Press Conference With Senator Chris Dodd; Senator Barbara Mikulski; Senator Tom Harkin; Senator Jeff Bingaman; Senator Patty Murray

Press Conference

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SEN. MIKULSKI: These are my -- a lot of these folks are my constituents. Let's have a shout-out for Maryland! (Applause, laughter.)

It's all yours.

SEN. DODD: Yeah, thanks. Well, let me begin by first of all thanking these wonderful men and women standing behind us, including my colleagues, but obviously these people who come from the medical profession, families, and others who are deeply interested, deeply concerned, passionate about the issue of whether or not we're going to be able to change the current system, which is a broken system, an unsustainable system.

There's a lot of debate about what we need to do, what we ought to do. But I don't know of anyone who's looked at this issue for more than five minutes who would conclude that the status quo is acceptable. It is totally unacceptable. And so we have no choice, in my view, but to change the system, to reform the system, to step up and do the job that the American public are asking us to do, and that is to create accessible, affordable, quality health care.

And that is our common determination -- my colleagues who are standing with me and, I believe, others across the so-called partisan divide here -- to come together to formulate a plan that will achieve those goals of driving down cost, expanding accessibility, providing quality health care for all Americans. That's our determination today.

Senator Kennedy, of course, is our driving spirit, the person who has spent four decades of his life committed to this issue. And no one wanted to be here more than the rest of us except himself to be a part of this thing, and he is in so many ways: as a guiding inspiration about our determination to achieve those results. And our hope is in the coming days he'll be joining us at some point here to carry on this debate. I'm a designated hitter until he gets back here. And no one wants him back here more than I do to be a part of this and to lead this effort. He means so much to this.

I don't want to spend a lot of time boring you with a lot of details. Many of you know it already: consuming 18 percent of our gross domestic product already. The estimates are that 35 cents out of every dollar could be spent on health-care costs in a matter of just years, a few years; that one out of five, one out of six Americans are without health-care coverage. And, as we learned only a few years ago -- that at any given point in the year -- and particularly in these days, with so many people out of work -- that as many as 85 or 87 million Americans at one point or another had no health-care coverage during the year.

Now, if we can talk about these numbers and statistics, that behind them are real people, like some of the people standing behind us here this morning, or this afternoon. That family who finds themselves out of a job and simultaneously finds out their child is in desperate need of health care, how are they going to pay for it? That woman, that worker, that job holder who all of a sudden finds that that insurance is no longer there at a critical moment when they need it.

And that happens every single day all across this country.

We find that infant mortality rates are the highest among the industrialized nations, a hundred thousand people lose their lives every year because of avoidable medical errors -- statistics that ought to be shameful in a nation as affluent, as well-heeled as our country is. And so we've got our job to do in order to correct the system.

Let me just say at the outset that as Democrats here in the Congress, we're not interested in changing a system for the sake of changing. If you like what you have, you get to keep it. We believe in choice. If you ought to be able to -- you ought to be able to choose your doctor, choose your hospital, choose the kind of coverage you want to have. We're not interested in changing that which works, we're interested in reforming that which doesn't work. And a lot doesn't.

And we spent a lot of time over the last number of months -- in fact, going back a year or more -- sitting which each other, the staffs, working together to formulate the bill that we introduced last week.

We're going to start a markup tomorrow. We're going to have more meetings today. We'll -- so-called walk-throughs, with our colleagues, to listen to their ideas and thoughts. They've introduced a number of amendments -- the Republicans have -- on our committee, but my determination, as the -- as the sort of fill-in for Senator Kennedy, is to move this process along. My hope is, we can achieve bipartisanship. I've said that all the way along here. Nothing would make me happier than to have us come out with a strong bipartisan bill. And I'd begin the process with that goal in mind -- not to achieve bipartisanship and a weak product, but to have a strong product that's endorsed by people across the political divide in the United States Senate. I still believe that's achievable. I still believe it's achievable. Our determination, again, is accessible, affordable quality health care.

Senator Kennedy asked several of our colleagues on the committee back a number of months ago to take on some significant responsibilities. He asked Senator Tom Harkin to examine thoroughly the issue of prevention. One of the major cost savings for us in this bill will be to avoid people showing up at a doctor's office or a hospital altogether. Senator Harkin's not here this morning but has done a terrific job on that issue.

Senator Mikulski of Maryland was asked to take on the issue of quality, to look at how we can improve the delivery systems, the quality of health care in our country, and between she and Senator Harkin and Senator Bingaman, who took on the issue of coverage, I think had some 11 or 12 hearings just on those three subject matters alone since the first part of the year.

And Senator Patty Murray of Washington has taken on the issue -- the workforce issue, the delivery; how do we get the people, the health-care providers, the technicians, the primary care physicians and others, the numbers we need in order to serve that expanding population as a result of increased accessibility.

And so I'm going to ask each of my colleagues here to share a few words with you about this, and then we'll open it up to any questions that you may have about the process. But the process will begin, and it's a first step in a process. But again, the goal is to achieve that accessible, affordable quality care; allow people to keep that which they have and like and to, first of all -- and secondly, fix of course the problems that are not working well and in desperate need of reform.

It's an economic issue. It's also a human rights issue, in my view. It's a question of providing that which people ought to have. This is not an optional commodity. This is not about what sort of a car you want to buy, or whether or not you think you ought to have a TV or not. An American gets sick and is in trouble, they ought to be able to have the comfort of knowing they can be helped. And it ought not to be determined by how well-off you are. It ought to be determined on how well we can make you, how we can avoid you falling into that health-care problem.

With that, let me turn to Senator Mikulski.

SEN. MIKULSKI: Thank you, Senator Dodd.

SEN. DODD: (Referring to box.) Yes, I want to kick that over.

SEN. MIKULSKI: Can you kick that over for me, Patty? And then you can use it when it's your turn. (Box is put into place.)

(Standing on box.) It's a little wobbly, just like our health- care system. (Soft laughter.)

Today we're standing together with men and women from throughout this country, many of whom are here from Maryland. And we're standing together because really, whether you're a patient, whether you're an employer, or whether you're a provider, you need a government on your side to make sure that we write a brand-new prescription for what is ailing the American health-care system.

And we know what's ailing it. We know that the costs are skyrocketing, whether you're a patient trying to afford health care, where you might not have coverage, or whether you're underinsured; whether you're an employer who wants to be a good guy, to be able to provide it, but you find the cost of the insurance plans escalating; and if you're a provider, you know the costs of just running the practice forces you to practice volume medicine versus value medicine.

So we're here today to talk about how we want to bring about change. We believe that the health-care initiative being developed on a bipartisan basis through the HELP Committee will address those concerns, to reduce costs for families, business, providers and for our government; to protect that sense of choice, where if you've got -- if you like what you've got, you get to keep it.

But we have to deal with the fact that 46 million people are uninsured. And many millions are underinsured.

Every day in America, families are forced to choose a different doctor, because their health plan was changed, because their employer could no longer afford the old plan. Every day in America, families see their health benefits plan erode, because they can't keep up with the high premium co-pays and deductibles. Every day, small businesses who see their profits shrink and their health premiums go up have to either jettison their employer benefit or shrink the opportunity.

And then for the providers, what they see is a system that is a sick system, that it is a broken system, that it rewards really taking care of disease rather than taking care of patients, to help them improve their health outcome.

What we want to be able to do is be able to change that. I believe that we can deal with the cost by improving quality initiatives, reducing medical error, administrative simplification, better management of chronic disease and illness and preventing hospital readmission within 30 days, by again better case management and better use of health information technology.

It is estimated that each one of those items costs the taxpayer and the system more than 30 to $100 billion. When you add it all up, it's a trillion dollars. The cost of doing nothing is far more expensive than the cost that is being proposed in this bill -- the cost to people, the cost to our country and the cost to our economy.

So the time for change is here. And when you listen to the compelling stories like I have, throughout my own state, it really moves you to action. We have a man here by the name of Mark. (Inaudible.)

Mark, do you want to hold up your hand and your plan and let us know where you are?

Mark owns a moving and storage company started, by his family, in 1956. He provides health insurance to 30 employees and their families. he said, Senator Barb, I can do it for now, but it's not easy.

Again Mark and so many other small businesses are saying, health premiums are going up; profits are going down; I'm concerned that I'm going to have to shrink my health benefit.

Mark needs a government on his side that recognizes the business -- the challenges that business face both in the marketplace today and in the health marketplace where they have little places to -- little opportunities to go. He needs to make sure his government helps provide insurance plans that are affordable to him and affordable to his employees. We believe we'll be able to do that with what we're doing, including the public option in our tax credit for small business.

Then we have another compelling story, Phyllis Zolatoro (sp), who is here with her son Craig who's 24 years old. Phyllis and her family have coverage that is very spotty and very spartan. She has a medical care plan now, but it only provides primary care. She doesn't mind me saying so, and we've discussed this: She has Crohn's Disease. She needs access to specialists. She might need hospitalization. Let's hope it doesn't, but if she has the right care, she'll be able to get it. Her son suffers from an immune system problem. He needs an access to primary care where the immunization -- immunologist will be there. She needs coverage. She needs coverage where her government is on her side, to make sure her insurance is reliable, undeniable and comprehensive.

Phyllis and her son Craig need a medical home. They need to have a reliable medical home where they get that primary care, where they have that access to specialists, where they have the drugs and medication they need, and be able to turn to a community health home for those important things, particularly on nutrition counseling which is a chief component to dealing with Crohn's and immune challenges.

So we -- those people here, who talk to their elected officials every day, have told compelling stories. Though they have compelling stories, we need to be equally as compulsive about getting this job done.

I want to thank Phyllis and Mark and all of my constituents who spoke up, who participated in my techno-town hall meeting yesterday. They're telling it like it is, and what they're saying is, we need change, and we need change that's reliable, affordable, undeniable. And I think we're ready to do it.

Thank you very much.

SEN. DODD: Thank you, Barbara.

We've been joined by Senator Harkin. (Inaudible.)

SEN. HARKIN: Let me just say I do think there's a serious effort starting tomorrow in our HELP Committee to craft legislation that will correct some of the well-recognized problems that need to be corrected in our health care system. This is not a -- throwing out the old system and replacing it with an entirely new system. This is correcting problems that there's general consensus need to be corrected.

We had a good hearing Thursday afternoon, which Senator Dodd chaired, and we had a broad cross-section of witnesses there representing a lot of health-care providers, insurance providers, experts of various kinds. And the thing that struck me about their testimony was how much we agreed upon, how much they agreed upon.

Four things in particular that they said they agreed upon is -- reforms of the insurance market. We should not have people selling insurance policies on the basis of who can they find who's not going to need insurance and sell them a policy. We've got to have a system where if you're going to sell an insurance policy -- a health-care insurance policy in the future, you've got to make it generally available to the public, and you can't have a lot of "gotchas" in the policy. It's got to cover the things that people need insurance to cover.

We need to have some kind of a requirement on individuals in this country to obtain coverage one way or another, either through a public program or some kind of private coverage. But I think there's general agreement on that. We're not going to deal with the 45 or 50 million people who don't have coverage unless we have some kind of requirement.

Now, having that means we've got to subsidize. We've got to provide some help to those people so that they -- many of those people, at least, so that they can afford coverage. And I think there's general agreement on that as well.

And then we need to be sure that there is assistance to small employers. Mark was referred to here by Senator Mikulski. I think he's an example of an employer who is providing coverage. There are a lot of employers in my state who are also providing coverage, but many who are not; they can't afford it.

And we need to have government-supported credits that will help those folks to provide some coverage and assist with that coverage.

So there's a lot we can agree upon. I think that, building on those common agreements, we can put together legislation that will be very good for the country. And I hope that we have serious -- a serious buy-in by all of our colleagues in that effort, and that's the purpose of the markup that starts tomorrow.

SEN. DODD: Thanks, Jeff, very much.

Patty, do you want this box?

SEN. MURRAY: No.

SEN. MIKULSKI: Show-off. (Laughter.)

SEN. MURRAY: (Laughs.) You know, six months ago, in his Inauguration speech to the nation, President Obama said that the question we all need to ask ourselves is not whether our government is too big or too small, but whether it works. And that is really why all of us are working so hard on this: because we know that the health of our families, the survival of our businesses and our long- term economic stability depends on us making sure that health care works for all Americans today, because today it just is not.

Thanks to the president's directive and the tremendous work of the senators you see up here, Senator Dodd and Senator Kennedy, as well as the Finance Committee, we are working hard because we know we have an historic opportunity to make health care work and to take on the challenge of providing quality affordable health care for everyone.

Whenever I go home to Washington State, people come up to me from all walks of life, and I hear from them whether they're just a small family trying to make it, a small-business owner, or work for a large employer, or have lost their job in this economic downturn, or for whatever reason, who tell me that the skyrocketing cost of health care is just overwhelming them or their business. The financial instability that it causes -- people are exposed to higher premiums and deductibles. All of this is putting people at the risk of losing their coverage today.

I hear others on the other side who say we shouldn't be moving forward now, we should slow this down, that -- basically what they're saying is the status quo is working. Well, I tell people, the status quo is not working for anyone today, whether you're paying higher premiums because you're covering so many people who don't have unemployment, whether you're a family like I heard from recently who were telling their kids, "You can't go out for sports because we can't afford health care," or whether you're talking to a family in the hospital who's fighting insurance paperwork rather than fighting for their life, or you talk to the millions of Americans today who are virtually crawling to 65 so they get Medicare and are covered by insurance.

The health care system isn't working well for America today. And there's a tremendous amount of work, on our side, to move this forward hopefully in a bipartisan way but, at the end of the day, to change the status quo and make health care work for Americans again.

Senator Dodd has asked me to work on the workforce side of this. And a very important title of our health care bill that we'll begin to mark up tomorrow deals with the fact that even if provide health care for everybody, if you don't have doctors and nurses and medical workers, across the board, X-ray technicians, physical therapists, people will be denied coverage.

We have to have a strong title that will begin to reach out and grow the workforce, so that we can lower the cost at the end of the day. And that's why this title is such an important part of this bill.

So a lot of work has been done. I really want to commend Senator Dodd for working with our committee. I'm looking forward to the markup. But at the end of the day, I'm interested in changing the status quo and making this country work better for all Americans.

SEN. HARKIN: First of all, we're very unfortunate in not having the one person who's identified with providing better health care and working for better health care, for all Americans, here with us today. And that's Senator Kennedy. But we are very lucky to have his next- in-line, Senator Dodd, leading this charge.

Senator Dodd is providing great leadership on this issue. He has had a string of very good wins this spring, I might add, a very successful legislative spring, this spring. And this is going to be another one. And so we are very lucky to have Senator Dodd leading this charge.

Secondly game time, tomorrow, 10 a.m., game time. I hope that as we go through the gate, I hope that we'll focus more on what brings us together than what pulls us apart. I think there's more in there. There's a center of gravity pulling us together, rather than a few things that might tend to pull us apart.

Third, it will be an open process. We're going to do our darndest to finish the game before the 4th of July recess. We're committed to staying here, as many hours, as many days as it takes, to get that done.

And lastly I hope that we'll do two things. One, I hope that we will begin to change the sick care system in America to a health care system. I want these young people behind us here, who are entering the health professions, I want them to give as much time and attention and care to keeping people healthy as they will do keeping -- getting people well, after they've been sick.

So we got to the change the sick care system to a true holistic health-care system.

And lastly, when this game ends, I hope it's not looked upon as a Democratic win or a Republican win or a bipartisan win; I hope it's looked upon as a definite win for all the American people.

SEN. DODD: Thanks, Tom, very much.

Any questions? Yeah?

Q Senator Dodd, as I'm sure everybody knows, the CBO released a preliminary report.

SEN. DODD: Right.

Q Now that you're kind of captaining this thing through, how large of an investment do you think this -- the public's ultimately going to have to make to get this done? Could it approach 2 trillion (dollars)? The CBO said 1 (trillion dollars) without a public plan and that it is --

SEN. DODD: Well, we don't know. And your question sort of is the answer to the question as well. It's a preliminary set of numbers that we've been given. We'd asked for it. It's going back some time now that you're getting various numbers.

As I think many of you know, I -- we as a committee here intentionally left out of the committee draft a couple of sections where, arguably, contentious issues -- for the simple reason that was an invitation to sit and talk about these issues.

So there are not numbers in those areas, which are cost drivers down -- particularly the public option, in my view, is a cost saver for us as well, but that's a debatable item, obviously, as is the pay- or-play provisions, as well as -- the follow-on biologics is sort of a separate matter, but nonetheless, they're open-ended.

And obviously we're going to be working this week. We don't have a final product at all yet. Obviously the markup begins, and we'll be counting on CBO to step up and provide additional numbers as we move through this.

But we still believe -- the present day, it's 2.3 trillion (dollars), I think, is the cost annually, which are outrageous. And for that, you're not necessarily getting the quality in major parts of the country. In fact, there's a direct -- there's no direct correlation between the cost of the health care and the quality you get -- in fact, quite the opposite in many areas. And so those numbers are unacceptable numbers.

As I mentioned earlier, every indication we have that the status quo -- and there are those who apparently think the status quo is fine; we don't. The status quo will tell you that those numbers, that 2.3 (trillion dollars), could end up $7 trillion by the year 2025 -- in one estimate, anyway.

So we're looking at just an unsustainable rise in the cost of health care, not to mention the availability of it and the accessibility of it and the quality of it that is absolutely critical if we're going to provide the kind of benefits that people want.

So these numbers are important. We're following them carefully. But as you point out, they're preliminary.

Q As a quick follow-up --

SEN. DODD: Yup.

Q -- is there a number, I guess, at least in your opinion, that's too high in terms of federal deficits?

I mean, you mentioned that --

SEN. DODD: Well, the president has said he wants a deficit- neutral proposal, and that -- in 10 years. And the numbers he's talked about, I think, already the savings, the Institute of Medicine and others have argued that there's a -- a third of the savings just by eliminating a lot of unnecessary exams and tests and assessments that are being, I think, conducted that are unnecessary.

The cost savings talked about yesterday by the president in terms of Medicare savings in addition gets you close to a trillion dollars right there alone, not to mention the administrative costs that Senator Mikulski talked about, the waste issues, the medical errors that cost 100,000 lives every year. There's a lot of cost savings in the proposal before you get to any additional source of revenues you may need. And we're certainly going to explore and mine those areas.

What Tom Harkin has talked about and done such a tremendous job in prevention. Steve Burd, the CEO of Safeway, the other day testified before our committee, as Jeff was talking about, that in the case of obesity, which is a major -- one of the chronic illnesses that costs 75 percent of health care today, for every pound an obese person loses, according to Steve Burd, there's a reduction of $50 in premium costs per year -- for every one pound of an obese person's loss of weight. That's an incredible statistic just in one area.

Smoking. The bill last week that we passed here to now have the FDA finally regulate tobacco products. Smoking costs us $180 billion a year in medical costs and lost wages -- just that one issue. And already now with the passage of that legislation, while I'm not expecting in the space of a year or two to have dramatic elimination of those kinds of numbers, certainly pushing those numbers down, reducing that 3(,000) to 4,000 children who start smoking every day, a thousand of whom become addicted, and half that number die prematurely, not to mention life-long illnesses associated with it.

So we're on the right track, and I think cost savings can occur in large measure there.

Yes, Karen (sp).

Q Senator, that CBO report -- granted it's a partial bill -- it's a pretty ugly report. A lot of money, with, I think, a disappointing amount of coverage being provided for. Did that report, as ugly as it was, bring any clarity to your thinking of what we have to do on some of these unresolved items, what the public plan is going to have to look like, what an employer mandate is going to look like? (Off mike.)

SEN. DODD: Well, it does. It points out certain areas. We've already, at least talking among ourselves, trying to reduce some of the costs, some of the idea of (counsels ?) and other matters here, where it might be good ideas, that cost savings can occur in that area.

Having, for lack of a better set of words, a public option, but I think certainly that's the words that people understand at this point, has to be a meaningful one if it's going to have the kind of downward pressure we want on costs.

One of the things that's disappointing about CBO, and frustrating, is all the work -- and I'd have Tom talk about this -- all the work that Tom has done on prevention, looking across at prevention, and that's really the major cost-savings in time. If we can really make a difference on keeping people out of doctors' offices -- right now, our system is a sick-care system.

It's a quantity-driven program. It's not a quality- or value-driven program. You get paid based on how many people show up in hospitals and show up in doctors' offices.

Reversing that is a major challenge, but you don't get the benefit in CBO of cost savings with prevention programs. They'll tell you how much an anti-smoking program may cost, but they don't tell you the benefit that occurs when a number of people stop smoking. So we're wrestling with CBO numbers that, frankly, an actuary has to look at them in terms of what expenditures you're making. And they're not very good at providing you with the other side of that ledger and equation, and that is, what are the cost savings? Put aside for a minute the human costs. What are the cost savings financially as a result of an aggressive prevention program?

Maybe -- Tom, do you want to comment on that?

SEN. HARKIN: No, no, no, that's all right.

Q Senator Dodd, in paying for the overhaul, one of the ideas being debated is taxing employer-provided benefits. How good of an idea do you think that is, and what are the difficulties?

SEN. DODD: Well, I'm not attracted to that idea. I know others are, and have talked about it. I know others jumped to it and feel that unless you do that, you can't pay for that. I don't buy into that. You know, that debate will occur, but I'm not satisfied that's necessary.

I don't know how you're going to explain to people -- because there are an awful lot of people who have plans they like. And in our bill, we say, if you like your plan, you stick with it. And so, they'll stick with the plan they've got, and then we're going to turn around and say, and by the way, we're not expanding that plan for you, but by the way, we're also going to tax you for the first time. A lot of people could fall into that category. And I think, frankly, that's going to be a source of tremendous frustration for a lot of people at a time, frankly, when their costs on home heating oil and job loss and foreclosure matters and so forth are mounting up on them -- tuition costs. And the idea of leveling a tax on them at this time here I don't think will be met very favorably. Others may have different opinions on that, but that's my conclusion.

Yes, sir?

Q Senator Dodd, in your opening remarks, you talked about not being interested in bipartisan support for a weak reform bill. Does that mean there's only so far that you're willing to go in order to try and --

SEN. DODD: Well, look, if we get through this process, and all we've done is driven up costs and moved the deck chairs around, we'll be indicted by a generation coming along. Our job here is to drive down costs, increase accessibility and vastly improve the quality of health care in our country.

It's a daunting task. I mean, the president has admitted as much. We've been debating it for 60 years, and Democratic and Republican administrations have tried.

But this is the moment, in many ways because of the crisis we're in -- economically, as well as what's happened to people on health care costs, 86 percent increase since 1996. In my state of Connecticut, a 45 percent increase in six years -- gone up. The average family of four today is paying $12,000.

I mean, these numbers -- we're told that if we don't do something at this moment, as much as 50 percent of the gross income of the family -- an average family in this country -- could be spent on health-care costs very quickly. That is just unacceptable, not to mention, of course, what people are going through and struggling with in case after case after case that we hear anecdotally, that people mess with every day in terms of trying to meet their needs.

So my view on this is, look, we've got to have a meaningful plan. We've got to reduce those costs, both to our country as a whole and to our families out there whom this is not a question of an option. This can wipe you out, when 62 percent of the bankruptcies occurring in this country are because -- driven by a health crisis in the family. Sixty-two percent.

The foreclosure issues. How many times have we heard statistically, debating about foreclosure mitigation over the last year and a half, that so many of those foreclosures occur because of a health care crisis in that family?

At a time when 20,000 people a day are losing their jobs in this nation, virtually losing their health care, falling into those gaps, and then, Lord forbid -- Lord forbid -- your child, your spouse, discovers they've got cancer, they've got a major problem, how will they going to take care of that? Where do they end up?

And in this country of ours, your fate on health care ought not to be determined by whether or not you lose your job one day or have it the next. That's just unacceptable. That's unsustainable.

Q Senator Dodd, the president has proposed in his budget finding some money, you know, by going outside the health care system -- (off mike). Is that ultimately where you think the Senate has to go in order to make this balance?

SEN. DODD: Well, I could make a case for that. I think that certainly would make more sense to go in that direction than taxing health care benefits for people who are struggling to hold their families together.

What else?

Q Senator, how far are you at this point from having -- or reaching closure on the form of the public plan or whatever form that takes? When do you expect that to reach closure? How far --

SEN. DODD: Well, we'll need to get -- as I said earlier, one of the ideas was, a week or so ago -- we went through, by the way -- and I know many of you know this. I didn't total up all the hours. We spent a lot of hours in the last two weeks on these walk-throughs with each other. I want you to know that. I mean a lot of time. And the staffs spent a lot of time on this. And leaving that sort of -- it wasn't (blank ?); it was open for discussion, I think was the line we used.

And certainly that can still happen, and I hope it does, to examine ideas and alternatives.

As the president has said -- and -- he's flexible about how you achieve that. He's not flexible about whether or not we're going to get this done, or whether or not we ought to have some option out there for people. But I'm willing to listen to various ideas that our colleagues are coming up with. But at the end, we've got to have an option, it seems to me.

Q Do you have a sense, temporally --

SEN. DODD: Temporally, I think we -- my view would be -- and I'll -- this is a matter I'll discuss with my Democratic and Republican colleagues -- that we would begin the markup -- and we'd do this title by title. I'm just not going to open up the whole thing all at once. And we'll probably begin in areas where I sense more common interest, things like prevention, quality, workforce issues, where I sense, in the conversations, the hours we've spent talking to each other, that there's a general agreement these are matters that we've got to deal with.

Now, there may be some differences on how best to achieve that. My view would be to try and do as much of that before we get to the more contentious issues. So the end of the week, first part of next week, maybe, depending on how things go.

Q Senator --

SEN. DODD: (Gail ?) -- yeah. Yeah.

Q Huge new cost studies on palliative care in hospitals --

SEN. DODD: Right.

Q -- have shown that they could be -- potential for huge cost-decreasing efforts in hospitals. And we know that the chronically ill and the seriously ill use up -- they're only 10 percent of the Medicare population, but they use up two-thirds of the Medicare budget. And they are -- they're not treated well in hospital. They're in acute-care hospitals, but chronically ill people don't get better in acute-care hospitals. So palliative care, either in hospital or at home, is a huge potential cost savings, although it means revolutionizing the -- (off mike). Is there anything in your bill about palliative care?

SEN. DODD: Well, only to the extent that pain-management issues is part of palliative care. Hospice support for hospice programs, in that -- I know what you're driving at here, in a sense, but these are highly contentious issues that they've -- have dealt with.

Q Why -- (off mike)?

SEN. DODD: Well, for obvious reasons. You're talking about, you know, if -- all of us can tell individual stories and so forth about people in that situation. While I'm not unmindful about costs associated and the remaining days of a person's life -- but our bill itself, in answer to your question, does not explicitly address that issue, at least I don't believe it does.

Q Senator --

SEN. DODD: If there's any staff around here to correct me if I'm wrong -- but I don't think any -- there's any provisions in the bill specifically on that, (Gail ?).

Q Senator --

SEN. DODD: Think -- yeah.

Q How much progress have you made in your talks with Republicans? I know you had said you're willing to move back the markup if you saw progress.

SEN. DODD: Right.

Q What progress have you made? And how will you address all of the --

SEN. DODD: I'm told over the weekend that the staffs actually made progress on some of these underlying issues. And we're going to meet this afternoon, in an hour or so, and we'll get a better -- we'll get a full briefing on that as we go forward.

So I can't tell you explicitly, but I know there's been some progress made.

Yes.

(Cross talk.)

Q How do you address all the amendments that are being put out there. There are hundreds of amendments. (Off mike.) I mean, how do you get --

SEN. DODD: This is a -- you know, there's no other issue like this one. (Inaudible.) I think 60 million people have taken advantage of Family and Medical Leave that Tom Harkin worked so closely with me on some 15 years ago. That's a big number.

This bill is 100 percent of the population of our country. Every consumer, every provider, every business are going to be affected. It's a big issue. It's an economic issue. It's an issue involving the basic rights of people to have access to affordable, quality health care.

We have set aside the next 6-8-10 weeks, whatever it is, into the fall, to grapple with this issue. And so I'm not surprised by the number of amendments that's an indication of people's ideas. Many of them may be very good ideas. I haven't seen any of them yet. But we're going to talk about some of them, this afternoon, and the areas we'll start addressing. And I welcome people's ideas and bringing them to the table.

So I'm not surprised by that number. This is a big deal, to get this right. And so the leader to his great credit has set aside, in July, Monday through Friday, no exceptions, starting Monday morning, going as late as we have to on Friday, to work at this. And I know Max Baucus plans on doing the same, in his Finance Committee, as we will in the HELP Committee.

I'll take one or two more.

Yeah.

Q Senator Dodd, yesterday, President Obama -- (off mike).

SEN. DODD: Not in our bill. Others may try to offer something along those lines. But that would be a pretty contentious issue at this point.

Q (Off mike.)

SEN. DODD: I'm not inclined to at all. I'm happy to see what people -- what ideas they have. But at this point here, I think, that's kind of been a red herring. And I'm one by the way who has offered the class-action reform stuff, the securities litigation reform and so forth.

So I'm not opposed to the idea of tort reform. But I'm not convinced that this is a legitimate issue, that it's going to have that much of an effect, as people claim it will.

Thank you all very much.

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