and what tom coburn said is correct and tom harkin answered. you have to have transparency and metrics. if we're going to succeed in the years to come, we have to demonstrate that what is occurring out there is actually working. if we don't do that, then obviously people undo all of it. so i want to express my support for his concepts and ideas that we've got to have in place. you can't just write the checks and not demand accountability for these dollars. but if we don't have this moment here, i worry about whether or not we can really achieve the goal. so i thank my colleague from iowa. i want to be heard on this amendment if, not, we'll go to senator mcculski. why don't we vote on this one? i think we debated this already. the outcome i think is -- yeah. we'll have a recorded vote on harkin number two. >> senator dodd? >> aye. >> senator harkin? senator mccull ski. >> aye. >> senator binghamman? >> aye by proxy. >> senator murray. >> aye by proxy. >> senator reid? >> eye by proxy. >> senator sappeders? senator brown? senator casey? >> aye by

senator tom harkin has a big effort going on to look at ways to encourage more of this prevention and wellness, and healthy living. host: we have an e-mail that is asking us to do a program on who promotes the myths about canadian health care. we have focused on that issue. we will do so again. thank you for the suggestion. the next call is from tennessee . caller: i am amazed at the people who want someone else to pay for something that they want. tell me one program the government has ever run that they have not run into the ground. medicare is broke. tencare in tennessee is broken. it has corruption and abuse. all of their drug dealers get their drugs from tencare. tell me one thing the government does. people want single pair. they tried to get around it by calling it a public plan. they are playing with words. people want someone working to pay for their medicare. guest: it has been a little while since i have been down to tennessee to take a look dat tencare. i'm not aware of the latest with the program. it has gone through some difficulties. on medicare, i hear these complaints

so i commend my colleague tom harkin for his work in this area and we can make fun of some of this stuff anyway but i think we do the point try to make by minimizing the importance of what these opportunities remain. >> before we go off the deep end on this i'm not eliminating anything, not eliminating most of what a senator harkin said. of the meal act can happen, it needs to happen. the meal act will happen. restaurants across the and and as states have been waiting for some kind of direction from congress that make them the same across the country so there weren't having to decide on kind of a menu in california and another in iowa and connecticut. so that is something that is tremendous and on the fall. that is not the $80 billion worth of cost. we talked about we don't want kids to eat fat foods and want them to exercise, we don't want them to smoke -- that's not the 80 billion is about. of a 80 billion build structures and there is no way in there to get the kids incentivize to use the structures here and i'm not sure how saint ides of fact that, but they're all nice things we like

caller: tom harkin and danny davis introduce a bill simultaneously dealing with long-term care to remove the institutional bias so that people can receive care at home at 1/3 the cost. i am wondering if you're a person from "the political -- i am wondering if your person from "of the politico" can talk about if we can get this 12-year-old choice act through. we have the baby boomers coming, and we're not even ready for them. host: ashburn, virginia, laurie, on our democrats line. caller: hi. i had an opportunity to listen to the president's speech to the ama yesterday, and he said distinctly that he was not going to advocate a single-payer system but a choice like we have in the federal government, of care providers and insurers. but when i get my insurance statement for my yearly checkup with my primary care physician and i see the insurance companies have negotiated, my primary care physician gets less for my yearly checkup than my mechanic does when i take my car in for service? i think there's something wrong with my health system, and i am not sure how we're going to retain the high

you are going to hear from tom harkin shortly as it goes to the issue how do we get people to change lifestyles. you've spoken about this in the past how that may be the critical piece in the long-term implications bringing down costs and improving quality of health in the country so i think there is again one of those moments there is a great sharing of common principles in this bill. things we ought to be built to achieve and to and i can't say with all the details of the amendment but i think some concepts the ones we all embrace and share i think striking the whole section is where it gets an easy because there are very valuable sections senator mikulski has included that are important that go to the heart of what we are trying to achieve, so i would oppose the amendment but again, as barbara mikulski said there is an appreciation as a medical background and it's important to hear when you had to say. >> mr. chairman if i might, just one point is the process is causes an amendment like this. we are told here's a bill. i would much rather have gone through the bill piecemeal, but

but let me turn to senator mikulski and thank her immensely for the job that tom harkin and jeff bingaman and patty murray have done all along with others in developing these ideas and quality prevention coverage as well as workforce issues. i'm going to ask senator mikulski to lead the debate on this and we recognize her. >> thank you very much senator dodd and good morning to all of my colleagues here this morning we are taking up title to, the quality section. and after that i believe senator dodd it wants to proceed and prevention. these two titles go hand-in-hand and even interface with each other. once you hear the conversation we've had over the last several days has been related to the cost of health care. there is no doubt that it is skyrocketing. in we see as to all public health policy experts that the issues of equality and prevention could in the long term until late reduce the cost of health care while it increases health outcomes. in my area we focused on those issues, five big issues that were readily agreed upon by all as drivers with their needs to be improving in qualit

. >> since cdc was so much of the conversation and monday of this past week i spoke at the tom harkin conference center at the center for disease control in atlanta, i thought i would change what senator brown said. all of us have perceptions of what's going on out there sometimes that aren't correct. cdc -- and this is a guess -- but i would say probably 75% of cdc's funding is not reactive but it is proactive. and i think one of the things senator coburn is saying so well, and i'm thinking about myself, we fund the nih and the cdc and we put a tremendous amount of money in dod because we have a controlled group of people upon which you can do research, making determinations all the time on best practices that somehow never get through this clearing hois to get promoted. they kind of get stirred around and we add more money to them. rather than think of this as a negative approach, it's kind of saying -- and i'll be the first to say i don't know all those best practices, either, but maybe it's time we look at what we know before we put more money to find out what we already do know a

i strongly support congresswoman rosa delauro's bill, senator tom harkin's bill. we need to get that because it will change how we respond to the stimulus. we need a range of tools. i was giving a talk at google and went into the cafeteria and it was striking. there is either a red, yellow or green sign right in your face and i will tell you it has a real affect. red means eat small amount for taste, yellow, each a moderate amount common dream as much as you want. i was in charge of regulating food and i tell you it had a major affect on me. we have to change how we proceed stimulus and we have to have greater disclosure. we have to change -- we don't stop with just manual labor. what is served in the schools, with the vending machines -- parents, it's so hard you try as hard as you can and the kids are being stimulated with fat, sugar and salt. they have to change how we regulate advertising manual labor is a key step changing how we perceive the product. >> thank you very much. >> thank you. >> good afternoon. a quick question despite your comments on rules we c

and i have to say that i am pleased that senator kennedy has delegated this committee to do and tom harkin and who i have worked with him very strongly on the health and other and barbara mikulski worked on the american action everybody on this committee. this is a committee that this war to help people in america and i came to for the first for years we got into some scraps and we have been scrapping all these years we developed a great love for each other and frankly i pray for him everyday and wish him well and we do miss them. there are so many bills to put together that he is a master legislator. in answer you in some of the others in this committee. this committee does build good leadership because of the myriad programs -- the largest authorizing committee and the congress and was a privilege for me to chair the 21981 and 1987. lme take some time today and not be too long and take a few minutes to talk about them affordable health choice act. first and foremost the may make this point again even though concern to summon a broken record very reforming our health care system to insure

not everyone can do that but i think tom harkin is suggesting with his proposal over 10 years which is a fraction of health-care cost is to build into the system here and obviously for lack of a better and incentivizing employee but where rican is a look across the range of ages use can they think about this as well in terms of how women make a difference so when we talk about people getting out into what they're doing in terms of visible exercise that is a mandate requires investment in this area with an anyone suggest going to work perfectly in will be out government functions. we know there are dangers associated with this but deeply concerned that if we didn't make these investments were wounded or incentivizing people's personal behavior and responsibilities we're going to come up short of that going and actually changing lifestyles and getting people to reduce the cost. our system is entirely dependent upon people showing up in a doctor's office or hospital to get well. that is entire system here and we're fundamentally trying to alter that and incentivize the system this is you

>> the transparency and accountability and metric, that's a good point, but tom harkin has a good answer. >> first of all, there are a lot of different things that have been brought up that i'd like to respond to and i'll take it in order. senator burr brought up the medical coverage and we have it in the bill and also that we're working with the finance committee right now@@ hv@ @ rr@' >> can i point out one thing to my friend? >> yeah. two examples, real quick. the u.s. preventive service task force as it relates to psa exams says the evidence is insufficient for recommendation in men under the age of 75, yet the american cancer society and urology association offer it to all men over 50 years with a life expectancy of at least ten years. as it relates to breast cancer associated with mutation effects. the task force recommends against routine referrals for counselling and the routine screening for sus sent ability gene, testing for women whose family history is not associated for an increased risk for del torious mutations in breast cancer susceptiblity gene. the comprehensive cancer

what we need in rural western states is oftentimes different than what tom harkin mining and i along reckon i can't wu. >> mr. chairman kim and because there are different views and different problems and difference shortages. in general other shortages you bet. other petitioners in shortages and oklahoma we have done a good job with our p a program but not as good job of the earners practitioner program so it will allow the flexibility of the state's to decide where they want to put the money based on the shortage that they have. rather than washington to signing with what they are going to do so the whole idea is to move it out of here, but a closer to where it is going to be spent with the wisdom of the state's knowing how best to spend the money. so we strike all of the title with the exception of a commission in the state works worst of all the programs and i am willing to change that and to whenever you want but i think it is much more effective if we are going to have an impact on these shortages and were all well, as chairman is pediatrics of it allows them to really directed

i think tom harkin has told the story several times over the last two weeks we have been together about that part to position. cardiologists and iowa where it sank while our people lawyers to prepare in the answer said if you pay primary-care physicians what you pay me you have a lot more in primary care -- a pretty honest answer why we're not giving people for the reimbursement rates are what the profession pays. so my inclination and another will be a lot of amendments in the area we are talking about for the of our consideration to including senator mikulski is but i am supporting what senator murray is doing now because it will solve the problem. senator coburn is right, it's not good to solve the problem but it is still a major piece of this at least a significant piece of what the financial burdens of like that have influence on decisions he met alan brinkley said, i think it is a very good thing that we all seem to be on the same page. nco lot of disagreement in understanding there is a crisis and we have to move toward in a number of the runways. i mentioned for the record the b

mark -- tom harkin and barbara mikulski -- i didn't hear any differences on the principles of what we're trying to achieve and obviously there are means to achieve those but that's a pretty good place to begin and mike enzi said we're 80 percent of their beer and i will start a marked up with a present any day of the week. ultimately we were able to achieve that understanding with each other and so i am a great believer that the way you get there is to start doing it. if you don't start doing it than just sitting around talking with each other doesn't necessarily produce results and my intention is not to jam and a thing or $0.4 a thing but to go through a process whereby we can talk to each other and come to conclusions. i know the sats have had a chance to do with all of this yet, but senator enzi has indicated they will evenings and over the weekend, we have made some of 21 or 22 amendments to accept republican eminence and offers some propose already and are going to look at those and see if we can adopt agreement on 20 eminence before we have an amendment offered in the formal proce

vilsack, who i served with as governors in neighboring states and senator harkin's home state, tom vilsack was the to term governor and actually governor when i got elected and i learned a lot from him so there was a lot of collaborative discussion underway on everything from food safety issues as we've redesigned the food safety initiatives under the fda, looking at obesity, clearly food, nutrition and classrooms. a couple of programs you mentioned we haven't had on the screen yet but i think we definitely need to add those. the president is interested and committed to having cabinet secretaries work in a very interagency fashion leveraging the assets of the agencies and not replicating or duplicating programs that work well in one area but borrowing good ideas and trying to work together in a collaborative fashion. so i think you have made some important suggestions and i will certainly circle back with those with secretary of agriculture. >> the president's budget request creates or suggests there should be created a new mandatory t.a.r.p. program. under the current formula these bonds

tom? >> just a query of senator harkin. if our goal is to get everybody in health care with either government option or everybody insured and access, should we put a sunset on this, school-based health clinics if in fact we're going to create access through the rest -- should there not be a sunset that says in this that at some point in time, whether we do oral care or not, is there a timing point when everybody has insurance, everybody has a medical home, that we still want to continue to fund school-based clinics? >> let me -- go ahead. >> senator coburn, i don't know what your experience has been in oklahoma, but my experience in vermont has been that school-based health care is enormously cost-effective and it works really well. we have had not a huge number, but we have now two or three schools that do in-school dental care, phenomenally successful. you want to talk about success programs, these really have worked. so i'm a big advocate. this issue was raised before, that we have kids in schools where they don't even h

harkin. >> no. >> senator mikulski. >> no. >> no by proxy. >>er? bingham. >> no by proxy. >> senator murray. >> no. >> senator reid. >> no. >> senator sanders. >> no. >> senator brown. >> no. >> senator casey. >> no. >> senator hagan. >> no by proxy. >> senator berkeley. >> no. >> senator whitehouse. >> no. >> senator enzi. >> aye. >> senator greggg. >> aye by proxy. >> senator alexander. >> aye by proxy. >> senator burr. >> aye by proxy. >> senator mccain. >> aye by proxy. >> senator hatch. >> aye by proxy. >> senator macao ski. >> aye by proxy. >> senator kennedy. >> no by proxy. >> 10 ayes, 13 >> number 783. coburn number 73. >> this is just another level of trying to keep us accountable. since we don't want the states to do it, and we don't want to give the states flexibilities, how about if we find that a work force program is ineffective, allowing the secretary to say so and redirect the funds to where the program is effective? that's all this amendment does. if the secretary says this isn't accomplishing anything, we're throwing money

we combined the two and senator harkin as well. i'll ask unanimous consent that burr amendment number 3 as modified be agreed to. all those without objection so agree. one more, tom? >> yeah. i've got to find it. >> sure. go ahead. >> go ahead. >> sorry. i'm going to bump in front of my colleague here for what i hope will will be a quick amendment. this is my amendment number 10. this is as it relates to the right choices program, and as the language is drafted now now, the eligibility requirement is that the individual is 350% at the fpl, federal poverty level. i'm proposing that in an effort to deal with the costs of the bill that we have in front of us that we replace it with federal eligibility requirement of 200% of the federal poverty level. the amendment also includes that one of the criteria for eligibility be that the individual must have a chronic disease condition. and i recognize that that may be a negotiable proposal here. we are looking at this right choices program. it's been scored at $15.2 billion over ten years. i

tom, you've been terrific and a real help and others. senator harkin, i thank him as well. we don't have to go into evening and finish up 40 minutes, half hour. >> we're going to finish this now? okay, good. tomorrow we'll begin on wo workforce. that will be the goal. >> want you to go ahead, mike. start talking about it. >> i've been informed that i'm number 80, that that is kind of included in the burr amendment. >> okay. adopted? so we can drop number 80? >> yes. >> number 80 is gone. 80 is withdrawn. is this enzi 80? >> yes. okay. so i'd offer enzi amendment 50. >> enzi amendment 50. i have 51. >> while that is being passed out, i would say that is to ensure that the secretary conducts workplace wellness evaluations in publicly funded programs before evaluating the privately-funded programs. i'm not sure why we are having cdc evaluate programs outside of the government when we haven't evaluated the ones in the government, so this would ensure that we would have evaluated our own programs before we starts a cessing the value of the impact of the privately conducted progr

i don't know of my colleagues of be interested in having tom talked about the propension section. the vote does not occur until 5:30. over the weekend the staff worked very hard to break this down into themes within the prevention areas though it is more manageable to understand. actually, i gathered had some success in resolving effectively so we can have a good debate and discussion on this section. what i invite come to share some thoughts and views on a section of the want. it may be valuable for colleagues to hear that before we pick up in the morning. essays said, before you came in and johnny came in, my intention is and again i'm conscious of people's schedules and other matters, but my intention would be tomorrow to move to prevention with the amendments, to complete that tomorrow if we could or by wednesday morning. i would like to complete as much of this bill is because by the end of the week and these other sections, other, and it may be difficult because we need cbo numbers. i can't we'll bring it up without cbo numbers so i want to make sure all of my colleagues are

i appreciate tom harkin's efforts and the staff's efforts over the weekend to get to over 50 of those amendments. it certainly made today a lot easier and i think that the workplace issues, there is a lot of agreement in that area, anyway, but a few differences to work on, and we will try to finish up the fraud and abuse potentially tomorrow as well, and the long-term care, the two other remaining issues to try to get done. my goal is that i would love to get this done by tomorrow or thursday and then we will still have when we come back from the break, and i presume i will have these numbers and i'm not about to bring up language without numbers, so on the issues of the coverage, and including the pay gea go, we will have to have numbers. we have worked hard for this for two weeks and making progress. i am grateful to the members and particularly to staff. the staff has worked hard on this over weekendts and nights and when we quit to this table, a lot of people go back to their respective tables and plug away at this. so i am grateful to them about the time and effort. this is is a