Tom Harkin

So you pay on the basis of outcomes.

Well, if you have got some suggestions on how we do that, I would like to know.

Do you think that that is possible to do that, to set up a system like that?

So Medicare is solvent.

Are there any provisions in Medicare that would allow for the up-front payment or establishing chronic-care management programs?

Just one last question for you Dr. Mentel. How did you convince Mayo to come up with the capital for this?

It needs to be streamlined. It needs to be brought up to date. It needs to be less burdensome, because it is just eating up too many of our resources.

I am just wondering what we should do nationally, maybe through Medicare or something else, to try to encourage other hospitals to go that route.

You have got to have that. And then--but going overboard on some of this stuff--I mean, I have got to believe that that 350 pages really--no one really looks at that.

I do not know where one ends and one begins.

But I think--I end up spending a ton of money on programmers programming to get the data that he needs--even if I automated the darn thing, I would still be spending buckets of money on programmers to get the data out he needs to report…

I just wonder if, in some of the debate that is coming up on Medicare and stuff, I know it is all focused mostly on prescription drugs, but I am wondering if we should not--when the horse is leaving the barn to try to get on some of this…

It is almost like a crescendo now of different things--bankruptcy because of medical bills, businesses forced to scale back their benefits.

This is third and final one in the series, in terms of what is happening, in terms of coverage, lack of coverage, cost of insurance.

Again, I ask the Senator from Michigan, when Medicare came in, was it not because the private sector had failed in terms of elderly health care in America?

Was that not the history? And if one has these private plans, that they are going to pick and choose, and they are going to cherry pick, and they are going to have a segregation of elderly pushed off in some corner someplace, begging for…

Now we only have 11 percent of seniors who chose that. I ask the Senator from Michigan, does it somehow appear that since voluntarily the Republicans could not get seniors into HMOs and private health care plans, there now seems to be an…

No. What I am suggesting is that in the past, as we know, a portion of the money was not added to the highway trust fund, it was added to the general fund. And there was a partial exclusion from tax on each gallon of gasohol sold. In…

I profoundly disagree about what you have just said.

I have had people tell me that at one time it used to be the border towns were various kinds of tourist attractions, now it is pharmacia, pharmacia, pharmacia as they go across the border.

My constituents literally are choosing between groceries and staying on their prescriptions. This is not only a crisis, it is an urgent crisis.

We will need the FDA's cooperation for that legislation which I am convinced will pass once again to make that work.

America remains the only major industrialized society in the world that does not negotiate on behalf of its citizens a better price.

I do not think we can do that.

The authorizing committee would have to approve of that.