>> began doing intensive oral history interviews of individual administrations under the leadership of my senior colleague, jim young, and the aftermath in the jimmy carter presidency in the early 1980s. and since that time, we've done authoritative interview projects on presidents carter, reagan, george h.w. bush, clinton and we're looking forward at some future date to beginning work on president george w. bush.

we have in past years conducted two similar symposium to the one like we organized here done. one on the white house congressional relations operation and on the on presidential speech-writing. there's two great vir to yous beyond what we typically do on individual administrations. the first is that this is an opportunity for those of you across administrations to sit together at a time and reminisce about the kinds of experiences and lessons that you came by during your years in the white house. and although we feel there are important things that scholars can learn from our individual interviews, it is equally true, as we've discovered over typically, there's great virtue of people serving in several democratic issues to have people talk about these issues. that's the one great difference

the ability to cross-fertilize ideas. the second major difference is that when we do individual interviews as a part of our presidential historical work they are done under a veil of confidentiality and many of these interviews are held on to for a long period of years and unaccessible for scholars, and students of american politics. the second great virtue of doing this kind of work is that we're able to do this in an open forum. the proceedings are being simulcast on the website and it was help people on the kinds of questions we will be asking today. the great vir to yous are that we have multiple administration experiences and we can do this in a way that allows us to inform public debate now.

although i was one of the principals for organizing the event, it's a great pleasure that i turn over most of the activities to my colleague, michael nelson. professional nelson holds a faculty position at rhodes college but a nonresident fellow at the center and has worked on multiple interviewers and have proved himself to be a splendid interviewer as well as teacher and author. i recall having seen on a website within the last year or so a list of the top 15 academic publications used in courses on the presidency in the united states and if my recollection is right, those top volumes are edited by you and we're happy to have your experience at the table and i'm delighted to have

you as the moderator for the proceedings. thank you all for being here. >> thank you, russell. we're enormously pleased to have this gathering here in the room and also through the miller center's website and through c-span, the larger audience, of people interested in public affairs. this is gathering similar it one that we had last year which was also broadcast on c-span that brought together former white house together, last year's speechwriters, people from the domestic policy office, along with scholars who have studied what they do and what their institutions have done over the years to simply talk about what identities like working on domestic policy in the white house. and as russell has pointed out we have people through the nixon administration through the second bush administration. so there are four sessions all together. this is one of them. and look at c-span, look at the miller center website to see when the others will be available.

but our theme for the next 90 minutes is, what happens in the transition from campaigning for president, making a number of promises and pledges responding to a variety of questions regarding domestic policy issues and after winning the election and then becoming president and to somehow take into account what you've said during the campaign with what you actually can do, need to do, are pressured to do as president. and what a distinguished group of former white house domestic policy people we have here to help us do that. i'm going to introduce first burt carp, who worked not only for president jimmy carter as deputy assistant for domestic affairs but also as legislative counsel prior to that with senator walter mondale who, of

course, vice president in the carter administration. burt carp, after years working in the cable television industry in one important capacity or another is currently vice chairman of the firm of williams & jensen. the second person i'm going to introduce is not here yet but who will be joining us en route from london during this 90-minute program. and that is stewart issenstat also a part of the carter administration, later part the clinton administration. he was domestic policy advisor to president carter for the entirety in his office. and he served in clinton administration as u.s. ambassador to the european union as well as in other capacities. recently, he's been working in the area of holocaust-area issues, restitutions and so on. and has written a very well received book on that subject

called "imperfect justice: looted assets, slave labor and the unfinished business of world war ii." the third member of our panel up here who will be participating in the discussion during this session is bruce reed. bruce reed currently president of the domestic -- democratic leadership council, famously served al gore as chief speechwriter when gore was in the senate from 1985 to 1989. became a part of the clinton/gore campaign in 1992, serving as deputy campaign manager for policy, and then for eight years of clinton's presidency, serving as domestic policy advisor or close to domestic policy advisor during the first term and particularly associated with the clinton reforms in the area of welfare reform. and then finally and finally republican in this group today, margaret spellings in terms of

this conference, part of her service that's of greatest relevance is that she was bruce reed's successor, if you will, in the george w. bush white house a domestic policy advisor during the first time later, of course, went on to be appointed and customed as secretary of education and in both jobs involve very closely in the development and the enactment and the implementation of a no child left behind act. now, at this point, i'm going to turn things over to the gentleman to my immediate right who's going to conduct the discussion. and that is my great friend and colleague, andrew bush. this is a homecoming of sorts for andy. he got his doctorate in government from the university of virginia but he's gone on to do great things, enviable things from the standpoint of an admiring peer. currently professor of government and associate dean of

the faculty. his sentence as an administrator ends at one month he tells me and the author of 11 very well received books most recently "epic journey: the elections of 2008 and american politics" as well as his mentor and claremont mckenna college, jack pitney. it has nothing to do with the subject of this conference but it's a wonderful book. and that will cost you $1,000 for that book. so andy bush, it's your time to shine. all right. thank you, mike and thank you russell and thank you all for coming. it's a real pleasure to be here. the theme of this particular panel is moving from campaigning to governing in domestic policy. and this could be thought of narrowly that is just as the transition period from election day to inauguration day but i think it makes much more sense

to think about this more broadly. more in terms of the question what the campaign talks about in the policy after january 20th. and more generally, how does the campaign affect domestic policy after january 20th? so i'm going to ask a few general questions. there may be some specific follow-ups to the individuals who are the main participants and then about halfway through we'll open it up to anybody else at the table. and that's how we'll proceed with this. just by way of very brief introductory comments. there seems to be several things to think about. one of them what sort of context is established for domestic policy by the campaign in a general way. the second is, how does campaign rhetoric about domestic policy

translate about the sorts of thing does as president. and what continuities are there rhetorically when it talks about domestic policy. the third thing is appointments. how does commitment to the president's campaign agenda translate into appointments in the domestic realm and what other factors come in? and then there's the policymaking themselves in terms of the executive orders and the legislative agenda particularly in terms of how -- how you go about targeting the first executive orders setting the legislative priorities originally to try to fulfill the campaign agenda and what other -- what other sorts of things get crowded in that maybe moved the campaign agenda out of the picture? over that process. so starting with the general context, i guess my first

question is just, during the transition and early stages of the presidency, to what extent were policy discussions influenced by the president's domestic policy commitments during the campaign and what other sorts of factors came in to maybe disrupt some of that focus? and that's just a general question to the people at the head of the table? >> i'll jump in. well, in our -- in clinton's experience, we treated the campaign -- the campaign promises as gospel. that was the only scripture to guide us. he loved all aspects but he loved the policy part of it best and his view was running for president was the ultimate job interview, and that the agenda he laid out represented the terms of his contract.

now, when we got to washington, that's not necessarily how the congress regarded it and even some in our own party had followed the campaign closely and listened to what he said but weren't necessarily convinced that every promise was a good idea. so there was an enormous amount of back and forth, and a lot of pressure from people who weren't part of our party to edit the campaign promises but from clinton's standpoint, he always felt that that was the way he should keep score. and for those of us who had been on the campaign, and i'm sure margaret had the same experience, that was our strongest weapon internal debates within the administration and in the debates with congress was to be able to say, this is what the president promised. we have to keep this promise.

and that's a hard thing for the president's allies to dismiss. >> i absolutely concur. i still travel with my renewing america's purpose july '99/'00. it informed the second campaign as well and i think bush did -- really had a very dense policy agenda with lots of specifics, more so than had been the practice at least in our party particularly to the extent that he had talked about things about being a different kind of republican that, you know, not everybody on my side of the aisle was wildly enthusiastic about. literally a different kind of republican, conservatism, immigration, education, faith-based initiatives, all those sorts of things that had a good bit of an edge to it and that's why not only did they inform our first work but they -- you know, we knew that

we had to get them done quickly and when i see president obama tackling healthcare right away, i see a lot of the similarities that his popularity is as high as it's ever going to be. likewise, i assume that's the case generically but some of the scholars would know better. that's the time to do the things that are maybe the most difficult to do. we lived by it, absolutely. to the extent that there were specifics and it lays out a series of principles, ideas or a core philosophy or orthodoxy which i believe the president's did it had a guiding effect into multiple iterations. so those key stones continued to inform our point of view throughout the administration. >> i'll never forget being picked during the transition by someone who was clearly an enemy to present --

[laughter] >> to present to president carter a case for an incremental case for welfare reform. this meeting did not go well. [laughter] >> and i think -- i think -- you know, presidents are campaigners, it's a huge effort and a huge labor and what nobody else are listening and these guys are very much listening to what they have said. and when they said them for over two years, they believed them. we had a notebook that was personally edited by the president and it was full of campaign promises. it was absolutely sacrosanct. at the same time, carter was more, i think, even than those who found him a kind of insurgent candidate. i worked in the senate.

he wasn't our candidate. and he ran against washington, and he believed that, too. and he had a very, very difficult time, i think, making his agenda fit with their agenda. it never did really work how the if i could say one more thing, i think he did a tremendous favor to his successors. we had a failure of leadership to some extent and a failure of followership. we lost a ton of senate seats when we lost in 1980 that nobody ever thought would leave. nelson, george mcgovern who thought they were not in trouble and if things didn't work out for their president, that they just not work out for them. and so i think there's been ever since then much more of a driven

effort to work these things out because there's a fear factor there that i think was not there until that unpleasant experience. >> okay. so it's a given, i think, you come in, you do your best to pursue the plan that's put out in the president's campaign. obviously, cases are going to arise from time to time when that's not possible. either you have to back off or sometimes in some cases even back-track and reverse yourself. when those discussions came, what kind of problem was there that it was a campaign commitment other than those problems that would arise from that policy? was that a central -- >> well, i think -- i mean, my experience is that it varied by degree, okay?

so if it was -- particularly, as those who worked in a campaign setting, though, i always thought about things that were our must-haves and things that weren't nice to have. on the must-haves, i knew, the president knew because they were created around a set of ideas, principles, believes, whatever, what those were and what was -- you know, up for grabs. and i think those are the things -- there's actually two score cards. there's the score card, you know, what is so integral to the president and for one example, no child left behind, annual assessment. all the stuff we stole from the d.o.c. [laughter] >> just kidding. that's how we got 87 votes for it, though, i'll say that in the senate. and the things that were, you know -- were less important and ultimately did go by the wayside. and those fall by the wayside because various ensuing events

like 9/11, because of budget issues and on and on and on. there's actually two groups of issues in this kind of context. >> and i think those of us in the white house are not the only ones paying attention, obviously. you know, the day we took office, "the washington post" ran a full page list of every major promise that we had made. i put it up on my wall, as margaret suggested, i had a separate list of the ones that were i thought essential. but every -- even in the transition, before we took office, when there was a hint that we were going to deviate in any possible way, it was front page news. and, in fact, i can remember people who had not been on the campaign leaking that we were going to break a campaign promise long before a decision

had been made to practice a campaign promise because they thought it would increase their leverage. part-time we took office we already had a reputation for breaking some of these campaign promises that in the end that we did not break. i think the -- the biggest new piece of information that bill clinton inherited was a dramatic downturn in the revenues coming in. they were coming in at the tail end of a recession and so the deficit turned out -- the deficit inherited turned out to be a lot larger when he anticipated when he got in the campaign and that forced him to -- in order to keep the campaign promises he made, it forced him to propose a bunch of painful cuts that he wouldn't otherwise have done. he was actually not bummed out

by this at all. he thought -- when we first told him we were all terrified about breaking the bad news, or the country had half as much money as we anticipated, but he thought that it would be an interesting challenge trying to balance the federal budget and keep his campaign promises at the same time. and it actually, i think, was a -- you know, a disciplined forcing mechanism. it made it easier to prioritize which campaign promises really mattered. >> can i ask burt carp and then the others. during the campaign, you're talking about what you hope to do as president in the present tense. in other words, when i was elected here's what i want to do. you got four years. is there a process by which you try to educate voters that even though we're not going to try to keep every promise the first year, that it is a four-year

term? that we have a sense of order in which we intend to proceed and it will get to everything? having not preached patience it, seeming like now in office you've together preach patience and how do you do that and how well does it work? burt? >> well, i think most presidents are in a big hurry to get to things that they most care about up there. i mean, partly because we all believe people are -- have more clout at the beginning. but one thing i want to say is, a tendency that i certainly look back on with some regret about our tenure is we tend to have big ideas in political campaigns and we submit these big ideas and sometimes when the big idea isn't adopted, you know, you when the comprehensive welfare reform isn't adopted, or we just move past it. it's like riding a horse anyway. and there's not that tendency to

stay with the thing and if you can't get the big thing to get -- to put some building blocks together and so we tend -- when those things don'twork out, we tend to leave these ruins behind. [laughter] >> that discourage other travelers, i don't want to go there. so i think that's -- that's the bad things because you become so dedicated to your campaign idea and somebody else has smaller ideas and you've dashed those smaller ideas and you've gotten elected and i think that's too bad. and it wastes a lot of expertise that's built up on congressional committees and among people in the administrations when they just -- you know, just -- when you saddle up and ride down the hill. >> i want to add for a second. i agree with that in part. i think we -- that was our experience with immigration. i mean, one of my great, you know, disappointments is how --

that we have left the place worst than we found it with respect to immigration and the democrats are going to end up passing president bush's and ted kennedy's immigration plan. that notwithstanding, i do think there are places where you move on and then there are places where you say, okay, not a piece of legislation but executive orders, regulatory, you know, process issues, commissions, various other ways to scratch the policy itches. in those pronouncements that we lay out in campaigns it doesn't always say we're going to pass a bill that does this or that. so there are other ways to scratch the itches and i think that's part of the game plan that you have to consider. >> can you think an example doing that, for example, or commission instead of seeking a law? >> well, and i think to the extent the patienceo deal that's why i raise it in this context. so i'm thinking about postal

reform. you know the postal union -- or the post office was in bad shape. we needed legislation. it was overdue for reauthorization. we need some build some ideas the president appointed a commission. it did its work and we needed all that leadup for all the people who cared most desperately about postal reform, we got this commission over here and well get to you. >> there's the need to take the long view because you can accomplish -- as long as you hold onto the job you can accomplish a lot of over a long period of time. we were able to double education funding over an eight-year period even though we were making kind of incremental shaping. particularly, for your own

supporters who have been waiting a long time for you to get in power, saying to them when you come interest office, well, don't worry. we're not going to double funding in the first year. it's going to take us four years or eight years, that's a tough message for them. but i think in washington, it's as important to preach impatience. you've got an entire congress that is counseling patients particularly on the things that you want to do that may want to do. i could remember after -- after clinton took office, the congressional leadership met with him and said, well, we know that you said we should cut our staffs but we don't to. and we know you want to reform the campaign finance laws and the lobbying laws but really you can't do that because if you do campaign finance reform, that's taking away our current jobs and if you do lobbying reforms that's taking away our next

jobs. [laughter] >> clinton deferred to them on their staffs but end up pressing and lobbying reform anyway. the country is willing to be -- the country doesn't expect that much. but i think -- the key is for a president in the white house to recognize which issues are better dealt with one step at a time? and which issues do you have to kind of go along on first down otherwise our not going to have a chance? >> this brings up, obviously, the importance of what the message is, the talk that goes on about domestic policy. and so my next question is, were there -- i guess, out of all of the areas of domestic policy,

what were the areas where the presidents message or his rhetorical content remained more or less the same. and was there a significant difference between how he had to talk about something while governing versus how he had to talk about something when he was running for president? >> well, i can give you an example of presidential rhetoric that was treated as sacrosanct in the administration of what it meant. bill clinton -- one of the central promises of his '92 campaign was to end welfare as we know it and he laid out in some specific terms what that meant. that everybody who was able to work had to go to work, and that they had to do so within two years. this was going against the grain

of his party, not a promise that washington wanted it get to any time son. -- soon. and so there was a lengthy internal debate about what did it mean to end welfare? and if just did this in a couple of states would that count? if we let people stay on welfare forever, would that count? but what was interesting about it was in part because the phrase itself was so ambitious. it was very difficult to walk back from that promise. it would have been difficult i p'd there were -- i remember e welfare -- the welfare commissioner from connecticut actually printed out the acnism and welfare as we know it and

posted this every welfare office and tried to instill in her workers that promise even before we'd figured out exactly how to keep it. >> well, i think, you know, 9/11, of course, you know, introduced a set of circumstances that, you know, obviously, you know, had the effect of recalibrating our game. there are certainly in the domestic agenda, there's more that got done and more that was in a similar sense with maybe the exception of social security and i think the way of handling it, we didn't get it done, we changed direction, we had a committee and it remains undone by us and everybody.

>> yeah, i don't really believe that's part of our problem but i don't recall an issue where we really changed direction in any respect. >> well, then let me ask this. were there examples of cases where on a particular domestic policy issue it actually proved counterproductive for the president to sort of remain in campaign mode when he was talking about issues? >> well, i don't know that, you know, it's counterproductive to remain in campaign mode. circumstances dictate how you react to particular things and what your point of emphasis is. it would have been president bush talked about education in the faith-based initiative in october of 2001.

i mean, i think that's where the reactive part of it gets into it. that's not that you abandoned your agenda or less committed to it. there does at some point to be just as we're seeing with president obama and the economy you're playing the cards that you're dealt and, obviously, bruce -- everybody had a lot of that. >> i mean, i think, you know, if there was one word that president carter repeated throughout his primary and general election campaigns, it was comprehensive. the word on the other side was incremental. you know, and those speeches washington was a place of incrementalism. and that was what was wrong with washington. you know, he was elected 'cause he believed it. he believed it. you know, and because washington at that time especially was an incremental place, it created -- it created the conflict that

characterized the carter years but on the other hand but i don't know how you move from the blair house and to the white house and turn into incremental. >> i think the intentions that all throw of our presidents faced is that in each case, the president came from -- was elected from outside washington. had an agenda that was somewhat at odds with his own party. and had, you know, to some degree a mandate for the changes that he was seeking. and so the question is, when you get to washington, you're faced with a reluctant congress that if it had wanted to do what you were coming to do, it probably would have done it already and what kind of -- what compromises are in your interest and in the

country's interest and what ones aren't? and i think bill clinton was influenced by jimmy carter's experience. if you push congress too hard, they'll just give up on you. i think he was quickly cured of that approach by the '94 midterm results. because we found that really the only way we could govern effectively is to govern the way we had campaigned and through trial and error we got to that point. it's an important debate that a party has to have. if you don't -- if you don't make any incremental progress on your agenda, then the country is going to regard you as a failure

and so i think that the most successful presidents with their domestic agendas have found a way to keep speaking past the congress, past washington directly to the country on the items that they want to get done and eventually congress is more likely to bend to the will of the people and a popular president than to stick to their guns. >> i do think there's a point to be made here to defend the guy who only got through four years. you know, carter came into office right after the nixon and ford administrations which were probably, i think, the best period of time for democratic members of congress in the history of the world. everything you think was past under lyndon johnson was passed under these two guys and i our guys didn't have to take responsibility for the parts that wasn't perfect.

that's epa. best we could do. best we could do. it would have been better but best we could do. [laughter] >> the situation where party is different hands and not getting along. this is a political secret lovefest and, you know, then comes carter who's like the same guy and like saying no. it's like whoa! and i do think that the big electoral defeats especially in the senate in 1980 made it -- made the lives of subsequent presidents easier than they would have been had -- i mean, congress is still opposed -- their supposed to be antagonists and we may have to hang separately if we don't hang together have a the '80 election that was not present before then. >> talking about how campaigning translates into governing, there's the intervening event of

the actual election and the size of the victory that the incoming president wins. so carter, clinton, bush -- they all campaigned talking about either comprehensive changes they wanted to bring about or something equally big. they win victories that are not landslides. carter narrowlily elected, really no coat tails in the form of new democratic members of congress. bush, famously a minority president in terms of the popular vote. clinton wins a significant victory but far from a landslide, 43% of the populist. do you take into account that they weren't elected with a reagan-style or even an obama-style landslide and sort of adjust accordingly in terms of what you put on your domestic agenda? >> no. [laughter]

>> and even to the contrary, i think. he redoubled his efforts to, you know, educate and, you know, talk about, you know, the reason for the message and so forth. it felt like he had more work to do to continue to get those numbers up. and instead of saying i better turn a different direction, though. >> in our case, clinton got 43% of the vote. but ross perot got 19 so there was a huge ground-swell for change more or less of the same kind. so we felt like the country wanted things to change in a hurry. i do think it's one of the reasons why ideas need to be central to campaigns. why the domestic promises you make need to have a high profile in the campaign because you want to be in a situation when the president is elected. he's claiming a mandate that the country is actually aware of,

not one that, you know, just happens to be in some campaign literature that reporters might have read or that a few wonks on the campaign are familiar with. the more the country is aware of the fine print, the better off they are. i think it varies from time to time how willing -- how much the country wants to get to the fine print. sometimes, you know, they just want a new president and not even going to -- they're not going to get to the bottom of the contract. i think in our case, because the country wanted a lot of change but was skeptical of government's ability to change on that and had some doubts about our party, they scrutinized everything we did and were quite aware of the promises that we had made.

>> i think presidents -- or at least president carter certainly felt that he had to implement this agenda he laid out in the campaign. as you worked your way through that agenda to some success, and less success. i found as we moved through the years, it was more possible at the beginning stages like where with are we going to put our priorities and exactly what is this program going to look like? to have, you know, how enactable it was to be a factor. i mean, not how popular it was but how enactable but if you go past on the things he campaigned on. but he he was much less interested in how enactable it was. but if you get past to that stuff and get to programs that were designed inside the administration, then you could -- you could at least get

congressional relations concerns to sort of move up the list of things that were taken into consideration. >> the other thing that i think is really important is, you know, we've all been involved in the development of the policy on the campaign trail and how good a job you do in bringing in members of congress and local officials and whomever else you can to be part of that and have, you know, feel some ownership of those policies. i'm thinking about -- obviously, i'm most familiar with education stuff. the others who only liked about the help committee was the pensions stuff and maybe a little of the healthcare, but, you know, education was not their thing so george bush had to do and did do a lot of education with them about, you know, what is this about? and they bought into it and it became their deal as much as his. and so i think how you spread around the equities is real important and, you know, helps predict whether you're going to be successful or not.

>> okay. so you come in to office, you have to deal with office. you've made a lot of campaign commitments. congress gets overloaded to a certain extent if you try to do too much at once or at least that's what they claim. how do you decide? i think there have been clues to this but i'm going to ask it explicitly. how do you decide which of the campaign commitments to put on top? and which ones to say, well, we'll wait till the second round? we'll wait till next year. >> ladies first? it's a series of things. i mean, how ripe it is on legislativ legislatively. is there a leftover, is there an appetite moving forward on that issue? is it something that the president is -- i know when we

put education first, i mean, the president was most comfortable with that issue in his -- you know, his facility around the issue was strong and was a good strong place to start. you know, what are the prospects for bipartisanship and passage and whatnot all those sorts of things. so i think it's a series of elements on how you decide. >> we wanted to flood the circuits. there was no desire to -- we figured that congress was going to -- would slow-walk things as it was that we didn't to have make it any easier for them. i think one of the areas where we ran into the most difficulty was that the congressional system is not well set up to necessarily handle a couple of priorities at the same time. so bill clinton actually wanted to pursue welfare reform and healthcare at the same time

because he felt that they were intrinsically related as policy and that they spoke to different anxieties of the electorate. unfortunately, they went through the same committees and even worse we had the house side that wanted to do healthcare and not welfare reform. we had a finance committee who wanted to do welfare reform and not healthcare. i think, you know, at a certain point any white house makes the calculation this is what we can get do and we'll have to pursue that and we'll come back later. i do think that white houses are wrong in assuming that political capital is -- you start with a lot of it and then it -- that it has a half-life and it all goes away. that was not our experience. our experience was, you know,

you start off with capital. when you spend it well, you get more if you make a bad bet you end up with less. >> we had to basically -- we had to pick between doing welfare first or doing healthcare first. i think we felt that you could do the same things at the time for two reasons. one was you had one department of health in this case and welfare and it was really not possible, capable of designing two major programs at the same time and the other was that you had that you had these two in the committees and the ways and committee in the house who had the dominant role in dealing with both of those programs and you couldn't possibly do it to them. i think we kind of flipped a coin and i think we're good democrats and we put the poor people first. it could have -- it could have come out the other way. i must say, this administration does not seem to have that problem.

now, they've got different cabinet departments and bureaucracies involved in their -- in their -- in their big initiatives but they certainly are jamming these congressional committees and it'll be -- it never would have occurred to us, never would have -- i don't think anybody ever spent 2 minutes thinking about sending a welfare reform proposal and a healthcare proposal up there at the same time to these committees but that is -- that is -- that is exactly what this administration is doing and maybe we're going to really learn something here. >> okay. i think we're going to open it up. >> just one more thing. >> yes, sir. because we've been talking about this transition and the very serious and grand terms of public policy but here's what i want to know. coming out of the campaign, how did you get your job? [laughter] >> and what did you think your job was going to be? >> if i could put a mod fire on

that. they get dothey get to transpose what's going on in the white house and the cabinet. >> i want to know how the campaign resulted in bruce reed and burt carp and margaret spellings in the domestic policy office. [laughter] >> two things. first, we were in an unusual situation because a democrat hadn't been in the white house for 12 years, so almost no one on the campaign even knew anyone who worked in the white house. so we had very little idea what these jobs were. we had a general sense and we knew stu so he told us a little bit about how the place worked. but even with people who were older than i and more senior than i, they really didn't know how a white house worked.

and you can see a dramatic difference in how the obama administration hits the ground running and what we had to do in our first couple of years because they've got people who've done it before and we had almost no one like that. i imagine that most campaign workers feel the same anxiety the moment that their candidate wins in realizing that now you have to share this thing that you helped build with everybody else, with a whole party full of people who either weren't helpful, were actively unhelpful, didn't root for your guy and then they were in as good a position to get an influential role in the administration as you were even though you'd given up your life for a couple of years and you actually believed in the guy you

just elected. it's difficult and important for a white house to figure out how to -- how to intergrate the rest of the world that it's going to have to live with and make sure that, you know -- make sure that people from the campaign are in a position to fight for the promises that they helped make. one of the roles that gene sperling were the keepers of the flame. we reminded the more senior people or the older people who weren't part of the campaign and we did promise this and the american people signed off on this and this is really what the president believes and what he wants to do. and bill clinton completely empowered us to do that because he wanted to make good on those promises. he didn't want to have to

sacrifice them. i think it's -- it's just all part of the moving to washington aspect of governing. you know, everybody -- people on the hill thought that because they'd been doing domestic policy for the last 10 or 15 years, that they were as natural a candidate to do the kinds of jobs they were doing as we were. >> we had not a dissimilar experience with respect to the, you know, eight-year period republicans were pretty united because we had been in the wilderness. and so the president, i know, wanted a combination of dc people, the andy cards of the world, the josh boltons and the people he had, you know, worked with and known and could trust, et cetera, not that he couldn't trust those people but he knew us better and to the extent i

grew up around a state legislator and worked on behalf of local governments and whatnot, there was a lot of alignment between that and the domestic agenda and so i never forget when andy card called me -- this is closed press, right? [laughter] >> called me and said, you know, the president -- i think the president wants to talk to you about being the domestic policy advisor and i was like what? are you kidding me? 'cause i was mystified by the mighty washington 'cause i had been in houston, texas, and whatnot. and i thought, my god, can i do that and all those sorts of things and karen hughes and i talked about this and how we were going to manage -- of course, andy went through the whole thing. i was a single mother at the time. you'll never see your children. it's hell. and it's really hard work and the people are evil and mean and, you know, it just sounded as bad as possible. [inaudible] >> so karen hughes and i had to talk about that and she said

well, i don't think we can go. i mean, i can't go under those circumstances. and the next they think i knew the president was calling andy saying, are you running off the mothers? [laughter] >> needless to say, the mothers weren't run off but that's how i got my job. >> i worked for mondale in the senate and i went down to atlanta for the campaign where i worked on the speech-writing and make sure the policy stuff was all-important and i came up here and i did some things on the transition but i didn't have a job. it might have been that welfare briefing i gave the president. i don't know. [laughter] >> so mondale had a christmas party. he had a christmas party. and he walks up to me at the christmas party, and he said well, how are you doing? i said i'm doing good for a guy who had absolutely no job. and he picked up the phone and the next day i had a job.

>> okay. very good we had a chance to chew on quite a few things and i think we should open it up to the other participants. [inaudible] >> there's kind of a folk wisdom about whether it makes good sense to develop policy. during a campaign it identifies what voters are voting for and if it's a mandate or if it's a bad idea because candidates running overpromise. they may not understand the tradeoffs -- they do understand the tradeoffs but not to give them airing. we can see that with the current administration in iraq and healthcare and whole slew of other areas. is the campaign a good place to develop policy? and if it isn't, does it then make sense to look to the campaign to inform policy during the governing policy? >> i feel pretty strongly that anybody who runs for president needs to know before they get into the race why they're doing it, why they want to be

president and what they want to do as president. as a practical matter, once the campaign gets going, you can still make policy and you should and you could still search for ideas and new ideas come up. but if you don't why you're towing it and the most important things you want to accomplish are before you seek the job, i probably won't get it for starters. but you'll also be completely at the whim of your political operation. you know, i divide the two parties are hacks and wonks. we're all wonks and we speak hack but we aren't hacks. [laughter] >> both of those -- both those personality types are necessary in a campaign, but the country

will get a much better result if -- if a presidential candidate has an agenda that he or she has thought about, is serious about, has thought through how -- all the different aspects of it so that -- that it makes -- makes some intellectual sense. and for that matter, i think that the best candidates are ones who run on something instead of run on a phrase or run on a theme, run on a mood. and i think our system was, as i said, designed to be a job interview that negotiate the terms of the job contract and what you are going to do for the country ought to be foremost on that list. >> i completely agree with that. would add only one ps to that and that is all those -- all that string of reasons that bruce stuck together, i would

add a track record experience that substantiates that philosophy and that agenda. >> one of the things that presidents discover when they get into office is when might be called legality -- reality. and campaign promises are very valuable in setting a path and charting a course but ultimately you have to dole with the situation in which you find yourself. now, curiously enough, bruce and margaret came into office with their party in control of both houses of congress. i ended upped working for throw presidents, ford, bush reagan,

who had majority in both houses. reagan had a majority in the house but not the senate when he first came in. now, given that, you have to figure out what your strategy is going to be to deal with the context. it's one thing if you got your own party it work with. it's on the thing if you're gerald ford or george h.w. bush which had larger opposition majorities than any president in history. the first thing you have to take into consideration what's the composition of the congress and what can do you? the second thing is, what is the reality that i face in terms of the real world? when reagan came in, we had two years of back to back double-digit inflation, the only

time in the nationo history. the interest rate was 21%. spending had increased 17%. we had residing unemployment. and every taxpayer, because we had a graduated income tax with the lowest bracket at 14 and the highest bracket was at 70 so we had the phenomenon of bracket-code. and so when he came in, he had no alternative but to focus his attention on the economy. now, believe came at -- was a source of intense irritation it many of his supporters who were very interested in the set of social issues that they thought were important.

that had animated their support for him during the campaign. and i can remember being in a number of meeting where they were excoriated him on a number of reasons. and he said i cannot focus on a number of things simultaneously. i have to decide what are the priority are now and those priorities are driven by what you said and they are driven what is the context you face with respect to the congress and they're also driven by the reality of what's happening in the country. we went throw a campaign just ream where the number one issue was going to be iraq. if you had look at the primary campaign in the democratic party, the thing that was dividing candidates was what was going to happen on that. ..

>> can assist you because i think reagan's campaign promises on the economy did assist him in pushing through the tax and spending initiatives that he did. and the extent to which they can prove to be an albatross around your neck because you have made the promise in good faith partially because you believe in it, partially because it is

going to engender support from groups that are important to you. and then reality changes, and you get into office, and you now have to decide what are you going to do? and george h.w. bush faced this with respect to a promise that he had made with respect to taxes and how he was going to be able to produce a balanced budget through what he called a flexible freeze. and when that did not work because congress would not go along with it and deficits were rising and mounting, he was now faced with a campaign promise that proved to be very difficult to keep. likewise, most presidents have come into office with one or more commitments to the steel industry which tends to be

enormously successful in using section 201 of the trade act to present presidents with an escape clause case in their first six months in office that they're going to have to deal with, and i know this caused an enormous amount of consternation in the most recent president bush's administration is how are we going to deal with this campaign promise we had when internally large numbers of administration officials thought this is, this is not the direction that we really want to take policy. so i would be interested in other people's experience as to how do you deal with a situation where you've made a promise that has now been effectively overtaken by events. >> margaret? >> why do i have to start? [laughter] come back to me. >> not that you have -- [laughter] >> well, i'd say in the

albatross department we had don't ask, don't tell right out of the box in the clinton administration. i traveled with bill clinton for the better part of two years. i don't think i'd ever heard that promise made. it was there in putting people first somewhere, he had, in fact, made it, but it was not one that had been -- no one had thought through how are you going to the convince the joint chiefs of staff to go along with this. so that was one where there just wasn't any way to get it done, and he had to fold his hands and it was an example of, i think, you have to be careful in making your campaign promises that you don't promise things you have no possibility of delivering. or that if you make those kind of promises, you have to level with people that it's going to be extremely difficult and you may not be able to do it. i think one of the most important decisions for a candidate to decide is where they're going to accept reality and where they're going to try

to transform it. i think the best example of a promise we made that opened doors that wouldn't open otherwise is that clinton made such an ambitious, audacious promise on welfare reform. never would have happened otherwise. all of our own side would have watered it down to nothing if they could, but because he promised so much we had to, we had to make good on it. something that bill galston worked on, it wouldn't have come out of congress on its own. the luxury of a campaign or the possibility of a campaign is that it's not entirely bound by existing reality in washington, cbo scoring, all kinds of things. i think it's important for campaigns not to promise what is mathematically impossible or to, to pander in ways that are

fundamentally dishonest. but it is important to try to raise the sights of american politics because a presidential campaign is the one chance you have today that. >> i just want to make the point that's why it's so important that he's doing what he's doing. i mean, to a large degree the presidential campaigns are going to be what they're going to be, and the speech writers are going to write the speeches. the intellectual content that lies behind that is, they're not think tank presidents, you know? and our parties go through various cycles in terms of how intellectually prepared we are for -- [laughter] and these cycles, you would think, would correspond with who gets elected. [laughter] but they don't always. so, i mean, i think, i think, i think on both sides of the aisle having a really vibrant intellectual back pinning is

critically important, and there are, there are times when each of these groups has gotten into real trouble because that part of it wasn't, wasn't quite up to the speeches. >> well, and i think the other thing i've observed is you mentioned steel, yucca mountain, i mean, but my observation was when i sit here and try to invenn story those things is they were all sort of things that were very important to a subset of folks. and so to the extent that there are, you know, you end up maneuvering or disappointing or whatever on some of those issues, they're not so macro, and like i said immigration is my personal biggest disappointment domestically is that it overtakes everything. you know, yeah, you make a lot of people mad -- school vouchers, that's another one. people are still writing about why we capitulated so early,

etc., etc., but -- >> why did you? [laughter] >> why did we? we couldn't pass it. yeah. i mean, like duh, right? [laughter] >> who else? >> there probably are no generalizations about american politics that hold true of all cases to the same degree without exception, but there are some broad tendencies, and i think that this question of campaigning versus governing and the transition from one to the other does, you know, bring to the surface a real structural difference between campaigning and governing. to a first approximation campaigning is about addition and governing is about selection. it is no accident that people often say that to govern is to choose. it's much less frequently said that to campaign is to choose.

[laughter] you know, and there's, and there's a reason for that and what that, and what that means is that in the transition you're going from something broader and more capacious to something that in the nature of events is going to be narrower. and that carries with it, you know, two imperatives that are very, very difficult inside a white house. one is the struggle and it frequently is a struggle for the control of the secrets of major initiatives. and, you know, bruce and i both remember the first 12 months when we had, you know, health care, welfare reform, a major change of direction on economic, on economic policy, a very controversial decision to proceed with a couple of votes on trade issues that were quitedivisive within the

democratic party. and so the question of what comes before what because you can't do everything at once with any hope of success is very important. but secondly, circumstances can highlight the tensions or even contradictions between or among equally serious presidential campaign promises. it is no accident that during the transition in the first month of the clinton presidency there was the famous battle of the bobs, all right? because bob reuben authentically represented an important promise that bill clinton had made. bob rush authentically represented a different set of genuine, important promises that bill clinton had made. and the president as president decided that he had to decide, and he made, you know, as history recorded a clean decision.

and it was a, it was a brave, i think fateful, ultimately productive decision that paved the way for a subsequent partial redemption of the original promise of putting people first. but, you know, it certainly was not manifest during the campaign that there would be some tension between these two pieces of putting people first. but, you know, but circumstances forced the president's hand, you know, in a very, very difficult way. and i think that virtually every administration can probably by the end of the day record instances in which there is attention between two equally important intended promises that's got to be resolved with a choice rather than a compromise. >> [inaudible] to egil's point i think that campaigning is something like falling in love, and governing

is something like marriage. [laughter] in campaigning it's all wooing, and in marriage it's a lot of arguments p. -- in governing its a lot of arguments. [laughter] purposeful and ultimately more satisfying, but more difficult. and the interesting thing about the early days of an administration is that as bill suggested there's a lot of willful disbelief that goes on in campaigns, and so a president, a new president's supporters see in him or her what they want to see and tend to ignore the other parts. and so there were plenty of battles of the bobs that went on where people who fundamentally disagreed with some major promise that bill clinton had made had just sort of selectively ignored it and

thought, well, really he's for this, he's just saying that on the campaign trail. and it is, and for the president himself keeping all these people happy that, who have, you know, fallen in love with him for different reasons is a challenge. >> a comment. richard nixon, 1968, ran on the law and order platform. and one of his main points was i'm going to cut the crime in the district, the crime capital of the world. and during the transition we were trying to figure out, now, what does that mean? we're going to cut the crime? [laughter] and my first meeting with the president he said, you know, the crime's gotten up very high here in the district, and katherine graham has been over to see me, and edward bennett williams, and we've got to cut the crime. so i wrote on my pad, cut the

crime. [laughter] and i went back to my office, and i called mayor walter washington, great american. i said my name's bud krogh, i've just come with the president, he'd like to cut the crime in the district, so would you go ahead and cut it and call me back? [laughter] there's this long pause on the phone. and as i mentioned, the crime rate, i sort of set that aside, i'll check into that three months later. three months later it was up to 202 per day which was not progress at which point we had to figure out, now, what do we really do to cut the crime? i mean, that was a campaign promise, president had repeated it several times. and then we had a brilliant man, robert dupont from the district of columbia, you might remember him, and he 45d done a -- had done a study between the correlation between heroin addiction and the crimes we were

trying to address. i said i've got this data here, i think we need to support you with some drug treatment programs. and this is where you said that nixon and the ford white house were the democrats' best years. we look around to see who did drug treatment, and there with respect any republicans that did that. -- weren't any republicans that did that. [laughter] so we then had to look around the country, who can do this? who can address this problem? we found another brilliant person in chicago, we brought him to washington, and we set up drug treatment programs all over the district of columbia. methadone maintenance was a huge thing for us because, you know, can we possibly support making an opiate available to addicts? i mean, these were very tough policy questions for us driven by the campaign promise to cut the crime in the district. and that was our scorecard all the way through, how are we doing? well, we got to the point where we were able to reduce the rate of increase, and that led to a

metaphysical discussion, are you really reducing the crime, or is it -- i mean, it's very difficult to come up with an answer. [laughter] but after four years and to show you just how broad minded we were, we went down and hired dr. peter bourne, once he the head of the drug treatment plan for president carter? he came up and did yeoman service for us. do you know about this? because we don't, and we need to learn. but that campaign commitment he made in 1968 was a very important part. we were checking to see how are we doing not just in the district, but cities all over the country. >> there's an aspect of connections between campaigning and governing that hasn't come up that i'd be interested in hearing the domestic staff people's views of, and that's the idea of the permanent campaign which is the idea that campaigning doesn't stop when it

ought to. but the attitude and the activities of the campaign kind of have too much influence on what goes on in government, and i'd be interested in what people think about, whether there was too much campaign anything their white houses, whether it was something that just has to be done, was it somehow beneficial? >> the romance never ends. >> yeah, exactly. i agree with that. [laughter] >> [inaudible] >> permanent campaigning is, you know, obviously pejorative, but the person with the biggest moo cophone in the country needs to take it and use it to advance the legislative and other policy agenda that's going on. if that's a permanent campaign, then we're all guilty as sin. and how the president uses his time is the most valuable commodity you have, and how you use that to enforce against what you're trying to do is the name of the game. yeah, it's permanent campaign,

and this one's just like it the last one and the one before and the one before. >> as long as it's a permanent campaign for ideas. if the next election is what's driving everything and it's just the politics of it, then that can be destructive. but margaret's exactly right, president got elected on ideas, he should spend all his time fighting for them because if he doesn't, they won't happen. >> right. >> i think it's a two-edged, i think it's a two-edged, i think it's a two-edged sword. i mean, you can't, you can't deal effectively with the congress unless you demonstrate an ability to go over their heads to some degree. there's nothing worse than going over their head, i'm an expert in this. there's nothing worse than going over their heads and not making a connection. they all know it, they all go out there, they all go out there and hold their town hall meetings, you know, you don't need a poll. congress is the most

sophisticated poll we have in this country. so you've got to -- and it's, i think the presidents who have been the most effective have been the ones who have managed that the best and have not gone out there and too many times and proved they couldn't deliver. because as soon as that happens then i think you're -- >> the romance is over. >> you're not having a good -- >> there's a separation. [laughter] >> yeah. i just wanted to pursue a little bit more something roger brought up about parties. it's not only significant whether you have unified government or divided government, also how sharp the line is between the parties. as burt suggested, we've moved from where party politics was flexible and pragmatic to a

situation where it's much more pulverized and rancorous. and i wonder how each of you had different experiences with party politics, but i'd like to hear how that, the party lines and the way party politics operated in congress in the country affected your lives in the white house. >> well, i mean, i think this is a fairly simple phenomenon. i mean, when i first came to washington in the early '70s as a p as a elementary school intern, you know, the south had still not gotten over lincoln. and what that meant was that you had a democratic party, a national democratic party that governed on a coalition that went from, you know, the deep south to wisconsin and minnesota. but these people disagreed about most things except who the identity of the speaker and the majority leader ought to be. [laughter] but then in order to legislate

whether you were from mississippi or whether you were from wisconsin, you had to go find some friends in the other party. so no wonder everybody was nice to everybody. whether you were democrat or republican, you were running with one set of people, and you loved them, and then you were legislating with another set of people, and you loved them. and we had, we had a golden age of civility. but the south did get over lincoln, and we have just a ideological lineup now. that magic moment is just, is just over. and i believe this is the new reality, and i don't think it's, there's any point in, you know, bemoaning the old days. we're just not going to have real liberal people in the republican party, and we're just not going to have real conservative people in the democratic party, and that may be a good thing or bad thing, but it's just something that's happened.

>> i might have a little variation on that. you know, i think the party per se obviously the president has a strong degree of influence over who the national chairman is, and so the rnc or the democratic party its own self is not problem mat call. it's all the subset, issue identity groups that are heads affiliated -- less affiliated with you or anybody that you're connected to. and so, you know, i don't fundamentally disagree with you, burt, that we're, you know, we are where we are and that's changed, and it's going to have an effect on, you know, our country and it's going to be a vexing thing for president obama as it was for bush. >> yeah. i don't think it's insurmountable. i think that in spite of the efforts of all our respective bosses to try to change them, washington has gotten progressively worse. but it's possible to make

progress where there are areas of, of common interest. we found as burt probably found with the congress of the other party -- or as burt was alluding to how nixon found with the congress of the other party that where there were general goals that, that both parties were interested in working on even if they didn't start from the same spot, it was possible to find common ground. so we actually had a pretty productive period of a couple of years before the other side went off the deep end. working on balancing the budget and reforming welfare and doing areas where there were things that they wanted to do and we wanted to do, and it was just a question of, of working out details we could agree on. actually where we ran into

trouble was when we got to the end of the list of common things on our to-do list, and there just really wasn't any -- you know, when we got around to proposing a big expansion of child care in early 1998, congressional republicans looked at us and said, we don't have any interest in that. we're not going to do it. so they decided to launch impeachment hearings. [laughter] and i think that the challenge is not that the, is not the partisanship in and of itself, it's whether there are people in either party who are willing to go out on a limb and reach and break with orr dock si in their own ranks to make it possible to reach agreement across party lines. i think there are plenty of areas, look, in state government it happens all the time. it's the expected model in most state capitols. in washington it's not, it's founded on -- partly because as

margaret said, there are all kinds of interests that raise a red flag anytime you move towards progress. but, and i think that members of congress run in districts that are on the house side anyway that are very narrow ponds. they're not -- so they are accurately reflecting their constituencies by being, by being more ideological than the country is as a whole. >> to me the thing that is really critical here is there's nobody in the congress that feels accountable for passing legislation, and they're not going to go home and suffer the consequences if a health care bill doesn't get enacted. president obama is, president fill many the blank is. so, you know, that's why when i think about my friend ted kennedy who, you know, is a legislator and wants to do some things, that is at least as important as this, all this yada yada that's going on in the

interest groups. nobody on the hill feels really accountable to execute a play. >> you know, there are three presidents presented at this end of the table, but also three vice presidents and probably the three most influential vice presidents in history, mondale with carter and gore with clinton and cheney, of course, with george w. bush. and i wonder, during the campaign and then the transition and then into governing to what extent was the vice presidential candidate steering you towards certain promises and then maybe holding your feet to the fire to try to achieve those promises? burt, you worked for mondale before he became vice president. >> he always said he wanted to meet the guy that we had hired to work in omb who had studied his career and go down there and try to cut every single program -- [laughter] and take entire, entire life.

>> [inaudible] [laughter] >> well, and in my case i think as is famously known, the vice president's primary interests were not necessarily in the domestic agenda. so while his staff would, you know, weigh in from time to time, you know, he had, he had other interests. >> no, but i think, seriously, if there's a frustration that the carter white house staff had with the vice president, it was that we could only get him to engage really a lot less than we wanted him to because he was, you know, certainly the most effective staff lobbyist. but he didn't, he didn't like, he didn't like, he didn't like people knowing what he was doing or what his conversations were with the president, and he didn't want to, you just couldn't dial him up. sometimes on things that we thought were quite important. where if we had dialed him up,

we could never prove it even to ourselves. [laughter] and then there were other issues where he was basically senior lawyer in the government where he really did go out there and take an open position, but, you know, he, he might have helped to build this model because, of course, he was a protege of hubert humphreys, and i think he had studied the vice presidency as a hobby for a long time before he was in it and brought a lot of, a lot of thought to it. but i think of all these vice presidents, he was the hardest to really figure out what he was -- you knew he was doing something, but you -- [laughter] you didn't necessarily know what it was. >> [inaudible] >> al gore was a very passionate advocate for the, for the promises that he worked on in the campaign and actually even before clinton picked him as vice president, he had consulted gore on his environmental policy. so gore helped write the

environmental policy speech that clinton gave back in the primaries. and luckily for them, clinton and gore had different, different interests that they were especially passionate about. so clinton hadn't spent that much time on environmental policy as a governor, and so he, he was happy to give vice president gore some running room on that, on that issue, and that was true on science and technology policy and, you know, i think it might have been more difficult if you'd had two guys who were such young hard chargers who had worked on all the same issues and were, had made different promises over the course of their career that were at odds with one another, but it worked out quite well for us. >> andy raised earlier the question of this early months when you come into office and how you go about translating

campaign promises into some form of initiatives or reality. one thing that we haven't mentioned that i think is worth noting since we all came from out of the may lieu of the white house and the executive office of the president is that when the president first comes into office, he's got a large number of people at least positions in departments and agencies that require senate confirmation. and people cannot act in those positions until they have been confirmed. in fact, there are lots of good reasons for them not to be involved in the making of decisions beforehand. so the initiative inevitably swings to the white house, and the office of management and budget because the directer has to be confirmed but he will always get confirmed along with the rest of the cabinet

officers, but the associate directors at omb, etc., don't have to go through senate confirmation. so when you're putting together that first program that the president's going to deliver at a joint session of congress, reagan did it on the 18th of february, bush i did it on the 9th of february, i can't remember when clinton did, but it was february. it's very shortly after you come into office, and that's the first opportunity that a president really has to address the congress and the country as to what my priorities are going to be now and what specific proposals am i going to advance? .. staffs particularly during

the first six months, arguably the first year before you start filling out people in departments and agencies and they then are in a position to be a little more effective countering what the white house is doing and the initiative and drive is always coming from right out of the white house. >> time is our great foe and i have to call an end to this really intriguing and articulate discussion how in domestic policy the transition is made from campaigning to governing. i'll just note this is one of four sessions in this miller center of public affairs symposium on white house domestic policymaking, go to the miller center website.

just google miller center, virginia go to c-span.org to find when the others will be aired and andy busch thanks as much for weighting this discussion. >> thank you all. >> thank you. [inaudible conversations] >> live now to the national press club where we're covering a discussion today over the debate of healthcare legislation. we'll hear opening remarks by two former surgeons general followed the discussion of the role of government if healthcare and then later we'll hear discussions on medicare costs and end of life issues.

the health policy journal health affairs hosting the day's event. it's running a little bit late so until it gets started we'll show you yesterday's state department briefing referencing refuge issues. [inaudible conversations] >> okay. welcome. we're very pleased to have with us today eric schwartz, who's just recently customed as you know of the senate as assistant secretary for population refugees and migration. mr. schwartz has had a long and

distinguished career working on some of the issues that he has taken the lead for us here at the state department on. he's served at the u.n. office of the high commissioner for human rights. he's also worked as senior director at the national security council and the clinton administration. and in addition to a number of other important roles, so i'd like to turn it over to mr. schwartz, who will make some remarks and then, of course, he'll be pleased to take your questions. mr. schwartz? >> thank you. i thought i'd talk for about 10 minutes and then maybe take questions if that works. it's a pleasure for me to be here on what is world humanitarian day. the general assembly at the end

of last year adopted this day first to underscore the critical importance of international humanitarian assistance including protection of the most vulnerable populations around the world. but also to note the contributions of the individuals and the organizations engaged in the provision of international relief and humanitarian assistance and also to honor the -- to honor the victims of those who have lost their lives in the effort to provide humanitarian assistance. so this day, august 19th, also commemorates the lives of the 22 individuals who were killed in the tragic canal bombing in baghdad in 2003.

the group included, as you all know, sergio viara demello, one of our great humanitarians. this day has personal meaning for me. i had just gone to work for sergio. sergio was seconded to baghdad from his position as u.n. high commissioner for human rights and he had asked me to serve as his chief of staff in the human rights job. i had just begun that job when this tragic event occurred. ours, unfortunately, is a growth industry. there are the indicators that we use to determine -- the challenge show that international humanitarian crises are sustaining or even

increasing their level of severity. some 42 million people around the world have been uprooted by conflict and persecution and 16 million of whom are refugees outside of their countries and that number has probably increased by about 25%. over the past seven or eight years. it includes 26 million internally displaced people. and in this year as you all know, we've seen substantial displacements in somalia, in sharebankaa -- sri lanka and pakistan. some 214 million people were affected and economic costs were

estimated at about $190 billion and the death toll and the costs for last year were far higher than the average for the six, seven, or eight years before. so for me in this new job, i guess the starting point for me are the words of the secretary of state. secretary clinton said at her confirmation hearing before the senate foreign relations committee that she would do her very best to elevate the attention of the u.s. government to refuge issues and to develop comprehensive strategies to address humanitarian crises. and there are many reasons why protection of the most vulnerable populations should be at the center of policy-making. first, there's the moral imperative. the imperative of saving lives.

and i have to tell you, it's remarkable how consistent and generous has been the support of the american people and the u.s. congress for very large levels of assistance. and that is a -- that imposes upon us in the administration, i think, a very profound responsibility. to do the job right. second, it's critical that we sustain united states leadership on these issues, the policy benefits of which are enabling us to drive the development of principles, policy and programs. it's essential that we strengthen partnerships with key friends and allies and their populations and the populations of our adversaries where our efforts not only help to break down negative images and stereotypes but also communicate to the world at large our commitment to principles of

responsible u.s. engagement overseas. and finally, we have the key goal of promoting conditions of reconciliation, of security, of well-being, and circumstances -- in circumstances where despair, desperation and misery not only impact prospects for stability but also can dramatically affect the interests of the united states. and we have a special role to play. as the breadth of our humanitarian engagement really is quite remarkable, in short, if there's an international humanitarian crisis anywhere in the world, the resources of the united states, of the department of state, and the u.s. agency for international development, the civilian resources of the united states, in one way or the

other is likely to be there in support of protection of victims. last year -- or this year, we estimate that in terms of magnitude of support will be about $4.5 billion on the civilian side. today, on world humanitarian day, it's my distinct honor to tell you that we are planning now to provide an additional $160 million in support of critical international and nongovernmental efforts to provide humanitarian assistance and protection and to help create the conditions for sustainable recovery. in this case, the money will include, for example, some $58 million for assistance in africa with a particular focus on -- >> we'll leave this recorded briefing now and take you back live as promised to the national press club for a discussion on

the debate over healthcare legislation. the health policy journal health affairs hosting today's event. live coverage on c-span2. >> we would not be here. our premise as the nation's leading journal of health policy and also i should stress is a nonpartisan peer-reviewed journal of health policy is that a serious health reform effort warrants a serious national discussion. health affairs was founded in 1981. my predecessor is in the room today. and john would be the first to tell you that health affairs has been in the business of covering health reform since 1981. as our system is an extremely dynamic one. periodically more dynamic than others. health reform at health affairs and, therefore, we are very delighted to be sponsoring the session this morning. as many of you have been observing the current debate know, we have become aware the

discussions now going on about health reform are not always proceeding at the highest level. which is part of the reason why we decided we needed to have this today. some of you may have seen this cartoon in the "boston globe" earlier in the week summing up how the tone is at some of the town hall meetings as you see. the questioner says that we will allocate the question time among the badly misinformed the i justidly ideological and the actively hallucinating. we have an anecdote of this morning. we understand these issues are difficult to follow this fake protester is holding up a sign saying we have no idea what we are talking about. we recognize that these issues are complicated. we recognize that the issues really demand a longer conversation than is frequently the case. as we started on this voyage of thinking that we could do something useful, we selected several topics that we thought

we could bring something to in order both to harken back to work that health affairs had published in the past and also capture some of the issues that we understood were of great concern to the public. we do not pretend by any means that this is a comprehensive systemic review of every issue that could possibly come up in health reform and by the same token we do not have a universally representative sample of speakers representing every possible ideological, ethnic, geographical or other perspective. we're not pretending that we're doing that. what we are pretending -- i hope more than pretending what we're doing is bringing you some solid, substantive nonpartisan discussion on some of these very key issues. we are most honored to have a couple of special guests on the line with us today to kick things off. these are individuals who as they will tell us and remind us have been in the healthcare trembles for quite some time and have a very special perspective

personally as well as professionally on the importance of health in the united states. first, we are most honored to have on the telephone lean with us this morning from his home in hanover, new hampshire, former surgeon general c. everett koop. you have bios in your pockets that tell you more about our marvelous speakers today. dr. koop is about to celebrate his 93rd birthday this year. he was born in brooklyn, new york. he received his m.d. degree from cornell medical college following his undergraduate degree from dartmouth. after serving at an internship he did post-graduate training at the university of medicine, the boston's children's hospital the graduate school of medicine at the university of pennsylvania and received the doctor of science in medicine in 1947. he was a pediatric surgeon for many years. he's presently the liz professor

of daughter mouth as well as the c. everett koop institute. he's an internationally respected pediatric surgeon and as you a know, he was appointed surgeon general and deputy secretary of health in the u.s. public health service in 1981. as surgeon general he oversaw all of the activities of the public health service commission corps. he took a great interest as many of you will recall in smoking and health, diet and nutrition, environmental health hazards, immunization and disease prevention and make the chief spokesperson on hiv and aids. he's a force in health and health education and we're most delighted to welcome this morning dr. koop. are you on the line? >> i'm on the line. >> good morning. >> good morning to you. i'm very pleased to join you today by telephone. i wish it could be with you in person, but my doctor has advised me to minimize

unnecessary travel, and when you're 92, i want you to remember that you always should listen to your doctor. [laughter] >> i have spent my life in the trenches of healthcare as a physician and surgeon, as a public health professional and as an educator. since my retirement from the post of surgeon general, i've devoted much of my life to the subject of healthcare reform. we're now at a place little is more important to us than having a first-class healthcare system than truly advances the health of the american public. since my -- we are now at the place where we are facing

critical questions about shaping a system that is equal to our great interest. in that context, there are many serious issues that demand serious discussion and debate. forums such as today's are essential to that objective and are essential to our democracy. i congratulate the participants, the sponsors and the audience and wish all of you well as you advance these discussions today. signing out from hanover, massachusetts, this is dr. koop. [applause] >> thank you so much, dr. koop and say hi to your doctor for us. we're also very grateful to have with us also on the telephone line from arizona, former surgeon general richard carmona. dr. carmona was the 17th surgeon general of the u.s.

he served as the nation's top doctor at the time as you will all know issuing calls against major health concerns such as obesity, heart disease, cancer and the dangers of secondhand smoke. during his tenure he focused on shifting the paradigm of healthcare from treatment to prevention stressing lifelong healthy living is a key component of medical care. he's been passionate about eliminating health disparities. he's championed health literacy. he also has become a specialist in the area of public preparedness and led the nation as surgeon general in combating many global threats to health, safety and security. he grew up in an impoverished hispanic family. he dropped out of high school and experienced health disparities firsthand. then he went on to become a decorated green beret in vietnam, a police officer, a s.w.a.t. team member and eventually graduated from college and medical school at the top of his class.

his very broad medical career includes having served as an e.m.t., a nurse, a trauma surgeon, and a community physician before being unanimously voted into office of the surgeon general. he now serves as the vice chairman of canyon ranch, which is as many of you know the 27-year-old life enhancement company. he's chov executive office of their health division and is president of the noncanyon ranch institute. dr. carmona, are you on the line? >> i am. good morning, susan. how are you? >> welcome. thank you for joining us. >> thanks so much. good morning to all of you and i'm delighted to be following my distinguished predecessor, surgeon general koop in bringing you greetings this morning. like dr. koop i spent most of my life in healthcare's trenches. in fact, before i became the 17th surgeon general of the united states, as you heard i worked as a paramedic, a registered nurse, a physician, a

surgeon as well as a public health officer, a hospital ceo and a professor of surgeriy jus to name is health. as surgeon general i became more acould you telly aware than ever of the health and public health needs facing our country. i believe that it behooves all in our great nation regardless of party affiliation to take the current debate over healthcare reform seriously and participate. help drive the debate to a rational and logical conclusion. i too salute today's efforts and others like it that are taking place around the country to bring all serious and reasoned perspectives to bear on this discussion. and, susan, thanks for yours and health affairs and our colleagues' leadership to bring us together for this important conference that hopefully brings

clarity and transparency to this complex issue. and from tucson, arizona, where the probably hotter today than in washington, this is rich carmona signing off. thank you. [applause] >> thank you so much, dr. carmona. we had also invited dr. david sacher to say a few words this morning. unfortunately, he was unable to join us even by telephone but also sent his regards and support for this conference. i'm most pleased now to introduce david colby from the robert wood johnson foundation. he's vice president of research at the foundation. his bio is in the packet and he has a few words of greetings for us. david? >> thank you, susan. on behalf of the robert wood johnson foundation, i want to thank you and everyone at health affairs for hosting us today and

especially for putting together this event. it comes at a crucial time because as we've all seen over the last couple of weeks, over the last month, the facts of health reform are too often getting lost in piles of myth and gigabytes of fear or maybe i should say terabytes of fear or if i could, i think, make up a worth zetabytes of fear. as some of you know, i spent nine years at the physician payment review commission and then at medpac. and i was there during the last health reform debate. i'm proud of my years in washington. unfortunately, i had a front row seat to watch the last debate on health reform be derailed by panic and the politics. as a researcher and a fan of dragnet, it pained me to see

cold hard facts and painstaking research drowned out by the likes of harry and louise. so with joe friday ringing in my ears, just the facts, ma'am, i want to do my part not to let that happen again and sessions like this certainly help. in order to fix which is inarguably wrong and broken in our healthcare system, reform efforts must be driven by research and data and for this go-around, lawmakers and policy expert have no shortage of objective information. they are now guided by tremendous arsenal of what's wrong with the healthcare system and how to fix it. we know much more than we knew last time. we know definitively that americans receive the wrong care or at least not the right care about half the time. we know that even though we spend more on healthcare per capita than any other country on earth, our outcomes are not the best. we know that there are huge

geographic variations within the united states on who's receiving what care at what price and whether it's working or not. as a private philanthropy our role in the healthcare reform debate is to provide our leaders and policymakers with the resources and tools they need to support the healthcare system that will achieve coverage, and improve quality, value and equality for all americans. that's why we support health affairs and why we're working with susan and her team on a series of health policy briefs that provide clear, accessible overviews of the most salient health policy topics of the day. the briefs include competing arguments on all sides of a policy proposal and relevant factual research. the briefs and a lot of other research-based information are available on our website by visiting healthreform.org. the foundation's dedication to

objective research and above all just the facts is why we are proud to support today's symposium. in closing, i want to thank all of the participants for sharing their knowledge and their dedication to the issues that are important to all americans. thank you, susan. [applause] >> thank you very much, david. david mentioned the health policy briefs. we are also bringing out a new health policy brief today that deals with many of the subjects we'll be covering this morning. that and our earlier briefs are available also on our website at www.healthaffairs.org. they are available for free and we encourage all to access them. we are now going to move on to our first panel discussion. and again, we selected some specific topics that we thought were going to be of most interest today based on what we

thought was the greatest area of interest in the public at the moment. what we could gauge was of concern at the town halls and so forth. and that we believed was this whole question of the fear of government-takeover of the healthcare system. all of you have heard variations on this theme. i simply selected one here that was written up in roll call a few days ago about a woman who went to a forum with senator chuck grassley out in iowa. this woman is a 61-year-old factory worker who was one of 2,000 people who showed up last week at one of grassley's town hall meetings. as you see here, like many of her counterparts, she had a message for the iowa republican, a key healthcare negotiator stopped president barack obama and congressional democrats from enacting their healthcare plans. and she goes on to say, quote, when 9/11 happened i was very terrified. i honestly am more terrified now

than i thought my government was going to protect me. now i'm afraid of my government. we have the car industry being taken over, the banks were taken over, now i feel our healthcare. i think we have -- we're leaning towards socialism and that scares me to death she told grassley and this is in the methodist church where the town hall had to retreat because it had overtaken the capacity of the earlier facility. this led us to believe that we needed to go back and look again at some of the basic facts. what exactly is the role of the u.s. government today in paying for and/or providing for healthcare? and how might this change under leading health reform bills now in congress? and we've asked two distinguished people to address these topics in sequence. first we're going to hear from lynn nichols the director of the health policy at the new america foundation and he's going to lay out just so we're on the same

page what does the u.s. federal government do in healthcare today? then we'll hear from gail wilensky who's a senior fellow at project hope, a veteran of many positions in government in particular having been the administrator of the healthcare financing administration now the cms from 1990 to 1992 and also having served in the white house under president h.w. bush as a health policy advisor there. gail is then going to talk about how the government's role might change under leading health reform bills now in congress. so first let me turn to you, lynn nichols. ..