i realize this task force would be under the jurisdiction of the department justice, not hhs. i want to know number one, would you support its revitalization and how does hhs intend to work with the department justice to ensure that these acts of violence are eliminated and do you agree that this type of violence could discourage medical schools from teaching doctors how to perform abortions, and how will hhs work with medical schools and provider organizations to ensure that this procedure is being taught? >> congresswoman, i share your interests in making sure that health services are delivered within the law, and that providers certainly are protected for their activities, and the attorney general was quick to reach out and make a very clear that acts of violence would not be tolerated, that he would use the assets of the justice department to provide protection, and they think to also send a very strong message about axe in the future that would be prosecuted. .. >> thank you. and following up on another issue, with the insurance industry. from 2001 until 2004, health plan

it would prevent the secretary of hhs to deny a service or treatment. you think that would be uncontroversial. i hope, at the end of the day, it is not controversial. nobody wants their health care rationed by somebody in washington d.c. comparative effectiveness research could not account for preferences by patients and their response to personalize the medicine. the breakdown of genes in the body to all of the different elements which make as unique as individuals. what the research focuses on is what exactly is it in your human gene composition, the human genome that might be different than someone else's? impersonalize treatment might work for you, but it might not work for someone else. they are finding that they can tailor specific drugs to treat specific genes in such a way that if they know you're human composition, they can find a way to treat your condition, say cancer, slightly differently than they would treat somebody else's cancer. whether it is in the dosage of the medicine or in the specific kind of medicine. the point being that not eve

it's being redirected to other priorities within hhs or being directed or redirected to other priorities to larger hiv/aids organizations that don't focus on minority community tease but the white depopulation and not the intention of the m ar . this year the funding was open for competition to the for-profit organizations for the first time and this puts a lot of pressure on the organization's and the local community organizations. understanding this and the possibility of the pressure on the organization's what faults do you have about that process? are you thinking of changing that or is it your opinion that it's a fair process that everybody is on even playing ground? and would you also can it to meet with the national minority aids council so they can also express themselves for themselves the way that we see the issue? and i think that those issues will come and they will express that with you. i hope that you will be able to make some time for them. the other area is the health disparities. the try caucus i want to emphasize there's a recognition there is a stark disparity and it

cannot be used to deny coverage of the there a healthcare service or treatment by the secretary of hhs and we say the secretary of health and human services because all of the various entities that might do that in the federal government are part of hhs, so we simply prohibit the secretary of hhs from using this comparative effectiveness research to deny healthcare service or treatment. now, you would think that that would be uncontroversial and i'm hoping at the end of the day that it is not controversial. nobody wants their healthcare rationed by somebody here in washington dc. it would also require that comparative effectiveness research account for differences in the preference of patients and their treatment response to personalize medicine and something called genomics. genomics is the breakdown of the genes in the body into all of the difference elements, which make as unique as individuals and what genomics research focuses on is what exactly is it in your gene composition, the human genome that might be different from someone else's. that means a person lies treatment would wo

they would not have an opportunity at this point. >> this requires the secretary of hhs to verify the safety of imported prescription drugs, so i don't know what more you want in it. but if we get the amendment out maybe could clarify it for you. >> appreciated, thank you. >> i don't know of any senator who opposed an amendment that would allow unsafe or dispersed and oftentimes that did not meet all the safety standards. so simply put it would provide access to safe import a prescription drugs and much lower price. the amendment would actually lower the price of this legislation due to the significance savings and provide americans and the government the eminence would waive the federal food and drug demonstrations limitation on the importation of prescription drugs from outside and require to verify safety of imported prescription drugs, prohibit manufacturers from engaging actions to restrict the importation of, prescription drugs and% for the provisions governing the purchase of prescription drugs from an internet web site. they have been found imported to be 35 to 55 percent less

this budget includes increased funding to help hhs achieve our part of the bargain. the budget also helps mufasa towards a central goal of health reform. improving as congressman tiahrt mentioned the quality-of-care. thanks to chairman l. b.'s leadership the recovery act has already included in critical resources to buy health care seceded infections. as well as new support for prevention and wellness programs that can keep americans out of the hospital in the first place. .. . bob to support a wide range programs. the funding in hanses nursing schools, increases access to healthcare, works with minority and low-income students, and places an increased emphasis on ensuring that america's senior population gets the care and treatment that it needs. finally, the 2010 budget will support our department as it were to protect the health and safety of our citizens. as the recent outbreak of the new h1n1 flu virus reminded us, h h s has a significant and critical role to play in preparing for an responding to the outbreak that threaten the health of the american people. --

who decides, is it secretary of hhs? is it the employer? is it the person who is -- the self-injured. by the way, i want to promote these employer based initiatives. i think they are outstanding. but you see who decides whether someone is in compliance or making "a" for effort. >> the differential is 20% and the employer sets up the procedures where the person gets prescreening, stops smoking, who pursues healthy lifestyles, gets an economic benefit from the differential. >> we heard one employer talking about -- >> but the decision process won't be any different. it will mean that differential can go up to 30% with the potential of going to 50% if the secretary sets out certain standards that will be met. >> i think the goal here is to reduce the health care premiums for everybody. and so if you can incentivize a huge number of people that are currently not getting screenings, are not, you know, just doing the nurse coaching that's available. a lot of very simple steps that really over the long run will be much more from a preventative nat

under the previous administration, hhs determined that medicare dollars could not be used for pediatric measures. i'm wondering if you can comment on this and what plans the administration has to address pediatric health care quality and what the view of the agency is going to be? >> well, congresswoman, i think that we're convinced that medicare can be a leader in improving quality of care for all americans. certainly, the development of quality standards i think is appropriately done under that umbrella. but all americans definitely includes children and that is a huge priority of the country's moving forward so there will be a coordinated effort to make sure that the pediatric standards are very much developed in terms of quality outcome. >> do you think that can be done with the medicare dollars or is that something we're going to have to explore as we move forward to the final legislation? >> in discussions with the current leadership team they're confident that we could fulfill the mandate in the bill right now to develop standards including pediatric standards. >> i know you reco

health on public health policies and programs that impact racial and ethnic minorities and coordinate hhs wide efforts that address minority health issues. first, in terms of what we talk about when we say health disparities, health disparities can be defined as significant gaps or differences in the overall rate of disease incidents, prevalence, morbidity, mortality, or survival rates of the population as compared to the health status of the general population. the institute of medicine defines disparities as racial or ethnic differences in the quality of health care not caused by differences in clinical need, patient preferences or appropriateness of intervention. the landmark institute of medicine report in 2002 served as a significant data point in terms of tracking and analyzing issues related to health disparities. overall health status in the u.s. has improved significantly as demonstrated by increases in life expect expectancies for the majority of populations. however, in spite of the many improvements in health over several decades, gaps exist by race, ethnicity, gender and othe

in fact, there are a number of programs i would suspect that hhs today that have some up with a budget of zero funding. the secretary doesn't believe or the president doesn't believe or omb doesn't believe they work, but ultimately i think the accountability has to be here in terms of terminating a program, shifting funds to another program. that's the legislative process, and to short circuit it by giving -- and this would be i think unprecedented, actually allowing the secretary to terminate the program effectively and redirect at any time in the course of the year, you know, not through the budget cycle, simply saying i don't like this. this program is not working et cetera. i think the question is account ooblt, that the accountability should be here. we have to stand up. otherwise, i mean, again, can't think of any other situation or week to tell a secretary, for example, secretary gates, can you terminate the f-22 program at any time you want if you don't think it works, and we have no say about it, and can you direct that money into helicopter lifts. this is essentially a legisl

certainly not everything hhs does is as important as what we're doing in this bill. and the things that are less important right now for our country ought to have less labor put to it and more labor put to it in what we're passing. rather than say, whatever it takes we're going to just grow the size of the government. so that's in essence the purpose of the amendment. and if we get rid of it, i won't offer it again on any other title, you have my word. >> mr. chairman, i guess we move to a vote, then. >> well, let me just say, i mean, this is -- at a certain level i suppose this amendment can be appealing. the idea of an exchange one for one. and this bill that we're dealing with health care, i think all of us recognize that our goal over the coming ten years and beyond that is to stabilize and reduce the overall cost of health care in the country. and we've all agreed, i think, even without having to sit down and work it out in the principles we're trying to achieve here. that is to achieve accessible, affordable, quality health care for all americans. we also i thi

i really have to insist on a certification from the secretary of hhs on safety. i can only do it as a matter of really good conscience. i want our consumers to get the best deal. i would love for them to be able to import inexpensive prices. everything i know from both classified and unclassified briefings, i really would have some enormous amount offing anxiety as voting for this amendment as constructed. >> senator roberts? >> i would like to echo the remarks from the distinguished senator from maryland. i was chairman when she was most helpful on the committee when this first came up. i don't think we are leaking anything classified here when we say we did have hot spot hearings and basically with focus on the i did not realize, and i apologize to the senator, i did not know that she had an amendment -- that is another thing. i thought we would do this next week under the coverage section of the bill. >> the mccain amendment. >> yes, but i had an amendment or modification to that one. it was not filed. his is but - 9. i thought the deadline was next week. last

senator hatch has the need for separate health care offices within hhs and department of justice. none of those will be offered this morning, but i would ask you to take a look at them, see if there's some value in them, some way they can be used and some way that we can switch from placing this emphasis on the arisa companies that operate over a variety of states so we are not making their health care more expensive and more administrative-oriented rather than health care-oriented. i thank the chair and i think that leads us to the mccain amendment. >> if i could, i appreciate that very much. as i understand it here, these are -- obviously, i'll have the staff take a look at these proposals. as i said earlier in the week when the issue was raised by i think it was senator coburn raised the issue, we wanted to proceed by doing title of title by this legislation so we have a manageable way by which to proceed. we still have remaining obviously to deal with the long-term care issues because of the scoring problems and we still have title i to come back to, as well. those matters wil

we are going to delegate responsibility to hhs and the tenth amendment does have priority in saying it stays have some responsibility. but if we are saying a delegate our responsibility to the states that in a secure, it is their responsibility. we are taking money from him, 200 times in this bill. >> in the bill? >> i'm not saying this title, i was very clear, what we say the secretary of health and human services will make all these decisions. in this title we create 20 new programs and to commissions. more government, bigger government, government coming from washington to tell us how to solve this problem and all i am saying i don't expect it to be accepted, i understand that and i don't expected to pass but the point is when there is some virtue in allowing some freedom for the states to make the decisions without causing them to have to jump through the hoops of what we in washington think is best. >> i don't see any debate about that but for us to sit here on a bill -- this is not uncommon for us to sit and micromanage every detail. we defer to the secretary of interior and the

you can refuse those vaccinations, because hhs has essentially has companies to manufacture vaccines. you can just say if this harms me, what can i do? guest: in terms of this commission, which will be at heritage at 11:00 a.m., they are moving beyond iraq. they are talking about wmd's. they believe there are real challenges out there. i think it is important that the american public pay attention to this issue and not become confused about our own security. we are still in the cro

you can refuse those vaccinations, because hhs has essentially has companies to manufacture vaccines. you can just say if this harms me, what can i do? guest: in terms of this commission, which will be at heritage at 11:00 a.m., they are moving beyond iraq. they are talking about wmd's. they believe there are real they believe there are real challenges out there.

when we bring this up on the floor, i would ask that the mccain amendment be sent to the secretary of hhs for her comments. in preparation of the debate. i'm ready to vote now, but if we are going to do it on the floor, i would like to have more information. >> i'm sure that request would be in here, too. clerk will call the roll on the mccain amendment. >> senator dodd? >> aye. >> senator mikulski? >> no. >> senator bingerman? >> pass on that for a moment. >> senator murray? senator reid? >> aye. is that correct? >> senator sanders? >> aye by proxy. >> senator brown? >> aye. >> senator casey? >> aye. >> senator hagen? >> no. >> senator enzi? >> know. >> senator gregg? >> no. >> senator alexander? >> no by proxy. >> senator byrd? >> no by proxy. >> senator mccain? >> aye by proxy. >> senator coburn? senator roberts? >> no. >> aye by proxy. >> did senator coburn vote? has he voted? >> no . >> senator bingham votes no by proxy. >> senator sanders, did you get that? >> yes. >> did you get that? all right. >> vote is ten ayes. >> it is not agreed to. all i can say is my nose counting was corr

add the zero j and dea made -- the primary focus is preventing trafficking of illegal drugs whereas hhs mixed sure how people have access to -- sick people have access to drugs. how do we become a neutral arbiter? certainly there areome big issues that are out there with regard to state secrets and other issues and their competing interests. one thing that was fascinating to me and maybe this is because i was unable professor. you see the difference between republicans and democrats. maybe at a certain point, people could see a difference between senator clinton and senator obama during a primary. when you deal with government, often there are differences between components of the same administration. how do you work through that? how are you going to negotiate through that so that you can come up with some coherent policy? that is what we're trying to do in a variety of areas, including those that you mentioned. >> maybe i will go back to you -- both of you. this is an administration that made a commitment to policy. one thing that is not transparent is who is in charge. we have the ci

senator roberts, you have an amendment, hhs, you consider unique characteristics of rural hospitals and low volume hospitals when establishing reporting progress on hospital readmissions. again, i think that adds a great insight and dimension that my original framework was backing. i thank you for that. i'm happy to accept that. >> what number was that? >> that's roberts number two. we accept murkowski three, four and five related to indian health, 60 and 61 also on indian health, roberts number two on unique characteristics. they're telling me how i should talk. i'm 72 years old. i did pretty good so far. roberts number two as modified. we're going to take the rural and low volume hospitals. so we've got those done. so that's two, four, six, eight, ten, we have cleared 11 amendments and we're going to be looking at a couple of others during the break related to hatch and murkowski. >> i actually counted, i have three, four, five, 60 and 61, roberts number two, and i have enzi number 10, 11, 12, 15, 6 and 96. did i miss one? >> 10, 11, 12, 15 and 96. >> and 96. but i was right on the ot

interested in all the testimony about the existence of the disparity and i would be glad to yield to hhs and its addressing of some aspects of that. our special jurisdiction is somewhat limited. that is to focus in on the causes and the extent to which there is explicit racial discrimination. in particular, the last three that tried to get at that, as i understand, this is a terrible general -- a terrible overgeneralization. there are socio-economic reasons that have a big part to play before there is interaction. this may be related to the other factors. then there are those that impact the health care system. we have heard that there is at least a concern with some research that has to do with the clinical experience and by s and some has to do with the and even this in the quality of care. i wonder, i think the doctor began to put some of this into words. what percentage -- pick of the disease if you know it. some diseases are caused by these factors -- what percentage of the disparity does not have really much to do with the system and then, what percentage is related within the heal

the new hhs secretary, kathleen sebelius has and op-ed there, too. she writes that we need reform that will improve the quality of care and give doctors the best research to help them make the most effective decisions, not just the most costly. we need to reform the eliminate the barriers. we must insure americans are not denied coverage because of pre- existing conditions, and we must provide insurance security for americans who lose or want to switch jobs. that is secretary kathleen sebelius writing in "the hale" newspaper this morning. caller: please bear with me. on the revenue side -- it is a well-known fact as i have been cancelled by my accountant and people of my brokerage firm, that i should not report my profits and options since options are never reported to the government. that is a trillion-dollar industry. it is voted down every time by a voice in congress. that tells you how deep the corruption goes. secondly, we should be taxing oil. and since when does being a doctor make you a millionaire? they buy into other mri facilities and repe

co-sponsor senator demint's act id hh i voted for and chairman prior spend a lot of time on have a lot of unintended consequences. connect nanay i have 8, soon to be 9 grandchildren. one of my daughter's in law with a mother of 3, all under 5, chairs the largest second-hand clothing sale and second-hand book swabbing the history of dankind. when that law passed, within weeks they were called by their attorneys, because of the potential effect, legal liability put on them as a second hand manufacturer who did not take responsibility. we need to look at the unintended consequences of that legislation. there's a stay in the implementation but i hope you apply the same diligence in south carolina education as you did to that part to the subject. they are so onerous for people it was never intended for. >> if i am confirmed i will work to resolve many of these issues that are coming back to you and other members of this committee. it is my understanding, i have read the guidelines on secondhand stores and asked people house things are going. many of them say we read the guidelines and are n

>> when we bring this up on the floor i would ask the mccain amendment be sent to the secretary of hhs for her comment in preparation of the debate if we are going to do it on the floor i would like to have more information. >> i'm sure that request will be in here two. >> the clerk will call the roll on the mccain amendment. [roll call] [roll call] [roll call] [roll call] one [roll call] >> the amendment is not agreed to appear in a and all i can say it my nose counting is correct. the other any additional amendments. >> wanted to. >> to the fraud and abuse section for a couple of moments. i know that senator enzi has some comments before dealing with senator mccain's amendment so i wanted to respond to a couple of innings. and wanted to commend the the way seven tariff enzi along with our chairman has conducted himself in this whole process over these many days and weeks and grateful with the way he has approached this bill, as difficult as it is an much as there is conflict of a lot of major elements. with regard to the fraud and abuse section i wanted to do a couple of things very

he wrote dreary o drearily on hh 37th birthday that more than half of his days had run out and the remainder of my days, i shall rather decline in sense, spirit and finance activity, he complained and yet i have my own and my children's fortunes to make. he hoped, he wrote, another time, to provide for his children the foundation for a happier life than has fallen to my share. john had back bored, if not disenchanted with his life as a lawyer in ptsd. he continued its pursuits as his duty to provide for his family. and now, unforeseen by him and everyone else, he was running a revolution. his spirits were

madigan said of trust fund for hhs to spend billions on wallace we should improve our prevention agency cdc and prevention. we are giving cdc a lot to do in this bill on top of their heavy workload. as an even have enough funding to evaluate their own programs but the title of this requires them to by employers wellness programs and a set of trading more than 15 a programs we should modernize current programs. we should evaluate and improve our federal programs before we spend tax taxpayer dollars in aid to ensure those programs are not duplicative. this title requires incentives to develop recommendations relating to prevention specifically employer sponsored -- programs. i'm concerned these recommendations will become requirements and employers must have the flexibility to provide effective on this programs and in good job of this right now and should be allowed to continue to innovate. government mandates will make that difficult if not impossible but employers are not the ones who must bear the burden of multiple federal requirements even with the stimulus funds for political leader

we recommend section 104 strengthen for collaboration between hhs and usda and allstate agency's education, research, enforceme nt with regard to produce progress important we have the broadest base possible to hubbell stakeholders understand and comply with the fda said public health standards. section 107 entrees ability the fresh produce industry is committed to trees ability of our products and as i presented in detail testimony on appropriations on the subcommittee earlier this year we have underway a produce trees ability initiative to provide electronic trace ability for 6 billion cases of fresh produce the movie annually within the united states a mass of an extremely expensive long-term undertaking but a commitment we have made. however we are concerned the prescriptive nature of section 107 could derail these important efforts to bring these costs efficient and cost-effective technology to bear on the challenge for graduate provisions we urge congress set a goal the mandate for future stability but not overly prescriptive requirements such as those in this bill. we believe congre

guide organizations and courteney the systematic planning implementation and evaluation efforts of hhs of minority health as well as partners across the country, dealing with some of the individual and systemic factors related to health disparities. we also recognize that there are other components related to the health-care system, in terms of not just health-care reform, but the digitalization of health care and the emergence of electronic health records and personal health records, which provide a powerful tool for standardizing. >> i could listen to you all day. >> i am sorry. >> if you do not mind, we can follow that up. thank you. doctor? >> members of the commission, distinguished panel, other guests. we want to shine a very bright light on this issue of health disparities. before i begin, i think it is important to quote dr. martin luther king when he said that in justice and health care is the most shocking and inhumane of disparities. there is someone at the university of nebraska, where i am. i even tried to understand the solutions to the growing problem of health dispariti

oil is warm going through the pipeline and makes them amarous and up to 30,000 caribou in that heard hh. turns out that -- herd. but it reminds one a little bit about the scare that went across the nation about carbons. we had toe outlaw those that were destroying the ozone layer. and one eruption of mount saint hellens put that into the atmosphere. sometimes i think we think much too highly of ourselves as human beings and the effect we have on the world and the globe when we need to be good stewards of this wonderful planet, but we should not be fear monday engineerers that scare people out of doing things to help themselves and their families. i appreciate my friend from california. mr. rohrabacher: i appreciate my friend from texas reminding us of a past scare that proved not to be based on science. and i remember i was about -- couldn't eat cranberries for two years. they took sylimates. and 9 same intensity on global warming indicated we needed massive controls on our economy based on controlling acid rain. and what happened to that? ronald reagan held firm. there was a project th

coordinating committee with similar purposes that includes all of the agencies under the umbrella of hhs, nih, cdc, hrq, and others as well as the more relevant agencies that are also on senator harkin's council, the va, the department of defense, epa, department of education and department of labor. this interagency coordinating committee does not include the department of transportation. the department of housing and urban development, the department of homeland security. prevention should be about health care, points that i will will make and touch on. the other thing is, the health council inappropriately defines health promotion roles of non-federal entities, whereas this council has a laser-like focus on making federal programs work more effectively. i understand that none of the public health council's findings are binding, but americans might find it troubling that a federal board of bureaucrats would tell state and local governments, community schools, work sites, families and businesses what they should be doing to promote prevention. we've already clearly outlined here that th

i know hhs cent over a proposed rule but it is taken a long time. do you have an idea of when we are going to appeal to finally lift the ban as a relates to hiv-positive people coming into the united states? >> my understanding that is very much on the radar screen and it should be soon. >> thank you very much madam secretary. >> thank you mr. chairman and then secretary. it is great to have you here and i want to associate myself with the common bipartisan sentiment by directing money toward specific diseases. if i was drawing on personal examples i would talk about alzheimer's and ms in my family. if i was looking at my district i would talk about diabetes and the native american population. once we go down the slope we would have a lot of arguments here that would be well intentioned but probably not productive for us and i don't think i have opened the door for two and not open it up for all. let me ask you specifically. i think, but i want to make sure, is the president's position on healthcare now that it would be mandatory everybody participa

when governor bredesen name was being floated in for the director of the hhs, move on fattah authors said we don't think he is with us, we don't think he's going to represent our needs and we were -- we were one of the first at the gate and the rather is to do that as well. we were very pleased now that we have sibelius' in that position. [applause] i'm going to raise the rest of this because i don't have time of the second point is getting back to the basics of democracy. at this moment in time people have had bad taste of their voice smattering and we need to maximize that absolutely. we have got to simplify policy-making, the process of how we legislate as well as content of our legislation is a very confusing. it is on us to actually simplify both the process and the content for all americans of they can weigh in at a prepared times. who here has time to read isakson group dupage staff even energy bill that is filled with charts and graphs our job is to make sure that our members know what is in there and know how to make their voices heard. we need to hold all members of congres

my friend andrew sullivan, conservative gay writer who is hims hiv positive and in fact if hhs doesn't change the ban, he himself faces deportation to england as much as he loves this country and wants to liff here and has made it his home for sefrls years. so real lives are affected by these policies. and it has required a lot of people stepping up and speaking out for compassion and responsible policies, a problem doesn't go away because it is ignored or is as treated as it is sort of ghettoized as an issue for one community. we've come a long way since then. we have leadership, we have i think a bipartisan recognition now of how serious that matter is internationally. president bush was very good on hiv funding for africa, for example. host: if you're trying to get in touch with us via twitter, the address is c-span wj. and geevet this one from captain mergo. do you think employees will start adding their friends to their coverage? how will the government keep fraud at bay? >> it's hard for me to imagine, rob. why somebody would pose as a gay married couple for benefits . first of a

we have a bill that is incomplete, no final cbo scores, not technical assistance from hhs or cms and we are still headed full speed ahead. those things are absolutely mandatory. if you're going to do good legislation of that to know where you're going and certainly have to have those kind of scores and technical assistance for people who deal with these problems every day. and even though we might not agree with some of the conclusions that they made it is extremely important that we have the best ideas we can and those people who are in the best position to give them. why? what are we rushing so much? what are we trying to hide. this is a much more serious situation than that ill-conceived stimulus legislation. if we fail to do this the right way to simply shut the health reform box we will all suffer the consequences for the rest of our lives. the preliminary cbo's korea today and it is a preliminary estimate was another clear indication at this is moving in the wrong direction amid the point that it did not comply with the democrats' own plant them to keep you have asthma than 22

when the appropriations bill from hhs comes, this will not be an item that will be subject to -- >> mr. chairman? >> i'll make two points. one is evaluation is totally different than having to prove your metric that you're accomplishing something. that ought to be associated with every grant that you have to prove that you actually made an impact and if you can't do it it shouldn't be eligible to pay the grant. number two, we've gone from 10 billion down to 8 billion, but this is mandatory spending, folks. this is 8 billion you're going to borrow from your grandkids because we sure don't have it and everybody needs to know that. this money isn't going to come except from borrowing it from your grandkids because we're absolutely out of luck on medicare. we're out of luck on social security. we're out of luck on medicaid and we're running a $2 trillion deficit this year and we're going to add $8 million and we'll say grandkids, we're going to do it now. just another chink at lowering your opportunity and lowering your standard of living because we don't have the guts to pay for it by dec

senator and at one point candidates for hhs secretary talked about, he had knowledge in a book that erupted doctors and patients might resent any encroachment on their ability to use certain treatments but he called for the same kind of body in his book that would in effect allocate treatments based upon this kind of cost research. there are many others who have spoken about it as well. we know from experience that this hasn't worked out so well in countries that have tried it like great britain and canada. but, and in fact i will just quote one other individual who has talked about this, a professor at the harvard business school. he said that the stimulus, the comparative effectiveness research in the stimulus bill could easily morph into what, and i'm quoting, which called an instrument of healthcare rationing by the federal government and as they said there are comparisons to what is being done in great britain, and other european countries and canada. ironically at a time when those countries are turning away from the federal monopoly or the national monopoly because of the fact that i

secondly there are so many regions we normally have at meeting of justice secretary sebelius from hhs, but also secretary napolitano. we have issues with the airport and tsa as any other governor and i have plenty of things to do and wednesday morning i was testifying before the committee on the bill h.r. 2499 regarding providing for a congressional mandate in the status and so i have a myriad of issues i'm dealing with. >> host: let's talk about health care how is puerto rico fearing an disk eight? >> guest: puerto rico has never farewell even though i represent some 4 million u.s. citizens, even though per-capita we contribute more men and women in uniform to every one except one state. we still do not participate fully in the major programs that encompass health care. that's medicaid, medicare, colburn and schip even though we pay for medicare taxes we still don't participate. >> host: why is that? >> guest: we are a territory. when you come from territory things are different and i certainly want that to change and we are willing to carry the burden as any other state and certainl

now, in 2009, hhs inspector general reported that 80% of the insurance companies participating in medicare part d, the prescription drug benefit have overcharged subscribers and taxpayers totaling an estimate $4.4 billion. how is that? is that a good way to be spending taxpayer money? typical estimates of the medicare and medicaid fraud are around $60 billion. now, i want to just touch on because we have not gotten into this, to make a simple point, we have uniquely in the industrialized world a health care non-system which is dominated by private corporate interests. i want to touch on a few of the aspects of that. when you talk about health care costs in america, you are always talking about the cost of medicine, and prescription drugs are expensive in america where we pay by far the highest prices in the world for prescription drugs. let's talk about some of the major pharmaceutical companies and the role they play in making our health care system by far the most expensive in the world. start out with the largest, pfizer, and some of you may know this, but just this year a jury found th

now in 2009 hhs inspected general reported 80% of the insurance companies participate in medicare part b the prescription drug benefit have overcharged subscribers and taxpayers tooling estimated $4.4 billion. how is that? is that a good way to be spending taxpayer money? typical estimates of the level of medicare and medicaid fraud around $60 billion. now, i want to just touch on because we haven't gotten into this to make a simple point. we have uniquely in the industrialized world a health care system dominated by private corporate interest. i just want to touch on a few of those aspects. when you talk about health care cost american you always talk about the cost of medicine, prescription drugs are expensive in america. we pay the highest prices in the world for prescription drugs. let's talk about some of the major pharmaceutical companies and the role they play in making our health care system by far the most expensive in the world. let's start with the largest, fisa. some of you may notice but this year a jury found flies are owed the state of wisconsin $9 million for violating

he was the ranking member on the labor-hhs appropriations committee for many years. he retired in 1993. and i would yield to mr. mccotter, who represents plymouth, michigan. mr. mccotter: i thank the gentleman. i grew up in carl's district. we watched as he went from a wayne county commissioner to michigan state senator and then into this illustrious body. and as a young person growing up getting interested in politics, carl's example was an inspiration. it showed that a fine and decent gentleman could come from the smalltown of plymouth, retained his main street dues and do the people's business in the people's house. the last several years had not been kind to carl. he is in a far better place, and we are all diminished. our best goes out to his family, and we'd appreciate it if we keep him in your prayers. i yield back. mr. upton: mr. speaker, i ask for a moment of silence. the speaker pro tempore: members will rise. members in the gallery will rise for a moment of silence. the speaker pro tempore: without objection, five-minute voting will continue. the question