medicare. they even use the words "like medicare" in it to describe it. 72% said yes, they would be for a public plan. well, i hope and trust we will come out of here with a strong public plan. out of this committee and i'm sure we will. and hopefully we can keep that as we go through melding the two bills and on the floor and on to the president's signature. while i recognize it may not be there, i've said before i want a chance, perhaps on the senate floor, to vote for a single pair. not that it's going to go anywhere, i understand that. i just, you know, when we finally get to that 20, 30, 40 years from now, i probably won't be around. i want my kids to say my old man voted for that a long time ago. i do want to have that opportunity. i thank senator sanders again for bringing in a little dose of kind of reality as to what the parameters are on health insurance. mr. chairman, our staffs have continued to work on these, on the prevention and wellness title. they worked out the two amendments

medicare part d for divine was $29, which was 30% lower than the original projected when we passed medicare part d in 2003. i understand you issued a report yesterday showing that employer-sponsored premiums for health care doubled between, i think it's 2000 and 2008, for health insurance? medicare part b premiums have more than doubled. 110% increase in the same time span. i think what a lot of people are asking me about when i was home in arlington and fossil and out in my district they're saying, if medicare is going broke by 2017, and we're going to just expand and add all these people into a government-run system and we can't get access to providers now, when the government runs the system, which you know is a big deal in rural areas, they're saying, how does the new government-run plan going to hold down costs? and how is it going to expand? how are we going to pay for this is the underlying issue here. the estimates they are just saying, you talked about health insurance could cost us, you know or health coverage, $4 trillion. this plan alone, i think, some estimates are that. so peo

people, the thought that we would move to a model such as medicare and i believe medicare is desperately in need of repair, desperately in need of reform and a fix that concerns me a great deal. i think as others have mentioned that our constituents want us to be working on a bipartisan basis. i think they want reform, but again what constitutes reforms may be different depending on where you're coming from and what your knees are unfurling within this country our federal government provides health bill services for a number of different federal agencies and organizations and when we think of our garment run plans it is iranian health services and two medicare. those men and women who have served our country, their families have access to the virginia and serve over a million are retired service personnel with medicare and misspent 440 billion in 2007 roughly 16% and refer this numbers over and over into the eye a chess threw up the system have 45 hospitals, three and three house centers and i wish i could tell you that the federal government has done a good job matisse three areas in te

medicare -- i am over 70, and it works fine. it runs at low cost, so i do not understand why you are not more or less promoting that. also, you would be given a choice so if you wanted your own company, you could keep your own plan. but also, you need to take insurance companies out of it because insurance companies are making these huge profits. they can turn you down if you have the pre-existing condition. they can say, no, we're not going to pay for that particular procedure. we need single payer health care for all, and it would run like medicare at low cost. guest: well, medicare is currently on affordable. as president obama has saysid, t is a big drop ever of projected -- is a big driver of projected insolvency. but it does not a good -- it does not do a good job of policing fraud. it just shovels money out the door. that increase its total cost, so i just think that the caller is wrong about what a medicare base model would mean for the country's fiscal health. host: terry joins us on the democrats' line from chicago, il

we know that medical care, which is -- medicare, delivered for years, we know that medicare is delivered very well in the great majority of cases for the american people, for the elderly, but we also know that medicare has a 2% or 3% administrative cost, again, contrast to the 15% to 30% with private insurance companies. interestingly, there was a statistic -- there was a study several years ago that medicare -- that of the major -- of the -- a study of the richest industrial democracies, france, germany, japan, israel, italy, canada, and the united states. and they rated all of these countries according to several indices, life expectancy, faint mortality, the inoculation rates for the children. the united states ranked 12th. even though we spend twice as much as any other country on ert per capita, our outcomes were not as good. we were 12th out of 30. one area that we -- if you get to be 65 in this country, the chances are you're going to live a longer, healthier life than almost any other country in the world. why? because we have a health care system, medicare that provides health i

would medicare have the form? >> no. this does not portend that medicare would have the form. it portends that medicare would provide the information of the requirement when they come in to register and they would consult, recommend they consult with a family physician. i would suggest also that medicare makes it a requirement that they have it, people will respond in the health community, the faith community as well as other communities to have that information readily available because it's a great thing for everyone to have. >> i think it's a great thing to have and as i said -- >> it saves the will federal government a ton. >> but i'm also thinking about not only saving the federal government money, and as you know, end of life decisions are fraught with enormously complex medical and ethical considerations. many of this, in this room have been through it with their own family, someone who has practiced medicine, someone who has been a social worker. my concern is that requiring everyone to fill out an advance directive would add an incredible burden to a 65-year-old to be

there are probably some plans that are not on the same basis as medicare. they are paying something equivalent, close to equivalent to what medicare pays. the evidence is that most private insurance plans pay something higher than what medicare rates are. >> should we require all insurance companies including the public auction to pay the same reimbursement rate? >> i don't think we should require hmos to pay the same reimbursement rate for the reason i mentioned, they pay in a different way. if you pay your doctors on a person basis or salary or using bundled payments, it is not comparable to the way medicare pays and as we have argued, we think strongly that medicare should move towards innovative ways of paying for care. proposals have been discussed in the past for having private plans that are competing with public plan or separately from a public plan, as the rates that a public plan would, in many countries, the rate setting. the medicare advantage will pay rent care range, the privacy for service plan. something that should be said that is very impo

medicare is not perfect. but it does have the benefit of being pretty easy to understand for the most part. the payments are pretty easy. you do not lose the insurance if you get sick. i do not know if the whole nation is going to be on medicare. i do believe that a significant proportion will be, if we get the bill out of the house. i believe a significant amount of people will choose their private health insurance. i think that is their right. i do not think the whole nation is going to be on medicare could one thing i like about the president's plan, even if that were to happen, it would happen very gradually. you would not overwhelm the system. in terms of how the payments are going to work, the payment will be related to income. if somebody is making $100,000 per year and they want to be in the public system, then they will probably end up paying the full cost of the public system. of the $4,100, what you are paid is supplemented what you have already paid over your lifetime of work. so you have built up

in 1997 we amended the medicare bill. it included preventive health care services keeping our seniors healthier, better lives, and less costly to the system itself if we can detect diseases at an early stage and in some cases we can prevent diseases with preventive health care. it saves money. 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 medi

we have already seen it twice in the public plan medicare when they created medicare plus choice they paid the public or the private sector 95%. congressman stark complained the private sector was siphoning off all of the help the people and that is why it was able to do it at 95% or 5% less than medicare when they created medicare advantage they paid the private sector a little more, about 13% and they complain about that there over reimbursing bid ministration and congress want to cut the reimbursement rates. the point* being of the private sector is doing a good job, they will come in and change the rules so it cannot do it. it will be a rich benefits package. we have already seen that. it will make it very expensive and as a result healthcare spending can explode. because of the public option and the dissatisfaction there has been a public option a proposal called a co-op maybe we can move to a co-op and find a middle ground. dirty habit co-op out there there are trade associations, various types of farm groups that work as a co-op and they provide health insurance. there is a new

more than 25% lower than medicare. one group that has a significant presence in my state illustrates the problem with 1,300 physicians and 500 advance practice nurses specializing in the care of newborns and vulnerable children. they noted the lack of appropriate reimbursement is the most common reason for physicians to refuse to accept new medicaid patients. they have noted that within our own national neonature toe patient population the current government rates pay an average of 28.7% less than rates from private insurers. no wonder it is hard for medicaid beneficiaries notwithstanding what congress does, it's hard for them to find a physician who will actually see them at that kind of rate. they say they believe a public plan will erode the availability of private health insurance and impact negatively patient access to needed health care. the fourth problem with the plan in the kennedy bill that i have is that the government plan would ultimately lead to rationing of health care so that means delaying or denying a

it's called medicare and medicaid. it has price controls. everyone is forced into medicare, part a. if you sign up for social security, you have to be in medicare part a. there's a lawsuit out there trying to give people the freedom to opt out of medicare part a. but currently, you got to be in it. at least that's the way h.h.s. sees it. there's rampant fraud and abuse in medicare and medicaid. whatever the government-run program starts -- however it starts out, it is eventually going to look like medicare and medicaid at some point in time. there will be price controls. one aspect of the legislation, one piece of legislation sfatted that it would be medicare plus 10% for the government-run public option. so they would give doctors and hospitals a little bit more than medicare. maybe. maybe. you may have noticed that congressman wrangle has suggested that he would like to pay for this in part with $400 billion in cuts to medicare and medicaid. the president has suggested a little bit lower number than that, but he included in that $110 billion cut cuts in what they're calling produc

[applause] >> today we are paying medicare advantage plans much more than we pay for traditional medicare services. this is a great deal for insurance companies. it's a subsidy to insurance companies. it's not a good deal for you. it's not a good deal for the american people. and by the way it doesn't follow free market principles for those who are always talking about free market principles. that's why we need to introduce competitive bidding into the medicare advantage program. a program under which private insurance companies are offering medicare coverage. that alone will save $177 billion over the next decade. just that one step. [applause] >> second, we need to use medicare reimbursements to reduce preventable hospital readmissions. right now almost 20% of medicare patients discharged from hospitals are readmitted within a month. often because they are not getting the comprehensive care that they need. this puts people at risk. it drives up costs. by changing how medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits but drives up cost for eve

beneficiary, the average expense to medicare is $24,856, which is 27.9% of everything medicare spends on the average patient in their lifetime. so if we are talking about savings, and we're talking about quality, and we talk about a system where 90 days prior to your 65th birthday you come in to sign up and begin the process of registration for medicare, i think if we require the advanced -- proof of the advanced directive to be part of the qualification, we would ensure that everybody's wishes were respected in those difficult times of life and that physicians, care providers, et cetera, would have legal direction as to what the patient would have had done. >> well, if i could just comment, first of all, i understand the objective that the senator from georgia seeks but this is legislation that would affect the eligibility for medicare and i believe it is truly outside the scope of our committee. is there -- i don't want to sound like a parliamentary fussbudget here, but -- >> i think the senator, i think she's right, it's a finance committee matter. i must say, i like the direction

if we're going to fix health care, we ought to address fixing medicare. we ought to say we're digging a big deep hole over here in terms of being able to fund medicare, but we also are adding to our deficit hole which is going to complicate that. it's a very straightforward amendment that says we don't spend this $8 billion in years we haven't addressed years on medicare. >> i'll be very, very brief. my concern, obviously medicare and social security have got to be dealt with. we all know that. how we deal with it, there will be some debate about how you do it. the president realizes this is a high priority. the obvious question in my mind is one of the things we're trying to do with this whole section, or the whole bill for that are matter is to deal with people's health issues. obviously people end up on medicare with chronic illnesses and problems drive the costs up. to the extent we're able to induce the number of people who enter the medicaid, medicare age period whoit chronic illness or manageable illnesses that cost less, obviously we're reducing t

from medicare advantage? >> well, sir, i certainly hope so. the proposal to stop overpaying for medicare advantage is one that is included in the president's cost savings after years of examination, there are no enhance the benefits and they're being paid at about 14% higher a rate than other programs. as you know, the center for medicare services has proposed that there be fewer plans this year because of the proliferation of plans and the fact that consumers didn't often choose them. and that's not a cost-effective way to run a system. but ideally, the doctors and networks will remain veilable. >> the gentleman's time has expired. mr. chairman i thank you for your patience and madam secretary, thank you for your response. >> next we have gentleman from ohio. >> thank you, mr. chairman. thank you, madam secretary for joining us today. as a native ohioan i welcome you as well. there are so many different areas worthy of discussion that it's difficult for me to define one to ask you about. but given the rural

very explicit in medicare. for public payers, there's an additional issue about fairness to different types of providers. now, both of these goals are achieved when relative payment rates align with relative costs. so it's really not rocket science to know what payers would like to happen, but it's also -- it hasn't really been working out that way. so let me talk about how the pattern of the payment structure deviates from of the cost structure. to if you talk about inpatient hospital payment under medicare, we've known for a long time that the surgical drg's are more profitable for hospitals than the medical drg's. now this was never intended to be the case by cms, and cms deserves a lot of credit for having reduced the magnitude of these distortions, in a revamp of the drg methods under mark mcclellan's leadership, but the distortions in hospital payment remain for many private payers, who are not using drg's, either the old system or the new updated medicare system, but they are paying on the basis of per d

social security was 15%, medicare had yet to be enacted. by 2007 defense spending 20% of the budget while social security makes up 21% and medicare makes up 16% and it is rising at an alarming rate. the u.s. has a commitment to health care almost double any country in the world from the standpoint of the overall cost. it is unsustainable. we can do a much better job but it can't just be by spending money. mr. chairman, the national health care anti-fraud association organization of 100 private insurers, public agencies estimates 60 billion, about 3% of the total annual health care spending is lost to fraud every year. but the figure is considered conservative by the new england journal of medicine. 2008 government why proper payments cost the united states treasury $72 billion or 4% of the total outlay for related programs. medicaid had an estimated improper payment rate of 10.5% or $18.6 billion for the federal share of medicaid expenditures. the highest rate of any federal program. and it is my belief that in the second half of the legisl

they are being considered in legislation related to medicare that would get medicare i think the much-needed ability to get important quality and cost measures quickly for their beneficiary so that the impact of reforms like these can be evaluated much more quickly and can be potentially an important part of achieving meaningful health care reform. thank you all very much. [applause] >> thank you, mark, for sharing your perspectives. now it's my pleasure to introduce uwe reinhardt as we turn our attention from finance and cost management to increasing access. and there is really no one better to speak about this than uwe reinhardt. he is an internationally known expert, and i'm sure known to all of you here in this room. he is well regarded for his humor, also for his keen insights and his ability, his keen insight and his ability to communicate these very important issues around access. >> thank you very much, nancy. first of all, i want to add my thanks to bob reischauer's remarks to you. these meetings take a lot of intellectual activity, is it important, someone has to frame it, and then

medicare. insurance company fraud against medicare. a private hospital insurance fraud and i hope this with medicare and medicaid we put in our figure who is committing fraud. i hope we rephrase. >> i think it is medicare and medicaid to have the obligation to do the enforcement of its demand that is fair enough but we can make that better but when for example of some it doesn't pay your taxes in the go to jail or don't get a government job we don't say is the irs fraud. we say you did not pay your taxes appear less put our finger on the people, i agree with you i think that is what this bill is trying to do but the people who are committing that fraud is not medicare and medicaid, it is prime rib corporate insurance. >> i tried to quantify this does not easy but briefly share with my colleagues how much fraud is out there. in 1990 the fbi estimated 10 percent of all health spending is lost to fraud and abuse. in the national health care anti-fraud association estimates 3% this lost to fraud an

so if you expand medicare to where everyone is eligible for a medicare-type plan, who in their right mind is going to stay on private insurance when they know that they're going to have to pay increasing sized premiums in order to get the same level of care that those on medicare who are largely supported by taxes are going to get? and so what ends up happening is you lose that critical mass of those under private insurance and so private insurance then becomes only an after thought, a sliver of the economy and so what you're left with is a giant public system, a medicare that's much bigger than we have today and incidentally i'll remind those that today as it stands, medicare will run out of money within 10 years, as it is. it's unsustainable as it is. now, if we grow it into a much bigger system, where are those cost savings going to come from? and so i'll yield back in a moment, but i just want to bring out the fact that no one has ever been able to show that a government-run system, particularly a health care system, but any government-run system in which the economy is being con

i ask my colleagues: do they consider medicare socialist? would they like to abolish medicare? probably some of them would. but medicare -- hello, my friends -- is a government-run plan. it is very popular with the american people. very few propose eliminating medicare. so let's be real here. the public option is about offering americans a choice in the market that far too often offers them none. i'll tell you the choices too many americans face: whether to pay for health insurance or health care or to pay for other necessities of life, because health care has become so expensive. that's not a choice anyone should have to make. and maybe that explains why the american people don't agree with the critics of the public plan. half of all americans think the government plan will provide better health care coverage than private insurance companies, and a significantly lower percentage disagree with that statement. let's be clear, a public plan may not have special built-in advantages. it would be a coverage option that would compete on an equal footing alongside private insurance pl

i happen to me on medicare and frankly i do not like the idea i was forced to take medicare -- guest: you are not forced. there is no law that forces you to take medicare. you can pay for it out of your own pocket, you can come up with other options. but we spend 16 percent of the federal budget to give people a choice, making a huge people -- different lots of americans. there is no gun in your head. caller: medicare has to be my primary and by private insurer has to be my secondary and now medicare is gatekeeper for united healthcare and instead of getting the test that i need before preventative maintenance, i have to wait a year for a prostate exam, concerns about pet scans and cats can't ping allowable and my wife had lung cancer -- guest: i would strongly recommend. you have great people in new jersey. i strongly recommend you talk to your member of congress about being forced to wait a year for a prostate exam. let me go back to my comments, objective data by independent sources that evaluates the costs of health care and looks at the outcomes in terms of how long people live.

just look at medicare. if the federal government did not move for medicare our seniors would not have had affordable health care coverage. our disabled population would not have had affordable health care coverage. i don't know of a single member of this body who is suggesting we repeal medicare. and that's a public insurance option. a public insurance option does not have the government interfere with your selection of doctors. the doctors are private. the hospitals are private. we are talking about how we collect and pay for the bills. and medicare has worked very well. as tri care for our military community. we want to build on that experience. the main reason that we want a public insurance option is to keep down costs. that's our main reason. we know that medicare advantage -- this is a private insurance option within medicare. well, i'm for a private insurance option in medicare but what i oppose is giving, costing the taxpayers more money because of that. and we know that medicare advantage costs bet

under medicare it is either medicare or no care, that's the law. i know because i tried to get it changed. we tried to get something called private contracting, the same as in canada, we troyed to get that for medicare so -- we tried to get that for medicare so if you were not satisfied with medicare and you wanted to speed it up and you could find a doctor who could do it, whatever amount he would charge you had the right to do that. no, what congress did was to say, and this is in the middle of the night in a conference committee, you can't do that. only if a doctor says, in advance, i will treat no government patient, no medicare patients, for at least two years, is he able to provide that care to you. so we have a perverse incentive, if you want to take care of patients outside of medicare you have to not take medicare patients. we should encourage them to take more medicare patients and allow the option that they have in canada. the bottom line is, washington-run health care is not a good idea. republicans are not going to support legislation

i wonder if he has read "medicare and you." if you had read this book you could not say what you just said. we had lacrosse in 1954, and now my husband is 72 and we do not have the finances to pay insurance. the only thing we have now is medicare. and also, it is not free. they take to under dollars out of our social security costs, which leaves us very little. when we see a doctor, we have to pay a copayment. we pay the doctor if we get a cold or a shot, anything like that. we pay extra. it is not free. all of the news media keeps saying, "oh, medicare is stored to be free for everybody. but if it is free for everybody, what our senior citizens paying money out of their social security? >> she is right. she made the point i made, as well, that 90% of beneficiaries have some form of coverage, because medicare alone is not enough. so she is one of the 10% of seniors on medicare only and that coverage does not always fill the bill. clearly, just a government solution will not work. but obviously, having held for people of low and

i would not be able to participate if i'm getting medicare plus ten. so for me, not only do i worry about what that means to the individuals that are currently being covered, but if we were to enact it, how many providers then step out of taking medicare eligible individuals? and there may somebody eyebrows raised saying well, gosh, they are just trying to gouge the public here. how much money do they really need to make? but -- and i would be happy. i'm gathering information from the providers, you know, obviously we're not going to turn over the full books. but in terms of what it is that they can take on, the amount they have to make. i had one doctor and he's -- his focus is on diabetes. i'm trying to remember. it was like for -- i got it right here. for every seven medicare patients that he brings on, if he has one who is a private care, he can balance that out. it's a 1 to 7 ratio. so when you think about what you have to do within your practice, the number of individuals that you need to see on a daily basis to basically cover your costs, i thin

that is medicare law. so, not only do we have that preclusion, we are talking about now we are going to judge it in terms of age adjusted quality of life. quality and we are going to have somebody decide what the quality of life is. so, i would strongly ask you to it please consider something along the line of senator enzi's the amendment and i will make the point again. rediker it is denying a drug today in the procedure today that has great indications for certain people, but they decided it cost too much so we can't, you cannot have it. so, for five people are going to die this week because of medicare's limitation on virtual colonoscopy. i will guarantee you that, because they can't have a virtual colonoscopy so they have to have one that has much higher risk to them. >> mr. chairman. >> is there debate on the amendment? if not, we will call the roll, mike. the clerk will call the roll. mikulsk sni. >> no. >> senator bingerman? >> no, by proxy. >> senator reid? >> no, by proxy. >> senator sanders. >> n

now, what can medicare do? well, there's a -- what i call an easy part of the reform agenda, a bunch of steps just to, you know, change the current -- revise the current payment structure so that it more accurately reflects the pattern of relative costs. this is easy, it appeared in a -- in the house schip bill, i guess it was a year or two ago. it's probably doable today. and basically involves a better process for updating physician work values, because that process, which is done by cms, with advice from the relative value update committee, called the ruck, has not succeeded in identifying those services, which because of productivity gains over time have become relatively overvalued or overvalued compared to the other services. there's also a need for much more accurate estimates of facility. -- facility costs. and there needs to be frequent updating to reflect declining costs associated with technology, probably even considering projections of unit costs. let me give you an example of the problems with the

the medicare program provides an important lesson here and as a political compromise medicare was set up in 1965 to pay doctors and hospitals the same rates as a private sector. faced with rising budget pressures congress quickly abandon this level playing build approach and an active presence is for doctors and hospitals. today medicare payments are 20 percent less as an engine for doctors and 30% for hospitals compared to the private sector and many doctors won't take them on. i have been told by doctors from utah that discontinues they will simply stop seeing patients altogether. and now to mention a few words about comparative and effectiveness. this is a wonderful set of terms that we do a lot with in this debate. clinical comparative effectiveness if done right can provide us with the label information while protecting patient and medical innovation. the key is to focus on what worst that where an internet -- for inpatient not simply what is the cheapest option. unfortunately the language included in this bill the latest down the path of rationing care and i don't know many peop

medicare has two%. france has less than 2%. that is up to two hundred dollars billion every year that a solid waste a. you never see that mentioned in the pages of the "washington post ." -- that is up to $200 billion. guest: thank you. you give us the opportunity to plug al gorour blog. some of the single payer advocates had a meeting with the senate. i do not know if you will like what came out of the meeting. senator baucus says he's taking it off the table. he has more to do with the progress of the legislation than i do. it is something that we cover specifically in "daily dose." we all long for peace that is in the pipeline here. you should be able to read it in our newspaper in the next few days. it is not something we are ignoring. as you can imagine, a lot of people have a lot of important aspects that they want us to cover. we're going to try to get to them all as quickly as we can. caller: ok. let me say something that is general. you refer to the article that i have of course read. that article is about process. i a

so medicare is hardly the model. we need to fix medicare, yes, but we don't need to take the current broken system and blow it up and make it the system for 300 million people and consider this we've done our job. i mention that the $38 trillion in unfunded liabilities. it's estimated that medicare will go insolvent in the year 2017 unless we do something about it. in fact, many beneficiaries of medicare know that it's inadequate alone, so they buy supplemental policies. medicare forces many providers, as i mentioned, to limit the number of patients they accept because reimbursement rates are so low. and then here's another part of why medicare is a bad model. "the washington post" estimates that $60 billion of taxpayer money is stolen or wasted or lost to fraud in medicare each year. surely, we need to fix that problem. senator martinez, the senator from florida, and i have introduced legislation. we believe it will cut the figure down dramatically and make sure more of that money goes to treat medicare beneficiarie

cbo has reported that 5% of medicare beneficiaries account for 43% of overall medicare spending, and cms has noted that approximately 20% of medicare beneficiaries are with five or more chronic conditions account for 66% of program spending. could you talk a little bit about how we can focus on those medicare beneficiaries with multiple chronic diseases, and how perhaps a program like that focusing on home and better coordination can help reduce the costs? >> well, we have not only the demonstration that you are responsible for, but i think a number of projects under way looking at coordinating care, particularly for the vulnerable high-cost individuals, and certainly having an opportunity to do that in a home base, instead of a hospital based service is not only better for the patient, but may provide some enhanced cost savings. so we are eager to work with you, mr. markey, to continue to figure out better ways to not only coordinate care for individuals who suffer from various chronic diseases, and have ongoing underlying conditions, but also to make it a more patient centered syst

we have made progress in 1965 with medicare but other than medicare and medicaid in so many ways we are still waiting for a health care system that delivers on the promise of affordable quality coverage. we are waiting for reforms that were cost for businesses and families who are buckling under the weight of every climbing premiums. we are waiting for reforms that foster competition and the insurance market and gives america better choices including a public health insurance option. we are waiting for the reforms that bill accountability to the system in shoring patience that they get the highest quality care in the world. we are waiting in other words for reforms that fix what's broken and keeps what is working. that's why this is a historic time and this historic room because i think the weight is about over. it's not a moment too soon for many of high winds who are one illness away from financial catastrophe. take for example ann from dayton ohio in the southwest part of my state she wrote with me to share her story. the past five and a half years she paid $125,000 climbing in healt

guest: medicare. caller: medicare, right. if we had to create a new tax, just like they take your fica out of your check before you have a say in it. i think 2% instead. if i am paying 90%, as long as everybody else will take 2%, i think that's a good idea -- if in the 2%, that is a good idea. guest: they do some form of it in every other democracy in the world. why is it that here we are struggling with their health care costs and making us economically and competitive. we're losing jobs. every country does it differently. yet, the conservatives are renting and reagan about too much government control. -- the conservatives are ranting about too much government control. we should at least give people the choice. the president is not trying to make anybody get into a system that they will like. why are the republicans against giving america the right to choose? host: the e-mailer asked by the u.s. is ranked 37th in the world. guest: because our system is not effective. you can get terrific health care in this country. most peo

mabey providers don't love medicare but medicare is probably more credible than private payers and medicare has the ability to engage the provider leadership in its work and also medicare has sufficient clout with many providers and very contrary to predictions by my fellow economists when the medicare physician fee schedule was introduced in 1992 and changing the pattern of relative payment it was and to really any evidence of access problems caused by this change in the medicare payment structure so medicare does have clout. and we find private payers are increasingly falling medicare payment structures so that if medicare changes in many areas the private payers will automatically change as well. the medicare bill to value scale for physicians is used extensively although private payers often need to deviate to accommodate the market power of a particular provider such as a p.o.w. waffles in symbol specialty group. now, what can medicare do? well, there is what i call and easy part of the reform agenda a bunch of steps just to change the current, revising current payment structures of it

so i agree with of the comments that have been made about medicare and medicare payment reform, it's going to be important to have critical mass as we move through that. a variety of other instruments about been put into play to sort of get at the cost issue, because there isn't one flavor that suits everyone, and you have to have a lot of different approaches. so certainly, we've done things to tier networks, so some these smaller employers, who are making more cost-related choices are making them around what delivery system works for them. we have done work around centers of excellence. minnesota happens to have 16 designated centers of excellence within the blue cross system. so it gives us lots of choices and opportunities there. we profile providers on their quality, and use that data and made that data transparent in hour market, and that's been important. has it taken on the full flavor that i think it will in the future? no. but it actually has put information out there and i think it will become increasingly more information -- more important as that information becomes more

i do not fall under medicare or medicaid. the gentleman that i work for, honest, good man, a republican, cannot afford insurance for those i work with because of a guy like me. get real. this is easy. host: will the spending policies of the obama policy to help a guy like this in kansas? guest: yes, the health care policies will. to make it possible for those who need health care coverage to get it. that is essentially the long term plan. john is right when he says that things have to be paid for. costs do not disappear. you will not get health care for free. on the other hand, there are many savings to be had. we keep talking -- i have been talking about getting the most effective treatments and being efficient. there is a huge amount of administrative waste. some keep government investments can begin to rectify that. there are problems because doctors do not have access to the comprehensive medical history of those they're treating which ends up with costly problems. the caller -- it is people like the caller who would be h

wellpoint, the 2009 cms board wellpoint from participating in medicare part d and medicare advantage stating they've demonstrated a longstanding persistent failure to comply with cms requirements for proper administration of medicare advantage prescription drug program. aetna and 2003, agreed to settle a class-action suit brought by physicians by paying $470 million overhauling business practices that doctors say were shortchanged patient care. amana in 2000 he managed a 14.5 million to settle federal charges of overcharging government health programs. sigma, and 20 of repaid $24.5 million to settle allegations of medicare fraud at a hospital that it owns. that is some of what insurance companies do. then you've got hospital change. many people here are familiar with. that in fact in 2000, the hospital corporation of america agreed to pay $745 million. 745 million to settle civil charges that it systematically defrauded. medicare, medicaid and other federally funded health care programs. later that year they agreed to pay criminal fines of around $95 million. finally, and 2003, hca a

is medicare and medicaid. that is -- when you hear all these projections about all these trillions of dollars and red ink got out as far as the eye can see, almost all of that is because of the increase in medicare and medicaid costs that are going up much faster than inflation. host: what is your reaction to the president's speech yesterday? guest: there is no question that health care expenses are a big driver of federal debt and federal deficits, but i think what he said is true but it is misleading because his plans and the plans being circulated on capitol hill by his allies, do not have much in the way of cost control. it is hard to come up with an example of a country that has expanded coverage while cutting costs. he may talk a lot about cost control, but the driving force on capitol hill is to expand coverage and that will cost serious money. host: what do you envision health care reform looking like? guest: i would like to see an end to the tax penalty for buying insurance policies yourself, as oppos

improvement in the medicare program? >> i think that there is no question right now. there are areas where we are spending money that do not result in higher quality care or better results for patients. i think what this discussion draft its foreword is a way enhance the current program and put dollars into areas where we think there will be much better results for patients. hospital read missions is a category that is targeted toward this. one out of every five patients leaving the hospital today is readmitted with in a series of weeks. that is not good for the patient and will cost a lot of money for the system. coordinating post-release care, actually in fighting incentives for follow-up care, is a significant improvement that will not only lower costs but actually provide a lot better care. those of the examples that the discussion draft incorporates. better quality in the long run, following what we know, our practices that are in some parts of the system but not if hearing throughout. they are not continuing to ove

drug companies to help cover costs of medicare recipients. from the white house, this is about 10 minutes. >> i want to thank you for having us here, mr. president. we certainly appreciate it. and aarp is proud to stand with you, chairman bauccus, senator dodd, to announce that gap in medicare, the drug coverage ban known as the doughnut hole to all of you will be substantially filled for millions of middle income americans as part of health reform. i want to applaud chairman bauccus and senator dodd who continue to be champions for this issue and have always fought for people who are struggling to make ends meet. and we stand with both of you. senator bauccus as your strong leadership of the senate finance committee and creativity which led to the development of this very unique solution. we also support your finance committee's process and look forward with optimism to its next steps. but bottom line, without you, chairman bauccus, we certainly would not be here today and we offer all of our thanks for that. >> when the president issued his

a signature part of it was medicare, part d, the prescription coverage option. the democratic majority said this was not going to work unless we had a public auction, a public plan, the federal government negotiating down the prices. and when the amendment failed, there was another one that said, ok, look, let's make sure we do not pay too much and let's set the price, the monthly premium, for a prescription drug plan. let's set it at $42 a month. unfortunately, that also failed because the miracle of free- market enterprise brought in at $24 a month. now, some might argue that over the last three years it has increased somewhat -- certainly, because of inflation -- but it has not gotten to $42 yet. we do not want the government to be a player, a competitor on the field, and setting the rules at the same time. what would result from that is a crowding out of more employers who currently provide health insurance for their employees, and that is an 80% favorability rating. why would any good politician try to cut the meat out of an 82% issue and kraut all of those

medicare is having severe financial problems. the other day when the president spoke before the a.m.a. this were points where he obviously was not very well received. let me tell you, the doctors in my district and drinks around america are not booing but they are informing their patients both medicare around non-medicare patients about the dangers of the obama health plan and what the democrats are proposing. people want to have access and they certainly want affordability. one of the reasons why i'm very excited about the plan, i also have a large number of people who are 55 to 64 who moved to florida as to many districts and they then start to have some health problems. this offers them availability and affordability. so they won't have to wait until they are 65 to get medicare. there is additional fixes in the bill that will increase funding and availability of federally qualified health centers which are a great resource in the majority of districts that offer very low-cost healthcare insurance as part of the solution. so, d

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 forward and hopefully in beijing, brokers in the very discussion. >> you would agree the investment is only the beginning of the amount of money that we might need? >> welcome 634 billion plus another 200 billion is 800 if to 2 trillion-dollar range it is a good investment. >> so it would be important to know the details of the proposal and cost of the proposal before we vote on the proposal and act on the proposal if we are to show respect to the president's desire on paygo and not adding to the deficit? >> hope we

citizens on medicare. there have been proposals to have medicare for all -- a single payer plan for all americans, and that person likes it. there are some appealing things to a single payer plan, and there are some countries where that has worked very well. here is the thing. we are not starting from scratch. we have already gone -- because of all sorts of historical reasons, we have primarily an employer-based system that uses private insurers alongside a medicare plan for people above a certain age, and you have medicaid for people who are very poor, so we have a patchwork system. it was my belief and continues to be my belief that whatever we might do if we were starting from scratch, that it was important in order to get it done politically but also to minimize disruptions to families, that we start with what we have as opposed to trying to scrap the system and start all over again. my attitude was if you have an employer-based system, and a lot of people still get their health insurance through their

medicare is a perfect example. it is on a path to fiscal meltdown with part a already facing bankruptcy within the next decade and we all know it. it underpays doctors by 20% and hospitals by 30% compared to the private sector forcing increasing number of providers to simply stop seeing our nation's seniors. according to the june 2008medpac report, nine out of 10 medicare beneficiaries have to get additional benefits beyond their medicare coverage. nine out of 10 of them. we have a broken doctor payment system in medicare that has to be fixed every yr so seniors can continue to get care. this year alone this broken formula calls for a more than 20% cut. i can keep going, but the point here is simple. washington and a government-run plan is not the answer. talk about creating problems. the supporters of the government plan, they know these facts, so they are trying a different approach by claiming that the government plan is simply competeing with the private sector on a so-called level playing field. give me a brea