>> the number of primary care doctors being trained is half of what it was just a few years ago. the american college of physicians called our current circumstance a collapse in primary care. only 300 or so geriatricians are trained each year, fewer than those entering retirement. currently there is but one geriatrician for every 8000 people, over age 65 in america. why did this happen? how has this happened? doctors didn't create this problem. bad public policy created this problem. perverse payment incentives have undermined primary-care medicine, have promoted specialization and technology over face-to-face interactions between doctors and patients and families. all insurance systems for medicaid to manage your have undervalued doctors like me for decades now, devalued our time, our cognitive conferencing and consensus building skills, rewarded us only for the wrong things. another trip to the er. another round of antibiotics. another course of chemotherapy.

we need to take the time to restore a system where the primary care doctor patient relationship has meaning and value again. peoples family want and need someone to trust, someone to advocate for them, who will go to bat for them, who will tell them the truth. who will talk to them in the most difficult times, educate them and offer options. and study after study has shown that the health care provided by primary care doctors, restoring them to the center of the paradigm, will be less expensive care and more satisfactory care. and it also involves educating the public about the importance of advance directives. this is a wonderful website would together by the center for medical humanities and ethics. where i teach by our bioethicists in texas living wills.org. we need to educate. we need to educate the public. what procedures, under what circumstances are helpful and which are not, we'll let our

health care proxies, what are the role, what can they do and not do? what is the role of the family, for doctor? let me make this clear, nothing in anything i have seen is proposing that doctors substitute advanced care planning for medical care. no one is proposing death penalty were outside experts to decide who lives and dies. i would not be a part of such a system nor would any physician i know. but any system that refuses to reward the work of health care professionals for doing advanced care planning and conferencing with families during difficult times is preordained to be cold and bureaucratic, sterile and uninhabitable. and will subject our failed elderly who finds him or herself with an end-stage disease at the end of their lives to inappropriate, unnecessarily expensive and possibly futile care. end-of-life discussions are complicated. decisions are often arrived at incrementally your family

members often at odds over many things must all be on the same page. and electronic medical record is not much help here here most of the time there is no need to rush the process. it's a lot like health reform ought to be. well thought out and implemented with caution and concern. at the end of his life, my father no longer knew that i was his son. but after each visit with my father, if he was still awake, i said to him, i love you, dad. and it was always a surprise when he answered, i love you to. because this was something my father could never bring himself to say to me when i was his 12 year-old son, or his 50 year old son. from the depths of his dementia my father gave me a great gift or he would be honored by my your presence here today. thank you. [applause]

>> thank you so much, all three of you, for giving us a sense of what it really is all about in the areas you operate in everyday. i want to start, we're going to open this up once again to questions from the audience, but i wanted to ask you. we have heard now in the weeks since congress adjourned that many lawmakers want to back away from section 1233, that is basically been thrown overboard as far as some of the members of the senate finance committee are concerned. it is too hard to explain. people are too confused. it is just not worth it. how does all of this make you feel, given what you talked about?

>> i have very mixed feelings about it. i think in the end, this national dialogue about and of care like there will turn out just as the kerry shopper debacle turned out to be positive. although there was a lot of heat and smoke in the end, there was actually a lie because people basically said throw them out. throw government out. these decisions belong within families. this is not, you know, this belongs to us. and i'm hoping that in the end, that will be the same conclusion as a recognition that advance care planning is about restoring power and control to the objects of all of this discussion and expense, the patient and the family. and that we have begun, as i and all my colleagues have increasingly been doing, talking to the press about what advanced care planning really is. that we have begun to turn the tide on these lies about death penalty and that's all they are,

in his life. and we just need to keep saying that. i also think that the most salient health reform changes to improve access to primary care, geriatricians, like me and jerry, to improve access to palliative medicine are things having to do with workforce. those are much more important than, you know, a $75 payment for a discussion about advanced care planning which is not going to be sufficient to turn the tide on the physician incentives to keep doing things. all the incentives need to change, so this is just kind of a strongman for assault, but not that critically important in and of itself. if we could do something about loan forgiveness, to get people to go into geriatric nursing or geriatric medicine, or if we could do something to get medicare dollars to support palliative medicine fellowship training which not all the attendant medicine fellowships

are is an entirely supported by philanthropy, which is a pretty failed me for public policy. i might add. those policy changes which are unlikely to be controversial would actually have a huge impact on access to quality care. so i am hoping that some of those measures and there in some of the bills that senate finance is considering, survive. and they don't survive this time, we will keep on getting them in next time. >> chris? >> it's a very interesting question, susan, and i think my concern is that so much of the heat, not only about the death penalty issue, but the others, has not been in any way related to what's in actual legislation, as you know, and as we've talked about all morning. so the lasting in the world that i would want strategically for the nation is to hold onto something that gets

misinterpreted and gets used for political or other kinds of reasons, and not get to what we have been talking about all morning today, which is expanded coverage for americans, reduced cost burden for the families, and improving quality of care. that's what we really need to accomplish. and within that, what we are talking about, the end of this morning about palliative care, is part of the picture but it isn't the whole picture. so i would not want -- i would want that to undermine the chances of a reform package getting through. i do think that diane's point is very well taken, that there are a lot of things we need to do in changing the payment incentives. the previous panel talked about bundled payments, accountable care organizations, medical homes. you could build in expectations about palliative care and about palliative care expertise into every single one of those. that would have much more impact

overall than as diane said pang a primary care physician $75 once every five years to have a conversation. that is not going to transform our system. >> and, jerry? >> well, you know, i think a lot of people when they hear about some of the proposed legislati legislation, get frightened. first of all, as i said, they are frightened about the subject of death anyway. they don't like to talk about it and they certainly don't want any kind of top down system imposed on them. so obviously, you know, as a practicing doctor, i am in favor of education. you are right. every five years of communal, in a conference in the exam room is probably not going to do it. but we have taken great education campaigns in this country to do with other health issues. think about smoking. now we are engaged in one with obesity. i mean, this is, to change

attitudes, to get people thinking about these issues and comfortable talking about these issues needs to be an educational campaign. and i don't really know how to do that, but i do know there are people that do know how to do that. and i think that's what we ought to really be focusing a lot of effort. >> i think you all do a pretty darn good job of it and have done so here this morning. let's open this up to questions and discussion from the audience. once again, i would ask you to identify yourself by name and affiliation. if you would like to address it, to a particular analyst, please do that. if it is one for everybody, please indicate that as well. while we are waiting again for any more to come forward, if we build this kind of system, chris, that you just mentioned, and that the other panelists also discussed, accountable care organizations, where payment goes to an organization and it is not on a fee-for-service basis. it is not stimulating this ct

scan that particular intervention, but really did, in fact, engage people as diane said, and when finally there is a recognition that maybe things are not going according to hope and that the time is near. what would these look like? these are also kind of scary concepts for americans because there are not a lot of these entities out there to go to and say see, this is something you might actually like. >> there are, i mean, there are a lot of them but there are some of them. and they are not small. i mean, we heard this morning about geisinger and mayor and kaiser which is eight and a half million people. and intermountain. and a number of other integrated groups. what could happen with something like an accountable care organization is that you could force the hospitals and all the

different physicians specialists to come together and say what do we need to take good care of this population of patients. and then they would figure out they needed a palliative care expert and they would figure out a way to pay for it. and it wouldn't require any specific sort of overengineering if we're going to pay this much for this and that much for that, because these systems would figure out. that is what you have seen happen at tranninety at most of these physicians are on salary. if they have in the incident, it has to do with patient satisfaction, which is a pretty good thing it seems to me to care about. and then ultimately, it does end up costing less. and there is very good about that. without anybody having to ration anything or limit any care that actually makes a difference, but by really coordinating care and getting rid of the things like

that frightening story that diane told about the first patient, where you know, huge amounts of that expense, not only were unnecessary, but were terribly painful for that patient and for the family. >> diane, would you agree with a comment darrell made any earlier panel that there are lots and lots of physicians out there who want to participate in this change? >> absolutely. one thing i didn't mention was a conversation i had with judy's oncologist when he offered her chemotherapy directly into the brain. towards the last four weeks of her life, and she called me and said my doctor offered me chemotherapy into the brain. what do you think? you know, should i say yes to the. he had been hitting them out of the park all for the prior six years, so we wanted very much to take his recommendations. so i called them. eni had been in regular contact

for about 14 months about judy. and i said, you know, what are you hoping that this treatment might accomplish for her? and there was a pause and he said, i actually don't think it will help her. so then there was another pause while i took a deep breath, and i said well, do you think we should be recommending that she do this, given that it is pretty high risk? because if you put a foreign object in the brain, the risk of infection. and toxicity is quite high. in his response was very instructive. his response was i don't want you to think i have abandoned her. so this wasn't about money. this wasn't about that's what he gets paid for. this was about he did not know any other way to signal his commitment to her. to signal how much he cared about her. my job with him was to help them show how much he cared about her by going to visit her at home, which is what i did. i said she really wants to see you. she wants to say goodbye to you.

can't you make a home visit? he had never made a home visit in his entire career. he was in his middle '50s. takes care of cancer patients. it was incredible meaning for to her and him. and he spoke at her funeral. hopefully it will make it easier for him next time. but he had never knew how to have that conversation. he never knew how to understand that his presence, his commitment to her is what she needed. not another procedure. but the motivation was to show her how much he cared about her. so doctors do desperately want to do the right thing for their patients. there are no evildoers here. the system is structured to get the results that we see. >> jerry, i have seen you notting. >> i want to pick up on a point. teaching young doctors, medical school and residency, teaching them the kinds of behaviors that you mentioned, getting them to

understand the importance of doing things to patients at architect and logical, but our humanistic is very important. and i have to say that in very -- and not very many places as it ought to occur, is this occurring in america today. i have really had the privilege. it has been a privilege, my wife and i., my wife is an attorney, and we both volunteer our time to teach a basic ethics module at the university of texas health science center in san antonio, both in the first year and the fourth year. and, you know, what do we do? we have conversations like we're having today. we read essays. we read short stories. we read poems. we talk about these very difficult conversations that we must have with patients, and how important it is for us to be

attentive to these needs. i mentioned in the beginning of my talk that i deal a lot in nuance. you know, patients very often are afraid to ask these questions of us. how long do i have? what is therapy going to be like? what can i expect? but if you are taught to read the nuance in your patient, in a face-to-face conversation, it can make a tremendous difference. you can really have a breakthrough with someone. and this needs to be a standard part of medical education. and just like everything else, very often the dollars aren't there for those in medical schools. i mean, we don't treat patients at the center. we don't get research grants. we read poems with medical students. you know, why should that be paid for? in our system. well, let me tell you, i believe

that this can make a big difference. it has made a big difference, and so aside from educating patients at end-of-life issues and advance directives we need to educate health professionals in being able to engage their patients during difficult times. >> can i just add to that? i mean, think about mrs. g.'s pain, untreated pain. really come her doctor did not know how to manage pain. i hate to break it to. most of her doctors had ever been taught to manage pain. you should be scared. they don't know what they are doing. it wasn't in the curriculum. most medical schools have no mandatory training on this, what they are very good at integrating somewhat and putting them in the icu. or you know, ordering a cat scan, we are really good at the doing that. but the most fundamental human needs have been lost from the curriculum, and most medical

american schools and we have no national control over the curriculum. medical school by medical school determines this. it is a huge problem and there is no health reform without medical education reform. >> let's take a question here in the front from gail. >> i agree with the concept that has been raised several times about the need to change the reimbursement system, reward the kind of behavior we would like to see. i am very supportive of selective loan forgiveness. i think it'd be much more effective in an era when medical schools missions are very high and physician income growth has been very low, or negative and were not giving it enough attention. but aside from changing the monetary incentives, important as that is, i am going to implore you to use your influence, to indicate that this is more than just about getting the money redistributed.

it is going to be, how do we try to make sure we have the full spectrum of people who could be working on these issues, how can we make more and better use of advanced nurse practitioners to help us with our shortage of primary care physicians. you talked about training new positions in these issues, which i applaud. i am going to plea with you, we need to figure out how we're going to reach this stack of physicians, 600,000 strong or whatever we are, that are out there. we can't rely only on helping to retrain the new ones coming through. i have to say, when i have spoken to physicians that are in residency, or while they are still in medical school, i am not overwhelmed that they are treating, seems that much different from the training that other positions, including my husband, who was trained in the

1960s, somebody not fundamentally different. so i'm going to urge you, because you spend your life on these issues of trying to think about in addition to arguing for more money and for better recognition for primary care and geriatrics, and in particular, to think about strategies that we can use to reach out to existing physicians. i was, diane, when you talk about the lack of knowledge about pain management, but i don't know is, do you think that most physicians know they don't know about pain management? i mean, is that sort of the first thing that we need to do? you don't know what you're doing, but actually there are ways to fix that, just like you can call on other people to help you and hear our modules that you can take in your next cme about pain management and other issues ask i think that it's just not enough to talk only

about more money and not enough to talk about only reaching out to the medical students. i mean, that is just not going to get it done. >> gail, you couldn't be more right, and i would point out we do talk a lot about the pipeline, but every physician is expected to learn new stuff throughout the course of our careers. we all do that. and actually now all 24 specialties within the abm as boards require periodic recertification to show that you have been keeping up with your knowledge. so ashley have a tool now where we could begin to both offer that kind of education and also measure it and told physicians accountable. and actually recognize them when they achieve it. so i think that your point is very well taken. you should be aware that some good news on the horizon, we've been talking about all the problems out there, is that 10 different specialties got

together to create a subspecialty certificate. diane was very involved in this, in hospice and palliative medicine. medicine. so there now are board-certified specialist in this area, and notches in the primary care arena but in several different surgical specialties, in psychiatry, in neurology, in pediatrics as well. so the fact that there is no kind of a recognized way of saying this person actually has these skills should allow us going forward to be able, and maybe even have, you know, educate consumers, especially family members, ask these kind of questions. you know, do you have a specialist in this area, or do you have expertise in palliative medicine. learn that term, and ask people about it. that will begin to make a difference to. >> well, i appreciate your comment, gail, but i have to say this. someone who is work and the

fee-for-service medical sector for over 30 years who has been basically at the mercy of whatever medicare, cms, decides every year what my services are worth, i have to tell you this when you talk about, let's not talk about more money in the system. and i'm not talking about that either. i would like to see them shift some money in a system that when an air nose and throat doctor gets more money for cleaning blocks out of my patience here because that is a surgical procedure, then i get from a 90 year-old woman comes into me and tells me she has had a little spell and i have to use my time, my diagnostic skills to try and figure out is a serious, does she need to go to the hospital, do i need to do some tests in the office, what can i get away with with this woman and it might take me an hour. and somebody cleans wives out of an ear and gets more money. i would say there is a problem with the system. and in my estimation, and i talked about medicare being flawed system. it is very flawed, but it is

fixable. it is fixable. if someone will sit down with doctors who have been doing this for a while and say, you know, how would you fix this? is it right that an mri scan is reimbursed at $1200, but you get, but dr. winakur, you get a $60 when a patient comes in with a little spell? well, i say yes, we don't need more money in the system, but we need to reallocate what is in the system. >> all right. as we wind our way to a close, i want to do a slightly different version of what i did with the earlier panel where i asked the earlier panel to speak to their elderly parents. i'm going to turn things around and ask you to speak to your children or grandchildren. and i know chris in particular has a very smart 13 are sold year-old grandchildren i want you you to imagine infinite you a couple really sharp 12 and 13-year-olds who are your grandchildren or your children, and i want you to tell them what

your hopes are for the health care reform debate that we are having in this country. and in particular, with respect to these issues. now these of course are going to be 12 and 13 euros. they are not prepared to think about death or dying, but they perhaps are smart enough to know that they too will get there someday, or they certainly sensed that their parents or their grandparents will. so you have 30 seconds of their attention because they are about to go play on the wii or something else like that. >> what a great question, susan. well, what i would say is if you are right, not to talk about death, but most importantly, this gets to the topic of the whole session today, is that my hope for her would be to live in a country where she didn't have to worry about going broke because of health care expenses

herself personally. that she could live her life and be confident that there would be some reasonable approach to providing medical care for her parents, for me, and for her, should she need it that would be affordable. and that she could actually be reasonably confident that it would be good quality care. and so that, that would be the main thing. what i would also say, getting to jerry's important point, is that i have been trying to entice her into going into medicine, of course. and what i would say to her is, and it would be a system that would provide you a very personally rewarding career as a physician, knowing that you could help people in the ways that made sense. >> diane? >> well, i have a 23 year old and a 20 year old.

and what i would say, what i do say to them is that i am working for a time so that when they are my age there will be no debates about health reform. everybody who is born an american citizen will know that they have access to high quality medical care, just as they know if they put a letter in a mailbox it will arrive. that is not true in many countries of the world. that the postal system works. we take it totally for granted. i want a health care system like the postal system, that people can take for granted, that it works quite well. is consistent. it is standardized across the country. that people will get the care they can benefit from and the care they need, no matter where they are, no matter who they are, no matter what color they are, what no matter what their income is. that that is what i am working for so that my kids and their kids will inherit that kind of system. >> jerry, the last word to you.

>> i have two daughters who we call doctors. one has a degree in redish romantic poetry. [laughter] >> and the other is about to earn her doctorate in counseling psychology. why they did not choose to go into medicine, i think, well, we touched on some of those issues today. but what i want to tell betsy and emily is that your father has written down and you know where it is what he wants when it is his time. and i encourage you to, at some point in your lives, have this conversation among your own family and write it down. >> and on that note, we will bring this to a close. i want to once again say that health affairs really is so

grateful to the organizations that made his forum possible today. the robert johnson foundation, the association of american medical colleges, the american board of internal medicine, and the american hospitals association. we pledged to bring you a serious discussion that was at the level that the topic demands, a serious health reform as we said demands a serious discussion. i hope in the process we have also brought you one that you have found provocative, stimulating, informative, and as we heard from the last panel, even emotional. thank you very much for coming today. please take a look at our website, www., including the policy briefs we published today and the policy brief will bring out today. that you so much. thank you to this really excellent panel and the previous panels. good day. [applause]

[inaudible conversations] >> [inaudible conversations]

>> does fall into the home to america's highest court from the grand public places to those only accessible by the nine justices. the supreme court coming the first sunday in october on c-span. >> how is c-span funded? >> the u.s. government.

>> probably benefactors. >> i don't know. i think some of it is government raised. >> it's not public. >> probably donations. >> i want to say from me, my tax dollars. >> how is c-span funded? america's cable companies created c-span as a public service. a private business initiative. no government mandate. no government money. >> a discussion on the future of charter schools and voucher programs. it is hosted by the thomas b. fordham institute. a think tank focused on education issues. this last about an hour and a half. >> good afternoon. good afternoon. my name is michael petrilli, one of the vice president here at the thomas b. fordham institute. very excited on a full room on a hot day in washington in august. not everybody goes to martha's vineyard from washington.

and so we are glad to have you here. it's going to be a very interesting discussion. it may not be quite as contentious as the health care debates that are taking place around the country. we don't expect there to be anything thrown at him by the way, dc has a very strict gun laws so you have to check, i'm sorry, check those guns at the door and turn those cell phones off. but this is a very important debate that we are having right now with the new education policy world about charter schools, school vouchers and other forms of school choice. for those of you who don't know too much about the thomas before an institute, we are a think tank here in washington, d.c., which covers education policy. we also do on the ground work in ohio, and specifically in dayton, ohio, where we have an office and also policy work in columbus are to where we live in a real place and in a place with real kids were we serve those kids directly. wee for a long time have been promoting various forms of parental choice in education. that includes private school

vouchers, in dayton, ohio, we hope to start a privately funded voucher program over a decade ago. the state now has a publicly funded voucher program statewide. of also been very active in the charter school movement in a while, and would actually sponsor, oversee six charter schools in dayton and columbus and in the cincinnati area. so we are very much involved in this movement. we are supporters on both about your side and on the charter school side. but we have also noticed as political winds of change in recent months and an amazing year, that there has been a lot of discussion about whether or not there is still a viable future for the private school choice movement. vouchers, tax credit, the ability for parents, usually income parent or disadvantage pairs take it public dollars to the private school choice versus what you might call the ascension of charter schools. everyone that the obama administration has embraced. and in fact, israel has been a lot of political capital promoting in a variety of ways,

from using the race to the top funds, this $5 billion incentive fund for states, to tell states that if they want to get a better shot at getting the money they have got to adopt a more charter school friendly policies. let me start off by reading a quote from the president he gave an interview about a month ago to the washington post when the race to the top application came out. here is what he said about these various forms of choice. he said i have been opposed to vouchers because i worry about resources being drained out of the public school system. until you have the public school system only dealing with the toughest kids. on the other hand, i think charters, which are in the public school system forced a kind of experimentation and innovation that helps to drive excellence and every other aspect of life, and i think that is a positive thing as long as we are continuing to set high standards and apply them consistently to these charter schools. so you can say that charters are hot and vouchers are not in today's washington. and the question for today is

does this matter? does this ascendancy of charter schools have negative implications for the private school choice movement, or do these two movements go hand in hand? are vouchers and tax credits kind of passé, a thing of the past or do they promising future ahead? that, the way we would even frame this debate as cadenza was being charter schools against school vouchers has already been a matter of some debate. you have to love the blogosphere. is already buzzing about this event in advance. j. greene wrote on his blog wrote dismissing policies because they aren't on the agenda of the current majority, as in school vouchers, is like the type of art and heard in the 1980 film had its. so we'll talk about the that whe voucher is the new bulimia. so many things. is an analogy. so lots to talk about. we have a star-studded channel to address these caches today. i will introduce them prefigured

it will make brief five minute comments and then we will get into a moderated conversation and then after that open up a conversation to the audience. again, we have refreshments are. don't be bashful about getting up and getting another cup of coffee or a brownie to keep you going. i don't think this conversation is going to require too much caffeine. so let's start here. started on our left. we have gone under i -- we have john kirtley. john, remind me the name of your organization. >> up on mac. >> the school choice on which is the largest tax fund credit scholarship granting organizations in the country and in florida. we have kevin carey, at education sector. what is your official title? thank you. policy director. gérard robertson, thank you so much. here is the president of the black alliance for education. and susan zelman who is at the

corporation for public broadcasting and used to be the state superintendent in ohio. again, where our home roots are. and of course is the susan zelman of the zelman decision. the decision back in now 2003 at the supreme court level that found school vouchers to be constitutional, including vouchers for schools that are religiously affiliated. so we're going to start with john and kevin and put on the panel this would. and have a very interesting conversation. so john, let's start with this. article from president obama. we have a popular democratic president, granted less popular by the day, it looks like it but a popular president willing to spend political capital on charter schools but not on doctors. there seems to be a political moment for charter schools, so why shouldn't people that care about expanding choices for parents to put all of our energy right now into growing the charter school movement? >> well, first of all thanks for having me here. i am pleased to be your. and thank you all for being here today. and wherever you are on this

topic, thanks for caring about this issue because you are already ahead of most people. so i want to thank you for that. i'm going to talk about a lot of details today, but they all revolve around a few main points. and the first point is that i think this is an exciting time to be in k-12 education because whether we want or not it is changing so rapidly. and the delivery rapids untrimmed methods are changing so rapidly. you have charters, magnets, virtual and some kids are combining those two even dual rolling and commuter colleges. what might main point is private schools, particularly faith-based schools are an essential element of the public education delivery mix. and the first critically important point i think is morally wrong to exclude that option from low income parents. it is one of the most prevalent options in urban and other low,

areas, not just urban areas. and that surprises a lot of people. it is just morally wrong to exclude that option from parents. i will give you a real-life example. in jacksonville, florida, it is a very large urban district are probably 350,000 kids in the public school system. faces all of the challenges. there are six charter schools in jackson. six. and not all of them serve low-income kids by the way. there are 90 private schools serving children, low-income children on the tax credit scholarship program in jacksonville. now, imagine you are a low income single mom in jacksonville, and you have a son who is doing very poorly. is not the fault of the school. is just not a good fit for that school. and you want to put your kid, this is a real-life example that there is a private school and a low income kid and 90% of the kids go to college. and you want to put your kid in

that school. how do you explain to her that she shouldn't have a right to do that? how do you go to her and say, you know, i am for school choice, but i am just for charters. and you need to wait until we bring a charter school. in fact, a high quality charter schools to your neighborhood before you have an option. she will look at you and say my kid is going to be dead by the time a charter might get here. until the first main point is, it is just morally wrong to exclude this option from the low income parents. and the second main point i want to talk about today is the main opposition i hear to being poor low-income families is it is too politically difficult to get this done. and the first response i have is what if the civil rights movement took that approach? is just too hard to have full empowerment for citizens. let's just take it incrementally. i don't think i would've gone over very well so i think certain things are just so right you have to fight for. at the second point, and i think

we have proven this in florida. and i want to spend a lot of time about this today, i hope i'm asked about it. we have taken an incredibly hostile environment to broad parental choice. and we have turned it around, and you can make your political environment for educational reform more funding for all other options if you pushed for broad parental choice. in 2001, we passed the tax credit program for low-income kids, and only one democrat voted for that bill in the entire legislature. and we used the assets that private school choice gives us, from a political point of view and a legislative point of view and i would love to talk about those in more detail if i had time, but parents, ministers and others, we use those assets to change the climate. and any most recent legislative session, a terrible budget session, we expanded this income, half the democrats voted for the bill.

majority of the black caucus voted for the bill. 100% of hispanic caucus voted for the. one of the sponsors of the bill was the leader of the democratic party in our state senate, and we have completely changed the environment in florida such that it -- there is now a growing consensus that bipartisan consensus around broad parental choice. and charters basically exist in that safe harbor of support. did you get a legislator to support a tax credit program, which we can do, they will support charters, they will support merit pay, they will support curriculum changes. they will support h. everything else is easy. so one of the messages that i want to be with you today is, i think that charter advocates, if they are charter only, are selling themselves short on the kind of environment they can create for reform by not pushing for broader parental choice.

>> of a. thank you, john. next up is going to be kevin carey. and kevin, i'm going to ask you to be the other side of the story. so why shouldn't, say, progressive reformers like herself embraced this broad-based parental choice? why does this have to be an either/or, charters instead of private school choice. and would you say to john's point that places like jacksonville you would be waiting a long time for charter school if you're a parent, as was this question about this safe harbor that is created politically for charter schools because of the advocacy, unsuccessful advocacy. >> no, i would say -- i think vouchers are a very simple version of a very good idea, which is an idea that i personally support, which is that we ought to give all parents options for where to send their children to school here and in particularly, that you don't have that option by virtue of being wealthy enough to decide where to live, which is what about public school choice has worked and continues to work in most of the country.

and it got to do that in a way that creates market competition amongst schools, and in a way that provides incentives for new actors and new resources to enter the public school system. i think these are important goals. i think they are a vital element of school reform, and again i support them. but once you start to think about how to apply those very broad goals to public education, i think you quickly come to somewhat i think are pretty straightforward conclusions. and one is that given the idea is to spend large amounts of public money in this enterprise, and that there is a very high interest in making sure that children are not exposed to low quality schools. there needs to be a strong element of public accountability. we cannot just rely on market

responds to provide the kind of schools that children need. and then when you think about what to do based on those things, i think essentially you are thinking evolves very quickly to charter schools. i think charter schools are basically vouchers with all of the rough edges going down to it i think ara more evolves public-policy. and they are more effective kind of public policy. they are clearly if you look at what is actually happened as we tried vouchers and tax credits in some places in charter schools and other places, the charter school environment has created a whole new ecosystem of very effective resource intensive nonprofit organizations that are accountable to the public, and yet also have the flexibility to try a new educational models that have the proven ability to bring new resources both financial resources and human resources to the service of providing education in large part to the most moldable

students. district of columbia is a perfect example of that. the fact that we now have a president who is, you know, not as liberal as many people making out to be but certainly a democrat. no question about that. who has decided to, has very clearly made a choice to be pro-charter schools. not a choice he had to make. not a surprising choice. he was very consistent with what he said during the campaign, but it is one thing to say something during the campaign and something else to be handed $5 million from congress and basically have a blank slate to decide what to order issues you are going to use that money to a really, really impressed states on. and say one of those issues, the thing that i will take responsibly for is a charter school caps. artificial, in my mind, detrimental barriers against expanding the charter schools. that didn't have too happen. a democrat could easily have run i think the occupying the white house and be neutral on school

choice, just enough to get by but not really support a school choice movement. that's not what we have. we have a president who again, i think unambiguously pro-charter school. and so in that sense it is really a historic opportunity to break down what continue to be a lot of major rhetorical barriers, to school choice generally. a lot of people, a lot of people out there and i will say this as a progressive, on the left and on the right who are hostile to the idea of school choice you don't really believe in markets and education. i think this is an opportunity to bring it to fold around a policy i did that again that crucial element of public accountability for public resources. >> okay. thank you, kevin. all right. we're going to go to gerard and it is a similar question as to john. again, you have this popular president willing to really talk about this issue. he is embracing it as a civil rights issue, gave quite a speech in front of the naacp a few weeks ago, largely about education, talk about charter

schools. why not say hey, that's an opportunity, a political opportunity, let's focus on that right now? >> first of all, let me thank the fordham foundation for the opportunity to participate in this discussion. in fact, my first symposium that i attended in milwaukee so years ago, the person i had a chance to sit next to, it is good to be here. one of the many deficits that the american school reform suffers from is the inability to show a rank and junction of the fact that we now are in a position where we have to make a decision of do you stay with vouchers or do you go with charters, goes really away from the mission statement that we found. our mission is to empower families, to create quality options for black children that when we say quality options, that includes vouchers and charter schools and virtual schools and a whole host of schools. because when we talked about this in 1999, 2000, we were

visionaries. many other people were talking about is our fault haircare is the big difference. before there was a very large push for charter schools in 1999, when the movement was somewhat still in its infancy, we were the ones saying that charter schools can make a difference and they work for kids if there is parental involvement here before there was a doctor program in washington, d.c., and one in new orleans, only one in milwaukee and at that time one in cleveland. it was going into its fourth year that we were the ones saying that low-income and working-class parents who pay taxes into the system, they should have the opportunity to choose where to send their children. and if it means getting that money for a private school, that's great. they can leap over jefferson's own separation which is more of a political decision than not. and so we don't see any need to have to choose one or the other. we support charter schools as baeo. from the gates foundation to

open up to small hostile to so rather than become an opportunist, were going to focus on being a proven options and that is to make sure we support them all. what i also find interesting is that people don't want to support vouchers because they only held 1% of their children. when we talk about school integration and the whole push for brown, schools and education and what do we say? we need to increase the magnet school programs while we fix public schools. went tfa came into the market place to bring in quality teachers, they have a historic peace. they didn't reach more than 1% of the children at one time. what did we say? we need to increase more quality teachers and tfa while we fix the school system. even with charter schools. they are not educating old unquote more than 1% of the student population. and what we say is let's expand 1% and at the same time increase

the charter market. it becomes very interesting when the only there was 1% of kids in voucher schools we do and about-face and then say what about the other 99%. very interesting. i think it is a line of reasoning that is going in the wrong direction. were pretty clear on why we support both and we see ourselves supporting charters and vouchers along the way. >> so what your state superintendent in ohio, the legislature created the cleveland voucher program, the charter school movement grew dramatically. eventually the court case went to the supreme court with your name on it. but you have indicated that you think perhaps the school choice movement isn't the centerpiece to educational reform. tell us about that. >> at state superintendent in ohio, i was responsible for administering to voucher programs, or as it is called community schools. i am here today both as a former school officer but now senior vice president of a corporation for public broadcasting in education where i have actually

no official position on either vouchers or charter's. but i have never let my personal beliefs about charters or vouchers interfere with my professional responsibilities. to ensure that these programs were administered fairly and with integrity and with the authority given to me by the state legislature. when the voucher case was settled, i did say while the court is back, the jury is out. and the reason why i said that is we had some longitudinal data about the cleveland voucher case, and the reality was that the data was a wash. it was unclear whether the voucher students fared better in the program and a comparable student in the cleveland public schools. you know, as a state superintendent, i always ask the question what is good for our children? and actually, i do believe that community schools or charter schools are good for our children. it's hard for schools to address the needs of all children, and

public education needs experienceextremeedition and in, particularly now in the era of individualization and customization. so i look at charter schools the same way al shanker look at charter schools, which was for the research and development opportunities for our public school system. and you might remember that ousted was the first person to propose charter schools at the time when my friend was assistant secretary who then opposed charter schools. so i always thought it was a divine justice that i was the state superintendent that gave you guys the charter. but given that, you know, i really see that a charter schools can in fact be part of a larger school strategy. however, as state superintendent, i really focused very hard on raising the bar for all children and closing the achievement gap, and really building a strong viable system of public education. first, by raising expectations,

for being very good about what we want our students to know and be able to do so in a comma importunity was a in the same and the rich could very. i work hard and aligning the standards to a new system of assessment and curriculum models, and as i was leaving we were really working on a new vision for assessment system which really dealt with the whole issue of multiple measures. he worked hard to build the capacity of the system to meet these expectations. we redesigned our whole human resources and for the profession, we decide our policy for recruitment to retirement. we advocated for a new vision of the teaching profession, around differentiated roles and responsibilities, and differentiated compensation systems. we try to help districts and schools that needed it the most, but developing a set of diagnostic tools and technical assistance tools, and developing turnaround teams. we engage the community through a variety of different community engagement activities and we try to support innovation and

experimentation in many of our policy issues. we also worked hard to develop a fair and credible accountability system, and we were one of the first states to put in value added measures. but you know, as state superintendent, i did not focus i think enough on the power of these new emergency and technologies to use our public school system more effective and efficient. for example, how new media can engage students in learning and how to convert a 19th century analog system of public education into a new digital learning environment. and quite rightly, that is one of the reasons why i came to the corporation for public broadcasting. at cpp -- cpb, we fund productions for educational content on line, on air and in the community. public service media through broadband should be in every school in our nation. our content is a trusted source of information for parents,

teachers and communities, and our educational materials are motivating and engaging and are of high quality. i believe if we integrate public service media, which for example, can provide multiple representation of difficult concepts into the curriculum, we can do a better job of motivating, inspiring, and helping poor children. my mission is to integrate public service media into standards sessoms, teaching development and link our content into state database systems. where teachers can in fact use this content to customized structure for students. we will be devalued and we are guided and important art ranges in these emerging technologies and i welcome the opportunity to work with public schools, charter schools, or voucher schools in this endeavor. thank you for the opportunity to be on the panel. . .

issues of church and state separation. i know the zelman decision has brought some law around but that doesn't mean public policy ought not to consider to respect the sort of historic and i think very wise separation of church and state in the united states. we have had a robust system of faith-based education for as long as basically there has been

a country because we have a very robust system of faith in the united states. we have, you know, a very pluralistic society with many institutions that have resources and are able to give parents those choices and are able to subsidize the cost of religious education so i'm not sure -- there's no reason for me to think that's going to change nor there needs to be or ought to be a new infusion of public funds in the service of religious instruction. >> john? >> i totally disagree. first of all, there's certain children -- and i think those of us who work in this field, and many of us do -- there are certain children who are only going to be saved by faith-based school. my goal is not to put children in faith-based schools. my goal is to put children in school that works for them. i have literally had hundreds of conversations with parents and children who have said to me if i had not attended that school,

i would not have survived. i was going to join a gang and i was going to drop out. i probably wouldn't be alive and it was the faith-based aspect of that school that saved me. and the academics and primarily the faith-based aspects of the school. the faith-based schools have to be in the mix for how public education is going to be delivered in this country if we are going to save low-incomed children, period. and you say the court has put some structure around this but maybe public policy shouldn't allow faith-based schools to access public funds, well, i guess, i would ask, do you also object to the g.i. bill. students for a long time have taken public funds to go to faith-based colleges. should that not be allowed as well. in florida we have a pre-k children where 100,000 kids take funds and attend faith-based

pre-k funds. same case in new jersey. should that not be unlawful and not allowed? we have to be consistent across-the-board. these are schools that are very unique and eliminating them, you take one of the most vital tools to closing the achievement gap off the table. >> so let's keep pushing on this and susan, i want to ask you about this. >> sure. >> now, kevin said there's been support for these faith-based schools and that's true although we see in the catholic sector particularly a real crisis, 300 students displaced since the 1990s because of closed inner city catholic schools. you look at the supreme court, the two minority members of the supreme court sonia sotomayor, clarence thomas -- both went to catholic schools as young people. you know, and yet we see catholic schools closing. so the zelman decision, as you know famously decided that there wasn't a constitutional problem with the vouchers going to religious schools if it was an issue of parent choice and there

was lots of choices in the system. what's your own personal choice as a matter of public pale, catholic schools, other religious schools should be in the mix? >> i believe the separation of church and state and the way it worked in the cleveland voucher program and still works is that the money goes to the parent and the parent theoretically chooses to go to the parochial school but the reality is to make sure that that choice is strong, we send the check to the parochial school and the parent comes in and signs it. but from a policy perspective, i really believe very strongly about the separation of church and state. however, you know, i taught at a catholic college for 14 years and worked very much in my -- in my younger life with the archdiocese schools and they have played an important role in serving poor kids in poor communities and i think we -- i

mean, if i were a district superintendent and a parochial schools were having financial difficulty in my district, i would really try to work very hard with them to assure that we could form some type of partnership where religious instruction was not taking place in the day but they could be absorbed in a public school system to keep the parish community school element going and do something. first of all, i think it would be very cross-effective for us to do so because when a parochial school closes, the students usually go into the public school system. sometimes there's overcrowding. sometimes new schools have to be built. so i am for forming a partnership in terms of what works. >> okay. you know, i told susan ahead of time -- i had to admit i was trying to see if she would do a jane doe here and renounce the zelman decision. that would be an interesting newsworthy event. you haven't quite done that yet.

you're on the line. you're on the fence. what do you think, when you look out at this particular crisis in catholic education happening in many of our cities -- we had literally good choices that are disappearing, what are some effective ways to keep catholic schools alive and is that a reasonable goal of public policy? >> we can't reduce this discussion to the advancement of religion because that's what the opponents of vouchers do all the time. they use the separation of church and state argument often. and in cities where we work, parents have often said well, i thought i could participate in the voucher program because the constitution said the separation of church and state doesn't exist in the constitution. and the whole idea was separation of church and state comes from a letter that thomas jefferson wrote to danbury baptist where he talked about separation and church and state and that we somehow incorporated that into our lexicon about school reform. this isn't a discussion about advanced catholic schools or

religion. this is about advanced parental options and if they choose to put their child in a religious school, amen, if they choose not to, amen. i want to make it clear this isn't a catholic or protestant or religious debate because in the wisconsin law there's an opt-out of religious education and they can opt out. what they have done is go out to the streets, what i call the soul to soul movement. you got to put on shoes and touch people. in july, louisiana had signed a new law to create an opportunity scholarship for students there in the six-day period we walked 18 zip codes. we were able to get 1,088 parents to sign up. you don't do that just by going on radio, although that helps. you have to get out and do it. guess what, this past weekend we had to reach out to parents again in new orleans. not one parent said, you know, what? i'm going to return my voucher

to you because president obama supports cheaters. -- charters. no one said well, if i support charters -- i mean, vouchers, am i undercutting the resourcing of the public school system? these are parents whose children would be undercut by the public school system. although there are good public schools that work in new orleans. so much of what we debate about vouchers and charters is cocktail conversation for the materially comfortable. that's what we do. but when you talk to people who have to live with the consequences of public policy decisions made by people who aren't on capitol hill, it looks very different. so we spend time with the soul to soul method. parents have been great. and these are parents who voted for the president and yet none of them have said, again, i'm not going to participate because the right wing is behind this. they don't care the right wing or left wing as long as they give children wings to fly away from schools that don't work and fly to the schools that do. >> the church/state question as

a reason to oppose vouchers. another issue that comes up and kevin raised it was the issue of accountability. this concern though private schools are accountable to their families, to people who pay tuition to people choosing to send their kids there. there's no considerations in terms of testing, in terms of reporting. accountability that we have in mind when we think about the no child left behind act, things like that. let's start with you, john. how do we address those kinds of critics? fair and an area where we need to do a good job to support vouchers and tax credits? >> yes. it's a very legitimate criticism of the parental choice movement, the school movement and there's healthy debate in the movement about this topic. my own personal opinion and very strong opinion is that if you are a private school and you want to take a certain number of children on a publicly financed program whether it's directly through a voucher or indirectly to a tax credit -- if you take a

certain number of kids, then you're going to have to be accountable to more than just the parents. you're going to have to be accountable to the taxpayers. you're going to have to be accountable, frankly, to the legislators who created the program. you got to be accountable to the public. and, obviously, there's two areas of accountability. there's fiscal and there's academic. i believe again that there's -- if you take a certain threshold of kids and there's a lot of debate where that threshold should be, you must show to the public that you're using the money properly. it's not hard to do. i mean, you should do an audit of your books or a financial review of your books and, you know, i think that's the easier thing to tackle. the harder thing is academic capability and transparency. i believe personally and there's a lot of debate on that -- i personally believe if you take a minimum number of kids, then you need to demonstrate again not just to the parents but to the public that you are making a certain amount of progress

academically with those parents. and how we implement that, we have to be very, very careful about because you don't want to overregulate or impose things on the private schools that will, you know, take away the uniqueness that have made them so effective. but i think that's something that we're going to have to start doing if we want private school choice to be on the table as one of these delivery options. >> okay. so let me ask kevin and thennard in the context of voucher accountability we should have something of a sliding scale. the more public dollars a private school gets via vouchers or tax credits that means the kids they're serving those programs the greater for transparency and accountability. so if you're a school in milwaukee where all your kids are on scholarship be publicly funded you are a public school and you should have to take the public tests to be very transparent.

if sidwell and the requirements should be much less. those kids should participate in evaluation but you shouldn't have to be transparent about how all the kids are doing on standardized tests. is that the basic idea? does that solve your concern around accountability? is that something you would be willing to look at. >> well, it seems arbitrary to have some number and say if a student is at a school that the number is not high enough, therefore, there is no accountability about whether or not they're learning. i think on some level this starts to become kind of a semantic discussion about what the distinction between a private and a public school is. private schools quite properly are going to want to retain autonomy in terms of curricula whether or not they want to have a religious element in their instruction, who they hire, et cetera, et cetera. i think that's -- again, there's a role for private schools and i think they ought to hold onto their private nest, if you will. but the quid pro quo is you don't get to take large amounts of taxpayer dollars.

and -- but remain private at the same time. and i don't think that we can rely on -- merely on parental choice as our marker that a school is of sufficient quality and we know this empirically from the charter schools. there are charter schools that are successful in convincing parents to send their children there. presumably, parents are satisfied enough to have made that choice and yet we know when we overlay a test-based accountability system that there are very poorly performing schools. it's not enough to show you're spending money properly, you need to know you're spending it effectively. and there are plenty of charter schools that have not demonstrated that and that's why we have these public:ib accountability mechanisms where if they don't perform they get shut down. and again, you can't just wait for them to go bankrupt for lack of money. i think our obligations to

children require us to intervene much more directly than that. that's impossible in a private school. the government should not be able to shut down a low performing private school unless it, you know -- you've descend to a level of criminality but it also means you can't have enough accountability -- as much accountability as you need. >> okay. though, it should be said several of the voucher programs do have public accountability requirements. milwaukee added some new regulations. some that were focused on testing and accountability. some in other regulation kind of areas and in some ways to be able to enter the program as a private school in milwaukee it's kind of like a process that charter schools go through. let's ask about this question. this is such a hard one. poor parents have chosen a school. they've chosen to keep their kids in that school but the test scores are bad and this can be a charter school or a voucher school and now the government or the authorizer or somebody is going to come down and say, we're going to close that school or we're going to withdraw the

scholarships. we're going to basically second-guess the decisions the parents made because we don't see the results. what do you think of that dilemma? >> there's definitely a healthy debate within the proscholarship side of the camp on the accountability issue. even before the wisconsin legislature passed a new law recently, there's been accountability in the milwaukee choice program from day one. it's amazing that people speak as if accountability was lacking or was nonexistent. the accountability standards matured as time went on and we learned more in 2009 that we learned in 2009 and so we grew with that. but to act the only reason that the program in milwaukee or even d.c. and now new orleans are all of a sudden accountable is because the critics said if you become more accountable and if you take tests, then you're more legitimate. i'm not sure they're in any position to talk about accountability. every time a child drops out of

school in washington, d.c., and can't get a job, the public school lost money. every single time that a kid graduates and really can't figure out where to go, where to invest more money, that's a problem. i support accountability. to be real clear, accountability for some people means overregulation and then a very smart way of getting lawyers involved who then come back in and say, guess what? there's so much regulation now in the private school it really is a public school and, therefore, really did -- you know, offend the first amendment and now we're going to close it. don't think some people haven't worked out some of that logic. i think accountability is important. i'm just not sure that test scores alone can prove that. and it's interesting that we can close a private school for failure but in traditional public schools we let them open up year after year. >> okay. and this is interesting. it's the point you're making about excessive entanglement if the government became excessively entangled with religious schools we would have a constitutional problem. >> what our critics are saying,

here's a role. we call it a jump rope and we'll jump so much and take so much regulation it's a noose and by the time we're hanging we realize it wasn't a jump rope. >> i didn't quite hear you answer my question. >> okay. >> in either of the context, say charter school context where kids do have to take the test, let's say in milwaukee where the wisconsin test is ridiculously easy. we know that from studies we've done at fordham but there's a school where the kids are not passing the test year after year. they say it's safe and it's better than the other choices does the authorizer or the government have the right to close down the school that we don't see the results academically? >> yes >> that seems to be taking choices away from parents. >> just because you choose a school doesn't mean it's a quality school. for example, bale added quality to its mission even though we

didn't have high quality schools because we realized a school opened is quality. in a charter school sector they close, that's part of the contract that you make with the authorizer. >> susan, i'm going to ask you a question and i'm going to get the audience in here in just a minute so start thinking about your questions. so you talked a lot about a broader vision for school reform. so let me ask you and i'll ask the other panelists too. what role do charter schools and maybe private school choices -- what role do they play within the broader reform movement. is it helpful competition or r & d or how does it fit in the broader reform world? >> first of all, i think it's helpful competition because when i think about my urban schools in ohio, we had eight large urban districts, they were really losing population to charter schools. and surveys really told them that parents did not like the way they were treated in public schoolsnpñ and they wanted a sa productive education environment

for their childrenm5 and they wanted choice. now, i think our urban sort of realized it's hard for our schools to be all things to all kids and in the era of individualization and customization what is happening is that many of our urbans are developing a lot more options within the urban system, magnets, different types of schools, which are trying -- 'cause they're desperately trying to keep kids in school, and i think they are much more focused and have a greater sense of urgency around education reform as a result of this. so i think competition does work. and i think it's made our urban superintendents less tactical and more strategic and more willing to serve their customers. >> okay, interesting. kevin, same question to you. is that how you see the role of charter schools and mostly healthy pressure? why couldn't vouchers play that same role?

>> well, i think -- again, i'll use d.c. as a pretty easy and obvious example. one, to the point you made earlier, a pretty rapid increase in the availability of school choice options. so if you have the right set of policies which means fund charter schools and have strong oversights so you'll have good schools, you can, in fact, see a rapid expansion of school choice options for students in a relatively small amount of time. we're up to, i think, close to 40% of students in charter schools as of this year. but it's not just about putting pressure on the public schools. i mean, you know, we had -- the thing that's put pressure on the public schools to improve here in d.c. we had a mayoral election. that was the signal event that changed the attitude toward public education. i do think that's part of the role of school choice to provide pressure but to me, in a lot of ways, the most exciting thing and the most important thing is

creating space for essentially nongovernmental public school providers. that's what these charter management organizations are. the most successful ones, you know, your achievement first. i mean, there is -- because of the charter school law, there are brand-new, you know, school buildings -- investment of tens of millions of dollars of new educational resources here in d.c., not taxpayer dollars in the service of public schools in the toughest neighborhoods in the city. that's all because of the charter sector and that's all come through these nonprofit organizations which again have the ability to raise capital in ways that i think private schools to do which would be for-profit schools to do and have a mission to serve the students whom i think everyone on the panel thinks ought to be served. so it's creating room for education and entrepreneurs to come in, escape the sort of bureaucratic chains of some of

our traditional public school systems and really do what it takes to provide excellent public education. i think that's the most important thing that charter schools have done. >> john? >> everything kevin just said about charter schools is true about private schools in urban areas. everything. they have a mission to serve low-incomed kids. they are free from bureaucracy to be innovative and effective. they bring incredible investment that is not taxpayer funds to dying urban environments. in milwaukee where they had a vibrant private school choice program for over a decade, there's been over $100 million of private investment brought into the city of milwaukee to expand private schools all private-funded. everything kevin just described is possible with private schools. it's possible with charter schools. my point is, why not do both? why exclude them? why take one of those options off the table when it is a unique and different option that is the only option that's going

to work for some kids? and i think i heard kevin say, well, charters -- you know, don't worry mom in jacksonville. remember the mom i talked about in jacksonville where there's only six charter schools in a huge urban district. i think what i heard him say, don't worry, mom, charters can expand fast enough such that one will arrive in your neighborhood in time to save your kid. that's a tough sell. and remember there are 90 private schools, not all of them are excellent but some of them are. 90 private schools that exist right now in jacksonville that she wants access to. don't deny her that access. >> and john, say some more then -- what do you see private school choice. what is that larger role within public education reform? do you see competitive effects in florida? >> in florida, fighting for full parental choice -- and we fight for charters. we fight for virtual schooling. we fight for magnets but we fight for the whole spectrum.

and again, full parental choice for low-incomed families is the tip of the reform sphere. if you get get a legislator to back that, they're going to back everything that you want to do, everything that susan just described, all which are wonderful -- they will back all those reforms if they will back private school choice for low-incomed families and you can get them to do it. i mentioned earlier that we were in the worst environment for the support for -- to try to create bipartisan support for this idea. in 2001, it was the most peculiarized environment you can imagine. i mean, there was a lockdown on the democratic party in our state against parental state across-the-board. and we have reversed that. i don't have time to give you all the examples but, you know, we have the most beloved black democrat in our state who used to be a very outspoken opponent to school choice. she's now running the school choice program. she's a participant. her nonprofit gives out the

scholarships. there's been a sea change there. what it does it starts to kno down the barriers and it starts to change the dialog and it creates this -- what i call the safe harbor and i'll leave you with one more example that will blow your mind. last week, we announced a joint venture between my organization, a private school choice organization and everybody knows what i do -- we're in a joint venture with the hillsboro public schools and the hillsboro teacher's union and that joint venture is going to be providing professional development for the teachers at the private schools that are serving the tax credit kids in poor areas. and the district superintendent and the teachers union president in hillsboro said these are all our kids. we got to take care of them. that kind of stuff would not happen unless we're out there fighting for this idea and making people believe in it. >> this is about the eighth largest school district in the country. >> absolutely.

>> big deal. kevin, are you willing to skied that it's helpful to have people at least advocating for vouchers that helps the charter school movement? >> no, i'm not really to skied it. the politics is a major issue. like it or not, i mean, vouchers have become an extremely well-known and an extremely politicized idea in education. it's essentially something that every conservative knows they're supposed to be in favor of and every liberal knows they're supposed to be against. now we can lament the fact that's the case and, in fact, you know, there were -- there's some historically you go back to the early 1970s. there were some very interesting progressive provoucher ideas that were floated up and never went anywhere. but that's the reality that we have today. and i think you mentioned earlier well, some people are against vouchers because they think they are a right wing plot to destroy public education. well, there are, in fact, right

wing people who want to destroy public education who want to use vouchers to do it. none of them are sitting here in this panel today. they don't work at the fordham institute but there are certainly, you know, folks who say, if they are, you guys are doing a good job in keeping the secret. but there's certainly folks who say, look, we need to privatize private education and break the teacher unions and save ourselves a lot of taxpayer money and vouchers are the way to do that. vouchers -- and, you know -- i mean, vouchers are tainted by that and so that -- i think that also kind of -- what that does is it makes it harder to pursue again a more moderate and well-designed set of school choice policies, which is charter schools. for a lot of people, speaking to somebody who speaks to progressives a lot, a lot of progressives see little difference between vouchers and charters even though there's the essential difference in accountability so i think it hurt politically speaking. i think it hurts as much as it

helps. >> i'm sorry, can i counter that? i think that is a washington, d.c. mindset. i'm not trying to be offensive here. >> that's okay. >> and again, i point to my home state. we were exactly where you just described, kevin, where democrats hated vouchers. hated private school choice. there was a lockdown on their party. we've come 180 degrees from that. so don't give up. it's not that hard. if we can do it in florida -- maybe you can't do it in d.c., but i think you can, but there's some stuff going on that a lot of people only know about. we're about to get some programs, tax credit programs in states that are going to blow your mind and the efforts are all being led by democrats. and this is the kind of thing -- i think it's going to be like the berlin wall. after the berlin wall, everybody said, oh, yeah, i saw that. they didn't know that was going to happen. there's stuff going on right now -- we're going to come back here in three years and say holy

moly, we should have seen that coming and i can't wait to come back and talk about that. >> what do you think about this political conversation? kevin says, look, vouchers are tainted. they're forever tainted. by the association with the right wing. how do you see it out in the field? >> five years ago, dr. fuller, who's a founder and chair of bail, myself, and some other leaders -- we got together and realized one of the biggest impediments to the school choice movement in america were central city black democrats. ..

what is political about that? voters are the extension of what black folks have fought for in the 20th century. it in the 20th century was making sure they participate and in the '60s it was committed to control and the '70s it was the independent school movement and in the '80s it was on the accountability movement. vouchers it is just one medium for a bigger piece of participation but again the parents will see this political, what they think as political is the ability to be told to say

where there. >> it is interesting the politics. remember hearing from some of my liberal friends that they felt like the bush administration, which i was a part of the way back when, did harm to the charter school movement because we were in favor of charter schools and just having, white conservatives and having president bush and conservative republicans in favor of charter schools was that for the charter school movement. it is not a totally crazy argument for gun lse barack obama in favor of charter schools is going to help on the left it more people on board but these issues go each way so we have to see how they are floating. let's give the audience into this conversation. raise your hand and we will get a microphone to you. please tell us you are and please give your question right away, making a question and not a speech. fae i see someone put their hand down after that. [laughter] now justice beach, refrain it as a question. we have got a hand up up here. >> my name is chris and i am

from buffalo new york and cofounder of the lice dystocia hyundai private voucher program and buffalo. we have been running the program for 15 years and we have about 1,000 kids a year. thanks also to the partnership of washington, so that it is a scholarship fund at of new york city, the children scholarship fund. one reason, the reason i was so interested in coming today and why i think this is so timely, when we started the program 15 years ago, we had about 50 schools, mostly parochial, some of the other denominations. our children to and an abundance of schools that were around many for 100 years, built by emigrant populations, but since left largely a minority, largely non-catholic populations by providing a great education and values based education.

in the last ten years, almost 50% of those schools have closed. so, beyond the policy of how we work a bout church or whatever, i think there is a public policy, do we see a value in having these institutions here? in our cities and my bias is the city come in our cities and do they help the overall environment as far as charters an improvement in the district's schools, and it is clear to me that the model, the financial model that is important to those schools so we have heavy support from the parish and largely not paying the people that work there, that that is not there anymore. >> so, susan says there can be partnerships with public schools. what we see what they say? >> the question is, the reason i feel so strongly in the discussion needs to happen now, if we wait ten more years until the next administration comes in

who has an interest, that infrastructure, largely will be gone, and then we will have private schools remaining that were largely on the servicing higher income people and not a minority people, so that is the challenge i think in the timeliness and a sense of urgency that i feel from my community. >> great, thanks chris. great question. back to this question about catholic schools. what is the right response to this crisis? >> it is a good question and i don't mean to minimize their real potential loss of institutions that have been both effective educationally and really vital parts of our communities going back decades. i think we do need to recognize that this isn't just about education. there certainly have been larger and very profound changes in the nature of american catholocism over the last 50 years. a lot fewer seminaries than there used to be. i don't think anyone is talking

about the government stepping into make sure that we are producing more priests and nuns and people who to your point used to work essentially for free or not as much money as we now have to pay people to work in schools. at the same time i think we can't have it both ways and parental choice. if you think it is important to give parents choices then they are choosing to not send their children to catholic schools and that is kind of the way things are working out, we see here in d.c. where catholic schools have chosen to infect convert to charters that this. it seems reasonable to me that an institution could provide a, an appropriately public education that he does not breach that important separation of church and state and that their religious institution could from its own resources provide religious instruction to students and a different environment as it has, as they have not just in the catholic church but in all kinds of dates for centuries and always will i think. >> of course the parents that

are not choosing catholic schools anymore, tuitions are rising. >> except for the parents are choosing them. >> parents can afford to send their kids there. parents are desperate to send their kids there and the schools which are graduating in many cases 100% of the kids are dying off while we sit here and debate and the academics, that is insanity. the answer is very simple. we have got depass programs such that we can access public dollars whether it be directly in the form of vouchers or indirectly in the form of tax credits and give the parents and buffalo as they have in florida, as they have in pennsylvania, as they have here in d.c., give them the empowerment, give them the money to make the choice to go to that school board the school so they don't go away. it is as simple as that. it is black and white. >> now, that doesn't succeed in the short-term what about this idea of converting more catholic school to charter schools, doing religious school before school

and after-school? is that a reasonable option? >> the catholic education had its institute of the late last month at notre dame, were the subject came up for the right now the jury is out on how that actually would happen. we know here in d.c. that is taking place in you had mentioned it as well, in the ohio schools. i am still thinking about that. >> fair enough. let's get another question. raise your hand. tell us who you are and make it a short question. >> it is a question. actually two quick questions. kevin, my first question is a political one. i once heard howard fuller say look could you give up on vouchers they will be acting charters next, so i mean i want you to respond to that political question. >> let's take that one first. >> i don't believe that is true. i thank there are obvious and fundamental differences between vouchers as they exist now and

as i think vouchers supporters would like them to exist in the established, robust and growing charter school sector and the differences are in fact that the necessary differences and order to have broad bipartisan political support, which is why i am sitting here as the progressive supporter of public school choice. >> okay, second question. >> just in terms of supply high-quality options if you look at the figures of faith-based schools, not as catholic that are dying in our inner city in the short-term how do you replace them especially when you look at the slow pace of growth of high performing charter networks? what is the good way to replace those schools for those four kids now as opposed to funding those parochial or other schools? >> i will say it again, i think it is not the government's role to step in and subsidize religious institutions that for a variety of reasons are struggling, and i would assume

that that is a world that is an attitude that people who are pro-faith would embrace. again, the separation of church and state, it is not as much about protecting the state from the church as it is from protecting the church from the state and i think, so i think we need to-- [inaudible] >> so what you do right now for the kids is catholic schools are closing? >> i have no problem with allowing charter, a catholic schools to convert to charters that is it they are willing to be subject to the sam accountability that everyone else is subject to henigan i think it is very clear that given the right set of policies in terms of governments and funding you can in fact quickly create an environment where you will have a large growth in charter schools because that in fact has happened. >> first of all you are not subsidizing religion. you are subsidizing parents to make a choice to send their kids to a religious school.

there is an incredible difference and if you just do that, then the schools will survive and those options for those kids will be there. and, i think it is ludicrous to say it is too politically difficult to keep the catholic school a catholic school, so let's do the expedient thing and strip it of its religion and make it a charter school, so it is easier politically. that makes no sense to me. if you talk to parents who send their kids to a catholic school and then after it converts to a charter, he made it surprising opinions about that. they have strong opinions about the kind of school they want to send their kids to school and a charter school is not the same thing as a catholic school, period. >> when the conversion happened here in d.c., there were six of seven catholic schools that converted to charters status. my understanding is they lost half of their student population as some of those kids live outside of the districts of they could not attend the public school in d.c., but they get and

the whole nother way that kids who are now very excited to get to go to these schools for free but it was a very different mixture kids even though the schools from the outside might look the same. of course the crosses are now off the wall. >> i think this whole discussion of around the interaction between public-school choice in catholic schools points to i think a larger deficiency in the voucher idea, which is that it is very unclear to me what they plausible scenario is, whereby some significant increase in the out-years what in fact engender a market response in terms of greater supply. with were just talking about a system that is probably going to shrink one way or another, again not for educational reasons and keep them going for a while or something along those lines, there has been little or no i think really success in terms, from the for-profit sector which we haven't talked about but presumably any kind of growth

scale would involve bringing in money from the private capital markets and get the one big example of edison schools going bankrupt, so again, with charter schools, there actually is a model with the organization that is working, that retains all of the positive aspects of independence non-governmental public-school providers in terms of the innovation and all of the rest of it, but gets us away from these political, church and state issues but in fact is more effective. >> but with a lot more money. >> kevin is saying that these catholic schools and private schools are going to die and no matter if we fund appearance with enough money to attend. that is just not sure. >> that is not what i set. >> what are you saying then? >> i just said, the public school is going to be anything other than a niche program, as a

topic of discussion but it is really going to matter substantial percentage of schoolchildren then there has to be a plausible process by which it would, they would expand substantially from where they are now, but yet the one aspect of the private market that we are talking about that we have spent spending most of our time talking about, the catholic school market is contracting. >> why is it contracting? >> it is certainly not because of charter schools. >> why is the contracting and urban areas? >> to the extent-- >> it is contracting in urban areas because the parents who want to go there don't have enough money to pay the tuition, and i will just refute what you say with facts. milwaukee, wisconsin, where they fund each parent with roughly what is it now, $7,000 per kid, which is a huge discount by the way in what they spent in the public-school system.

day fund each parent would $6,700 their catholic schools there who have private money, greatly expanded their seats. you don't even have to think about or worry about directly funding schools through the government. you don't have to worry about the church and state separation. if you adequately fund people, even at a discount in what we are spending in the public schools, the private schools, as they have done in the waukee will attract private capital and as they have done in the waukee will expand their spaces significantly. >> we did find in a report last year that the overall market in milwaukee, the catholic schools did still contract. interestingly in the lutheran schools in milwaukee, they responded-- >> i think you'll find a cheap thug into a rd&d quality schools are the ones that expanded. >> i lived and worked in milwaukee for two years, left charlottesville to immerse myself in these good, bad and ugly school choice and i can

tell you first-hand the schools that had a waiting list were looking for more money to come in. we it is true that there was a contracting population of catholic schools, last year of 125 schools and only 33 were catholic so there's the whole number of those schools that aren't catholic, jewish, muslim, protestant. we forget about those folks and these are the ones we see a growing population because mike said the catholic schools, timbers said of the kids are scholarship and the protestant schools that is 100% so you open up a brand-new market for people who are waiting to enroll in if you like it urban school districts their population is going down where the applications for vouchers is going up every year. >> okay, let's get another question. i see one right here. tell us your name, where you are from. >> dill mcdonald, national caplet association. in this discussion and elsewhere when accountability comes up the presumptions as the private school has to do the same thing

as the public school to be accountable, and my question is, will differentiated measures that respect the independence, the difference in curriculum and standards in the private school ever be a viable option? >> to translate, let's say the public-school people have to take the state test, would you allow for accountability in the private sector for the private schools may be to pick their own tests and national standardized tests, different than the state test? >> not justice. >> not just the tests, graduations and things? >> as i stated earlier in order for private school choice to be a viable elements in the performing mix that has to adopt a certain level of physical and academic accountability and transparency. now, what is going to have to be done in order to be viable is going to vary on the state to state basis. you might have one state where they don't have to take the state tests, where they can take

a national test and only redbait-- repeat then scores just and a scholarship program. you may have another state where it you want access to public funds weathered be directly or indirectly you may have to take the state test, and schools are just going to have to come a private schools are going to have to decide whether it is worth the access to the funding, in some schools will make the decision that it is not. >> let me ask you a question. earlier jones it's something very interesting. is this going to be like the berlin wall, we will be amazed at how many states have passed new voucher programs? that cuts agents wisdom about how vouchers might be on bling. what do you think. put on your political analysts have. in the age of obama are we going to see any progress on the voucher and tax credit fund? >> you know, i think when vouchers, charters and tax

credits were sort of-- i looked at this is sort of utopia. i thought it was going to in some sense they the way. however, i think in the era of vendibly galatian, customization which is now becoming not only in education but part of our culture, i really think that charter schools are really going to become incredibly strong, because really, charter schools are public schools and their part of the public system. i think voucher schools really serve a few kids, and i think the issues of public accountability are so complex that it is not going to grow, and i still think liberals, such as myself, still have this notion of tax credits in the days of segregation, when in fact a tax credit helps you support segregated schools in the south, so i see a growth in

charter schools, but not necessarily the other two policies. >> the school choice in its annual report card of schools for 2008/2009 showed there were 171,000 children i believe in 18 programs across ten states in d.c. that are benefiting from a private school choice. if you look at the number of those children who are benefiting from tax credit programs, it has grown over the past seven years ago that is where the growth area is. much lower for a whole set of reasons, but in the tax credits side that is a huge growth from even 2000. i think it was 1999/2000 were there had been 18,000 to 171,000 to date so there is growth there because there is a demand. even though there is a political debate, there is a demand for. secondly, i want to be very clear people often argue against vouchers for the same reasons

the superintendent mentioned because it one time in american history, there was massive resistance and people created tuition tax credits to create white on the academy's which were used to segregate ago in a chapter that i wrote called, brown vouchers and the philosophy of language, did an analysis showing the voucher program in 1994 as the liberty base model which does not remotely touched the segregated race-based intention of the tuition grant programs of the 1960's. from accounting standpoint, a tax credit that smacks of those to have no relevancy in the conversation. >> are you optimistic in the next couple of years that we will see more states passing vouchers and tax credit programs? >> yes, in georgia we have a special needs call on ship program. we have a tax credit individual and corporate. that is going to continue to grow. some people say i don't believe public money should go to private schools. that is why they vouchers but they like tax credits because they get an individual and that at the end of the year.

>> can i come in on this? >> by the way all this talk about tax credits, most of these programs, it is not that the families sending their kids to schools are getting a refundable tax credit. eight is that individuals or corporations can donate to a non-profit scholarship funding get a tax credit for doing so on that is created large pots of money that can be used for scholarships. >> i just heard that liberals oftentimes don't like this idea because of this history of segregation. i just want you to tell you one quick story. two years ago week mccollough to parents who have kids on the tax credits college a program in florida. we told them to come to our capital to show their support for this idea in this program. 4500 people showed up and our capital is literally four hours from the nearest city. we had 1,000 people from i am neesley bollon buses overnight to come and march-- it was the biggest march in our capital

since the civil rights era and i will tell you that there were probably 5% of those people that were not african-american, hispanic and there was probably 80 to 90% african-american. you can judge for yourself. go to youtube and enter the words, florida school choice, and i think probably the third thing that will come up is a video of this day. one of the things that you will see is a man speaking at this rally, and he is an minister who marched with dr. king across the selma bridge. he is the most reverent figure in the civil-rights movement. he was jailed 31 times, sent to state prison, up in front of our rally and said parental choice is an extension of the old movement. i can't give up and say something like that, but he can, so when i hear that liberals don't like parental choice, because it is linked to segregation may be liberals are

unlinks from people like him. to answer your question, i will just give it some more facts. five years ago there were just a couple of state legislatures that passed parental choice programs. at and i should safehouses of legislators. in this year, 25 houses of state legislators passed either voucher or a tax credit bill. there is a trend there but i'm going to keep quiet because i think it should be a quiet moment. we will come back in a few years and like i said we will surprise people. >> kevin. >> i am glad we are talking about tax credits. the fact that we are now having to play these financial shell games through credits is an indication of the widespread and i think reasonable public discomfort with the idea of direct taxpayer subsidies of private institutions. you can say look, the corporation decides to give its

money to a non-profit non-profit gives it to the school in the perron shows up and the government gives the credit corporation. that is again just obscuring the reality of taxpayer money being given to private institutions to provide an education so again the fact that this, this strategy of essentially trying to pretend that direct subsidies are something else by making them less direct shows that there is a reason for that. it shows that the public is i think rightfully not comfortable with direct subsidies. kind of getting back a little bit to the question that came up before about would it be okay to have accountability measures that are individual to schools depending on their mission and curricula, no i think is the answer because if you have that than you don't have comparability and if you don't have comparability you don't have accountability at all. i will ask this question, how many schools are there participating with these voucher programs right now?

which one is doing the best job serving its students and which one is doing the worst job? does anybody know? nobody knows, because that data is completely hidden from the public in terms of how the student, individual students are doing in those schools. we can answer that question precisely, for every school in d.c. and every charter school in the seed for the private schools that are receiving federal taxpayer dollars to the voucher program, we have no idea. that is from accountability standpoint and a bad idea from a parental choice stand point. parents need that comparable data of their corn to make smart choices on behalf of their students and if the market is going to function correctly. >> the cities like new orleans, where they do have, they will be able to answer that question for the voucher program. >> before mill back amended its law which said that children who receive a voucher have to take the state exam, wisconsin

institute showed that over 90% of the voucher programs were taking tests than those data were made available to parents because they knew that. now they are making it available to the public. i am sure the parents at the voucher schools in washington d.c. are not ignorant, i have no idea what my kid is doing. there also privacy issues, but it is not true that their parents have no idea how their kids are doing. >> viewers sing parents no but it is fair to say that policy wonks don't know in dig into the data. >> in milwaukee and i am sure the ball-- >> we have time for one more very quick question. if anyone has a burning one before we have to go. last call. jack. tell us who you are. ask a gary quick question. jack come back out of retirement, recently retired but t of retirement. >> i am a recovering reaucrat from the department of education.

kevin, i would like to address something i think-- and that is that the people who are affected by these issues are inner-city people whose parents want to make certain choices. the people opposing them are suburban, white people who are much more affluent and can choose whatever school they want for themselves. so, my question to you it is, do you feel a discomfort about the fact that excellent suburbanites are making these decisions for inner-city? >> to your question the answer is yes, i do. i personally and i am on the record for saying this, when democrats in congress decided hey we needed to shut down the d.c. voucher program i said i thought it was a bad idea. in fact i think it is immoral to take those kids who are, have

now been given that opportunity to be put in those schools, to pull them back. i offered the following words, may be advised to people who i respectfully disagree with on the voucher side of things. there is a very powerful rhetorical message when you boiled this down to desperately poor parents, whose children have historically been stuck in terrible public schools and say look, yes or no, are you in favor of giving them an opportunity to go to a better school? that is a fair question to ask. but what i would say is, if that is all vouchers are about, then vouchers are in the end not going to go very far. basically, i feel in a lot of ways we don't really have a voucher based school choice program in d.c.. i think we just have the government subsidized, the public to private transfer program again because it is limited because we are not

taking money away from the public-school system so we are not creating any kind of competitive pressure there. it is not so big that any of the private schools are really going to have to make any tough choices about the makeup of their school but he or whether not they want to adjust their curricula or their teaching practices to focus on the needs of disadvantaged do this. they can absorb five, ten or whatever the average amount is. and i've not opposed to that. if somebody came on tomorrow and said we are going to double the size of the d.c. voucher program i certainly would not stand up and say that is a bad idea. that however it's a long way from the really robust and widespread system of parental choice, not just for the students who are worse off but for students everywhere. i think the students in the suburbs need school choice also. i thank drought american public education, i think a lot of the students in the suburbs are not getting as good an education as

they think they are. i think the route, we need to create more market dynamics, more competition, more innovation and vouchers almost particularly the find in these lifeline terms are not going to get us there. >> we are going to let kevin get the last word. we are out of time, but i would ask all of you to join me in thanking our panel for their very useful comments. [applause] ..

[inaudible conversations] does fall into the home to america's highest court, from the grand public places, to

those only accessible by the nine justices. the supreme court, coming the first sunday in october on c-span. see that as a health care conversation continues, c-span's health care have is a key resource. go on line and follow the latest tweets, video ads and links to also keep up-to-date with health care events, like town hall meetings, house and senate debates, even upload your opinion about health care with a citizen video. the c-span health care have, at c-span .org/health care. next remarks of education said terry arne duncan. from earlier this week this is about 40 minutes. >> i am really pleased that the opportunity to introduce him. arne duncan was nominated to be secretary of education by president elect barack obama and

was confirmed by the u.s. senate on inauguration day, january 20, 2009. as you listen to him talk about the reforms in the agenda, it will become apparent why the president selected arne duncan to lead this transformation. prior to his appointment as secretary of education, he served as the chief executive officer of the chicago public schools be coming the longest serving big city education superintendent in the nation as ceo, his mandate was to raise education standards of performance, improve teacher and principal quality, and increase learning options. in seven and a half years, he united education reformers, teachers, principals and business stakeholders behind an aggressive education reform agenda that included opening over 100 new schools, expanding afterschool and summer learning

programs, closing down underperforming schools, increasing early childhood and college access, dramatically boosting the caliber of teachers, and building public-private partnerships around a variety of education initiatives. in other words, he brought to the department experienced in implement all of the reforms in the presidents agenda. and not only implementing reforms, but success. is a bio details the successes he had in each of these areas. in addition to his experience running a nonprofit education foundation, and working with a team to start a new public elementary school built around a financial literacy curriculum. now what you don't get from reading his bio, is his passion for doing what is right for kids. and the urgency he feels about the time for reform is now.

i have observed both of these on numerous occasions, beginning with the all staff meeting he held his third day at the departed. i recall walking into the auditorium and sing emblazoned on the overhead screen, call me arnie. he began by telling the staff he was honored to have the opportunity to work with us as partners. he said he has much to learn from us and much to contribute, based on his experience. he talked passionately about the presidents agenda, and our role in its implementation. he shared his belief that education reform starts locally, in classrooms, schools, districts and states. and that his role is to encourage, reward and support the innovation and progress that takes place at the state and local level. he talked about pockets of excellence, and yet how he wants to scale up best practices.

and he challenged us to make the department of education become an engine of innovation. he also talked about the importance of working with our extra partners. in the last six months, he has visited over half of the states to listen and learn, from parents, educators and community leaders about what is working and what is not. he has met numerous times and conducted numerous conference calls with stakeholders to share information and listen to their ideas and concerns. he demonstrated his commitment to do what's right with kids, most recently with his letter to the chief state school officers urging them to that state policies and guidelines to ensure that every student is safe and protected from being unnecessarily or inappropriately secluded or restrained. as he speaks, be thinking about what you would like to ask him because he wants to hear from you while he is here this morning as well.

please give a warm welcome to arne duncan. [applause] >> thank you so much and good morning, patty. thank you so much for that kind introduction. i think my mother probably voted for you. but it is really an honor to be here and i was looking at the thing, leading change in challenging times. that sums it up pretty well. that's exactly where we are at. and this is a fascinating, fascinating time to be working in education. it is obviously a time of real prices, never ever been on a more financial stress, dressed than me are today. but rahm emanuel, the chief of staff never wastes a good crisis began as many of you know, that in times of crisis sometimes those are the only kind you can

really get the kind of reform that we desperately need in the currency. so we are really at a tipping point, and to me this is absolutely a test of leadership. and staffing that patty talked about, i was in alaska last week, and north carolina yesterday and one in florida tomorrow. as you travel the country you really get a sense that in some places due to the magnitude of the crisis, and frankly due to a lack of strong leadership, people are a little bit paralyzed if they don't know where to move, they don't know where to go. and other folks are using this crisis to push dramatic reforms, get dramatically better. so this is really a test of all of us and a test of our medalist leaders when things are tough, what do you do. do you freeze up? do you go under a show, or do you use this to kind of breakthrough and get to where we need to go. i think the country will look back on education five, 10 years down the road from now and really judge us and see how well we do of using this time in prices and time of opportunity to get dramatically better.

and for all of the tremendous crisis we know we have, it is absolutely awesome and unprecedented opportunity. over $100 billion in new money for education. while money is never enough, i don't know how have you ever walk into a department the first time and had your budget more than doubled. it doesn't happen too often. i was very excited about coming here well before i knew about those possibilities. and so they're really, really is a chance to do something. and what we want to do with that money, first and foremost we want to save hundreds of thousands of teaching jobs around the country. it is in the country we had to get better and we are worried to do the economic crisis that we seize class-size go from point by to forget 40 wheezy social workers and counselors and librarians laid off and we take a step backwards. we all here know that we cannot afford to take a step backward. we have to get dramatically better. so we are convinced that starting this fall there will be hundreds of thousands of teachers teaching around the country in classrooms helping students who wouldn't have been in were not for the recovery package. let me be clear.

if all we do is save jobs as important as that is we miss this once-in-a-lifetime opportunity to drive reform. and we have to get dramatically better. we know around the country we have some students receiving world-class education. we have some students who aren't. we know our dropout rate. for everyone, producers with disabilities is unacceptably high. we know today stakes have never been hi. though students to drop out today are basically a social better. there are no good jobs at the. there is nothing for them to do. how do we use this time in crisis, how to use this time of opportunity to take our country, our education system to an entirely different level? and the presence really challenges dickey said we have lost a wicket we used to lead the world in% of high school graduates,% of college graduates. we have flatlined. i think we have to educate our way to a better economy. that is the only way we'll get to. and i see this as the civil

right issues of our generation. the dividing line today is less a long race and class than it is around educational opportunity. shouldered from whatever background they might be, if they have a chance to go to great schools, they will fulfill their dreams and become productive citizens. if they don't have an opportunity to get a great education they are going to struggle. so we have this huge opportunity, this real crisis, this chance to drive a very, very strong reform message that we can't afford to let this moment slip. and what we fundamentally believe is that every single child in our country, regardless of disability, race, ethnicity, or economic situation, has the right to a world-class education. as patty said we can't wait, we can't afford to lose another generation of children that we have to move absolutely as quickly as we can to make sure every child has that chance to fill their god-given potential. because of the progress made,

under the ida and 88, parents now have expectations so their child with a disability will graduate from high school or go to college, and gainfully employed. student with disabilities today, both of those who graduate from high school in june and one starting doing now and september are members of the new ada generation, a new generation of americans with disabilities growing up with the expectation of academic achievement, employment, and ability to get back to others, and to the community. this progress is largely attributable to the hard work and the passion and the perseverance of parents who work so hard to make sure their children have the opportunities they desperately deserve. at georgia state directors of education, who are constantly looking for new and better ways to make sure that we can educate our children and prepare them for the world once they leave our schools. and today i want to talk through our administration's overall education agenda which some would argue is a little too

ambitious, but i would say it's the only way we're going to get there is like a just every little on the education spectrum. you have to start with early childhood education. and i think a very compelling case could be made that we get our babies, our three and four-year-olds off to a great start. they will have a world of opportunity available to them. if we don't get that in place are constantly playing catch-up. and as an education system we have to get out of the ketchup business and make sure all of our children in kindergarten with skills and tact and the socialization skills and tact. we have to make sure we engage parents. and again, this parent committee has been more engaging than the larger parental committee, i think you learn so much for advocacy and from her commitment and from her hard work. we have to make sure that parents are reading to their children every night, turning off the tv, tha they are actively engaged. we know those early years during brain formation are critically important. and we're not making a difference then, we really put ourselves behind the eight ball. we have unprecedented resources.

north of $5 billion to do two things. to dramatically improve access, to make sure that every child has a chance to go to an early childhood program who wants to. and sickly to dramatically improve quality. if all they're doing is glorified babysitting that is not going to get us where we need to go. but if we can do both of those things, dramatically increase assets, and push quality very, very hard, i think long term those investments we know will pay tremendous riveted and over both in terms of dollars because of the committee but more important helping our students to fulfill their tremendous potential. we have to work very hard on the k-12 agenda. our dropout rate is 30 percent around the country is unacceptably high. lots of positive trends, lots of states, lots of district going in the right direction. i've met with all of our country's governors. i've met with all the states guccis and i've asked them who is outside with her graduation rate is high enough? in the room gets real quiet. there is a recognition that collectively we have a long,

long way to go. so we're pushing it very, very strong agenda and we have some resources, $70 billion to back up those commitments. so how do we want to get that? a couple of reform pieces that we are looking for. first, is making sure that we raised the bar in terms of high standards. college rate, career ready, and international and benchmark standard. and what i've been arguing around and you, there are too many states, we have 50 different goalpost, 50 different benchmarks and ministate due to political pressure we are dumbing down those standiford and in fact we're lying to children and parents. the logical assumption for a parent or student would be they are on track to be successful. we know into a place of those children who are meeting to state dinners are barely able to graduate from high school, woefully unprepared to go onto college. so how do we raised the bar for everybody? we have 46 date working together to come up with, and college ready career ready international benchmark standards. the unions are onboard with this

pick the business commuters are crying out for a. nonprofits like college boards, gates foundation, working very, very hard that everyone is at the table working together. it is so important that parents and the state dredgers of education be at that table to ensure that the standards are being developed that make sure the unique needs of students with disabilities are being considered. as we move forward, we want to be thoughtful. this is tough work. it is complex but we need everyone at the table to make sure we're doing the right thing for every single child and that we can stop lying to children and academic so this is a huge step. a couple of years ago this was a good read if you couldn't start to talk about this. these are not federal standards. these are not national standards. b. should be international benchmark standard and our children should not be able to compete with all the children. that's the competition but that is a global economy we are and we want to make sure that states are doing everything they can to differentiate and provide all

children, including those with disabilities, the chance to meet these much higher bars as they get developed. secondly had weak boost quality? we all know the biggest determinant success is not race, not class, not social economic status. it is the quality of teachers in further. in fy07, spent 80% of more of their time in regular education classrooms. how do we make sure not that every single teacher can be a teacher of children with special needs? how do we use these unprecedented resources for massive professional developers to make sure we're not putting kids in the basement anymore, that we are mainstreaming, we aren't going to make sure every teacher has the capability of supporting the students. how do we do a much better job of not burning out our special education teachers? we know how to network is, we not overwhelming the paperwork is, we know that that turnover is way too high. the loss for our students not just with adults, but a lot of our students is uncatchable.

how do we change that. how do we provide better mentoring, induction, how do we reduce the paperwork? and most important how do we start to be more creative and create incentives for our best teachers, mascot, size, how do we make sure our best years are going to historically underserved communities? be that rural poor inner-city urban. we have to challenge it everyday. i like to focus a lot on what i call the opportunity gap. i'm just convinced that children have been historically underserved have the best and brightest teachers and principals working with them. we have to work very, very hard there. how do we fundamentally turn around our struggling schools? i have challenged states and districts to think not about the 99% of schools. i put schools in three categories that are best schools around the country, are absolutely world-class purveyor of the best in the world we should be learning from them and

replicating for them and sharing best practices. we have a set of schools in the middle that are improving every single day that are quite where we wanted to be. let's lk about the bottom 1%, not the 99% but the bottom 1%. though schools where students are falling further and further behind each of. though schools that are quote unquote dropout factories where 60, 65, 70, 75% of the students are to graduate account with challenge the status quo. had we do things in a very different way? and into it with a real sense of urgency so we don't lose another generation of children. i think we know what we need to do. i think frankly we lack the political courage to do the right thing by children. and soap is a challenge to the country to think very, very differently about this. every year we took the bottom 1% of schools in the country and to fundamentally change what was going on there, turn number one, if we did that three, four, five years in a row we would basically elevate the bodies of our portfolio and i would convinced we would end the cycle of poverty integers where, not

due to a lack of good intention, but due to a lack of good results. we as educators have been part of the problem in perpetuating poverty and social care. how do we think about comprehensive data systems? that really link teachers to schools of education, to understand that he didn't make the biggest difference in our students live. how do we monitor progress throughout a student academic career, each academic year so that teachers and principles and real-time know what is working for students, know what is not working and difference in construction. there's been a wave for data-driven instruction across the country over the past five to 10 years, some of our best teachers talk about how this is transforming the classic how do we make that the norm rather than the exception. had we been much more transpac use data to do what is working, what is not working and help us all get better. i think there is a real significant chance for us to improve there. in all of this, to what end?

to what end? our goal is to dramatically reduce the dropout rate, dramatically increased the graduation rate, and make sure that many more students are academically prepared to go on to college. the higher education act which we authorized last year and with it as you all know came an important provision. for the first time, eligibility for federal pell grants, federal work study, and federal supplemental educational opportunity grant program funds will be expanded to include students with intellectual disabilities. and we at the department of education are working hard now on developing regulations for this law which will be posted for public comment. as part of the package, as part of a stimulus, over $30 billion in new money for college, increased pell grants, increased pergamon. increased work-study. trying to do low forgiveness on the backend, income-based payments of people graduate and want to come back and teach or work in the public sector will not be burdened by such huge loans. there is an unprecedented

opportunity and i worry about this one a lot. the time of going to college has never been more important. it is also been ever more expensive and families have never been under more financial duress. i were not just about the juniors and seniors. i worry about heart really committed nine and 10, 11 year old who had that dream that mom and dad loses her job what i say 50% got. website with resources on the table so that all of our students, our third and fourth and fifth and sixth graders know that they work hard, they do the right thing, regards of what's going on at home, they wil have an oppornity to take that xt step. also, as you know, oneime some north of $12 billion in ida funds gives us an unprecedented opportunity to think about how we can dramatically improve the outcome of students with disabilities. we are encouraging to consider strategy and activities that are consistent with those for reform goals i talked about a minute ago. they should be playing for effective uses of response

should be done within the broader context ofhe schoolwide reform initiatives that are designed to improve the learning outcomes of all students. i think again if we can use a massive influx of one time dollars to help every teacher become a great teacher of students with special needs, that the benefits, the dividend will far outlast where those last dollars are spent. not only do we have the formula-based, the era of ney going out north of $100 billion, we've unprecedented discretionary dollars, $4 billion. we want to invest heavily in state, and school districts that are willing to leave the country where we need to go. and what we want a set of states, whether it might be five, 10, 15, 20, states that are willing to challenge, you know, push the envelope, challenge the status quo and we want to invest hundreds of millions of dollars in two states, in thoseistricts that are willing to take the next step. we have $665 million in innovation to work with bishops

and nonprofit that are doing two things. closing the achievement gap, and they are raising the bar. before i came to washington, i definitely didn't think of all the good ideas came out of washington are now i'm here i know all the good ideasome out of washington. [laughter] >> the good ideas are always great to come at the local level, from paris, from teachers, from you, who are driving change every single day. what we have is a unique opportunity. i want you to understand its. a unique opportunity to invest unprecedented resources to take to skip what is working around the country. for all the challenges i have never been more hopeful, we have more grade classrooms, we have more great schools. we have more great school districts than we've ever had had as a country. think of if we can just scale of those best practices. think it would take us to what works and what to invest hundreds of billions of dollars in the district, in those days, and those nonprofit. they are proving every single day that it doesn't matter of the challenge our students they certainly do the right thing and provide the right set of opportunities, support the resources. our students can go on to do extraordinary things.

patty talked about the safety and restraint issue. and that is one that was extraordinarily troubling to me. at a minimum, before we talk or educating children, our chart have to be kept safe. we as adults are doing things that endanger the safety of our students. we are absolutely do the wrong thing. and so i pledge to you that we will watch this very, very closely. we have asked every state to submit to us their plans around seclusion and restraint. i'm fortunate to come from a state that understood is that i have background in this but this is been way too wide open. and unfortunately the cost of some students to their families have been devastating. it has been tragic. so when we go forward and the next go year we will continue to watch this very closely. we're going to post them publicly on the web. we want real transgression around this. again we want to share best practices and we want to let folks who don't quite get it yet have an opportunity to speed up their learning curve very, very

quickly. [applause] >> finally, as patty said, we are thinking about no child left behind reauthorization. and first of all we need a new name for no child left behind don't you guys have some good ideas. [laughter] >> if you have some great ideas we are open for those. i think i will find a real sport ten-year old and get that idea and run with it. but that is a symbolic part. we have a real opportunity here. we can build upon what works and we can fix what did work that we are traveling the country now that i think i've been to about 26 date. i'm not going to get to every state but state but between me and my senior team we will hit every single state to talk to parents, stakeholders, to talk to children, to talk to teachers, to talk to parents,

printable, community members, to what kind of the poles of the country. as fascinating as big a role, urban suburban, there are some differences there. but the common themes are very, very profound. the challenges we all face i think are much more similar than they are different. as we move toward reauthorization is a something we'll will not do every year. this will be the new law of the land for the next five, six, seven years excellent for travel the country and listening on this morning to her, i would actively ask you to please come to those hearings, come to those meetings, but sure your voices are heard. at it is a real chance for everybody to step up and to be part of the answer. i just want to close and have folks think about the magnitude of the opportunity. those of you have been an education for 20, 30, four years i don't think you've ever seen $100 billion of money coming into education. i don't think you ever seen north of $10 billion in discretionary money.

i am a little biased but i will pick i've seen it president ho despite fighting two wars and the tough economy, week after week keeps coming back to education. keeps coming back to education and you guys know with him and with the first lady, michelle, this isn't like an intellectual wow. this is real personal. this comes from their hard. neither one of them was born with a source within about. both of them came from very, very humble beginnings. and they are who they are leading the country, leading the free world because they got a great education because they had great teachers because they worked so hard. and so they know personally. they don't intimately what it means to receive a great education, and they know what it means when you don't have those opportunities. over all the tremendous problems we face, we will never have this kind of opportunity again. i want us all to think collaboratively. i want us to push each other. i want you to push our department. we have many, many members of the team will be with you here today. i want us to push you that i want us to work in ways we haven't been before to dramatically improve our children. if we can do that over the next couple of years, i think we can

change education for the next couple of decades. i would just close by saying that's the goal. huge amount of money. this money will be gone in the next two, three, four years. get that money is gone, and there is no lasting success, there is no laughing track record, legacy that we would have lost an opportunity. it we can use these resources in the time of crisis to drive a level of reform it will change education in this country not for the next four years, but for the next four decades. than we would have done something really, really special to get. so it is a tall order, ambitious, a challenge. but i'm absolutely convinced as i traveled the country we have that opportunity and we would love to do it together with you. thank you so much. i will stop there and taking questions you might have. [applause] >> i think we have a couple of

mics here. just come up to the mike's. >> thank you very much. i appreciate everything you had to say. you are preaching to acquire. i am from missouri, and the state department is with you on everything you said. but i do have a question for you. we were one of six states that were selected to participate in the state implementation and scaling of best practices, but there is no money to go with that. and unfortunately we've had to be on the inactive list because of that. and i'm just wondering why there is no funding for that? and would encourage you to look at that. >> when we selected? >> a year and a half ago. >> okay. [laughter]

>> we hoped that was a change in administration. we would be able to move to active. and unfortunately, that didn't happen and there was no money but behind that at all. the reason we were selected is because of all the great work we're done with the system change in missouri. and we've come very far with three-tiered models. but we have lots of financial problems. and human resource problem i will take a look at him have any of the answers for you identify what they regard as of that grant, think about $4 billion race to the top, think about $650 million in innovation for. we can look at that specific one. but going forward, unprecedented opportunities to build upon past practice of. >> and they are wonderful, but once those requirements and regulations change from what we have been hearing about, that will exclude is also. there's some real issues with some of those requirements and i know those are out for, and we'll have to see what they turn out to be.

but from what you say, i mean, really it sounds like what you are about is system change. and it seems like if we got states that are already in the process and are just needing that extra push to scale up, and need extra funding. not a lot of money, just a little, would really do it. i would appreciate you looking at that. >> thank you so much. and thank you for your hard work. >> i'm with parent training information center. in minnesota. and i thank you. i especially a procedure comments about children being safe. we receive many calls from parents, especially kids with disabilities who are being bullied. some horrific calls. and the hundred 60000 children stay home every day because they have been bullied, and in georgia and massachusetts, 11 euros, to 11 year-old boys committed suicide in the last couple of months because of being bullied. and we have a national bullying

prevention week in october starting october 4. i wondered what your administration is doing in terms of looking at helping children in this country who are being bullied. >> it's a great question. is a huge issue and just to take one minute before i answer specifically. if i wanted students thinking about not just high school but college, if they are not safe, they are not to come if they can't see the blackboard, their social emotional needs are not being met. i traveled these foundation things. you guys probably know alexis was done and extraordinaire job leading this effort. [applause] >> she is a real star. i am lucky to have her come in. we have brought in a man named kevin jennings who you might know. i try to bring in people with this work is personal. it is personal for a lexus. i am bringing him as she started yesterday to run our elementary

and secondary was in the ll student who was told she could go to college and into getting a phd from ucla. kevin jennings as you was going up was bullied. and overcame some really horrific situations and went on to be strong and successful. so i don't have all of the easy answer to. i would tell you, you have people that lived this, who'd been on the receiving end, and where this is very, very personal. i look forward to kevin's leadership and dumb as their ship and a lexus leadership to help us think about it, it's an approach to make sure that every child not just in school but to and from school. we have to make sure our schools are safer to and from school are sick it we can't be satisfied yet. we have a lot of hard work to do and i just promise you we are trying to build a team of folks where this is not just a job. this is an absolute passion and those couple of people i think we could have gotten more like a. >> thank you for much. >> over here. >> good morning, mr. secretary. i am from new mexico. i have two children, a parent to

two children with disabilities. that have graduated from college. one is actually going on to become a teacher. and it is an incredibly difficult journey. but i've got three things for you that i think will really help, and i think you hit on. three things to make a difference. highly qualified leadership for school administrators. i really believe we have a huge deficit in that area. transparency and partnerships with all stakeholders. i really believe can make a difference. just those three things. and if you can't help that happen, i personally would be very grateful. thank you. >> i appreciate that. i couldn't agree more. i want to congratulate you. i know the children wouldn't have made it without you working xor node are. i think this is been a huge burden on parents historically. and how we take some of the burden off another we stubbing

the enemy, and a lot of hard work to get there but we want to make sure that stories like or children become the norm rather than the exception. i am thrilled, couldn't be more thrilled that one will be a teacher. we need more teachers. thank you very much. [applause] >> i will take these two lassoed and i have to sneak out unfortunately. >> good morning, mr. secretary. i want to thank you first of all for being here and for your comment. it just is a lot that you are here. i also want to thank you for your vision. i couldn't agree more with what you have laid out in your plan. and in saying that i want to challenge you to keep that vision and to think differently. you talk about differentiating and increasing the graduation rate, decreasing dropout rate. when i return to north airline i have a letter from the united states department of education that our peer review has negated

our alternate assessment. we worked very hard on those alternate assessment. and they have a rigor and challenge pic but every child that we teach is not the same. and so those families are going to be very discouraged that once again, their children's test scores are not going to count because of the peer review process. and i believe this is about the second or third time that we have been through this and trying to get our alternate assessment correct so they have rigor, challenge, or aligned with standers but can't assess the children that are disabled and cannot accept their regular tests. so i just encourage you to keep that vision, to think differently, and understand that every child is not exactly the same. >> and i appreciate that. i don't know the details of your specific proposal. i am sorry it's been a tough one for you. but for me it is a huge one. as we talk about no child left behind reauthorization, i would

make sure we're not excluding students but how do we make sure we're accessing them operably. you talk about her accomplice wanted to write and i'll be looking across the country at the state doing creative things to help give us a model to build on that. is a huge issue i'm focused on right now. >> thank you and i would encourage you to include some of us as stakeholders in looking at that. thank you. >> we absolutely will. and i enjoyed visiting your state yesterday. >> i represent a number of groups, but i'm going to ask my question on behalf of the national alliance of pupil services organization, which is a large coalition here in d.c. that represents related services under ida, pupil services under the sba. the same group of folks. you talk a lot and i push it also represented the school social workers and you always mention is. thank you for the. you have a question about bowling. it had a question about dropout and grad rate. one of the things that we are very concerned about is that we

are seeing with all the economic problems, a huge number of positions being cut and you just alluded to that. in your comment. that folks are not retaining the positions of the school counselors, social workers, all of the therapist, and we believe number one that those folks should be available to all kids and not just students with disabilities. i do want to put you on the spot but i wonder what the leadership in the department will do to ensure that local school districts have the means and understand the necessity for keeping these folks on board. >> these are all great questions. this is a really hard one that i frankly would a lot and would go so far as to say it is shortsighted to be cutting those positions where can i take them a place of those ratios are already lack of counter, social brazier, are already too high. if those ratios the sky rocket i think the impact on those children on the school climate in general will become. having said that i ran a district for seven years.

it was definitely underfunded and every year i did make really tough budget cuts. i had to cut things just because i had to to balance the budget so i understand the tremendous difficulty that school districts and states are under right now. and there isn't an easy answer. again, we have a hundred billion dollars on the table. i know the cuts go beyond that. it will not save every position. literally hundreds of thousands around the country, but my only rule of thumb was to try and make those cuts first that were furthest from the classroom. and do everything you could to protect classrooms and protect what was going on in schools. and so states very. some states are in okay situation. some states are having horrific budget situation. so all i can do is urge folks again when times are tough, it forces you to prioritize. and those priorities, how we spend money sort of talk about how much we value. and when we are cutting things again in tough times, never easy

decision for anybody. but just really urging folks to be very, very thoughtful about what they are doing and do everything they can to protect the classrooms, protect teacher learning and protect children aren't that easier said than done. but the more folks are thinking long term. and obviously were hoping next year, if we can hang in there for the short time, and will be in a very different spot we hope. but i worry where those cuts are happening and i worry about the impact on german. thank you so much. take you for all of your hard work on behalf of children. [applause]

[inaudible conversations] [inaudible conversations]

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>> and now a portion of a conference on h1n1 swine flu. we will hear from a local and national health official on efforts to prepare for the virus among which could become widespread this fall and winter. as part of the conference, it is about an hour and 50 minutes. [inaudible conversations] >> will go ahead and get started. [inaudible] >> i want to thank everyone once

again with all the world being with us here today. i want to thank you for sharing your time with us. we want to give a great appreciation for our sponsors, and let me make sure i get their names and i want to make sure i save them directly. and that is energex systems. and also ecolab. would want to appreciate them for their support as well. while everyone is falling and i'm going to go ahead and at least going to read the bio, or the information of our next speaker, who will be speaking. as we prepare our next round after that, it will be a panel discussion with three esteemed guests after our next speaker. our next bigger is going to be speaking on the advanced warning of influenza outbreak. his name is dr. samuel bogoch.

dr. bogoch is a faculty of the harvard medical school, and he is now the boston university school of medicine. dr. bogoch is a founder in chairman on nervous systems, and in a. and he is a founder and chairman of a and replikins. ltd. i am going to allow dr. bogoch to come up and join me here because i am excited about what he is engaged in, and i think it is a lot of scientific information that he is going to share with us on this disease that we see. and so ladies and gentlemen, if you could please give me a warm welcome for dr. samuel bogoch, please.

[applause] >> as the technology now exists to tackle one of the most vaccine problems facing brawl just and public health officials. how to correctly predict if, when and where a particular strain of influenza virus will break out, and how long it will last, how severe it will be, and when it will go away. dr. andrus mentioned that world health organization was alerted in april of 2009 to the present

h1n1 outbreak which became pandemic. april 2009 was just a few months ago. in april 2008, we published a warning that the h1n1 outbreak was coming. this was not noticed too much until recently, but this was done not by any local methods, but by the first method that we have too examined quantitatively the genome of the virus. and to measure quantitatively a group of new pet guides that we discovered some years ago that related quantitatively to rapid replication of the virus and to

outbreaks of the virus. we did this in 2006 when we measured the increased in the h5n1, and its occurrence first in indonesia. my friend said we don't mind if you tell us thathe velocity of h5n1 is increasing, but please don't tell us the exact spot where it will hit first. well, we did publish in 2006, and it did occur that there was an increase in the centrality in 2007 in humans. and it did occur that it hit first at worst in indonesia.

slightly encouraged by this, by thinking that it might still be peculiarity of the data, we noticed when we and everybody else was paying attention to h5n1, that in fact the other surveillance we were doing with our computer system indicated that h1n1 was increasing markedly. and when it reached the level, what we call the replikin count, the count of these peptides, that it was at in 1918, we thought we were obliged to take notice of this and published that on april 7, 2008. now, as public health officials, which i think most of us are here, i think it -- it's worthwhile to think whether it

would be the useful to have a years extra time, please, to organize our public health response and a year extra time to begin to produce our vaccine so we didn't have this awful crunch of days and weeks, as the fall approaches, and not having enough vaccine produced. i think the answer is clear that both from a public health point of view and from a vaccine production point of view it would be very useful to have such early warning. now the history of early warning is worth a moment of note. you know that there is prominent in the fall of the sparrow. and you know who said that? that was shakespeare in hamlet. and he was probably talking

about something other than the h1n1 viruses but we don't know. at least there is some association with something that happened beforehand and a something that was to come. the next thing we know is that paul revere got on his horse and rode furiously to warn that the british are coming. in history, therefore, early warning, this was sort of the next milestone. the next milestone, i guess, was in the use of pigeons to take messages in europe about the wars they were having to give effect of advance notice. the next milestone was in the war, second world war when the german bombers that were approaching britain were

constantly surprised that the spitfires were up there waiting for them. how did they know that they were coming? they do because of this newfangled invention called radar. and in honor of that, we have called our effort bhairon radar. because we are, as far as we know the first quantitative measure, biologically of what was coming. what is coming in virus technology to bother us. the next major event was 1960. you know that when hurricanes came before that time, if you had a day or two morning you were pretty lucky. but with a satellite up there, we got days and weeks of warning. we could watch the storm forming. we could watch its path. we could estimate its target. this is a huge change,

scientifically, to be able to measure what was coming. just because nature is about to take a punch at us, doesn't mean we have to stay in the way to receive it. if we know in advance that it is coming. the next advance i think has occurred with our discovery of a new group of peptides in the genome of virus and other infectious diseases, which tells quantitatively what's happening. is the virus sleeping? is it rapidly replicating? where is it rapidly replicating, geographically? so the warning published in april 2008 noted that the replikin count of the h1n1 strain of influenza virus has

recently increased to its highest level since 1918, h1n1 pandemic. and while a few people have noticed what we were doing for a few years, they paid attention this time because obviously they said how did you do that? and how we did that was the same way we predicted the h5n1 a couple years ago was coming. so we are getting some reassurance that this is a method with which it could be useful, and both getting early warning and in tracking. the current h1n1 virus appears to be rapidly replicating. it may succeed h5n1 as the leading candidate for the next expected overdue pandemic. this within our april 7, 2008, released. i wish we would have known, doctor anders did because we would have run to him and said look what we have got here. let's get moving a year ahead of time. and he probably would have said well, i am not sure.

let's take it to committee. but maybe not. maybe he would have said yes, we have to start paying attention to this. in june, 11 to 2009, who declared the pandemic swine flu pandemic. what is a replica in doubt and how can it forecast the onset of an influenza outbreak? replicas are a new group of peptides and viruses and other infectious organisms and cancer proteins where they were first found by us, related to rapid replication. replikins concentration is quantitated as replikin count the number of replikins per 100 unbeknown acid. increase in replikin count is associated with rapid replication, and has been known for many decades rapid

replication of the virus is associated with virus outbreaks. what do they tell us about the prospect of an influenza outbreak? a strong correlation between high replikin count and major disease outbreaks has been shown, will show you some of this. replikin count peptide quantities increased before strain specific, flu outbreaks. and they decreased to signal the outbreak is over. this is the first virus chemistry which correlates with influenza epidemics and pandemics. the chemistry of a rapid replication. this is what we search. we look at all of the published data, and here's an example of what we see. an influenza virus instances you will see there are several genes listed, pb2, pb1, etc. each of these genes is examined for the accession numbers, which are shown in blue. and those accession numbers are

detailed sequences, protein and dna sequences, of that particular strain of influenza which is actually isolated from a nasal swab or elsewhere in body secretions. and the sequence is published. and this is terribly important i want to emphasize this now and that in. very important for the government organization and public organizations to get those sequences out. there are people now who can read them. and tell you back what's coming. this is the kind of sequence that one sees. this is an example of the hemagglutinin gene and h5n1 and you see their whole bunch of letter standing for those of you who are not familiar with amino acids and peptide sequences and protein sequences.

and you see there is just a roll of these things. and how would you know what this message is, what is the message, what is the language? we had no language up until now to decipher this. we didn't understand this. this is a language which was obscured. the replikins were identified as particular units within this long string, which permits you to translate. here is what it looked like for about 40 years. [laughter] >> to the computer that was trying. the best computers attacked this problem and said we have got to find something that will give us some warning from the sequences. and this is what we saw until the stone was dug up, which translated these hieroglyphics in three different linkages, and then it was obvious.

now, everyone can read hieroglyphics. we believe we have gotten the language for one particular aspect, which is rapid replication. . . sales. rapid replication in cancer cells. there's a piece of that long sequence which had several groups, 1h and we thought what a strange-looking beast that is to biochemical industrieses in the audience and when we went looking for relatives of it they were all over the place. they were wherever rapid replication occurred. they were in tomato mosaic virus. perhaps you've never seen of it. i've never heard of it before which destroys -- massive

which the stories, massaleit destroys tomatoes crops all over the world. the laurean remains viruses for good they were in hiv, they were in and malaria, and they were in influenza efforts of the cdc was very helpful and sends us all of their tapes from 1918 forward on the eighth at the theological aspects, the naprosyn particular years and which particular strains were responsible for those outbreaks bertels have we tried to correlate the information we were getting from our computer research for such beasts, with the outbreaks. we thought we would be lucky if there was a day correlation since no correlation has been shown in the past with any other method of examining these structures. we were quite surprised and pleased to find that, there was literally points to point correlation. what the computer does, we have told it to a series of criteria that it must use to counts, to

identify first and count replikins. replikins are six to ten amino acids the parts that have one histamine group with seven to 50 amino acids along that have greater than 6% lysine. a list of catechism so to speak of what must be fulfilled for it replikin to be identified, then the computer counts them. says how many of these are there for 100 amino acids? and then, we said are there replikins concentrated their of the genome? are they in particular places in the genome concentrated? this site is interesting because it shows you the a-10 genes of h5n1 and shows you year by year from .032.06 from 2003 to 2006 and it says, in 2003 and 2004, there was nothing much going on in any of these genes, going on

means in terms of replikin count. how many replikins for hundred amino acids? that was even true for this last one, which shows that in 2005, 2006 it took off. now, we used in effect the counting of these replikins to identify the gene location of the replikins, and they would not tell you while they were not active but when they became active, as you see in the one on the right, then not only did the mean, which is in blue, the replikin count in blue, but the red which is the standard distribution very important as it gets a much larger. a small percentage of the total in all of the, in all of the other genes, but when it takes off, the standard deviation is much larger, which means you have the population of viruses,

some of which are still sleeping, some which are taking off but very rapid replication and high replikin count. so, in effect, the function exposed the structure, and that is a very useful concept, so we isolated the gene by in silico methods. we know about in vitro. there is a new thing called in silico, as we use the computer to isolate where the activity is and that tells you which jean has been stimulated. it is not just the jean. there's the epigenetic phenomena. the jean accounts for 2%, and 90% is in the epigenetic instructions, get overacted. one jean is told, stay put in another is told. that is what we are looking at here. we are looking at one gene which has the bulk of the replikins

and so we call it the replikin peak chain. now, if you look to all of those epidemics and pandemics from 1918 to 2007, they are stressed out here from all of the data on the public accession for all the accession numbers, and you will see that first look a bunch of them are very short and some of them are pretty tall. that is a replikin count, 1918 it was something near 20, and the black is h1n1. this is strain specific. so, the h1n1 was elevated in 1918 and you see the numbers of these increases as we did more and more of these-- not weep but as the world did, more and more of these analyses. but, if you follow the black,

after rebounds in the 30's for h1n1 which fits exactly what what happened it didn't do much, didn't do much, but until 2007, if you look at the dark blue, that with the next pandemic in 1957 and that was h2n2. if you look at the green, that with the next pandemic in 1968. if you look at the red, you see the trouble with h5 and juan acting up in these last couple of years. so, that to give up to 2007. derry important controls of light blue, the sky blue and it is all through their, they are all short. none of them get up above five. the replikin count does not get above five n influenza b is what that is. influenza b does not kill people yet, and yet in 40 years or so,

67 years represented on this graph, it is very low so that is an important control. that means that when he speaks come up, you are in for it. or are already in engaged in it. here is an example of human h1n1 virus and we isolated to gene locations one for infectivity and one for lethality. >> infectivity one is more concentrated in the hemagglutinin area and these lethality is more concentrated in the preliminary area bud annie how do you infectivity, the-- is in red. you see the doan very together necessarily, and what you see is that there is a gradual increase but creeping up since 2002 of the infectivity and when that infectivity got to be 70, which was the number was in h1n1

pandemic is when we blew the whistle. in 2009, we will show you. here it is again, to show you that that increase in h1n1 in infectivity and the lack of increase in the black, which is the lethality, is not a universal signal. that is h1n1. if you look to the right, h1 51 is just the reverse. the red states down, the infectivity stays down and the lethality is increasing. now, that is exactly what we know that the genealogically about h5 and one that it is very lethal but thank goodness it doesn't transmits to well. you have to be baby who has got a pet chicken that you take to bed and in indonesia with you, and then, you get infected or a

mother who is morning her daughter that she just lost from h1n1, from h5n1. and h1n1 we have hi infectivity, low fingers crossed lethality. let us hope all the shifting that viruses do will not bring these to piece together. because then you would have high infectivity and i lethality. here you see a condensate of the replikin count that we are now doing instead of annually. we are doing them every day and you see the beginning on the left how low it was. it was around for four infectivity and it gradually went up, until it reached seven and then as i say we blew the whistle, and then look what happened after that. that was in april of 2008, when we made that announcement. and then, in may of 2009 it had

gone up for there. aidid gone up another 40%. interestingly the lethality had not gone up at that point, and we-- within the month between may and june the lethality started to creep up, the black and it is still way out here in the end of july. it is still up about 25% above its resting levels, which we observed back here, so all this talk about well, it is very infective, that is true but the lethality thank goodness is low. it is not quite right. remember this is predicting six months in advance so what we are seeing now is the lethality index which is 25% higher in not too comfortable in the infectivity index which is 40% higher from what it was when we issued the warning in 2008. and there is no evidence that it is dropping.

now, how would you know if it was dropping? here we look, we see that the h1n1 fires shows no signs of abating in the next six to 12 months ago the replikin count of infectivity increase an additional 43% is still 39% above that in may of 2009. >> lethality is up 65% and still 25% above that in may 2009. remember that forecast beta predicts six to 12 months in advance. so, what we missed what they slide, i don't know why, but there is a slide of the sars virus that showed that when sars virus was just beginning, the replikin count dropped. it being up, had it been up in the corn viruses in general,

fourfold in 2002 and in 2003 the sars virus hit but just at that time the replikin count went back to normal from where it had been from ten years before and that was what we were hoping for in this picture. we want to see a drop in those back to the resting levels. we have not seen it yet, therefore we cannot be too optimistic. there is a lot of discussion about how would this not going to be so bad, it is over high turnover exaggerated. this is the only quantitative data we know of that indicates exactly what the virus is doing in terms of the eye slits that we have. and it does not reassure. now, in conclusion, the forecast technology is now available to permit quantitative analysis and fires genome data for the first time in from the analysis to predict the in fatality and geographic location of any strain of influenza virus six to 12 months in advance however not

all the genome sequence data for which these predictions are made is rapidly published. when the centers for disease control, w.h.o. and other public health bodies and research institutes determined and published most importantly published, viral genomic sequences as soon as available the flu forecast software services available to accurately predict the course of the current pandemic into forewarn a future outbreaks. advanced warnings, six to 12 months before the outbreak or the improvement gives advantage of time to both public health and vaccine efforts against influenza. thank you very much. [applause] >> thank you very much dr. bogoch.

we are going to go into our panel discussion. and a panel discussion i will introduce our next three esteemed guests. they will introduce the topic of the day of their professional expertise and they will try to entertain some questions and answers, hopefully in a timeframe before lunch. one of the things i am hoping they will definitely stay around for your interfaith and communication as well. it looks like it may have to get a third chair here. i am going to introduce each one of them, successively here and then we will have them come forth. my first guest, country reports in situation update, dr. georges benjamin, director of american public health association. well-known in the world of public health as a leader in practitioner and administrator. benjamin has been executive director of the american public health association, the nation's

oldest and largest organization in public health professionals since december of 2002. he came to's from his position as secretary of the maryland department of health and mental health hygiene. i would like to have him come forth and he will definitely be talking more about his professional career to you and his presentation as well and he will take the seat closest to me. our next speaker, dr. rony francois, assistant secretary in louisiana department of health and hospitals. dr. francois was appointed to the secretary of the assistant secretary of the office of public health for the louisiana department of health and hospitals. he oversees the daily functions of the dha-- dhs possum office of public health and dr. francois served as the secretary of health for the state of florida.

dr. francois. dr. adewale troutman is the director of the louisiana metro public health and wellness. dr. troutman is the director of the metra public health and wellness since january of 2004 and also currently serves-- pardon me? louisville. [laughter] he actually is also currently serves as the soucy professor of the university of louisville school of public health and previously dr. troutman served as the public health director for the fulton county department of health in atlanta, georgia and later in new jersey sill ladies and gentlemen please give a round of applause for three panelists, please. [applause] i am going to let them go ahead

and begin their top pick in the way the reduced and we will first start off with dr. benjamin. [inaudible conversations] >> good morning everyone. let me say how delighted i am to be here today. i am going to try to take this from the national perspective and my colleagues are going to talk about both the state and local perspective, and i am going to talk a little bit about what i think our experience has

been with h1n1 so far. again, just reminding as many other people, i feel is important to remind that seasonal influenza is already a challenge for us and has a significant morbidity and mortality, has huge economic costs and clearly this is something we ought to deal with every day. you hear a lot about these numbers and the number of people who have died a number of hospitalizations. we is it important to understand that these are averages and these numbers have huge ranges from a few thousand deaths in some years to 50,000 deaths, as we had in other years and even higher as we had in the 1918 influenza outbreak. so it is really important to understand that these are average numbers and that is why we do have some seasons, which influenza is a bad season, or some years in which it is not as

bad. and of course many of us are all sitting around waiting for the next great pandemic to come and we spend a lot of time and effort beginning to plan for this because we know pandemics to happen. they happen with some degree of regularity, some degree of predictability, but we obviously can't tell exactly when they are going to hit. so, while we are sitting around watching for h5n1, class sprang, a novel virus did present in mexico at fairly high numbers and while mexican authorities were struggling and trying to really address this, the united states actually had a couple of people in texas and california that we picked up with a new influenza-like illness that ultimately turned out to be the same illness that was occurring in mexico. i would just point out that time of year, as the look around the

room. i want you to think back a couple of years to when you were in college, just a couple because i'm trying not to become too old. and, think about the fact that we had that time of year, if your children were doing what my children were doing, they were all in mexico over spring break-- break so we had this huge group of americans and other people of around the world at this time and then of course when they return home, many of them return home ill. it turned out to be this new h1n1 influenza. then of course, this has grown and as you know, eventually has already turned out to be pandemic. i remind people that the term pandemics simply means it is all over the world and it does not tell you anything about the morbidity, does not tell you anything about the lethality of this virus. it just shows you where it is that and how prevalent it is around the world.

this particular influenza, it actually looks like influenza with one caveat. there seems to be a heavier dose of gastrointestinal disease, nausea, vomiting, loose tools as part of this symptom complex. there may be some things unique about this virus that caused it not only to attach itself to respiratory but also to gastrointestinal, the gastrointestinal tract and that may very well explained, even though it is not really well-known and i need to point that out, not really well-known, it may have something to do with the fact of why it is living a little longer osc no norma league influenza comes in the fall and winter and goes away in the fall and summer. yes we have had some influence outbreaks but usually it is not very prevalent in the hot weather. this was a very famous photo,

fundamentally. this is the way people get influence the. you cough or sneeze in the air, whether not the influenza virus spreads short distance from long distance depends on the droplet size and other factors, wind conditions and things like that but primarily it is through respiratory droplets in the fact that when you cough in your hand any touch something, the virus can live on inanimate objects for a while. notch real clearly sure what the g.i. tract rule is but just something to think about and for those of you who are researchers and scientists, this is an area of research that you may want to begin looking at in seepage has some role because of the high symptomatology of gastrointestinal. also to point out we are seeing more and more that having a fever is necessarily indicative of an acute infectious phase.

in other words there are lots of people who are still infectious and did not have the fever, so that fever, we'll certainly a problem and syndrome of influenza is necessarily diagnostic by any means. i have always promised that as part of the fact that i like to work in the pork industry is the point of the fact that you can't get this by eating pork. this was a big issue. i also went to point out that it also tells us we have to be a lot more careful as public health practitioners in terms of naming things. this virus actually consists of both human avian and swine virus on particles and genes and while the swine component is predominant in many ways, and that is how it got named, it has had a huge impact on the pork industry, and because people's used it for many reasons to

identify a particular food as a risky food and to point out that this is not the case at all. so, again miscommunication is a very important part of what we need to do anything this is another one of these lessons learned. we at the same thing with the bird flu. we probably didn't learn our lesson when we ted h5n1 is the bird flu but something for us to think about. our mitigation strategy for this outbreak, because we did not have a vaccine, was primarily a perspiratory etiquette hygiene phenomenon. we focused very much on telling people what the virus was, what they could do to protect themselves in terms of covering their nose and mouth winikoff for sneaked, proper handwashing, social distancing and i will come back to that in a bit, antivirals for those at risk to have the disease or prophylaxis, issues with prophylaxis we certainly can discuss, and to

encourage people to be healthy. lead healthier lives and get your chronic diseases under control and paid much more attention to your asthma, door diabetes, your heart disease because obviously those of the people with chronic diseases who are historical more at risk. and that is fundamentally our strategy. normally for influenza we have a vaccine strategy but we didn't have a vaccine. it was clear early on that the seasonal vaccine would not protect us, at least one that we had doses on. this was at the tail end of our usual seasonal flu outbreak, so we had the clinical experience of knowing that scene wasn't going to be protective and as you have heard, there has been some evidence that those of us who were born in the early '50s may have some degree of protection depending, we are not quite sure how much protection but you may have some.

social distancing is an strategy to protect others and we have tried to use that strategy a fairmount and encourage people if you are sick to stay home, at least for a weekend at least a few have been symptom free for 24 hours, and the goal is ultimately to interrupt the chain of infectious transmission as we go forward. dealed-month-old with social distancing it to take a pandemic like this which has no intervention, to move that curve down the line and then ultimately to mitigate that curved so that lets people get sick over time from the outbreak. this is a very important studies in that people use to try to impact the health impact and there is some historical evidence that this was tried in 1918 and 1919. there is historical evidence

that social distancing has the mitigating effects and a slowing effect on the outbreak. now, granted that is a disease outbreak that has a modest as-- influenza was barely infectious but it is important that one thinks about trying to do this social distancing in a rational and functional way. now, the real science behind how you get infected certainly is the incubation period, how long it takes for the virus to actually incubate, the probability in transmission with that concept which has lots of issues around, as you heard earlier, how far the virus particles fly when you sneeze or cough. the probability of someone getting infected themselves, of course they have to be infected and then they have to be able to infect others and the concept will grow, which is the real

extent of my epidemiologic knowledge, it is a term and a number used to try to address that. for those of us who are not epidemiologists and tried very hard not to be one, the short answer is it means each case reproduces itself in a breault greater than one means that more transmissible disease and the more broadly it can spread to others, so the goal is to try to lower their row as quickly as you can in any way possible and this is really an example of what it looks like in terms of how infectious and how it functions in the real world. now, this is an epidemic and this one, this one is just for discussion purposes has a row of two which is a moderately spread the epidemic, somewhere a little bit above what influenza is and

this basically shows if you have a person that is infected, that person it vexed to people in each of those people infected with the people and it basically shows an epidemic growth. now, the goal is to try to break that cycle anywhere you can indeed do that through a variety of mechanisms like vaccinating people, by getting immunity so the disease does not spread. there lots of things one can do so ultimately break this epidemic cycle but that is fundamentally the idea behind social distancing and fundamentally the idea behind vaccinating people and fundamentally the idea behind separating folks in such a way that you can ultimately break these cycles as quickly as possible and this is not rocket science but it is something to think about as we do. this is from the cdc's surveillance system, looking at influenza-like illness. one of the things that folks

need to remember is we don't really count influenza. of when influenza enters the community and some basic idea which we extrapolate up from as to how many people might be sick with influenza. understanding of when -- what is going on, and this gives you an idea what actually happened but for this current bout of influenza polis and miquelon is

in january than it moves on through the year as you can see we are below the national baseline even though we know we have out some outbreaks in some camps and other places with this new virus. this also gives you an idea kind of what the state outlook looked like in the united states. you notice there is no state that was not infected at some level. most had some sporadic activity, some had widespread activity during this last outbreak and this is the weekend august 8th. and again, once the next influenza season starts again we will begin trying to come this. it will be more challenging of course because we have to outbreaks that will occur. we expect the seasonal influenza to return and then we of course expect h1n1 to return. as we look at what happens so far we are guessing about 1 million u.s. cases were estimated for this virus. again this is a guess because you don't measure every single

case buy any means. reportable hospitalizations for over 7,000, and over 400 deaths have been counted. and these are cases that probably confirm culture positive cases. let's just say confirmed cases, they may or may not be culture. there were confirmed by some culture test. as we move to the following winter we will have an outbreak addition strategy and now it is a vaccine strategy. we were hoping to start buy effectively vaccinating people starting with both seasonal influenza because we are going to have to do that. of unlawful h1n1 vaccine, and of course i always remind folks one of the reason many folks dying is from secondary bacterial infection. the least of those people age 65 and over we will have to give pneumonia vaccine. you only get that once, but imagine yourself being in 65 or

67 year old senior now we are going to give a seasonal influenza shot, maybe to novel h1n1 shots and a pneumonia shot. those of you that note that the more medication you offer some one and the more shots you have to give them the less likely they are to take those shots in the full range of shots from the vaccination schedule so we are going to have a challenge in terms of vaccinating people this year but we understand what we have to do and it's going to require work. we are going to respond to hygiene as we have in the past. there will be work on social distancing. we learned a lot from the last outbreak last spring. antiviral is from those at risk and appropriating some of those that need to be treated for sure, the prophylaxis area remains to be a very complex and in many cases not as clear as we would like when we are looking at that very carefully. and again, encouraging people to manage their chronic disease.

the healthier they are as they going to this the healthier they i mentioned there's a vaccine strategy that are -- i shouldn't use the term to strains because obviously the seasonal vaccine is multiple streams with that vaccine and then the h1n1 vaccine we are going to have to actually give this series of shots. there are safety and efficacy studies now under way at the end of those we will know exactly how many shots we actually have to give, what will be the spacing of those shots, what will be the actual space to the commercial regimen that will come out of those studies. we will also know -- you can guess right now it will be somewhere around four to five weeks from the first shot to the time you are theoretically fully protected but we won't know that until actually these clinical safety and efficacy studies are done. thinking today is you can give

the seasonal shot and h1n1 shot at the same time, and again promoting the need for the pneumonia vaccine for those over the age of 65. now, cdc has come out with dates in durham priorities and recommendations which include pregnant women who do appear to be at increased risk. all people from six months to age 24 years of age, and persons aged 25 to 64 who have chronic conditions, cardiovascular disease, kidney disease, cancer, hiv, any kind of complications will probably be given the vaccine first. now also people most likely to spread the flu so anyone taking care of a very young person under the age of six months because we are not going to be vaccinating those people, those john coltrane, and therefore trying to take care of their care workers, family members etc. will be important. health care workers because they

have to be protected in order even though they are probably not at more increased incidents from the last event they are certainly at increased risk because they are taking care of sick people. note that these recommendations are different from the recommendations for seniors and the seasonal influenza. again that is because the showing not at greater risk. this is with the actively eckert retroactive rates appear to be from the spurring event. note again people age 65 years and older will have much less risk than people between the ages of five to 24. so those are examples why they have made those recommendations. let me also point out that like any wonderful pandemic plan all of these plans will go out the window because normally what we do is we vaccinate and then the

disease shows up. we may very well find ourselves in a situation where the disease shows up and then the vaccine shows up, and so our priorities may change and we are going to have to be very agile to rethink these very quickly based on risk. and then of course we are going to have public demand. the first time someone dies from h1n1 that has not returned and would not have a vaccine available and that person is outside one of the normal risk categories there will be, you know, a demand to rethink that strategy so we need to have some alternative models already in the can that think about how we would respond to those kind of things. we also are going to distribute the vaccine a little differently. the seasonal vaccine is going to go through the usual system meaning providers will by the vaccine as they normally do. the unlawful flu will be

different. it will come through the same process we use for the vaccine for children program through the state and health departments. there is a single distributor that will certainly be mix usable, public and private sides. the fed said they are going to cover the vaccine and related supply cost. the america's health insurance plan i understand have announced that their insurance plans will cover reimbursement for administration, for the usual members on the usual routes, and we also expect to have the mayor russell three available for younger kids and pregnant women as we go forward in a single post delivery files. so that will hopefully address many of the concerns people have around distribution and availability. again we know we don't -- it isn't coming in to the timeliness we thought it would so that's going to be an issue as we go through this. we had expected to have

195 million doses by december. we still expect to be there. we also -- we expect it to have by the middle of october october 120 million doses. at least newspaper reports said there's going to be more like 45 million doses in other words it is going to come out of the hopper slowly. but theoretically if this was a normal influenza season which have substantial amount of vaccine by the end of october -- actually that is a misprint, it should be the end of october, not september 1st, but we should have a full set of facts seen by the end of that month. we will have some challenges and concerns by the antivaccine movement. lt inslee there are people out there who are not comfortable getting vaccines. they are revved up around childhood vaccines in particular. one needs to recognize they are out there and their needs to be

a message so we get the facts out around this issue. we will have some issues are not the antiviral supply. there is always courting, it always happens. so to the extent we can do things to try to minimize that hoarding will be important and there's also the risk of antiviral resistance that can develop. we do have pockets, small numbers of cultures that have been shown to be resistant to some of the antiviral agents. it's not an issue today, but it could very well become an issue depending on how we use the antiviral agents. we all continue with our mitigation strategy this fall. cdc came out with school recommendations and they've kind of divided them into two boxes. box a ase of this outbreak looks like the outbreak we had in the spring, then they are going to encourage people to stay home when they are sick. they are going to encourage

schools to separate the il's staff and kids so they come to school and you find them sick then you will separate them from the others and send them home. in forcing good hand and respiratory etiquette, player of the schools as routine, nothing special needed there are some guidelines that american academy of pediatrics i think has for schools, and obviously early treatment of high-risk students and staff so if you are in a school with special needs kids you will have to have special protocols and procedures to figure out how to deal with those children and may be selected schools missiles. you have children you know are ill, children with asthma etc you have to decide how you are going to handle those children. i have a picture of kids on the boss to do a couple things. one, to show you that one-fifth of the population of the country are in the schools either the kids were students or people that work in the cafeterias, maintenance people are around the place, lots of people around our schools. the kids are often the first to

get influenza in the community and, you know, this will take all of you way, way back i suspect. this is where it looks like to be on a school bus. close proximity to one another, in a closed space and this certainly explains one of the reasons why they get sick. we know that if the event we have is worse than we had last spring they are going to encourage active screening in that school, actively looking for kids in fever, doing that a couple of times a day, having high-risk students and staff to stay home. obviously if a student has an ill household member to encourage them to stay home so they don't bring the illness into the school. again doing more aggressive distancing of people in the school, simply moving desks apart, not having school assemblies, mabey canceling sporting events, those kind of

things at the school. and doing school dismissals both preemptively, meaning that they feel there's a lot of influenza in the communities of the close the school, pretty much what we did this last spring and react fully which is what you did when you have a big outbreak in the school so we have to look at both of those kind of school dismissals but this will happen and these recommendations ocher if there is a much more robust outbreak. i remind you all of these decisions are local decisions. the school superintendents barred the authority to open and close their schools with great vigor. i learned that as a state health official. and so that these are very much local decisions that are made at the school so the more that we can give these schools good guidance and also the more the media cannot compare one community with another recognizing these things need to be tailored based on the situations in the community we are going to be better off. with that i will stop and pass

it over to my colleague. thank you. [applause] >> there you go. >> thank you, dr. benjamin for that national oversight. please give dr. benjamin another round of applause. [applause] that was weak. [laughter] i want to -- i want to acknowledge international visitors, some of them have traveled great distances to be here with us. let's give them a strong round of applause. [applause] and my point is simply that we

are in this together. so let me go ahead and start and try to give you the perspective from louisiana, and again, we are going to look at the three pillars of our response, infectious, the laboratory as well as into virus and vaccines. this map shows you basically the spread of the disease. the focal point happened to be in region number four. there is no way is after this. region number four is right here so we ended up losing some schools. we are very aggressive because again, when you hear the word new and it's in the middle school or high school, it gets

to be very sensitive and we certainly responded appropriately, and now, here is a snapshot of our epidemiology curve. i don't like this curved. and if you give me a second i will show you the way we would like for this to look next time. he essentially if you follow -- [inaudible] we would like to have low incidence and by ourselves some time, some time. the reason for that is that the vaccines are supposed to be here the middle of august as dr. benjamin mentioned. but we are not going to have

enough for everyone so, therefore keeping that incident low and binding ourselves some time through what i call universal hygiene precautions and social distancing measures especially in his resource poor areas of the world these are going to be the way to go. and again, when we talk about our global family, those approaches are very important because it only takes a flight, boat ride and it's in the next continent or and next country. essentially the age group that was most vulnerable in louisianan is between five and

24, and that sort of reflects the national picture. and the key question is what did we and our stakeholders learn from our experience? let me tell you that i am so glad that we had this pandemic finally happen in a mild way because it will return and they may get worse. so the spurring for me was practice and hopefully for you all it gave you an opportunity to take your plans and operationalize them and take this entire pandemic issue seriously. i was in florida back in 2005, and it was hard to get partners to the table. but now i think we have got everybody's attention because again, it is a team sport. it's not a health issue or a dod or dhs issue.

we have to have a global response if we are going to be successful. and then what are we going to do differently in the fall is another question. so, again, we had a very aggressive approach initially new virus, scary. we have to develop protocols and triggers for school closures. but also school events, community events, you know, dance recitals and so on. by week three if you all remember, we had a pair of line shift and the approach was scale back, and of course the questions never stop. now, in the spring we were closing schools. in the fall as you heard from

dr. benjamin the approach is going to be different. but again, we always need to remember the source of the infection is a person. so, and that sort of counter to our culture, stay home and you are sick. well, i have been in many environments where they say we don't care if you are on a stretcher we are gwen to hang the ivy over here in the corner and put a lot of on your belly so you can do your work. we have to change that, ladies and gentlemen, because it takes one infected person to wipeout and decimate your work force. you've really don't want to do that. so again in the fall we are going to ask our teachers to be a lot more vigilant in terms of watching the kids. they are not health care providers but they can certainly identify kids with a lot of

coughing, sneezing and so on and then sort of try to screen them that way. the media interest i think will still be there and again, dr. benjamin he alluded to the regular flu. we lose anywhere from on the average 36,000 people. but the media coverage isn't there in terms of -- there is one in orlando, there's one in l.a., new orleans. so again that is exactly what we did with h1n1 that raised the anxiety level. the engagement of the response partners, again, is key with respect to security, antiviral deployment. as you heard whenever there is rationing what does the public say? i want mine now. people who have never gotten a flu shot every time they since there is a vital bit of a delay in production or delivery they

want theirs. so it's going to get worse because we are going to have priority groups. again, in louisianan we are going to have three forms of surveillance, of central physicians and providers essentially work with us and submit infectious -- influenza-like illnesses of samples from patients to us and we can sort of communicate with the cdc in terms of, you know, overall brought influenza surveillance. we also have the hospital system and work with the hospitals like in every case that is admitted with a influenza-like illness will be reported. and then suffered peace obviously are the schools. we are going to monitor and track absentee's, absenteeism

and dismissals. the laboratory response, and i'm flying through this by the way -- there are some slides that you have the bite taken out just for the purpose of time. so, you know, that is what happened. again, in terms of the laboratory, if your state is like my state, i know there are folks who are probably not convinced that public health laboratory? what does that do? weld these are the folks dustin up 24/7 to respond to this -- they work harder than anybody else. and so, again, on a daily basis they provide ongoing surveillance as i just mentioned. and that is the basis. the sentinel system is the basis for what happens to the strain

that is in the next vaccine in the following season. so that data comes from the work that public health laboratories to across the country. again, and thus bring we have a lot of testing. this fall it is going to be limited to again folks who are hospitalized and so on. again, we know that the fda has cleared the first commercially available influenza so those will supplement the things of public health laboratories. and of course we will be using an fda-bleared test and we continue to do that and we will also be losing real-time pcr. we have crossed trainer was tough getting ready for the

fall. we have bought some additional equipment. but a few like -- if we are like any other state there are, you know, hiring freezes and reduction and so on. so again, additional safety cabinets. we have got an additional automated obstruction of equipment, additional real-time pcr, and again, this specimen will not be accepted from everybody. it's quick to be just sentinel's up matters and hospitalized patients, and of course we have issues with people putting the specimen using like a bacterial media and so on and that is not helpful. so the state epidemiologist will be getting the results along with the supporters.

now, the last piece of my talk is about anti-virus and vaccines. again the strategic national stockpile has been working on this for years and we appreciate the federal support in getting the country ready for this pandemic. these louisianan did purchase its full amount of antiviral santa that varies from state to state, as you know, but thank god for sns that brought in 25% cash, and we went ahead and distributed that to hospitals, nursing homes, and other -- and other partners like federally qualified health centers, department of corrections, again, military and tribes.

fi, again, with that distribution you also have to provide some guidance, and we are doing that as the data evolves in your handout we talked about some assumptions and those assumptions have to be taken into account. i don't have them here but you can read them at your convenience. but essentially, there are quite a few pieces to pandemic flu activities for the fall, and again i am not going to read them to you. i think every state, every local public health entity is going to be doing some of those things as well and maybe some other activities. again, in terms of prevention we

are not only pushing the regular flu vaccine but also encouraging our elders to get the vaccine because there may be some synergy that obviously if you get the swine flu, the regular flu, pneumonia, is when to be tough to get out of that. we are establishing groups wherever you do that it causes anxiety and folks who don't fall within those groups were dr. benjamin went over that. again, the party population he mentioned those come pregnant women pregnancy is compromised state essentially the woman has a baby that is half somebody else. so for her to be able to carry that for nine months system in

every pregnant person is sort of tamed down in order for them to go through the entire pregnancy. but by the same token, it puts them at higher risk for infections. dispensing are going to be done, is going to be done through traditional outlets and also nontraditional outlets. vaccine distribution we are going to be using the louisianan immunization network for kids and that other people who are older than kids and make them part of it in order to track not only the vaccines that are being given but also in order to track the number of vaccines at each site. .. real-time, demographics,

inventory and so on. okay. the role in our plan implementation will come from obviously our legislature and so @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @

>> again, i want to thank doctor, our state epidemiologist, doctor martens, lot of that lab director, doctor welch, medical director, and ms. griffin who put the slide together for me. i want to leave you with a quote, dr. benjamin try to take you back. i'm taking you back at well with some latin. it means the safeguard of the people. and then the second part says, meaning the supreme law of the land. so essentially the safeguard of the people ought to be, should be, is the supreme law of the land. so let's break down those silos, come together as a group of family to tackle pandemic flu. thank you. [applause]

>> while i applaud this presentation, i am reminded of all the conversation we've had about the perfect storm when it comes to pandemics. okay. and that is to say that this new virus, great. new virus. highly lethal, easy transmissible with a perfect storm for pandemic flu. our perfect storm is that i am the last thing between you and your lunch. i am the third presenter and everything that has been said that needs to be said, and i have a plane to catch. and i'm from new york and i talk fast anyway so let me just take to what i'm going to talk about is the local response. i run this department in metro louisville, population 700,000 people.

and we are the last line of defense, if you will. we are where the rubber hits the road. as i was sitting listening to the presentations, you know, i am reminded of how important every thing that has come up to this point in terms of our preparation and are planning has made us, has put us in a position to be as ready as we can to address this issue. and then on top of that, this past year in metro louisville, we had the evacuees from perkin gustav, from almost 2000 people came to our community, that we need to take care of special needs shelters and medication, etc. we had hurricane ike actually came through metro louisville, and knocked out some 600,000 people, in terms of power. we had a game, medical or special needs shelters issued there. then we had a flood, just a couple of weeks ago, that has caused us all kinds of problems. so we are tested and ready for anything in metro louisville, i hope. one of the things i want to mention very quickly, we did in fact put together a structural

change in our organization at the local health department to be able to do with these issues. so we started in the office of health emergency preparedness a few years ago. i think we have forgotten maybe that we've been talking about this ever since 9/11, but also ever since west nile virus. you are not all the conversation about the need to communicate and crisis communication and partnerships and collaborations. all that is kind of fertile ground for us to be where we are. this is our mission and vision. i just won't mention the purpose that we work to prevent disease, injury, and assure conditions in which people can be healthy, which is the mantra for all local health department. so some of the things we don't read for pandemic preparation, we follow the all hazards model, and what we're doing for pandemic flu is really an extension of that. we have been focusing on training and retraining our staff, multidisciplinary partnership, rt and critical. we have something called the

group in metro louisville where everybody you can possibly imagine who has a role sits around the table. many of them with boulders on their ankle, meaning very great guns. they are like the fbi, the police to you all don't relate to that? [laughter] >> that's all right. and many other partners that need to be around a table for us to do this work effectively. our collaboration is from city to county to state the region to federal. all at the same time involving themselves in getting ready for what we are acing. we follow the the management system. we work on creating scenarios. we been exerciser though samaras. we evaluate. we put in corrections and we reevaluate an week we exercise, which is a pattern that we've been following for the last several years. just an example of some of the people involved, yes, kfc with their boiled gauge what is it? grilled chicken. grown chicken. so even they are coming along in terms of their sense of public health. but you see the sheriff department, targets our transportation system, the

police department, metros sewer district and many, many more that didn't fit on this slide. i want to spend a few minutes with ueberroth going over our effort to see how we could handle mass numbers of vaccinations in our community and a short period of time. and we used last year, we used last year's influenza preparation to do this. there are a series of slides i want to go through to show you what we did and what we tried to accomplish by putting this process in place. so we called ourselves the influence of production operation at the fairgrounds. kentucky has a huge complex for the state fair with multiple venues. that's where the univerrity of louisville basketball team plays big in. consequently it is a huge parking lot with a ring road that goes all the way around the operation, and seven booth to drive through, to pay your fare into the parking lot. this is a picture of that complex and how extensive it is. we thought we would try to use this. by the way, we moved to this

particular version of access to populations after organizing a point of dispensing and sculpted our first ever was, so we have all the schools all over the community we can use the schools as a place to provide mecation, vaccines, what have you. and found difficulty with logistics. the road that schools were not built on roads that were huge big enough for lots of people to come through. and they were in smaller communities and have small parking lot. we began looking for other ways to address this issue. we came upon the idea of using the fairgrounds. this is a photograph of what you see when you come to that main road. there are seven lanes actually that are set up to take money, and we could actually extend that to be nine by moving one to the left and went to the right. we therefore build our operation to providing flu vaccine to this particular setting. just another view of those seven lines of traffic coming through to pay tolls.

we put together this particular sheet to give us an objective, a direction of what we wanted to do. you can see our goal was to provide 60 vaccinations per hour per booth beginning at 10:00. so we put the word out to the community. we are getting free flu vaccines at 10:00. .com before -- don't come before 10:00. well, that didn't work. i will show you some slides in a minute. this is how extensive our organization was. our medical director, we literally put this together in the context of the incident command structure. this is what we saw when we got there. so we told them don't come before 10:00, and this is a 30 in the morning. we have several hundred cars lined up. and actually, it worked to our advantage because we are able to get out the paperwork to those several hundred cars well in advance of start time. it actually helped us to get, but one of the things we blew on

this context, we forgot to tell the sheriffs department, you better get your early just in case. so the sheriffs to barba was actually in the briefing with us while the cars were lined up outside. fortunately, in an orderly fashion so that was a message for us for the next time around. what you see, this is from the other side of the tollbooth, the cars that were on the other side coming towards us. and we pointed out this one particular car. let me tell you what the punchline is in case i run out of time. we were trying to make sure we had a way to get the cars through, get the paperwork done it and as you'll see in a few minutes by the time they got to the tollbooth, they had their window rolled down, their sleeves rolled up, nurses were in the tollbooth. and literally reach out the window, rubbed their arms, gave him a shot, push them onto. and were getting people through in seconds. not even minute. and i will give you the punchline in a few minutes. but it's funny how things happen when you don't prepare for the. this car that you see here broke

down. [laughter] >> never thought about that. what do you do if a car breaks down in a line. and we quickly asked the medical director, myself and a few crew ran up and push this guy out of the way. but it made us recognize there are things in a contingency planning -- they did get their shot. [laughter] >> so you will see the young lady in the yellow, part of what we're doing was giving out information sheets while they were waiting on line having them fill out paperwork so everything was done by the time they got to the booth. and our objective was to get these information sheets to cars before they got to the. we were 97% effective. media, how to handle the media? what we establish a process that the medical director will be incident command and myself as the department head, i was the media got. so any media questions were all directed to me. and i did many interviews that day from local media asking questions about how, why we're doing this and what was the

issue a round influenza. we even had our environment helpful under health. we're going to have problems with carbon monoxide we had to have monitors out there to measure the carbon monoxide levels as people were driving through. we allowed 16 seconds in our plan to administer the injection. and that's if we use all my lanes and 100 cars per hour that would give us a certain endpoint that we know we wanted to reach. here is another problem. this guy, this structure, he was coming in to deliver some dirt. and we hadn't figured on him. so we actually had put together a special-needs area and our analysis with this guy should've been special to. not allowed to get in line because we also set a time, a number of people in each vehicle. no more than three. here comes a van with eight people. and the adaptiveness of our nursing staff is wonderful because three of four nurses

jumped out of the booth and saw eight people in this man. they all got their needles and syringes. went into the van, immunize everybody and then move them along at a very, very quick fashion. [laughter] sinecures a guy who broke down and we pushed off to the side. and there's the special-needs area which we had created for any special situations like to meet people in a vehicle. i'm going to pass. oh, this photograph on my right here, i guess would be in the corner. once we started seeing a slow down and the number of cars coming we actually started shutting down lanes to keep the pressure on to make our goal to get a certain number through and it will with a certain number of people. we had multiple partners as i mentioned, the police, fire and sheriff department, ems. everybody was on the scene was as. we even had this very, very high-tech traffic radar photography thing set up so that we could get a look at the entrance to the fairgrounds from wherever we were in our

operation. and here's the map. we wanted to do 10-point cars per minute. that's one car. just show you how fine that we did the operation. one car every 5.7 seconds, etc. and you can look at the numbers. 20160 cars in 32 hours. and looking at the population that we have, and our desire to be able to put together a procedure that could accomplish our entire population and a short period of time, we felt we would need 31 drive-through pods. the next up of this was to find banks which were ready to step up to the place. for now we have banks throughout our community that have similar situations would you three or four lines that we in fact did an exercise with there. that's the bottom line on that day. we did 1000 flu vaccinations in 40 minutes. which is absolutely amazing. so we have set up a process that if we need to we could put into place with all these drive-through pods throughout the city. and because we have worked with the school systems prior to this, and have set them up as

part of what, we now have the school system ready to go. and by the way, school started in metro louisville last week. so if you're looking or a central location to see what's going to happen, we are already having conversations about handwashing and social distancing and communications message, etc., with our schools. very quickly, this is the pot exercise we just did recently at the -- with the banks pictures to show you numerous partners, ups was involved. park system, and bringing both the supplies and people to the various location so we had a stinking, very military like staging area at one of the stadiums and town where everything was gathered, brought together. and then from there, the vehicles took us out to the pods on public buses. this is one of the banks. and you can see the official leaving this bus, which is from

the kentucky national guard were the strategic national stockpile was delivered for us to break down. that he ups again. there is another bank and. i am moving fast because of tommy. i wanted to stop with a 40 minute because one of the things we recognized was that in order for us to be ready to address anything at anytime, we had better do some pretty prepared this work. we been established about a dozen of these trailers with everything that we would possibly need at any one location throughout the city. they are sitting ready right now in something called the legal underground which is a big cavern in metro louisville. all we have to do is hook up a truck to these and take them out to the location, break them down with our staff and we are ready to go. so all this exercise has been very helpful to us to get us ready. i will go through a few slides do some local considerations and then something from national association of county city health official. obviously an assistant city much has been mentioned so i won't spend any more than mention on

a. crisis communications, certain a critically important. availability of vaccine hasn't talked about. we are waiting to see what it will look like. the recommendation that there will be a focus on the mass vaccination program with the school system as the primary focus is what we are working on along with our school system for obvious reasons. and then the importance of partnership with the school system can't be underestimated. we now have a mixed team in place that has our staff as well as staff from school system, regular communication between myself and the director and the superintendent of schools so that we have consistent messaging and methodology in the work that we do. and i mentioned that we have schools that up that we can be set up as pods if we need. remember surge capacity. yes, this is -- we are all saying this is a relatively mild disease, but there is the opportunity for multiple businesses, hospital or emergency deposits or hospital admissions. what is a surge capacity in your

community when it comes to this year's and what are you going to do if you are overwhelmed by that surge capacity. making sure the plan activation is done at all levels, definition of the medical surge which i'm not going to go through and read it because you can read this as i can. you guys know what surge capacity means i think other considerations, community dynamics. i talked a lot about but what are the social determent issues in your community that affect the ability to get everybody access to vaccines? once the level of poverty? how make it in your school ride school buses before? wants the level of physician-patient ratio? access to primary care clinics, what are those dynamics in your community and what has to be addressed to make sure there is equal access to the vaccines once they come out again and from as i wrap up, these are similar to what we've already talked about but i wanted to give them their own couple of slides as we consult on this

before coming in. their issues are never won, and this is of course looking at all local departments across the united states. promoting continuing to promote community preparedness on the focus on other things that we mentioned, handwashing, coughing, sneezing techniques, staying home when you're ill. this is not just a public health response which we have talked about, collaborative committee response. i mentioned the group earlier. but public health as the lead agency in this regard. providing protection, mitigation and the coordination of mass vaccine programs. and obviously in support with the school system and others. that we have -- and this is critically important. i will say this again and again. collaborative relationship with me has to be a two-way communication. they should not been a part of your local planning. if not, you need to get them at the table not just let them what the messages are but to have them sit with you and come to those messages because they need to understand their role as an educator and supporter and not just about a place to

potentially, and fanaticism in some instances and anakin others with the messages that they put a. media has the tendency to do the. is there any media media people to. i am sorry about that but i've had my own personal experiences where the media goes to the sensational and not necessarily as a supportive partner in the events of this nature. strong partner for the school system. obviously in this instance has to be critical. understanding how the decision is made about school closings are just the superintendent is the ultimate authority but if you can build a relationship with the superintendent, looks to you as the public health director, to say what do we do, what is the recommendation, how do we make this happen pegging of the great situation going. the effect on job was mentioned, social distancing, making sure you will have presentations to all concerned, the parent teachers association, critical arm of getting the families

involved in this. the unions, teachers unions, the school workers. those who work in the cafeteria, are we talking to them as well about these issues. and of course the personnel if you're fortunate to have nurses in your school you are a long way towards mick and his team were. joint planning and ongoing communications. did some special issues that we have been talking about. is there an informed consent protocol in the schools that you're working with? no, we're not so sure there is. there is a. we've had problems with this for several years but how do we signed signed by the parent giving us permission to get a shot or treat their child is something is a potential problem that it is not in place, the cdc is he having conversation about a national standardized consent form. something you should look at indoor venues. liability. shouldn't be a problem, but you start talking about bringing in volunteers, medical reserve corps, other people who are not actively working or license,

giving shots. they are concerned about liability. what if something happens. am i going to get to. so there has to be a way to make sure you will have taken care of that problem when it comes to addressing those issues. are there sufficient personnel -- are there enough people out there to do the job. we're talking to the dean of school, nursing and others in our community to provide us with medical students, nursing student from various colleges that have been trained to do vaccinations, under the umbrella of this liability waiver that we hope to put in place. so we have enough people to infect addressed the hundreds of thousands days we have about a hundred thousand kids in our school system that we want to address as well as those others in the group that we are talking about. and then of course the availability we have talked a lot about that. win, how much, one dose or two? you want to talk logistics, and if we are in a situation where you have to give three separate shots, not even two at once, but three separate shots. the logistics for public health

problems and school issues to address this will not be overwhelming but certainly a major problem. to get people in if you are done through programs, to get people in once for a seasonal flu is a real challenge. to get them now and two more times for h1n1, i don't know. we are crossing our fingers and praying to a higher power that this is all going to work a. but it will be a real digestible challenge for us. and then last but not least, and doctor benjamin mentioned this in his presentation, there is already some community concern regarding autism and thimerosal. we have been informed and given good information on the a scienc basis that the question is not, but nonetheless the committee still believes it is. so there is a new vaccine coming out. there is discussion about thimerosal, yes, no, isn't going

to be in single dose as georgia has pointed out. but it becomes a potential problem that in fact derail our efforts. i think this is my last slide. going back to this because i feel very strongly about this. there must be a special concern given to ensure equity and access to information so populations in lower social economic groups and those generally left by virtue of color, class, leverage, and insurance status. just think about katrina and what's possible in any country, certainly becomes an issue that needs to be addressed and addressed head-on. that's my contact information. i thank you for your attention, and i think we are back on. [applause] >> let's give another round of applause for doctor benjamin, dr. francois, and dr. bogoch. [applause] >> i don't hope will have any

q&a time. but i think, what i would to just do, are you going to be around for a while? he has to catch a plane. that u2 will be here, and we will have a chance, you get there mugshots, okay. make sure you walk up to them and talk with them. them will be tied throughout the conference to dialogue with them. but we want to try and move forward. what i wou like to say, one announcement. i have lost something in one of the bags. it is a black binder. all it has is build in it so if you want to pay my bills it's okay. [laughter] >> but if you happen to find it, just leave it at the front desk for me and then that will be great. we are going to go ahead and break down. do we wanted to take one question? are there any questions at all for us? really burning questions. there is a burning question right there.

[inaudible] >> none of the speakers mentions origin of influence. most speakers talk about h1n1. but may be confusing as, continuous mutation. as a matter fact, we know that. [inaudible]

[inaudible] >> i am not worried now that i'm worried about the future. like more in the future we might have more influence that is more effective, more lethal, more effective. thank you. >> i think the point, the question was about the next stage in development of influence and where this virus may go. and i remind people that this is an rna virus. and what they do is they replicate themselves. and they replicate themselves with great efficiency, but they don't replicate themselves with efficiency with exact copies.

and they make terrible mistakes and so they go into a cell. they make millions of copies of themselves. some are lacking the pair but most of them are different. they reassortment genes very quickly, and so yes, there will be lots of different strains of influenza that will develop out of any encounter with the virus changes. having said that, history tells us that they change frequently, but they only make major changes not very commonly. but those when they do, they cause pandemics like this. and you know, 10, 20 year cycles. so that we can always expect that this virus is going to change. and we should anticipate that. and i think as you heard earlier from one of the other speakers, our great fear is that it will combine with some other virus which is also more lethal.

another influenza virus that is more lethal. but today there is no evidence that it has done that and i guess that is a good thing. >> one more burning? okay. >> to real quick questions if i may. first for the moderator, are we going to get the presentations that were not in the package? are we going to have those on the website, do you know? >> let me follow up with the administration with that. >> that would be great. good information so i don't want to lose it. secondly, as far as the vaccines, the one big red flag that i have seen so far, well there are probably several, but the biggestne is that vaccine production seemed to be much slower than is anticipated. and so if you do the math,

six-point 7 billion people, it looks like i think 1.6 billion, if you take that 33%, the higher percentage of the vaccine they expect, so 1.6 billion vaccine doses might be available. and if you happen to have do a trip to doses, that is 800 million people that can be protected. so that's not going to cover even those targeted populations, let alone the rest of the world, right? and that is in the first year. that is on this october and next september, likely, as far as vaccine production. because there was vaccine protection of virtue. am i reading that right? >> yes, i think the slow production is creating an issue for us. but also remember that once we get through this year, then the folks that look at this and decide what's going to be in the next year's seasonal vaccine, it may turn out that if this becomes a predominant strain it will be one of the major strains

in the next seasonal vaccine. and unfortunately, next year we only have to get one shot again. but again, that remains to be seen. and hopefully remain a mild illness so that while vaccine-based vaccine is very important. it may or may not be essential as it is if there were a high morbidity and mortality. >> if i may add. again, in the u.s., there is always an issue of timing between the production of vaccines, the distribution and the administration of vaccines. those three components are not always concordant. but what i can tell you is that every year we throw away a surplus of the regular flu

vaccines. so it's never really been -- we have never really had a shortage specifically. because at the end of the year we always throw away an excess. if that's the history, we should expect that in the fall with new h1n1 vaccine that we should expect some problems. >> any other burning? okay. well, we can all go to lunch and we can return back at your sessions. make sure you look at the back of your presentation in your packet to see which room you will be going to next. after lunch. we look to see you later on this evening. [inaudible conversations]

>> this fall into the home to america's highest court. from the grand public places, to those only accessible by the nine justices. the supreme court, coming the first sunday in october, on c-span. >> as a health care conversatio continues, c-span's health care how it is a key resource.

go on line and follow the latest tweets, video and links. also keep up-to-date with health care advance like town hall meetings, house and senate debates. even upload your opinion about health care with a citizen video. the c-span health care hub, at c-span .org/health care. >> starting about five minutes the senate hitting hearing from july, specifically in the financial sector. but before we get to that, some background on the story and possible legislation that could make its way through congress this fall. we recently spoke with a capitol hill reporter. >> we are joined by phil mattingly of congressional quarterly. why is congress considering a plan to regulate the risks of the financial system? >> i think if anything has been clear over the last two years there is definite gaps in the system. congress is hoping at some point to be able to close those gaps.

commingle at this point is to have some type of systemic risk regulator that is kind of a buzzword at the moment, whether it be one entity or a committee of the regulars that could oversee the entire industry so as not to end up having an implosion, like occurred over the last 18 months. >> out of the lawmakers ideas compare with the regulatory overhaul that the administration has proposed? >> i think broadly there are several aspects that they agree upon. there definitely needs to be something overthink systemic risk. there needs to be in terms of the non-banking industry, the mortgage lenders who weren't necessarily under the purview of some of the federal regulators. does need to be overseen. that i think in the details is where the biggest issues are coming. the administration has proposed a federal reserve be the primary systemic risk regulator. senator chris dodd of the banking committee, barney frank, the house finance committee, both al qaeda pulled away from the. they think more of a committee of regulators, a council of regulars is a better idea at

this point. >> tell us about the opposition both those on the hill and outside groups, what are the arguments against regulation? >> obviously, the banking industry is a very powerful lobby. is a very public or. it stands to lose a lot. dysregulation is today. their argument is if you tighten the reins on them they cannot perform. they cannot innovate if they cannot make money. if anything has been proven over the last couple of years is that the banking industry is to decide at a whole so they're trying to do their best to say look, we understand something needs to happen. we are fair game with that but please don't tightknit too much. another aspect within congress is the republican party which it surely is not in bed with the banking industry by any means but they have these similar free market approach. their hope is that any regulation passed, it put into play is not too prescriptive. >> you quoted jeb hensarling archivist overseeing the plan will result in it permanent government occupation of our

acorn untrendy coming. >> absolutely. i think senate republican, the big government here right now is certainly possible, and i think what congressman hensarling is trying to say is look, you're putting your hands in places maybe they ought not be. and i think their hope is they are in the minority, so pretty large minority in the house. they might have a huge say in it but their hope is they at least keep that in mind that you need to keep private industry private. >> lawmakers also explored the idea of improving oversight of the insurance industry as part of this regulatory overhaul. how does that fit into it? >> it's going to be tough. it is an industry that i think for years people have said something needs to be done. were not really sure what. there's been a lot of proposals. most of the big national firms are hoping for an optional federal charter type thing where they would be able to be regulated on a national basis instead of just a state-by-state basis as the industry currently is. obviously come with aig issues,

it is a monster and sure which has been the poster child for things gone wrong over the last couple of years. the impetus is there to make a change. i think at this point lawmakers are still kind of tip toeing around that they are not necessarily sure where they need to come in, and how they would come in. >> lassa, so much on the congressional plate when they come back. health care, energy. where does all of us, this we regulating a financial regulators, the changing of the regulatory system, where does all this fit in? >> that is the big question in a. president obama has said by the end of the year he wants something on his desk that he can sign. the treasury has been aggressive getting the proposals out there they have sent legislative to the hilt. i think in the house, it's almost assured, mainly due to the majority just due to the rules of a system that they will move something in the fall probably early fall. they're going at a piece by piece basis separate bills and then combining them into a single package. the big question is the senator for china's obvious at a minimum. health care is going to be the big issue. and in that energy which is just contentious. senator chris dodd, the wrecking

chairman, is one of the leading democrats on the health care battle. has obvious he pulled away from financial regulation. i think they want something done by the end of the year. audi get it i think at this point in the senate is anyone's guess. >> phil mattingly congressional courtly. thanks for joining us. >> thanks for having a. >> and now that hearing from july on regulating large firms whose failure could pose a risk to the entire economy. we will hear testimony from sheila bair who heads the federal deposit insurance corporation. this hearing held on the senate banking committee. this runs about three hours and 15 minutes. >> [inaudible conversations]. >> the committee will come to order. after consultation with my

friend and colleague from alabama, what we're going to do is i'm going, we have to iron items to do with it we had the hearing this point deal with systemic risk of we also have to go into executive session and consider an original bill and that of the public transportation act of 2009. and we normally have 12 members here to actually vote out of this bill. but i think what we will do, as i'm going to have a brief senate remarks about his bill, very brief. senator shelby will make some brief comments about it, and then as soon as we get the 12 member to show up will have a vote, a voice vote on that bill. but in the absence of that we will go forward and actually with the harry. so that we're not wasting time and having people wait around until the 12 member shows up. we are still five short. but we will be considering as i mentioned here a public transportation extension act of

2009. this is a bill that authorized, being authorized under the safe accountable flexible transportation equity act. a legacy for use. this bill is developing a bipartisan fashion with my colleague and friend, senator shelby, and his staff and extensive extensive public transportation programs for 18 months. from october 1 of 2009 through march 31, 2000. at fiscal year 2009, authorized funding levels. we expect that this bill be merged with similar bills from the environment, public works committee, the commerce committee, the finance committees on the senate and the floor next week. let me just express it like in my view. while i agree with you ministration and the leadership of the senate, that assembly is too much on our plates as an overall body to what the transportation bill, moving through congress this year. i am not ready to concede that

we cannot move forward on a transportation bill early next year. but get the 18 months is there. i think, debate on how things work out this year we could get the transportation bill next year. and the administration presented its proposal, the senate leaders i advocated for six months. instead that we could at least try to get a bill up next year rather than wait until 2011. regardless of the length of the extension, congress ultimately passes i intend to work with our colleagues obviously on this committee but also with others to try and move a bill early next year if the authors of the opportunity present itself. investing in our transit systems, high speed corners i think is too important for our nation's future economic competitiveness, economic growth and quality of life to put off for too long in these difficult economic times. a new transportation bill is needed. to both reform the way we

approached transportation policy and to increase the amount of funding we invest in our transportation infrastructure. one changes needed in our approach in transportation policy, a special interest to this committee, is the need for renewed commitment to investing in public transportation. is our jurisdiction and we must assume a responsibility for it. and if we had to address the challenges like climate change, energy security, the worsening traffic congestion, all of us have to confront, not to mention the significant population growth and demographic changes, we need to take a new look at public transportation. and for all of these reasons, i am going to continue to work with our colleagues on this committee as well as those in the full senate and the house, and of course the administration. i do for opportunities advance and transmission of transportation bill. early next year. or as soon as we possibly can. i'm going to turn to senator shelby for any comments that he may have. senator bob menendez has an interest and wanted to be heard briefly on the subject matter as well. and again, as soon as we have

the 12 member, we will vote to go out. let me turn to senator shelby. >> mr. chairman, i would like my statement to be made part of the record. and other than that, i want to associate myself with your remarks. this is an 18 month extension. it is clean, but what we really need is to do the real deal. we need to continue to do that. and if we do, there will be certainly out there for a long time. and i hope we will not wait till the deadline to start working again. i think you're right. >> i appreciate that very much and i allow, switch gears, and we will move into our hearing this morning that i will make some opening comments, turn to senator shelby for his and then invite our very extinguished under distinguished witnesses. and i will advance if we interrupt your testimony. to deal with this legislation. so let us shift gears, if we can now do the hearing, and that is as i mentioned earlier a hearing

to establish a framework for systemic risk regulation. let me just share some thoughts if i can, and again we have had a loud discussion about the subject matter over the last number of much it we have had some 40 hearings in this committee since january. not all of it on the subject matter but the boca bearings have been on this whole issue of how do we modernize our financial regulatory structure. not only address the problems that are brought us to this point, but also how do we create that architecture for the 21st century. to allow us to move forward with innovation, creativity, it has been the hallmark of our financial services sector. and yet once again restore the credibility of the safety and soundness that has been the hallmark i think of our financial services sector for so many years. and get a laugh and abuse of many over the last number of years resulted in the economic problems that so many of our fellow citizens are facing. with joblessness, with house, foreclosures, retirement accounts being whiteout, and all of the ancillary problems that our economy is suffering through. systemic risk is going to be an important factor in all of this,

and i can't begin to express my gratitude to my fellow members here because unlike other matters that the congress is dealing with, my sense is on the subject matter this is not one that has any ideology that i can sense to it at all. what all of us wanted to figure out what works best. what makes sense for us here. now that we are going to solve every future problem. i think we make a mistake, if we sort of promising what we cannot deliver on. there will be future problems. we will not solve every one of them. but if we can look back at it and see where the gaps have been, either one where there was no afford it, or two, when it was adored but it wasn't being exercised. and how do we fill those gaps anyway that nicks said i think would be a major contribution. and i want to particularly thank senator shelby, former chairman of this committee, ranking member now that we've had a lot of conversations together we don't have a bill ready at all. there have been a lot of talk at this point but i get a sense among my colleagues as i discussed the subject matter with them that we share a lot of common just about as. and that is a good place to

begin. doesn't mean we'll agree on every answer we have, but i sense the overwhelming majority of us here are committed to that goal of establishing what makes it sound and solid regulatory process. the economic crisis introduced a new term in our national book at the. systemic risk. not words we used much. i don't recall using those words at all back over the years. it is the idea that an interconnected global economy it easier for some people's problem to become everybody's problem. and that is what systemic risk is. the failures that destroy some of our nations most prestigious financial institutions also devastated the economic security of millions of working americans who did nothing wrong and never heard of these institutions. that collapsed and put them at great risk. jobs, homes, retirement security. gone in a flash. because wall street greed in some cases, regulatory neglecting others, resulted in these problems. after years of focusing on short-term profits, while

ignoring long term risks, a number of companies, giants, of the financial industry found in cells in very serious trouble. some as we know tragically failed. some were sold under duress. and an old untold number only survive because of government intervention, loans, guarantees, direct injections of capital. taxpayers had no choice but to step in. that is my strong view. assuming billions of dollars of risk, and say to come is because our system wasn't set up to withstand their failure. their efforts to save our economy from catastrophe when real damage remained as we are are all painfully aware. investors who lost billions were scarred geisha were scared to invest their credit markets dried up. with no one willing to make loans to businesses could make payroll. employees were laid off and family could get mortgages. or most abaya on a mobile even. wall street failures have hit mainstream as we all know across our nation. and it will take years, perhaps

decades to undo the damage that a stronger regulatory system either could have prevented. and while many americans understand why we had to take extraordinary measures, this time, it doesn't mean that they aren't angry. because they are. it doesn't mean they aren't worried, and they surely are that. it doesn't mean they don't expect us to fix the problems that allowed this to happen. first and foremost, we need someone looking at the whole economy for the next big problem with the authority to do something about a. the administration has a bold proposal. to modernize our financial regulatory system. it would give the federal reserve new authority to identify, regulate and supervise all financial companies considered to be systemically important. it would establish a council of regulators, to serve as a sole advisory role and it would provide a framework for companies to fail. if they must fail in a way that does not jeopardize the entire financial system. it is a thoughtful proposal. but the devil as we all know is in the details and i expect changes to be made in this

proposal. i share my colleagues concerns about giving the fed additional authority to regulate systemic risk. the fed hasn't done a perfect job to put it mildly, with the responsibilities it already has. this new authority could compromise the independence the fed needs to carry out effective monetary policy. additionally, systemic risk regulation involves too broad of a range of issues. in my view, for anyone regular to be able to oversee. so i am especially interested to hear from our witnesses this morning on your ideas and how we might get this right. many of you have suggested to counsel with real authority that would effectively used the combined knowledge of all other regulatory agencies. as president obama has said, when we rebuild our economy we must ensure that its foundation rests on a rock, not on same. today we continue our work to lay the cornerstone of that foundation. strong, smart, effective regulation. that protects working families without hindering growth,

innovation, creativity. that has been again the hallmark as i said earlier of our financial services sector. and now i return to the senator shelby and then i will introduce our first panel. >> thank you, mr. chairman. at the core of the administration's financial regulatory reform proposal, is the concept of systemic risk. the president believes that it can be regulated and that the fed should be the regulator. but as we begin to consider how to address systemic risk, my main concern is that while there appears to be a growing consensus on the need for a systemic risk regulator there is no agreement on how to define systemic risk, let alone how to manage a. i believe that it would be legislative malfeasance to simply tell a particular regulator to manage all financial risk without having reached some consensus on what systemic risk is and whether it can be regulated at all. should we reach such a consensus, i believe we do and

must be very careful not to give our markets a false sense of duty that could actually exacerbate our too big to fail problem. if market participants believe that they no longer have to closely monitor risk presented by financial institutions, the stage will be set for our next economic crisis. if we can decide what systemic risk is, and that it is something that should and can be regulated, i believe our next question should be who should regulate it. unfortunately, i believe the administration's proposal largely places the federal reserve in charge of regulating systemic risk. it would grant the fed, as i understand, the authority to regulate any bank, securities firm, and sure, investment fund, or any other type of financial institution that the fed deems a systemic risk. the fed would be able to regulate any aspect of these firms, even over the objections of other regulators.

in effect, the fed would become a regulator, giant of unprecedented size and scope. i believe that expanding the fed power in this manner could be very dangerous. the mixing of monetary policy and the bank regulation has proven to be a formula for taxpayer funding bailouts and poor monetary policy decisions. given the fed ultimate responsibility for the regulation of systemically important farms will provide further incentives for the fed to hike its regulatory failures by bending out troubled firms. rather than undertaking the politically task of resolving failed institutions, the fed could take the easy way out, and rescue them by using its lender of last resort facilities, open market operations, even worse, it could undertake these bailouts without having to obtain the approval of the congress. in our system of government, elected officials should make decisions about fiscal policy

and the use of taxpayers dollars. not on an elected central bankers. handing over the public purse to an enhanced deity is simply inconsistent with the principle of democratic government. augmenting the federal reserve's authority also risks burdening it with more responsibility than one institution can reasonably be expected to handle. in fact, the federal reserve is already overburdened with its responsibility for monetary policy. the payment system, consumer protection, and bank supervision. i believe anointing the fed is a systemic risk regulator will make what is proven to be a bad bank regulator even worse. let us not forget that it was the fed that pushed for the adoption of the flow of basel ii write here in this committee, which would have drained our banking system of capital. it was the fed that failed to adequately supervise citigroup and bank of america, setting the stage for bailouts in excess of

$400 billion. it was the fed that failed to adopt mortgage underwriting guidelines until well after this crisis was underway. yes, it was the fed that said there was no need to regulate derivatives right here in this committee. it was also the fed that lobby to become the regulator of financial holding companies as part of. the fed won that fight, and got the additional authority itzhak. 10 years later, however, it's clear that the fed has proven that it is incapable of handling that responsibility. ultimately, i believe if we are able to reach some sort of agreement on systemic risk, and whether it can be managed, i strongly believe that we should consider every possible alternative to the fed has two the systemic risk regular. thank you, mr. chairman. >> thank you very much, senator. and we are still missing one. i think, is it one? one. i need 12. if i have a colleague that can

count well, i am willing to move ahead. [laughter] >> after all, this is washington, you know. we will wait for the 12th to arrive. >> is someone sitting here? [laughter] >> let me invite sheila bair and let me briefly introduce people who hardly need an introduction. and before this committee on numerous occasions, and we thank them. sheila bair as we all know is our chair of the federal deposit insurance corporation. served as assistant secretary to the treasury, extensive background in banking finance, and of course many of us up here have noted over the years when she was legal counsel to bob dole. and a great job in that capacity at the. so very familiar with the senate. merrie schapiro is the new chair of the securities and exchange commission. and prior to her appointment, mr., she served as the ceo as a financial industry repertory authority. also serve as a commissioner of

the sec during ronald reagan's administration, president bush 41 and the clinton administration and dan turow, is the new member of the board of governors of the federal reserve system and again a familiar figure in many of us appear having served in public life and numerous occasions. in the past, including assistant secretary of state for economic and business affairs before he served as chief counsel for employment policy on the staff of our good friend senator ted kennedy as well. and todd georgetown university law center. we thank you for your service and all of you. let me quickly now turn if i can to our markup and not just inform our colleagues who have arrived after statements were given we are considering of course the extension of the transportation bill. and we have completed our statements. bob menendez has not arrived. what i'm going to do when he comes in, at an appropriate time

to intervene, make some comments and apply the conversation we've had about transit, but i want to move along if we can. so i now move that the committee first of all that we move will be in executive session to do that without objection. so order. i now move that the committee report the original bill title public transportation extent and act. all of those in favor reporting the bill, signify by saying imac. those opposed, and then back. ththe eye of max howitt and i ak consent that the staff make technical and conforming changes and that the ruby way. no objection. so order. the executive session is adjourned. how about that for expediting a major bill? and now, get back to our witnesses. you have been introduced and ms. schapiro we will begin with you. all statements supporting materials and the like that you think would be valuable for our committee, as we consider modernization of the federal regular tour structure of course will be included in the record.

that is also true of cores of all of our colleagues here as well. and we would like if you could try to keep those remarks to five or seven minutes so we can get to the questions as quickly as possible. thank you for joining us. >> chairman doug, made a great ranking member shelby. i appreciate you holding this hearing. in the wake of the great depression. we are emerging from a credit crisis that has reached havoc on our economy. homes have been lost. jobs have been lost. retirement and investment accounts have plummeted in value. the proposals reported by the ministration to address the causes of this crisis are thoughtful and conference of. however, these are very complex issues that can be addressed in a number of different ways. it's clear that one of the causes of our current economic crisis is significant regulatory gaps within the financial system. differences in the regulation of capital, leverage, complex financial estimates and consumer

protection provide an environment in which arbitrage became rampant. reformed urgently needed to close these regulatory gaps. at the same time, we must recognize that much of the risk in the system involved financial firms that were already subject to extensive regulation. one of the lessons of the past several years is that regulation alone is not sufficient to control risk-taking within a dynamic and complex financial system. robust and critical mechanisms to ensure that market participants will actively monitor and control risk-taking must be in place. we must find ways to impose greater market discipline on systemically important institutions. in a properly functioning market economy, there will be winners and losers. and when firms through their own mismanagement and excessive risk-taking are no longer viable, they should fail. actions that prevent firms from failing ultimately destroyed