Bret Baier, "Special Report" HOST: Top Obama 47-nation nuclear envelope to solve the problem of loss of nuclear material, saying his country to sign a plan for the next four years. .

. If you look at the proliferation and North Korea and Iran, and possibly those with greater access to nuclear terrorism, nuclear terrorists, Iran and North Korea, we have seen that North Korea multiply, proliferation was captured in 2007.

httpv://www.youtube.com/watch?v=LaikQ64NIjQ&feature=youtube_gdata

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• Nuclear terrorism is most urgent threat – CNN

. China announced this week that its president, Hu Jintao will attend the next summit of nuclear safety in Washington April 12 and 13, ending weeks of speculation that the Chinese were involved.

He called China's decision to attend the summit of nuclear very positive step, especially after a visit to China last month by two officials of U.S. security – James Steinberg, assistant secretary of state, and Jeffrey Bader, Senior Director for Asian Affairs at the National Security Council – appeared to poor performance. .

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. A two-day summit brings together international nuclear in Washington on Monday, with nearly 50 nations, sending officers to participate in the discussion.

Even if the United States and Russia have sought nuclear material dangerous for more than a decade, without being an international summit on nuclear safety level and broad-based. .

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• Nuclear Summit Takes Urgent Tone – NPR News

A two-day summit brings together international nuclear in Washington on Monday, with nearly 50 nations, sending officers to participate in the discussion. .

and Russia is seeking nuclear material harmful to over a decade, had never before been a major international summit to a high level and focused on nuclear safety. Although the United States.

httpv://www.youtube.com/watch?v=w9c3WyHz4wk&feature=youtube_gdata

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• Nuclear Summit Takes Urgent Tone – NPR News

Now he's on a mission to provoke a serious debate on the Law of the costs to argue that "swallowed alive", if not controlled. When the numbers are the weapon of choice policies, the Republicans turn to Paul Ryan to make his fight. In preparation for the February 25 broadcast of the health care battle with President Barack Obama, was Ryan, a representative of the hills of southern Wisconsin and industrial zones, the task of challenging the health of Math 2 , 3 trillion of U.S. wages government review. At 40 years and in his sixth term in office, Ryan has the perfect combination of freshness and experience yet. In 2006 he spent the last 13 senior colleagues to become ranking Republican on the Budget Committee of the House.

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I am pleased to join with President Clinton and the Foundation for California to continue building on our work for a healthier future for our children and all Californians .. We have made considerable progress in promoting healthy eating and active living since my first summit in 2005 but still the action that you can do to promote a healthier world for all of California, Arnold Schwarzenegger said.

The government should not engage in personal problems at home. One would think that Arnold has enough problems, you have to do a beter job as governor and let everyone handle Clinton boring problems.Let management of obesity in their own homes. That's where it starts thats where it should end.

What is shocking is that this government has been rich since focused on the need to divert my taxes and my scarce public resources to these events. My health and my choices are part of a sphere of privacy that this element of society has no moral right to occupy, if they think their portfolios to be official. "Obesity is now the ruling class in a keyword to be used politically to marginalize the very people who are socially marginalized, such as regularly walmartians" or simply "Wal-Mart, among them more than acceptable hatred. Of pure hate. Note note that the governor is a fool and used again for the culture war has become a standard – so tired my disgust.

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They promised to renew his criticism of democratic legislation and speaking in general terms about how the private market can reduce healthcare costs and achieving "universal access" .. While the president tried to unite the Democratic Party behind a single proposal, Republicans have spoken with pride that bring new ideas to the table. Today Health bipartisan summit could be the end of the beginning of the reform of the health system.

This is what the Republican Party is saying and why they were wrong. This morning, the Wonk Room publishes a guide viewers bipartisan Summit Healthcare. And while the survey evidence of their point of conversation may seem convincing, the solutions of motion of the Republican Party actually costs and risks of insurance and split the market in insurance plans for low-cost and higher cost for health patients.

httpv://www.youtube.com/watch?v=vtMCk5b9fAE&feature=youtube_gdata

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While the president has tried to unite the Democratic Party behind a single proposal, Republicans have spoken with pride that bring new ideas to the table. Health Today bipartisan summit could be the end of the beginning of the reform of the health system. They promised to renew his criticism of democratic legislation and speaking in general terms about how the private market can reduce healthcare costs and achieving "universal access" ..

This is what the Republican Party is saying and why they were wrong. And while the survey evidence of their point of conversation may seem convincing, the solutions of motion of the Republican Party actually costs and risks of insurance and split the market in insurance plans for low-cost and higher cost for health patients. This morning, the Wonk Room publishes a guide viewers bipartisan Summit Healthcare.

httpv://www.youtube.com/watch?v=vtMCk5b9fAE&feature=youtube_gdata

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But does anyone think the substance of Obama’s health-care plan or the proposals of Republicans will change significantly at the summit? If they don’t, will the mere spectacle of the gathering and the dueling rhetoric be enough cause fundamental changes in the current political pecking order?. The gathering of President Obama and congressional leaders at Blair House has prompted the media to flood the zone, with wall-to-wall cable coverage and nonstop analysis befitting a history-making event.

The Los Angeles Times says yes: “The healthcare summit that convenes Thursday in Washington has emerged as a high-stakes gambit for President Obama and opposing Republican lawmakers, carrying risks for both sides that could not only alter the outcome of the healthcare debate but also November’s midterm elections.” The voters say probably not. “Public expectations are low for today’s high-profile White House summit on health care: Three of four Americans in a USA TODAY/Gallup Poll predict President Obama and congressional leaders won’t reach agreement on a bill,” USA Today reports. Congressional Democrats seem to agree; the Washington Post says they “are already looking beyond the White House health-care summit, reckoning that Thursday’s session will amount to little more than political theater and focusing instead on a final round of intraparty negotiations that are likely to determine the fate of President Obama’s top domestic priority.”.

Brace yourself, because it’s all a “big bipartisan lie,” Politico says: “If President Barack Obama really wanted to show he’s serious about winning over Republicans on health care reform, he could offer up some key concessions at Thursday’s summit, like caps on malpractice awards or allowing insurers to sell across state lines. Do you remember mournful editorials and somber seminars about ‘dysfunctional’ government when liberals defeated George W. But that would assume either side is willing to do this.” George Will says the summit “comes at a moment when, as happens with metronomic regularity, Washington is reverberating with lamentations about government being ‘broken.’ Such talk occurs only when the left’s agenda is stalled. Bush’s Social Security reforms?”. And if Republicans wanted to reciprocate, they could at least acknowledge the congressional scorekeepers are right – the Democratic plans cut the deficit in the long term and rein in health care costs.

Republicans say their plan is aimed at reducing health costs, but unlike the Democrats’ proposals it wouldn’t seek to provide near-universal coverage to the uninsured. Instead, it would rely on curbing malpractice lawsuits, encouraging states to experiment with their own health-system fixes and modest rule changes to prevent insurers from denying coverage to the sick.” Karl Rove writes that Republicans “naturally want to prevent the president from turning it into a PR stunt. Across the aisle (or in this case, across the table), the Wall Street Journal reports, “The six-point plan that will be presented by Republicans . What will the participants actually say? “White House officials said Mr. draws from a House bill introduced last fall. They’ll not only have to point out problems with his plan and offer their own ideas, but correct the president when he makes statements that are not true. Obama would use his opening remarks to make the case that Democrats and Republicans are not as far apart as they think on health care, because both parties are concerned about the deficit and rising health premiums — issues, the president will argue, that can be addressed only by controlling health care costs,” the New York Times writes. The GOP participants appear ready for the first two tasks.”. This is no easy task.

The Hill checks in with swing Democrats and finds “centrists said they are feeling less pressure now that Obama has used the Senate bill as the foundation for his proposal and are happy with the president’s decision to hold Thursday’s bipartisan healthcare summit.” The Wall Street Journal says “Obama’s decision to unveil his own health-care plan Monday signals a sharp tactical shift. But the recent shift toward more assertiveness has irked Republicans and Democrats alike, failed to bridge political differences and even threatens initiatives ranging from the 9/11 terror trials to financial regulation.”. Obama faced criticism in the past for espousing broad policy goals and leaving Congress to work out the details. Many Democrats openly called on him to provide more leadership. After a year marked by extensive congressional consultation–and little progress–the White House is rolling out policy decisions fully formed after closely held internal deliberations. Mr.

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He said, “When is something going to happen on health care in America? I can’t hold out much longer.” I have a letter — and Michigan seems to be where I get some mail on this subject since I’ve travelled there recently — the woman who said that their family — to pay their deductible, they have to subtract it from their food budget. Let’s make sure that we talk about facts. It was caught late, and that’s a hard cancer to diagnose. And you said that the current system is in critical condition. What is the doughnut hole? Well, a senior citizen will tell you what the doughnut hole is. And that’s what I want to mention here in the next few minutes. I hear from families who have hit lifetime limits and because somebody in their family is very ill, at a certain point they start having to dig out of pocket and they are having to mortgage their house and in some cases have gone bankrupt because of health care. And I don’t need to tell people here about the effects on the federal budget. You, Mr. Thank you so much for participating today. And I hope that those who are here will agree I’ve got a pretty good record of working across party lines and of supporting the President when I believe he’s right, even though other members of my party might not on that occasion. Thank you, Mr. But I do remember the last six months of her life — insurance companies threatening that they would not reimburse her for her costs, and her having to be on the phone in the hospital room arguing with insurance companies when what she should have been doing is spending time with her family. It was almost a year ago, March 5th of last year, when you brought us together in a bipartisan way to set us on a path to lower cost, improved quality — expand access to quality health care for all Americans. We believe that our views represent the views of a great number of the American people who have tried to say in every way they know how — through town meetings, through surveys, through elections in Virginia and New Jersey and Massachusetts — that they oppose the health care bill that passed the Senate on Christmas Eve. Thank you very much for bringing us here today. And that’s just one of the concerns she mentioned. You began your remarks, Mr. Paul Ryan has discussed some of the issues surrounding Medicare. And the doughnut hole. I was very pleased to see a glimpse of bipartisanship in the Senate recently in passing a jobs bill, and I hope that continues, and I know there are going to be some additional pieces of legislation moving forward around, for example, making sure that small businesses can get financing. We have a moral obligation to reduce the deficit and not heap mountains of debt onto the next generations. It means that for millions of Americans premiums will go up because those — when people pay those new taxes, premiums will go up — they will also go up because of the government mandates. Several of us were part of the summits that you had a year ago, and so I’ve been asked to try to express what Republicans believe about where we’ve gotten since — since then. In its life it will create 4 million jobs — 400,000 jobs almost immediately; jobs, again, in the health care industry, but in the entrepreneurial world as well. And I’d like to just mention those in a sentence or two. But I’d like to make sure that this discussion is actually a discussion and not just us trading talking points. All right? SENATOR McCONNELL: Thank you very much, Mr. President, by saying there was a glimmer of bipartisanship in the Senate for the passage of the jobs bill. One is out; some are still in. That day, March 5th, Senator Kennedy said health care is a right, not a privilege. But we would like, respectfully, to change the direction you’re going on health care costs. We simply must make the cuts in waste, fraud, and abuse in Medicare so that the benefits and the premiums are untouched. And what it means is a health initiative that is about affordability for the middle class, lowering costs, improving access for them. I can tell you many stories as I travel the country where I’ve seen grown men cry. I mean, if you look around the table — and I’m sure it’s true on the Democratic side, as it is on the Republican — we’ve got shoe store owners and small business people and a former county judge and we’ve got three doctors. They want to give consumers more choices and insurance companies more competition. I’ve looked very carefully at John Boehner’s plan that he put forward. You can say that this process has been used before, and that would be right, but it’s never been used for anything like this. (Laughter.) Not wanting to be a hypocrite, I wanted to give you some slack. Appreciate being here. In the individual markets, it’s even worse. And my request is this, is before we go further today, that the Democratic congressional leaders and you, Mr. You have talked about how the present system is unsustainable for families, for businesses large, modern and large, small — any size, and how it’s unsustainable, as you said on March 5th of last year. I want to start by talking about a young man by the name of Jesus Gutierrez. So it’s like giving someone a ticket to a bus line where the busses only run half the time. I want you to know there was a blaze of bipartisanship in the House yesterday — with, what, 406-19, we passed under leadership of Congresswoman Louise Slaughter, Tom Perriello, Betsy Markey and others the lifting — repealing the exemption that insurance companies have on health insurance and the antitrust laws for health insurance — 406-19, a very strong message that, yes, the insurance companies need to be reined in. It means there will be about a half trillion dollars of new taxes in it. Now, some say we need to rein in the insurance companies; maybe we do. For people who couldn’t afford it, we would provide them some subsidies. I hear from small businesses who have just opened up their new rates from their insurance company and it turns out that the rates have gone up 20, 30, in some cases 35 percent. It’s not appropriate to use to write the rules for 17 percent of the economy. So that’s why we continue to insist that as much as we want to expand access and to do other things in health care, that we shouldn’t expand a system that’s this expensive; that the best way to reduce cost — to increase access is to reduce cost. And it strikes me that if we’ve got an open mind, if we’re listening to each other, if we’re not engaging in sort of the tit-for-tat and trying to score political points during the next several hours, that we might be able to make some progress. And we know how to do that. He works hard. When Republicans were trying to change the rules a few years ago — you and I were both there; Senator McCain was very involved in that — about getting a majority vote for judges, then-Senator Obama said the following: “What we worry about is essentially having two chambers, the House and the Senate, who are simply majoritarian — absolute power on either side. The basic concept is that we would set up an exchange, meaning a place where individuals and small businesses could go and get choice and competition for private health care plans, the same way that members of Congress get choice and competition for their health care plans. This is such a complicated issue that it’s inevitably going to be contentious. He has a restaurant in Reno, Nevada. And so I know both the House and the Senate are interested in how do we propel economic growth forward; how do we create more jobs. You mentioned Mike Enzi’s work on the small business health care plan. Now, everybody here has those same stories somewhere in their lives. And we’ll just go back and forth between the Democratic leaders and the Republican leaders, House and Senate, and then we’ll just open it up and we’ll start diving in. But to do that, we’ll have to renounce jamming it through in a partisan way. I can’t mention health care in Michigan without acknowledging Chairman Dingell. But he was fortunate — they were going to have a baby and it was going to be a little girl. But it’s said — it’s a lot like the Senate bill. SENATOR REID: Mr. So as they also say in Detroit, again, we think we have a better idea. But most people haven’t heard about that. My mother, who was self-employed, didn’t have reliable health care, and she died of ovarian cancer. We also talk about how we can help to make the Medicare system more effective and provide better quality care. That’s what the American people are looking for. But combined with six others and six more and six others, they’d get us in the right direction. We had the best senators we’ve got working on that in a bipartisan way. And unfortunately over the course of the year, despite all the hearings that took place and all the negotiations that took place and people on both sides of the aisle worked long and hard on this issue and — this became a very ideological battle. You know, I was looking through some of the past statements that people have made, and I think this concern is bipartisan. You talked about stories — Senator Alexander did, too. Our country is too big, too complicated, too decentralized for Washington, a few of us here, just to write a few rules about remaking 17 percent of the economy all at once. Senator Moynihan said that many years ago, and that’s what we have to do here today. So this is the only place, the Senate, where the rights to the minority are protected and sometimes, as Senator Byrd has said, the minority can be right. After you spend $2,000 approximately in medication, you are finished until you spend $3,500 more out of your own pocket. Across America, more than 60 percent of Republicans, Democrats, and independents want us to reform the way health care works. But I just hope that as we sit around this table, we understand the urgency that the American people have about this issue, how it affects not only their health but their economic security. They want to know what this means to them. Again, Lamar, you’re entitled to your opinion but not your own facts. And that’s to take many of the examples that you just mentioned about health care costs, make that our goal — reducing health care costs — and start over, and let’s go step by step toward that goal. Is it any wonder? They want it so that businesses can afford health care. We’ve still got a long way to go. As controversial as the efforts to reform health care have been thus far, when you ask people, should we move forward and try to reform the system, people still say yes, they still want to see change. I don’t know that those gaps can be bridged. President, renounce this idea of going back to the Congress and jamming through on a bipartisan — I mean, on a partisan vote through a little-used process we call reconciliation, your version of the bill. It means working together the way General Marshall and Senator Vandenburg did. Last Monday, a week ago Monday, all over America, results were run from a poll done by the Kaiser Foundation. They did some surgery on the baby; he was happy — that is, Jesus was happy — until he got his mail four months later, opened the envelope, and the insurance company said, “We didn’t realize that your baby had a preexisting disability. Imagine an economy where people could change jobs, start businesses, become self-employed, whether to pursue their artistic aspirations or be entrepreneurial and start new businesses if they were not job-locked, because they have a child who’s bipolar or a family member who’s diabetic, with a preexisting condition, and all of the other constraints that having health care or not having health care places on an entrepreneurial spirit. Chuck, you’ve been working on this a long time. Let me just close by saying this. It was interesting what that poll said: 58 percent of Americans would be disappointed or angry if we did not do health care reform this year — 58 percent. But often they had to persuade me to change my direction to get our state where it needed to go. That’s just not what the Founders intended.” Which is another way of saying that the Founders intended the Senate to be a place where the majority didn’t rule on big issues. He had everything that he wanted, except a baby. And health care reform is entitlement reform. We’ll split it up, and so we’ll let them make some quick remarks. We’ve made our ideas. President, as you know, as a young Congressman gaveled Medicare into law in the House of Representatives. This shouldn’t happen to anyone in America. Number six, House Republicans have some ideas about how my friend in Tullahoma can continue to afford insurance for his wife who has had breast cancer — because she has a preexisting condition, it makes it more difficult to buy insurance. That day, March 5th, we all remember the bipartisan spirit, the hope that was in the room, and also when Senator Kennedy came into the room and declared himself a “foot soldier” in the fight for health care for all Americans. Now, what I did, what the White House did several days ago, is we posted what we think is the best blend of the House and the Senate legislation that’s already passed. It means reducing health care costs — and making that our goal for now, and not focusing on the other goals. We think it is a plan that works with the existing system, the employer-based system, the private health care system, but allows a lot of people who currently don’t have health care to get health care, and more importantly, for the vast majority of people who do have some health care, it allows them to get a better deal. When fully implemented, the bill would spend about $2.5 trillion a year, and it still has the sweetheart deals in it. THE PRESIDENT: Well, thank you, Lamar. Now, you’ve presented ideas. Mike Enzi, in the past you’ve put forward legislation around small businesses that are very important. I know you met with some governors just the last few days. The only thing bipartisan will be the opposition to the bill. In our state, half the counties, pregnant women have to drive to the big city to have prenatal health care or to have their baby, because the medical malpractice suits have driven up the insurance policies so high that doctors leave the rural counties. My hope in the several hours that we’re going to be here today, that in each section that we’re going to discuss — how do we lower costs for families and small businesses, how do we make sure that the insurance market works for people, how do we make sure that we are dealing with the long-term deficits, how do we make sure that people who don’t have coverage can get coverage — in each of these areas what I’m going to do is I’m going to start off by saying, here are some things we agree on. “But that’s okay,” he was told. Think of an economy with that dynamism of people following their pursuits, taking risks — we want them to take risks and yet we lock them down, and we have an anvil around their businesses because of these increasing costs of health care. Most of the governors I’ve talked to think that would be a good way to increase competition. When I was elected governor some of the media went up to the Democratic leaders of the legislature and said, “What are you going to do with this new, young Republican governor?” a few years ago. We couldn’t afford it if our employer weren’t helping us do that. He was afraid of what was going to happen. I mean, John Boehner and George Miller did that on No Child Left Behind. And in addition, it dumps 15 to 18 million low-income Americans into a Medicaid program that none of us would want to be a part of because 50 percent of doctors won’t see new patients. Your stories are a lot like the stories I hear. I say to my friend, Lamar, who I have great respect and admiration for, you’re entitled to your opinions, but not your own facts. And if not, at least we will have better clarified for the American people what the debate is about. And that’s exactly what this does with the expansion of Medicare. This legislation is about innovation; it’s about prevention; it’s about wellness. We all know this is urgent. But because people would have some pooling power, the costs overall would be lower because they’d be in a stronger position to negotiate. And General Marshall said that sometimes Van was my right hand and sometimes he was his right hand. We’re going to have Nancy and Harry — I think my understanding is you guys want to split time. As a former governor, I also want to try to represent governors’ views. I mean, we want you to succeed, because if you succeed our country succeeds. And we’ll be saying to the American people, who have tried to tell us in every way they know how — town halls and elections and surveys — that they don’t want this bill; that they would like for us to start over. We’ve got people who are used to solving problems step by step. President, thank you very much for the invitation. Almost all of it. What I will then do is just address — John, are you going to make the presentation yourself? Okay. John Boehner and I have selected Lamar Alexander of Tennessee to make our opening framing statement, and let me turn to him. So it is — it’s a very important initiative that we have to take. That is the single biggest driver of our federal deficit. And if we don’t get control over that we can’t get control over our federal budget. What we do here must be relevant to their lives. But we’d like to start over. We owe it to our country. So, with that, I just want to say again how much I appreciate everybody for participating. And I thank you, Mr. I said at the State of the Union, and I’ll repeat, I didn’t take this on because I thought it was good politics. It came up in the Senate. President, again. Now, in conclusion, I have a suggestion and a request for how to make this a bipartisan and truly productive session. And I am going to now turn it over to Senator McConnell so that he can make some opening remarks. Businesses are having to make decisions about just dropping coverage altogether for their employees. We’ve watched the comprehensive economy-wide cap and trade. He had health insurance. I do remember that. The character of our country has formed the backbone of our country, our working middle-class families in America. And that’s why we said 173 times on the Senate floor in the last six months of last year, we mentioned our step-by-step plan for reducing health care costs. I’d like to begin with a story. It means that from a governor’s point of view, there are going to be what our Democratic governor calls “the mother of all unfunded mandates.” Nothing used to make me madder as a governor than when Washington politicians would get together and pass a big bill, take credit for it, and then send me the bill to pay. And all of us, when I was in the Senate, and all of you as House and Senate members, have good health care. SENATOR ALEXANDER: Thanks, Mitch and John. And these are letters from all across the country, constituents from every walk of life. Right now it’s projected that premiums for families with health insurance — not people without health insurance but with health insurance — will almost certainly double over the next decade, just as they doubled over the past decade. Our budget cannot take this upward spiral of cost. Your opinion is something that is yours, and you’re entitled to that, but not your own set of facts. And I want to say, because Medicare was mentioned, unless we pass this legislation we cannot keep our promises on Medicare. That’s a good start. Later he will inspire us with that, but he, Mr. So I promise not to make a long speech. That’s the way we worked for eight years. John McCain has talked about how rising health care costs are devastating to middle-class families. I have said repeatedly — I said at the State of the Union, I said last night when I was meeting with the Business Roundtable — that in addition to dealing with the immediate challenges we face in the recovery, it’s absolutely critical that we also look at some fundamental structural problems in our economy that are hurting families, hurting businesses, and having an impact on the exploding deficits and debts that the federal government, but also state governments are carrying. It’s affecting not only those without insurance, but it’s affecting those with insurance. President. And if we don’t, then the rest of what we do today will not be relevant. The baby needs a couple more surgeries. And for them, they don’t have time for us to start over. Almost all of the long-term deficit and debt that we face relates to the exploding costs of Medicare and Medicaid. So this bill is not only about the health security of America. Welcome. Here we are today. And it may be that at the end of the day we come out of here and everybody says, well, you know, we have some honest disagreements; people are sincere in wanting to help, but they’ve got different ideas about how to do it, and we can’t bridge the gap between Democrats and Republicans on this. President, with your leadership we passed the American Reinvestment and Recovery Act last January and got a running start on some of the technology and scientific advancements in this by the investments in biomedical research, health IT — health information technology — a running start by your signing the SCHIP, the children’s health bill, insuring 11 million children. And then let’s talk about some areas where we disagree, and see if we can bridge those gaps. But I want to talk for a moment about what it means to the economy. My wife has breast cancer; she got it 11 years ago. President, for your leadership in getting us to this place. I mean, what’s fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what’s fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming? So our view, with all respect, is that this is a car that can’t be recalled and fixed, and that we ought to start over. We’d like to do that, and we appreciate the opportunity that you’ve given us today to say what our ideas are, and to move forward. When I go down on the floor — and I’ve been there a lot on this issue — some of my Democratic friends will say, well, Lamar, where’s the Republican comprehensive bill? And I say back, well, if you’re waiting for Mitch McConnell to roll in a wheelbarrow in here with a 2,700-page Republican comprehensive bill, it’s not going to happen because we’ve come to the conclusion that we don’t do comprehensive well. And I can tell you that at least two, sometimes five, of the 10 letters relates to the challenges that people are experiencing in health care every single day. I’d like to say the same thing to you. Senator Byrd, who is the constitutional historian of the Senate, has said that it would be an outrage to run the health care bill through the Senate like a freight train with this process. You had a running start on expanding access, and not only that, but doing it in a way that is of the future. And when you talk to every single expert and you just talk to ordinary people and you talk to businesses, everybody understands that the problem is not getting better, it’s getting worse. Both I and Lamar went a little bit over our original allocated time. So we’ve got to do something.” And that’s about — that’s where we are. And politics I think ended up trumping practical common sense. He had employees that liked him. In each of these cases there are corresponding ideas on the Republican side that we should be able to bridge. And the baby was born, and in just a few minutes after the birth of that baby, he was told that the baby had a cleft pallet. And many of the provisions that are in our bill are initiatives put forth by the Republicans — others of our colleagues will talk about this. I’ve looked at Tom Coburn and Senator Burr’s plan that’s been put out there. You’ve mentioned that yourself. “We can take care of that.” And they did. It means it will cut Medicare by about half a trillion dollars, and spend most of that on new programs, not on Medicare and making it stronger, even though it’s going broke in 2015. And it doesn’t work for most of us. One man in Michigan, Mr. This is not just about health care for America; it’s about a healthier America. In the course of that time in our committees in the House and the Senate, we’ve had lively discussions. He paid his premiums. It means putting aside jamming it through. Let us move in a way — who can say “ram”? We started this six weeks after your inauguration, just six weeks after your inauguration, on March 5th, with you extending a hand of bipartisanship. But what I’m hoping to accomplish today is for everybody to focus not just on where we differ, but focus on where we agree because there actually is some significant agreement on a host of issues. So there are six ideas. And they said, “I’m going to help him because if he succeeds our state succeeds.” And they did that. Our insurance is $2,000 a month. SPEAKER PELOSI: Yes, Mr. We’ve watched the comprehensive immigration bill. When I went home for Christmas, after we had that 25 days of consecutive debate and voted on Christmas Eve on health care, a friend of mine from Tullahoma, Tennessee, said, “I hope you’ll kill that health care bill.” And then before the words were out of his mouth, he said, “But we’ve got to do something about health care costs. You mentioned that in your opening remarks. So put us down on that side of the ledger. And more importantly, we want to talk about — we believe we have a better idea. All right? Nancy. I was trying to think about if there were any kind of event that this could be compared with, and I was thinking of the Detroit Auto Show, that you’d invited us out to watch you unveil the latest model that you and your engineers had created and asked us to help sell it to the American people. We know how to do that and we can do that on health care as well. I am very grateful to all of you because I know how busy you are. And what happens during that hole that we’ve called the doughnut hole? Seniors in America are splitting pills in half, not getting the prescriptions filled, taking them every other day. Senator Byrd in his book — Senator Reid in his book, writing about the Gang of 14, said that the end of the filibuster requiring 60 votes to pass a bill would be the end of the United States Senate. You’ve discussed the unsustainable growth in Medicare and Medicaid in our budget. I’ll get letters from parents who — whose children have preexisting conditions and maybe those children were able to get health insurance when they were young but now they’re growing up, they’re about to move out, and they can’t get insurance no matter what job they find. I remember reading Alexis de Tocqueville’s books, which most of us have read, and he said in his “American Democracy” that the greatest threat to the American democracy would be the tyranny of the majority. But we think to do that we have to start by taking the current bill and putting it on the shelf and starting from a clean sheet of paper. Number five, expanding health savings accounts. And it’s for that reason that last year, around this time, actually, I hosted in the White House a health care summit and indicated to Congress that it was absolutely critical for us to begin now moving on what is one of the biggest drags on our economy and represents one of the biggest hardships that families face. And those people sitting at that kitchen table, they don’t want to hear about process; they want to hear about results. You and I and many other senators worked together on the America COMPETES Act. And we go and you do that and we look at it and we say, that’s the same model we saw last year, and we didn’t like it and neither did they because we don’t think it gets us where we need to go, and we can’t afford it. But remember maybe when you were younger, when you were first starting off — I can certainly remember Malia coming into the kitchen one day and saying, “I can’t breathe, Daddy,” and us having to rush her to the emergency room because she had asthma; or Sasha, when she was a baby, getting meningitis and having to get a spinal tap and being on antibiotics for three days, and us not knowing whether or not she was going to emerge okay. As we sit around this table, I think we should be mindful of what they do when they sit around their kitchen table. THE PRESIDENT: Good morning, everybody. What I will then do is just address a couple of points that were raised by you, Lamar, in terms of process, and then we will start diving in and getting to work. And there’s probably nothing that modern medicine could have done about that. And after World War II in this very house in the room back over here, President Truman and General Marshall would meet once a week with Senator Arthur Vandenburg, the Republican chairman of the Senate Foreign Relations Committee, and write the Marshall Plan. And I think that’s why Lyndon Johnson in the ’60s passed the civil rights bills in Everett Dirksen’s office, the Republican Leader’s, because he understood that having a bipartisan bill not only would pass it but it would help the country accept it. Thank you very much. Accessibility — affordability and accessibility are closely aligned — and accountability for the insurance companies. What I want to do is just make a few brief remarks on the front end, and then we’re going to allow leadership from the both the House and the Senate to make some opening remarks, and then we will dive in. He had health insurance. But I think it’s important to note that if we took all the profits of the insurance companies, the health insurance companies, entirely away — every single penny of it — we could pay for two days of the health insurance of Americans, and that would leave 363 days with costs that are too high. So this is an issue that is affecting everybody. He was too proud to tell his children that he needed help, because they were raising their own families. There’s an 11-page memo on the — I think it’s important for people to understand there’s not a presidential bill. Give states incentives to lower costs, number four. He was at the end of the line in terms of his finances; he might have to lose his home, and she was bedridden. It’s not perfect overlap, it’s not a hundred percent overlap, but there’s some overlap. Some of you know that I get 10 letters, out of the 40,000 that I receive every day, for me to take upstairs to the residence and read every single night. President, my friends in the House and in the Senate, I want to spend a few minutes talking about Nevada, about our country, and not what’s going on here in Washington. And I think everybody here is profoundly sympathetic and wants to make sure that we have a system that works for all Americans. We’re not covering the $90,000 in hospital and doctor bills you’ve already run up.” So he’s trying to pay that off. Senator Pat Moynihan said before he died that he couldn’t remember a big piece of social legislation that passed that wasn’t bipartisan. And we’d like to briefly mention — I’ll briefly mention and others will talk more about it as we go along — what those ideas are, what some of them are, what some of the suggestions we have are. Mike Enzi and Ted Kennedy wrote 35 bills together. We’ve watched the comprehensive health care bill, and they fall of their own weight. His institutional memory of how difficult it was to pass Medicare, how he has worked over the decades to improve it, how committed he is to preserving it, and how important a part of preserving Medicare is to this passing this health care bill. He will explain why it covers more people, costs less, and helps small businesses offer insurance, too, helping Americans buy insurance across state lines. And then, later he wrote to you and said this is not just about the details of policy, it is about the character of our country. Dingell told me that his wife had been sick for a long time. It has more taxes, more subsidies, more spending. I hope that this isn’t political theater where we’re just playing to the cameras and criticizing each other, but instead are actually trying to solve the problem. President. We also have some insurance reforms in there that, for example, prohibit people who have preexisting conditions from being banned from getting coverage. Now, I’m telling all of you things you already know. They have a big stake in it. It’s about jobs. And it means going step by step together to re-earn the trust of the American people. So if we can do that — start over — we can write a health care bill. And Mitch, you’ve said that the need for reform is not in question, and obviously there are comparable studies on the Democratic side as well. We owe it to our seniors. So here’s the bottom line. Mike Enzi, who’s worked on this and partnered with Ted Kennedy on a range of health care issues as a chairman of the committee, you said that small businesses in your home state are finding it nearly impossible to afford health care coverage for their employees. So what that means is, that when it’s written it will be 2,700 pages, more or less, which means it will probably have a lot of surprises in it. Last year obviously was one of the toughest years we’ve had on record, and all of us in one way or another were devoted to focusing on breaking the back of the recession, restoring economic growth, putting people back to work. And so when I look at the ideas that are out there, there is overlap. They’re just six steps, maybe the first six. Under the Medicare law that is in existence, you can be sick and you can get your medication paid for for a while. If they’re not doing that, then the money that they are spending on health care is money that otherwise could have gone to job creation. And those are the kinds of things that I think all parties and both chambers should be able to agree to. I’ve got a doctor right downstairs. Many of them are at the end of the line with their insurance, with their caps, with their — this and that. Mr. Everybody here understands the desperation that people feel when they’re sick. That sort of thinking works in the classroom but it doesn’t work very well in our big complicated country. In each of those instances I remember thinking while sitting in the emergency room what would have happened if I didn’t have reliable health care. I will try to stick to the time because we have many people to hear from. So I’m very much looking forward to working with you on all those issues. Maybe more personally I should just mention the fact that I now have about as good health care as anybody could have. Number three, put an end to junk lawsuits against doctors. We’ve got some people who’ve been working a very long time on figuring out how can we control the huge expansion of entitlements. I’ve looked at those very carefully. It became a very partisan battle. There are good suggestions and ideas on the Web.

Those aren’t my numbers; they’re from Congressional Budget Office. So the bill on the floor that my friend Lamar is lamenting here has significant input from the Republicans. These facts show that the story that I told about Jesus is not just a story of some young businessman in Reno, Nevada, running a restaurant that gets jerked around by an insurance company. The same happened with Chairman Baucus in the Finance Committee. Remember, Chairman Dodd in the HELP Committee held weeks of markups. It’s as if there’s a different mindset, a different set of facts than the reality. So let’s look at the facts a little bit more because they can be stubborn, you know? Harvard just completed a study that shows 45,000 Americans die every year because they don’t have health insurance — almost 1,000 a week in America. Most of it has been used by Republicans, for major things, like much of the Contract for America, Medicare reform, the tax cuts for rich people in America. I so admire her tenacity, her legislative brilliance. And in the bill that he reported out of that committee, there’s more than 150 Republican amendments that are part of that legislation. But also, it becomes your responsibility to propose ideas for making it better. And that is your right. It should be about people fighting for their lives and fighting for a better quality of life, people like Jesus and that little girl. But remember, since 1981 reconciliation has been used 21 times. We need to do health care reform. Of course it’s not the only way out. Let’s work on it. If you have a better plan for doing this while cutting the deficit, as our bill did — during the first 10 years, our bill cuts the deficit by $132 billion; the second 10 years up to $1.3 trillion. About 70 percent of those bankruptcies were filed because of health care costs. We spent most of the last year talking about health care. So if you have a better plan for making health insurance more affordable, let’s hear it. And those were put together, that’s what we brought to the floor. This debate shouldn’t be about whether an idea came from Democrats or Republicans, or one side of the aisle or the other side of the aisle, but whether the idea will improve the health care delivery system in our country. In 2008, about 750,000 bankruptcies were filed. I want the American people to know that we need to work together, and I want to do everything that I can as a senator to work with my colleagues on both sides of the aisle to get this done. I’ve spoken with Madam Speaker on many occasions, numerous times, about health care. Eighty percent of the people that filed for bankruptcy because of health care costs had health insurance. President, to get this health care reform over the goal line. And I will do everything I can, Mr. I so appreciate the President getting us together. Health reform shouldn’t be about political parties fighting each other. If you have a better plan for making health insurance companies more accountable, let’s face it. Happens all over. So reconciliation isn’t something that’s never been done before. I know, it’s obvious, we’ve heard it — our Republican friends oppose our legislation. America is the only country in the world where if you get sick or hurt, you’re going to have to file bankruptcy — 750,000 bankruptcies in 2008. So we’re ready to listen. No one has said — I read what the President has online — no one has talked about reconciliation but that’s what you folks have talked about ever since that came out, as if it’s something that has never been done before. Now, we as leaders here, the Speaker and I, have not talked about doing reconciliation as the only way out of all this.

And it will lower the cost of premiums for these small businesses and allow them to insure more people, and to keep people that are already insured on the books, because we all know — we all know stories like we’ve heard here of small businesses that are saying, I can no longer provide insurance for my employees. And you give us the information — and we’re going to be here all afternoon. We believe there needs to be better coordination of care. The main point is we basically agree. Now, there was real disagreement on that issue, but many in my caucus thought that would open up competition, would provide for access for every citizen if they didn’t have access in some other way. And I’m not talking about creating walking paths — I’m talking about paying people who actually do a good job to do prevention; talking about changing the school lunch programs where it meets the needs, nutritional needs, of Americans; changing the food stamp program where it incentivizes people to eat the right things, not the wrong things. SENATOR ALEXANDER: So I appreciate the opportunity that Mitch and John gave me to talk. But the fact is, is we know how to treat acute asthma. You’re a doctor. You want to just wrap up real quick? SENATOR COBURN: No, I’ll just finish with that, is with one out of three dollars not helping everybody, we ought to go for where it is. So we have to deal with that. President, since some liberties have been taken here, let me just make a quick observation. President. And that is that we get stuck in the idea of treating the symptom rather than treating the disease. And we’re going to go to the University of Maryland Hospital. We also believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed. I think it is not irrelevant that the American people, if you average out all of the polls, are opposed to this bill by 55-37. Max is going to go, and then I’ll go to you, Rob. And there’s a philosophical difference in how we do that. One wants more government-centered approach to that; I would personally prefer a more patient-centered, market-oriented approach to that. I’m going to yield to John here. SENATOR COBURN: Thank you. Expanding HSAs — that’s fine, there’s nothing wrong with HSAs — but we also have to have products for poorer people, lower-income people. You mentioned the school lunch and food stamp programs. And we haven’t attacked that. And Harry mentioned several polls. So what I would hope we would do is that we would go back and concentrate on the areas that have the biggest pot of gold for us. You mentioned the idea of buying across state lines, insurance. So what I thought we ought to do is maybe talk about why does it cost so much? Because the thing that keeps people from getting access to care in our country is cost. And the good thing was that both of you in effect said the same thing, that we need to get to the objective of covering all Americans and having them have access to affordable health care. We’ve dealt that — with that in our bill; we’ve dealt with it previously, as you well know. Steny. That’s a 67 percent increase. And the total cost per employee is expected to rise to more than $28,000. Now, you may have a better way of doing it. I wanted to give people a little bit of a wide berth starting off, but we’re going to need to be more disciplined moving forward if we’re going to be able to cover every item. We basically know what the problems are, all of us. But here’s what I want to emphasize is that even without the subsidies it’s estimated by the Congressional Budget Office that the plan we put forward would lower the costs in the individual market for the average person who’s just trying to buy health insurance and they don’t — they’re not lucky enough to work for a big company, would lower their costs by between 14 and 20 percent. Their bill is going to go up to $1,830 — $1,830 next year. We are actually quite close. I had a message on my telephone answering machine just a little while ago, a couple of weeks ago. You will have a menu of private insurance options that you’ll be able to purchase, but because you’re not purchasing it on your own, you’re purchasing it as part of a big group, you’re going to be able to get lower costs. And what I’d like to do then is to start first with something I heard everybody agree on, every single speaker, and that was the issue of cost. Now, the — what we’ve done is we’ve tried to take every single cost containment idea that’s out there. What we’ve said is that if you join one of these exchanges, you will have choice and you’ll have competition. SENATOR ALEXANDER: Mr. I’d like to get this issue settled about whether premiums are reduced before we leave today, because I’m pretty certain I’m not wrong. On the prevention side, there’s a whole host of provisions inside the legislation that’s been passed by the House and the Senate, and I think Steny will talk about it. We don’t do that. I’m sure we can get there, too, an agreement. I think the disinfectant of sunshine helps — it helps consumers, it helps our people. So tomorrow, if we got together and fixed fraud, we could cut health care 7.5 percent tomorrow for people in this country. Most doctors do. What have we done? We’ve stopped premium discrimination. SENATOR REID: Mr. President, I’d like to yield to Mr. We want to go after fraud, waste, and abuse — I’ll reiterate that — a transparent market; stop premium discrimination; and make sure that people with a preexisting condition — as none of us have a problem with, but a lot of people do have — because we’re in a big group — that are in a large group and would prohibit that. So we’ve identified some areas we agree on and then the question just is, does that help the average family in the individual market who potentially can get cost? But, Steny, why don’t you — SENATOR COBURN: Well, let me just respond to one thing. The costs for families for the same type of coverage as they’re currently receiving would go down 14 to 20 percent. In your new bill, you have good fraud programs, but you lack the biggest thing to do. What I’d like to do is to see if we can proceed and have a very concrete conversation about what are the ideas that you guys have that you don’t think are in our bill to contain costs. And what I would like to do is get back directly to you with why I believe — with respect — you’re wrong about the bill. It sounds like you have maybe one other idea that you don’t think is in our proposal, but the idea of undercover patients, but that’s something that I’d be very interested in exploring. And I’ll try to set the example here. And in addition to that, Senator Coburn, we certainly agree with you that one in three dollars is not being spent as effectively as it should be. SENATOR BAUCUS: Sure. Now, I’d like to call on Dr. It may turn out, on the other hand, there’s just too big of a gulf. We also know there’s some other real things that we ought to address. Everybody went a little over time, which is not surprising with a room full of elected officials. THE PRESIDENT: John. But as I said, we’ve adopted a lot of the ideas that we’ve heard from your side of the aisle. Boustany is guilty of it — is a large portion of the tests we order every day aren’t for patients, they’re for doctors. And so we believe that we ought to address that issue by allowing these small businesses to band together in the same way that I think, Mr. They called me up and said, “We don’t know that we can afford to keep our small business going.” So all of us — John McCain, my good friend, that was your quote, as you probably recall, in the debate that you had with President Obama. I think we’re going to have Steny Hoyer go next. But we certainly have addressed the issue of making sure that we have wellness as a focus, not sickness. Also, cutting Medicare benefits by a half a trillion dollars to fund this new entitlement is I think a step in the wrong direction, and many Americans do as well. So we’ve worked very hard on that in this bill. I think that Senator Alexander framed our overall position very well when he said that we’re looking at thousands of pages of legislation and we believe a better approach is to go step by step to address these issues of cost. And we’re working on that, trying to get her some additional help. SENATOR COBURN: — we’re shifting it to the private sector. And we have a lot of provisions in both bills, as you well know, that try to get us to a place where administrative costs, health information technology, so many other things are done to wring the costs out. So that would be my proposal. And the biggest pot of gold is, is we don’t incentivize prevention. President. You get cost-shifted every penny that gets wasted on Medicare, and that gets cost-shifted to the private sector. And we think it’s a far better way to get these economies of scale than the exchange thing that’s in the huge — that’s in the huge bill, that this will actually allow businesses to be able to lower their cost exactly the same way that large businesses do. It’s another example — we really are close. A woman that I know well called me up. As I listened to your description of the House/Senate bill, as well as the proposal that I put on our Web site, obviously there were some disagreements about how you would characterize the legislation. So if in fact we’re wasting it in the public sector — THE PRESIDENT: It would help. President, we are basically including most of those provisions, if not all, in our joint legislation. These are pools where people can come in and get the same purchasing power as members of Congress do as part of the federal employees health care plan, as people who are lucky enough to work with big businesses can do because there are a lot of employees in those big businesses. Maybe other colleagues will say that. THE PRESIDENT: I think it’s a great idea. President, it’s a Republican idea. And we believe that we have been addressing them and trying to get some of these stories that all of us hear to a place where they won’t be so tragic for individuals and for families. We certainly agree with the premise you stated. We certainly agree that you get better economies of scale if you can come together. Well, Mr. Thank you, Mr. CONGRESSMAN BOEHNER: I’d like to yield to Dave Camp to continue this conversation about cost containment. We believe that there ought to be a way that we can incentivize the coordination of care. What would happen to access in this country if tomorrow everybody’s health care costs went down 15 percent? Access would markedly increase. THE PRESIDENT: Tom. We actually create more diabetes through the food stamp program and the school lunch program than probably any other thing because we’re not feeding — offering and incentivizing a great response. President, you mentioned, large companies do — I mean, really the same way — so that they get all the advantages of, if they self-insure, being able to avoid the 50 state mandates; being able to lower their administrative costs because they’re not having to deal with that. You’re shaking your head in agreement, and I know we all agree on that. As you’ve said, Mr. President, if I could just say, I’m not an expert on much but I am filibusters and we’ve got 40 members of Congress here. They can do what they want to do — and Senator Wyden also has a proposal; Senator Cantwell has a proposal. I just want to make this quick point. President, thanks for having us do this. Thank you, Mr. I think all of us around this table agree that a free market does that — an open market, a transparent market — where people can compare prices and compare what they’re going to get. Now, Senator Baucus is going to speak more specifically in terms of our cost containment, but doughnut hole certainly is one of the issues that we need to deal with. We did it a little differently, but that’s what we tried to do. So I think we have agreement on conflict of interest in delivery of medicine as well. SENATOR ALEXANDER: Mr. But I would suggest to you that one of the things that many in my caucus felt very strongly about in terms of competition was having a public option. We’re trying to do that. As a consequence, a lot of small businesses have dropped coverage altogether. I think we all agree on that. They’ve been asking for it for years. There are conflict of interests within the medical field. THE PRESIDENT: Tom, you made some powerful points. We have proposed in both the House and the Senate in fact for a number of years that small businesses be able to band together in small business health plans or association health plans. And it’s pretty good — it’s 35 percent tax credit first couple years, and then once the exchange is up it’s 50 percent. Kline from Minnesota, who will talk about the small business health plans in terms of how we would propose to do this. The issue of prevention, and that includes, by the way, things like how our kids are eating and getting exercise. THE PRESIDENT: Well, Tom, I appreciate what you said. And that’s for everybody in the country. SENATOR ALEXANDER: Well, may I — may I — THE PRESIDENT: Let me just finish, Lamar. I think today is going to be enlightening. And my hope would be that we would look at where the money is, and if truly it’s accurate — and I don’t know many people that will disagree that one in three dollars doesn’t help somebody get well and doesn’t prevent — then we ought to be going for that one in three dollars. I suppose there are a whole lot of every Americans and American families listening to us today and watching us, and they’re hoping that we’re all sitting around here talking about them, not about us. I’ve talked to other businesspeople who say, we were going to hire but we decided not to when we got our monthly premiums. We have a competitive edge. Tom Coburn — he’s been a practicing physician for many years — to address the cost containment issue. So, Lamar, when you mentioned earlier that you said premiums go up — that’s just not the case, according to the Congressional Budget Office. So, let me give you an example. With respect to small business, we’re not that far apart. I think as we focus this part of the conversation on cost, a lot of Americans say to me, if you’re really interested in controlling costs, well, maybe you shouldn’t be spending a trillion dollars on health care as the Senate and House bills do. I promise you we’ll get this settled before the day is out. THE PRESIDENT: Dave. Go ahead. That clearly ups cost. That’s going to help, in my judgment. Well, when you look at the total amount of health care that’s government-run, you’re talking $150 billion a year. She said, “Steny, I was just diagnosed with a tumor, and I’ve got to be operated on. I don’t have insurance. Secretary Sebelius is working to try and find ways to encourage states to settle, resolve issues before they become big, bad lawsuits. And I’m proud of the First Lady for working to see what she can do on that front. Then I’m going to call on Dr. And I promise you, I’ve gone through this carefully with the Congressional Budget Office. President, if you’re going to contradict me, I ought to have a chance to — the Congressional Budget Office report says that premiums will rise in the individual market as a result of the Senate bill. But they didn’t say that the actual premiums would be going up. So rather than start at the outset talking about legislative process and what’s going to happen in the Senate and the House and this and that, what I’d suggest is let’s talk about the substance, how we might help the American people deal with costs, coverage, insurance, these other issues, and we might surprise ourselves and find out that we agree more than we disagree. The biggest thing on fraud is to have undercover patients so that people know we’re checking on whether or not this is a legitimate bill. Mitch, who would you like to talk about cost? SENATOR McCONNELL: Yes, Mr. President, I compliment you because in your proposal you go even farther. The government now directs over 60 percent of the health care in this country. Small businesses have been asking for this for years. We would hope that it is in legislation that we agree upon, because seniors are confronted with extraordinary out-of-pocket costs for a very significant portion of the cost of their prescription drugs. Coburn to make our framing statement on the issue of cost containment. Now, it’s not in your legislation, but you certainly agree with capping out-of-pocket expenses on an annual basis or lifetime basis, that you don’t think that’s right that people ought to be — continue to be covered. Many in my caucus believe that one way of doing that is to increase competition, to have an open, free market that is transparent. We need to talk about how that better way is. One thing I think we need to be acutely aware of, ladies and gentlemen, we are here representing the American people. In addition, you mentioned lawsuits. Mr. An open, transparent market will bring down cost, we believe. If you look at Thomson Reuters — when they look at all of this, they say at least 15 percent of government-run health care is fraud. And that’s — there are some provisions in the legislation that’s already been passed through the Senate and the House that directly relate to this that I think you’d be supportive of. We agree on prevention. And I would guess that most small businessmen would like to do that. We think this bill does that. But I just think it’s very important to understand that what we’ve done is to try to take every single cost containment idea that’s out there and try to adopt it in this bill. It is absolutely true that if all we’re doing is adding more people to a broken system, then costs will continue to skyrocket and eventually somebody is going to be bankrupt, whether it’s the federal government, state governments, businesses, or individual families. The non-partisan actuaries at the Center for Medicare and Medicaid Services say on page four of their letter on the Senate-passed bill that it would bend the cost curve in the wrong direction by about a quarter of a trillion dollars. We know that we do not — we absolutely do not incentivize prevention. And the facts we know is one out of every three dollars that gets spent doesn’t help anybody get well and doesn’t prevent anybody from getting sick. Every good idea that we’ve heard about reducing fraud and abuse in the Medicare and Medicaid system, we’ve adopted in our legislation. And you’re right, we have to get there. We give a lot of flexibility in that regard. What the Congressional Budget Office says is, is that because now they’ve got a better deal because policies are cheaper, they may choose to buy better coverage than they have right now and that might be 10 to 13 percent more expensive than the bad insurance that they had previously. We basically know that the current system is unsustainable. Let’s take the list, for example, that Lamar mentioned. So let me respond to what you just said, Lamar, because it’s not factually accurate. President, for the invitation today. I don’t know yet whether we can. I know — and some — you have some of that in these new thoughts, in terms of incentivizing states to do that. By one estimate, without health care reform, by the end of the decade premiums for businesses would more than double in most states. CONGRESSMAN HOYER: Mr. Whether they’re an individual — this woman who has the tumor — or whether they’re a small business, they can get into a large group. So when you break down the cost, what we know is 33 percent of the cost in health care shouldn’t be there. Now, I’ve already indicated some statistics, but I just want to reemphasize these. Hopefully, we can. And I’d just like us to kind of just — there’s opportunity for us to work out some of these differences. So I think if — I think it’s great that we’re coming together, but the goal is in, where’s the cost excesses? And what I would hope we would do is we would look at that and say, how do we come together and actually achieve a reduction in the extortion that goes on in this country in terms of medical malpractice — and there’s lot of ways to do that without us mandating to the states. We’ll figure out a way and means to get there. A quote I will use is, we should have available and affordable health care to every American citizen, to every family. CONGRESSMAN CAMP: Thank you, Leader Boehner, and thank you, Mr. You have a number of doctors in the room. The doughnut hole we deal with in our legislation in the House. And if throwing money at it and creating new government programs could solve it, we wouldn’t be sitting here today because we’ve done all that, it hasn’t worked. So part of the goal here I think is to figure out what are the areas that we do agree on, what are the areas where we don’t agree, and at the end of that process then make an honest assessment as to whether we can bridge these differences. And then we’ll have to figure out how we proceed from there. If you’ve got some bigger purchasing power, insurance companies want more customers, they would drive down those costs. And how do we go about doing that, and what are the components of that cost? And when you look at, when it’s studied, and if you look at what Malcolm Sparrow from Harvard says — he says 20 percent of the cost of federal government health care is fraud. We agree. THE PRESIDENT: Good. President, I’ve had my time — THE PRESIDENT: And what I’d like to do also is to make sure that you maybe suggest some of the ideas that are currently in the bill that you think are good, because, Lamar, in your opening introduction, what I saw was sort of a — the usual critique of why you thought it was bad. That’s what we’re trying to get for every American; that they have access to a large group. Fewer than half of businesses with fewer than 10 workers now offer coverage. You mentioned Malia and Sasha. I just want to address very quickly, Lamar, the issue of process that you raised at the beginning and then we’ll move on and start talking about the specifics. Some suggest association health plans where small business people can band together in an association, pool, and get better insurance. So that’s an example of where we agree — we want to eliminate fraud and abuse within the government systems. If they need nursing care in the future, they’ll get it; lost wages; reasonable awards for punitive damages and pain and suffering. The issue of defensive medicine, as I indicated, Secretary Sebelius is working on this, but I think that there are things that we could do at the state level to help foster innovation and eliminate some of the concerns that you’ve got. It’s an exchange, you go to the exchange and shop around, and you get your best price. And I’ll be happy to present this to the press and whoever is listening, because this is an important issue. There’s not a lot of difference — close in the sense that, without being corny or dramatic about this, if the American people want us to do something basically reasonable, it doesn’t have to be one congressman, one senator’s provision, but basically reasonable — we are on the verge and the cusp with not too much effort to try to bridge a lot of gaps here because the gaps in my judgment are not that great. I would be interested in hearing from any of our Republican colleagues what objections they have to what we consider one of the biggest ways of driving down costs, and that’s what Steny just referred to, which is allowing individuals and small businesses who are currently trapped in a very expensive market — essentially they’re having to be out there fending for themselves — to be able to buy into essentially a large group, to become part of a large group just like all of us as government employees are part of a large group, so that they have more negotiating power with the insurance companies — which I think we all agree would drive down costs. We have a system throughout the country where we’re encouraging lawsuits that aren’t productive for the country and what they actually do is cause the cost of health care to go through the roof. And whether you go to Harvard or whether you go to Thomson Reuters, there are some facts we know about health care in America. We also agree on trying to change the way we reimburse docs. We have to deal with sickness, but what we really want is wellness. And so my question is, is there something in terms of the way the House and Senate bills have been structured that leads you to be concerned or want to not move forward on that approach? John. There are major prevention provisions in our legislation, as Senator Coburn mentioned. But they may get labeled with a preexisting illness after that, and that’s another thing I’d be happy to talk about at a later time. But nevertheless, there’s where we can come together, just on those two areas, where we could cut costs 15 percent tomorrow. What we don’t do a good job of is preventing children from getting acute asthma. Exchanges, as you mentioned, Mr. We all know that there’s a wide disparity in what hospitals charge for the same procedures. After that, Lamar says we should find ways for states to be able to lower their costs, so we do that — we let states opt out. We have those provisions in our bill. As far as Mike Enzi’s proposal, he is ready to talk about it; others are. There are some additional ideas that Republicans have presented that we think are interesting and we also tried to include. So that’s where there’s some overlap. For folks who even with those lower costs still can’t afford coverage, we’d provide some subsidies. Absolutely, though I’d first like to say something that just strikes me just in spades. And that’s what we’ve tried to do in both these bills. We also know that about half of the uninsured either work for small businesses or depend upon somebody who does. Small business participates in their own exchange and gets the advantage of all the pooling, and then they can do what federal employees do — they can shop and compare and to get the best deal. We agree with that. We don’t pay rewards for a great management of chronic disease. I might add that we’re also providing tax incentives, tax credits, for businesses and small business that wants to purchase health insurance for its employees. There’s nothing wrong with addressing those and taking those off. President, let me — let me show some respect for my colleagues here. Let’s recognize, though, that those savings in the government systems, which will help taxpayers and allow us to do more, doesn’t account for the rising costs in the private marketplace. The second thing we know is, from the Congressional Research Service, that most of the mal drivers today in health care come from government rules and regulations. Now, the private marketplace, you mentioned the issue of medical malpractice and frivolous lawsuits, and as you indicated, these are areas where Secretary Sebelius has already begun to try to give states some incentives to do that. There’s not a lot of difference here. So I might say, too, that if you look at all the provisions that Steny outlined, may help them, we agree. President, thank you very much. THE PRESIDENT: Okay. Every one of us has a story. Barrasso is guilty of it; Dr. And fraud and waste, we talked about that. So I hope maybe you could say, well, those are the ones that we think are good ideas; here are the things that we think are bad ideas, as opposed to just painting in broad brush. I don’t think conceptually that would be a problem. All right. There’s estimates that there’s $15 billion worth of fraud in Medicaid a year in New York City alone. THE PRESIDENT: Well, thank you very much, Harry. But I think what the American public that’s listening and watching expects us to do, Mr. You go to Orbitz or Expedia to buy a airline ticket, you compare it to get the best price — that’s basically what this is. They’re all here eager to speak, all sure they could do a better job than I could on any of these points. What they said was they’d be going down by 14 to 20 percent. CONGRESSMAN BOEHNER: Well, Mr. So what we ought to do is do the Willie Sutton thing; we ought to go for where the money is. And we ought to do it not by creating a whole bunch of new government programs, but by creating an incentive to reward people. Here’s what the Congressional Budget Office says. And I think that once we keep pushing on those areas that we’re close, this will make a difference. More than a quarter of small businesses have reported a premium increase of 20 percent or more just last year — 20 percent. You’ve made some interesting points, and why not let other members of Congress have a chance to talk. And what I want to do is to see if maybe we can adopt some of those or refine what we’ve already done in order to further reduce costs. So rather than argue with you in public about it, I’d like to put my facts down, give them to you. Every proposal that health care economists say will reduce health care costs, we’ve tried to adopt in the various proposals. THE PRESIDENT: Well, exactly. My husband makes $28,000; I work part-time and make about $5,000.” She says, “We’re making too much money for Medicaid. SENATOR BAUCUS: They’re great ideas and we addressed unnecessary readmission rates in hospitals, et cetera. On the other hand, when I listened to some of the steps that you thought Republicans would be open to, I thought, well, a bunch of these things are things that we’d like to do, and in fact are in the legislative proposals. THE PRESIDENT: Mitch, is there somebody — SENATOR McCONNELL: Yes, Mr. We all know, and I’ve heard everybody say here, that small businesses are the engine that drives our economy. And in addition, you speak eloquently and correctly about wringing fraud, waste, and abuse out of this system. I think that it shows some promise. And the reason they’re there is because we are risk-averse to the tort system and extortion system that’s out there today in health care. And there are a lot of ways to fix that, but I just went through last night — if you add up what Thomson Reuters, which looked at all the studies that have been done and combined them in — they say between $625 billion and $850 billion a year of health care dollars are wasted. We haven’t gone where the money is. So it seems to me if cost is the number one thing that’s keeping people from getting care, then the efforts of us as we go after cost ought to be to go to those areas where the cost is wasted. So the main point is we’re not really that far apart. A key way of reducing costs that’s missing from the House and Senate bills is responsible lawsuit reform that guarantees injured parties, much like our two largest states have adopted — Texas and California — access to all economic damages, such as future medical care. That’s his number. Preexisting conditions — clearly, we all agree on that. We have major provisions in our bill to reduce fraud and waste. And the insurance company doesn’t have preexisting conditions for us, they just take us as a group. I think the biggest game-changer here, frankly, is how we reimburse our doctors — based more on quality rather than quantity. What we provide for in our legislation is something similar — it’s called the SHOP Act. I think probably everyone around this table agrees to it. We take care of that in our bill. What’s the other area? What we do know — and I’m guilty of this; Dr. I also think that we should — hospitals should publish the cost of their basic procedures, what’s an appendectomy or a colonoscopy or whatnot, to enable consumers to shop around, where’s the best price. CONGRESSMAN KLINE: Thank you, Leader. THE PRESIDENT: Before you go, Max, I just want to ask, whether it’s you, Tom, or anybody else on the Republican side, and maybe some of the House members might be interested — Senator Coburn mentioned some cost containment issues where it sounds like we agree: fraud and abuse. President, is what you’re doing — bringing us together, coming to agreement to make sure that we get to a place where we reach the objective that President Obama and candidate McCain expressed as the objective on behalf of the American people. And so one of the goals that I set out very early on in this process was how do we control costs? Now, what we have done, as I mentioned earlier, was to try to take an idea that is not just a Democratic idea but actually is a Republican idea, which is to set up exchanges. So you can imagine what that does to hiring, what that means for incomes, and you can imagine how many families are going to be unable to afford insurance. Cost containment is clearly one of those issues that we need to deal with — cost containment for that small business that is having a 67 percent increase; cost containment for that woman who can’t afford insurance but has a health care issue that she can’t avoid — it’s not optional for her. I know you’re happy to have seen in our bill — in the House bill and in the Senate bill — very substantial investment in doing just what you suggest. THE PRESIDENT: No, no, no, no — let me — and this is an example of where we’ve got to get our facts straight. We absolutely agree on that. They want 50 percent down of a $25,000 bill.” She doesn’t have that. The first thing I would do is put out a caution to us, because what I see the Congress doing — and what I saw this last year — is us actually performing bad medicine. And seniors are concerned about that. THE PRESIDENT: You and I agree on this. And we know from a USA Today Gallup poll out this morning, they’re opposed to using the reconciliation device, the short-circuit approach that Lamar referred to, that would end up with only bipartisan opposition by 52-39. Why? Because we’re in a big market. I know Tom Coburn really agrees with that as a doctor. You agree with that rhetorically. That’s the message they’re sending to all of us, and they’re absolutely correct. And that would then help to dictate how we move forward. Frankly, we all have studied this issue a lot — health care reform. Your bill would increase premiums, I believe; you say it wouldn’t. We’ve put incentives for prevention in here, which you mentioned. They’ve always tried to do right by their workers with their family-run company, but they had to do the unthinkable and lay off employees because their health care costs were too high. HSAs work pretty well if you have middle or high income. SENATOR ALEXANDER: That’s my point. Various senators, bipartisan, have worked on this, and basically it allows — sets up a small business arrangement in exchanges. They specifically say the health expenditures under the Senate bill would increase by $222 billion. That’s something that I’ve put in my proposal that’s actually in the Senate proposal. We’re trying to find ways for small business to pool, small business to take advantage of competition, they shop and compare; and also some tax provisions that enable — to encourage businesses to get health insurance. So what we’re going to talk about is the how. If you’re in a small market, as the President pointed out, you’re going to pay a higher price. I know some of you have agreed to this as a concept in the past. President. SENATOR ALEXANDER: Mr. And you don’t know who’s an undercover patient and who’s not, and all of a sudden you start changing your attitude of whether or not you’re going to milk Medicare or you’re going to milk Medicaid. It works. What I like about exchanges — it’s like Orbitz, it’s like Expedia. As I mentioned earlier, I hear stories from people all the time about how these costs have very concrete impacts on their lives. It’s not a new idea. That’s fine. So we have to deal with costs, and I haven’t heard anybody disagree with that. My hope is that we can and I’m going to be very eager to hear and explore how we might be able to do so. I spoke to a family, the Links (ph), from Nashville, Tennessee. I had a small business in my district, like all of you, who last year paid $1,100 — a couple, healthy, paid $1,100. We hope we can get agreement on doing that. You mentioned that as — that Mike Enzi has previously said, that he’s interested in small businesses being able to pool in the equivalent of some sort of exchange. THE PRESIDENT: We took some additional ideas from folks like Congressman Roskam. Selling insurance across state lines, for example — we allow for that not exactly in the way that some would, but assure it with compacts and once state exchanges are up people will be able to buy and sell insurance across state lines and achieve that competition. We don’t do the good job of prevention. How do we do that in terms of creating an elimination of fraud? When you compare the private sector fraud rates, it’s 1 percent, compared to Medicare and Medicaid. Max, do you want to address this issue of how we can allow people to buy into large groups, how the Senate bill accomplishes it, and I don’t know if you want to remark on what John just said. The fact is, is with young kids going to the ER, whether they have meningitis or asthma, they’re going to get treated in this country.

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