific about the nuclear waste. i hear what you are saying, doctor rock wwell. let's suppose in a worst-case scenario, we have nuclear waste behind the reactor in a green building. what if some nefarious person gets in there and gets hold of this nuclear waste, what damage could he do to the country and the population? if you could comment about that, i would appreciate it. >> i will take a crack at it. >> the big advantage of nuclear power as a source of energy is that the waste prob

so if we could take the practices and change them in the high-cost regions do match the low-cost regions, we would save in medicare alone hundreds of billions of dollars. our job is to change the rules of the road so they encourage and enable all providers to act more like the high-performers, those providing higher quality, lower cost health care. that's why this legislation needs to get us to start spending our health care dollars more wisely, investing more in prevention, investing in chronic disease management, building a research base about what works and what financial incentives are necessary to utilize those practices. rewarding care delivery built around coordination and efficiency rather than fragmentation and volume. we know these things work. and we need to make them the norm, not the exception. mr. president, we cannot stop the bleeding in our health care system without doing something about broken health insurance marketplace. the first thing we need to do is to end the insurance company practices that penalize you if you are he old or if you're sick or if you've ever been

lowering the cost of health insurance. also, they say the number one priority is to expand health care coverage so that americans who do not have health insurance can get it. those two goals are very important, but the most important goal is to determine whether you live or die, to make sure that especially if you are facing health care challenges of the most severe degree, you have the greatest chance for you or a member of your family to survive. this is most clear in the case of cancer. when a patient, when you or i or a member of our family gets that terrible diagnose from a doctor that you will be fighting cancer, the question asked, how much time do i have? will i be able to able to survive. "the "lancet" did a cancer survival study of cancer rates and found you are more likely to survive in the united states than you are in european countries. they looked at a number of different cancers. prostate cancer, 78% survival rate in europe, which is fairly good, but a 99% survafle rate if found in the united states. bladde

customers of the lowest possible cost. and neither can the government. that is why i strongly support policies such as our es and carbon pricing the sampras signals to the market and on leash creativity and entrepreneurial spirit of the american people. thank you. >> thank you, mr. izzo. the next witness is joe nipper for governmental affairs of the american public power association representing the nation's more than 2,000 community owned electric utilities. thank you for being here and whenever you are ready please begin. >> thank you and members of the subcommittee i appreciate the opportunity to be here. we represent the interest of 2,000 publicly owned state and locally owned utilities across the country collectively serving 45 million americans. american utilities collectively own about 8% of the nation's transmission lines of 138 kilovolts or greater and the great majority is members of transparent that is dependent on facilities owned by oberst require of the electricity they need for their retail customers. our me

but premiums and co-payments under the public auction will cover the cost? >> that is my understanding. >> the public auction must adhere to the same rails and regulations as all other plants? >> that is correct. >> the public option will be administered by a separate agency from the one that runs the exchange? >> that is the way the draft is written. >> the public option will offer the same minimum benefit designed as all other plans in the exchange? >> yes, a level playing field. >> individuals and families will be permitted to apply subsidies toward both public and private plans in equal fashion? >> yes, sir. >> i apologize to you. we have a lot of business to do. madam secretary, there has been concern over the consolidation of the health insurance market and the impact it has on health insurance claims. according to the american medical association, 94% of the insurance market in the united states are now highly concentrated. this has decreased the amount of competition. this is a major problem of health concern. >> there is a monopoly and much -- in mu

including with the associated transmission costs. the alternative view is that they should plan and cite transmission that would connect areas with strong renewable resources to areas of high electric demand via some green transmission super highway paid for by taxpayers. under this model, thinkment would pick technologies and locations and build transmissions to facilitate them. i have strong views about this approach. first, it can lead to expensive outcomes. all business owners know that if they establish the fact to keep production costs down they have to weigh that against shipping costs, but if we socialize shipping costs of renewable generation, we skewed decisions away from locally based options that may have a lower total cost. that is why a bipartisan coalition of ten northeastern governments wrote to congress warning that this policy would undermine their efforts to grow renewable industries. moreover, building thousands of miles of transmission lines in anticipation of the arrival of renewable generation may lead to an ex

so the government can't control costs. sully only way it can end up doing so -- so the only way it in and of doing so is reducing the amount of care and what coverage is provided. that is the only way. there is no efficiency and innovation frankly that will come out of washington in delivery of health care, so your point is a very good one. host: this tweet from cats -- congressman, cobra is insane for most of the folks who wish to have continued health care after leaving a job with health insurance. guest: absolutely. it shows we have even added to the insanity of the increased costs of cobra coverage and others this year in congress. we have gone in the wrong direction. what we need to do is put patients back in charge. we need to be providing a subsidy for individuals, in the individual market, and not just businesses, to get out there and be able to choose what they need if they are put in a situation where they've got to access that type of coverage. again, it goes back to the republican plan. we have in the plan the

reasonable alternative said the considered and the costs are appropriately allocated to the beneficiaries. thank you again. >> thank you and we thank our entire panel. allen going to turn and recognize the gentleman from washington state, mr. inslee. >> thank you. first i would like to put in the record a white paper which is quite instructive called title green powers super highways provided by the american wind energy association and the solar energy industries association. mr. chair, if i may? >> without objection. >> thank you mr. chair, i appreciate that. this white paper does confirm what some of the witness talked about which is that we have got three and a thousand megawatts of wind projects waiting in line is essentially to connect to the grid and they point out that the lack of transmission capacity is also hindering state's ability to meet multiple renewable energy goals and it just confirms what several of the witnesses have testified today. i want to ask mr. detchon about the greenhouse gas interconnection standard that your proposal has inc. and basically what essentially al

levels the cost is shifted to the private sector than congress comes in complaints about the cost of the private sector. yet they are responsible for its. we'll there be lower administrative costs in the public option? no. we have the actuarial firm to a study of two years ago medicare head and administrative costs when they talk about the 2% administrative costs that is simply what a cost to pay the bills. the rent on the building, salaries, management , insurance, all of that comes under other parts of the federal budget. that is what the study did go up during it in the of budget even the prod the office of inspector general comes under a different budget and the medicare administrative costs. those are actually very high they may not be quite as high as the private sector but very high and they will be higher in the public plan. then there's the startup cost of yugo start an insurance company you have to raise millions of dollars to have been reserved the federal government will not do that it will just hit the taxpayer for it and claim it as a savings. in addition what if the pr

and what is the cost? >> when i come up with legislation i usually have the cbo numbers before i introduce a bill. >> we're trying to get language appear that has the numbers we cannot run the numbers until we kraft the language. >> they run the numbers it is $1 trillion. >> weir unprecedented no question with health care a lot of things we're talking about cbo is under pressure from the house and finance committee to produce numbers on various ideas for commonality but it is the check-in and the eight numbers language without the numbers makes the question obvious that what does it cost? if i cannot answer the question then the indictment is you put up the language without the numbers so we try to accommodate both and is simultaneously recognizes by the rules of 24 hours which is a normal process that is difficult to do so i want to accommodate that senator burr has raised to give adequate time for people to respond so you can have amendments ready if you are not happy with the cbo numbers provided. >> mr

over the cost of this same time, health care costs went up by 80% and the cost of higher education went up by 60%. these are not nice to have, these are essential things if our middle class is to remain intact and we're to preserve the american dream for the next generation of americans. our revenue as consumers have been far outstripped by costs of things that are essential to all of us. it is one of the reasons we find ourselves in the fiscal mess we're in. in order to finance that gap, we piled on credit card debt. we had home mortgage loans we couldn't afford, all to try to finance this gap. it's unsustainable. it's a house of cards and we're dealing with the consequence now already some coloradans are seeing cutbacks on the benefits of their coverages and some businesses are no longer able to afford coverage for their workers. faced with the unchecked increases, health coverage is a luxury some families an small businesses can afford. many people are cutting back on other essentials, visiting the doctor less frequently even when they know they need care. we must meet this economic

i-2035 alone, the total cost is over $4,600. -- by 2035 alone, the total cost is over $4,600. we estimate of losses averaging 1.4 5 million from 2012 to 200035. these are net losses after the much-hyped green jobs are taken into effect. many jobs will be outsourced to nations like china and india who have repeatedly stated they will not help -- they will not hamper their own economic growth for the sake of energy policy. higher gasoline and diesel fuel costs, higher electricity costs, higher natural gas will erode profits which are expected to drop 28% in 2012. as with american manufacturers, it puts farmers and the global disadvantage. other food-according nations will have no comparable measures in place. overall, it reduces gross domestic product by an average three and $93 billion annually and cumulatively by 9.4 -- $9.4 trillion. these costs are not distributed evenly. low income households would be hit harder in average. of course, part of this is to give back some revenue to low- income households, but in my view, it will only restore part of what was taken off from hou

we don't have the details of the bill. we don't know the costs of the bill. even though the president just within the last few days has said that pay-as-you-go is important. if we're going to spend a dollar, he said, we ought to raise a dollar. or he might have said raise taxes a dollar. that's what the president said. so surely we are not going to mark up a bill or finish marking it up until we know whether or not we're going to have to save a dollar or tax dollar or how many dollars we'll have to save or tax in order to pass the bill. but this we do know about the regulation that our committee is considering. we do know that it leaves 30 million of the 47 million americans who are uninsured today -- there are 47 million americans uninsured today. it leaves 30 million of them i will uninsured. we know that it expands one failing government program -- medicaid -- and creates another, putting washington in between you and your doctor. it reduces the ability of employers to give incentives for wellness and prevention. it doesn't increase it, it reduces it. it f

out if we get it to the fifth year of the operation of the program as written of the cost of the program over 10 years is closer to $2 trillion rather than $1 trillion and that doesn't include the cost of expanding medicaid the government insurance option and the tax on employers. the baucus bill in the report says that as the one being considered is a trillion and a half dollars. one independent study said that it would be $4 trillion. over the next 10 years. the national governors' association and we've got i think all 13 of us in the senate to use a big governors and chief executives of stays with medicaid programs, it says that the medicaid expansion alone will cost the state's $500 million over 10 years if you count of this expansion of medicaid in the increase in reimbursement costs that are provided in the kennedy bill. in tennessee alone the amount of money that we would be -- have to come up with whoever the governor is in 2015 would be additional $1.2 billion. doesn't sound like a lot of money up here but in our state that would be about the new 10% state income tax, that is ho

to the cost of capital. that's what level lives, equally as the overall metric for utility. if you're having to pay literally 30% more to borrow money as you don't have a loan guarantee versus if you do you're probably not going to make the decision to build. plain and simple. the merchant utilities and irregular states have pretty much said that. unless they get a loan guarantee they are not building. you're going to see some reactors they respected of anything else because you have states that allow the utility to build and/or rate. at that point they are guaranteed a return. they don't have to worry about being able to pass onto the consumer because it's guaranteed in the law or through a regulatory body. but it we want to see the expansion to the tune of 100 new reactors, we're going to have to ensure that that applies to more than just a handful who can finance it through their states. we have to be able to ensure that the merchant facilities or the merchant utilities also have the capacity through loan

the doctor-patient relationship because that is where the cost, the primary cost driver at the intersection of that relationship. there are secondary cost drivers in the insurance market. what i like about what we have done, we have taken a comprehensive look at this because my goal was to ensure that all americans have the highest quality access to a doct doctor. and our plan will do that. we also look at the insurance markets and make some substantive reforms in the insurance markets creating a wide range of choices that will open things up for americans and create different options for different families, small businesses and so forth. so, we have taken a comprehensive look at this. but i have to say once again, if you don't focus on the doctor-patient relationship, the behavior of the doctor and behavior of the patient and where that intersection occurs, or where it doesn't occur, that is where we are really driving the costs with utilization, care in the emergency rooms and so forth. so we focused on all those things i have just mentioned and i believe we have a very good plan that wil

the cost of failure for the last three to four decades has cost this country. progress will be far less expensive than failure. my children, my grandchildren and the generations to come will be either the beneficiaries of our stewardship or the victims of our neglect. i urge my colleagues this day to reject this substitute not because it is bad for the words -- words that it incorporates, because its effect would be to stop action so desperately needed by this country and this globe. i urge my colleagues, defeat this substitute, pass this bill, take this historic opportunity for our children, our grandchildren and generations yet unborn. i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from virginia. mr. forbes: madam speaker, could i request how much time is remaining? the speaker pro tempore: the gentleman from virginia has 3 1/2 minutes remaining. the gentleman from california has 10 minutes remaining. mr. forbes: madam speaker, i'd ke to yield myself 1 1/2 minutes, please. the spe