Reforming Healthcare: The Latest Solutions from the United States Congress
Major congressional stakeholders and influencers will come together in New York for a public forum on how to achieve bipartisan healthcare reform that benefits all Americans. The main participants are authors of four major pieces of healthcare legislation now making the rounds in Congress: the Healthy Americans Act, Bob Bennett, U.S. Senator, Utah (R) and Ron Wyden, U.S. Senator, Oregon (D); the Every American Insured Health Act, Richard Burr, U.S. Senator, North Carolina (R); the Universal Health Care Choice and Access Act, Tom Coburn, MD, U.S. Senator, Oklahoma (R); and the United States National Healthcare Insurance Act, John Conyers Jr., U.S. Representative, Michigan (D).
They will be joined by Bob Kerrey, President, The New School; former U.S. Senator, Nebraska (D), who currently co-chairs with Newt Gingrich the National Commission for Quality Long-Term Care, an independent body charged with developing long-term care solutions at a time when a disproportionate percentage of health care dollars are spent on the elderly- The New School
The Honorable Bob Bennett
Bob Bennett served as a U.S. Senator from the state of Utah from 1993 until 2011. He was a senior member of the Senate Banking Committee and a member of the distinguished Joint Economic Committee, where he was at the center of national economic policy discussions. He also served as the ranking Republican on the Senate Rules Committee and as a member of the Senate Appropriations
Committee, where he worked to balance fiscal discipline in government with the needs of maintaining a strong national economy.
Senator Bennett is a highly successful entrepreneur. Prior to his political career, he served as the CEO of Franklin Quest, Inc., where he grew the business from four employees to more than 1,000,
and got it listed on the New York Stock Exchange. In addition to his success at Franklin Quest, he has been a key participant in multiple private and publicly held companies. His success has been based on his ability to see clearly the inter-dependence of private enterprise and an expanding national economy.
Senator Richard Burr is the sponsor of the Every American Insured Act, a proposed legislation on healthcare reform. Elected to the U.S. House of Representatives in 1994, he established himself as a passionate legislator on health care issues and worked to restore accountability to the federal government. As a North Carolina Senator, he is dedicated to finding common-sense solutions to increase access to affordable, quality health care for all North Carolina families. Senator Burr is a vocal advocate for our men and women in the military and their families, and for the growing population of veterans across North Carolina.
He serves as the ranking member of the Senate Veterans Affairs Committee working to improve the quality of health care and service veterans receive. Senator Burr also sits on the Senate Intelligence Committee; the Health, Education, Labor, and Pensions Committee; the Energy and Natural Resources Committee; and the Indian Affairs Committee.
Senator Tom Coburn is the sponsor of Universal Healthcare Choice and Access Bill, a proposed legislation on healthcare reform. His priorities in the Senate have included reducing wasteful spending, balancing the budget, improving health care access and affordability, and protecting the sanctity of all human life.
He is a member of the Senate Judiciary Committee; Homeland Security and Governmental Affairs Committee; the Indian Affairs Committee; and the Committee on Health, Education, Labor and Pensions. As a medical doctor and a citizen legislator, Senator Coburn has pledged to serve no more than two terms in the Senate and to continue to care for patients.
Representative John Conyers, Jr., is the sponsor of The United States National Health Insurance Act (HR676). Representative Conyers, in his 21st term, is the second most senior member in the House of Representatives. For more than three decades, Representative Conyers has led efforts to reform the health care system. He is the founder and chairman of the Congressional Universal Health Care Task Force, a 45-member caucus whose mission is to pass universal health care legislation. Currently, Representative Conyers is working on legislation that would protect workers' pensions and health care in cases of bankruptcy such as those involving Enron, Worldcom, and National Steel.
January 1, 2011, Bob Kerrey completed his tenure as seventh President of The New School, a university founded on strong democratic ideals and daring educational practices, an environment that was well suited for his leadership. He also served as New School's President Emeritus from January 1, 2011 to January 31, 2013.
Prior to coming to The New School Bob Kerrey represented Nebraska in the United States Senate. For two terms, Senator Kerrey emphasized the direct connection between citizens and their laws, and made a concerted effort to allow Nebraskans to participate in writing laws that defined the quality and inclusiveness of their health care system, their schools and the safety of their communities. He served on the Senate's Agriculture and Forestry Committee, Senate's Appropriations Committee, Senate's Finance Committee, and last but not least on the Senate Select Committee on Intelligence where he worked to restructure our intelligence agencies to improve their capacity to meet the threats faced by our country. Prior to serving in the U.S. Senate Bob Kerrey served a single term as Nebraska's Governor. He established a reputation as a fiscal conservative who regularly crossed political party lines for the good of Nebraska and the Country.
Bob Kerrey served three years in the United States Navy. While in Vietnam, he was wounded, permanently disabled from the injury, and from this injury received a great gift: Sympathy for those who are suffering and an appreciation for the capacity of government to save your life. Before his time in the Navy Bob Kerrey attended the University of Nebraska graduating in January 1966 with a BS degree in pharmacy. He was born in Lincoln and attended public schools there. In 2002 he published a memoir "When I Was A Young Man."
Bob Kerrey is married to Sarah Paley and lives in New York. The couple has a 12-year-old son, Henry, and Mr. Kerrey has two children from his previous marriage, Ben and Lindsey Kerrey, and four grandchildren.
Ron Wyden is a US Senator (D-OR) and a respected voice on health care, technology policy, natural resources, and consumer advocacy. He serves on the Senateâ€™s committees on Finance, Select Intelligence, Budget, Aging, Energy, and Natural Resources and on subcommittees on Forest and Public Land Management and Science, Technology, and Space. Previously, he served for 15 years in the US House of Representatives, representing Oregonâ€™s third congressional district. A graduate of Stanford University and the University of Oregon School of Law, he has taught gerontology at several Oregon universities and was the founder of the Oregon chapter of the Gray Panthers.
A very interesting point about "defensive medicine" came up when they talked about who is responsible for decision making for defensive medicine: are law suits or doctors the people making the decision on tests? Do doctors actually ask for "unneeded" medical tests merely because they are afraid of a lawsuit? What does that mean if they do? What is the definition of "unneeded"?
If a doctor says a test is unnecesssary, then isn't that also making a cost-benefit analysis about whether the test will provide needed information verses the cost of the test? If a doctor was really convinced that a test won't provide the information, then the doctor never orders the test. But the question is about when the test "might" give information and the doctor has to decide the percentage of value about what can be given by the test, whether or not a lawsuit might be involved. But if a doctor says, "I better ask for this test because a lawsuit my hold me liable if I didn't" then isn't that something we want? I don't want my doctor saying not to do a test that might give the information just because the doctors says "well, there's only a 20% chance that this test will give me the information I need, so I won't order the test." The doctor must be able to know the problem. I don't want my doctor saying, "I'm going to treat your problem as if it is XYZ but there is a 30% chance I'm wrong, and that test has a 30% chance of showing I'm wrong but I'm not going to ask for that test because .......(fill in the blank)."
To think outside the box, I'm interested in the comment about the cost of health care being able to give $200,000 per doctor per zeven families. While I'm not to gullible as to take this at face value, because it doesn't realistically divide up health care costs, such as hosptial machinery costs that don't go to any individual doctor. Still the idea of having per patient relationships for doctors is interesting and worth brainstorming. What would be a realistic number of families for a doctor to have and get a guaranteed income from a nationalized or regulated health care system? That is a very interesting question.
Good afternoon. My name is Bob Kerrey. I am President of The New School, still. And I want towelcome thank you all for coming here and I am going to welcome especially our our paneliststhere will be one additional panelist that is not John Conyers have just set down but but John willbe joining us how soon? In about 10 minutes John will be here. What and - on the panel right nowwe have, Senator Ron Wyden and Senator Bob Bennett, they have introduced legislation, they aredealing with health care and Senator Tom Coburn from Oklahoma and Richard Burr like if I can get it out herein a minute from North Carolina is here as well. I very much appreciate not just their willingness to talk to usabout this extremely difficult of difficult issue of health care. But the courage that takesto simply to introduce legislation today, it should not go either unnoticed or unappreciated.I am going to ask each of them to get up and describe their legislation and then we will have a littlepanel discussion and I want to point out that Richard Burr has to leave at 3:30 he has got a catch ashuttle to get back down to to Washington for a 6:30 meeting. So when he gets up and leave, it's notbecause he is angry with something that I have said, or you have said or - he is an appreciative of theopportunity to talk to because he has to go out to La Guardia I believe he will catch a shuttle back to DC. RonWyden of Oregon is a co-sponsor along with Bob Bennett of the healthy American's act. Thisact briefly describe and allow individuals to choose the best private health plans of their needs whileplacing emphasis on wellness, prevention and disease management. Bob Bennett is a co-sponsor of thisbill. He is from Utah, Ron is from the state of Oregon and in addition to what I have described - his acttheir act proposed to offer high quality, permanent health care with no increase in cost and I toldthe senators before coming out here that just in the past couple of weeks we have been wrestling with abit of a problem we have The New School, we had a 23 percent increase in our in our health insurancepremiums, that will take effect in January 1, so anything that will give us no increase in cost gets myattention right away.Senator Tom Coburn of Oklahoma is a sponsor of the universal health care of choice and access bill.This bill seeks to create the same innovation and competition in health care that we see in otherAmerican industries there by creating a greater access to better care at lower prices. John Conyers ofMichigan who will be joining us shortly is a sponsor of the United States national health insurance actwhich expands on our current Medicare program to offer, publically financed, privately deliveredquality health care regardless of an individual's employment, income or health care status. SenatorRichard Burr of North Carolina is a sponsor of the every American insured health act which wouldprovide all Americans regardless of income or employment with a flat tax credit enabling them topurchase affordable patient focused health insurance of their choice, I hope Senator Wyden that youand Senator Bennett's idea of this becoming the first series of opportunities for citizens themselves tohear from all of you who are wrestling with this issue to hear your specific proposals. We are fortunateto have all five of this individuals here today to talk us about an issue that if if I am any judge or thefuture is going to get more difficult to resolve, not easier to resolve going forward.Just looking at Medicare alone, Medicare costs in 2007 was and Medicaid cost together were $628billion - Medicare was a federal program for health insurance, Medicaid as a federal state programlargely administered by the states, Medicare is a non means tested program based upon 10 quarters ofwork of contributions that are made by individuals in the work force. Medicaid is a program thatwas originally designed as a as a anti poverty program administrated as I said by the states but fundedjointly by the states and the Federal Government.This is the first year that the baby boomers began to become eligible for social security, I think 62 is isthe first year of eligibility for early eligibility, they started drawing benefits under social security thisyear, in three years the baby boomers will start to become eligible for a Medicare and over the next tenyears the $628 billions for Medicare and Medicaid will grow to a trillion $271 billion. It's atremendous challenge, because that that obligation is mandatory, it's required under law and it willgive Senator Coburn you have a lot - less opportunities to go and object to appropriations in thatbecause since we are a lot fewer of them as a consequence of that growth. The challenges seems to meis contained actually in what I hear a lot which is the promises when you see hear the presidentialcampaign on both sides and what we are going to give you is high quality affordable healthcare and it wascontained in that statement a conflict because healthcare, if it's high quality it have to be expensive andthe challenge is meeting the promise of of those words - it is an exceptionally complicatedsystem, it's an exceptionally a demanding system about the bottom line and senator Wyden whobecame all of you know that, but he married a women whose family owns a strand book store righthere and she flew out to Portland Oregon last week and on Friday delivered twins Will and Eva wereborn on last Friday.Pictures available after the program.All right, his father came here from father and mother came here from Germany and moved toWichita, Kansas, so that was an usual move, I don't know the details of that one but he has got deepNew York roots and has a recent experience, now will the healthcare system I askedSenator Coburn who is a an obstetrician how many babies he has delivered and hisanswer was 4000, I think that was the answerearlier, so I think all of you have both personal and policy experience with this issue,otherwise you would not have run the risk of introducing a bill trying to solve this problem. So I verymuch appreciate your coming here, I very much appreciate the attention to this issue, and I would verymuch appreciate it if you would - Senator Wyden would take over tell us about your bill.Thank you very much President Kerry and I I want to start by saying that I was following the eventshere at the New School, the last ten days and some of the decisions that were made and the first thingthat occurred to me is that the senate's loss is the New School's gain. You are very, very fortunate tohave President Kerry and the reason we wanted to start this discussion is the new school's tradition ofhaving open debates on critical issues. The New School has recognized particularly on healthcare thatwhile the presidential candidates can orate about healthcare, somebody's is going to have to legislate.And the five of us who are on this program have different views as you are going to find out over thenext couple of hours, but all of us share a common desire to work in a bipartisan way to after 70 yearsof discussion which goes back to Harry Truman 1945, the 81st Congress, the common bond among thefive of us is we want to fix healthcare and we know to do it, you have to work in a bipartisan way.Now President Kerry asked us to give a brief discussion starting with what is the heart of the problemin healthcare? And I would sum it up by the way of saying that our country has a vacuum tube erahealthcare system for a micro chip world. You start with the fact we are the only country on earth whoprimarily throws the burden on to the back of employers, to the fact that there is a bias for sick carerather than healthcare and finally the incredible reality Bob made mention of the fact my wife ownsthe strand book store, so I watch for example, the relationship with amazon.com. I could tell youamazon.com knows a whole lot more about the buying habits of their customers, than people know -than providers know about their patients with respect to their healthcare needs. So Senator Bennett andI have decided we, want to change this, we introduce the first Bipartisan Universal Coverage Bill in 13years in the Senate. There are nine Senators on the bill, so we got nine percent of the senate and thelegislation covers all Americans who are not on Medicare or in the military.And in effect what we do is we make it possible for all Americans to have private health care choiceslike they are members of congress. Under our legislation all American could have a card like this theWyden twins will be covered under this and they could choose Kaiser, Aetna, or anybody else that theysought to go with. We hold down the costs for the coverage with that card by fixing the broken privatehealth insurance system so that private insurers compete on the basis of price benefit and quality, notjust who can pick the healthy people and sent the sick people over to government programs morefragile than they are.We hold the administrative cause in our system with that card down to 3.4 percent, this is also on ourwebsite, on Senator Bennett's and my website and the independent authorities who study these bills saythat we also achieve very substantial, additional administrative savings by running the whole programthrough withholding, so in effect just as you have withholding today for social security and the moneymoves off into the world of electronic transfers, that's how it work under the healthy American's act.There is personal responsibility so that people do make their own choices in the health system, but weredirect the $225 billion in tax expenditures that now goes mostly to the affluent and subsidizesinefficiency, we redirect that money to the middle income people and those in the lower middle incomebrackets so that they can afford their - their coverage. So the bottom line is, this proposal will save justunder $1.5 trillion over the next 10 years as it expands coverage and that is all outlined by the Lewingroup. Last point that I would make is this, we are spending enough money today on health care, weare not spending it in the right places.This year, America 300 million of us will spend $2.3 trillion on health care. It divides 300 millioninto 2.3 trillion and we could go out and hire a doctor for every seven families in the United States. Wepay the doctor $200,000 a year and the doctor would take care of seven families. Every time I bringthis up with the physicians they say, "Ron where do I go to get my seven families?" because they liketo be physicians again. So we look forward to the discussion, we particularly look forward to workingwith our colleagues, nine United States Senators, five republicans and four democrats have joinedSenator Bennett and I Bob, is it your theory that will just go right down the row or how do you want todo it in terms ofActually it's more than a theory, that's what I would like.All right so Senator Bennett, you don't have to be a tall person to be a supporter of the healthyAmerican's act as well. My colleague - incredibly important and influential member of the republicancaucus in the United State Senate welcome Senator Bob Bennett.In addition to the height, the one thing I share with Senator Wyden is that I too am a father of twins.And I have told him based on real experience there are no economies of scale. So when it comes to thelate night feedings and all the rest of it, it's exactly twice as much work but hanging there, they do growup. Let me focus on one aspect of this bill that has particularly attracted me that I want you to thinkabout on a conceptual fashion, if you want all the details of the bill, go to our websites and we can fillyou in. the thing that has bothered me about healthcare from the very beginning when I first gotinvolved in this debate, when I first started running for the senate back in 1991. This is the only portionof our economy where the individual receiving the services does not control the money that pay for theservices and as a consequence, market forces which have been so influential in all of the rest of theeconomy in achieving a variety of economies and direction don't apply. It took me a while tounderstand that in conversations with healthcare providers because I come from the business world. Iam one of the few members of the senate who is unburdened by a legal education, I am a business manand I come from the business world where I see how the market really works and it took me a while tounderstand that what the providers talk about when they talk about the market is not the same thing thatthat I talk about when I talk about the market. I naively assume that the market for healthcare wereindividuals who were sick. For the providers, the market, and the insurance companies and theemployers who pay. All right, those who pay have a different agenda than those who want the services.Those who pay have as their primary agenda holding down the costs. Bob Kerry, that's his bigconcern, 23 percent increase. Those who receive the services have as their primary agenda getting theservices they can.Paradoxically, it is true in healthcare President Kerry did the contrary now withstanding higher qualitymeans lower cost. Why is that? Well, there are a bunch of reasons and Dr. Coburn can probably explainthem better than I can. But let me just take one example heart transplants, as I got looking at this, thisis very esoteric part of healthcare. As a general rule, the place where you get the cheapest hearttransplant is the place where you will get the best the best medical result, why? Because that's theplace that has done the most of them, if you go get a heart plant transplant some place in rural Utah,they have probably done only one or two in the whole history of that hospital, and it's very expensiveand the chances that they know what they are doing are not nearly as good, as if you get a hearttransplant some place where they do two or three a week, or even two or three a day and as they keepdoing them and the volume goes up, their price comes down as their quality increases andparadoxically, the place where they charge the most is not necessarily the place where you get thehighest quality.We don't have transparency in healthcare transactions, so we don't know anything about cost andquality. We don't know who does the best job because those of us who want the services are dependentupon those who are paying the price to make the decisions for us. Now Senator Wyden has held up hiscard and said, "We have choices in the federal government" and that's true. But our choices are limitedto the attitudes of the providers that, or employer the federal government has decided to endorse. Ifwe had choices or we could go where ever we want, or practically we have a range of choicesbrought enough that we like it, but if the individual who is buying the services controls the money thatpay for the services, you will see a paradigm shift. So the thing that impresses me the most aboutSenator Wyden's legislation which I am happy to co-sponsor is that it breaks the link between theemployer and the employee as far as control of the money is concerned and I won't get into the detailsof how you can hang on to your employer coverage, if that's what you want, but the main point is theemployee makes the decision as to where the money is going to go. And if the employee finds himselfat one HMO where he has to wait in the waiting room for four days before anybody will see him andthen when he does show up it's another four hours before the doctor shows up and then when it comesin who is somebody that doesn't seem to know what they are doing, the employee can say, "I amtaking my money down the street to another HMO where they will let me in the same day, I will beseen within 15 minutes and the person who talks to me is interested in me", which will cause the firstHMO to say, "wait a minute, we are going to start losing this business if we don't shape up". But underthe present system, if you don't like the HMO you are in, you are stuck because your employer hasmade the decision that's the HMO where you will be in and you have no control over it and there is nomarket force to say to that HMO you should change because as long as the employer has made the dealwith you, what you do with the patient makes little or no difference and the other thing that is essentialabout this is that if you get control of the dollars, if you get control of how you are spending for healthcare you are no longer stuck with the job you hate. I ask this question in all my town meetings let merun the risk of seeing if the answer is the same in New York. How many of you are, or know someonewho is stuck in a job he or she hates because they feel they can't leave for fear they will lose theirhealth care insurance?Ah, you are just like the people of Utah. Most of you know some one like that. the key thing of thehealthy Americans act along with all of the things that Senator Wyden has talked about is that it putscontrol of the dollars in the hands of the people who are buying the services and that will transformtheir lives and it will transform the market place for good. And that is the direction in which I think weought to go - Dr. Coburn.Thank you and good afternoon. Ron, congratulations, I have only done that about 60 times, deliveredtwins. So I know exactly what the parents are feeling. I think it's really important the one of thegreatest areas that we are at risk for in our country is our health care. In terms of costs, people areunhappy with the costs, some times they are unhappy with the access sometimes they are unhappy withthe quality but on whole, we have a pretty good health care system, but it costs way too much and wehave a limited choice and what Senator Burr and I have designed is a system that addresses the majorproblems every major problem that our health care system faces - every one and offers a solutionthat's based on freedom that's based on competition and that's based on quality.It also is based on compassion. When you tell a veteran, you are going to give him health care, youought to give him health care and what we do is, we allow veterans to go where ever they want if theyare not getting what we are supplying through veterans. So that's just an example of it. We do spend,$2.3 trillion on health care, but only 70 percent of that goes for health care. So the question ought to beis how do we how do we take that $2.3 trillion? And make sure we go into health care - and what ishealth care? Health care has got to be prevention as we have this demographic shift of my age, babyboomers and of Medicare, if we don't start emphasizing prevention, there is no way we can design thesystem or we can afford the health care at he level of which we have become a accustomed orunaccustomed in this country. So we have to change the paradigm in health care in this country. Whatgrandma said an ounce of preventions worth pound of cure and we need to reorganize the federalgovernment in terms of prevention. And what we can do, that's a legitimate role for the federalgovernment. But it is not a role for the federal government to start making your choices for you whichis what all the other plans do. They don't do that directly, they do that indirectly by limiting the type ofplan you can have. What our plan says, you can have any plan you want.Ron's bill actually says, we are going to trust the insurance companies to do a good job for you. Thecongressman Conyers says we are going to trust trust the government. Our bill says we are going tolet you make great decisions. Now, if you look at every aspect of our economy and I believe Ronmentioned this or Bob did is that we trust markets in this country. When they are when they are oversided properly and looked at properly, markets allocates scarce resources. And what we want is truemarkets. But if we limit the capability of markets, then we are not going to get an allocation to that andI am talking about accountability, have you ever asked yourself the question why is it that the doctorsknow who the bad doctors are, but you don't? Have you ever asked that, why the hospitaladministrators know the bad hospitals but you don't? It's because we don't have market forces sayingyou have to demonstrate quality, we have to demonstrate competency and you have to demonstrateprice and so we create a system that gives a tax credit treats everybody in this country exactly thesame. If you are a multimillionaire you get the same tax credit, and if you down on your line and itgoes for healthcare, and it buys everybody who want they want - now what the government tells youmust had, and if you choose not to buy it we will allow your straight opt into a default policy of youchoose not to buy it, so that you don't have, and you don't become part of the 200 billion dollars a yearin cost shifting in this country.Our bill the first year is in effect was cut the healthcare cost $200 billion, a $1000 per person in thiscountry in terms of their insurance cost, just by eliminating cost shifting. It will create in us in senatewhere we take the Medicaid stamp of the foreheads of the poor people in this country, because weallow the Medicaid money plus the tax credit to go enhance the ability of those less fortune that to getthe best healthcare in the world. And we - and it cost nothing it cost nothing. So what we have doneis design a plan that's based on quality, based on prevention and in stabilizing prevention, now we haveto talk about that we get into that, and based on a accountability and transparency, with the individualAmerican get in to the side what they want to do, rather than have the government run it or governmentsay what you must as a minimum must have. It's different for me. I am a two time - two time cancersurvivor the latest colon. I am going to want something different than somebody to have lessrisk factor for me.Why would I want the government to decide what plan I would want? Why wouldn't I be able to dothat? And you are going to we are going to hear about mandates we have mandates for out ofinsurance in the every state in this country yet 15 percent of the people don't have all the insurance. Somandate didn't work and if talk about administrative cost, three percent administrative cost that whywe have Medicare now, we have 45 billions dollars worth fraud. So it's not a real three percent, its 13percent administrative cost in Medicare when you figure figure in the fraud. So markets work itsworked in every other thing what we have to have this transparent markets and addressee governmentthat will make sure the markets are transparent. Thank you.President Kerry Jesus that sounds pretty good.You ever thought about that?Let me bring you greetings from North Carolina, and thank my colleagues what what I think is thenumber one domestic issue in this country. And an issue that members of Congress run from like theplague, why? Because it takes a great deal of time or either a profession like Tom Coburn, to give youthe knowledge you need to confidentially talk about healthcare, and I listen to Bob Kerry's firstcomment, 23 percent increase in the cost of healthcare for the employees of The New School. WellBob you are not you know when you buy yourself. For the last decade we have heard employers talkabout it, and specifically not the effect on them, because it's a deduction. But on the employees and theshift, an additional premium cost that there haven't a shift over to their employees.Now our current system let me ask you just to focus on it. Private insurance, that currently triggerswhen we get sick. That's not a design for product that produces results from prevention and wellness.Our our health insurance today is designed to only trigger when we get sick. First it tells you that youneed fundamental insurance reform in this country. The products have to change the products have toreflect what people want. Now what government wants, federal or state? Not the corporations wantbut what - we is individual's need more importantly what our healthcare needs our income and our ageare. And now I had a first hand experience just recently. It's hard to believe that I have got a 22 yearold, but I do it. Looking Ron with twins among this, but reality is I got that notice from the federalgovernment and we are supposed to have the best healthcare in the world, trust me. When I left theprivate sector Bob, the two of us are out of business. I actually got a coverage with the same companythat I had my insurance with in a company of less than 50 people, and the only difference was I had thesame coverage paid, the same percentage of the premium, only the percentage when up when thefederal government negotiated that healthcare cost. So I get a notice last year that my son is going to be22 years old, September of that year. And based upon federal laws he he automatically is dropped formy insurance regardless or whether he is still at college or not. So I immediately called over and I saidI am sure that we have got some type of transition plan that you have negotiated on behalf of all thefederal government employees. Thus all all three main federal employees are under the same plans,and they said, sure we do.We have negotiated the exact same plan is under, how much is it? $5400, 22 years old healthy as aboveis that kid that probably if should task with pay and pointing himself would say don't need it. Iimmediately call the University of North Carolina and I had to mention competitors and said geezyou have got to have something that negotiated on the half of your students, sure we do. They gave menumber to call, I found they negotiated the same plan, same plan he was under under my plan as themember of Congress. I said what's the cost? $1400 a year, I say $4000 for two phone calls. One thatshocked me was what the Federal government negotiated, the second one, what a college thatunderstood who in fact they were insuring and that was 22 21 20 year old healthy kids, moreimportantly they understood that they couldn't afford the cost and they went to the table to negotiate onbehalf of the individual who is the policy holder. Amazing realization on man power that when youhave got the individual in mind and negotiations, all of a sudden the negotiations change.Well Tom is right but two things that we to accomplish in healthcare reform, one is transparency andtwo is competition. It amazes me the democrats talk about turn it over to the Federal government.Republicans talk about turning it and what they insures what do we up here talking about, turning overto the American people. Letting them be the ones to decide, making sure that we force to reforms - thestructural reforms in the system in insurance, products, so the prevention and wellness plays the centerpiece of the coverage that everybody would have. And let me caution here today. We are all going tomake it sound really good. That's our job, because we believe in the products that we sell. But that wasthat was in the details. You have to read this bills you have to study it, you have to - look it yourcircumstances and ask how does it affect me? I can only speak for time in myself, we have constructedto build - covers everybody in the country, they didn't cover some, it provides the resources for everyAmerican to go out and negotiate their coverage. Does it in a budget neutral way? We are not puttingmore real tax dollars into a system to provide this for anybody. Here we shift them around, because wedrastically changed the system, we do refundable tax credits. Lot of people don't like it. Well, I havenever figured out how to give the tax deduction to somebody with no income unless you just give theman outright cash subsidy. And to give them an outright cash subsidy you have got to steal it from some where.Reality is we will make in tough choices, and we are doing what members of congress not normally do.We are throwing ideas on the wall, because we all believe one thing that if we don't change healthcarein this country the healthcare you and I have and our children will not resemble what we grew up with.Look around here today in any market in this country and ask yourself do we have the specialist inevery area that we need to treat the population. Where our shortages OB-GYNs. Ron knows that,Neurosurgeons, Thoracic surgeons, individual that treat, Americans that get older andreplenishment of the population, that couldn't be two places. That we are more vulnerable to haveshortages, then the two places that we have got it in our system today, if we don't change it who isgoing to try in the next generation of doctors it comes through. Its in everybody's best interest in thiscountry that we engage in this debate and in an honest and thoughtful way, but at the end of the day wecome out with solutions. Thank you very much.Well done and I am John Conyers. Ladies and gentlemen I am John Conyers. And I have I am goingto make the case for his bill even though I haven't read it, I have a general idea what he is trying to dowhich is I think single pair proposal puts all of us into Medicare. So we can start off with great respectfor my colleagues, blah-blah-blah oh I meant that I meant that blah blah blah and say - thequestion for all of you is really whether or not you trust the market place to deliver your health care andif you do, and you got to love most of the proposals you have heard today and I am my argument isthat there is something that only the government can do and there are that only the market can do andthat health care is not like buying a car, not like buying a suite or cloth but it's a different kind ofpurchase when you are taking your wife to a hospital to deliver your baby, when you are taking overyour mom to a hospital and have her treated for a cancer. Or when you are taken yourself to a hospitalto be diagnosed and treated, you are not shopping any longer. You are dealing with a life and deathconsequences of the decisions that that doctor and that hospital will make, that's my argument. It's adifferent kind of thing, service that we are buying and so my I argue that you should havesubstantially more government. I am making the case fore more government involvement.Substantially more government involvement than we currently have and I don't believe you can get toa point where you will feel safe. All those of you who have raised your hands saying you there wasNew School in place raising your hand saying, there is now me being Bob Kerry again. But I knowemployees at the New School, who are only here because of health insurance, somebody love it besidesbut it's very - very difficult and the only way you are going to get to a point, I don't believe that you getthere with any proposal that I have heard here today, what you know for certain is that you change thelaw the federal law, so the only thing which you have to prove in order to be eligible for some kindof subsidy if you need it. and if you don't need it, you won't get one - is to change along, so youbecome eligible as a result of proving that you are an American or a legal resident.Under current law you have to prove that you are old enough, that's Medicare, that you are poorenough, that's Medicaid, that you work for the right employer, that's the employer based tax system,that you got blown up in a war, Bob Kerry is sitting over there, got blown up in a war, the guy that wasnext to him, didn't get blown up, he is not eligible and once that eligibility is determined, you can goanywhere you want. That's where the market can take over, that's where the transparency, that's wherethe prevention and all the other sorts of things that had argued up whether you need and this system cantake over. But unless and until you would pass a law that says the only thing that you know toprove is being an American legal resident, you will never get to where you want to go. Now that means for allof you who have embraced Medicare and want to hold on Medicare as exactly as it is, you are notgoing to be happy or the VA system, the income tax system or the Medicaid system. We have triedover the series of the last 60 years to solve this problem by satisfying one group or another. Bydelivering to a group of elderly, a group of poor, a group of veterans, a group of employers, the thingthat they wanted and needed. As a consequence, we are the only industrial nation on earth that doesn'thave a health care system. We don't have a health care system. We have got individual systems reachto these programs. So my proposal is to create a United States health care system.And I am perfectly willing by the way to accommodate some of the terrific ideas that I heard heretoday in particular to improve the transparency of Medicare and in particular to create incentives forpreventions in - in order to monitor and hopefully get better outcomes and we look at the outcomes,the United States of America relative to other industrial nations. It's it's pitiful. It spend $2.3 trillionand we are among the most unhealthy people on the planet. Some thing is wrong and I am sayingwhat's wrong is the federal law that disaggregates and say that you got to prove a different system of eligibility.Remember, that a group is put together for health insurance because what you are trying to do is spreadthe risk. And one of those concerns that I have got with Senator Wyden that now I am back to BobKerry now. And when you say, you going to break the link with employment, I get sort of excitedabout that when you say that you could have the option of staying with your your employer, what Iam afraid of is my healthy people are going to go out and buy some thing else and my unhealthypeople get they think 23 percent increase is too much, it will 40 percent the next you are out. Thesafety comes with the group - and I am John Conyers again. I am proposing I am proposing a groupof 300 million Americans, that's the group that I would like to say. And once we are all in the samegroup, planning by the same rules we are more likely to ask for the things that are beneficial not just forus but for everybody in the United States.