>> the financial regs have not moved.

and at the end i think bill at the end there, well, if the jobs come maybe the healthcare will come. so i think they view the sequencing differently than the administration has focused. of course, stimulus first but there has not been a real sustained effort to keep high up in the minds of voters whatever they are doing on the economy. >> this was pretty much a 50/50 audience, democrat and republican, but i was still struck how likeable obama was even among his opponents. he was large political element of ronald reagan in the '80s. we have a long way to go in this presidency. >> boy, is pelosi the shield. she's catching all the darts and bullets. half of them didn't even know

who reid was. >> i think congress -- pelosi and congress in general, i have to go back to that because everyone -- everyone has some amount of anger and they look at obama and they say, i'm not going to place my anger here for some reason and it's just shifted to pelosi and congress. >> good. charlie, what are you going to write about? >> i guess i'll go back for the obama people he's our guy. i don't think democrats or republican leaders of congress could find any solace in anything they've heard today. >> mark, what's the -- >> i would say -- the poster for walter mondale referred to ronald reagan as a great president. that aside, if barack obama drove a convertible with a top down through a car wash, congress would get wet. that's really it.

i mean, he is -- he's got a teflon quality right now. now, i don't think -- i don't think it is perpetual. i think he's been given the benefit of the doubt. he's been given a long leash but i think if we're looking at ,h÷ second year and a year from tonight, we're looking at 12% -- or 11 -- 10% unemployment then i think we'll see a far different reaction. but the willings in no, sir blame both parties in congress, the congress is an institution rather than him -- if healthcare goes down, nobody blamed him. it was just remarkable. i really do think the wall street thing is just sitting there. i mean, i cannot believe the republicans are not running against both washington and wall street. i mean, it is a natural -- i mean, if you're looking for two villains but for whatever reason they seem incompatible of so doing. >> great session. thank you guys for joining me. >> thank you.

>> katy? >> we did it all for you. [inaudible conversations]

>> karen ignaagni the president and ceo of the group america's health insurance plans spoke recently at the detroit economic club. >> karen iganagni runs an

influential trade organization that sits firmly at the center of the nation's health reform debate. they have 1300 members. they provide americans with their mental, health, dental coverage, long-term insurance plans, disability benefits. the;ou organization is active i all 50 states and, boy, is it active in washington. it represents every large insurers, bill alvin of the detroit based health plan is among her board members and is here today. welcome to bill. it was formed in 2003 from the merger of the american association of health plans and the health insurance association of america.2 you may remember hiaa from its

clinton era harry and louise commercial. relevant today. early in her career, karen worked on capitol hill and for the afl-cio. she joined hhap and has joined many accolades for her leadership. washington magazine named her one of three top guns of all the trade association heads in washington. "new york times" wrote in a city teeming with healthcare lobbyists, karen iganagni is considered one of the most effective. she blends a detailed knowledge of health policy within an intuitive feel for politics. "fortune" magazine described her association's political program as worthy of the presidential election bid. and we think that's a compliment. [laughter] >> no wonder that modern healthcare magazine ranks karen

among the most powerful people in the field. in recent years she has appeared before congress on matters ranging from medicare to homeland security to patient protection. and to the all-important issues of access and affordibility. she's a prolific advocate author of more than 90 commentaries and publications ranging from the "new york daily news" to the new england journal of medicine. she's appeared on all national network newscasts and every influential cable policy program. while healthcare is currently before the senate, we're fortunate that karen has broken away from the bubble to provide us with her perspective. no subject is more consuming, nor more confusing.k/p please give karen a warm, detroit economic club welcome.

>> thank you all. thank you. it is just terrific to be here. it is great to get out of the bubble. i want to thank john for that very, very kind introduction. i also want to say something about the students who are here. i was so impressed by your thoughtful questions, your courage and asking them, and i hope i gave you in that brief time we had together some insights into how to think abouo policy issues but i want to encourage all of you to think of careers in public policy and washington and we need people like all you, so thank you very much for coming here and really working so hard. it's great to see such industry and such enthusiasm and you and your teachers deserve a lot of credit and to the detroit economic club for sponsoring such a marvelous education initiative.rq÷

i would like to thank the health plan community that has come out so many of my friends -- a number of you that i haven't been able to meet personally but i know by phone. we have so many conference calls and emails. i'm sure you think, oh, that woman again sending me another email but it's just so lovely that you all came and it means so much.8$ and i want to say thank you. i also reflected and did a little research and bill was very helpful in all of this as well about the detroit economic club and what i'd like to say to all of you as i begin -- it's really striking that if you look back at the speakers you've had and the forums that you've encouraged for 75 years you at the detroit economic club have encouraged discussions that look beyond the conventional wisdom. and the immediate horizon. i hope to contribute to such a discussion today with regard to healthcare reform and, frankly, this is why i wanted towwkñ com

because of the record that the club has in giving people an opportunity to get out of that bubble as john saidd and reall engage in the issues and look beyond the here and now. first, however, i'd also like t recognize two women whom i met when we came to detroit. we were here last summer, summer of 2008, niki dobi, who's sitting right there in the red, and shar v#xgoolsby who came to listen to the concerns of working families and small businesses and patients who were worried about whether they could afford healthcare or might be denied access to it. that they d

and their experiences reminded us of how important health reform is. and how important it is that health reform provides peace of mind along with affordable coverage and quality of healthcare. our outreach campaign convinced us that the united states had arrived at a crossroads. in the health reform debate. the measure of whether we succeed now to accomplish what hasn't been accomplished for a century, of false starts is whether -- not whether a bill gets passed but, in fact, whether it generally provides that health security.

and i was reminded by that -- i know i'm italian i use my hands and my head. it's very bad for microphone coverage. i'll try to focus on the mics as well as the words. we're reminded this morning of the questions the students asked. so i think as we think about health security, what does it mean? what's the standard? where is the bar? in our view there are three issues and three objectives we have to hit. first, without a doubt, we have to bring all americans into the system. going without medical coverage is a medical and financial time bomb for our citizens and from our country. we have to move forward. we have to address that issue. second, we have to ensure there's portability of coverage so that nobody is left out of the system if they change their jobs, if they lose their coverage, if they have a preexisting condition or they get divorced. all of us make life changes and we need to be protected that we will and know we'll have health

security. last, we need to ensure that the investment in expanded coverage is matched by a commitment to improve quality and reduce costs. if we accomplish these goals, it will define our nation and, in fact, it will define our era. if it don't address to establish costs simply to attach a health reform label to something, we will have made promises that we can't keep. deficits will increase. medicare will remain financially unstable. government subsidies will be inadequate to protect families and employers will find it more difficult to provide coverage. a year ago, with these goals in mind, it appeared that we faced an opportunity of a generation. we had a new administration committed to the issue. we had a national consensus that the time was right. now is the time for reform.

we had leading stakeholders in agreement that reform was necessary and feasible. and an economy in which the burden of healthcare costs reminded us every day of the urgent need for immediate action. but in less than 12 months we've gone from the perfect opportunity for a comprehensive reform to an opportunity seemingly lost on the issue of cost containment. and to expand access without constraining costs is not sustainable and the american people have weighed in on this question. in fact, the polls show that millions of americans are worried that the pending legislation doesn't do enough to bring costs under control. not that long ago, as 2009 began, costs were at center stage. indeed, the congressional budget office projected that under the current system, healthcare costs will increase by 6.2% each year over the next 10 years.

as all of us know, that's far faster than any projection for the economic growth, the general economic growth of our country. you don't have to be an economist to understand the consequences of that. if the gap between healthcare costs increases and economic growth continues, it'll continue to exert downward pressure on workers wages, add more stress to already strained family budgets and business payrolls and crowd out other important investments that our nation urgently needs to make in energy, in jobs, in infrastructure, in education. and last spring, the president appropriately challenged all the stakeholders to put aside their differences and make reform work. our industry responded. the men and women in this room from the health plan community were at the head of that line and we had already been working for three years to come to the table with solutions.

we developed a comprehensive proposal to reform the insurance market and make preexisting conditions a thing of the past. we also worked very hard to develop a plan that would accomplish that by putting us on a path to universal coverage. our industry is also laying the groundwork to simplify and streamline healthcare administration and paperwork. and i know each individual as a patient sitting before me will appreciate that. with the guidance of hospitals and physicians and other stakeholders, we've been developing operating standards that will achieve progress comparable to what the banking industry accomplished in converting to the atm possibility so that we could put any atm in any machine in the world and get cash. that's what we have done in creating the operating rules. the technological challenges in

healthcare are complicated certainly. but the advantages in accuracy and simplicity and simification for physicians will be similar and the most important result of this effort that we have undertaken will be in fact to assure physicians and hospitals but primarily clinicians they can spend more time with patients and not worry about conflicting standards for paperwork. unfortunately, the cost containment discussion in washington has been largely sidetracked. the bills currently before congress don't include a comprehensive system-wide plan to bend the cost curve. indeed, as far as cost containment is concerned, it's as almost as though the house is on fire and washington is bringing a cup of water to the scene. today our healthcare system has an unworkable and unsustainable cost structure. although the fact is widely recognized by healthcare experts

and the american people, it hasn't received anything close to the kind of attention we need to give it in washington. even worse, the current legislation will actually bend the cost curve up by encouraging people to wait until they get sick to get insurance, add new taxes on healthcare coverage which puts more of a burden on families and businesses, and imposing new medicare cuts that ultimately will get past on to private insurers. how did this happen. the cost has been completely overshadowed not in congress but also in the media by a debate on whether healthcare reform should include a government-run plan. that single question became the focus of months of congressional statements, public opinion polls and sunday morning talk shows. as a result, a genuine cost debate never occurred. and the government-run plan became the litmus test for

reform. what followed was sadly predictable. a substantive discussion about healthcare reform was narrowed to ideological debates and then a focus on health plan profits and administrative costs. i want to present those data to you today. the data, the facts show, that health plans represent 44% of total health expenditures. according to "fortune" magazine, our sector earned profits of 2.2% in front 2008. ranking it behind all the other large healthcare stake hoerlgdz. -- holders. as the president reaches the final weeks of debate, it's imperative that the nation return to the important discussion about costs and the other 96% of expenditures. it's true that pending the cost curve has become a phrase which by now may have the aura of a cliche, but if we just do enough

to satisfy the scoring requirements of cbo, the congressional budget office, call it a day, but not yet do enough to make healthcare truly affordable and sustainable for the decades ahead, then post of the other reforms will have prove unsustainable. in fact, the entire system will be unsustainable. the good news is it's time still to get it right. the barrier, which is tall and it's wide, is the perception that the politics of washington inevitably make it impossible to take on healthcare costs in a comprehensive fashion. for example, the bills before congress settle for timid pilot programs rather than requiring major challenges or changes. it creates incentives that only -- that only apply to medicare rather than across-the-board. and it establishes a new oversight body but severely limits its scope of review.

at best, the approaches miss the opportunity to focus on the forces that drive up healthcare costs for the 200 million people with private coverage as well as for medicare and medicaid. at worse, the pending legislation actually creates incentives for costs to accelerate. for example, healthcare suppliers and providers are already increasing costs to compensate both for actual and anticipated costs reductions in medicare and medicaid. we can see that in what's happening now in 2009. massachusetts proves to be a cautionary tail. -- tale. on the one hand three years ago they introduced sweeping healthcare reforms. and today marvelously, 97% of massachusetts residents have healthcare coverage. that's a major step forward. it's a landmark achievement. it's a model of the nation in terms of access. but expanding access is only one element of expensive health reform.

healthcare costs in massachusetts are already among the highest in the nation and are continuing to climb rapidly, which puts enormous pressure on families, employers, and taxpayers. the situation exists in massachusetts because while rising to the challenge on access, they avoided confronting the tough choices associated with bringing down the rising costs of medical care. it brings us to the basic question, why is cost containment so hard? first, consider the mixed incentives that drive american healthcare. our system rewards doing more. more tests, more medicine, more specialists. whether or not it improves a patient's outcome or improves the result. our system is further driven and burdened by a malpractice liability system that threatens to punish a clinician for failing to do everything imaginable versus what he or she believes is the right thing. then there are these related

factors. there's no systemic process to identify and remove ineffective or dangerous practices from our system. there's no systemic process to reward best practices and consensus on what constitutes best practice. and then we pay 50 to 60% more in unit costs than every other industrialized nation for medicines, for technology, and for professional services. these problems are part of a culture of healthcare delivery that's been building up for decades. changing it will require more than just adjusting incentives. it will require setting tangible goals that we can manage and we can measure. today, i'd like to offer five solutions that can promote health security, allow us to hit that mark for all americans and help set the country on a sound economic course. first, set a national goal with respect to expectations about

reducing costs and measure progress. as any one of you who are running your businesses. it's imperative for congress to set a goal to bend the healthcare cost curve. for example, if we reduced projected growth by 1.5 percentage points per year, it would produce an estimated $2 trillion in system-wide savings. now, that doesn't perhaps sound like a great deal when we're thinking -- looking ahead to spending 37 trillion over the next decade, but 2 trillion is more than the cost of, in fact, moving forward with health reform. just to scope it for all of you and to give you some perspective. this would reduce future growth to a still robust 4.7%. it's the same goals presented by the president's council of economic advisors of the summer.

what matters is having a goal that's meaningful and measurable. and having a conversation in washington throughout the country about what that goal should be and when it should begin and how do we measure it? the legislation pending in the senate would establish a new commitment to review medicare spending. that's an important start. but it won't provide the comprehensive oversight needed because it would focus only on medicare expenditures. at the same time, it would also exempt hospitals, physicians, and other key services from review. that makes no sense. we need to have a comprehensive, clear objective, commit to real savings and monitor and evaluate how we're doing. to achieve results. this process should look at all spending categories and shine a spotlight on areas that are not providing high value, quality care. it would give the american

people an assurance that the cost containment and quality improvement are being assessed continually and can go hand-in-hand with the access expansion. essentially, congress needs to answer the question, how do we know these savings will materialize? this will require accountability across the entire healthcare system. so that families, businesses, and taxpayers will know that the healthcare costs problem will be brought under control. in the absence of such a clear strategy and clear objectives, healthcare reform is likely to be a risky bet. a bet that timid pilot programs, modest spending incentives, a medicare commission that's barred from examining the bulk of medicare expenditures and attacks on high value health plans will be sufficient to markedly constrain and contain costs over the next decade. the second recommendation, build on the pilots and incentives in

the senate legislation with a comprehensive plan to introduce healthcare delivery reforms across the entire system. if we agree that we need a comprehensive systemic process to ensure that costs are brought under control, that coverage becomes and remains affordable for all of us in the country, then that means looking closely and continually at all of the areas that make our health system unaffordable. that's a tall order. to address all of these issues, which involve a comprehensive look at system wide administrative costs, the incidents of inappropriate, dangerous and unnecessary care, our relative high unit cost for drugs and professional services and our relatively low productivity as measured by outcomes, the inadequate attention being given to prevention, wellness, the importance of it, and how do we encourage more of it and chronic

care management and creating payment systems that now do not reward value but reward volume we have to transition. and to address all of these issues, we're going to need a multistakeholder effort. no stakeholder can do it alone. government can't do it alone. no one industry can do it alone. we all have to be called upon to work together. we need to bring together doctors and hospitals as well as patients and employers and health plans and manufacturers to ask and address, that's the key, ask and address, the hard questions. what practices yield the best outcomes. what is best practice? how do we define it? how do we measure it? and how do we operationalize it? what steps will reduce post-hospital readmissions? what strategies would encourage more coordinated care and how can we implement these changes quickly across public and private programs? we need to jumpstart a

transformation of the entire delivery system with the objective of shifting the focus from counting what is done, processes and procedures to rewarding and incentivizing best practices and rewarding value. this would free clinicians from having to cope with conflicting standards and would ensure that they can focus on providing state-of-the-art care. third, reforming the legal system to protect patients and allow doctors and hospitals to do what they want to do, which is deliver best practice medicine. by reforming the malpractice system, we can change the incentives that force providers to order tests to protect themselves from lawsuits rather than doing what they believe is the right thing. this is one of the largest barriers to achieving that gold standard of evidence-based medicine. at the same time, we need to ensure that a new system adequately protects patients and their families.

there are precedence for achieving this balance and we ought to get on with the job as part of reform in addressing this issue. fourth, empowering patients and their doctors to make the most informed healthcare decisions. the unfortunate reality which all of us know today is that patients are not always getting the right healthcare treatments. in fact, according to the rand corporation patients are receiving the most effective medical care about 55% of the time. moreover, researchers at dartmouth university and other parts of the country have document the wide variation in practices that exist. geography is destiny in our country and patients with the same condition get drastically different treatments depending upon where they go for care. moving to prioritize the evidence, prioritize the research with the right incentives will improve the

quality of care that patients receive. to accomplish that goal our nation needs to make a significant investment in improving research on the effectiveness of drugs, devices, therapies and technologies. the current legislation makes a very important down payment on this objective. but we need to do more. patients and their physicians have a right to know not only what treatments work best but which treatments are cost-effective. the entire industry needs a major dose of transparency. too often patients are making healthcare decisions in the dark without access to information about what hospitals and doctors provide the best care, the cost of treatment, and the effectiveness of various approaches. focusing on the transparency agenda will make the system not only more effective but allow patients and doctors to make the right decisions and help put our healthcare system on a more sustainable path.

last, avoiding reforms that increase costs. policymakers need to avoid potential traps in the current proposals that will actually lead to increased costs and let me give you a couple of examples. experience in the states has shown that insurance market reforms, while very important and we are strongly committed to them, but the experience in the state shows that they need to be paired with an effective coverage requirement if they're going to work and not provide rate shock for those currently with coverage. unfortunately, the current senate proposal provides a very powerful incentive for people to wait until they get sick to purchase coverage. this will penalize current policyholders with higher costs. the current proposal also imposes technical rules that will significantly raise the cost of coverage for millions of young families in more than 40 states. and increase the likelihood

because of that cost increase that they may choose to stay out of the system until they are sick. the proposal also includes a series of new health taxes and fees that will raise the cost of coverage for individuals, families, and employers across the country. that's the opposite of what health reform is supposed to accomplish. in conclusion, we believe these issues can and must be addressed. the key for the nation is to make a commitment to reducing the high rate of growth in healthcare costs. and to make a commitment to bend the cost curve. as everyone here knows and as the detroit economic club has often discussed, our country has paid a high price for avoiding tough decisions in other areas of the economy. the devastating housing and financial crises should serve as stark lessons. if reform fails to address the unsustainable cost drivers in

healthcare, we may be laying the groundwork for the nation's next crisis. one that will impact every american. we can't afford that outcome, but we can still now change direction and incorporate cost containment. sustainable healthcare reform is still within reach. the nation can provide affordable coverage to all americans. but to get there, all of us, with a stake in the healthcare system and that's each and every one of us, need to heed the call to a higher national purpose that trumps political expendient si. is that objective? is that goal? is that promise, is that hope a reality. each of us and the country as a whole need to decide that question. because how it is answered will determine whether we can as a nation fulfill the promise of health security for all americans today and for generations to come.

i thank you for listening. it's a pleasure to be here. and i look forward to your questions. thank you. [applause] >> thanks, karen. i think the -- your remarks underscore the complexity of this issue. we can probably better understand how it is that these pieces of legislation grow to 1,000 pages, 2,000 pages. god bless you for reading every word. we have a lot of questions, some of them quite fundamental. let me begin with this one. let me begin with this one. there's a basic hypothesis in health reform that healthcare is a right. is that your view? >> we think that all americans should have healthcare coverage

and we are working very hard -- all of the proposals that we have advanced begins with the proposition that we have to get everybody covered. >> ahip opposes the current legislation proposals. what are the ramifications if no bill is in place 10 or 15 years down the road? >> this is sierra important question. in our view afford as a country not to do healthcare reform. at the same time, we can't afford fought to have those three pillars of getting everybody covered, improving the quality and reducing the rate of growth in healthcare costs intertwined as objectives. our concern is that while the conversation has focused on one, we have -- the conversation on three has been crowded out and one could say the conversation to two has been crowded out, we

think it's important to reeling the three. >> is it your -- karen, is it your practical expectation that congress will reach a compromised agreement next year? >> i think that there is a great deal of effort now on the part of members of congress to get closure on the legislation, move forward and as a country we need to achieve the objective of getting everybody covered. but at the same time, if we don't bend the cost curve, all signs point to the fact that the system not only will not be workable but won't be sustainable. and looking at massachusetts, which did a fantastic job of getting everyone in, it is an appropriate cautionary tale to include the cost discussion, which is the hardest part of all of this, in this discussion so that we can do it in tandem and that's an issue that concerns families. it's an issue that concerns employers.

it concerns the various stakeholders. and we ought to be called upon to work together to do more to advance that objective. but i do believe that because there had been such an intense focus on the one issue -- the singular question of whether there should or shouldn't be a public option, this whole issue of cost containment was put aside. so all of those difficult conversations that should have been held about how to do this and how to do this correctly got swept aside. now we need to go back to them if we're going to have a bill that can be sustained and i think that's what the american people want. we're looking at provisions in the legislation that because of a lack of a cost containment they're forced to impose new taxes and fees. they're looking at very aggressive medicare cuts. we need to focus on sustaining medicare. we need to get healthcare costs down and do more for working

families than what has been able to be accomplished because of the lack of cost containment. if we contain costs we can do more for working families in terms of subsidies to assure they will be able to afford the system. so that's how it all works together, i believe. >> there are some folks who believe that the public option is a central component to cost containment. what's your view on that? >> well, i think -- if you ask any hospital or physician in the audience and you ask them the question, can you live on medicare rates, which is the proposal that was advanced early in the year and then it was medicare rates plus ten, general people what people in the provider community will appropriately say absolutely no. the only reason we can maintain our service in medicare now -- and the numbers of physicians participating in medicare beginning to go down and the only reason we can maintain our service in medicaid and a number of physicians are no longer taking medicaid patients is because we do shift the

underfunding burden to the private sector. so unless we stop passing this hot potato, we're never going to be able to get this system under control. so employers are focused on this issue of cost shifting. there'sg#q two kinds of cost sh if you allow me for a moment because you talked about john fundamentals. with we talk about cost shifting number one what's uncompensate care, people going to the emergency room because they don't have coverage and getting covered, that cost gets spread across the whole system for everyone who has coverage. we pay for that. that goes away if we get everybody in. that problem is largely solved. now, for some hospitals that are disproportionate-share hospitals who rely on almost exclusively public programs, there is still additional burdens that we have to be attentive to. the cost shifting i'm talking about is the current underfunding of medicare and medicaid which from a perspective of how much a family

is paying, that specific item is even larger in terms of the burdens on families and the uncompensated care burden. so we're paying an additional $1,000 for uncompensated care, 1500 for the underfunding of medicare and medicaid. if we build another program on an underfunded budget then the question is how much will be left in the private sector to pick up that slack or will there be additional liabilities added to the federal budget? it will go one of either places. so again it's a question of how do we stop passing the hot potato and do what needs to be done in terms of bringing that cost curve down. >> karen, one of our high school students has asked this question. in my research i have discovered that you are the voice of insurance companies. the public perception of insurance companies not that high. how can you persuade the public to believe that your choice for

our country's healthcare is the best choice? and what steps are you taking to gain a the public's trust? >> well, first of all, there was a lovely young woman who asked me this question. i won't embarrass her to ask her to stand or raise her hand but i of the question and her ability to get right to the heart of the matter. and for our health plan colleagues i'm going to answer the same spirit of frankness and candor that she asked the he question. we need to do more. in our proposals for guarantee issue, getting everybody in, taking preexisting conditions out of the system so no one has to worry, people have peace of mind, not rating according to health status, we have recognized that we have a high bar. we've also been very frank and have done our homework about how have states fared who have tried to accomplish these objectives by maintaining a voluntary

system and not getting everyone in. and what we have found across the country is that if you don't get everybody in, then those systems -- those promises are very hard to keep because it means that people in the system, in a voluntary system will pay more. sos3÷v that is why we have come the public with the proposal that is very aggressive. we didn't wait for anyone else to tell us to do it. we heard the american people. we heard them here in detroit. and we heard them throughout the country back in the summer of 2008. and they asked the same question that this lovely young lady asked me. what are you going to do? we are prepared to not only commit but to guarantee and be federal rules and regulations that will be implemented at the state level that people can expect the system will work. they can get in. they will not fall out. they will be fair and equitable. we want transparent rules. we are prepared to meet them.2.

and we want to be very clear that we intend to be open to public scrutiny to make sure that happens. so we understand the high bar. i think people need to hear from my colleagues here and across the country much more. speaking for themselves. about what we stand for and why and how we -- and why we agree with the american people that we have to get everybody in. and nobody falls out. and they need peace of mind and assurance. so that's how i answer the question, john. we need to talk more about our values, about our value proposition, about what people can count on and the fact that we are not sending a message to the american people of trust us. we intend to be subject to rules that will be transparent so people can count that people will be adhered to.oczñ >> karen, you said the stakeholders in this debate need to reach beyond their special

interest and reach for national purpose. and i wonder what compromises might be generated from ahip in order to reach that goal? >> several. first, again, i think it was a very important contribution that we offered more than a year ago now actually, the concept of insurance reform. we indicated to the public very, very actively that we intended to be for it. in addition as i hope people gleaned from my remarks, we've been working for more than three years on a massive administrative simplification initiative. we understandtl5 that health pl can collaborate together to work on back-office functions so that physicians and hospitals don't have to deal with different eligibility standards, different requirements for checking on a claim.

and without getting too technical, to make sure that this whole process is simplified and organized. now, we didn't come into the system thinking that;úe we wer going to talk about a voluntary effort. in doing all of that background to be there and the work had to be done at a robust level to make sure we were hitting the mark for doctors and hospitals, we didn't come into the -- this discussion with the idea that we would propose a voluntary effort. we are supporting a legislative requirement that this get done, so we are committed to it. we intend to -- we have been supporting it. we intend to comply with it and we're very excited. in addition, we have another series of projects going where we've now started and we're moving on a state-by-state basis checking and making sure we're testing the technology, about six, seven weeks ago in ohio we

introduced a portal for physicians. essentially one pipe through which all the physicians could communicate with all the health plans in the state and no longer have all these individual stickies and individual offices of folks who are doing claims payment for physicians. and it's been very enthusiastically received by the medical society. we're partnering with them and a number of physician societies. we'll be testing a different technology in new jersey during a very short period of time and we want to make sure we have the technology right. we're doing a number of things in healthcare disparities and we're doing a number of things in the area of quality improvement. so we intend not only to be held to those objectives. we intend to meet those objectives and you'll be hearing much more from us on additional things we'll be doing. i think the opportunity now is

for the entire stakeholder community to talk about how each of us can play our part in getting healthcare costs under control. but it is as you implied in your question, it's a tall order because folks aren't normally called on to work together.ñyd but we need to work together. there's been dramatic progress in the area of working together on quality improvement measurement, which we are making great strides in across the stakeholder community working together. so capturing that idea and bringing it system-wide just to take the area of wide variation and practice partners and getting the specialty societies, the consumers, the employers, the health plans and the hospitals, the government, manufacturers together to say how do we address this issue of healthcare variation and what are the most appropriate things to do, i'm not talking about cookbook medicine or anything. i don't want anybody leaping to those conclusions. but what is best practice and

how can we encourage it? and how can we encourage it together? that's the opportunity. you can only do that, however, not sector by sector but in a multistakeholder process. that's another example. >> well, a number of the stakeholders have reached an agreement with the obama administration and made some kind of an endorsement, of course, you've been a side of that. are there discussions that involve ahip that would involve an endorsement and do you feel like there's a constructive path to follow? >> well, here's what we've done so far. no stakeholder community has not only volunteered but pledged to support such a dramatic change in how its market or operations work. we came to the floor and supported insurance market reform, number one. and we still support that. we made it very, very clear. i talked about administrative

simplification. we support that. and are committed to it. we support the concept of medicare advantage, which is the private part of the medicare program playing a role in healthcare reform. but not at the -- not at the level that we're seeing in the bills where we know that it would make it impossible for seniors who are relying on this program in the future to have it available to them. so we're looking at for you in the health reform arena -- we're looking at administrative changes simplifications, which we support, we are looking at insurance market reform, which we support. we're looking at -- significant medicare advantage cuts. we support the concept of making a contribution and making sure that we are contributing to the sustainability of medicare. but michigan is a great place to have this conversation on medicare advantage.

back in the 1997 period, there were changes that were made in medicare reimbursement for medicare advantage that virtually insured there would be no access to medicare advantage here in michigan. in 2000, a bipartisan group of members stepped up and put more resource back into the program. and indeed, the floor in michigan is higher than it is -- than 100%. substantially higher because it's a relatively low he medicare payment rate state. so when you hear stories and discussions about medicare payments being -- medicaid advantage payments being at a fairly high level, michigan is one of those states because of the legislation that was -- resources were put back to recognize the underfunding that occurs in medicare. and michigan is one of the states that stands to lose medicare advantage participation because of the draconian nature

of the cutbacks that are proposed both in the house and the senate. so we offered in terms of offering a very aggressive path but a sustainable path to make sure we were taking responsibility to fully participate in the cost containment discussions, but not so much that would take choices away. so i'm glad you asked that question. in addition, we're looking at $67 billion in tax increases over a 10-year period. that amounts to 6.7 billion per year starting next year. every health plan here in this audience will tell you that people have already have their policies for 2010. it would involve an opening up of policies or it would involve a double taxation for '10 and '11. in 2010, the obligation in the senate bill is 6.7 per year.

the total profits according to "fortune" magazine are 8.2. you can't have a 6.7 compared to 8.2 and have any rationality associated with that. so, yes, we need to -- we need to contribute and pay our fair share. there's also an additional $25 billion that's added over 10 years so it makes 67 plus 25 is 92. and then we have a tax on high cost health plans for the workers and employers that have been fortunate enough to promise benefits that are comprehensive. so all of those bring our numbers well over the $200 billion arena and we're 4% of healthcare expenditures. so the scale is wrong. we're ready to contribute. we have been contributing. but looking at all of those -- the confluence of factors plus the fact that the legislation now has incentives for people who are young and healthy to stay out of the system, and that will mean massive cost increases

for people who have coverage, we are very concerned about what we're looking at now. do i think that there are strategies to address each and every one of these problems? yes he. -- yes. >> our last questions comingles two extremely difficult public policies. do you see that there is a place for a -- a proper place of abortion in the healthcare debate? >> i think this is one of the most contentious political issues that we have. and i think that members of congress have to decide how they're going to handle that. we thought in washington that the issue was settled when the hyde amendment was decided a number of years ago. and there are many people now talking about similar kinds of approaches. i think that our job as a health plan community is not to make those political decisions or answer those questions.

and what we do is provide services. in the case of employers or individuals, they decide whether to take those services. so we don't feel that it is our -- it would be presumption of us as health plans to make that decision for an employer and an individual. they make those decisions as they decide what coverage they want. particularly, in the case of employers. and about 55% of employers now decide to have that coverage. >> very good. thanks so much. >> thank you. [applause] >> if you're like me, sometimes you get up to work, i've got a whole lot on my plate today, this woman has got a whole lot of plate on her plate today. karen iganagni thank you for your words of wisdom. and john, thank you for our whole region. ladies and gentlemen, we realize you've got lots of opportunity

to spend your money and time today so we appreciate the fact that you spent that with us today. this meeting is adjourned. [applause] >> freelance journalist david axe was embedded with the u.s. army in afghanistan in october and november. he followed u.s. troops as they train the afghan national army and afghan national police. this was in logar province a mostly agriculture region south of kabul. we'll see how the u.s. army worked with afghan forces on security checkpoints. >> day-to-day military operations in afghanistan -- in many places sort of boils down to checkpoints. you set up a checkpoint at a key road intersection or in a village somewhere and you just sit there. and keep an eye on things. and the idea if you've got enough checkpoints you have a good -- you can lock a place

down. taliban can't move around. smuggling can't happen. you can lock down the opium trade and you can solve a lot of problems by keeping an eye on the traffic, really. and so checkpoints can be terribly boring. u.s. forces tend to delegate a lot of checkpoints to afghan forces. that's something they could handle. it's a pretty rudimentary task. you got like a dozen afghan troops who sit at the checkpoint 24 hours a day and the americans will go out periodically and check on them. so how are things going? have you seen anything? do you need some stuff? do you need help building up your checkpoint? and usually when the americans go out there, they'll gather up some afghans and do a little foot patrol true. since you're out there you might get some practice doing other tasks. >> how long have you been out here now?

[speaking in native tongue] >> translator: probably like two months. >> two months but you haven't been relieved? [speaking in native tongue] >> translator: no. >> i thought we were supposed to be working one two-week rotations? [speaking in native tongue] >> translator: no. >> how many men do you have onsite right now? [speaking in native tongue] >> translator: 12. >> and how many do you have? [speaking in native tongue] >> translator: five. >> okay. when we came up there was no one occupying the checkpoint. [speaking in native tongue] >> translator: he says today we received our lunch a little bit later and that's why we came to eat. >> you should think maybe working rotation?

you know, three guys on checkpoint and then, you know, everyone else eats and they get relieved and then you come and eat. that way we don't allow anyone to, you know, slip past that could maybe carrying something. if you develop a pattern of eating, then if i was the enemy, i would just stop and i would pass the checkpoint when you guys were eating supper. [speaking in native tongue] >> translator: okay. >> there was information that there might be an attack here tonight. [speaking in native tongue] >> translator: he says we are just waiting for some attack. we are just waiting to get attacked. >> but how about searches? have any of the searches turned up anything? [speaking in native tongue]

>> translator: he says there's lots of -- lots of way for the taliban. so if the taliban saw that we have a checkpoint right here, they will use another way. >> well, for like the big trucks, this is probably their fastest route from logar. [speaking in native tongue] >> and if we only call it just one a day, your commanders and my commanders and everyone will be very happy.

[speaking in native tongue] >> translator: sometimes he says we are not able to see around ourselves during the night. sometimes when there are some cars coming too fast, when they saw that there's a guy in the checkpoint so they are turning back. when we are turning back we start firing at them and then -- >> i understand that's a huge problem and for the short term, we're going to -- we've got the generator and we have light sets coming in to provide you illumination of this local area

but in the long term, hopefully, they get, you know, night vision devices for all your soldiers. . foreign .. [speaking in native tongue] >> yeah, because we want your

logistics systems to work for you. we want to make them work, force them to provide you with the the fuel, food and water that you need to conduct your operations. and when they fail, then we give you assistance. it's going all right. i mean, it always goes well when we're here. it's when we leave that, you know -- and i kind of understand it. i mean, they, their complaints or issues or, you know, or concerns are definitely warranted. but, you know, nothing in afghanistan happens in, you know, in a day or as quick as it would in the u.s. so, you know, it's just trying to get them to be patient, you know? i think they get a little impatient, and then they start building just like this tower here.

it's great that they took initiative to put a tower or some sort of tower there, but, you know, we can improve on that. and sometimes it's counterproductive. but, you know, it's their site, so they can do with it as they wish. but, you know, we just try to, you know, bring the standards up a little bit so, you know, some people say it's frustrating. i don't think it's that frustrating. i mean, because all we have is time, you know? >> i'm going to take a small patrol -- >> [speaking in native tongue] >> and talk to some of the local population to check on some projects that should be going on in that village. [speaking in native tongue]

>> and if you'd like, you know, if you'd like, you could send a couple soldiers with me. that'd be appreciated, but i understand if you can't. [speaking in native tongue] >> because if it's just us, we scare the children, the women -- [speaking in native tongue] >> [speaking in native tongue] >> translator: three mp, is that fine? >> that's perfect. >> translator: says when we got the report that it's gonna, the enemy's going to attack in this area, than we heard from the people and we got the report that there is some people coming, like, 200 meters far from this area and taking ambush. so when we move, they will attack us. that is why it is our second night that we are taking up

ambush around the check point, like 2200 meters around the checkpoint. >> that's good. that's appropriate. thank you. we won't take you from that mission, but we'd just like to have an asf face on all our patrols. >> [speaking in native tongue] >> so now i'm going to take -- they're going to give me a couple soldiers, four solds, two a and a soldiers and two police, and we're going to conduct a short patrol into the village and work on some solar power generation projects. that's it. they've got the generator, but they have no fuel. they have the means to get fuel here, i mean, and they have, they have their own fuel trucks, but there's a lot of -- same in iraq, there's a lot of corruption when it comes to

dealing with fuel because fuel's as good as cash here. and if we provide them with fuel, you've got to be careful. we provide them with fuel then that fuel won't be here tomorrow. >> sometimes you go to these checkpoints, and you check in on them, and they're all asleep. you try to get them to go out on foot patrol and they refuse to do it. getting that professional mind set when you're always ready and always working, getting afghans to think like that is, it's a big problem. it's a cultural thing, and overcoming that -- you can't change culture overnight. so in this case things went fairly well. the americans showed up, the afghans were mostly awake, they were doing their jobses, they had their weapons ready. they needed some help, they wanted more barriers at the checkpoint to protect them from attack. they coordinated how the americans might bring that stuff in and then managed to rouse

some guys for a little foot patrol, and they walked around the town for a little while and talked to some of the local elders. so all in all, pretty successful partnership. >> this month we're going to go west. short patrol and be back before nightfall. >> [inaudible] [inaudible conversations] >> they do every single patrol that we do. when we go out to do a village assessment, when we go out to do a key leader in the village, the

ama are always with us. we do mentorship programs with them every day, that is the primary focus of a policemen to have team. and they are, i mean, particularly focused on that one task. and it is their, it is their linchpin. the a and p, the a and a, the self-protection of afghanistan is the linchpin of everything that we do. all of their missions are missions that we want to do, and all of our missions are ones we want to take them on with us. so they are a linchpin. they are everything that we do. >> the a and p, the afghan police have proved to be kind of

unreliable in some provinces. how would you rate yours? >> i would say they are the least of our problems. you know, it's a a fledgling police department. the police chief here does an outstanding job of helping us with everything we ask for. if he identifies a place that could use some extra a and p support, he works with us to develop checkpoints to develop when he wants to send police there to visit those places. and he'll let us know right away where he wants to focus. so to say that -- perhaps another province if it's uneffective there, then i would say, you know, i'm sure they have their problems, but here i think the colonel is a very effective contributing part of our operations. and he does a good job on his own, you know, 99% of the time he works pretty hard.

[laughter] >> this is video from david axe, a freelance journalist who was embedded with the u.s. army in afghanistan in october and november. he followed u.s. troops as they patrolled the district in logar province south of kabul. [speaking in native tongue] >> translator: four days ago you guys hid right there up mr. the graveyard. >> yeah. >> translator: so the people -- [speaking in native tongue] >> translator: it was right there. here is the shrapnel we got from

our house. >> can you set that down? [speaking in native tongue] >> translator: he said there is shrapnel right in our house. this is our big e problem. [speaking in native tongue] >> you pulled that from where, your house? [speaking in native tongue] >> was anyone injured? speak -- [speaking in native tongue] >> translator: no injuries right now, but like three weeks ago -- >> yeah? >> translator: some animals dead. >> do you know where we're located? [speaking in native tongue] >> and do you come there with us

with any concerns you have at any time? we're there for you. [speaking in native tongue] >> call travis. you have his number now. >> translator: we are very -- [speaking in native tongue] >> translator: if any shrapnel got -- [inaudible] [speaking in native tongue] >> i will bring that up to my commander. it was not our intent to get it anywhere near local population, i'm sure. [speaking in native tongue]

>> [speaking in native tongue] >> translator: we all forget the russian regimes, but whenever we are hearing the rpg or the mortar rounds around our area, so we are remembering that situation again and again. >> and, sir, i apologize for that. it was not our intent to -- [speaking in native tongue] >> we're not perfect, but i will bring that, your concerns up to my commander and make sure that they -- and he will make sure they're addressed very quickly. if you could do me a favor and anytime something like this happens, don't wait to inform us. you can inform us right away by coming either to the checkpoint and talking to the police or the army or coming and informing us directly. if not, if you choose to call, you can call travis or any of

our hotline numbers to inform us that this has happened. [speaking in native tongue] >> and we're going to go on to ibrahim. again, i offer my apologies on behalf of all coalition forces. [speaking in native tongue] >> thanks for your time. [speaking in native tongue] >> i think it was that some mortar rounds fell on this hilltop here to the west and killed some sheep.

but -- and, you know, they're scared one's going to land on their house one day and, you know, that's a valid point. so i'll make sure we inform the commander, and, you know, we'll doing a better job of clearing our fires and, you know, where we fire and direct to and from. but they seemed -- no one was injured except for some livestock and, you know, the sad thing is they wait for a u.s. patrol to come through to address those issues when, you know, they could come to the district center at any time and address those issues to us directly. but i guess they have, and they were turned away, they were turned away by the afghan security guards that cover the perimeter of our post, so we'll try to make ourselves more available to the local

population, i guess, is our goal. >> freelance video journalist david axe was embedded with the u.s. army in afghanistan in october and november. to watch this program again or to find other programs produced with his video and interviews, go to our web site, c-span.org. in the search box type axe.

>> thursday russian prime minister vladimir piewt b held his annual question and answer session with russian citizens.

the entire event lasted four hours and was televised live on russia today television. mr. putin answered more than 80 questions submitted by audience members, telephone calls and e-mails including questions on russia's economy and whether he will run for president again in 2012. this is the last hour and 15 minutes of the event and begins with a question on prime minister putin's personal relationship with russian president dmitry medvedev. >> translator: there are several questions arriving at the web site just to start with the first one, one of the most frequently asked. what are the relations between putin and medvedev? >> translator: this is a very good question that i have answered many times. we have known each other for many years, and we have been working together for many years. we went to the same school together, we studied from same teachers together, same

professors taught us not just knowledge, but even attitude to life in general. these principles, these shared common principles allow us working successfully together. >> translator: why do you support someone else in the presidential election? >> translator: i don't support him in the election. we cooperate with hue schoen ca as the ukrainian prime minister. yours truly is the prime minister of the russian federation. we cooperate a lot. we have a plan for our joint work, and we are working according to this plan. as you know, we have a special kind of relationship with the party of region. >> translator: when will -- be released? >> translator: i just visited france, and they asked me the same question there. >> [speaking in native tongue] >> translator: the person you mentioned has been put in prison

by a court ruling. the problem is not when he will be released, the problem is that such crimes should never happen again in russia. we are talking about economic crimes now. by the way, the bankruptcy procedure for the company was initiated by western creditors, western banks, and this bankruptcy was carried out according to russian law. absolute according to law. absolutely according to law. i've never said this publicly before, but i'm going to say it now -- [speaking in native tongue] >> translator: the money from selling assets went to the state budget, but not just to the state budget when it happened, and this happened mainly in 2006.

you know, i persuaded my colleagues at the time that we should not just spend this money -- send this money to state coffers or send them to our reserve even though this might have been good. i told them we need to use this money in areas that are most problematic. if this money was stolen from the people at one point, we should give it back to the people. directly. and not just a large group of people, but specifically can to those people who suffered the most because of the tragic event ises in the early '90s and mid '90s, the poorest people in the russian selling assets we estli housing fund with this money,

and the results of this fund benefited ten million people. we repaired their houses, 150,000 people will move to new houses from barracks, and we will continue to finance this fund in the future. we use this money to improve housing conditions in many towns and villages of the russian federation. as for the criminal element of this affair, we will act strictly according to russian law. unfortunately, nobody remembers the fact that we have one of the chiefs of the security service in prison. he had no personal interest, he was not a major shareholder in the company. it is clear that he acted according to instructions given

by his bosses. and we have proved five murders committed by him. they should edit -- next to a key company in moscow there was a lady in charge of this little shop. this lady refused to sell her shop, and then she was killed in front of her husband. the mayor where he worked, he wanted yucas, and he got killed. he was murdered. those people, security service chiefs, were blackmailed by a family couple, and this family couple were killed as well. all these crimes have been

proved during investigation and court trial. let us remember about that. the fate of every man in our prisons should be decided by existing law, and the government will continue to work with this law. >> translator: what are your relations with george bush jr.? >> translator: after he left the presidential past in the united states and i left the post of the russian president, we have never seen each other, but i can tell you that during the period when we worked together, our personal relationship was quite good and friendly. i mentioned this before and i can repeat it again, and this helped us to overcome some difficult situations. george is a very decent man, he's a good companion.

if we have a chance to be together, spend some time together in the future, i would always be happy to be with him. >> translator: we would like not to allow the situation that many people are deprived of the ability to the possibility to ask some questions. now, we have tatiana in her sector. let's. [inaudible] you mentioned orders for the coaches and it's a question of survival. please, introduce yours and ask -- yourself and ask your question, please. hello, i'm an electromechanic from the assembly division. on the 12th of november, you said the orders for the

manufacturers has been canceled, and there is preliminary agreement to supply 500 coaches. and a thousand, more than a thousand coaches is less than, fewer than a half. if this level is preserved, every fourth of the employees will face the the possibility of losing jobs. it's a minimum. we can't afford it, and to preserve our working collect i - collective. [speaking in native tongue] >> translator: we had a conversation when i wasn't there. frankly speaking, it was very nice talking to your people because you were all well prepared. not just as specialists in your area, but also politically and economically. your reasoning was at a very good, professional level. and i'd like to tell you

something. we all realize that we give orders -- you can get orders from the companies that use your production, your product, and this is russian railroads, first of all, but there are other companies that produce the same goods. for example, the euro factory that also produces train cars, i visited your factory, but i didn't visit the euro factory yet. but it doesn't matter, doesn't matter whether i've visited. we should consider the industry as a whole. this industry of train car manufacturers as those companies that work directly with russian railroads. of course, this has to do with the efficiency and the economic recovery that requires increased

transportation as soon as transportation increases, revenues of russian railroads increase. we won't be able to support our infrastructure monopolies from the state budget. otherwise we cannot take care of our social responsibilities including pensions. but we'll do what we can. we did it this year, and we'll do it next year as well. we just promised 25 billion rubles to russian railroads. there'll be 50 billion of support next year. so i'm aware of the situation at various plants. i maintain contact with your shareholders. recently, we discussed some issues outside moscow. i talked to the russian railroads ceo.

the order of 2010 will remain at the same level as 2009. >> translator: at least this way i think that the country needs train cars. >> translator: there'll be less tape that -- train cars but more locomotives. overall, it will stay at the same level. that's what i was told, that the level of orders will stay at the same level. maybe it will even increase if russian railroads gets more revenues. >> translator: from the right wing sector, questions. let's give the floor to our young people. we have students from various high institutions, many questions. who wants to ask a question? >> translator: hello, i am maria. this year i graduated from the siberian institute of railway transportation, and now i have a

postgraduate course and many of my friends entered the postgraduate studies. we are active, and we are aware of what we are doing now, that this will affect our future and the future of our country. and we start to ponder what -- [inaudible] please, tell us what russia are we to build? what future do you see for our country?

we need to develop our infrastructure. we have many goals to work on, and i think if you have completed your education and you're in graduate school now, each person sets goals for himself. i'd like very much -- i'd like us to reach the goals that we set for ourselves including you. >> one more question if you will. hello, i'm a student from the university. and the question of sport has not been touched upon. i'm keen on that. and i would like to ask you a question he. russia's national football team is not qualified for the world cup. at the same time, we're planning and submitted our application to

2018 and 2022. is it the only way to get to the world cup for russia's team as a host? are there any more larger scale goals targeted? >> do you play football yourself? >> yes, i do. >> would you like russia to ask the world cup -- >> i would like to ask. at the same time, i'm aware that it's really hard. the infrastructure currently does not correspond to the conditions. >> i fully agree with you. first of all, you said a very important thing. you'd like russia to pass the world cup. infrastructure is not sufficient. actually, infrastructure was inadequate for the winter olympic games as well in 2014. our infrastructure was insufficient for the games in 2012. but we need to develop our

infrastructure. we need to do this. our infrastructure isn't sufficient for the apex summit in the far east as far as the olympic games 2014 are concerned. we have almost completed it. there was no normal water supply, no normal services in a mainly resort city. everything was dumped into the sea. talk about environment. we built a new electric power station. we'll build another power station soon and this is a major problem because electric wires in the mountains get icy. i can tell you, frankly, unless

we had such an occasion, probably we would not have done this in 100 years and our country would never have gotten this kind of resort but we will definitely do this. the same applies to the world cup. you're right in that we don't have infrastructure, but if we are going to host the world cup, it will be easier for us to organize, administrative and financial resources to address the problems of infrastructure. not only we'll to have build ten arenas actually to the world cup rules, it should be as close as possible but the world cup is different. fifa, they told me specifically, their goal is to spread venues throughout the country in order to produce infrastructure for sports developments but not only sports venue, we'll need hotels.

we'll need to repair our roads. we'll need communications, energy, environment, including sewers and whatnot. water supply. energy. airports will have to remodel airports or build new ones. and all of this will be left to the people. regardless of how our national team performs in the world cup, of course, i hope that we'll achieve a much better result then than we did today when our national team was not able to qualify for the final part of the world cup in south africa. >> i would like not to let our people in the highest states lose their hope to ask the question. >> hello, i'm a student from the siberian federal institute in alexandria. my question is -- sorry.

not long ago you attended a hip hop competition, the struggle for respect. to go there to gain more ranking for you? the other question is, the dom function of the tv is entertainment. we lack educational programs. the federal siberian institute university has a new student program. do you think our country needs federal student tv channel? >> let's begin with the federal channel for students. youth subjects are all channels. there are entertainment challenges which are orientated precisely toward the young people. there are quite a lot of them, too, but the combination of entertainment so far didn't work out and here i agree with you. the management of the channels

including state tv channels should get this work in line. now as for my participation in the program, how is it -- right. as a matter of fact, i not only visited this musical program but in itself the beatles respect program was initiated by the ministry of healthcare, the russian federation and was financed from the federal budget as a campaign against smoking, against taking narcotics and alcoholization. of course, we're talking about young people here and the ratings here have nothing to do with it because we have no such things as that. but to look as if these young

people who are going in for breakdancing and other modern types of art to make it -- look like these people do not exist is a great error. we must also work in this medium, too. when i was attending that, i had -- i had developed real sympathy towards these young people, not only those who performed. they did good professional work performances but all those girls and boys that were in the audience but, of course, they are young people. they are the young people, but they are very gullible and though to make them their idols, it's very important to get these icons of the young people to do positive work the same rap, for instance, quite recently those

who advocated rap -- rap, i mean, they were there at the -- they also advocated intake of narcotics, unfortunately. our rappers are advocating the struggle against narcotics and for this we should be thankful for them and we should consider the state should work in all mediums, first of all, among the young people. the structure of mortality rate from smoking, if i'm not mistaken, about 17% of the population. in the structure and in the narcotic death-related is about the same and the alcoholization -- everyone knows about that. we now have launched a number of programs to advocate a healthy way of life. and i recommend everyone not only the federation at the regional levels of these programs should be implemented. and i'm counting very much on

the initiative on the young youth organizations because working among the young people is question number one. >> we also have questions in our sector. just one more question if you may. >> of course. >> hello, mr. putin. i study at the university of mountaineering. i have a question and suggestion. for jobs. are you planning to take part in the elections? >> how about are you? i will think about that. we have quite a bit of time yet. i think and i believe that everyone in place today should perform his duty and work more efficiently and depending on how the situation develops in the economy in the social sphere,

these decisions will be concerning the election campaign of 2012. but now we are living in 2009. and the greatest mistake would be what to concentrate all the work of today for the future election campaigns. this would concern regional levels, municipal levels and the federal levels as soon as a person starts thinking about writings that you just mentioned how he would act in the interest of his future election campaign. he will be tied hand and foot -- he will not be able to take the necessary measures. such freedom for my colleagues.

from the plant to seek their support in future election campaigns but seek most optimal ways to resolve the questions, to speak outright and frankly about them. what concerns your educational establishment one can only envy you. i know that the institute in st. petersburg in their equipment and teaching staff is one of the best in the world. and it's too bad that not too many people know about it. it is true, you have support of those companies who are making use of the young people graduating. these are energy companies. they're sparing no money to hire these people in this engineer institute. i'm not afraid to say it is a superb education. i wish you succeed.

>> thank you. we have one more left where we have our special correspondent. ♪ [speaking in native tongue] >> translator: dear colleagues, we welcome you from the region. we are in the administrative section of mining in the city of people who work in the iron and steel industry. this is the place it was called the garden city. and lots of enthusiasm.

and here we are definitely for a reason because we can't really take the filming crew to the mines itself. so here we have miners from the local mines and many of them had intended to speak you personally when you came for a visit. today we're continuing this talk and if you have questions please raise your hands. please introduce yourself. >> i'm one of the -- i'm the head of one of the brigades. i'd like to know that our meetings have become a new tradition. and i would like to thank you for the attention that you paid to our region, first of all. going a bit back to our previous meeting, i think it happened during a difficult time for us.

the situation was unclear. but today we have a better picture, a clearer picture. starting in august we worked full weeks. the price for coal is growing. slow but steady. it happened partly because of the accident of the hydrostation. but we haven't overcome the crisis just yet concerning salaries and price for coal. we want to know what we expect in the nearest future? our region is a coal region, a coal mining region, and we all

depend on this. we would like to know perspectives for the future. [speaking in native tongue] >> translator: we're not certain about tomorrow. first of all, i remember our meeting with you. and i would like to thank you for the meeting we had in the past for that mood, that tone that the people had a very complicated period of time. you said quite readily there was a great uncertainty at that time. there were certain alarming echelons. there were signs of a slump. but in those conditions what impressed me i must tell you truthfully, your internal confidence. your self-assurance and your responsibility and the high level of discipline of the people with whom i spoke.

miners, of course, have been special people because of their jobs. your mood during the talk we had in the past, it inspired to some extent and helped me and precisely for that support, moral support, i'd like to thank you for that. and indeed the market is being slow but sure returning to its former level. about the energy coal, about more than 90% of the coal market, and 80, 85% and we see a growth in the world and in russia. i'm quite sure that we start to fall volume but it's not only a matter of restoring the world economy. it's also a matter that we must more focus on the energy sector.

we have very serious plans to boost the energy capacities of the country. i would like to repeat that. in the previous past 10 years, we introduced 10,000 megawatts, 13,000 megawatts in the next two years we should introduce 10 megawatts. this means that the demand for your products inside the country will increase. and besides that, there's an increase and improvement -- i mean, there's an increase of the technological equipment and machinery of coal mining. it's becoming more ecological friendly and more efficient. this too sends up prospects for the coal mining industry and last but not least, what is important here that i would like to draw your attention is theñ$

fact in respect to other primary energy prices for gas are lower. we consider those should be a balance between primary energy carriers that concerns coal in the economy. there should be a gradual evening out of the prices and the principles of price formation. this means that whole branches such as the whole mining industry leave prospects more stable and the horizon being put forward for a long-term peace. i mean, the horizon of stability, the long-term stability. for that i'm quite sure machine engineering will be developing as well, manufacturing and this will also -- from the iron and steel builders and coal miners. there are problems connected with the efficiency of functioning separate enterprises. separate individual miners. and the individual coal mining settlement. such a problem is in place. we know this. we know about this problem.

and together with the shareholders, together with the regional authorities we must gradually without spirits and starts to ensure the people with jobs and to create highly efficient enterprises. there's a whole complex of problems here. that i'd like to repeat. but together we shall be able to resolve them in a decisive manner. >> andre, do w34uju @&hc% questions? [speaking in native tongue] >> translator: well, so much a question. we have here one of your friends. we all know that you gave him a lift 'cause he was -- he has got a new apartment. there he is. [speaking in native tongue] >> translator: hello. i would like to thank you for coming. and you came here to -- because

of the issue of the old housing, the old barracks were down and 300 people got new apartments and have a new life. so from our whole heart, i say thank you from me personally as well. but i don't know if i can say that. if you allow me.sa i would like to exchange my apartment for the apartment with our -- with my mother-in-law because she has a bigger apartment and i have two children. so now they have their own rooms and now my whole family -- this is not a question. this is -- i just wanted to say this from my whole heart. >> thank you. it's a pleasure knowing that many more friends, i'm very

happy that you're resolving your housing problems. i hope together with the governor and the local authorities we'll be able to continue those programs because very many people are to be resettled into new housing. housing that are depleted to the condition. there are quite a number of housing in your area. and this program resettling in new housing, we shall be preserving this program for next year and subsequent years right up until we solve this acute problem in the main. i do hope in exchanging with your mother-in-law, your mother-in-law didn't suffer. [speaking in native tongue] >> translator: we'll continue here in the city. we've been working -- going for over three hours already.

we have a new question on the website of our program. recently, we often see you with tigers, whales, leopards and in the pictures you look happier than when you are with the ministers. does that just seem to us or is that really so? by the way, you actually elected the chairman of russian geographical society what does this status mean to you? >> the more i learn about people the more i love dogs he said. but with respect to ministers this is in no way connected with my relationships either with ministers or my friends, colleagues. i simply like animals. and i must tell you here, i'm taking advantage of this

opportunity of my post that i would like to -- to resolve some of the problems which are very acute. you probably know in the red book we have very many species of animals which are on the verge of extinction. these animals -- they are more far east tigers. there are only 500 -- and in the far east, they are in the worst condition according to special -- only 40 or 60 such leopards. and they're being seen just for shooting. they don't -- i don't know why. i can't understand. they do not cause any special damage to the local population there. as hunting trophies, i think, that this is also is no longer of any great value.

tigers are being killed because the neighbors in china are being used from the whisker tigers and the tiger tails are being used. it's a cult thing. i think next year we shallfxo expand this program by polar bear because the polar bear is also now in danger. i call upon people, all people to take these very cautious attention about nature, about animals. i also mentioned about the olympiad in 2014, we are doing very much there so that in contact with the ecological organizations to do everything possible to use the funds being provided by the state, not only for -- not to cause damage to nature but in order to improve ecology there. i spoke about the you sewage systems.

this is a step in that direction. but besides all that, if you draw attention to the north republics, and practically every emblem has a caucasian leopard but there are no leopards in the 1950s. all of them were killed. in the 1950s. and nothing remains of those lemmards. -- leopards. and within the framework of preparing with the olympics together with the curators, the representative of the international olympic committee, we are forming a program for restoring those animals in the caucuses. some species of these animals were provided to us by the president and he supported us in this undertaking but they are

being sort of greedy in the sharing like they don't like -- they don't want to give us any more. but on a technical level this is being problems and we'll probably have to appeal to the president and we're counting his support. he's supporting us. in iran there's these types of animals but there are different types of leopards. it was considered that these snow lynks and their populations are being restored and i urge everyone to voluntary work in this direction. everyone will be rewarded for this. [speaking in native tongue] >> translator: we have many people in the audience who want to ask questions. we have here in the upper level people from the defense industry representatives.

who wants to ask questions? here's a lady here. please introduce yourself and your question. [speaking in native tongue] >> translator: my name is ulena. and i work in the electric equipment department. you went to our enterprise recently and you said the crisis, we still have great perspectives for the future. our colleagues say that -- confirm that they do have state contracts. we also heard that the defense ministry is going to buy french helicopter carriers and other equipment so now basically