>> host: and mentioned the cbo, you gavel maturing on c-span.org this morning beginning at 10:00 o'clock. the gala with hemlines on a number of papers in the news reports about the budget office assessment of the cost of this planet, the headline in the "washington journal": a budget blow for the health plan and a right ahead of the congressional budget office caris since his non-partisan organization is used to determine the official cost and the legislative proposals. what sort of impact of his words have in the committee today? >> guest: the president himself said months ago that he was not interested in signing a bill that was not going to reduce the growth curve on spending. the cbo is saying this will increase spending and that is a deep concern for members across the aisles. to say how we will pay for this and still deliver healthcare. >> host: we will take calls for timothy until at least 830 or so. in texas, good morning to jim on our democrats line.

>> caller: good morning, people. i listened a little bit of information about pennsylvania and, first of all, the purposes by the fact that the republicans are offering from a memo greatest by a lobbyist giving them talking points about government mandated health care, that they will -- let's talk pennsylvania. in pennsylvania you have an 86% increase from 2000 to 2007 in health care. -- to the premium combined for employers and employees went from $6,721 to $12,513. and the congressional budget office said over the next four years premiums will increase another 20% in nine years increase another 70%.

so in terms of raising the question about health care, i think that you have to start talking about whether asking a question for example about having all allah the congressman bill into the new health care plan. >> guest: it really becomes a matter of health care costs going up but that doesn't mean we approached this i have in the government take over and pay the bill. this is about fixing the problem is not financing them. the new england health care institute, an organization review that $24.000000000000 spent in this country they said 700 billion of that is waste. it is the wrong medication at the wrong times, it is inappropriate use of medical care, is not handling chronicle and ellis welcome a number of errors. we need to clean that up. i suggested to the white house and other members we need to go at medicare and medicaid and clean it up because of the

problems of our systems and i believe you can almost unanimously say to do this, but happens in the cbo is saying here is simply say the government will pick up the tab without substantial forms on how health care was designed and delivered it doesn't get us to the point where the family can afford not given example. pittsburg university medical center in washington hospital have looked up programs to reduce three hospitalization of people of chronic illness. they found that you can reduce 75% by managing diabetes different. washington hospital said you can cut rehouse position of heart disease if you manage different. it does not something we have tried, that has been found difficult so elected and china. we've got to approach health care in terms of real reform and i think sometimes what we do in government is let's start off with these mandates and as people go through election cycles they say let's have more to it in medicare and medicaid and before you know it, the problems become much more. one of the reasons health

insurance and pants and a cost $15,000 is because there is so much on mandates. states like, utah, may be 2000. why can't i buy a plan in another states and that's another reform to look at. that people shop around. >> host: palm springs, this is our independent line. >> caller: good morning, sir,. i don't have a lot of questions to ask about the health care but i do have a question. i want to know when you hold up a big stack of papers like you got there right now, does the house printing office and to lay the printing that much paper and put it on every congressman's desk? >> host: we receive this at the committee meeting yesterday and we also had to receive a previous version and now we are receiving management. yes, we have those things and we are uplight time to go through. >> host: did your staff in advance peace is? is my duty to get them on the

internet, my internet has information so people can access, but understand there is a lot of references in here which would add a couple thousand pages to this. >> host: i believe we will have this link later on on c-span2 board. good morning to daniel in virginia, republican caller, how are you guys doing? i think when it comes down to it when a lot of people are realizing that if we would just live a little healthier in the long term as citizens of the united states. the health care reform, i understand it is something that is redone but why we have to rush it to pass it would hasn't been changed. it is like reinventing something on a grander scale. >> host: how did they do that? >> caller: basically we have

to get health insurance every year and is this something you go online and then your costs get up 3%. >> host: is in any of that address? beslan no, not through first response. there are elements for prevention but that will be developed over time. he is bringing up a point of our personal responsibility and one of the questions is if you do voluntarily do on how these things like let's say yes much should you have a higher premium this bill says no, not unless it is based upon age and family members but they can't do anything else. but when you add of the things should we have more transparency, what the bills are going to be. issues to be able to shop around the nation and find cheaper plans or join as a group, those and not just in the bill. >> host: to some of the specifics congress reports that the bill establishes what is

called health insurance exchanges. tell us about that. >> guest: at which any more to explain, it comes back to a yet to be designed side were you could look at insurance policies in review. now, that is helpful if you have apples and compared to apples but the way things are designed now a government plan you can buy anywhere in the nation. it would have basically 10 different mandates for things to cover. you could join one big group and the government with purchasing power pushing drug prices down. the private plans would not have that advantage and would be stuck in your state. you'd have to go by their rules and if you were in individual and my daughter is graduating college, she's on insurance group of one and there is now negotiating purchasing power. that is an unfair in greenwich and we ought to open up this market place to get information like a consumer reports that you can find out about your toaster or washing machine you ought to get on health care and compare across the nation but that exchange needs to have information on a fair playing

field. >> host: here is florida, welcome on our democrats line. >> caller: hi, i listened to a lot of the debates in committee last night on c-span radio. >> guest: god bless you for doing that. >> caller: is pretty trying actually because to tell you the truth i don't know why and how we are consulting with republicans on any of this because you also like to just fell off the turnip truck. but we have been debating health care, i am 58 now and in this country my entire lifetime. we ought to know by now if we are going to save any money in the system, we need a system white medicare. my mother is on medicare, we go to any doctor, we want, we never have a problem. and she has a supplemental. now my sister who has lived in many countries around the world says that she experienced the healthcare plan of the best in france and that is a basic system which you can buy

supplementary policies for. and she said it is an expensive system but it delivers the best health care that there is so i don't know why we are trying to reinvent the wheel here. and my question for you would be you are talking about how we are going to pay for this, isn't that the cited by the finance committee and your committee? >> guest: we all have to look at that and all have a responsibility to see how we are paying in our committee has great responsibility for making sure we have real reform to reduce health care costs and improve quality. one of the great benefits of having a country like ours to have diverse paying to govern together and have resolution. france has some good things but they also have a lot of problems. medicare has good benefits but in the last congress there was 152 bills introduced by members of congress to make changes in that since medicare and medicaid came up in the '60s there has been no fundamental reforms to make those work better. they were designed at a time when the most sophisticated medical tests or x-rays and

hospitals. by the way i will .52 bills passed and 13,000 co-sponsors of those from members of congress. we recognize we need to have a system that needs to continue to improve. i worked in health care of my professional life, i bring that expertise to congress and it is not a matter of just i don't agree with use a shut out the republicans because we all represent this country, we represent millions and millions of americans and one side of the aisle does not have any monopoly on truth. nor a monopoly on compassion. we're deeply concerned about happens to patients and we want to make sure they have accessible affordable health care. >> host: two different headlines in this morning on issues involving health care, we talked about health care costs and a headline in the washington post about lawmakers warned about health care costs and cbo chief yesterday. also this morning front page of usa today the reports that the proposals could create the highest tax rates in 25 years. what are you hearing from your constituents in terms of those

two different polls of issues? what are the most concerned about? >> guest: the cost and access to doctors, they still want doctors to make decisions not government. we have had probably as of today 11,000 letters and e-mail some calls that had our office because people are deeply concerned about the long-term impact. part of this we also look at is the cost, that is what is given much of this discussion of making it on affordable. two save us some tax rates on the federal level will push up to post a 50% for some people particularly small businesses will be paying extra fees if they don't have health care, additional taxes and other things with death tax that will have to pay. this is as significant change in what i'm saying is instead of taking out of one pocket and take from another, listening these reforms and the cbo is saying this bill does not make reforms reduce cost. >> host: next call from pensacola, florida on our independent line. >> caller: good morning. i have been watching c-span and

listening to all this stuff about the tax, health care plan. my question is that, you know, they are saying that it is going to be a tax increase on a lot of people who made substantial amount of money. but they're also saying that you are going to be required to have health care insurance by either a private person or by the basically in government. in so how is it just a find that people who make a certain amount of money and still wonder how it is when to get paid for if the people who are going to have the insurance are going to be required to pay for it as well? >> guest: the cdl is a it can't be sustained by putting taxes on higher income level and understanding huge number are half our people who have small businesses who themselves look on paper are taking several hundred thousand. >> host: ping an individual

way to. >> guest: and when they come back and say is that they cannot suddenly have a jump toward 25 percent of what they are paying employees and now tax and other fees or they may have paid 50 percent for health insurance and that is where they said they cut some employees. and we asked cdl if they look and they said they did not look at the impact. >> host: couple of headlines of massachusetts from business week, radical surgery in massachusetts to rising health care costs and try to limit fee-for-service system, the same headline in the morning york times massachusetts panel on health care six fee-for-service care. what is that and it is the house learning lessons from the massachusetts? >> guest: we need to learn from massachusetts and tennessee that both senate was have a government takeover so we can reduce cost and find their costs accelerated dramatically. on the positive side massachusetts is sanguine of 97% people covered by health care. the negative side is they don't have the doctors to handle this

and that's the problem and acosta so high that that is accelerating our quickly than they know to do with. and again it goes back to this issue that energy and commerce committee is spending a lot of time of the next few weeks discussing reforms to reduce the costs. increases and make a better health care and not just pay for what is there has my partly as a psychologist practicing psychologist, other concerns of the psychologists and practice at a different from that of a physician and a family doctor or surgeon? >> guest: we all are interested in the patient's health and how to live in a global perspective, understanding treating the whole person. there are some physical aspects of heart disease has doubled the risk of depression, untreated depression and heart disease doubles the cost of health care. what we have to look at in terms of the improvement of health care is making sure the physicians and their great how they are delivering health care so operating on stovepipe you see the specialist and a

specialist and information never exchanges hands. we feel comfortable of doctors talking to each other and one that doesn't happen health care costs go up. >> host: jacksonville, florida, couldn't quote morning to a republican cholera. >> caller: good morning. i have been on medicare for 12 years, i am 75 years old. whenever started i think it was around $40 that they took atomize social security check. in just over 12 years i have had three operations, hernia operation, hip operation, and tonsillectomy. i pay all my bills, every time i paid taken out of my check from social security and i added it all up, i've been on medicare 12 years and came up to $91 a month. i don't have a supplement

program. now according to the republicans idea of socialized medicine medicare is socialized medicine. by the then read this big long bill that you just picked up there that is going to absolutely go nowhere in just cost the taxpayers a lot of money, you know that is not -- you're going to have an -- it is not going to get straight republican votes, you know that is my cure some things you can look at. one thing that happens with medicare is a that you are allowed to shop around with your medicare. and government pays the bills and tries to negotiate prices to hospitals and doctors. this new plan will not have the same access and what some are pushing is allow medicare like plan whereby people will have some supports about or subsidy of some sort, changing based upon your income level so lower your income level the more support will taper down and gives a little more flexibility

and you can add some two this and then we will see if the proposal goes anywhere in the next few days. >> host: new york city, devon -- democratic caller, john. >> caller: thank you come i tried to get through for many months of like to make a few quick points. personally obviously the europeans have a great health care, france, germany. they have a gas taxes and a drive small cars and i don't know why we don't have the political backbone to slap a dollar per gallon tax on gasoline. i realize there is political problems with that. i pay for my health insurance and a pocket each month to my employer. it's expensive debt. i can't get any information pricing was from a buy health insurance carrier, and locked out and it only goes to the plan administrator. i've had that in the past with other companies. a private plan in new york city would cost me double. the exclusions are mind

boggling. the deductibles are huge. through a aarp i get a plan in florida which is also confusing but i can get in in new york state. in new york state has a plan called helping new york which is clear, straightforward, simple, affordable, but i can't buy into it because i make a little bit too much money. i would allow insurance liability companies to deny claims and that a rise from undocumented workers, from the employment of undocumented workers. he would put people back to work and i think that is an idea that should be floated about. >> guest: i like that idea and it is one that i support in terms of letting your shop around. can you imagine if you're making some other big purchase in your life, a car, and applies or something, you're only allowed to shop of the store and despite we're only going to let you choose this one are too.

that is what happened in pennsylvania. we have to dominant insurance plans and in that if you're negotiating an is an individual there are about 3,000 variations of these in our town and is pretty much the way it is around the country. that is where insurance companies have you over the barrel. you should be able to shop around and find the best prices and plan. and made sure that in this is were i think government can have a poor rural, make sure the information is clear and compare it. it was happening with health insurance getting more confusing and showed charts in terms of what two these plants look like this on three different interpretations and i don't think that makes it easier for the consumer. >> host: these are the charts, this one here from republican interpretation of the plan and this is another one from the chamber of commerce i believe you said. in one last plan as we pull this off to take a look at. this plan above the three main be the most confusing but this is from where? is mike sanchez companies said they interpreted to be an all in all what we're trying to make

simpler so people can understand and access their health carol we haven't got their. >> host: this morning cq writes that the blue dog democrats with a handful of other members said they will support the bill in the current form, mike ross of a blue dog have seven members on the committee and then to vote against the bill unless a few changes are made. what sort of political challenges to the present? >> guest: is an important part of the discussion because there sank cbo says this will not control costs and violence with the president said as a goal. in san spending out of control and they are saying they don't want the government to run its insurance company. if we allow people to shop around and get support we want to help those who cannot afford insurance. that is a number we can help with. but that is where we have debate. >> host: rep. ross of arkansas will be with us on sunday newsmakers 10:00 o'clock right after "washington journal". a couple more calls, virginia, i.t. good morning on our

independent line. >> caller: and maureen, rep. and i'm calling from georgia. i had a short statement i wanted to get to and ask a question about it. my question is based on a now i am not in short, but iç have bn insured, i am a rick teacher that was outsourced i guess you'd say. i was diagnosed with post polio last year. but i have a one doctor and one hospital to another doctor and hospital, all of them within 6100 miles of where i live in order to go to the procedures to get another information so i can finally go to a doctor who could then diagnosed that i have post polio. but there used to be clinics or you can actually go and get all the diagnostic texts under one room and they would be the variety of medical expertise there that would be able to also follow-through with suspicion because of this test and this

test has of this illness but because the insurance companies they are no longer able to do that. and so in essence the insurance companies are the ones controlling what test you can add, when you get them, how you get them and if they are accepted or not. >> host: . >> guest: that brings up the point with regard to one of our big frustrations of insurance companies is in a control the marketplace and what is done. a lot of times doctors are not making the decisions here, a couple of things from what you're saying -- one is committed to health care centers or clinics run the country which i believe we should invest more and are able to deliver some good integrated care with a wide range of medical practitioners and our price. one of the things i have worked with particularly with congressman green is to allow doctors with it on a person shortage rate, it is amazing we have not let doctors and other time to these things and the other element here is another to be a place to be a medical home for many people in continue to get the care. but in all of this we have to

make sure we're not replacing one here pursue another that says no to patients -- we want plants to be personal and permanent and we want them to be portable as opposed to barriers and bureaucracies. >> host: question on twitter, a tweed from rich asking the government plan will have ended manage over private insurance, isn't that the point? competition will lower cost. >> guest: it is not competition. i think the government will have advantages of pulling people together. let other people have a chance to pull together. let's say you are a carpenter, why not let you join in with all the carbon is america and maybe your community and maybe alumni of a school and people of a church want to join in that is when you get purchasing power. that is where you have real competition because of one plans as we will offer a little more for the price. that is what we will have opposed to the politicians going to election cycles. >> host: one more quick call for tim murphy from our read in baltimore.

>> caller: hi, how are you? my question is what is the rash? it is a big long form that you have to read and how can anyone read that? >> guest: a couple things on that, on the one hand, we want to make sure that people are covered quickly. this plan doesn't take effect for a few years. the tax system and a few years but the rest doesn't kick in for a few years and by 2017 there is a mandate that regardless of what happens people participate in this so there is not an immediate rush, not like people purchase this health care insurance by november. we have time to do this right. we have time to support the people who are in need of some assistance and clean up the system and i hope that we can accomplish that. >> host: congressman tim murphy of pennsylvania, the markup session this morning live this money on c-span.org and c-span2. thank you for being with us. >> guest: great to be with you. >> energy congress will be back

next week for more work on the legislation. ways and means committee finished up their work early today on their markup for health care. will show all of that markup session later this evening and 7:30 p.m. eastern on c-span 2. ahead of that president obama and others will be speaking about health care and will have president's comments on the white house coming up at 3:15 p.m. eastern. associated press reports his top economic advisers increasing health coverage for americans is not the enemy of cost control. lawrence summers director of the white house national economic council said today president obama bollea is the way to reduce rising health care costs is by expanding access to health coverage. he made those comments earlier today at a washington area think tank and will show you his comments later in our program scheduled. just a short while ago at the capitol speaker policy and a key congressman and chairman of the committee sessions dealing on health care spoke to reporters about the progress of the bill.

>> good morning in a good morning it is, indeed,. the chairman has been up late and has produced historic results for us. the congress, indeed, has made a start progress on health insurance reform that will put patients and doctors back in charge and ensure quality, affordable accessible health care for american middle-class. the level of progress has never been made before. three major committees of the house and the senate as reported out legislation already. two more to go. as you know, the house committee and the senate pass out a bill on wednesday, mr. miller? a couple of days ago. and last night the ways and

means committee was an in until the wee small hours of the morning and he will report on their success and mr. miller until 6:00 a.m. this morning and then back at 9:00 o'clock to finish off the votes. so they have worked very hard and very wisely on behalf of the american people and we're here to celebrate success that they have had a as we again and make progress and move forward. the goals that we have with universality, affordability and accessibility and we want to do this in a way that as we continue to lower cost, and strengthen the package. as america's affordable health choice act moves through the legislative process, we continue to build more momentum as we go along. expressing support for america's affordable health choices act, a leading force for america's

physicians, the american medical association wrote that the legislation includes a broad range of provisions that are key to the type of comprehensive health care systems. if you don't have that letter you should see it because it is eloquent testimony to the merits of our house bill and over the coming days congress will continue working with president obama to provide it stable prices and a secure coverage and quality care for all americans. we're very pleased we have the support not only of what the doctor is as you saw with president obama the other day and the nurses. we certainly have the discipline of the american people. with that i am very pleased to go to this digressed chairman of the ways and means committee with admiration and respect for the excellent work the committee is doing ingratitude to him personally for his leadership. >> thank you, madam speaker. i feel privileged to be a part of a great orchestra, the house

of representatives with a great orchestra leader that has brought us together sometimes in the afternoon, sometimes in the evening and now in the beginning of the morning. but we were able to come together to get this great ship and that the president had wanted to get out which is national health insurance. and we feel so proud at that we will now be able to join the family of nations where we can show that we care about the health of the people, we care about the quality of people that we will be able to say whether you're young or old, black or white, that in this great nation will be secured with health insurance. it is not just keeping down and the ever-increasing price of health insurance, but it is also making certain that america continue to be competitive and so on this ship one we have been working on and are waiting to work with our friends over on the other side of the capital is to make sure and that we have a

health system that we can be proud of and have primary care, that we can have hospitals that provide quality care, that we can have nurses, we can have people going into the health business. not just to make a dollar but to make life better for some of the people. it is so poor and we have done this on the outside because the matter with the president's hopes and dreams are, unless we get our ship out there as we all have a working together, then, of course, we can perfect it. the things we still have to do even when signed into law the battle just begins, but banking madam speaker for having the confidence and thus allowing us to work to reach the goal that we have done and we look for it to getting this bill passed and go to conference with the other party. >> thank you very much, mr. chairman for your excellent leadership and great success and now i'm pleased to yield to another distinguished chairman, chairman miller of education and labor committee and commending him i also wanted knowledge --

chief stark has joined us of the health subcommittee of the ways and means committee. thank you very much for your leadership. our distinguished leader is here and are distinguished -- so much has happened and looking forward here. the members will come and go so i want to be sure to acknowledge the leader mr. khyber and an egg and egg knowledge that rob andrews, chairman of the subcommittee on education and labor that is dealing with this health insurance issue is with us as well and commend him for the leadership. i am pleased to yield and again with appreciation and admiration to the distinguished chairman of the education labor committee, george miller. >> thank you very much, madam speaker, and thank you for your leadership and drive on this issue that is so important to our families and to our nation and to our economy. i want to congratulate chairman rangel and pete stark for the success they had in the ways and means committee last night.

it took us a little longer and want to thank rob andrews for his help. we had a very long been very exciting evening for the members of our committee. finally after so many years after so many years of talking about and working for universal health care, the members of our committee had an opportunity to vote for universal health care that will lower and reduce the cost in the future of health care to families and two businesses, the dramatic increases in the cost. we heard over and over again from our members loss nine our crushing families and crushing businesses and undermining our economy. last night they get to vote for health care that would reduce those costs. they got to vote for health care that would be available for families forever. that no matter what happens to them whether they lose their job or start a new business or get fired or have a divorce or have a terrible illness in their family, they will not lose their health care. never again will they be without

health care. that is what that vote was about and what our members understood and that is what they were so excited voting for. never again will people have caps on how much their insurance company is going to pay for them as of that they are just one illness away from bankruptcy. this happens to thousands and thousands of families in this country. our members spoke out about the fear that families live then, that they may lose their health care, about the fear of whether and how their children will be covered with those votes last night and the passage of the bill at a ways and means and at our committee, we set a course for this nation that will protect those families and make it affordable for small businesses, that will assure that our economy will not continue to dedicate more and more of our resources to health care that is not giving us the kind of coverage, the kind of support that families need. that is the excitement of our votes, that's when we got together at 6:00 o'clock this morning after the votes now we

get together as a caucus and just cheered for the fact we're able to participate in this very historic evening in the house of representatives that takes us on a major step forward to passage of this legislation and to the signing by president barack obama. thank you very much can i thank you very much, chairman miller, chairman and rangel appear in a chairman waxman. he is on duty. we're having votes now so we may have to go in and out by chairman stark, thank you for your leadership and chairman angers, thank you chairman waxman war with their committee. as we have seen today, there continues to be great momentum to pass health care reform. even as 6:00 a.m. in the morning. it is also gaining momentum outside the congress as we have seen from endorsements from such important groups as the american medical association which

represents hundreds of thousands of positions to know first hand in that health care reform is not an option. they'll year is not an option. the american public are urging us to pass this bill and we're going to respond. they elected barack obama to pass this bill, they elected this congress to pass this bill and still there is no doubt that the bill is going to have a change as it moves through the process. i would be shocked as a legislator and that was not the case. it is a work in progress but we have made very significant progress as of 6:00 a.m. this morning and mr. chairman, of course to move things a lot faster. ..

>> and do we have good health care in america? we do but it is not accessible to many and it cost twice as much as most countries of the world. if bankruptcy a middle-class families and handcuffs and small businesses, drives down and puts us a deeper into debt every year which jeopardize

the security stability and peace of mind they deserve. no american family should go to sleep at night and worry about their child getting sick and not having access to healthcare. ron all those reasons we will pass health reform as the president recently said, we have been talking and talking and talking about fixing health care for decades. the other day some of you were here and i said in six decades john dingell is the principal sponsor of this legislation. he is a leader in this effort and these are leaders. no one has led more forcefully than our speaker. the next couple months will be our chance to finally deliver. and we will. [applause] >> and we will.

i like that. and we will. that was wonderful. they all associate ourselves with the remarks and we will. we also mention mr. dangle who was also in committee the energy and commerce committee will be marking up but it is important to note to them mr. dingell said yesterday that the endorsement of the american medical association is not only great for this legislation but historic. since the 30's when the country began the debate on healthcare the ama has never endorsed. the member's speech we their committee and of the floor, led to the point* the ama has never endorsed the healthcare health insurance reform bill and they have endorsed the house legislation. and as we go forward, as i

mentioned before, and the endorsement of the nurses and so many organizations and the list continues. we're proud of the reforms and a package and very proud of the cost savings of course, we want more and we will take any questions. somebody newburg you ask the first question every time. >> [inaudible] how can americans have confidence in this plan [inaudible] >> in the ways and means committee we have the most civil discussion the amendments the republicans raised were substantive and not political. it is unfortunate they could not come together with one bill that we could negotiate but this is just the beginning we don't know what else is

going on and if you listen to the three democrats that did not but with us he would get the impression there were just waiting for the opportunity to be able to do that. i felt very comfortable as republicans and democrats that this vote recognize the need to get together on the health reform but we are not there yet. >> [inaudible] >> yes we will. >> i concur with what german wrangle has said that throughout our very long 20 hour markup we accepted a number of amendments from the republicans and worked out arrangements on those we did not except that we thought had merit the staffs are getting together to do at and so i am not sure they ever and of the voting for the kind of health care that president obama has

presented to the nation the security he has presented, the kinds of getting rid of the exclusions and co-payments and the rest. the point* is that our members are in full force to come to the floor and to support this legislation and they will report for duty at the time that vote is taken off. >> mr. waxman will put his bill out the middle of next week and then we will be preparing for an hour rules to take a bill to the floor when the american people see what this means for them in each congressional district, over 100,000 people in many rural areas in america over 100,000 people will have health insurance that did not have the floor of the 100 million of meeting the needs of public health hospitals will be

there. and just a very few people called upon to help with the revenue. it is pretty exciting and transformational and will make a difference and again we have members from across the political and geographic specter with concern that is a regional and we believe it will be addressed as we go forward. >> [inaudible] at. >> the letter that the year referring to is the two the chairman when he said i wish

to express the administration's strong support for the health-care savings proposal and a the committee health discussion draft dated june 19 virtually all policies are consistent with those but fourth by the administration and are essentials to our shared goals of reforming health care in a fiscally responsible manner. adopting deficit neutral health reform that expense -- expands coverage is not enough because it would perpetuate a system which best practices that are universal. i commend you for proposing delivery system reform that will begin the process to transform the health system so quality is improved, cost growth is contained and waste is reduced for good goes on to say other things upheld then

he says we agree to the markup of legislation and i urge you to maintain and strengthen these policies. cohmad is a very positive letter. you are talking about medpac? >> a way for medicare reimbursement. >> yes. you're talking about medpac. that is something we have been discussing with the administration. i wish mr. hoyer were back for him to address it because he had some concerns but even before seeing this a letter read task the staff to see how we could come together so we can get the savings' medpac would put forth but the responsibility of congress would be reflected in the criteria we put forth and the administration can have of what they want. i am not here to announce that is final but under certain

circumstances we would be receptive too. >> at [inaudible] >> when we are ready with our legislation hour plan is to move forward to have a bill on the floor. we have to see what the senate will do. again, the idea that we may change medpac is something we have to take up and it has not been taken up in the committee perhaps it will be taken up in energy and commerce. but we're on a schedule to bring up the legislation before the break and we continue to be on that schedule. and eight comments from merck chairman on that subject? >> [inaudible]

aho. >> i have not seen the letter yet but i have so many letters on my desk, it is a giant kaleidoscope you turn the dial and you get a new set of letters. i me regularly ... >> [inaudible] [laughter] >> i do meet regularly with a freshman and i do know their concern a small business and some of those changes have already been -- the it been made in the ways and means committee with lifting the element and the rest but we will see what people are putting forth that stipulate to a set of facts as to what really is the case and go forward but i have a full confidence and and no doubt that we will come to agreement on all of these issues.

this legislation, for example, that congressional district that has over $100 billion going to the public hospital and over 123,000 more people would be ensured, a 23 so -- 23,000 small businesses would be given tax credits to provide health insurance so the public pass to know the upside of all of this and in a quantified way what it translates into numbers. it is historic and transformational and momentous an important and relevant in the lives of the american people. while we get everybody is letters and take into consideration their suggestions but if they take us toward more quality, lower costs, better quality and enhanced choices for the american people in a fiscally sound why we are very receptive to what we feel comfortable about that.

>> [inaudible] >> i am very happy about that. yes. >> [inaudible] it. >> three suggesting i should be suggesting something for the president to say? i would not even presume to go to that police. -- place. we are in excellent shape. this is the legislative process where the bill takes shape as it comes more clearly into focus as the committees have acted upon it hear are suggestions we have to go to the next step this is the dynamism of what we do this is what we came to do so many of us in our careers to come here to pass health care reform for all americans and we will do that and we will do it with

the full participation of our caucus and full consideration of suggestions they may have. unfortunately we have the votes so we have to give back. [inaudible conversations] >> you just heard from congressional democratic leaders on health-care legislation and congress continues to work on health care and coming up today at 7:00 p.m. eastern we will show you the house ways and means committee markup session from yesterday on a health-care bill. coming up shortly at 3:15 p.m. eastern 1/2 hour from now president obama has remarks on

health care at the white house and we will bring that to you live on c-span2 bring in the meantime a portion of today's "washington journal" with headlines and your phone calls. >>host: an article in the "washington post" that is in all papers something similar but defense secretary robert gates. he sharpens rhetoric in dispute on the f-22 funds we have been talking about this all week congress want to build more of 22 but the obama administration says no. enough. we want to talk about defense spending for 20 or 25 minutes on the "washington journal" but first secretary gates spoke at the economic club in chicago and here is a little of his speech. >> in some the security challenges we now face and will in the future have changed and our thinking must likewise change. the old paradigm of looking at

potential conflict aside a regular or your regular more conventional or unconventional, high end or low and is no longer relevant. as a result the defense department is to think about and prepare for war in a profoundly different way than we have been accustomed to throw the better part of the last century. what we need is a portfolio of military capabilities with maximum versatility across the widest possible spectrum of conflict and as a result we must change the way we think and plan. and fundamentally reform the way we do business and by what then is part of it is simply -- it will not do to base our strategy solely on continuing to design and by as we have the last 60 years only the most technologically advanced weapons to keep up with our stay ahead of another superpower adversary.

especially one that imploded nearly one generation ago. >>host: joining us on the phone is bloomberg news reporter how serious is this fight? >> good morning. how significant is this fight? >> it is quite significant in terms of the obama's prestige on defense issues because he is today a very strong veto message in a strong personal letter to john mccain and senator levin and the office of management and budget followed up a couple days later with a reiteration they would veto a bill that contained f-22 money. >>host: there are some significant members who are championing the building of these? >> you will not believe that but this by has been going on for several years and in late

2007 ted it kennedy john kerry and dianne feinstein urged defense secretary under the bush should ministry shin to continue the live. what now but lockheed is coming to the end of a three-year contract to build these plants at a time when the nation is in a recession and unemployment is at record high and members are scared. there are three unions that have come together working with the other defense companies to lobby the hell and one wonders of the strength of all of those members bipartisan members, unions and companies may not steamroll obama and mr. gates no matter how strong the rhetoric. >>host: where is the f-22 bill? >> it is built in murrieta george gut. where gates spoke last night

builds parts of the fuselage in washington state, the sophisticated radar is built in massachusetts in northrop grumman and los angeles and maryland prepared has pieces all over the country lockheed claims they are at 25,000 direct jobs and 70,000 indirect jobs in 40 states supporting this plane. >>host: how much money are we talking about as opposed to the entire defense budget? >> it is hard to say the scheme of the budget is 1.7 5 billion at play in the united states senate the vote comes up monday or tuesday that is part of the $640 billion budget but it is steep but the long term funding seven planes or 20 planes makes a difference but i think the support is to get something in the budget now and hope for more later. the air force wanted at least 20 more and they say that

would cost about $13 billion in the long term. >>host: is it fair to say it is a fight over the future of the u.s. military and who controls the destiny? >>guest: that is too much of a rhetorical sweep gave the package things even though rumsfeld pushed for transformation of the military to plan for the future more efficiently. he has more support than rumsfeld but a lot of it is seems was started by the clinton did ministrations bribe would not paid this and that may be over hype. >>host: we want to talk about the future of the u.s. military with our viewers and whether or not this is a future or what they think the future of the u.s. military will be bellwether spending should be controlled by the pentagon or congress.

here is more of the secretary gates last night in the chicago. >> if we cannot bring ourselves to make this tough but straightforward decision reflecting the judgment of two very different presidents to germans of the joint chiefs of staff and secretary of defense and chief of staff where do we draw the line? if not now, when? if we cannot get this right, what on earth can we get right? >>host: senator jim and hof from oklahoma rights in "usa today" this morning the nation needs more f-22 is some say it is too costly and requires mencia does not measure up but

the air force has successfully rebutted the arguments while arguments continue to document the need the independent line what do think? >> caller: good morning it is a new aircraft and a force multiplier so if we replace f-16s it is a cost effective military strategy. >> one rap tour could take out for iranian f-16s with the 1980 parts pretty simply because our advanced avionics technology that is why we spend so much for the planes they are better and you can use less manpower so it is a force multiplier so it is cost-effective but of course, we have the military industrial complex than people need jobs these things come into play in washington and that is hard to change but the

american people and knows where it is going they can go to the advanced research website and see they give arguments for why we need certain research in defense of buy weapons and air superiority and how we can be cost-effective. if gates will talk about advanced technology the house to talk about predator drones, not just raptor it seems like a dog and pony show over a budget of the future of the american military is our technology but it is about force multipliers they are expensive but we have to make last. >>host: what about the argument this plane was designed to fight soviet era air wars? >> i think at first during the cold war era plan we're still in financing with jetfighters jetfighters, we are designed to defend against the russian been the biggest exporter as well as a as well as other

military technology. they export their military technology to other countries with iran in particular and the other countries that may be neutral. we have to be more advanced even though the cold war between russia is over but that does not stop technology from advancing. that is something we have to understand this technology is out there already. the pandora's box is not just for america the russians have dockside has predator drawn so the technology will emerge regardless of who spends the money. they will do it. >>host: where do you get your knowledge? >> caller: just a self educated person a little college but it is common sense. if elected the emergence of technology in the private sector or informations systems

the rest of the world is not lagging behind china and russia has a predator program it is cost-effective. we stuck to research and spend money no matter what happens in america but our congress with the industrial military complex it doesn't matter other countries will do this and that will be the intention to our foreign policy. >>host: connecticut, republican line what do think? >> caller: i have to agree with the gentleman. i think the last iraqi wars have shown we save american lives by having air superiority in being able to win so readily and without that we would also have lost a lot of troops. when you have a china that is right now a very baller taebo country always threatening to attack taiwan, it is pretty scary out there.

a lot of things need to protect and we need to maintain their superiors 87 "politico" gates dismisses claims of defense budget cuts are risky. the bigger flashpoint could be the presidential helicopter program where john murtha who is on the appropriations committee chairman of the subcommittee on military is an assistant the government can afford to simply walk away from the billions invested without getting some operational aircraft "you cannot just cancel programs without getting something out of it but secretary gates was merciless in his speech describing as a military procurement to run amok with standards as allowing the president to cook dinner while in flight under nuclear attack. the cost estimates of salvaging a handful of aircraft are crashing and martha would provide 400 million more than requested to try to salvage

five out of seven of the costly helicopters but the prime contractor lockheed martin has estimated another 1.5 billion could be needed reflecting the navy is a tough and testing standards for the helicopters. this will fortified gates argument that taxpayers would be better off if the program were terminated outright. in his speech in chicago gates of back to what has been a consistent theme, battle defense weapon choices out to be weighed in the context of the new "zero sum game. my frustration has been with people who argue for a specific weapons system and people who do not have to make decisions between competing priorities pretty dismiss those as cuts as risky. those three words of requirement, risk, analysis are commonly evoked in defense matters. applied correctly they help us make sound decisions. i found more often they have

become the holy trinity of business as usual. cincinnati ohio, independent-minded. >> caller: i like to preface my comments by saying i have a degree in computer science with a second generation two brothers whose studied one spent 18 months in the middle east. when restructure our economy around defense or military, it encourages a war that does not have to happen and larger question of how we will structure our economy. manufacturing has been exported which now has 40,000 in the f-22 industry. we have to think about new ways. yes it is true about china and taiwan but it stops coming and our economy goes south we're not going to war with china any time soon and it is a false hearing put up before the american public, the false

negative two currie in industry and expand the industry for the sake of the industry would have to think about restructuring our economy that gets us out of four and gets us out of military that only bourse our budget and deficit 57 merrill lynch? democrat. >> caller: good morning we need to slash defense budget we spend more than the rest of the world on our a defense combined we need to use that money to combat the insurance companies that are killing more americans than al qaeda or any enemy that we could ever face. they are killing us by the ninth service that we pay for it in our health-care premium. we need national health care for all americans and not just

those were fortunate enough to have employers pay for its because 50 million americans don't have any health care insurance and many of them are working. that is where the money needs to go. the people running the insurance companies are killing us by denying us the service that we are paying for and we need to battle them

book no programs i have always been a republican and i wondered what prize and days president eisenhower was thinking i know not the industrial military complex but i did listen to mr. gates and i was very impressed with his presentation and the fact he had worked for many other presidents it sounds like he has a good perspective. on some of your "booknotes" that your authors have commented on the military that in this day and age you cannot afford and the civilian death that the newspapers are all over them, how many people were killed sell a lot of those drones would be very helpful but it could kill a

lot of people. i heard 12 singular authors say whenever somebody goes in to tell the president you can kill osama bin laden they say well, sir, what is the chance and they give him a percentage and what is the chance of civilian deaths? they say what is it -- that is 100% and he says then we cannot take the shot. i think it would take somebody very versed in the military to weigh all of these things but i definitely think we really need to watch what we are spending and cut waste i am sure there are a lot of a cut us we can be made in hardware i would like to see a lot of money spent on the men themselves and those who have already served.

>>host: secretaries at gates spoke of fort drum in new york more troops than expected may be sent to afghanistan. he told troops that there may be some increase but not a lot and troop levels beyond the 68,000 service members the obama administration and approved including the 21,000 that obama ordered this spring. >> caller: i am in the military but about to retire and technology is the way to go. the younger ones are now getting into information technology because the technical ability fell less likely to lose lives. i would like to see the administration focus more on ground troops projections. there's a lot of technology

out here. my thing is there really need to come together and go out into a field and into these areas of afghanistan and iraq and see exactly then come back and add technology as needed. as far as the army or navy or air force they will fight forever weaponry they want and it comes down $2 and cents but they don't put a soldier or the marines or the airmen first it is a no starter. >>host: gave quickly tell us about your military service? >> i have been a personal sergeant over 27 years it is my job to mobilize soldiers all across the country. it is interesting because you take these soldiers away from their homes for sometimes when year or as many as two years.

is a difficult task they put their lives on the line they know the job but do not undercut our life with the finding of the budget 57 from "the financial times" robson johnny said to energize reformist that former president supporter poppins -- opposition leader is expected to use the same platform with those who say the election was fraudulent many believe mr. refsanjani appearance of shows for a mass opposition strength on the streets of tehran. on the associated press he has made the speech and apparel, was packed to make sure the weekly paris that are broadcast life and one of iran's most symbolic platforms. from "the new york times" the

may recall harry and louise from the health-care debate they are back and this time standing here with democrats the same actors are back now in a new campaign this time to support a government overhaul per ma at day's promoted by democratic president could train group advocating affordable medical care reflected the strange bedfellows lining up behind the latest reform of first a little more cooperation and a little less politics. this is scheduled to appear on cable and network stations this weekend and we can get the job done this time. republican and line. >> caller: before going to anything i 12 correct one mistake you have said they showed a picture of aircraft that was not the f-22 you

showed at the f. 35 those are two separate aircraft and perform two separate jobs. >>host: how do know that? >> caller: if you are around enough military people and look at enough pictures the vertical stabilizers as well as the intake are significantly different from the f-22 they are similar looking to to the fact they're both with the same color but not the same aircraft. >>host: thank you for that are you on the air force base? >> caller: i am as a matter of fact. want to go into the fact that we do need to print -- procure more f22. i cannot go into history because that would take a long time but we have 700f15 eagles and this is aircraft originally designed and built in the eagles but to replace

these all the we do not need the exact same number we do need to at least replace them with 300 or 300 + aircraft so it is a two :1 ratio of replacing the f-22. as one gentleman said before the multiplier which means they give the ability to fight more enemy is with a smaller amount of aircraft or technology. here is the other issue this is what secretary gates is saying that instead of buying of 22 we need to buy the f-35 which is a platform designed to replace the forthcoming and the f117. >>host: do agree? >> caller: i do not because on a full-scale the f-35

should replace the forthcoming but not take the place of the f-22 because the f-22 is the air superiority aircraft vs. the multi role designation the f-35 has. that means you would be replacing aircraft like the f-15 which is their superiority aircraft with aircraft that is not designed to do that job. to answer those questions. >>host: very quickly. >> caller: the f-22 was designed to combat major amounts of russian aircraft cover it still can be applied today. anyone can see that iran, china, have large air force and that would take more than just 187 of 222 knock them out. >>host: are you a pilot? >> caller: not currently but i am in that direction. >>host: thank you for calling in.

cincinnati go-ahead. >> caller: yes. war is murder. there is no way getting around that. that is just a fact it does not matter what reasoner what right using to have to kill another person but that is against moral rules. you have no right to kill anybody for any reason whatsoever. what happens you get in there and have these four young men that just called the floor and you have these thoughts you have all of all these enemies in this stuff and we need to protect the world from all of these other enemies but maybe if you just calm down just try this one time in our life come a calm down. and see if anything happens and i guarantee nothing will. nothing will. >>host: and we have a twitter comment we will always

need the ability for r&d and to build advanced weapons the people we're fighting now will not be the ones in next time. >> president obama with remarks on health care coming up at 3:15 p.m. eastern we will have it live on c-span 2. in the meantime more from today's "washington journal". >>host: naacp 100 anniversary celebration one part politician and one part black preacher as he spoke his voice quiet and then thundering and unusually personal burma 1.20 audience shouted back at him he threw back his head and laughed and says i have the amen corner it was an unusual moment who was thought to transcend race and is only uniquely embraced his unique place in history. six months into his presidency he is more comfortable

embracing the first black president overseas than at home as was the trip last week to gonna sing i have the blood of africa in me. one reporter tried to move casts the speech as mr. obama's first robert gibbs said i think the first speech to black america are the america was the inaugural address. that is how "the new york times" plays it and here is the headline comment to many barriers discrimination remains problem. and here is the new york daily news, thank you to the naacp his story made possible by pioneers. what is your reaction? a couple of other news articles last night or early this morning the house ways

and means committee passed legislation to revamp health care including tax increase on the wealthy to help pay for the play and it is from 1:26 a.m. eastern the committee voted 23/18 to approve the bill that the committee chairs introduced earlier. three democrats joined all committee republicans in voting against the bill over the next decade it will impose 544 billion in new taxes on families making more than 350,000. that is from the associated press part of this is from "the new york times" to close the loop on the sotomayor hearings she offers concession clearing way for votes. staff aides said they expected at least one or perhaps as many three of the panel's seven republicans might vote to approve the sotomayor nomination and the senate to the full senate which is expected to confirm her in the

first week of august. senator leahy has scheduled a vote for next tuesday but republicans indicated they will ask that the vote be delayed one week the aides say they expect senator graham of south carolina whose questioning of judge sotomayor beard between support and wariness to vote to approve the nomination and said he could be joined by senators hatch, grassley, or cockburn. grass and -- hats and grassley have traditionally supported in the past but coburn said he was mighty impressed after questioning some of your and in 2005 john roberts received three votes from among the eight democrats on the committee. and from "the washington examiner", and the house democrats mezzo g.o.p. on sensitive issues and to tailor rights in their sealed to

protect their members from hazardous votes on issues such as gay marriage and gun-control democrats running the house are taking extraordinary steps to muzzle republicans inside this summer's to spending -- debates on spending. republicans hope to for school vouchers and medical marijuana as well as the marriage and gun-control as part of house consideration of the federal government contribution to this washington d.c. budget no way british or 12 bills totaling more than 1.2 trillion annual appropriation for finding government programs. low-profile legislation and typically dominates the work of the house. four decades the bills have come to the floor under an open process that allows any member to amend them and it was the right did democrats zealously defended when they were in the minority. house appropriations committee chairman insist a clampdown is

to prevent debates' from dragging on and on the republicans have agreed to limit the time debating the bill. that is in "the washington examiner" here is a little more from the speech that we will get to your phone calls but there's a reason the story of the civil-rights movement was written in our schools. there's a reason in third grade marshall took up the cause. there's a reason dull little rock nine defied a governor and a mob that because there is no stronger weapon against inequality or no better path to opportunity than an education that can unlocked eighth child god-given success [applause] and dat more than half a

century later this dream of a world-class education is still being deferred all across the country. african-american as soon as are lagging behind and the achievement gap which is growing in states that wants led the way in the civil rights movement. over half of all african-american students are dropping out of school in some ways. there are overcrowded classrooms and crumbling schools and corridors of shame in america filled with poor children. not just black children brown and white children. as well. the state of our schools is not african american problem, it is an american problem because if black and brown children cannot compete that america cannot compete [applause] >>host: north carolina, a democrat line what did you

think of the speech? are you with us? >> caller: i heard president obama and make a similar speeches and has an educator this is the strongest of message that america needs. what he is saying to parents i think is foremost and we have had books and research then that is criticizing schools and teachers over the past 20 years and not much has been said about the responsibility of parents if we look at other cultures sullivan and adults to come from india and china are other countries that we're competing west and we talked to those now professional adults about how education was treated in their homes and societies come with their parents emphasized over and

over again exactly the message that president obama is emphasizing that the education is the most important thing to a strong future and parents being willing to literally filled their homes and use that money to said they should send their children to america for the high quality education because they want that for their children and their families future for generations to come. >>host: what do you teach? >> caller: i am a university and i teach education for special-education. but my mother was an educator 40 years and i live and work around teachers of all kinds and worry about the dropout rate in our schools and somehow parents have to work

harder telling our children how important this is. we go through a saturation in education today were maybe we don't have the best and the brightest and every classroom in america but we do have some wonderful excellent teachers but you'll never go through 12 years of school with every teacher along the way being the best. >>host: robert from a milwaukee, good morning, what did you think of the president's speech last night? >> caller: i think it was a very good speech but there are few things that would like to stress about it. i think, what i would like is some of the young black men who are running around the town with their pants hanging down standing around smoking blind and not trying to

achieve anything, that they will have to shoot a different path. that is the main reason for the drop out. they are making babies and not taking responsibility for that. and i would like to see some of them joined the military just like i did in the '60s as a bit non veteran. they can get some sort of the guidance and get out of jail. >>host: pallone a california i thought it was extremely encouraging and i really enjoyed it and i thought it goes across all ethnics our poor white children and hispanic children and i thought it was encouraging

also like the part about the community and the paris. i know when i was growing up in actually happened to me and i really do think all parents need to watch our children i thought i was getting way being a smart girl but by the time i got all my mother knew everything i said. but for the past week and the month all children happen going through pk being very beat these very badly the rules of the game have been changed even though you get a great education and i still made it somehow they will change the rules so children would never call the warwick get the education. >>host: by the way you like to watch the president's full speeches about 37 minutes in length go to c-span.org just below the three pitchers you

see on your screen if you go below you can see what we covered it you can watch so whole thing fair and anything we have covered live on-line north carolina independent line. what did you think of the president's speech? >> caller: thank you for taking my call per garn blogged about this. i enjoyed the speech but i think what president obama does that it is asking the african community in -- african-american community he comes off conservative as opposed to a bleeding heart liberal. in front of a white audience. hi i agree come i think it is good he set up the speed to talk about discrimination and racism and prejudice but

racism is economic and personally i could care less was that rush limbaugh i could care less if they like we're not. so you talk about the economic conditions that produce the lack of education of black children in this country. when we talk about the education in this country we talk about for african american children is a good educational system and people like president obama who have risen to greatness have done that because of the educational system in this country but in spite of it. a good book for it president to redo be nemesis education of the negro that was written in the 1930's and is still relevant today. >>host: what is your blog? >> no warning shots fired.com.

>> caller: you can say i doable time because i update it every day at that is my passion i tried to do the hip hop centric spin to counteract the right wing nonsense. >>host: what do due for a living? >> caller: the african ministry a lot of people that are upset about black liberal theology of dr. jeremiah wright we also teach black liberation theology but we make it more relevant to the hip-hop generation. >>host: thank you for calling in. from the "politico" exclusive conservative group offers to sell the endorsement for $2 million. the american conservative union asked fedex for a $2 million check in return for the group's endorsement in a bitter legislative dispute then flipped and sided with etfs after fedex refused to

pay. in return for the $2 million a.c. you offered a range of services and a clinical mac producing op-eds and articles written by a the chairmen were other members of the border directors part of the conservative groups remarkable command black-and-white approval of a longtime washington practice known as pay for play was contained in a private letter to fedex that was provided to po ago. go to politico.com if you want to read dell amo article. this is from reuters about the h1n1 virus. it was named to the fastest moving pandemic and it is pointless to count every case per w and agency declared the pandemic on june 11 revised requirements of national health authorities only need to report clusters of severe cases caused by the new virus or unusual clinic patterns and

a front-page of the guardian out of london, a swine flu could kill 65,000 in the u.k. warns the house chief and the front page of toronto, canada and have enough flu vaccine to share. now back to your calls a republican in from a silver spring maryland. what did you think of the president's speech? we will put that caller on hold you have to turn down the volume otherwise you get the delay and we will move up two maryland. go-ahead. >> yes. i read the speech and it was a good speech. it was conservative. however as it relates to the recent ruling of the supreme

court by judge roberts concerning the firemen, i believe it is relevant because all i believe roberts decision was wrong. the reason why i believe it was wrong is because they're not looking at the spirit of the amendment. they're only looking at the letter. the 13th and 14th amendment and the voting rights and equal opportunity cause this stage clauses in the institution have a spirit to them to make up for the past in human treatment of black people.

therefore it's not going to be even further you cannot have two elements occupying the same space at the same time. >>host: it. >> of the bomb is education and why stop the clearly successful washington d.c. school choice program he says his children into the best taste of this. the independent line? >> caller: i think obama's speech was very good. i think the part about education is definitely on us and we need to do something about the 50 percent dropout rate however rest of america needs to know the institution has racism that you cannot have statistics such as white high-school dropouts have a lower unemployment dropout rate than blacks are people

with similar resume is when a white person has a criminal background and a black person does not and they have a high your call back rate and they cannot have two percent of this society with a 41% on death row. the facts and figures are there. america needs to realize that the overall the president's speech was very good. >>host: benjamin the head of the naacp said yesterday they have one black man in the white house and 1 million black men in prison. . . reid. senate majority leader slammed the democratic national committee on thursday running ads to pressure centrist democrats for the health-care plan calling it "a waste of money." his comments sent the staff in damage control mode but also

reflect a growing frustration among centrists who have been reluctant to back a government- run self -- health insurance plan. liberals have been urging centrists to support it from of using various television and radio campaigns. this week a wing of dnc said it will run ads in states represented by centrist senators. he slammed the of dnc for starting democrats as the republicans or special-interest groups. new york. from auburn, new york, what did you think of the president's speech last night? >> caller: . appended. barry good. i have been listening to some of the minority is calling up and all i can think is a double talk. they can't hardly articulate themselves.

the thing to do if i were them is go to school and forget about all the racism. some egregious race hate you can't overlook but some of that step they are talking about is just baloney. go to school. thanks a lot. >> host: this is from the new york daily news and honor screen is a picture of major jennifer greece. she is sitting in the capt. spot of air force one. all female staff on chopper is a first, the first time that an all female staff blue marine one, flew the president on marine want. major graves was appointed in marion one capt. during president bush's tenure. she flew president bush and president obama and now for the first time an all female staff blue marine won the first time

in history. fayetteville, arkansas, a democrat. >> caller: hi, how are you? i am calling because i was pushed through school. they did not know how to handle me. i had adhd and i was just pushed through school up until fifth grade and i see it happening to my daughter. she is wanted to quit school at 17. >> host: how does that fit in with a speech last night? >> caller: well, i just feel that children should be in school until they are 18 or they graduate. >> host: milwaukee, independent, talking about the president's speech last night to the naacp. >> caller: i particularly want to address robert and your

caller from of a minute ago. education is generally thought of as a way to get a job and education should be much more than that. and education to teetwo to learn the rest of your life and when you learn at one level you go to the next level and the next level and the next level. now in roberts case, he wanted to blame a black children are black men wearing pants off their hips as the cause of this and that is so ridiculous. it is not even close to the truth. the problem with black children in milwaukee and against many instances is the worth city and for black children to grow up is they have no value. they are not cherished because theç factory jobs, the agricultural jobs have gone away. reverse sold out to china for one. at a great benefit to the sellers which was congress and

if weç ever restore ourselves o the agriculture or to the industrial leaders of the world, the technology leaders of the world, we can employ everybody and this is the answer. but i'd like to hear anybody tell me to blame the victims. thank you. >> host: this is from the washington times, at cia director defense al qaeda initiative. for the clinton white house defended a george w. bush administration initiative to assassinate al qaeda leaders and the agency's decision to keep the idea top-secret. it doesn't appear as if they actually did anything with respect to these projected for possible assassinations.

tom, republican. >> caller: how are you this morning? i think that's obama is concentrating on the wrong thing. he is blaming racism for the problems of the black community. i think it is the black community themselves. they are not working to try to get to their own ship in order their, their own house in order. if that the conduct, they are murdering each other, drugs all over the place. so they wake up and stop having children when they are 14, what the hell did they expect their lives to be? i am irish descent and we were discriminated against and we overcame a lot and you have to get on with your future and stop winding about what happened to hundred years ago. my god, by. >> host: from "the wall street journal", a charter school gain in stimulus gramm.

somewhat cash grant are signaling a major expansion of charter schools to top $5 billion in federal stimulus funds despite strong opposition from some teachers unions, charter schools are typically not unionized and publicly funded alternative schools that have been widely promoted by conservatives as a needed dose of competition in public education. this is in "the wall street journal" this morning. next call from florida. democrats, high. >> caller: how are you doing? i am quoting because i think this situation and of last night at the naacp and the president was talking about the white and black involvement and what he really said is it for meat --

for me it is a necessity especially you have haitian and you have cuban and a mexican, people coming from all over the world. most of the people and i come here and some of them to the right things and some of them follow the rules and go to school and get education and some of the black people and even white taken for granted. for example, i was in china two weeks ago, a month ago and i see you how the kids go to school and they did trades. before they came at a school they've got their own a professionals, they become a professional and do all kind of work and work in the government and the factories. they do something, they have something to do when i get out and that is the way the united states should do to train the

kids. they can train these kids while they are in high school and when they go to the university something different. especially the charter schools and the committee center. you have the acquisition center just like we have and i think the gentleman, what you try to do is work with all the charter schools and everybody in the committed date the kids drop out of school and those who cannot start have a test that they can work so they can go to the school the same way. they don't want to leave anything, that is the reason why our president was talking about it. he doesn't want to see the

african-american and white americans with less education and go outside and with drugs and that is what some other people interpret it the wrong way. >> host: let's leave it there, they do for calling in. a tweed comes in on success and education and cultural, the larger cultural and family committed a culture. family is the most significant. here on your screen is a picture of larry, you might remember him from being a spokesman for president ronald reagan. he is now suffering from alzheimer's disease, he is 69 years old and there is a court fight going on in mississippi about him between his wife, his third wife and his kids about custody and custodial ship. this is an article in the reliable source in the washington post this morning. next call comes from augusta, georgia, good morning, how are you? i just wanted to say that the

president always gives great speeches and we should commend him on that but is not always about what he says, is about what he does. the president is against school choice and school vouchers and to me when a tape those options of the table for some people that can hinder them because in a community where the schools are not great they should have the option to go wherever they choose to go. many people did the government should be funding back to the government at this point is trying to find health care and many other things going on. someone called an earlier with a democrat and normally don't agree with the democrats any more but he made the comment the only time the president speaks like a conservative is when he speaking to african-american groups and i do believe. when he gives a speech he should give it to everybody and not just to the naacp and that is my comment. >> host: could you look for? >> caller: john mccain. >> host: thanks for calling in this morning. >> still waiting for president obama and remarks on health care

legislation, the president was expected at the white house at about 3:15 p.m. eastern time. running a bit late but we do plan to bring that to live on c-span 2. until it gets under way back to more from today's "washington journal". >> host: alex from the labor department chief economist and a report from the office of the president of council of economic advisers tell preparing the workers of today for the jobs of tomorrow. what does this report find the biggest challenge of doing this? >> guest: what is in part about this report is that to help workers a dank we have to and stay with the job market is going to look like in the future in 5210 years. and what the report finds is is very interesting in many respects the jobs are going to be the picture similar so many industries that are around today are going to be a around in the

future, but what two of the findings that are very interesting are that there will be a lot more jobs in health care and many more jobs on renewable energy. that is green jobs, alternative energy, pollution cleanup. weatherization and those kind of jobs and as an area expected to grow considerably over the next 5210 years. >> host: the last couple months we've seen with an unemployment rate goes up so how does the labor department and the council of economic advisers look ahead several years to say this area is going to see job growth? >> guest: well, there are some pretty complicated forecasting behind this. i should say that the bureau of labor statistics of the department of labor publishes a set of projections every year in these projections are the basis for this report. but it is really important to be able to do this. because we need to design our

training programs in such a way that we are targeting those areas which are growing to put workers into those jobs through our training programs so this is why it's so vital to build to do that. >> host: does in this report take any consideration the stimulus money? is this money from stimulus began to build some of those jobs? >> guest: to some extent. implicitly in this report there are some assumptions about how some assumptions have a stimulus is on to work its way to the system so what we will see is we are going to have jobs in construction and so the stimulus is going to have an impact on the recovery in construction. to concede that now, we can see that right now we've got about 5,000 or infrastructure projects under way as we speak and obviously that represents thousands of jobs. which may not be there otherwise of the report does take that

into account awaken naturally seen the reports that there is going to be projected a considerable amount of construction work. >> host: part of economic advisers' report has a chart looking at some of the things to the growth of the areas of jobs, transportation and utilities and health and education services and government jobs. this looks sort of flat but i want to pull this off and take a look at washington post this morning. they have a headline, thousands jammed a job fair for federal government openings and read the federal workforce currently at 1.9 is expected to grow to about 2.1 during the obama administration. this is according to the partnership for a public service. does this report from the administration take that into account? >> guest: i believe it does say that to account and we are seeing some growth in government

jobs, but we have to understand that this is -- and these additional workers are there a the the german labor we are hiring additional workers to help create jobs and to help workers adapt to the economies of its fundamental that this is happening. but it does take that into account. >> host: president obama in his campaign and in his inaugural address talked about the importance of not only high school -- not dropping out of high school education and beyond. how does our education system look different down the road? what do we do differently in terms of job training, in terms of college education etc.? what has to look different in the future? >> guest: this is fundamental so one of the key findings of the report is that jobs with more educated workers or occupations with more educated workers are going to grow significantly faster than other occupations. and what that means in practical

terms is that for a worker to succeeded in this economy and where the economy is going, they're going to be in a much better position if i have some of these skills. and so on monday the president announced the american graduation initiative and what that does is it is going to reform and strengthen our committed ecologist. the goal behind all of this is to get the u.s. and get this nation to be the leading nation in number of college graduates so what this initiative will do it is the aim to increase in the number of the students and committed the colleges sevenfold and this will be through investments in facilities to increase financial aid, and what it does is tapping into the potential of the american workforce. this is how we are going to lay the foundation for this recovery. we are not, we're tapping into the innovative and generative potential of the american workforce to come out of this and more competitive and

productive. >> host: was here from our viewers, dayton is first on our democrats lined. >> caller: hi, the last two years in the first time i've ever really been in a lot of nursing care facilities. my father had hit had a fall at 82 and paid into the system all his life so realize in the private insurance companies which my parents have i call the company on secure horizons instead of secure horizons -- have a corner the market on our health care and how the fact that not getting well is not necessarily the focus but their profit margins. but besides that being in three or four dinners and homes and several assistant living care facilities, i have become aware of how poorly the nurse's aide to get paid. generally in dayton, ohio what i have notice of being in credit facilities that pacers at $9 an hour. so they get paid poorly and then it jumps up to like $25 an hour

for occupational therapists and 35 to $40 for nurses so the pay discrimination is insane. as for the profit margin is off the backs of this nursing aides who do the bulk of the work from my observations which have been many hours. so how can we not only raise the pay legislatively of these aides have? how can we have the standards of more consistent because i see from one aide to the next and that the strategies are different. >> host: we will get a response from our guest. >> guest: you raise a lot of a great points and what this administration and the president and secretary of labor are committed in not just to ensure that we will get out of here with a sustained and widespread growth in jobs, but also that the decades-long trend in the stagnation of wages that we've seen in the middle class comes to an end and that when people

get into a job they see it opportunities for advancement and pay levels that will sustain a family. and that is what we're doing at the the barman of labor. we are committed not just in getting people into work but getting good jobs for everybody. you raise a very important point which is held support occupations and what the report we are discussing here shows of these occupations are expected to grow considerably, really even more than other health occupations because we have a relatively aging workforce. i'm sorry, population and as the population ages and there will be more need for physical therapists, people working in nursing homes and so it is crucial and that in these occupations because we will have so many of them have good standards and good pay. we are working to that end. >> host: buy to the unemployment issue, and your

rights in a tweed, why did the national unemployment rate is .1% in june compared with past months? is there possibly a stabilization? >> guest: i think it is too early, i am less concerned with how we are doing from one month to the next. one month fluctuations. i'm more concerned about the long-term trend in and so if you go back to january, if you look at where were in january we were setting 700,000 jobs a month. if you move forward in we are down to about 400 or maybe a little less so you can see that there has been some stabilization and some improvement but any jobs lost as too much. what i can tell you is this, that we didn't get into this -- when we took on this mess it is a mess that didn't happen overnight. it was years in the making. and we're not going to get out of this overnight. so i think what you're going to

see is some bumps in the road ahead, but we are going to see sustained and progress and a shift toward recovery. >> host: another year asks that what is a real rate including no longer receiving unemployment benefits? are they not being counted as much? >> guest: the bureau of labor statistics come to different measures of the unemployment rate and the one and that is often usually cited in the press is adjusting clues to those workers who are in job but it is true that the number of workers who are working part time but want more hours is at a record high and our workers who are only what is called marginally attached to a labor force so they are in and out. would you take those into account it is much higher. and that is something that is really important when we think

about the kind of services we provided at the department of labor. >> host: does of the department of labor bureau of statistics have any sense of what the unemployment rate would be absent the stimulus money? >> guest: we don't take a position on that but when i can tell you is it would be higher. we know this because we know that there are funds out there and a system of that are made into projects. we have more than 20,000 at stimulus projects in this economy right now, more than 5,000 infrastructure and our jobs there. and so we certainly have jobs that would not be there otherwise and i also want to point out that there are jobs that we are saving as a result of the recovery act. just two days ago the governor of florida talked about all the teachers in florida who would have lost their jobs have they not been in recovery funds like 26,000 and you hear stories like that for new york like 14,000 teachers so it is clear the economy would have been worse

sauce apps and recovery act. >> host: was go back to north carolina, good morning to susan on our recovery -- republican line, i want to know whether haven't done anything about the jobs with the illegals. we are supposed to have no work and while we do go into words the illegals are getting all the jobs. in since 9/11 since we had in the basin of people from all over, why they haven't done that for their workforce? and why they haven't done anything about gas? the unfair trade. we make good stuff, the stuff is coming in our country. it is like disposable lighters, you throw them away in about a month whose metier did it take effect of the immigration illegal or otherwise? >> guest: there are certainly studies on this, but what i should say i look at this as it

is not a situation, an economist paul zero some situation which is i went and you lose an eye when you lose. we are focused on improving everybody's lives so that is what we are doing at the department of labor. we are focused on putting up people into training programs, get them into a reemployment services and investing in this workforce so that we are laying the foundations for sustained recovery. that is really what we're looking at. >> host: 10 more minutes with alex mas and airport council of economic advisers preparing the workers of today for the jobs of tomorrow and taking a look inside to a specific area of job growth. the actual projected growth of environmental related occupations and other occupations between now and 202016. what sort of jobs are we talking about? >> guest: there is a host of writing a job so we are seeing again in health care will see growth amongst physicians, amongst registered nurses, hal

i.t. will be a really big growth area so record keepers. what that does not take into account is what could have been as a result of health reform so if we have a investment in electronics health records that itself will create jobs and i think it is important to say that this report has some projections but there are going to be jobs and can never predict it. if you go to the early '90s would not have predicted how and for the internet would have been. we go to the '80s would not have predicted that the pc would have been so important so i think we're going to see important innovations that occur which will create jobs and that is not necessarily in this report. what i should say is that why it's so important that people get and acquire skills because we know is when people have skills they are able to adapt in a dynamic economy. >> host: santa cruz,

california, good morning on our independent line. >> caller: can you hear me? >> host: sure can. >> caller: i live in santa cruz, california and our president obama, we got the first stimulus package and hear as santa cruz i understand we need to create jobs but then manufacturing jobs because california has gotten so big mistake, so rich devastate so that now the businesses, the big businesses, the big corporations like pfizer. you get where i am coming from. the big business, the big corporations. they are the ones running the show. we the public are not. i am disabled. i do not want to be a sponge just like a lot of people here

and i want to try to get retrained. thus my people talk about manufacturing jobs so that covers a broad range from automobile manufacturing to drug production this mack with this report shows is that to the decline and it's been a considerable decline in manufacturing is expected to moderate and debate. in fact, in some areas as you point out is a diverse collection of sectors really and some areas will see growth. and so could give you an example and pharmaceuticals or you will see growth and aerospace where you will see growth and in those areas there are occupations which are occupations that people can't see can with training. >> host: what is behind that growth in aerospace? >> guest: i think that there is projections that the market for aerospace will improve and we have companies and employers

in america that are leaders in this area. >> host: two-point out of the growth area for jobs spotlight, electrical power lines dollars in repairs. is this based on the passage of energy legislation or what the administration wants to do with things lexmark grids? >> guest: i don't think this particular example, the energy legislation is not assumed in the report but it is certainly an area which has already grown. so in the green area more broadly what we have seen is that between 2000 and 2006 we already seen these occupations are growing faster than average and are expected to grow even more apparent that is absent legislation. so what is safe to say is that with legislation in will be more promising areas. >> host: san cloud, minnesota, republican caller go ahead. >> caller: i just want to ask the gentleman.

with the health care insurance program but you are going to tax everybody, that is not going to create jobs. if anything is going to lose a lot of jobs and as captain traded. you are putting all of this stuff on the big businesses and it is going to trickle down to the small people, going to raise taxes. it isn't going to great jobs. people are just in denial. thank you. >> guest: here is with health care, here is in the issue we know the system needs reform. people in the u.s. pay more for health care than any other country of the world and quality is not necessarily that high. so what we know is that to the best we can do for our economy is to make the hard choices and to tackle this at the core which is something that has not happened in the past. it is not in a band a solution and we need to get at us now with the president has said is

we have in efficiencies in the system and that is clear, that the system is designed in such a way that there are inefficiencies that will drive up costs. that is what we're trying to get at here so this is really about helping families and helping businesses succeed because these health care costs if they are not restrained in are going to hamper growth. >> host: is there a potential point between the area of increased government spending to promote job growth and the necessity of increasing taxes which is evidenced by proposals to raise taxes for funding health care? is there a point of paying for individuals or families that you have to be concerned about? is like the president has made absolutely clear that people and families who earn less than the quarter million dollars are not going to see tax increases and so on what we are focused on here is taking the necessary

steps to promote growth in this economy and sustain job growth. widespread job growth. and i think no one wants to seem this economy more healthy than this administration. we are doing everything we can right now. we are pushing funds into the system through states to promote jobs. >> host: david, good morning honor democrats line. >> caller: how are you doing? question, there was a two-hour documentary about two weeks ago that was fantastic. there is an immediate need it, we have got dams that are giving way all over the country. many of them have a 50 year life and some of them are 80 years old. the same thing is true with bridges. they showed st. louis, missouri the areas and suburbs with these

machines that had gas completely coming out of the yards up and down the entire streets with gas leaks. there is a waterway is . >> host: wrapup please call mike with two and a half trillion dollars worth of infrastructure needs that have to be taking care of why aren't these on the top of the list. in his very second and why isn't obama and our democratic party you can't count the republicans for much more than the military and cancan on them for that anymore. but the point i am trying to make is when are we going to come to our senses, we need these jobs, we need this infrastructure. when are we going to get to them? why are they being showcased as potential jobs? >> host: thank-you. >> guest: we are doing that in the recovery act, making of

foreign investments in this country's infrastructure. as i said, we have under way within 20,000 projects under way including one and 5,000 in infrastructure and this is in all 50 states so coming out of this we are going to have an improved infrastructure in this country and in doing so we are creating thousands of jobs. >> host: here is a column from mississippi, james, in a better caller. >> caller: how are you doing? i was wondering you would be possible if this next inouye is packaged that president barack obama and his cabinet and the people can consider raising the minimum wage 15 or $20 an hour and a working through with the people that to the money is being spent in that stimulus package can work through the companies in the businesses that

raise these minimum wages and help the businesses out of it. >> host: we will get a response because the house is coming in this mack as you know the minimum wage is going to be increasing on 724 and that is in many ways an important development because what that means is that working families, people who have a full-time job will have about 120 more dollars in their pocket and that will go straight into the economy. >> host: the jobs you're talking about in this report from the council of economic advisers is much broader than a low-wage jobs this check absolutely and like i said our focus and the secretaries focus is on good jobs. on a well paying jobs that can sustain family is. >> "washington journal", we leave it to take you live now to the white house and the president with remarks on health care. >> and look at the unprecedented

progress that we have already made on reform that will finally lower-cost, guarantee coverage, and provide more choice. over the last several weeks we have forged a level of consensus around health insurance reform but we have never seen before in this country. in may we were able to bring together health care providers around agreements to do their part to increase the annual rate of health care growth by 1.5 percentage points annually. which will save us $2 trillion or more over the next decade and lower-cost for all of us. a few weeks later we have got the pharmaceutical industry to agree to $80 billion in spending reductions over the next decade. productions that will make prescription drugs more affordable for seniors and that is part of why the aarp has endorsed our efforts.

last week we reached an agreement with hospitals to bring down costs by another $155 billion. and just this past week both the american nurses association and the american medical association representing millions of nurses and doctors across the nation who know our health care system best announced their support for what we're trying to do. in these past weeks we have also built a consensus around specific reforms on which there hasn't been consensus before. let me list some of those and want to particularly applaud the efforts of the committees in the house and the senate to have worked long and hard to make this progress. we are now at a point where most everyone agrees that we need to invest in preventive andçç wellness programs that can saveç us money and help lead healthier lives. we have an agreement on the need to simplify the insurance forms and paperwork that patients have to fill and every time they go

to a hospital or see a doctor. we have an agreement on the need to reform our health insurance system so that if you lose your job, change your job or start a small business you can still get affordable health insurance. we have an agreement on the need to prevent insurance companies from denying coverage to americans with pre-existing medical conditions and we have agreement on the need for a health insurance exchange. a marketplace where people can compare prices and quality and use the health care plan that best suits their needs. so this is what health insurance reform will mean for the average american. it will mean lower costs, more choices, and the coverage you can count on. it will save you and your family money. you won't have to worry about being priced out of the market, you won't have to worry about one illness leading to your family going into financial ruin. americans will have coverage

that finally has stability and security and americans who don't have health insurance will finally have affordable quality options. these of the areas where we agree right now. in this consensus has brought us closer to the goal of health insurance reform than ever before. now we have got to get over the finish line and part of this process is bigger and how to pay for it. i have said that health insurance reform cannot add to our deficit over the next decade and i mean it. let me repeat -- health insurance reform cannot add to our deficit over the next decade and i mean it. already congress has embraced a proposal to cut hundreds of billions of dollars in unnecessary spending and unwarranted giveaways to insurance companies and medicare and medicaid. so we actually believe that about two-thirds of the cost of

reforming health care could be achieved through the savings alone. without any new revenue. of course, that still leaves one-third of the costs in order for us to cover all americans that we're still going to have to find a way to pay for it and the key committees in congress are working diligently with the white house to see if we can come up with an agreement on that remaining one-third. the bill i sign it will also include my commitment and the commitment of congress to slow the growth of health care costs over the long run. this is a separate issue and i just want to be clear. there is an issue of how do we pay for health care reform immediately and with this deficit neutral, but how do we also bend of the cost per so that we are announcing huge health care inflation over the long term that would not only make any health care reform package more expensive 15, 20 years out, but would also make sure that people who have

nothing to do with the government programs like medicare and medicaid, had we made sure that their costs are under control asç well. i realize there is going to be ç lot of debate and disagreement on how best to achieve these long-term savings. our proposal would change incentives so that providers will give patients the best care not just the most expensive care. which will mean fixed savings over time. this is what we mean when we say that we need delivery system reform. i have proposed to congress and i am actually confident that they may adopt these proposals that independent, an independent group of doctors and medical experts will oversee long-term costç saving measures. every year there is a new report that details how much waste and inefficiency there is in medicare, how best practices are

not always used, and how many billions of dollars could be saved. unfortunately this report and subsidy on a shelf and what we want to do is force congress to make sure that they are acting on these recommendations to bend the cost for each and every year so that we are constantly adjusting and making changes that will reduce cost for families and for taxpayers. we need an independent group that is empowered to make these changes and that is something that we proposed. i am confident that if we work with the foremost experts in the field we can find a way of to eliminate waste, slow the growth of health care costs and provide families for more security in the long term. now, i realize that the last few miles of any race are the hardest to run. but i have to say now is not the

time to slow down. and now is certainly not the time to lose heart. make no mistake, if we step back from this challenge at this moment, we are consigning our children to a future of skyrocketing premiums and crushing deficits. there's no argument about that. if we don't achieve health care reform, we cannot control the costs of medicare and medicaid and we cannot control our long-term debt and our long-term deficits. that's not in dispute so we are going to have to get this done. if we don't get health care reform done now, and then no one's health insurance is going to be secure. because you're going to continue to see premiums going up at astronomical rates, out of pocket costs going up at astronomical rates, and people who lose their jobs or have a pre-existing medical condition are changing their jobs, finding themselves in a situation where they cannot get health care.

and that is not what i except for the america cup and that is why those who aren't betting against this happening this year are badly mistaken. we are going to get this done a. we will reform health care. it will happen in this year. i'm absolutely convinced of that, i believe that members of congress are prepared to work as hard as is going to take to make this happen, and i am grateful for the work that already done. i'm confident that we're going to be putting in a lot more hours. there will be a lot more sleepless nights, but eventually this is going to happen. thank you very much. >> the president live at the white house, now on c-span 2 we bring you a house hearing on the use of antibiotics for animals. rules committee chairman louise slaughter is introducing a bill that would restrict the use and

approval of antibiotics on livestock. this event is almost three hours. >> the rules committee will please come to order. i want to thank all of you for coming today and i want to introduce my panel members. out like you to make congress woman from north carolina who has enormous interest in agriculture subject and also a freshman this year from maine who has a wonderful background in the common cause and members of the other said she held up. we were hoping for some other members who may or may not show up but in any case we're delighted to have you here my name is louis slaughter, i represent the 28th congressional district of new york's pierre and. i think this is a critically important issue as a microbiologist. i can't stress enough the

absolutely making sure our current stock of antibiotics is not becoming obsolete. every year 2 million americans acquire bacterial infections during a hospital stay. a 70% of their intentions will be resistant to drugs commonly used to treat them, 70 percent. as a result everyday 30 patients and hospitals and die of those infections. sadly children and infants are particularly susceptible to infections caused by antibiotics resistant bacteria. for example, salmonella causes 1.4 million ellis is every year. and over one third of all diagnosis occur in children under the age of 10 additionally infants under the age of one are 10 times more likely than the general population to acquire salmonella infection. in 1995, 19 percent of

salmonella strains were found to be a multi drug-resistant. that means their children are left to undergo multiple achievements for otherwise simple infections because we have a lot of the traditional treatments to become ineffective. the cost of these infections and the ineffective treatment to our already strained health care system is astronomical. in fact, resistant bacterial infections, increase health care costs by 4 billion to $5 billion each year. currently seven glasses of antibiotics certified by the food and drug administration highly are critically important in human medicine are used in agriculture as animal feed additives and among them are penicillin, this class of

antibiotics are among those critically important in our arsenal of defense against potentially fatal human disease. penicillin, for example used to treat infections and strep throat to meningitis others used to prevent secondary patients with aids entry mnemonic in hiv-infected patients. tetracycline is used to treat people potentially exposed to anthrax. but despite their importance to human medicine, the drugs are added to animal feed as growth performance and for routine disease prevention and otherwise these are not animals that are ill. this is the most nagging number of all. 70 percent on the antibiotics and related drugs produced in the united states, 70 percent are given to cattle, pigs and chickens to promote growth, and compensate for a crowded,

unsanitary and stressful conditions. and then on therapeutic use of antibiotics skyrocketed from 10,000 tons in 1985 to 10.5 million pounds in the late 90's. this 10 habitual non therapeutic use of a antibiotics and has been conclusively link to a growing number of incidents of antimicrobial in resistant infections in humans and may be contaminated groundwater with resistant bacteria and rural areas. in fact, the national academy of sciences reports that a decrease in antimicrobial use in human medicine alone will have little affect on the current situation. substantial efforts must be made to decrease inappropriate over use in animals and agriculture as well. resistant bacteria can be transferred from animals to humans in several ways. perhaps most glaringly

antibiotic resistant bacteria can be found in meat and poultry that we purchase every day they found a 20% of the made sample was contaminated with salmonella and 84 percent of those bacteria and salmonella or resistant to antibiotics used in human medicine and animal agriculture. i tear can also be transferred from animals to humans the worker and livestock industry to handle animals, feed and menorah. farmers may then transfer the bacteria to their families. a third method is by of the environment. nearly 2 trillion tons of a menorah generated in the u.s. contaminate our groundwater come our service water and soil. because of this contains resistant bacteria it can be passed on to humans that come in contact with the water or soil

and the problem has been well documented. a 2002 analysis of more than 500 scientific articles published in the journal of clinical infectious diseases found that many lines of evidence lead to a antimicrobial resistance human infections to foodborne pathogen of animal origin. and the institute of medicine 2003 report on microbial threats to health concluded clearly a decrease in the inappropriate use of anti microbial some human medicine alone is not enough. substantial efforts must be made to decrease the inappropriate over use in animals and agriculture as well. and as the impact of mrsa which is one thing i point out if you don't believe in evolution just think of what has happened with staphylococcus aureus which is now become mrsa. there is no day that in a byronic diseases are becoming

health minister many high priority response. despite increased tension to the issue response has been inadequate. part of the problem is been the fda failure to properly address to the effect of the misuse of the antibiotics and efficacy of human use. and although the fda can withdraw its approval for these antibiotics, is record of what reviewing currently approved drugs in the current procedures in the case would take nearly a century to get these medical imports antibiotics out of the seated into human -- and in october 2000 for example, the fda began consideration of a proposal to withdraw its approval for therapeutic use of antibiotics and poultry. and there a few an eventual withdrawal of approval to provide the five years to complete on its current regulation of the fda must review each class of antibiotics separately. the legislation we are here to

discuss today we face of the use just of the seven classis of a medically significant antibiotics that are currently approved for non therapeutic use in animal agriculture. ming no mistake in this bill would in no way infringe upon the use of these drugs to treat a sick animal. it is simply prescribed non therapeutic use. when we go to the grocery store and pick up dinner, we should be able to buy food without worrying that eating it would expose our family to potentially deadly bacteria that will no longer respond to our medical treatment. unless we act now we will unwittingly be permitting animals to serve an incubator for resistant bacteria. and it is time for congress to stand with the scientists, who, the american medical association, and the national academy of scientists and do something to address the spread of resistant bacteria. we cannot afford it as i said

from medicines to become obsolete. i thank you for coming in and look for to working with all of you and other members of this committee to enact this bill to protect the integrity of antibiotics and the help of all american families. miss matsui can i think every much madam chairman and i commend you for calling today's hearing and working so diligently on an important issue your expectation of subject matter is beyond question. the congress is forced to have sown with their experience and knowledge working on a topic of into microbial resistance. during today's hearing adelstein to represent two different perspectives. one as a member of congress and one as a daughter of a farmer. on the one hand, and serving on the energy and commerce committee as we are tackling health care reform. in his capacity i have studied it -- i have come face-to-face with the immense challenges our country's out of control health

care cost. our health care system is broken in our economy is really at our budget is out of sync because health care costs go up and up and up and never come down. according to the national academies of science health care in this country is about $4 billion more expensive every year because the drug-resistant bacteria. here at the house of representatives would have spent months trying to figure out how to reform our health care delivery system so that reduces costs to efficiency and innovation. a but one of the easier and most effective ways to drive down costs is to ensure that people do not get sick in the first place. finally into microbial resistance is a key component of this kind of population wide prevention strategy and you have demonstrated in madam chairman present leadership bonnet. you're bill, the preservation of antibiotics for a medical team in act is a critical piece of public health legislation this

fda is clear statutory direction to take aggressive action against this resistance. once it does so, it people lobate hospitalized by diarrhea, staph infections and food poisoning. on average every hospital stay calls by drug-resistant bacteria causes 6,000 to $10,000 extra pair and we are talking about billions of dollars that way to save our health care system. we're talking about untold numbers of lives which should be the emphasis for us to act on this legislation as soon as possible. and i will urge my energy and commerce committee colleagues to do so. i grew up also as a farmer's daughter in the california central valley and i know the kind of efforts it takes to make a farm in productive business. my father worked harder than anyone i've ever seen, but he tried to do so in a way that was environmentally sustainable even at a time he was farming.

which was over the last 30 years or so, he passed away about 10 years ago. he did this because it was the right thing to do and also because it was good business. today just like back when i was a little girl, people in america want affordable food that comes from natural sources. they do not want artificial or factory farm to me to. especially if that may pose a serious public health threats. the facts are clear -- animals fed this antimicrobial drugs on a daily basis are serious public health risk. farmers and ranches of this country bedrock. they should be our strength and not our vulnerability. i am convinced that american farmers and ranchers can be successful raising high-quality natural livestock. they can do so in a way that does not breed a super bug that is showing up in our hospitals and emergency rooms or frequently every day. in the preservation of antibiotics for medical

treatment act will help us reach goals we all share. it will drive down health care costs, it will encourage more ranchers to use animal husbandry practices that we already know work. and it will give american consumers' confidence that the foods they daresay if and do not come with a price of endangering public health. i look forward to working with the people testifying today and during their testimony. thank you madam chairman. >> thank you, we are joined by congressman jerry poll of colorado. >> thank you very much, madam chairman derrin i really appreciate the of the city to participate in this open and variable and hearing. as before a senate, your professional tennis and microbiology mesa the privet advocate on this critical issue and a valuable asset to our colleagues in congress. thank you for your tireless dedication to protecting our nation's health and well-being.

i am delighted that we have the opportunity to be here today in the committee to hear testimony on the support issue. we have spent so much time on a regular basis listening to other committee bills i sincerely look for to hear more about this bill today hearing from our witnesses. this bill the preservation of antibiotics for medical treatment act would mark a critical step toward in the fight to protect our nation's food supply americans have become so disconnected what their source of food and also fearful and frustrated about what is said. they really participate in the process of growing produce are raising livestock instead trusting that the food they buy other local grocery store is safe for their families. sadly enough that all too often this is simply not the case. experts agree the antibiotic resistance is a growing problem in this country as we've already heard and it is taking its toll on our health and on our pocketbooks. we spend more than $4 billion each year combating the spread of new and deadly strains of bacteria and we have lost countless lives in the process.

this can be contributed in large part as we vartan her to the overuse and misuse of a antibiotics as non therapeutic feed supplements for animals that are not sick. we cannot undo what has already been done by restricting the use of antibiotics to people and animals that are truly sick we can make sure that future generations have access to a safe food supply and effective antibiotic therapy this issue affects all of us. as consumers, parents and grandparents we have a right to know what is being put into our food and we deserve a government that invests in and resources and protecting our health. mber of congress but as myself a former organic farmer. and matsui is the daughter of a farmer, i'm a granddaughter of a farmer but i took@@@@@ @ @ @ @å

situation that they're in. i complained to be involved in the organic food movement in our state. i know the griese dairy farmers in our state are those that are selling milk. some are because consumers want to know what is in their food. we face a time of unpre facing a time of unprecedented challenges perhaps none more important and reforming our health system we are considering hundreds of different ways to cut costs and deliver effective care we must not forget the regulation

of antibiotic use has the potential to save billions of dollars every year and protect americans from unnecessary suffering from resistance of aggressive strains of bacteria per gram want to thank the chairman for holding this hearing, the witnesses to take the time to be here and i look forward to hearing from each of you. >> i yield back. >> thank you madam chair i am proud to be a co-sponsor of h.r. 1549 and the like to think congresswoman slaughter for bringing this forward. to put a human face on some of the issues of antibiotic resistant bacteria in my eight district of boulder colorado when dr. eric cornell teaching at the university of colorado a couple years ago unrelated to his werke had an affection of the antibiotic resistant bacteria on his arm. i had to amputate his arm for he now has one are because of

the fast-growing antibiotic resistant bacteria. several people at the university of colorado have contracted this beyond the public health threat the pivotal has been felt in our own congressional district right here lot about these issues my partner is a began and he is constantly critical of our animal husbandry practices with commercial agriculture in this country beyond the public-health arguments are like to add two additional considerations why this bill is important and these efforts are important. one has to do with the treatment of animals themselves and the second diverges from that. if you look at why people are seeking to use a non therapeutic use of antibiotics is it is so they can crowd animals closer together and

raise them in conditions which would not necessarily be healthy for those animals. that leads to stress and unhealthy conditions which can directly indeed well beyond the direct public-health negative outcome to simply have a poor nutritional profile and deteriorating health and nutrition for the need for human consumption due to stress of the animal caused by overcrowding which has been unable to buy the non therapeutic use of antibiotics. my district is also home to the holding company of horizon dairy the palm 24 moen three melt which together control i believe over 70 percent of the market share for those products. and again i think the consumer is rising up they have had a

from a regulatory perspective of people are realizing that to have residual antibiotic content and no bourse ticker leave for children is not only a public health threat but a personal health threat that can lead to resistant bacteria for their children. and for these reasons i support the bill and look forward to hearing the testimony today. >> [inaudible] u.s. food and drug administration i am happy to say we have beefed up that budget considerably so you can do your job better this afternoon but we're delighted

to have you hear. >> i am pleased to be here. it does not look like i have to push anything. madame chairwoman and members of the committee i am a doctor joshua sharfstein with the fda the department of public and human services and also a pediatrician and until recently a couple months ago the health commissioner of baltimore city. thank you for the opportunity to discuss the important health issue of antibiotic use in animals. i will provide background of permission on antimicrobial resistance with the agency you task force on anti-moat parochial resistance and the use of antimicrobial and annals to describe the work with nine it therapeutic use of the antimicrobial use in

animals and i will also make several comments. antimicrobial agents have been used in federal dairy maids and medicine for more than 50 years there are tremendous benefits many infections that were fatal or left individuals with severe disabilities are now treatable rollback terrie is adept at but it missed use of these drugs it contributes rapid development of resistance but after several decades of antimicrobial use we're seeing the emergence of multi drug-resistant pathogens which is reese left responsive to their be oftentimes the infection is more likely to cause problems and cause staff of action antimicrobial resistance left the combined impact of the microbial drug in considering the use in

humans and animals and as the health commissioner in baltimore a major public health issue that we faced i will mention that one of the last things that i did was report from the rand corporation about from 2000 through 2006 associated hospitalizations increase by 74% which was an extra 1,000 hospitalizations per year in the city of baltimore. as of today microbial resistance mechanisms have been reported for all antibacterial drugs that are currently available for clinical use in human and veterinary medicine. isolated strains are having multi bacterial agencies. the last decade there has been a significant increase in resistance to drugs with foodborne eight organisms including sam elah.

-- salmonella. there is no [inaudible] there is at the resistance traded in 1999 to have a plan to combat the antimicrobial resistance. the fda co-chair the task force with the national institute of health. this interagency group together an action plan to highlight the plan that includes surveillance to gather information for the emergence and spread of resistant microbes prevention and control including educational campaigns in the development of new therapeutic vaccines, research including a research agenda with microbial research assistance for a cause by the national institutes of health and product development as it antimicrobial drugs lose their effectiveness new drugs must

be made to prevent infections. those action items include developing new drugs and diagnostics and vaccines and the development of primary products which market incentives are in added by. i am here on behalf of the fda the commissioner is out of the country otherwise i am sure she would be here. this is an issue a personal interest the institute of medicine report she was one of the editors of that prior to coming to the fda. working with the staff of better dairy medicine the doctor and i strongly support action and to eliminate the unnecessary use of antibiotics to protect the public health of our four prominent labeled of the antimicrobial with deficiency, prevention, contro l, the vast majority of antimicrobial use in animal agriculture have been important in human medicine a

few antimicrobial of drugs that are used in animals do not appear to impact human medicine at this time although there are concerns if you use a medicine even if there is no human analog it could develop resistance that could cross over to the human drug. protecting human health requires judicious use of animal agriculture and the antimicrobial of human medicine to protect patients from the spread of antibiotic resistant bacteria from the food supply of humans per call i want to review how these principles apply. the first is growth promotion and the deficiency increasing evidence is shown that use of antibiotics contribute to the hybrid of resistant bacteria burger to avoid the unnecessary development of

resistance which are conditions of constant exposure such as deficiency antibiotic the use of antimicrobial should be limited to those situations where human and animal health protected. purposes other to the advancement of animal or human health should not be considered judicious use program davies will not compromise the safety of food. efta looks at using the end of fdi products for growth promotion for feed products and united states. by to talk of prevention and control the fda believes there is some indications unnecessary injudicious to receive animal suffering and death. important factors in determining whether prevention is inappropriate days shipper pri evidence of such a preventive use is consistent with accepted better year practice, evidence the use is linked to a specific agent for

bacteria the evidence is appropriately targeted, evidence of a reasonable alternative for intervention exist. to promote the judicious use, the fda believes all use of medically important medications should be under the provision of eight veterinarian. finally i would like to mention briefly treatments. the f.d.a. supports the treatment of the zero animals according to veterinary practice with the better and gary kline and patient relationship. the use of antimicrobial in an animal agriculture requires a strong commitment to research including monitoring, studying the ideologies of the causes, the use of antimicrobial in agriculture and assessing risk in difference settings and by riding strategies to support science based risk-management policy. and a brief mention some of the things going on an fda

with respect to antimicrobial drug and seattle. first of the risk assessment methodology guidance 152 during the new animal drug evaluation progress to quantify the use of antimicrobial in animals. it conducts research to understand the resistance and what regulatory decisions to reach out to all stakeholders on all sides or to assess the information and between the human health consequences using the national antimicrobial monitoring system broke it ceased to take advantage of the expertise and resources of a large number of federal agencies and it will provide regulatory officials with critical affirmation about resistance and bacteria. finally as 58 purchase base and international dialogue in antimicrobial with animals.

let me just mention several comments on and hr 1549a supports the idea to phase out the growth promotion use of antimicrobial and animals. no question that the process of withdrawing new animals is firm from the agency the fda recommends any proposed legislation facilitates the time removal of nine judicious use of drugs in producing animals and will be happy to provide technical assistance on the details part of the same time of the nablus legislation should have limited judicious use of antimicrobial and animals for prevention and control as previously discussed. to conclude antimicrobial resistance is an important issue for children as it is the pediatricians and the public as it is for public

health directors and industry and consumer as it is for the fda will look forward to working with congress on this important issue. thank you for the opportunity to testify. >> jiggy for being here. we're delighted to have you. >> great henry waxman, the removal for a the removal of antibiotic from the animal feed in my statement what would you consider time the removal? >> i think one from the growth promotion feed it deficiency uses a much shorter time period in one century but for the ability to accomplish that without having to expend a

tremendous amount of resources in the process of time and money. there are mechanisms to accomplish that we don't want to be in a situation where we have bottled up in the scientist that congress could legislate the. >> you're a pediatrician i am sure you would not recommend giving a nursery class of three year-old's and antibiotic every day if they have an erection so obviously would not recommend it or animals does the fda control that? >> the fda controls a label for how it would be used with animals. >> you can prevent it? of the legislation were passed? >> it would be under us. >> that is good to know. and one of the things we're concerned about is the

conditions under which these animals live. i noted as part of the background there was banned ninth antibiotic use it was found of no significance in 1998 and i think that is important but after the band course bandying and fireman's with husbandry with the ventilation and productivity was not affected at all. and i am sure most of us who consume i am sure all of us hope that they are raised and clean and help the conditions of the we know better. we're coming up pretty soon and we will talk to you again of other things you might want and they're thank you for being here your testimony is important and we look forward to working with you to make this a reality.

thank you so much. >> prevention of disease whether animals or humans are high priority it occurs on many days it makes sense on different levels i work hard to make prevention a key element of that congress push on health care reform and i support the chairman legislation because it does not limit the ability of medicine to be used rationally. and prevention is just a word. if we create more harm in the name of preventing minor one's. dr. joshua sharfstein in your testimony i found a very compelling because it really does tread a fine line between the preventative diseases and the annual population grew redo ourselves more harm the process.

in your testimony outlined how prevention can sometimes make things worse as in the case of using antimicrobial to five respiratory infections. please elaborate on how dangerous it can be for animal producers to assume 2. with antibiotics eight can be counterproductive to humans and animals. >> i think prevention is obviously an area that needs a lot of attention how to craft policy rather by legislation regulation i think clearly there are situations where you can prevent illness by giving medicine. for example, and baltimore as the health commissioner we had a case of meningitis we would give medicine to all the people who were in close

contact. we had a teacher who had a case and we tracked down all of the kids they were not sick but we give them medication. in that case, and pediatrics for example, there is strong evidence for the use of medicine in that situation other than those or left to be sick to understand we were treating with the bacteria and you're using and medicine that is targeted for that bacteria. the context for prevention and is in animals as well there'll be times when prevention is important but the decision on where that is permitted to be based on science, understanding of what you are trying to prevent, the evidence is there the fact there is no reasonable alternative and we want to use antibiotics and children or in animals but when we are going to use medicine is to be based on a solid foundation of

evidence. trying to set up a mechanism for that is challenging but i think as we go through when you set a time just like in pediatrics, this antibiotic is appropriate for this one is not. >> so you are looking at situations where it will be difficult to have a working definition? is that right? >> one of the things that has to be worked out. in the bill it says routine prevention and how do you define that? that is somewhere in there that is the kind of thing the agency hot like fda has done before and can do we can talk about the principles that would go into a determination like that how you would assess that but i agree completely this does not make it based on evidence or appropriate to use. >> that is you're working definition how we might move

forward? >> these are some principles by don't think it is so much a working definition i would not go that far but there are principles to look at to make sure we're limiting what is appropriate prevention to what is based on the science and supported by veterinarians. >> you believe current agriculture practice does not meet your sense of principles right now? >> there are two things. first of all, the growth promotion and if the deficiency has taken a position it should not be used and i have been struck as i learn about this issue how much we really understand and it is high priority for the doctor and die to get a better understanding of that it is one thing for fda to have the rules but we need to know it is actually being followed and see the use of antibiotics as coming down. >> that is a welcome change.

>> absolutely. on the fda website there is the judicious use principles endorsed by the american veterinarian medical association for at antimicrobial drugs one of these is other therapeutic options should we consider to antimicrobial there p.? is seems a full range of other options has not been considered by ranchers. do you agree more can be done within the industry to use alternative methods to achieve the same end of keeping animals safe? >> i don't know if i could give you an answer to that i am not an expert on the types but i do believe that analysis should be undertaken. if that is the case there

alternatives. >> then there is another judicious use principle to minimize environmental contamination with antimicrobial whenever possible value clarify what this means? >>doesn't mean not to let antimicrobial get into the water supply or vegetable fields? is that what we are talking about? >> that is a good question but i cannot answer that. i don't know what the veteran barry administration and means we are concerned about the environmental impact of not just animals and that is an issue we would want to engage john. -- on. we have written a letter to the attorney general about

antibiotics and we are looking at that. there's an environmental issue that needs to be aware of there is something we can do but i could not exactly the five -- the fine that because of the impact of environmental harm. >> thank you madam chair for your testimony that was very interesting. that adds to the dimensions of what we're talking about today i want to follow-up on what you were talking about. in your recommendation or potential recommendation when you talked about continued therapeutic use, i just want to clarify, i think we'll generally no this is widespread use without significant changes in the way that animals are raised come with the idea of infections

and outbreaks could easily continue at the rate they do now percolate and try to understand when you mentioned the criteria for not allowing research that shows evidence of the effectiveness and has research already been done that shows it is effective -- effective for preventing outbreaks? >> that is something we want to determine. maybe people use antibiotics not knowing what they are treating but in the realm of the growth promtion feed deficiency is to be be prevented but what disease? have you looked at other ways it to do a better reasonable first cracks of course, that goes into the assessment first. i could not in fact, with

pediatrics you know, you should be treating and should not. there's a huge campaign among pediatricians i called one of my old teachers and he said he did research that antibiotics have to a brought it down by 30% that is partly because of the government efforts and it is true the coming down from what pediatricians prescribe. what we like to see is something like that in animals although that is not seen as a key point* or at least clear looking at it what is the evidence unless uses of antibiotic prevention in

animals? in the pediatric field of medicine it has got to be that if the fda will put a label on a particular use it. >> it seems like extremely important i want to be sure that if you were allowed to therapeutic use or a broad description we did not stay with the status quo because the example you gave of said teacher was a very good example is about an outbreak of disease providing but we're talking about is a routine use it is a constant use of the medication. i would not want to see that the call therapeutic are necessary use. >> that is one of the reasons i am here. >> we will be joined by congressmen cardoza from california. >> thank you for your

testimony. when you say there should be zero or there should be a different definition between it therapeutic and on therapeutic use is that apply to animals or is the same definition to apply to humans and animals? >> as i am thinking i cannot think of the use of antibiotics in humans level of i can think of other times but i don't