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Good afternoon. My name is Bob Kerrey. I am President of The New School, still. And I want to welcome thank you all for coming here and I am going to welcome especially our our panelists there will be one additional panelist that is not John Conyers have just set down but but John will be joining us how soon? In about 10 minutes John will be here. What and - on the panel right now we have, Senator Ron Wyden and Senator Bob Bennett, they have introduced legislation, they are dealing with health care and Senator Tom Coburn from Oklahoma and Richard Burr like if I can get it out here in a minute from North Carolina is here as well. I very much appreciate not just their willingness to talk to us about this extremely difficult of difficult issue of health care. But the courage that takes to 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 little panel discussion and I want to point out that Richard Burr has to leave at 3:30 he has got a catch a shuttle to get back down to to Washington for a 6:30 meeting. So when he gets up and leave, it's not because he is angry with something that I have said, or you have said or - he is an appreciative of the opportunity to talk to because he has to go out to La Guardia I believe he will catch a shuttle back to DC. Ron Wyden of Oregon is a co-sponsor along with Bob Bennett of the healthy American's act. This act briefly describe and allow individuals to choose the best private health plans of their needs while placing emphasis on wellness, prevention and disease management. Bob Bennett is a co-sponsor of this bill. He is from Utah, Ron is from the state of Oregon and in addition to what I have described - his act their act proposed to offer high quality, permanent health care with no increase in cost and I told the senators before coming out here that just in the past couple of weeks we have been wrestling with a bit of a problem we have The New School, we had a 23 percent increase in our in our health insurance premiums, that will take effect in January 1, so anything that will give us no increase in cost gets my attention 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 other American industries there by creating a greater access to better care at lower prices. John Conyers of Michigan who will be joining us shortly is a sponsor of the United States national health insurance act which expands on our current Medicare program to offer, publically financed, privately delivered quality health care regardless of an individual's employment, income or health care status. Senator Richard Burr of North Carolina is a sponsor of the every American insured health act which would provide all Americans regardless of income or employment with a flat tax credit enabling them to purchase affordable patient focused health insurance of their choice, I hope Senator Wyden that you and Senator Bennett's idea of this becoming the first series of opportunities for citizens themselves to hear from all of you who are wrestling with this issue to hear your specific proposals. We are fortunate to have all five of this individuals here today to talk us about an issue that if if I am any judge or the future 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 $628 billion - Medicare was a federal program for health insurance, Medicaid as a federal state program largely administered by the states, Medicare is a non means tested program based upon 10 quarters of work of contributions that are made by individuals in the work force. Medicaid is a program that was originally designed as a as a anti poverty program administrated as I said by the states but funded jointly 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 is the first year of eligibility for early eligibility, they started drawing benefits under social security this year, in three years the baby boomers will start to become eligible for a Medicare and over the next ten years the $628 billions for Medicare and Medicaid will grow to a trillion $271 billion. It's a tremendous challenge, because that that obligation is mandatory, it's required under law and it will give Senator Coburn you have a lot - less opportunities to go and object to appropriations in that because since we are a lot fewer of them as a consequence of that growth. The challenges seems to me is contained actually in what I hear a lot which is the promises when you see hear the presidential campaign on both sides and what we are going to give you is high quality affordable healthcare and it was contained in that statement a conflict because healthcare, if it's high quality it have to be expensive and the challenge is meeting the promise of of those words - it is an exceptionally complicated system, it's an exceptionally a demanding system about the bottom line and senator Wyden who became all of you know that, but he married a women whose family owns a strand book store right here and she flew out to Portland Oregon last week and on Friday delivered twins Will and Eva were born on last Friday. Pictures available after the program. All right, his father came here from father and mother came here from Germany and moved to Wichita, Kansas, so that was an usual move, I don't know the details of that one but he has got deep New York roots and has a recent experience, now will the healthcare system I asked Senator Coburn who is a an obstetrician how many babies he has delivered and his answer was 4000, I think that was the answer earlier, 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 very much appreciate your coming here, I very much appreciate the attention to this issue, and I would very much 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 events here at the New School, the last ten days and some of the decisions that were made and the first thing that occurred to me is that the senate's loss is the New School's gain. You are very, very fortunate to have President Kerry and the reason we wanted to start this discussion is the new school's tradition of having open debates on critical issues. The New School has recognized particularly on healthcare that while 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 the next couple of hours, but all of us share a common desire to work in a bipartisan way to after 70 years of discussion which goes back to Harry Truman 1945, the 81st Congress, the common bond among the five 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 problem in healthcare? And I would sum it up by the way of saying that our country has a vacuum tube era healthcare system for a micro chip world. You start with the fact we are the only country on earth who primarily throws the burden on to the back of employers, to the fact that there is a bias for sick care rather than healthcare and finally the incredible reality Bob made mention of the fact my wife owns the strand book store, so I watch for example, the relationship with amazon.com. I could tell you amazon.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 and I have decided we, want to change this, we introduce the first Bipartisan Universal Coverage Bill in 13 years in the Senate. There are nine Senators on the bill, so we got nine percent of the senate and the legislation 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 choices like they are members of congress. Under our legislation all American could have a card like this the Wyden twins will be covered under this and they could choose Kaiser, Aetna, or anybody else that they sought to go with. We hold down the costs for the coverage with that card by fixing the broken private health insurance system so that private insurers compete on the basis of price benefit and quality, not just who can pick the healthy people and sent the sick people over to government programs more fragile than they are. We hold the administrative cause in our system with that card down to 3.4 percent, this is also on our website, on Senator Bennett's and my website and the independent authorities who study these bills say that we also achieve very substantial, additional administrative savings by running the whole program through withholding, so in effect just as you have withholding today for social security and the money moves 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 we redirect the $225 billion in tax expenditures that now goes mostly to the affluent and subsidizes inefficiency, we redirect that money to the middle income people and those in the lower middle income brackets so that they can afford their - their coverage. So the bottom line is, this proposal will save just under $1.5 trillion over the next 10 years as it expands coverage and that is all outlined by the Lewin group. Last point that I would make is this, we are spending enough money today on health care, we are 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 million into 2.3 trillion and we could go out and hire a doctor for every seven families in the United States. We pay the doctor $200,000 a year and the doctor would take care of seven families. Every time I bring this up with the physicians they say, "Ron where do I go to get my seven families?" because they like to be physicians again. So we look forward to the discussion, we particularly look forward to working with our colleagues, nine United States Senators, five republicans and four democrats have joined Senator Bennett and I Bob, is it your theory that will just go right down the row or how do you want to do it in terms of Actually 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 healthy American's act as well. My colleague - incredibly important and influential member of the republican caucus 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 the late night feedings and all the rest of it, it's exactly twice as much work but hanging there, they do grow up. Let me focus on one aspect of this bill that has particularly attracted me that I want you to think about on a conceptual fashion, if you want all the details of the bill, go to our websites and we can fill you in. the thing that has bothered me about healthcare from the very beginning when I first got involved in this debate, when I first started running for the senate back in 1991. This is the only portion of our economy where the individual receiving the services does not control the money that pay for the services and as a consequence, market forces which have been so influential in all of the rest of the economy in achieving a variety of economies and direction don't apply. It took me a while to understand that in conversations with healthcare providers because I come from the business world. I am one of the few members of the senate who is unburdened by a legal education, I am a business man and I come from the business world where I see how the market really works and it took me a while to understand that what the providers talk about when they talk about the market is not the same thing that that I talk about when I talk about the market. I naively assume that the market for healthcare were individuals who were sick. For the providers, the market, and the insurance companies and the employers 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 big concern, 23 percent increase. Those who receive the services have as their primary agenda getting the services they can. Paradoxically, it is true in healthcare President Kerry did the contrary now withstanding higher quality means lower cost. Why is that? Well, there are a bunch of reasons and Dr. Coburn can probably explain them better than I can. But let me just take one example heart transplants, as I got looking at this, this is very esoteric part of healthcare. As a general rule, the place where you get the cheapest heart transplant is the place where you will get the best the best medical result, why? Because that's the place 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 expensive and the chances that they know what they are doing are not nearly as good, as if you get a heart transplant some place where they do two or three a week, or even two or three a day and as they keep doing them and the volume goes up, their price comes down as their quality increases and paradoxically, the place where they charge the most is not necessarily the place where you get the highest quality. We don't have transparency in healthcare transactions, so we don't know anything about cost and quality. We don't know who does the best job because those of us who want the services are dependent upon those who are paying the price to make the decisions for us. Now Senator Wyden has held up his card and said, "We have choices in the federal government" and that's true. But our choices are limited to the attitudes of the providers that, or employer the federal government has decided to endorse. If we had choices or we could go where ever we want, or practically we have a range of choices brought enough that we like it, but if the individual who is buying the services controls the money that pay for the services, you will see a paradigm shift. So the thing that impresses me the most about Senator Wyden's legislation which I am happy to co-sponsor is that it breaks the link between the employer and the employee as far as control of the money is concerned and I won't get into the details of how you can hang on to your employer coverage, if that's what you want, but the main point is the employee makes the decision as to where the money is going to go. And if the employee finds himself at one HMO where he has to wait in the waiting room for four days before anybody will see him and then when he does show up it's another four hours before the doctor shows up and then when it comes in who is somebody that doesn't seem to know what they are doing, the employee can say, "I am taking my money down the street to another HMO where they will let me in the same day, I will be seen within 15 minutes and the person who talks to me is interested in me", which will cause the first HMO to say, "wait a minute, we are going to start losing this business if we don't shape up". But under the present system, if you don't like the HMO you are in, you are stuck because your employer has made the decision that's the HMO where you will be in and you have no control over it and there is no market force to say to that HMO you should change because as long as the employer has made the deal with you, what you do with the patient makes little or no difference and the other thing that is essential about this is that if you get control of the dollars, if you get control of how you are spending for health care you are no longer stuck with the job you hate. I ask this question in all my town meetings let me run the risk of seeing if the answer is the same in New York. How many of you are, or know someone who is stuck in a job he or she hates because they feel they can't leave for fear they will lose their health care insurance? Ah, you are just like the people of Utah. Most of you know some one like that. the key thing of the healthy Americans act along with all of the things that Senator Wyden has talked about is that it puts control of the dollars in the hands of the people who are buying the services and that will transform their lives and it will transform the market place for good. And that is the direction in which I think we ought to go - Dr. Coburn. Thank you and good afternoon. Ron, congratulations, I have only done that about 60 times, delivered twins. So I know exactly what the parents are feeling. I think it's really important the one of the greatest areas that we are at risk for in our country is our health care. In terms of costs, people are unhappy with the costs, some times they are unhappy with the access sometimes they are unhappy with the quality but on whole, we have a pretty good health care system, but it costs way too much and we have a limited choice and what Senator Burr and I have designed is a system that addresses the major problems every major problem that our health care system faces - every one and offers a solution that'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, you ought to give him health care and what we do is, we allow veterans to go where ever they want if they are 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 be is how do we how do we take that $2.3 trillion? And make sure we go into health care - and what is health care? Health care has got to be prevention as we have this demographic shift of my age, baby boomers and of Medicare, if we don't start emphasizing prevention, there is no way we can design the system or we can afford the health care at he level of which we have become a accustomed or unaccustomed in this country. So we have to change the paradigm in health care in this country. What grandma said an ounce of preventions worth pound of cure and we need to reorganize the federal government in terms of prevention. And what we can do, that's a legitimate role for the federal government. But it is not a role for the federal government to start making your choices for you which is what all the other plans do. They don't do that directly, they do that indirectly by limiting the type of plan 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. The congressman Conyers says we are going to trust trust the government. Our bill says we are going to let you make great decisions. Now, if you look at every aspect of our economy and I believe Ron mentioned this or Bob did is that we trust markets in this country. When they are when they are over sided properly and looked at properly, markets allocates scarce resources. And what we want is true markets. But if we limit the capability of markets, then we are not going to get an allocation to that and I am talking about accountability, have you ever asked yourself the question why is it that the doctors know who the bad doctors are, but you don't? Have you ever asked that, why the hospital administrators know the bad hospitals but you don't? It's because we don't have market forces saying you have to demonstrate quality, we have to demonstrate competency and you have to demonstrate price and so we create a system that gives a tax credit treats everybody in this country exactly the same. If you are a multimillionaire you get the same tax credit, and if you down on your line and it goes for healthcare, and it buys everybody who want they want - now what the government tells you must had, and if you choose not to buy it we will allow your straight opt into a default policy of you choose not to buy it, so that you don't have, and you don't become part of the 200 billion dollars a year in 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 this country in terms of their insurance cost, just by eliminating cost shifting. It will create in us in senate where we take the Medicaid stamp of the foreheads of the poor people in this country, because we allow the Medicaid money plus the tax credit to go enhance the ability of those less fortune that to get the best healthcare in the world. And we - and it cost nothing it cost nothing. So what we have done is design a plan that's based on quality, based on prevention and in stabilizing prevention, now we have to talk about that we get into that, and based on a accountability and transparency, with the individual American get in to the side what they want to do, rather than have the government run it or government say what you must as a minimum must have. It's different for me. I am a two time - two time cancer survivor the latest colon. I am going to want something different than somebody to have less risk factor for me. Why would I want the government to decide what plan I would want? Why wouldn't I be able to do that? And you are going to we are going to hear about mandates we have mandates for out of insurance in the every state in this country yet 15 percent of the people don't have all the insurance. So mandate didn't work and if talk about administrative cost, three percent administrative cost that why we have Medicare now, we have 45 billions dollars worth fraud. So it's not a real three percent, its 13 percent administrative cost in Medicare when you figure figure in the fraud. So markets work its worked in every other thing what we have to have this transparent markets and addressee government that 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 the number one domestic issue in this country. And an issue that members of Congress run from like the plague, why? Because it takes a great deal of time or either a profession like Tom Coburn, to give you the knowledge you need to confidentially talk about healthcare, and I listen to Bob Kerry's first comment, 23 percent increase in the cost of healthcare for the employees of The New School. Well Bob you are not you know when you buy yourself. For the last decade we have heard employers talk about it, and specifically not the effect on them, because it's a deduction. But on the employees and the shift, 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 triggers when 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 you need fundamental insurance reform in this country. The products have to change the products have to reflect what people want. Now what government wants, federal or state? Not the corporations want but what - we is individual's need more importantly what our healthcare needs our income and our age are. And now I had a first hand experience just recently. It's hard to believe that I have got a 22 year old, but I do it. Looking Ron with twins among this, but reality is I got that notice from the federal government and we are supposed to have the best healthcare in the world, trust me. When I left the private sector Bob, the two of us are out of business. I actually got a coverage with the same company that I had my insurance with in a company of less than 50 people, and the only difference was I had the same coverage paid, the same percentage of the premium, only the percentage when up when the federal government negotiated that healthcare cost. So I get a notice last year that my son is going to be 22 years old, September of that year. And based upon federal laws he he automatically is dropped for my insurance regardless or whether he is still at college or not. So I immediately called over and I said I am sure that we have got some type of transition plan that you have negotiated on behalf of all the federal 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 above is that kid that probably if should task with pay and pointing himself would say don't need it. I immediately call the University of North Carolina and I had to mention competitors and said geez you have got to have something that negotiated on the half of your students, sure we do. They gave me number to call, I found they negotiated the same plan, same plan he was under under my plan as the member of Congress. I said what's the cost? $1400 a year, I say $4000 for two phone calls. One that shocked me was what the Federal government negotiated, the second one, what a college that understood who in fact they were insuring and that was 22 21 20 year old healthy kids, more importantly they understood that they couldn't afford the cost and they went to the table to negotiate on behalf of the individual who is the policy holder. Amazing realization on man power that when you have 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 and two 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 over to the American people. Letting them be the ones to decide, making sure that we force to reforms - the structural reforms in the system in insurance, products, so the prevention and wellness plays the center piece of the coverage that everybody would have. And let me caution here today. We are all going to make it sound really good. That's our job, because we believe in the products that we sell. But that was that was in the details. You have to read this bills you have to study it, you have to - look it your circumstances and ask how does it affect me? I can only speak for time in myself, we have constructed to build - covers everybody in the country, they didn't cover some, it provides the resources for every American to go out and negotiate their coverage. Does it in a budget neutral way? We are not putting more real tax dollars into a system to provide this for anybody. Here we shift them around, because we drastically changed the system, we do refundable tax credits. Lot of people don't like it. Well, I have never figured out how to give the tax deduction to somebody with no income unless you just give them an 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 healthcare in 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 in every 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 and replenishment of the population, that couldn't be two places. That we are more vulnerable to have shortages, then the two places that we have got it in our system today, if we don't change it who is going to try in the next generation of doctors it comes through. Its in everybody's best interest in this country that we engage in this debate and in an honest and thoughtful way, but at the end of the day we come 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 going to make the case for his bill even though I haven't read it, I have a general idea what he is trying to do which is I think single pair proposal puts all of us into Medicare. So we can start off with great respect for my colleagues, blah-blah-blah oh I meant that I meant that blah blah blah and say - the question for all of you is really whether or not you trust the market place to deliver your health care and if you do, and you got to love most of the proposals you have heard today and I am my argument is that there is something that only the government can do and there are that only the market can do and that health care is not like buying a car, not like buying a suite or cloth but it's a different kind of purchase when you are taking your wife to a hospital to deliver your baby, when you are taking over your mom to a hospital and have her treated for a cancer. Or when you are taken yourself to a hospital to be diagnosed and treated, you are not shopping any longer. You are dealing with a life and death consequences of the decisions that that doctor and that hospital will make, that's my argument. It's a different kind of thing, service that we are buying and so my I argue that you should have substantially 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 to a point where you will feel safe. All those of you who have raised your hands saying you there was New School in place raising your hand saying, there is now me being Bob Kerry again. But I know employees at the New School, who are only here because of health insurance, somebody love it besides but it's very - very difficult and the only way you are going to get to a point, I don't believe that you get there with any proposal that I have heard here today, what you know for certain is that you change the law the federal law, so the only thing which you have to prove in order to be eligible for some kind of subsidy if you need it. and if you don't need it, you won't get one - is to change along, so you become 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 poor enough, 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 was next to him, didn't get blown up, he is not eligible and once that eligibility is determined, you can go anywhere you want. That's where the market can take over, that's where the transparency, that's where the prevention and all the other sorts of things that had argued up whether you need and this system can take over. But unless and until you would pass a law that says the only thing that you know to prove is being an American legal resident, you will never get to where you want to go. Now that means for all of you who have embraced Medicare and want to hold on Medicare as exactly as it is, you are not going to be happy or the VA system, the income tax system or the Medicaid system. We have tried over the series of the last 60 years to solve this problem by satisfying one group or another. By delivering to a group of elderly, a group of poor, a group of veterans, a group of employers, the thing that they wanted and needed. As a consequence, we are the only industrial nation on earth that doesn't have a health care system. We don't have a health care system. We have got individual systems reach to 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 here today in particular to improve the transparency of Medicare and in particular to create incentives for preventions 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 trillion and we are among the most unhealthy people on the planet. Some thing is wrong and I am saying what'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 spread the risk. And one of those concerns that I have got with Senator Wyden that now I am back to Bob Kerry now. And when you say, you going to break the link with employment, I get sort of excited about that when you say that you could have the option of staying with your your employer, what I am afraid of is my healthy people are going to go out and buy some thing else and my unhealthy people get they think 23 percent increase is too much, it will 40 percent the next you are out. The safety comes with the group - and I am John Conyers again. I am proposing I am proposing a group of 300 million Americans, that's the group that I would like to say. And once we are all in the same group, planning by the same rules we are more likely to ask for the things that are beneficial not just for us but for everybody in the United States.