products any country. even to the australian group members. however, we also have additional export lolls -- controls. and this refers to biological production equipment to amend vaccine production and you can find all the different kinds of biological processing equipment under the category of 2b252. so license then are required for the product and the technology to make that equipment.

now, there are some select agents which is on the cdc list that is not controlled by the australian group. so then this is considered unilateral controls. which means if you would like to export some of these items, let's say vaccines, diagnostic kits, against the controlled organism found, you require license. and ascension countries of five ascension countries which cuba, syria, iran, north korea -- i don't know if i'm missing anyone. iran. i said iran. but anyway, there are five control -- or rather sanctioned countries at this point. now, as i mentioned before, the cdc select agent versus the ccl. there are similarities but then the cdc then regulates a

transfer of pathogenic organisms within or among u.s. labs. and the b.i.s. however controls these pathogenic organisms to other nations. and as i mentioned before, the vast majority of cdc agents are controlled by the b.i.s. which means it 98% of the agents are controlled. however, the cdc sometimes add new organisms onto that list. and so it takes -- there's a lag time between what the cdc have on their list and what the control have on their regular list. so in other words it takes time for them to be updated. but in general, we try to keep the cdc select agents and the

commerce control agents similar. so that there is -- there will be an overlap. and in addition to data, the b.i.s. control organisms and not on the select agent list. so in other words, the b.i.s. would control genomic control. if the organism is controlled than the genomic materials is also controlled and this would be listed under 1c53. what we mean by genetic elements, the genetic elements refer to acid sequences that are associated with pathogenity, microcontrol organisms. so as long as the organisms are on the list, then the genetic element that is associated with pathogenity will be -- will require license if you need to export it.

the nuclear acid sequences may also call for a subcontrol toxin list and this will be controlled. gegnomic control is not limited to things like chromosomes, genomes and vectors so any -- any of these that fall under those criteria will be controlled. and it can be genetically modified or unmodified. now, the nuclear acid sequence, means any sequence that when transcribed will cause a significant health hazard. so in other words it will cause a disease, that sequence is

controlled. and it also means that if it has ability or rather it enhances the organism to make it more virulent, that would be controlled and this can be diseases that are harmful to humans, animals, or plants. so what is not controlled then under ccl, you may ask? there are some select agents that are not under ccl because they've been added maybe on a annual basis or on a -- you know, periodic basis, and there are some genetic elements such controlled. they do not have the open reading frame. in other words, if it's just a gene fragment and it's not a whole gene, then we do not

control them. and chromosome fragments we don't control them as well. in the case of e. coli, dna sequences, the sequence of must coat for a virile toxin and it does not, then it does not control. so basically the organisms, the microbes of the viruses that are controlled, very limited. in other words, it's a very selective group. a lot of organisms are not controlled so as long as it meets a criteria or the specific criteria in the ccl then you require license. if it does not, then you go by a principle of elimination. so now talk about technology controls for biological material. it's stuck.

thank you. so what kind of technology are we talking about? we control technology for genetic engineering of those controlled pathogenic organisms. that is if you're genetically modifying it to make it a more virulent organism, that's what it controls. if, however, if it's published processes, we do not control that. and we also control specific information that's necessary for development production of control microorganisms and this would be under eeco1101.

what does technology means? trademark take the form of technical data or technical assistance so in the next slide, i have example of what technical data means. it could mean it could be a blueprint. it could be a diagram. it could be tables. it could be anything that is on the tape. it could be even information on an email. that is considered technical data. and how extensive are these controls then? the technology controls is only for technology that is not publicly available. and when we mean by publicly available is if a technology is already published or will be published or refers to fundamental research or results

from research, it could be educational or it could be available in a patent application or in public libraries. commerce does not control any of those technology. so then any control that is not regulated, controlled regulations, that is under our jurisdiction and then again it would be development and production of these micronisms. so it will be only microorganisms that are under the ccl. if it is not a ccl, we do not worry about those organisms. and again, as i say the disposable technology is mainly used for chemical disposal. now, the related control for biological processing equipment and several eec unlisted there,

these refers to how do you make this particular kind of biological equipment. and in a next couple of slides i'll give you examples of what biological equipment do we mean? so the technology then for the use of the equipment is actually 2e301. but this technology that i'm talking about is different from the other technology that refers to the production -- the production and development of microorganisms. this refers to technology for biological equipment. so some of the equipment that are controlled, they are -- they will fall under, let's say, complete petri or p4 facilities which relates to bsl3 and bsl4 labs. and they can be fermenters that

are on the list. there are separators, cross-flow filtration equipment, freeze-drying eqt, aerosol-challenge chambers, protective and containment equipment. now, p3 or p4 level, this refers to the containment levels that are specified in the w.h.o. laboratory biosafety manual. so if it meets those guidelines then we control them. in other words, we do not control, let's say, a bsl2 laboratory facility. that does not require any license at all. in the case of cross-flow filtration equipment, this would have to meet this specific occasions. if it meets any -- everything

that is written on the slide, that means they will require license. if it does, then you do not require license. so the total filtration area would have to be equal or greater than 1 square meter. in other words, if it's a small cross-filtration equipment or a module that is used on a laboratory skill, that does not require license. but, however, this is mainly used for manufacturing facilities to make vaccines or to make protein, therapeutics and so on, and so this would require a license. the difference between that is, it does not control reverse osmosis equipment which is normally used for purification of water for drinking purposes or, you know, sterilizing water and so on. so in other words, the reverse

osmosis equipment may be used in the food manufacturing facility, so that is not controlled. this cross-filtration is only meant for when you're separating, let's say viruses or cell cultures in the facility. we also have controls for protective containment which means they could be personal protection but it has to meet those requirements, okay. it's got to have an external and so on. and the biological safety requirements -- the several names associated with this and so they could be glove boxes and so on, but it has -- it has to meet the class 3 safety specifications. in other words, if it's an glove box -- i'll give an example, if it's a glove box that has positive pressure, that is not

controlled. when we mean glove boxes, we mean it's got to be -- have negative air pressure flow control. now, the flu virus, the h1n1 virus that we're currently dealing with, this does not meet an export license at this point. the reason is simply because it's not under ccl. it's a new emerging virus. who knows? maybe five years down the line we may have a control for that. but at this point this is not controlled. so in other words, if researchers need to change virus controls from one country to the next, you can send it without licenses and it's perfectly legal and you would not get in any problems with that. in the case of the reconstructed 1918 flu virus, now, if it

contains any of the portion of the coding regions of the 8 gene segments, it's got to meet this speckification it would meet the requirements. and 1360.a.1 but this is a new rule or regulation that was added a few years ago, maybe two years ago with discussion with the australian group members and so every single member agreed that this should be controlled. this particular reconstructed virus and so that's why it falls onto our ccl. but i do not believe this is under select agent -- i'm sorry. it would be under select agent by now, select agent list of the cdc. in a case of the highly pathogenic avian influenza virus, we do have a control for

this particular virus. but, however, it has to meet this rigid criteria. if it is a low pathogenic avian influenza virus, you do not require license or export that virus for whatever purposes for making vaccines and so on. so in this case, it has to meet this criteria, and if it does not, then it falls out of the control. so what about vaccines then? what about vaccines to the hpai virus? now, if it is a human vaccine, it does not require a license. meaning, it would classify it as a very broad classification which means to most countries, it does not require a -- rather a license.

but if you were to export to north korea, then you would need a license 'cause we have unilateral controls with a sanged country. -- sanctioned country. the vaccine has to be made by trains approved by the fda and the w.h.o. if it's made from a wall-type virus, then it would require a license. in the case of poultry vaccines that means it's vaccines to the h.p.i. vaccine. this is classified as 1cc91. but that doesn't necessarily mean that you require license to most countries. it is just as i said to countries that are on the antiterrorism list and it will be to cuba, iran, sudan, korea and syria.

so in conclusion, i'd like to thank my colleague at the division of chemical and biological controls unit within b.i.s. and also to the organizers for inviting me to be on this panel. thank you. [applause] >> and if you have any questions, that's my contact information. >> we may have a few minutes for questions at the end of this session, too. postpone all those until the third speaker has spoken. and it's dr. douglas powell of

antigen express, inc. and he's going to be talking about h1n1 and h5n1 viruses. thank you. [applause] >> i'd like to thank everybody for hanging in there for the end of this session and i want to talk about vaccines in that we've heard the first speaker and also you've been hearing over the last couple days and reading in the media the response we've been using to make the egg-based vaccine for the last 50 years has been more or less sufficient but it's really not going to be sufficient for this pandemic or future pandemics and you may hear words being -- you know, numbers being thrown around like we're going to make 4 billion doses and that kind of thing but it will be difficult to achieve

that in any kind of reasonable time frame. i would like to talk about novel peptide h1n1 swine influenza vaccines that we're working on that are synthetic peptides similar to what we heard about earlier. and what they -- we focus on the stimulation helper cells that are mediators of immunity. they're helper subsets -- they're involved in cellular immunity with the protection of the antibody. this is what people relied on for the gold standard for the efficacy of a influenza vaccine and they're also -- they're involved in granule side activation as well as regulatory t cells which are a critical potent of the immune system. so at antigen express t helper cell stimulation using iit hybrids and the idea is here the immune system what are known as

mic class 1 and class 2 epitopes. so what happens is we use a technology -- this is an example of an antigenic epitope. he make a li-key hybrid which is a therapeutic epitope. they can be made by chemical sin these and make hundred of kilograms or tons of doses and you could make a billion doses at a time, i think in like a month or so. and what happens is the i.t. hybrids come along. they can displace epitope that's present and then bind and result

in an antigenic cell -- instead of working on infectious diseases we also work on cancer vaccines. we have both phase 1 and phase 2. of and there's an antibiotic molecule that targets the peptide. what we're doing is using a peptide protein to immunize people to stimulate their response to that receptor and so we've done this -- we've shown very good results in two clinical trials so far and we have additional clinical trials going on right now. we have the breast cancer and prostate cancer -- there's also a combo vaccine that has both a class 1 and a class 2 epitope. we have a melanoma vaccine. and we have h1n1 and h5n1 and also hiv and then we can also use this technique

diagnostically to diagnose diabetes in its early stages and we use another technique called i.l.l. technique this why is h1 more stronger -- in some countries it's more lethal in mexico than it is in the united states. it could be due to different factors but it clearly is more lethal than the standard seasonal strain both in humans and in animals. the ferret is used and the mouse are used commonly for animal models. the seasonal flu infections in humans is in the respiratory tract but the swine origin viruses causes unusual symptoms of vomiting and diarrhea in about 45 of people indicating it is not combined to the respiratory tract and also low white blood cell count.

it happens with higher than. it may be part of its pathogenesis. there's a lot to learn about the the h1n1 and h5n1. the swine origin infectious virus h1n1 causes more disease in ferrets. it includes mild to ryanitis and bronxitis it causes more lung damage than the standard flu and death in animals and people occurs through progressive pulmonary failure. so our pandemic flu program goal is to develop a novel synthetic next generation vaccine that's not dependent on eggs or cell-culture biological that could be mass produced utilizing existing technology. like i said we've had this vaccine technology around for 50 years growing the virus in chicken eggs and it's been -- it's a crude process, it's a

biological process. it's worked and, you know, the fda in other countries -- they keep going back to it because it works. well, we have the egg-based vaccine it works. there's funding on additional new technologies including dna vaccines, proteins that are made in bacteria, but these all have limitations and really the fastest way to generate a new vaccine for like a pandemic that's going on now is through synthetic peptides. so to develop -- so that's our idea is to develop a next generation synthetic vaccine and it will be designed to prevent infection and limit the severity of h1n1 in humans. most of you probably know in 1918, we had a similar scenario where there's a mild h1n1 flu-like illness that came around in the springtime but something changed during the year and when it came back in the fall it killed somewhere between 20 and 40 million people. hopefully that won't happen in this virus but nobody can tell.

the influenza virus is the most mutable form of virus that anyone -- we have any kind of experience dealing with. it can mutate in all the experts say can in the fall you can just to expect to be surprised. it might be a milder virus but a more serious virus. h1n1, the swine origin virus is in countries in indonesia with the h5n1 virus. and they can recombine and get a new virus. instead of getting a virus that kills 1% or less than 1% like the h1n1 you might have a highly transmissible virus that kills 50 to 60% in the worst case scenario and so but in order to prepare for that we have to be develop new ways to respond more rapidly. so the importance of the t cells in influenza virus, the flu-specific cd4 t cells that

protects against infection and the responsive memory t & b responsive cell responses or if you get a flu shot you have an immediate response but you also make what are called memory cells if you're exposed to the flu or you get another vaccine in the future it will amplify that reaction. flu-specific cd memory cells become effecter cells that provide complete infection of lethal nefection through multiple infections through animal models. so the objectives were to -- initially i'll go through this quickly. screen they are class 2 alleles that have class 2 epitopes and try to identify frequently binding and promiscuous peptides and we have done screening and looking at people with

documented infection webs swine, h1n1, but there's methods that become recently where you can in vitro flu and identify peptides. we hope three or four that will give broad -- protection to a broad population. they're synthetic. they're pure -- there's no any kind of contaminating material in there except for this synthetic peptides and they could be dry. they can be freeze-dried like coffee, reconstituted places, poor countries, africa, south africa, south america, some places where they don't have as good access to healthcare. so the idea is to identify active hybrids from pbmcs from

h1n1-infected individuals and we would select a group of hybrids that could be used in a genetically diverse population as in this population here or anywhere else around the world. so this is just a little bit of work we did in the mouse and we -- the vaccine -- the standard vaccine is given without atovans and they will be used with the swine flu and there are vaccine trials that are planned at this point. but typically the flu virus, as you heard earlier, it's grown in chicken eggs. it's purified, it's chemically activated and that's what's used as a vaccine. there's no stimulating -- nothing added to it. i want to show here -- if i could give one dose -- this is a mouse. if i give one dose of the protein only in a mouse, this is looking at the t cells response here you get a very low t cell

response but if i prime with one of these synthetic hybrids i get a much stronger response so these peptides can be used on their own or be used as mod laters to stimulate the response to a normal seasonal vaccine. if i give one dose of antigent that we're using i get a end point of antibody but if i prime with the epitope and boost with protein it includes end point responders which is very significant from a disease standpoint. and then this is some data that we sent out to sri, a private company that does h5n1 work. the typical standard for a flu vaccine is one that introduces a neutralizer of 40 or more.

40 is the cutoff for seasonal flu or for pandemic flu. but you can see here if we just -- just use it by itself there's no antibodies being used. if you use one dose you get it at at the point. if you use two doses of protein you get a 500, one dose of protein and one dose of peptide, you again get them that are acceptable and should be productive in humans. -- protective in humans. we did some testing of the vaccine from the h5n1. we immunized volunteers. this study was done at the university of rochester school medicine by john trainer. we drew 35 volunteers who participated in the vaccine trials a couple of years ago. the peripheral blood nuclear cells were isolated, criopreserved and shipped and i'm showing -- this is t cell

responses for gamma which includes an immune response to flu and it's reported as percent of vaccine responding or foldover background. we used a number of peptides in a pool that where it identified individual peptides that are recognized by people. a typical response is 10 or 20 spots per million cells and so we're seeing fairly decent response here to overlapping peptides but also these are class 2 peptides that were predicted by a computer algorithm and those worked as well. and this is kind of a busy table but basically what it's showing for two of these peptides we are looking for peptides that are recognized by a large number of different people and so the donors or the numbers across the

top are the different donors and the number down the side of the peptide numbers you could see this peptide are recognized by number of different individuals. we think it would make those good vaccine candidates and we have done one clinical trial in lebanon and this was using alom but quickly looking at this one individual it was boosted and after 50 days and 80 days you can see a real increase of this response to these c4 epitope and they may be protective. we just started -- completed one trial in lebanon. we hope to do additional studies in europe and also we filed a study with the fda to conduct trials in the united states.

so the advantage of the egg-based or cell-culture vaccines that these biological methods of flu vaccine are scalable and producing billions of doses can be challenging. some of the vaccines coming from the manufacturers they are not making as much vaccines they thought they were. only 33% of the vaccines with being made in the country and the countries that are behind in their production capacity, they've admitted they're not meeting their deadlines, they've already stated they're not going to give out vaccine until they have enough vaccine for france and other contracts so there are going to be supply issues. there is going to be scarcity of vaccine. even the rich countries in the united states it's going to be a problem. and as i said before, as our first speaker mentioned large scale chemical synthesis capacity exists to produce billions of doses of vaccine that sure to appear at the time. the virus can mutate and the

virus might be totally different from what's going on in the fall. we won't have six months or nine months to prepare for the new virus as we have using the other method. we need something that's rapid and flexible and it can you can make billions of doses in a short period of time. chemical sin these is more rapid and flexible to pandemic flu strains that are highly likely to occur as this virus did as these virus. i would like to thank the organizers and i would like to thank you for your attention and i want to make the main point that he we need to start thinking of novel vaccines for things like pandemic flu and other viruses that are emerging. thank you. [applause] >> give a hand to our speakers once again. [applause] >> we're running a tad off the schedule so we want to make sure we go on to lunch and we'll have

the rest of our presenters will be presenting at lunchtime so we'll see you over in the lunch. it's right behind us. while i'm at it i'm going to ask for a couple of people that we need to meet with them at the end. it's daniel barnett. would you please stay with us. gary, would you stay with us, please. james hagen, marsha sailors. let's see, lieutenant samuels, michael --

>> now president obama talks with democratic party activists about healthcare legislation. this event was hosted by the group organizing for america, a spinoff from the obama presidential campaign. it's just over an hour. >> my name is beth. i'm from chester, virginia. i was a volunteer during the campaign last year, and this spring i started volunteering with organizing for america. i got involved with the campaign

and i've stayed involved because i believe that we must change this country. i found and continue to find barack obama to be the one public figure in my lifetime who has the vision, ideas, passion, and commitment to bring the change that we must bring to this country. i was trained as a community organizer and now i'm one of 13 lead volunteers in my state. i got involved in the campaign because one man's vision restored my hope for this country. my involvement in health insurance reform is deeply personal. right now our system works better for the insurance companies than it does for regular people. that's why i've been organizing people in my community to get healthcare insurance reform passed in 2009.

i'm proud to be doing this work. thousands of people in my area have signed on already. and we will keep working. person by person, block by block until we get it done. [applause] >> and now it is my incredible honor to introduce to you the president of the united states, president barack obama. [applause] [applause] >> thank you, everybody. hey! thank you.

yes we can! yes we can! yes we can! >> thank you. thank you, everybody. please have a seat. this looks like a casual crowd. [laughter] >> i'm going to take off my jacket here. let me begin by thanking beth not just for the great introduction but for the unbelievable dedication that she showed throughout the campaign but more importantly almost now trying to actually get some things done. i want to thank congresswoman debbie wasserman schultz. where did debbie go? i hear you're on a scooter. i want to see that at some point. [laughter] >> that's pretty school. always stylish. [laughter] >> i want to acknowledge my great friend, tim kaine who joined us earlier by phone and is doing just a great job on behalf of not only the people of virginia but also on behalf of democrats all across the country. to all my organizing for america

volunteers, thank you so much for your unbelievable dedication. [applause] >> it is good to be here. [applause] >> it's great to be here with all of you because it reminds me how we got here in the first place. we're here because you believed that after an era of selfishness and greed that we could reclaim a sense of responsibility and a sense that we have obligations to each other, not just here in washington but all across the country. you believed that instead of growing inequality we could restore a sense of fairness and balance to our economic life and create lasting growth and prosperity. you believed that at a time of war and turmoil, we could stand strong against our enemies but also stand firmly for our ideals. and reach out to the rest of the world and describe to them what america is about and how we can

forge together a world of common interests and common concerns. that's the change you believed in. that's why you worked so hard knocking on doors and making phone calls in the hot sun and cold winds. [laughter] >> sometimes having doors slammed in your faces. your family members all saying, why are you doing this? [laughter] >> 'cause this guy has no chance. [laughter] >> that's something i'll never forget. but we all know that winning the election was just the beginning. i said this election night. i said it at the inauguration and somehow i think some people thought i was just a fool. i was serious. winning the election was just the start. victory in an election wasn't the change that we saw. it had to manifest itself in the real day-to-day lives of ordinary americans all across the country.

and i know that folks like beth and all of you at ofa have been working to make that change. doing the same things you were doing during the campaign. going block by block, neighbor by neighbor, having doors slammed in your faces. people telling you why are you doing this? it doesn't make any chance. but just so you don't lose heart as we enter into probably our toughest fight let's just recall what we've already gotten done. not one month into this administration we responded tot worst financial crisis since the great depression by putting in place a sweeping economic recovery program that has already made an enormous difference in people's lives. you've got millions of people who have unemployment insurance and got cobra so they could keep their health insurance and states who have been able to avoid layoffs of teachers and firefighters. a tax cut for the working

families and a commitment during the campaign that we have already fulfilled. thousands of people being put back to work all across the country, rebuilding our roads, our bridges and our hospitals. as a consequence of everything that we did just in that first month, we've been able to see a stabilization of the financial system where a lot of economists thought that we were going to be dipping into a great depression. obviously, we're not out of the woods yet, but we've taken steps to address the housing crisis and keep people in their homes. we made some tough choices to keep the financial and the automotive sectors for collapsing which would have further shocked our economy. that's on the economic side. in the meantime, we lifted the ban on stem cell research. we expanded health insurance programs to 11 million more children across the country. [applause] >> we passed a national service bill that will give thousands of americans opportunities to serve. [applause]

>> i get all choked up just talking about it. [laughter] >> we passed the lily ledbetter fair pay act to make sure women are treated the same way as men. [applause] >> we passed legislation to protect consumers from unfair rate hikes and abusive fees for credit card companies and some of those rules went into effect today. [applause] >> we passed -- we passed laws to protect our children from marketing by tobacco manufacturers. we prohibited torture. we begun to leave iraq to its people. we've taken the fight to al-qaeda and afghanistan and pakistan. we've rebuilt our military and we're restoring our alliances and our standing in the world. [applause] >> so not a bad track record. [applause] >> not a bad track record.

we should be proud of what we've accomplished but we're not satisfied. and we should be confident but not complacent. we've got more work to do and we've got more promises to keep and one of those promises is to achieve quality, affordable healthcare for every single american and that is what we intend to do when congress gets back into session. [applause] >> now, we all know this has been an emotional debate. we've seen tempers flare, accusations have been hurled, and sometimes it seems like one loud voice can drown out all the civil sensible voices out there. but remember one thing, nothing is more powerful than millions of voices calling for change. that's how we won this election. you know this and that's why since ofa launched it's health reform campaign in june you launched events in 45 towns in

every single state and every single congressional district, which is remarkable. [applause] >> and, of course, the tv cameras aren't there when you're doing all this. [laughter] >> and when you notice that nobody is paying attention to what you're doing, just remember we've been through this before. some of you were involved when we were in iowa. 30 points down. and all of washington said, oh, it's over. hang-wringing and angst and last year about this time you'll recall the republicans had just nominated their vice presidential candidate. [laughter] >> and everybody was -- the media was obsessed with it and cable was 24 hours a day and obama has lost his mojo.

[laughter] >> do you remember all that. [laughter] >> there's something about august going into september where everybody in washington gets all we-we'd up. i don't know what it is. [laughter] >> but that's what happens. but instead of being preoccupied with the polls and with the pundits and with the cable chatter, what you guys consistently did is you kept on working, steadily, deliberately, sensibly, knocking on doors, talking to people. talking to your coworkers, just giving people the facts, explain to them a vision of how we're going to move forward and that's what we're going to have to do today. because we're going to have to cut through a lot of nonsense out there. a lot of absurd claims. there was a poll done out there, "the wall street journal"/nbc

poll. it turns out a huge proportion of the american people are convinced, a, that somehow health reform means illegal immigrants are going to get healthcare. b, that it's a government-takeover of healthcare. c, all the money is going to be funding abortions. d, that -- what's the other one? death panels? we're all going to be pulling the plug on grandma. now, come on! [laughter] >> we can have -- [applause] >> we can have a real debate because healthcare is hard and there's some legitimate issues out there that have to be sorted through and worked on. as debbie talked about.

but we have to cut through the noise and the misinformation for the true information, factual information as all of you. you have more credibility than anybody on television when it comes to your family members and your friends and your neighbors and that's why you being involved is so important. now, i don't have to explain to you why it's so important to pass health reform for the 46 million people who don't have health insurance. but it's just as important that americans who do have health insurance, which are the majority of americans -- that they understand what health reform means for them. so let me just make sure i try to give you some bullet points here because right now the system works very well for the insurance companies but it doesn't work so well for the american people. first, no matter what you've heard, if you like your doctor, you can keep your doctor under the reform proposals that we put forward. if you like your private health insurance plan, you can keep it. if your employer provides you

health insurance on the job, nobody is talking about messing with that. if you don't health insurance, we do intend to provide you high-quality affordable options. and that is by the way not just poor people who don't have health insurance. in fact, a lot of poor americans have health insurance under medicaid. mostly it's working americans who don't have health insurance on the job or it's self-employed americans or small business owners or people who work for small businesses who don't have health insurance and what we want to do is to give them a menu of options that they can choose from and then a little bit of help in terms of making their premiums more affordable. so that is absolutely critical. now, one of the options we want to provide is a public option. now, this has been a confusion around this -- [applause] >> there's been a lot of confusion about this so let me just clarify. i think a public option is important and let me explain

why. we're going to have a marked place where people can select the options that work best for them. the insurance plan that works best for them. a lot of those choices, the overwhelming majority of those choices will be private insurance options just like members of congress have, they're allowed to choose from various proposals or various plans that are part of the federal employees health plan. if we have a public option in there, that can help keep insurers honest. it can provide a benchmark for what an affordable basic plan should look like, and so even though we've got a whole budget of insurance regulations that ensure that any private insurer that's participating in the exchange is giving you a fair deal, this is sort of like the belt and supenders concept. it means that not only do they have to abide by these rejection regulations they have to compete but instead is making sure that

the american people get decent healthcare. now,(v having said that -- [applause] >> having said that, i want everybody to be clear that the public option is just one option. it will be voluntary. nobody is talking about you having be in the public option. only -- the only thing that we're talking about is this being available to you as a choice. expanding consumer choice. and we think that's a good idea. now, there are a whole bunch of other aspects to health insurance reform, though, that people have to understand. we want to make sure that, for example, insurance companies can't prevent you from getting health insurance because of a preexisting condition. that will be the law whether you're in the health insurance exchange or you're just keeping the insurance that you already have, you should be able to keep it regardless of preexisting condition. you should be able to purchase it. there shouldn't be lifetime caps or yearly caps where you bump up against it and suddenly you've

got huge out-of-pocket costs that drive you into bankruptcy. we've got to make sure that there are basic consumer protections on that. you should be able to keep your health insurance if you get sick or lose your job or change jobs. when you need insurance most that's when the insureds decide to drop you and we got to make sure that that is against the law. and that's part of what health insurance reform is all about. so it's going to bring down skyrocketing costs. it's going to save families money and save businesses money and it's going to save government money. we are going to make medicare more efficient guaranteeing today's seniors better benefits than they have right now. we're going to make sure that that doughnut hole in the middle of their drug prescription plan, that that doughnut hole is closed because we want to make sure seniors who are already living on fixed incomes during difficult times aren't having to dig even deeper to increase drug

company profits. so i just want everybody to understand that in addition to providing health insurance for people who don't have it, even if you have health insurance, you've got a stake in this debate. 14,000 people are losing their health insurance every single day. millions of people all across the country are vulnerable to exclusions because of things like preexisting conditions. millions of americans have experienced the fact that premiums have gone up three times faster than inflation and faster than incomes. and if we go at the pace that we're going right now, there's going to be a whole lot of families to make the decision that they can't afford health insurance because the costs are simply unsustainable. and if you're a deficit hawk, then you should be especially concerned about passing healthcare reform because at the pace we're on right now, medicare is going to run out of money in eight years. it won't be totally broke but it

will be in the red because the costs are going up a lot faster than the money that's coming in. so when you're talking to seniors out there, tell them number one nobody is talking about cutting their benefits. talk to them about the fact that by the way, medicare is already a government program. [laughter] >> sort of when people say -- [applause] >> keep government out of our healthcare, make sure they know that medicare is a government program. but also explain to them that part of what we want to do is strengthen the program so that it's going to be there over the long haul. we don't want a situation in which medicare runs short of money because we did not make the changes that were needed early on. i am absolutely confident that we can get this done. but i want everybody to remember this has never been easy. never been easy. when fdr proposed social security, all across what was i guess the equivalent today's

internet. [laughter] >> all the newspapers and the radio shows and all that -- he was accused of being a socialist. he was going to bring socialism to america. how dare he? when jfk and then lyndon johnson proposed medicare, everybody suggested this is going to be a government takeover of healthcare. it's going to destroy your relationship with your doctor. the same arguments that are being made now have been made every time we've tried to propose a significant change that ultimately made people more secure, improved our healthcare, improved our quality of life. so we cannot be intimidated by some of these scare tactics. we have to understand that there are a lot of people who are invested in the status quo and making a lot of money out of it. we got to also understand that people are understandably nervous and worried about any significant changes when it comes to something as important

as healthcare because it touches on your lives. it's very personal. and so they're more vulnerable to misinformation and that's why what all of you do is important. people trust you. your neighbors, your friends, fellow community members -- they trust you. they know you. and if you are presenting the facts clearly and fairly, i'm absolutely confident that we're going to win this debate. but we're going to have a lot of work to do. i'm grateful that you're willing to do it. let's go get them. thank you very much, everybody. thank you. [applause] >> thank you. all right. >> thank you, mr. president. thank you for taking time out of your very busy schedule to talk to all of us, your supporters, about this critical issue. i would like to add for folks who are interested either watching this at home or at work, you can sign up to

participate or host a healthcare event right now by entering your zip code. and for folks who are listening on the phone, please go to barackobama.com and sign up to participate or host an event for you. we collected thousands of questions from across the country and we're going to take three, one from email, one from the telephone and another one from twitter and then we're going to open it up to your volunteers here. these are your best volunteers in the area to have you call them and ask questions there. with the first question, cindy? >> good afternoon, mr. president. our first question comes from julia in colorado springs, colorado. julia writes, i am a volunteer community organizer in colorado. this summer our volunteers have called 4800 members of that community and gathered declarations of support from over 2600 people. the debate is really heating up. what do you think is the most compelling argument we can make for health reform? ..

>> more and more employers are going to say we just can't afford to provide you health insurance. or if we do, we're going to push more and more costs onto you. you are going to lose more and more of your paycheck, even if you don't know it. it turns out in the 1990s, wages and incomes flatlined. and part of the reason, was because a lot of the company profits that normally would have gone to salary increases or wage increases, and that being gobbled up by health care. so if you have a plight under private plan, you have something to worry about. the viewer on a public program, like medicare, you have something to worry about because we're going to be running out of money. so the status quo is unsustainable. you've got to make sure that you explain that to folks. it's not as if we just stand still everything is going to be okay. point number two.

is that if you don't have health insurance, we're not forcing you to go into a government plan. we in fact just want to set up a system similar to what members of congress enjoy, where you have a menu of private insurance options. and we're just going to give you a little bit of help so you can afford the premiums. that's all we're talking about. now, one of the options will be a public option. because we think that potentially could be a better deal for consumers but nobody is going to force you into that option. it will, however, help keep the private insurers on is because if they are charging a lot more, higher profits, higher overhead, worst deal in terms of insurance, then a lot of people will say, well, i might as well take advantage of the public option. but it will be the choice of the individual. that's the second thing to emphasize. the third thing to emphasize, and probably the most important thing to emphasize when you're talking to people about this because most people have insurance, remember that, the

people who don't have health insurance they are already in favor of reform. but both america and have health insurance. so the most important thing to describe to them is this will be a set of consumer protections that provide you more safety and security. you know that you will be provided for if you get sick. because what we're going to do is we're going to say to insurance companies, you got to do certain things, like admit people even if they've got preexisting conditions. you can't hide under the fine print a lot of terms that allow you to draw people when they get sick or exclude them from care. in fact, the house bill actually has a provision that says insurance companies if they want to participate in the exchange they can only charge 15% and profits and administrative costs. the rest of the care has to go to actually making people will

so that will be a cost control element. but the point is that all these forces to taken together will help people know that when they pay their premiums and they've got health insurance, that in fact it is there when they need it and that they can count on it and they will not be jerked around. and over time, because of the cost savings measures that were put in place, for them, making sure the prevention and wellness is covered, are actually going to reduce the cost of health care over all over the long term. and that is going to be equally important is eventually that will show up in your paycheck's. in lower premiums. because right now americans are paying five to $6000 more per person in health care cost than any other advanced nation. so not only do these other countries have universal care, but they are paying five to $6000 less per person. we're not getting a good deal.

and so nobody is talking about a government takeover of health care. we are talking about making sure that people are getting a good deal for the premiums that they are already paying. and i think that argument, most of the time, will win the day. i was just on a conservative talk show this morning, or this afternoon, and a woman called and she said you don't have to admit that they show i'm glad that you explain how this public option works because i thought your whole plan was just the public option. there's a lot of people just have a lot of misinformation, partly because of, let's face it, health care is complicated. and you know, it's subject into a lot of misinformation out there, and that's why your efforts are so important. so thank you, cindy. wherever you are. >> thank you, mr. president. we have our second question. in our second question comes from the telephone.

>> caller: our second question comes from a caller over the phone. can't even. go ahead, connie. >> caller: good afternoon, mr. president. >> high, connie. >> caller: hi, mr. president. good afternoon. i'd like to thank you for taking my question. my name is connie lint and i'm with jay county florida i have lived in congresswoman's. [inaudible] [applause] >> caller: i am a retired health care administrator. i was a neighborhood team leader or your campaign and now i'm a new community organizer. my question, sir, are we winning support from members of congress? do you think we're making a difference, sir?

>> the fact is you've already got one of the best members of congress, so if you talk to her your kind of preaching to the choir. especially since she is sitting here right now. [laughter] >> but can i just say that even if you live in a strongly democratic district, where there's a strong progressive member of congress who's already in favor of health care reform, convincing people more broadly about the need for reform still makes a difference. because unfortunately, washington is obsessed with the snapple. -- snap poll. they are obsessed with what is played on talk radio or, you know, once said at a town hall meeting. you can have 20 really simple sensible town hall meetings, but if there is one where somebody

is screaming you know which one is going to get on television. and so every single person that you talk to this mind is changed is going to make a difference. and in your congressional district, i think debbie would confirm there are a lot of senior citizens. seniors right now are the most worried of any population group about health reform. they are the ones who are most nervous, and it is understandable. a., because seniors need more health care than anybody else. and they already have good health care under medicare. into their general attitude is i don't want change. i did want to make sure that you're not taking away what i already have. and that's why it is so important to emphasize to seniors, connie, that you're talking to that we are not reducing benefits under medicare, that we think medicare is a sacred trust. in fact, part of what we want to do is strengthen medicare by

closing the doughnut hole that is making prescription drugs really costly for those who need prescription drugs most. and by extending the life of the medicare trust fund over time because right now we are spending money on things like subsidies to profitable insurance companies. about $17 billion a year is taken out of medicare to pay to insurance companies who already are making a big profit. without any competitive bidding whatsoever because they are running a portion of medicare called medicare advantage. now, if we just have been a 10 mbit for participation, even if you still include them as a potential provider, that alone would save us $17 billion a year. and that would extend the life of the medicare trust fund. so you've really got to emphasize i think to seniors

that, number one, nobody is talking about messing with your medicare benefits. and number two, reminding seniors that at the same time you've got kids or you've got grandkids, they need to make sure that they have the same security that medicare provides seniors. there are a lot of people who are 50, in the mid '50s right now don't qualify for medicare, may have lost their job that used to provide health care. it is almost impossible for some of them to get health care because they've already had made a heart attack, maybe they've had an incident of cancer, maybe they've had some sort of other pre-existing condition that makes insurers want to shy away from them. their attitude is, no, we will take the young, healthy ones. and that way we never have to pay out and we make more profit. and that's part of what we want to change as well. you have to remind seniors that a lot of their family members who deserve the same kind of security that they have.

nobody is talking up about taking away their security. we want to expand that security to more people. great question, connie. next question. cindy? >> arthur question comes from randy in phoenix, arizona, who submitted her questions over twitter. she writes there are too many lies about health insurance reform. death.com rationing, you name it. where are these lies from? i want people to know the truth. >> no, look, we know where these lies are coming from. [laughter] >> i don't think it's any secret. you know, if you just click channels and then stop on them, certain ones of them. [laughter] >> then you will see -- [applause] >> you know, you will see who is propagating this stuff.

i said during the campaign that the best -- the best offense against lies is the truth. and so all we can do is just keep on pushing the truth. the truth is there is no plan that has ever been considered under health care reform in congress that covers illegal immigrants know what is proposing. and get a huge percentage believe that that is the case. so anybody listening right now, let's dispel that myth. there are no plans under health reform to revoke the existing prohibition on using federal taxpayer dollars for abortions. nobody is talking about changing that existing provision. let's be clear about that. it's just not true.

let's be clear about the fact that nobody has proposed anything remotely close to a government takeover of health care. none of the plans that are out there. the most liberal progressive plans that have come forward and come out of committee, all of them presume that, if you've got private health insurance, you can keep your health insurance. nobody is talking about getting between you and your doctor. and interfering with that relationship. what we have said is we don't want government bureaucrats interfering with that relationship. we also don't want insurance company bureaucrats interfering with that relationship. [applause] >> death panel idea, the genesis of this. this isn't interesting example, sort of tracing out misinformation spreads. there was a provision in the

house bill that very sensibly said, you know, a lot of people towards the end of their life, they haven't prepared for things like living will, they don't understand what their options are in terms of hospice. and we should reimburse people, if they want that council. voluntarily. if they want it, that's something that medicare should reimburse for. it shouldn't just be wealthy people who get good counseling and information about how to handle their affairs during a very difficult time. so that voluntary provisionthat permits reimbursement, which by the way, republicans had supported previously. this was previously considered a bipartisan concept, a republican senator, former republican house member introduced a much more aggressive bill on this issue,

in the prescription drug bill passed by the republican members of congress, they had a similar provision for terminally ill patients. so this used to be just a sensible thing that everybody could agree to it suddenly became death panels. and scared -- scare grandma. [laughter] >> and it's just a responsible. and i have to say part of the reason it spreads is the way reporting is done today, if somebody puts out misinformation, obama is creating death panels, then the news report comes across is today such and such accused president obama of putting forward death panels. the white house responded that that wasn't true. and then they go onto the next story. and what they don't say is in fact, it isn't true. [laughter] >> i mean, --

[applause] >> i just -- you know, it's fine to have a debate back and forth, he said, she said, except when sony else is just not even telling remotely the truth. then you should stay in your report and by the way that's just not true. but that doesn't happen often enough. and that's why it's so important that all of you deliver that message, and you've got to be able to back it up. all of you are receiving materials where it's not just saying this. these are third party ballot daters who are out there and can set the fact straight and when people get the facts and you show them, then most people will end up being persuaded. not everybody. there will be some people who, look, there are some people who for partisan reasons just want to see this go down because they

see this -- they see a replay of 1993, you know, we can beat health care it will likely do the bill clinton and then we can take over the house, you know, next year. there is some of the. and then there are some people just ideologically, they just don't believe in government get involved in anything. and that's a respectable position. there is a long american tradition of saying government just leave me alone and get off my back. and you know, those folks are consistent, and they are critical of bush when he got involved in government and they are critical of me in terms of being believing that government can do some good. and i think there you can have an honest philosophical debate, and they are just not going to agree with it. but the majority of americans understand, we don't want government in all of our business, but there are certain sensible reforms that we can pass so that consumers are protected so that the markets work in the way it should so that the american people are getting a fair deal. those are the people that we are

trying to persuade. and i think if the majority of people have the facts, that in fact they will be on our side. okay? all right. next question. now we can just go to the audience that was your. let's start with this gentleman right here. >> mr. president, i am charles coble i'm from north carolina. and thank you for turning north carolina blue. [applause] >> it's been a long time. i have two wonderful children, and i have four beautiful grandchildren. and so i am working for them and i'm working for people who, unlike me, don't have health insurance. it's unconscionable. now you have an outrageous -- lee good. [laughter] >> let me be clear. and trying to get a bipartisan

bill for this congress. and you've got three wonderful republicans willing to stand with you. but america needs this to happen and you know that. so we are going to go for it. >> let me, we don't know yet whether we've got any republican support. we've got three republicans who have been working very diligently, charles grassley, mike enzi and olympia snowe have been working in the senate finance committee with max baucus, the senate finance chairman of the democrats, to see if we can craft a bipartisan bill coming out of the senate finance committee. i give those three republicans a lot of credit because they are under enormous pressure, not to engage in any kind of negotiations at all. and in the current political climate, they are showing, you

know, some significant result. i don't know if in the end they can get there. i hope they can. and we are going to just continue to wait to see if they can get a product on, but at some point in the process, there's going to have to be a conclusion that either they can get a bill done or they can't get a bill done. and my commitment to the american people is to get a good product which will include republican ideas, but i have no control over what the other side decides is their political strategy. and my obligation to the american people says we're going to get this done one way or another. [applause] >> all right. i'm going to -- you guys have been in my town hall meeting so you know i always go boy, girl, boy, girl. [laughter]

>> good afternoon, mr. president. my name is teresa mccrae and i am from virginia, another state that went from red to blue. [applause] >> i live in spotsylvania county, and it's a rural county, but when i talk to people as a community organizer, it all comes down to money. and i may suggest, well, there is long term benefits and quality health care. but they come back to me and say, well, what's going to stop people from being in their, employer based health care and just quickly move over into the government health care. who is going to pay for it? what do i say? >> it's a great question. there are a couple of issues involved here. the first issue is how are we

paying for health care reform in general. one thing that is very important to remind people, because you knows there's been talking point from opponents. trillion dollar health care bill. i love repeating that. trillion dollar health care reform. first of all its imports are my people when they say trillion dollars. they are talking over 10 years. so we are talking about a hundred billion dollars a year, which is to a significant amount of money. but just to give you a sense of perspective, i mean, the amount of money that we are spending in iraq and afghanistan is -- what's the latest figure, debbie? you figure nine, eight to $9 billion? a month. right? so for about the same cost per year as we have been spending over the last five to six years,

we could have funded this health care reform proposal. just to give you a sense of perspective. that's point number one. point number two, about two thirds of the costs are actually going to be paid for from money that is already in the health care system, the taxpayers are already paying for, but is not a good deal. so it's reallocating money that's being wasted right now, taxpayer that is being wasted right now and using it in a way that actually makes people healthy. that's point number two. so remember i told you about the subsidies that we've were provided to insurance companies? that's an example. another example is the way we bremer's hospitals right now, we don't incentivized hospitals to get their patients the best treatment the first time out. because if a patient is immediately readmitted, we just

pay them the same rate as they were the first time. think about if your car needed repairs. and you sent it in and got it fixed, you thought. a week later the same thing breaks down. when you went back to the auto shop, you probably want them to give you a little discount on fixing it the second time it but we don't do that right now with respect to hospitals. and those are the kinds of changes we can make that would pay for about two thirds of the cost of health reform. that leaves one-third. and we do have to pay for that. i actually think that we're going to get even more savings with prevention and wellness, but unfortunately we can't count that. it's not in congressional scorable. nobody gives us credit for that because it's not provable, how

much money we would save on those things, even though everybody understands that the investment we're making, in prevention and wellness and health it is going to make a difference. so a third of it we will have to pay for, and what i have proposed was that we would pay for by having people over $250,000 a year, have their itemized deductions go to the same rate as everybody else's, 28%. right now, they get more because their marginal tax rates are a little bit higher. if we just went back to their deductions that existed under ronald reagan, that radical -- [laughter] >> -- then we could pay for all of the health care reform that we are talking about. now there are other ideas that are being floated out there, both in the house and the senate, but the bottom line is we are really talking about is about 30 to $40 billion a year that we've got to come up with.

and i am absolutely committed, and you can say this to people, president is absolutely committed to making sure that that is not funded on the backs of middle-class families. we are try to help middle-class families and give them additional resources to get health insurance. we're not trying to add to their tax burden. okay, so that's very important. now there was another question that you asked though and that is how do i know that my employer is not just going to dump me into the public plan. well, there are actually provisions in the law that say if your employer is already providing you with good health insurance, then you can't just send your employee over into some sort of public option. it's what's called a firewall. and so there are provisions to prevent that kind of shift. now, there are good to be a lot of employers, small-business owners who immediately are going to qualify for signing up for

the health insurance exchange, because right now they can't afford to provide health insurance to their employees at all. and we want to make sure that they are getting some help. partly because small businesses, they don't have any purchasing power when it comes to insurance companies. you know, if you've only got five employees or to impose or 15 employees, and you go to insurance companies that want to get a good insurance policy, they're not going to give you a great deal compared to if xerox shows up with its thousands of employees. and so when a small business joined this plan, they are going to be able to pool their purchasing power with all the small businesses and individuals out there who don't currently have health insurance. and that will help drive down costs. okay? rip or to his next. this gentleman right here. >> thank you, mr. president. my name is michael. i am from durham, north

carolina. i do cochairperson at the room for obama's health care committee. we have 11000 members. and all of my volunteers say the same thing, they are behind reduced costs. they are behind guaranteed choice. they are behind health care for all. and they believe and i believe that the only way to do this is to guarantee a public option available to anybody who wants one. and my question is, if that's the solution that you believe in, why aren't we pushing it harder and if that's not the solution, what other solutions out there would accomplish all three goals that you have? >> it's a great question, and this is an example, sort of a controversy that has been somewhat manufactured this week, so let me just be clear your i continue to support public option. i think it is important, and i think it will help drive down costs and give consumer choices. the only thing that we have said in his continued to be the truth, and sometimes you can

follow me for being honest to a fault, is that the public option is just one component of a broader plan. so let's just talk -- let's just use the example of making sure that insurance companies are treating their customers right. one way that we are doing this in this health reform bill is very directly through insurance reforms. we're saying to them you have to take people with pre-existing conditions. you cannot have caps on lifetime expenses or yearly expenses that people bump up against and suddenly had to pull out a lot of money out of pocket that they may not have. so we're putting in place a whole bunch of insurance reforms that regulate the behavior of insurance companies. now, alongside that, if there's a public option that is also offering a good deal to

consumers, many insurance companies have to look over their shoulder and they say gosh, you, if the public option is providing that good deal to consumers, then maybe we can just charge exorbitant rates and mistreat our consumers. so it gives them a benchmark from which to operate. now my point is this a sort of like the belt and suspenders concept, to keep up your pants. the insurance reforms are the belt. the public option can be the suspenders. and what we are trying to just adjust to people is that all these things are important. and that if the debate ends up being focused on just one aspect of it, then we are missing the boat. if all we are talking about is the public option, then the 80% of the american people who already have health insurance in the private insurance market, they say to themselves, well, what's in it for me?

their attitude will be this is not relevant to me. and in fact, they started getting scared thinking maybe what the public option means is that you are going to force me to give up my current private insurer and going to a public option. that's what those who are opposed to reform have been counting on. is to try to get twisted debate and feed into americans natural suspicion about government. and to use that, to cloud, right now people are not getting a good deal from the insurance companies. so i just want to make sure that we're focusing on all of the element in reform amah will benefit people without health insurance, what will benefit small businesses, what will benefit people who do have health insurance so that we can build the largest coalition possible to finally get this done. okay? are right. go ahead. . .

if we went back to the obesity rates that existed back in the 1980s, the medicare system over several years could save as much as a trillion dollars. i mean, that's -- that's how much our obesity rate has made a difference in terms of diabetes, heart failure and all sorts of preventible diseases.

and so what we want to do is to, first of all, in healthcare reform, in the legislation, encourage prevention and wellness programs by saying that any healthcare plan out there has to provide for free check-ups, prevention and wellness care. that's got to be part of your deal, part of your package. and that way nobody has got appear excuse not to go in and get a check-up. now even if we do that and there are a lot of -- there are a lot of businesses out there that on your own are already providing incentives to their employees, safeway, for example, is a company that has given financial incentives to employees to make sure they are taking care of their selves and getting regular check-up and colon oscopy and so forth. it has saved them a lot of money in terms of premiums. there's a lot of incentives to get in the business of prevention and wellness.

but you're absolutely right. even if we got legislation, even if companies are encouraging, part of what we also have to do, though, is teach our children early the importance of health. and that's -- that means that all of us have to, in our communities, in our places of worship, in our school systems encourage nutrition programs, provide young people outdoor activities that give them exercise. and michelle and i always talk about the fact -- when we were kids during the summer, you know, basically mom just -- see ya after breakfast. you were gone. [laughter] >> you might run in, get some lunch go back out and you wouldn't be back till dinner and that whole time all you're doing is moving. now, unfortunately, times have changed, sometimes safety concerns prevent kids from doing

that. there's a lot of kids who don't have a playground. little leagues may be diminished. that means we as adults in the community have to provide more and more outlets for young people to get the kind of exercise that they need. when it comes to food one of the things we are doing is working with school distributes and the child nutrition legislation is going to be coming up. we provide an awful lot of school lunches out there and reimburse local school districts for school lunch programs. let's figure out how can we get some fresh fruits and vegetables in the mix because sometimes you go into schools and you know what the menu is. it's french fries, tater tots, hot dogs, pizza. now, that's what -- let's face it, that's what kids want to eat any way. so it's not just the school's fault. a, that's what kids may want to eat. b, it turns out that foodiot

cheaper because of the distributions we have set up. we've got to change how we think about, for example, getting local farmers connected to school districts because that would benefit the farmers delivering fresh produce but right now they just don't have the distribution mechanisms set up. so, you know, michelle set up that garden in the white house, one of the things that we're trying to do is figure out can we get a little farmers market outside of the white house. i'm not going to have all y'all just tromping around but right outside the white house. [laughter] >> so that we can -- and that is a win-win situation. it gives suddenly d.c. more access to good, fresh food but it also is this enormous potential revenue-maker for local farmers in the area. and that -- those kinds of connections can be made all throughout the country and has to be part of how we think about health. okay.

>> sir, we have time for one more question. >> one more question. all right. this gentleman gets the last question. you got a microphone right there. >> thank you, mr. president. fred smalls, the city of maryland. there's a large number of young adults who are trying to figure out where they fall into the health reform plan. many of them are too old to be continued carrying on their parents insurance plan but yet they may be underemployed and cannot afford good healthcare. how does your plan account for these young people? >> well, it's a great question. look, first of all, one of the things that we've proposed is to extend the number of years that young people can stay on their parents insurance plan to 25 or 26. that then fills the gap between

college where typically they can get healthcare and those first few jobs they get. i remember my first few jobs and, you know, you're broke. [laughter] >> and a lot of times they're not giving you any healthcare. and if they do offer you healthcare, you're opting out of it 'cause you're trying to buy food, which you think is important for your health. [laughter] >> so being able to stay on a parent's healthcare plan a little bit later until you got a more stable job, that can help pull in a whole lot of young people. now, after that, it turns out that young people are actually relatively cheap to insure and so them being part of this pool -- part of the exchange where they can go directly and buy health insurance, they will be able to get a premium that's priced comparable to if they worked for a big company. now, it's still going to cost

them some money and there's going to be some young people out there who would still -- you know, prefer, if they can prefer just not to get health insurance and this is where there are going to be some young people may be frustrated because we don't treat you in the emergency room where everybody has to subsidize you if you get hit by a truck. so you are going to have to buy some minimal coverage just like you have to do with auto insurance to make sure that at the least you're protected against some sort of catastrophic illness and you're also able to get some regular check-ups but it will be affordable based on a sliding scale based on their income and then there are going to be some hardship exemptions and some who are in a different category. they're older, they're quite poor, but even with the subsidies, they still just can't afford health insurance and we may have to give some hardship exemptions to folks like that where basically we say to you,

okay, you have the option of buying insurance at, let's say, 10% of your income, but if you are just in such a strapped situation that you just can't afford that, then you are exempted, okay? so here's my closing message, everybody, the easiest thing to do as a politician is to do nothing. you don't offend anybody. you say all the right things. you don't rock the boat. your poll numbers go up. everybody in washington says, boy, that guy is a great politician. [laughter] >> look at his poll numbers. and you can get away with doing that for years. but that's not why i came here. and that's not why you worked so hard to win this election.

you came here because you knew that america can be a little fairer, a little more just, a little more efficient. we can provide better healthcare coverage. we can make sure that we use less foreign oil and develop clean energy here in the united states. that we can make our school system work for every child and not just some and produce more scientists and engineers that are going to be the key to unlocking a 21st century economy. we understood that, you know, we're human and government is a human enterprise but it's imperfect but we can do better than what we're doing. and this debate that we're having right now, this healthcare debate, is a test to that proposition. there are a whole bunch of folks in this town who were just waiting for this debate to take place because the story line they want to write about is all

the naive idealistic folks change we can believe in, yes we can -- that all their hopes were dashed because this is a tough cynical town and we are going to able to, you know, show them that basically you can't get anything done in this town. you can't change things. everything always immediately becomes partisan. government, you know, is way too complicated and congress is way too paralyzed and the special interests are way too powerful to bring about meaningful, big changes that help the american people. that's the story line they're operating on. but that's the story line we've been fighting against this entire time. from the day we announced this race, we were fighting against that. and they have been trying to write that story again and again and again. we are not going to give up now. [applause]

>> we are not going to give up now. we are going to get this done and show the american people the government can work for them. thank you, everybody. god bless you. [applause] [applause] >> yes we can! yes we can! yes we can! yes we can! yes we can! yes we can! yes we can! yes we can! yes we can! [applause] [applause]

[chanting] [applause] [applause] >> one of the recent town hall meetings on healthcare was

hosted by democratic representative joe courtney in wood stock, connecticut. this is some of the citizen video that was submitted online to c-span. >> the united states of america is the greatest country on earth. [applause] >> there are too many uninsured, too many unemployed, too many single moms who can't take care of their children and like the lady who spoke like there -- her husband and her both serve in this country in an honorable way and they have a child now who can't get healthcare because of a preexisting condition. that's a perfect example. there needs to be change in this country. we need to continue to be the land of opportunity. things need to be done. we can debate. we can talk. things can drag on like usual. another 100 years could go by. finally something is being done. and i want to thank you for that congressman courtney. something is being done and there will be healthcare for

citizens in the community, across the state of connecticut and across the united states of america. maybe it won't be perfect. but there will be healthcare so people will have continue to have opportunity. we're the greatest nation on earth. we need those opportunities. so behalf of the people i represent, joe, thank you very much. [applause] >> my family escaped communism, you know. 1973 that was coup to take over. the people rose, military and richard nixon. it's a long story, okay? and i have to say that this sounds like a lot like what my family escaped from. [applause]

>> because when you have the government take over your lives, you have no control. [applause] >> i have to say you americans were born here, okay. you're taking your freedoms for granted. [applause] >> the question is, sir, and thank you for this. this is a great democracy. where the constitution is the federal governmental rights to take over healthcare?

[applause] >> let me just say this, the government provides healthcare under va and tricare the people who are serving and for people who are 65 years and older. under medicaid, these are well established programs. they've been challenged in court. every constitutional claim has been brought and the u.s. supreme court has routinely dismissed those types of claims. there's a lot of people who asked the question, where's public education in the united states constitution? and the fact of the matter is, the courts have recognized a federal law to make sure that schools like woodstock academy have title 1 and special ed. and

funds which came from washington, d.c. so that teachers can keep their jobs in one of the worst budget years of the history of the state of connecticut. [applause] >> and as congress continues its summer recess, we want to hear from you if you're having a town hall in your community. what do you think about the healthcare proposals being debated by congress? share your experiences and thoughts on video at c-span.org/citizenvideo. >> i want to thank you very much -- >> live now to a conference on efforts to better prepare students for college and careers. the educational testing company act and the education consulting firm america's choice hosts this event which is just getting started. live coverage on c-span2. >> understanding that we are really in a transformational change era. and it's so-so important for all of us to help guide our groups through that change.

i always use about two quotes in most of my presentations about change. one i got from secretary reilly in an earlier speech he gave. he said he and his wife were in d.c. by the river, in fact, and they saw a man with a t-shirt on. and the front of it said, "change is good." when you look at the back, it said "but you go first." a couple weeks ago and linda lewis who works with us -- we were talking about change and she just noticed that in the paper that morning was another wonderful quote. it says -- it was a cartoon, and it says i'm all for change as long as it doesn't affect the status quo. [laughter] >> and, unfortunately, we know that's where many, many of the people -- the wonderful teachers and school leaders and others

that we work with are because they're so, so focused on the great things they've been able to do and they are truly great and sometimes it's a little bit difficult to open your eyes and say, what else do we need to do? as we talked about yesterday, we understand the world is moving so fast and the education of our kids has just got to catch up so that they will be able to compete with their peers around the world. and so without doubt, we know that change has to take place. now, this morning we're going to talk a little bit more about change. i'm sure you know that the buzz has been in the air. that we've got to raise these standards, you know. if you reach from the top as i'm sure the secretary would say, you're more likely to get there. and, unfortunately, i believe most of the commissioners around the country would say, it's time for us to look at standards in a

very different way. and as we know, a good chunk of them, more than 46, i believe, have been -- have signed on to a review of what the next generation of standards would look like. we're starting our morning by having scott and ilene about that change. which is just important. we're expecting to have ilene to be with us in just a moment but scott assures if she's not able to make it right on top, he will be able to carry through on the presentation. we're going to turn our attention to john deasy who's a strong strong friend of act and america's choice. and he's going to focus a little bit on that change part 2. he's going to talk about getting it done. and what we need to do as a nation to make that happen.

and then after that we're going to turn our attention to, you know, just over the horizon, we know we're going to have a reauthorization of esea and it's going to be very important for all of us given everything that we're doing and how busy we are to turn our attention to what do we need to do to make sure that we keep the things that have worked with no child left behind or this reauthorization, and then focus on what we need to have in place for the journey that is ahead. so having said that, scott, i'm going to turn to you and scott is the deputy director of ccsso, the council of state chief officers, and he's been right in the middle of just about every conversation in education for a very long time and he's going to give us a heads up in terms of standards.

thank you. yes. let's greet him. [applause] >> good morning. we had a powerpoint and it's with ilene. [laughter] >> stuck on a train but actually as we -- i talked to pat a little bit this morning, i think going without the powerpoint may be a better way to go anyway. i think i'd rather get into a conversation with you rather than us talking to you. and giving you a lot of set and gets. i want to go back to the beginning. every time i say that, i'm reminded, i live in fredericksburg, virginia, and i took the train up here this morning. it's an hour 10 minutes. it's a great time to sleep and do work on the way home. but if you've never been to fredericksburg it's a hub of history, george washington's boyhood home, numerous civil war battlefields but we have a great museum of fredericksburg history. i assume there's a mural that goes around the building that

kind of tells the history of fredericksburg and at the bottom at the beginning of the story i think they told the artist, you know, we want to start at the beginning and he took them very literally so at the very beginning of the mural it says, several billion years ago the earth was formed and so we're not going that far back. [laughter] >> but i will take you back a couple of years to where this started. this has really been a three-year project in the making. when gene came as our executive director, his very first address to the chiefs laid out about 12 different points that he thought needed to be changed in education and one of them was yñ standards. and we had a long conversation in our office about what that meant, did that mean national standards? did that mean we'd look at common standards? what did that really mean? and so we really focused internally for a good long time about how we would do that. we decided we didn't want to use

the term "national standards" because as soon as you think that people think of federal standards so we came up with a notion of a common core of the states the chiefs and governors as the primary moves of this initiative. ccs and aga spent some time about a year and a half ago developing a paper called the international benchmarking report. there's ilene. you can pick up here in a minute. [laughter] >> i'll get the hard part out of the way. spent some time developing a research paper called to action that many of you haved> seen o international barking, -- benchmarking where states need to come together and develop common standards. in april we had a meeting with 37 states who we spoke to about a memorandum of agreement that they would sign, what the common

standards initiative would be all about. and some of the key points that you've probably heard about but were really pieces of the discussion were that this effort would be different than others. it would be internationally benchmarked meaning the standards would have evidence that other leading countries were using standards that were included in this document. that they would be researched and evidenced-based and that really is -- if you've had the chance to see the standards most know they were leaked out before we intended to have them come out. that's not a problem. we had a lot of comments about those standards. but if you see those standards and there is a link on the english language arts document that has a link to our evidence base on writing, it is an interesting -- if you look at that, each one of those standards has a very clear link to where you can find research that those standards are either college or career-ready or that

they are used by other countries in their standards and what they expect from their own students. we've been very diligent. i know phil is here and i think sally was here. maybe she was here yesterday. i don't see her. >> she's chairing a meeting. >> okay. have chaired -- have facilitated the math and the english language arts work groups. they've been very diligent about making sure what's included in the standard is documents comes from evidence. that there's evidence there that it is college-ready. that it does promote career readiness or other states or other countries use those standards and not just any countries but -- i mean, we're talking hong kong. we're talking singapore and finland. high performing countries that outperform the united states on things -- we have been very clear that college and career readiness is a key piece of this document. and that work has formed the basis for what we'll do in the

future. if you've seen those documents, a lot of times we have gotten a lot of comments that they're not specific enough. well, they're not meant to be specific at this particular point. they are the college -- what we expect all students who leave high school, ready to enter college and by college we mean a credit-bearing entry level course without remediation. career, into career and technical training which as most of you know can be just as rigorous as entry level freshman courses at the entry level. college and career-ready that they leave high school ready for that. we've always fully intended -- in fact, the work will start in ernest here in the next couple weeks of building those college and career standards into the k-12 articulated standards. what those standards look like i think is still up for debate and how we discuss those with our work teams. i had a great meeting in north carolina a couple of weeks ago with a number of math