group themselves, but also with the g-77 in china group, with our partners from the developed world, to try to and ensure that there is a success to the process now in mexico. we have in practical terms, we have suggested that we show from now to mexico have at least five talks among the two working groups which have been set up, both on the bali action plan as well as the kyoto protocol. because we believe that this is really an urgent and compelling problem, that we need to intensify our differences to try to resolve that problem. so that is one important thing. . . elp other developing countries in the spirit of cooperation. we want them to meet the challenge of adaptation and mitigation. this is the spirit in which we will approach these negotiations. but if i'm president calderon -- >> if i am president calderon's

staff, i am taking note. smaller like-minded countries are coming together. sectors like the automobile industry are coming together. with a $100 billion package that is arriving. with models of the finance sector, the u.s. commitment act, basic countries have agreed to act and came together in new delhi and agreed to act. it sounds let a piece of cake. [laughter] sounds like a piece of cake. why is this so hard? >> i think president calderon made it clear why this is so hard. different countries have different investments and because different industries have very different interests in this process. like any process this will be with us and there will be

losers. the losers are very vocal in this process. as president calderon pointed out we need to find a balanced way forward. make the cake bigger and make sure we are offering solutions for different countries and different sectors of the economy. that is why it is important to not only talking of reducing emissions but also the impact of climate change and addressing the issue of deforestation and mobilizing technology and mobilizing financial support for developing countries to try to create the scenario in which there will be not may be something in it for everyone but hopefully something in it for as many companies -- countries as possible. in that context i want to make a statement about finance because there has been a lot of talk

about hundreds of billions. i would like to be the last person in this room to create the impression we are going to subsidize our way out of climate change. we need to subsidize our way out of climate change. the scientific community has been telling us for 15 years that we can reduce global emissions by 30% by taking action that will take us to lower interest for ideas. second thing is i do not believe it is physically possible to continue to grow the chinese eat economy at 8.7 per year using the current economic model. it can't be done. third, i believe europe's target of 20% to 30% reduction of greenhouse gas emissions is not an environmental target. it is an economic renovation target. it is an energy security target

with energy prices and economic agenda at the heart of this. this takes me to unimportant point made by carlos. it is important that the country set targets but what is even more important is that we get to those private partnerships that will design the solutions that make sense from a business point of view rather than just throwing billions of dollars at climate. >> thank you, yvo de boer. before we get to the promised questions let me give you a chance to summarize what has been helpful and what you think you have heard and whether the biggest problems you face in trying to organize this and lead us into this sunrise in canton. >> let me express my gratitude and sympathy for the indian government. we have a strong collaboration

in several fields. one thing we need to do is talk about -- between all the parties but especially developing the largest concept -- we talk about that in our group, india and china and mexico. we can build upon the efforts to get there. we need to work together. one important point, chairman, there is a loser. that is important. second, there are several technical proposals and financial proposals like cap and trade proposals as suggested.

you can change a little bit talking about american cap and trade and north american cap and trade because a lot of projects made in mexico, solar facilities on the border providing energy to the united states and it would be a way to match the commitment of prices in the united states. there are huge possibilities for the success of the proposal. third there is a commitment in terms of finance. it is not enough but we need to work together. fourth, there are very low expectations about cancun. i do prefer low expectations. the worst enemy of any

politician has high expectations. i prefer to work in this way. finally the action plan, we have the instruments of the working groups and the copenhagen agreement which was not enough. nobody is satisfied with it. we will be in contact to organize these meetings and take suggestions that are important for the two step meeting. finally, special indication for planning to build those bathrooms or electric vehicles or whatever you need to establish your plan and there is a huge market in the region and the world. we are very competitive for

that. >> thank you. that is a good answer to the question asked in this session, what immediate steps should be taken. that is very constructive and extremely important and difficult tasks. we are promised questions from all of you. if you could raise your hand a microphone will come in your direction. introduce yourself and ask a question. don't give an advertisement for your institution. >> don't you think one of the problems -- >> who would you address your question to? >> particularly the president of mexico. one of our challenges is the asylum mentality where we address global challenges in isolation. we deal with climate change, we urbanize the agenda on poverty,

development, we need to address these matters in a holistic manner because some missions are more concerned about development and hiv/aids. as you pursue the climate change agenda and not as vociferous on the issues that are affecting the communities, the challenge -- [talking over each other] >> a key part of the question -- >> how do we unlocked the language and interconnectedness between global challenges for a holistic and sustainable solution? >> terrific question. what makes this so hard? we are getting the edges. >> the first time i listened to global warming was in the 70s

from my father. he was quoting special research coming from the very famous research -- common future or something like that. talking about global warming and other stuff. the point is this. the main focus of this research is there are two caps threatening the future of humanity. those two gaps are the gap between the environment. the challenge is to connect the solution of both problems and the way to do so is to

established an economic system in which we can -- and at the same time we can provide economic opportunities for people in the world. is that possible? it is possible. one thing we need to see is fighting climate change will require new developments. a new model of development in which we can provide jobs and new opportunities of growth and new opportunities of investment and that is true. new industries will arise. new opportunities to come to poorest countries and we can create a lot of jokes elucidate it with renewable energies and

prevent deforestation. i was telling the situation of haiti, all other countries with rescue operations. one project to create jobs, pay for reforest the item which is in the caribbean sea. we can have more jobs, that could mean -- to disappear. it means to have a electric vehicles and a low carbon emissions. we need to find out a way to fix poverty and climate change at the same time. one way to do so is payment of

environmental charities. a program for instance, indigenous communities are the owners and and we are losing a lot. because they have not means to survive. we are providing to them a payment. their commitment is the rain forest and they are coming out from poverty and we are preserving the air and water that we need. >> excellent question to get us going. all the way on the end on the left. >> thank you very much. we have an environment in south africa. before i pose my question, the developing countries must be

understood in the proper context. that principle underpins the development of countries. it is a meeting in india. south africa will be taking its focus and moving away from business. 20, 25 on the condition that they are made available. we do not have the finances. it doesn't mean individual countries. there are programs. there are opportunities in our countries because we have programs to deal with climate change. the question i would have wanted

to ask directed yvo de boer. will be possible to speed up process by setting the political process into the process? we would need to come under the auspices -- question directed -- relates to the caribbean. there is a perception promoting protection and our would like your comment. thank you very much. >> south africa will be hosting 17 after mexico, it has shown real leadership. >> thank you for that question. we need to invigorate the process and speed it up and we

need additional meetings at the close of this year but additional meeting time is not enough. the president talked about having modest expectations for cancun. something that community needs to do is clarify what those expectations are. what we are working for and the meeting time however much it may be. we need more time but also a target on the plan. >> market protectionism? >> the legislation which i am the author of in the house of representatives and senate legislation, there are tens of billions of dollars for technology transfer from the united states and other developed nations. we have that responsibility in the same way that tens of

billions of dollars will be transferred to developing nations of their rain forests. at the same time, we are trying to convince all of our industries that there is a pathway from today, the jobs and industries of today and consumers of today in the united states to the industries of tomorrow. the workers of tomorrow. to convince the steel and cement industry and aluminum industries that they should move forward, we are saying to them that we will give them a long transition period but if there are countries in the world who try to exploit this incredible commitments we are willing to make to our environmental side, we are going to and short that that kikind of cooperation is n

exploited--the kinds of agreements that will be reached in mexico and subsequently will insure there is transparency, there is verification and cooperation amongst the nations of the world so there never will be implementation of measures by the united states or any other in the world. >> let me come here in this direction. maybe we want to come over here. the second row. here we are. >> one of the concerns we have about the outcomes of copenhagen

was the loss of momentum. there were expectations too high on the one hand and also a lot of people trying to do things and get things done before copenhagen and there is a hangover engaged in the discussions. one issue on would like to pose to all of you is to see what kinds of things could be done to restore this drive. there was a distinct suggestion that president calderon could take the lead, we get one achievement, could be red and mexico is a very important country and we could have that done, being the meeting in cancun. why don't we change the pattern?

the agreement before the meeting itself, something that would generate this momentum. what are your thoughts on how to generate this? >> the question is about a hangover. what do you do about the issue of expectation? how do you keep the reasonable perspective? >> if i were facetious which i am not -- the only thing i am sure of is to have another drink. we do need to come back to the process as the minister from south africa was saying. we need to build up the frequency and meet more often. we need subsets of meetings. trying to advance certain topics ahead of cancun is interesting although you know everything is related to everything else but

you can prepare a number of decisions. what is really important as president calderon pointed out in the beginning is transparency and inclusiveness. you babe -- that is important, to always take the advance to a larger constituency and make sure there is inclusiveness. >> quick comment on expectation? >> you would have to expand quickly under the leadership from brazil. beam emissions from deforestation and degradation framework. it is also a model that you can do it. and someit is also a model that do it. and some other sector of like-minded coalitions -- apart the ship could happen. not only on monopolized money

from fiscal coffers but how to form this partnership. in this end it will be a carbon price. give us the incentive to the private sector. that is why cap and trade is so important. a very important message the high panel would send. if the reform is scaling up in the future was also in the agenda. un the execution trading systems in different countries and the u.s. for there are vast budget expected from this offset. even the u.s. has one eager target from international sources. you need to scale up and reform. that would be a powerful message to the private sector. and fragmentation and regulation. the australians move -- let's

avoid fragmentation. and scale the volumes we expect. >> for everybody here as we come to closed, caio koch-weser reminds us that as the president tries to pull together these complicated political threads that have been mentioned today there will be a number of extremely promising working groups working on finance and renewables and cook stoves. a number of these coming together largely built around private sector initiatives to understand as yvo de boer would remind us what rules need to be changed to allow progress to be made, that juncture between political people changing the rules and private sector bringing together expertise and stimulating the technology that has to be there. a series of these during 2010

which may be the most important contributors to the success of what happens in mexico and cancun at the end of 2010. i am going to leave this to you for a final word. >> the first point is we need to create momentum again and in order to do so we need to support the efforts for canton. i share your feelings about copenhagen. it was very disappointing especially after the safety net in between. at 11:00 we went into a very short room. we were working at 4:00 in the morning and 8:00 and 2:00 in the morning and the day after.

lots of that time we need to be prepared with large anticipations. we need the energy on the political side. in mexico a little project could be offered for the -- finally, it will be very difficult. there are a lot of problems and deeper concerns, mainly the economic cult of any measure especially in developing countries but we need to work really hard. we have not more time to work on this. i don't want to see -- without substantial results. mexico will do our best and hope

there will be new mechanisms for the future of human beings up the pyramid. >> you have set a record on this difficult issue. this panel is the top 16 in mexico closing on time within the budget and we thank you very much. before thinking our panelists we want to remind everybody and ask you to remain seated for the presentation of the global statement ship award from the world economic forum. join me in thanking our panelists and whishing president calderon every bit of luck and good will as we move through to 2010. thank you. [applause] [inaudible conversations]

[inaudible conversations] [inaudible conversations]

>> a blizzard striking washington and much of the east coast. the federal government closed for these third day and a row. the house will be out of session until february 22nd. the senate will be back tomorrow for a general speeches, no legislative business but there's news of washington. the obama administration announcing they are imposing new sanctions on several affiliate's of iran's revolutionary guard corps. the associated press writes the sanctions expand existing u.s. unilateral penalties against elements of the guard corps which western intelligence believes is peterheading iran's missile program. ben bernanke is outlining the central bank's plan for reeling in stimulus money once the economic recovery is more firmly rooted. the a p rights in prepared remarks to the house committee mr. burning pieces the fed will start tightening credit by boosting the interest rate it

pays banks at the central bank. to an in to booktv for a three day president's day weekend beginning saturday. others inform treasury secretary henry paulson talking with warren buffett on the 2008 economic collapse. afterwards, historian and pulitzer prize winner gary wills on how the atomic bomb change the presidency and the role of the u.s. in the world. all day monday, books on american presidents. fdr, as seen on president obama and our culture on ronald reagan. for the complete schedule go to booktv.org. .

it is a little under two hours. >> meeting come to order. mahatghghandi, every worthwhile accomplishment has stages drudgery and triumph. in beginning struggle and

victory. the effort to add comprehensive health care reform has certainly seen its struggle and even its of drudgery. as we look back at progress we've made and look ahead at the short distance we yet to go, i remain confident we will soon move to the stages of triumph and victory. we're on the brink of a accomplishing real health care reform. we're on the brink of reform that will help millions of americans to afford care coverage. we're on the brink of reform that will improve the quality and efficiency of health care delivery for all. every day reminds us of a need for reform. latest report by the non-sawn congressional budget office warns once again that the growth of federal care spending represents, quote, the single greatest to budget stability, end quote. that's because health care costs continue to rise faster than growth in the economy and faster than growth in wages of american

families. in the last eight years, average wages have increased just 20%. but the average cost of employer sponsored health care coverage has doubled, more than five times health insurance premiums have tripled. the high cost of health care means that one in four americans lives in a family that spent more than 10% of its income on health care in 2009. and four out of five of these families have health insurance. the high cost of health care also diminishes the ability of american companies to compete. and high cost of health care makes it hard for small businesses to provide health coverage to hire new workers or to stay afloat. america spends nearly twice what the nextest spending country spends on health care, but the u.s. health care far too often produces uneven and poor outcomes. more than 46 americans lack any form of health coverage. another 23 million are underinsured. according to the cbo, within

a decade, 54 million americans will be uninsured. and the cms actuary's office thinks that number will be higher, reaching 57 million by the year 2019. we've tried incremental reform. we created rights and protections in 1996 for people who purchase group health coverage. and we covered millions of uninsured children with the 1997 enactment of the children's health insurance program. but we've reached a point where it is increasingly difficult to fix the system one step at a time. we can not add 46 million uninsured people to a broken health system and we can not meaningfully control the growth of health spending without covering the uninsured. over the past year, we have learned how hard it is to reform the health care system. but just because it's hard, does not mean that the task is any less necessary. just because it's hard, does

not mean that we should look the other way. and just because it's hard, does not mean we have to compromise so much that we failed to address the problems at hand. madam secretary, that for all your hard work over the past year and the work of your department inning us to craft health care reform. thanks to your guidance and leadership, we know that we can start covering the uninsured with preexisting conditions this year, through high-risk pool. we know that we can provide immediate assistance to bridge the medicare drug coverage grab, the so-called doughnut hole. we know we can jump-start quality improvement policies in medicare and medicaid. we know we can make immediate progress on insurance market reform. i'm pleased to see the president's budget assumes enactment of health reform. the budget accurately reflects that health reform has the potential to reduce the budget deficit by $150 billion over the next

decade. and as the president said in the "state of the union" address, reform also has the potential to reduce the deficit by $1 trillion over the second 10 years. this year the finance committee face as full agenda. we'll work on creating jobs, growing the economy and reducing the deficit. but given daunting long run fiscal challenges we face, we can not give up off the health reform that addresses interconnected problems of cost, quality, and access. i encourage my colleagues on both sides of aisle and both sides of the capitol and both sides of pennsylvania avenue not to give up. we can and must succeed in reforming our health system. of course we face other daunting challenges. the medicare physician payment formula needs reform. hhs took an important step by removing drugs from the formula. and just last week the senate recognized a long-term solution requires short term investment by

exempting part of sgr from the new statutory pay-go rules. i hope this push will aid us in finding a permanent solution for the take of our seniors who need continued access to medical care. and beyond health care reform, congress must reauthorize the temporary assistance to needy families, otherwise known as tanf this year. we have more work to improve our child welfare program. the president's budget did not assume a 5-year authorization. we must use this year to lay groundwork for reauthorization. i may conclude where i began. i agree with president obama, we can not give up on enacting comprehensive health care reform this year. we have gone well past this effort's beginning. we've endured our share of struggle. now, let us at long last bring this bill to victory. with your help, madam secretary, certainly with the help of the president, i feel confident that we will accomplish that objective.

senator grassley. >> thank you, mr. chairman and thank you, secretary sebelius for being with us today. particularly in these very extraordinary times. our nation is beginning a slow recovery from one of our worst economic downturns. now maybe more than any time in history people are focused on our nation's economic challenges and they're worried or maybe words that come out of my town meeting, people say to me, i'm scared. they have watched unemployment soar, auto industry go into bankruptcy, banks shutting their doors and families struggling to make ends meet. and as our constituents have tightened their belts and tried to rein in their own house spending they have seen some in washington support spending increase after spending increase. they watched as the federal debt increased by $1.5 trillion since president obama took office. on the heels of that, they have just seen a debt

ceiling raised by another 1.8 trillion to make way for even more deficit spending. as i travel around iowa ply constituents know these facts and they know figures affecting our economy as well as the debt and they know it more than many washington insiders. they also know that this budget only takes minor steps towards a very major problem. they know that under this budget, the amount of debt held in 2008 will double to 12.3 trillion. by 2013 and triple to 17.5 trillion by 2019. and the question they keep asking is when will washington come to its senses and realize we can't afford all this? all of the bailouts, all the stimulus, the new spending is paid for with our

constituents hard-earned dollars and they seem to express concern about it and they want to know what we're going to do about it. they fail to see the return on investment that some have promised. as a result they have lost faith in government spending. as we consider the 2011 budget with you, we need to be thinking about how we can restore that trust. that trust begins, i believe, with, transparency and accountability. in my years serving in the united states congress i made it my mission to insure that transparency and accountability are more than just buzzwords. they have got to be meaningful. i've held both republicans and democratic administrations to the same standard. when president obama was running for office he pledged to make government, quote, open and transparent, end of quote. another quote is, he promised quote, to provide a window for all americans

into the business of government, end of quote. actions speak louder than words and unfortunately, a year into this administration we have seen that this principle not always put into practice the way it was talked about in the campaign. transparency and accountability require an open and fraeng dialogue between people's representatives in congress and those in the administration. at this time, i have over 10 responses overdue from the department of health and human services on matters ranging from health care fraud, to public safety and those are listed up there. and the number of days that been waiting for answers. if departments across the federal government, i think my oversight efforts are resisted held up, frustrated and impeded by bureaucrats who seem more interested in governing than opening up. this lack of transparency and accountability is nothing new in washington,

the american public was led to that more could be expected when they voted for th predent that wanted change. promises were made. principles based on transparency and accountability were repeated over and over again and obviously, the vast majority of americans believed. well, i want to continue to work on the american people's behalf to government accountable for its actions and insure that the administration's conduct, conducts its business in the open and transparent manner that was suggested. while these accountability and transparency problems persist, i'm pleased to at least see that addressing fraud, waste and abuse in medicare, medicaid and chip has a problem role in this year's budget proposal as it should. if we learned anything during the health care reform de, it was fighting health care fraud, waste and

abuse is really a bipartisan priority. we all have seen staggering estimates around 60 dal billion of taxpayers money being lost and this seems to be a conservative estimate. i look forward to hearing from you, madam secretary on proposals to strengthen fraud, waste and abuse and prevention, detection and enforcement. before congress can weigh the merits of your legislative proposals as well as your request for increased funding we need to know what and how you're doing with what you all currently have. i mentioned earlier, congress has the duty of government oversight. this include reviewing annual reports that you're required to produce. one of these annual reports is on payment error rates. the latest one was due last november but congress has yet to see payment error rates for specific types of providers. so, obviously the seriously impedes our ability to conduct oversight.

and it limits our ability to evaluate how the federal government is addressing fraud, waste and abuse. so i look forward to hearing from you today on the status of that report. mr. chairman, in regard to that, i ask unanimous consent that the slides on payment error rates from cbs be entered into the record. >> without objection. thank you. >> in addition to fraud, waste and abuse proposals the budget assumes a six-month fmap extension to states. while i do agree the states still need assistance to make ends meet, i think it's time for congress to cut the strings staff attached to the aid we're sending them. as states struggle to balance their budgets, having federal government provide them assistance that pre-vents them from touching medicaid doesn't make much sense. we should give states control of their budgets so they can be more innovative and efficient with how they provide access to care. and of course, you're a

former governor so i hope you would agree with that, that flexibility is very important to be a good governor or state legislator. i look forward to discussing this and other issues with. thank you. >> thank you. senator. thank you very much. i like to welcome our witness, former governor of kansas, hhs secretary, we're honored to have you here, madam secretary. as you know, your full statement will be included in record. urge you to summarize. we usually have five minute rule but give you a few more than five minutes. why don't proceed. >> thank you. committee members. glad to be here today, to discuss the president's 2011 budget as it regards the department of health and human services. i think you will find the budget builds on some themes the president laid out in his state of the union. strengthening and security and opportunity for america's working families, investing build foundation

for future growth and bringing a new level of accountability and transparency to government. i abide by the president's pledge to try to identify that are redundant, obsolete or ineffective. as you know, health and human services provides the health that americans depend on and actually delivers human services to many of our most vulnerable populations. and we think that it's important to make some of the invests our country has been putting off for years, including invests in fighting health care fraud, strengthening our public health infrastructure, and getting more focused on prevention and wellness. i would like to give a brief overview of department priorities, focusing specifically on areas of medicare, medicaid and chip. excuse me. and i know that we'll have a chance to deal with some questions, and, look forward to working with all of you as we move this forward.

i would start with fraud and abuse as the ranking member grassley has already noted, taking this seriously is something that is long overdue. it is something that the president feels very strongly about which is why he asked the attorney general and i to work together in the creation of a new anti-fraud focus which is known as the health care fraud prevention and action task force, better known as heat. we've already had some unprecedented success with now seven strike forces in cities around this triwith a new data sharing system where we can monitor and observe changing patterns of billing practices and a whole host of new prevention tools which we anticipate will be enormously effective. so the president has included resources for new

systems and new personnel to focus on this effort. this is one of the efforts that we know actually returns significantly more than any investment we make. tomorrow will be a year from the date that the children's health insurance program was expanded and we know that in 2009 more than 2 1/2 million children who were previously uninsured got coverage from medicaid and chip. one of the efforts that our department takes very seriously is the outreach effort provided by congressional funding and we intend to work with state and federal partners to identify and enroll the estimated four to five million children who are eligible right now but still not enrolled. the budget does extend the fmap, enhanced match that

congress applied in the recovery. and as a, as a former governor i can tell you this is one universally welcomed relief for states who still have not seen their budgets recover. and since medicaid is one of the most significant expenditures that think state in the country makes in terms of the budget spent on health care, having an enhanced federal match is something supported i think by republican and democratic governors. we insure access up-to-date health care for seniors and people with disability who depend on medicare with new operations in cms that will help us change from a relatively antiquated claims processing into an actively purchasing quality care system, making the next

generation in health care technology to help providers raise the quality of care for all americans. we continue to fund patient-centered research projects which empower providers and patients to get the most up-to-date information about strategies and protocols that work well. this budget also, chairman baucus referenced the physician payment rate. the budget assumes 0% update for physician payments reflecting the last number of years that congress has taken care to make sure that seniors did not see a dramatic decrease in the provider rates for their doctors. we support the longer-term strategy and look forward to working with congress to that end. so this doesn't continue to be a yearly debate.

there is continued investment in neighborhood community health centers, following up on the recovery act investment but, an additional investment that will provide 25 new sites and will eventually provide care for about 20 million people a year, three million more than were served in 2008 with high-quality, low-cost preventative care. there's a continued investment in our health care workforce recognizing that health care delivery falls short unless you have the providers who actually deliver that care and the indian health center continues to be a presidential priority, trying to live up to the commitments made generations ago to american indians and alaska natives and in trying to reduce the woeful health disparities we continue to find. our budget includes new

funding for a 21st century food safety system through the food and drug administration. we right now live in a global food marketplace. just for example, half of our fruit and nearly 2/3 of our seafood comes from overseas and yet we have 21st, 20th century, inspection operation. so, designing the food safety system which gives american consumers the confidence that the food that they serve to their children is safe is something that we again take very seriously. following the signing last year of the tobacco legislation, the budget makes a serious investment in the battle against smoking. we saw dramatic decreases in smoking rates for years in america but they now are holding steady at 20%. frankly that's way too high. additional focus on better

ways to stop smoking, new research, community-based projects is part of this ongoing effort to try and lower the dramatic costs that are, underlying a lot of the chronic health conditions and directly related to smoking. public health security continues to be a focus. we know that we need to be better prepared for our public health emergencies whether it is caused by natural disaster or by attacks by our fellow man, we know that medical countermeasures stand at the front of those readiness efforts, the vaccines and treatments and respirators that help reduce spread of infections. this flu season we all have had a bit of a wake-up call responding to the first pandemic in 40 years and a opportunity to look where our system worked well and where there were gaps. so we continue to believe that funding new strategies,

new technologies, new research through nih, work at the fda on scientific break throughs but also, looking at a whole host of medical countermeasures is more important now than ever. and i have asked my assistant secretary for emergency preparedness to actually use the h1n1 experience as a template but give a report back by the end of the first quarter of this year which i look forward to sharing with you, mr. chairman and members of your committee, to look at where the gaps in our responsiveness system are and what kinds of strategies on a multiyear basis we need going ahead. and finally, mr. chairman, i wanted to mention some of our critical programs that don't deal directly with health care but deal with the human service side of our budget. we know that investments in children, particularly at-risk children, continue

to be terribly critical factor in how well and prosperous they may be in later life. so this budget again focuses on early head start and head start providing enough res to serve about 66,000 more young children and, just two years ago. what we know middle class families are not just taking care of their kids these days. often they're dealing with aging parents. so there is a new family caregiver program, recognizing the fact that about 80% of long-term care services are provided by family members. often that's great news for the derly family member who gets to be cared for by loved ones but can be financially and physically exhausting for the caregivers. this provides our agency on aging additional support for everything from counseling, for, caregivers assistance

and at adult day care centers. for periodic stays. rest it care, -- respite care and help for families trying their best to balance these care giving roles. some of the essential services that they are providing. so mr. chairman, that's some brief highlights of the health and human services budget focuses on the health and well being of americans and delivering essential human services. i think that we continue to work to improve the everyday lives of americans. i look forward to grew the health and well being of american people and answer some questions about this

thank you, madam secretary. our like you to explain to all of us why health care reform creates jobs and how it saves jobs. hear certain way the president went to new hampshire and other states helping encourage more a job promotion in our country. we in this committee will soon in -- not us but in the senate will pass a jobs bill and clearly to get the economy moving again have to do all we can to create jobs. and because health care costs are rising so much higher than wages, five times more since the last eight years in premiums rising three times the wages, it seems quite clear that there is a trade-off here. an employer providing health insurance, that is lost wages. and the more we get to health

care reform past year the lower rate of increase in its health care costs, the more that's going to help the employees get higher wages. if you could just expound on that a little bit, madam secretary, help explain to all of us and the country basically why health care reform really is a job creator and helps businesses and employees keep jobs. >> well, mr. chairman, not only as the health care sector a huge part of our overall economic picture represents about a sixth of the overall gross domestic product in america, so in an of itself, doctors, nurses, health care providers, helen i.t., a whole host of workers in the system are certainly part of our economy, but just focusing on a small business owners who are often regarded as the critical

engine of the american economy and produce more jobs in the long term, i hear over and over as i travel around the country about the crushing cost of health care for employees. small business employers are often in a catch-22, and they don't provide coverage for the employees will lose good employes. they can't retain the best and brightest who follow health care to the bigger company with a bigger market. >> there are things in this bill to help small businesses. >> absolutely, a major incentive and it would go into a fact in 2010 as one of the early deliverable in health reform to assist small business owners to essentially say in the health care market, and eventually there would be not only that assistance, but an opportunity for lower income workers to have

coverage. again i think the job future is not only would have more productive companies but more globally competitive and able to by reducing the overall health care costs not shifting from industry to industry, have an opportunity in this global marketplace to compete more effectively whether selling cars or widget with competitors around the world. i think the third aspect from jobs aspect is about having more productive workforce. allan wallis, prevention of illness and long-term chronic illness, keeping employes in the workforce, reducing sick days as a direct positive impact on our workforce. we have poor health results in many countries around the world. we have employees who live sicker and die younger than many places so having those kinds of investments for health reform and more productive workforce i think in the long run makes america a more prosperous.

>> isn't health care reform in the administration and hhs tried to implement some new ways to reimburse providers to get reimbursement based more on quality as opposed to quantity, that is limiting where admissions and excessive free admission for hospitals, for example. the value based purchasing for hospitals. go to new legislation in order to begin to enact a lot of these reforms which will clearly beginning to reduce the rate of growth of health care costs and at the same time improving quality. >> both the house and senate bills, there is a major interaction to begin shifting the piven system to quality outcomes so that everything from prevention and wellness, eliminating what americans now pay in a co-pays for preventive care, so encouraging screenings early detections, saving lives

of cancer and other chronic illnesses that can be identified early and corrected but also as you mention the hospital this infection -- we have 100,000 americans every year dying out because of what brought them to the hospital but what happens to them in the hospital also a focus on the hospital based in fractions and really directing our payments system to first provide incentives for hospitals to do well but eventually stop paying for care that is poorly delivered or makes people a sector. >> thank you very much. my time is expired. thank you. senator grassley. >> this past week i wrote to express my frustration with the lack of responsiveness to my request from hhs and the subordinate agencies, i'm still

waiting for responses to more than a dozen letters i sent last year to hhs, fda, cms and cdc. in my letter last week and ask you to get back to me by jr. tonight but i haven't received a response from you so please apply to have a let me know when i'll be getting a complete response and to all of my outstanding requests. >> well, senator, i share your interest in transparency and zero minutes. i know that we are now on a regular briefing schedule with your staff members. we are attempting to respond as quickly as possible and as fairly as possible through the information you requested. my information that we have given you complete responses to a number of requests, the majority, some we are still working on and what i assure you is as quickly as we get the

information together we will get it to you. i notice that correspondence often is ongoing and conversations on going to try and clarify and make sure we're getting exactly what you want. >> it seems to me that one of the problems is expediting the clearing process within the department and agencies so that letters from congress are answered thoroughly and the leopard -- delivered in a timely fashion. what are your plans to expedite the clearance process? it sounds like the letters are written, sitting on somebody's desk for approval was. >> well, senator, as you know we have a large agency which is not an excuse him for untimely responses. i have met on a regular basis with our executive secretariat and actually now receives at my request a weekly report on the status of correspondents, where it is, who has said, and following through the pipeline. so i'm taking this very

seriously and personally. >> well, you can see up here -- >> actually i can't. >> how many days it has been anathema we have been waiting for responses and and it seems to me that the list keeps getting longer and longer. you know, if we answer to our letters as senators like that, we wouldn't get reelected. let's go on. on another issue, as i mentioned in my opening statement of a strong supporter for transparency and accountability and as president obama mention he's disappointed there hasn't been more transparency in the health care debate. the budget assumes comprehensive health care will be enacted. in order for that to occur of assuming that negotiations between congress, the white house and stakeholders are continuing to take place. could you give it to me today that going forward any negotiations involved -- any of your senior staff in an effort to pass comprehensive health

reform will be done in the open and transparent manner? >> senator, i don't know what conversations with senior staff you're talking about. our staff is available to you and your members and meat -- meet with them regularly and are available to other members. i don't control the negotiations between the house and senate are the conversations. our staff provides technical support across the board of. >> so you're saying that your staff isn't anything more than just for technical support? they are not involved in any negotiations represented the white house or anything like that? >> conversations on a regular basis with republicans and democrats but i don't convene the house and senate and i am not a principal in the negotiations nor are my staff. >> i wrote to you in december asking you to explain why congress didn't receive the list all year 2009 comprehensive and air raids testing report, and

and that report was supposed to be out in november. the annual report shows national payment air raids were deprogram her show's improper payment rates for each type of a provider like hospitals or giambi suppliers and congress relies on this reports to evaluate how well are not so while medicare is doing when making payments. i ask you to tell me when i can expect the final report, you haven't responded to that letter, i have before me as i already showed him the senator for putting in the record a promise cms november presentation when, the committee staff of fiscal year 2009 medicare improper payment rates. each member here at the day as has a copy. everyone who i hope would turn to page eight of the slide in you'll see in november 2008 the error rate for durable medical equipment was seven and three tenths percent in november 2009

that number jumped to 51 in nine tense% and a very significant job if you go to page 10 that number goes up even higher to 73% from 73% is the rate that cms got what used the quote of quote the most trenchant criteria for calculating the error rates. that criteria is supposed to be using some question number one, how do you explain sitting on these numbers especially when this country is in the midst of health care reform discussions regarding legislation that would delegate more authority to the department on a broad range of financing until every system changes and new piven model? >> senator, i think a couple of things, first of all i think that we took very seriously the previous criticisms by the inspector general who that the previous administration under hhs who was not being accurate

about is perorates. >> ivory with you. >> and i'm pleased to hear that. in so that the changes this year while using the criteria that we agree should have been used for years was a new system. i would like to also i know you are well aware of this since you follow this closely but to make this clear to other committee members and air raid is not a fraud rate. there are different issues and could be as little as a doctor signature not legible for something in the wrong column, but again we think should be accurate. we are working diligently and to this new system. we put out with the global lubbers in november with at the time the budget was due. at the time the report was due. we hope by the end of this week to have the underlying numbers but the shift has not been one that has been necessarily a. quick because it has been a change from a traditional system in every single error rate and

we need to recalculate. we want to get right in abide by what the inspector general said we should have done all along and i will promise it will be hand delivered to you but i've been told by the end of this week we should have the underlying numbers ready to go. >> i hope you realize 73% is still a very high rate of error. senator rockefeller, it's your turn a. >> thank you, senator grassley. secretary of civilians, i'm glad to see you. i have a couple of points to make. one with respect to what senator grassley to is my dear friend and who s and some good things in his election years in the omaha paper and? >> it would not be on top. des moines maybe. >> i was concerned about something else, i didn't give you the proper respect, would you please repeated. >> no,. >> de des moines register.

>> that was the point. i was just saying that he and i have a good relationship. >> we do have a good relationships iraq but it occurs to me that sometimes in this question of i thank you have 70,000 employees were will come ninth one you have a responsibility over an enormous array of things, i don't know how many letters i write you but i often find simply to call either you in my case with were in their case some of your staff people because letters can actually be very efficient. and get back to end go through a process of been sometimes put in general language. sometimes a phone call as you indicated staff been in touch with staff is what i line is the best way to try and work problems out. i am just saying that.

for whatever it is worth. is it true that health care is the single and this particular point, the single greatest economic engine in the united states economy? that is in terms of rapidity of gropes of jobs? >> i think that is an accurate statement. >> my understanding is that over the past two years we there had been the 631,000 new jobs simply in something called the health care sector and that there have been in just the last month 22,000 new jobs. which is interesting because the economy isn't doing very well, as been explained and people are frustrated and we're trying to work on how can we create more jobs. well, if we can just do health care reform and coming get it

done, we will have contributed enormously and is already producing an enormous number of jobs. so to me it's one of the best and i think that's according to the bureau of labor statistics so i am not touting what they say, let me shift just a bit. there are over 100 community health centers and applied for the american recovery act funding mw and receives in my own state the applications that we have received about a 9 percent score on their proposals for facilities investment program which is evan i.p.. but they were left unfunded due to funding limitations. now, you talk about the important link between health

care investments and economic growth. does she think it's also possible that if we come back with a jobs program -- these are very important -- it is light health service corps people. if you don't have families suffer, if you do have them your people particularly in rural areas which in wyoming we have a great number of a, they gain enormously. one that if there are shoveled gritty projects and i am thinking out again of community health centers, that if we get some more money for that there would be possible to do more that particularly with people who score in 90 percent or over on your own criteria? >> as you know, senator, it was the recovery and to that provided a major investment in community health centers and they were wildly oversubscribed by a terribly long i think

beneficial projects that just weren't able to be funded based on in the amount of money available, but no question having the health center that it produces workers in that area and they operate as a community center often and have a huge beneficial effect on neighborhood well-being, on workers and on jobs. it's a construction project and long-term service project so we appreciate that continued investment in the 2011 budget. i think it's definitely a jobs program that also yields health results for the communities in which they are relocated. 20 million americans have a low-cost preventive health care for themselves and their families based on these community health centers and often the strain on hospitals and community hospitals is reduced as a result because

people are accessing health providers some more appropriately not going through emergency room door but actually getting help through a health center. so i think it has lots of beneficial ramifications. >> could become of my time is up for the moment karen. >> thank you, senator rockefeller. senator wyden and then senator enzi. >> thank you senator grassley and welcome secretary sebelius. secretary sebelius, we're obviously paying attention today to the fact that the budget assumes that comprehensive house reform is enacted and there would be savings of about $150 billion over the next decade. now, the president has said in that an essential part of comprehensive health care reform is expanding consumer choice and competition and i share the president's view. one way the president seeks to promote its choice and

competition is by creating a working marketplace in effect on net seven exchanges kind of white farmers markets where people can compare the various product. how would in your view creating these health insurance exchanges contribute to the savings that are in addition in the budget? by enacting comprehensive health care reform? >> well, senator, i think that having a new marketplace as you say with competing private sector plans which is what is envisioned not only has a beneficial impact for individual purchasers of some small-business owners, a self-employed, americans and others who often struggle with a high cost of care right now would have some choices, would have some options.

but also i think in the long term competition holds costs. is a great market strategy and if you have competition versus up monopoly really have an opportunity for the market to work. some might experience running a state employee health plan in kansas was that we made sure that employees have at least nine other choice of birth, at least two choices wherever they lived in the state. some were actively traded by the state system to provide competition and what we found was that got a best price of the lowest cost. people wanted access to that pool of workers, they wanted in kansas -- we have of the largest health pool in the state, 90,000 covered lives. people want and access to that and they ended up being very competitive in terms of the prices and services that they offer. that would operate within states involved a serious and i think

if folks joyce is right now the they don't have right now. >> i want to continue to work with you and the president on this issue. as you know, my concern has been that most americans don't have choices today and, of course, a member of congress can fire their insurance company. they can say in 2009 if you are not treating me while i go somewhere else in 2010 in line -- i intend to work closely with you and the president and chairman baucus and senator grassley on this because there isn't a market place today and we need one. let me ask if i'm right about another area i know we share similar views and that is the treatment of those who are chronically ill. the evidence shows that summer in the vicinity of 75 percent of the health care budget goes for a relatively small percentage of the population, may be 10%. there are bipartisan bills in the senate, senator.

and i, for example have one here, also in the house and markey and chris smith to provide what's called independents at home. and there you would have an impact on a coordinated team of practitioners doing in effect agreed to take lower payments so that it does not add to the deficit in order to get better care for people at home. you also don't have that in the budget and our just like to hear your response about what kind of priority in the independence at home after it would be for you and the department in the years ahead of. >> senator, i think that concept would be embodied in one of the health reform components in the senators -- centers for innovation. it is one of the strategy is that is operational in some areas and, in fact, in the northeast corner of the country we just added medicare to a provider reported to care

strategy that's under way in vermont, northern massachusetts, which operates where much along that way. i think it's a huge priority. back to the state issue as a former governor, the dual eligible population, those poor enough to qualify for medicaid and those who are old enough to qualify for medicare, they are again the fastest rising cost in the medicaid budget of any state operation and often are chronically ill, often have multiple issues in states are way ahead of the federal government right now in looking at ways to deliver better care and a much lower cost. certainly the independence at home is one of the strategies with a huge priority for me. >> senator enzi. >> thank you, mr. chairman, and i ask that my statement be made parts.

>> without objection. >> thank you. madam secretary, community health centers receive an increase of $290 million for the 2010 budget which is on top of the 2 billion they received in the stimulus package in addition to senator wyden notice assuming health reform is passed and that would provide mandatory and unlimited funding for community health centers and the president's stated of the union address he said families across america are turning their belts and making tough decisions. the federal government should do the same how is mandatory and unlimited deficit spending and not for community health centers with an additional increase of 290 million plus on top of the $2 billion provided in the stimulus package representative of those comments? >> senator, i think that the experience of health providers, of patience, and community leaders across america is that

to the investment in community health centers has been a great way to lower health care delivery cost. regardless of where they are in the country, the delivery of a highly attractive preventive care at a significantly lower cost than sort of competing systems has been proven and the ability to reach out in this case to lots of americans who either don't have insurance coverage at all or who have very modest coverage, and dan has been very attractive in terms of preventive care delivery. so i think that the increased footprint of community health centers of working in tandem which they do in many parts of the country with a primary delivery system with community hospitals, provider groups, has been a wonderful way. whether people have insurance are not to deliver health care and a very cost effective

strategy. >> i've been a supporter of the community health centers but this seems to be going quite a ways and unknown some private entities have sprung up in the meantime that are supplementing this and then sues to meet to be quite a huge increase. but to move onto a little difference subject says we have limited time, i think you're chief actuary, richard foster, said the medicare payment cuts in the senate bill could lead to as many as 20% of hospitals, nursing homes and other medicare providers to have to operate at loss. how many jobs will be lost if one at of every five health providers is losing money and therefore those out of business? do you think that mr. foster's analysis is correct, the level of medicare cuts in the senate bill may be unsustainable? >> senator, as you know there have been lots of different

analyses but by the various strategies regarding medicare. i think the most obvious point about medicare right now is that it is unsustainable on its current course. it is schedule with a current situation in to be totally at of funds within nine years and those numbers change it every year so that it's clear that not doing something -- and doing something is necessary. in one of the themes that i think are determined to a very serious lee who was looking at tibet strategy is for areas where we are overpaying for various services and goods. overpaying in subsidizing private insurance companies for

various kinds of medicare advantage programs. not taking fraud and abuse seriously which again returns money. we have are the in the less than one year i have been at the head of hhs, we have had over $4 billion returned to the medicare trust fund that based on various kinds of settlements and fraudulent activities that we shut down and. so we are taking all of that very seriously. i think that clearly if you have some significant reduction in and providers with the medicare system, there was really be a job loss but again the most imminent loss of jobs is 21 percent pay tied to that is facing medicare providers and congress doesn't fix the sgr rate. and that would be a dramatic job loss i think for seniors around this country.

>> i have known that medicare needs more funds and i know that half a trillion dollars we're talking about could do to medicare to fix some of those things and i'm hoping will take a look at that. i have additional questions out like to ask on health i.t. and, of course, of looking for to my report on dr. gruber who represented himself as an independent academic expert while making $400,000 from the department and that didn't show up on the list i got earlier in the year when i requested it so i'm looking for to that. thank you. >> senator cornyn. >> mr. chairman, let me ask for improper the human rights and medicaid. you talked with senator grassley about that. under the president's budget additional $26 billion will be spent on the medicaid program but according to some figures i've seen as much as 10 percent of medicaid payments are improper payments and, of

course, is as you know this is a shared expense program the state and federal government share in that expense. i have been trying -- my staff has tried to get from your staff since july in a detailed statement about improper payment rates of and so far we have been refused that information. you may not be aware that so i want to bring that too your attention. and i'd like to ask you would do see that that information is provided to us so we can make a better informed decision? about your proposal to spend additional $26 billion on the medicaid program? >> yes, senator i would. i am not specifically aware of your request. i assure you i will check into appearing as you know our department does not pay the medicated providers directly. that is done and the state level. the contracts are let the state level in each state has a

different kind of arrangement. our medicaid program to look like i was one nebraska's or our providers were different. so one of the difficulties senator it may be that collecting that data from 50 states around the country and updating and make sure its accurate to maybe one of the challenges because we don't hold that data and the department of health and human services. >> of course, about 60 percent roughly of those are federal tax dollars. >> we pay and match but we don't contract with the providers. >> anger stan, i think you're the permit would have an interest in whether federal tax dollars as well as state dollars are squandered and 90. >> i understand and that's one of the efforts in the fraud and abuse area. we have a series of new initiatives that will be worked out with our state partners to look at fraud and abuse and waste and error rates in the medicaid program. >> i heard you say that earlier and i like to get to that in the

second but that's why we need state-by-state numbers which is what we requested from your agency. and we would like to know whether those who improper payment rates are provider payment errors or errors determining eligibility. that's simply want to get information from, not reaching judgments and would like to get the information and i appreciate your commitment to work with us to get that information promptly. but i would like to talk to you second about fraud and abuse. as a former state attorney general, i can tell you that neither the federal government or the state government has enough resources to chase the from ministers and the people trying to cheat the taxpayer after the fact is we need to do a better job on the front end of certifying providers and stopping it on the front end. i would just ask you to look at one piece of legislation that i've introduced along with other senators called the seniors and taxpayers obligation protection

act. he may be familiar which does exactly that entrust to stop in on the front end as opposed to chasing on the back end. be critical. i don't think you'll ever have enough resources on the state or friend level to chase the fraudsters down. i think that's why we need to start on the front end. >> senator, i agree with that. definitely take a look at your legislation. we have begun some new certification practices, durable medical equipment was one that we had a huge increase in some erratic building. we've instituted third-party verification, more providers number, a much tighter, but i agree, every scheme we come after the back end, there'll be a new scheme at the front end. so, i look forward to looking at your legislation. >> while connotative victory much for that. i appreciate it.

he talked about the fact that medicare will become insolvent. in less than a decade. and of course, that has been the subject of a lot of concern by the american people, mcc is spending more on programs, our failure to meet our responsibilities to deal with current unfunded liabilities. while we've heard that health care reform is entitlement reform, we know from dr. elmendorf in the congressional budget office that the health care bills reform bills cannot be used to both pay for health reform and address the solvency of the medicare program. he said, the key point is the sapient to the health hospital trust fund under health refiner would be received by the government only once. so they can't be set aside to pay for future medicare spending. and at the same time, pay for current spending on other parts

of the legislation or another programs. since at least dr. him endorse opinions come you can't double spend that money. can you talk to us about your proposal for the administration's proposals to deal with these $38 trillion in unfunded liabilities for medicare rx >> well, senator, that health reform actually does include a number of proposals, which would certainly slow the growth rate of the medicare trust fund spending without violating any of the benefits that are currently relied upon by not only seniors, but so far most disabled citizens. and it not only looks to save money and the overall purchase of prescription drugs. they look to make sure that we are not paying for or overpaying

for services and procedures that are not cost effect is. they slow the growth rate by having competitive bidding in areas like durable medical equipment, getting a better bang for buck, while still delivering the services to beneficiaries. and also i think there's an enormous amount of health reform that anticipates prevention and wellness and having a different kind of strategy so that you don't wait until a senior enters medicare and paying for acute services. but hopefully, lowering the underlying conditions for chronic diseases. >> news snowe, you're next. and i thank you, mr. chairman. adam secretary, welcome. one of the first questions i wanted to ask you is regarding low-income fuel assistance. which is a critical program for my region and throughout the country, depending on the severe circumstances of the weather.

and senator reid of rhode island and i sent along a letter with other 46 senators considering the methodology we used to distribute the low income funding, the release said the emergency funding for example. in 40 million of the 490 that was released, we set aside the heating degree days in our state received 80% last content less than rhode island receive 50% less for an example. on the heating degree funding, and states like florida that is usually called received 3.9 million emergency assistance. texas received 10.0 in alaska, minnesota, maine, receive nothing here because of the calculation of these heating degree days, to which florida would have 30 heating degree days last december caribou, maine would have 137680 degrees days. four times the energy required. so i'm trying shoemake sense of what was the methodology used in

this distribution. i'm not arguing that florida received any funding. i'm arguing the point about why there was such a radical difference in the amount of funding the cold weather states can the severe cold weather states received in the relief of this emergency funding. lester mainer c. 2,929,000,000. rhode island has the second-highest in the country. so, we submitted a letter to you. and i would appreciate if you had a response here today to understand that why the money was distributed in this fashion. >> certainly, senator. we will get the detailed formula to you, but there were several factors this year that were lucked out. one is that the cost of heating oil is significantly lower this year than last. which affect did some of the cost in the northeast dade, which rely heavily on heating oil.

i think it was over $100 last year and it was down below 80 this year. so there was a significant ways. as the party said, some of the other states have particularly cold snaps, which was not a factor a year ago and needed to be calculated in. and thirdly, the formula not only included the overall look at the heating issues, but also unemployment numbers. so those three factors were the formula used this year to redistribute the funds. >> i think you'd agree that that is a dramatic change, given the enormous costs and heating oil that could be 50, 70, $80 a barrel as it has been this winter. and it's more than $2000 for a season. in a state that has very low wages. and so i think that's true for a number of the states that have signed this letter as well from

senators who represent those states. and i hope we can further discussion in the future concerning. i didn't see any consistency that occurred in this other state. i do want to create -- i just want to make sure we have a fair and equitable, you know, consideration during these, especially during these very difficult times. and the fact that home heating oil is very expensive proposition and i say for coming out, depend on it frankly. on the issue of health care reform, we talk about jobs. the reverse is true as well. that's what i'm here in my state among small-business owners, very concerned about the calculation of the potential cost that could arise from the changes made at health care reform. those one of the biggest issues in maine and that was cited repeatedly. the potential for raising the cost of doing business and where they would hesitate to invest in future capital equipment or at any jobs i heard that

repeatedly. the medicare payroll taxes and 52% increase as was concluded in the legislation, employer mandate. so they're a number of issues that could potentially raise the cost of doing business. and i have a deep concern that that's going to depress the ability, you know, of small businesses, especially to turn around the economy. we talked about those tax credits. and they are important. but it also requires small businesses to pay up front. they're going to have to lay down for money in order to get the benefit of that tax credit. we might not even be in opposition. so i think we have to look at the overall calculation and all of this. there are some things that we could do, you know, short of this comprehensive reform immediately on legislation that senator lincoln and i have introduced a small-business exchange along with senator durbin, bipartisan basis that would help to open the doors, you know, to small businesses at the very least. that should have done long ago. i also think we have to

calculate what was the impact of health care reform as authority been designed on small businesses and the potential to lose jobs as well. >> senator lincoln. madame secretary, would you like to respond. senator snowe's time has expired. i want to give you an opportunity to respond. >> i think the job circulation for small-business owners is huge. i have denoted a couple of forms in maine, heard from some of your constituents directly. i do think that the look of the land, as you know the small-business tax credits in both the senate and house bill would kick in in 2010. they were becoming more affordable market down the road therapy fixes in the system along the way. so at least while i think it's always important to look at the

impact, i think there is no question but that group being squeezed in the current health care marketplace is often self-employed and small business owners who have no choices, higher prices and fewer options and often lose employees based on the fact that they can't keep them. >> thank you, very much. >> thank you am i mr. chairman. on to thank the senator from maine to bring that up. i believe the largest percentage falls under that small businesses, self-employed, anything at contractors. and i think it's a great step forward in terms of what we could do that would be meaningful in this overall health care debate. and i certainly enjoy working with her. she does a great job. just a couple questions i like to throw out and maybe you could answer. i think i've got about four year. just want to touch on the technological divide between rural and urban america. in your original federal register notice on health i.t.,

you were going to preferentially fund rural states, those with underserved areas and those that needed to catch up. unfortunately, in your funding for health information exchanges and other grants like the beacon community grants, it appears that the funding is on a per person ratio or funding communities that are more advanced in their implementation. problem with that is we never get started in rural america. and so, i just would like to see some assurances that the health situation will be available to all americans, particularly rural citizens like those in my state. and making sure that this digital divide does not contribute to the increase in health disparities that exist in rural america to train rural and urban citizens. so i hope the july will focus on that and help us in terms of making sure that everyone's going to the fair shot at that health i.t. the older americans act, if the nutrition programs were provided with an urgently needed 100 million under the recovery

act. however, the budget, the fy 2011 budget only totaled about 8 million my concern is that the recovery funds that are going to be expended in helping are really questioning why the elderly nutrition programs are not included in the recovery extensions and the president's budget. i think that something important to focus on. the elderly are one of our most vulnerable groups. i was pleased to hear senator wyden bring up coordination of care and all of those different after its, hoping that you can elaborate a little bit on the coordination of care demonstration. i've been working very diligently on those over the passover years and understand the importance that that plays in us getting the biggest bang for our buck, but also getting better outcomes, particularly in medicare. one other thing was that the department released a draft of the healthy people 2020 report.

in its 216 pages, it contained 556 objectives, which is great. we're glad we're focusing on so many things, but i was a little bit concerned are disappointed i suppose that the words all farmers or dementia were never mentioned. the top ten causes of death in the united states, alzheimer's disease is one of the only ten without its own topic area in the draft report. and noting that it affects about 5.3 million americans, with a number expected to rise by midcentury to as many as 16 million americans. it is certainly a growing public health crisis and i hope that you can look at the possibilities of perhaps before the publication's final report, looking at additions that could at least include a separate topic area perhaps i'm all farmers alzheimer's disease in that report. i think it would be very strong message that we are focused on not in this country.

in the last to be the medicare extenders. i want to complement the chairman for working with us on the medicare extenders and these different issues that obviously we feel like you're going to fall off the edge of the cliff. whether it's the therapy caps, physical therapy, physical speech, language, occupational, the pathologist also. i think that ambulance, rural hospital in others. i know that you and i visit on the phone about that and understand your position, but if the administration does not have the legal authority to extend the policy, what do you believe you can do to be helpful to us if in fact we can't get those move down the road? how can we be helpful to those providers? at the lot, but i just wanted to get it all out there so you can jump on it that be great. >> let me assure you that health i.t. has a variety of strategies, looking at different areas. but the health extension offices, which will be

established throughout the country are very much focused on underserved areas, i very much focused on assets that need to be brought in. that really is their primary objective. sorted that they are not forgotten areas of the country, forgotten providers, smaller hospitals, smaller provider groups. so that footprint is very much aimed at that. i know that there is some concern that the nutrition aid for older americans is not enhanced along with some others. i would say that there are a variety of new strategies for older americans, but including the caregiver strategy and some others, which have new funding in the budget. but i share your concerns at this tough time, that we need to keep seniors who rely on those programs in our sights. in terms of 2020, what i'd love to do -- i'm going to carry the suggestion to dr. howard co. and

actually have them follow up with you about that. i think that's one that is very appropriate -- he is much more intimately involved with those 500 recommendations than i am and i think this is a great time to provide that input. the medicare extenders as i suggested, senator, we do not feel we have the administrative flexibility to merely push them down the line. as we talked about, there are strategies about holding bells, but that can only be done for a period of time. i assume that eventually if it's fixed legislatively we could do some retroactive repayment. but at this point, we don't -- our general counsel has looked at this very carefully and feels that we really would be in violation of the law if we just ignore what the deadlines are for those -- >> thank you, senator. i would just like to say i'm thinking about putting therapy caps in the extenders package.

>> you've done great and have been wonderful to work with. >> i think it will be in that legislation. thank you. senator stabenow. >> thank you very much. thank you for your leadership on health care and health insurance reform. first, just a comment. thank you for the chairman for working hard on helping to change the way we paid physicians through what's been at the sgi. i know we're going to be do something merit badges very important and i just want to urge you, madame secretary, this payment system doesn't work. i was pleased to offer the legislation to repeal it. i still believe we need to do that and i hope the administration will work the best long-term to do that. i appreciate your efforts to take the cost of prescription drugs under that formula, which is a very important first step. but i'm hopeful that you will as

well look for other ways in which you can fundamentally change that. we change the incentives in health reform. and if we are able to move that forward i think it's one of the positive things in there. but i would just urge you to continue to work with us. >> look forward to it. and as you know better than many given your long efforts in this area, the uncertainty for providers and for patient about the future of their medical care is really undermining the confidence in a great health care system. and i really look forward to a long-term fix to making sure that we can live up to the trust that we've committed to common medicare beneficiaries that they will have a provider, services delivered. >> thank you. we need to get that done. wanted to speak about and ask you about graduate medical education, which we know is so important. we need to get more students, more physicians and your primary

care and of course again that's another focus of what we've been working on with health care reform. and we know that there's a broad broad primary care crisis. but i do want to note that we have hospitals that want to train more physicians in michigan, in my state. i know in maine and florida and other places. but they've been frustrated by a cms regulation on new residency programs and medicare's graduate medical education program. unfortunately, it was process was changed. i'm sure you're aware of this, but originally in the balanced budget act of 1997, there was concern expressed about flexibility and hospitals moving forward. they were going to expand the residency programs. and cms initially allowed hospitals to qualify for residency slots under a cap when they created new programs. and they defined the programs

that would receive initial accreditation here it is a very straightforward process. hospitals move forward and so on. and then in august of 2008, there was a new regulation that penalized programs that received the initial accreditation. and unfortunately, this has resulted in revoking funding for programs that today, you know, are ready, willing and able to go forward to be able to train our primary care physicians. and in fact, we have programs in michigan who may close as a result of the lack of funding. and so, given the fact we need more physicians, we need more primary care physicians as we know. i'm asking if you would work with us to address this change that was made over a year ago and be able to allow hospitals

to proceed with they were authorized to do. >> well, senator, i would look forward to an august 2008 was a bit before my time and i'm aware of the new teams down, but i'd be glad to go back and revisit that and actually take a look at that with your staff. absolutely. >> thank you. and finally, i would just briefly urgent mass about your focus on mental health services. i felt that one of the positive things that we have done in crafting our health reform issues was to include mental health and substance abuse services, both in definitions on chronic care as well as prevention and so on. and yet, we are seeing states making drastic cuts in mental health services. so i'm wondering what areas of the president's budget will expand or improve on these critical health care services. >> well actually, there's the new regulations for the

wellstone parity act are now out and we look forward to making sure that they are enforced around the country and that certainly is a result of lots of good effort. we have a wonderful new administrator in the substance abuse and mental health services area, pam hyde, and comes with public sector and private sector experience in various parts of the country and is already engaged in lots of cross government efforts. we are working on with the defense department on homelessness for veterans. we're working with the department of housing on chronically homeless kids. rarely can substance abuse services is critical in prevention. there's some exciting new studies about the ability to actually prevent mental illness and work on this and preventive care. so there are actually investments in the 2011 budget which had behavioral health

services to a number of community health clinics, which had no mental health services in the past, but now will have an infusion of investments to make sure that a lot with primary care they'll be behavioral health services available, more mental health professionals. so were looking at areas across our agency and across the government where we can actually make sure that mental health isn't a silo off to the side, but is part of the whole look at health care moving forward in a much more holistic approach. we've got a significant dialogue underway with the agency for children and families, knowing that a lot of the prevention of substance abuse really starts at a very young age and making sure that we have the services available at head start and early head start programs also. >> thank you, mr. chairman. >> none of secretary, there's a lot of concern about fraud,

medicare and medicaid and other programs administered by hhs. and i think you'd agree are intuitive. my sense is that a lot of the delegations are probably true. there is a lot of ways on the headlight of fraud. we just don't stop. and senator lemieux came to a couple days ago with an interesting idea. and he's pretty concerned about ways of fraud in florida and generally. i remember couple a few minutes ago we looked at home health care outlier payments and a percentage in florida and some of these counties was way, way, way above the cap and a period in instances of seniors and those same counties. but his idea is this: maybe we can take a page from credit card

companies. as we know, if the credit card companies have put together a very sophisticated mathematical algorithm about their credit card holders, just like google does. google knows what books to buy and wants you to buy so many books based on your purchase. but the thought senator lemieux had is this. just in the credit card company will notify you at the credit card holder is there some charge in this outlier. you save some charge made down in brazil. but they call you up, did you make this charge? is this what you bought? and me ask you first and you can either authorize or not authorize. but they know because they've got really sophisticated computer systems. the thought is maybe we can do

some of this in medicare and medicaid and from other programs. now that gets into payment as a provider, how long does it take to be reimbursed. but on the surface, i think it has some appeal. senator lemieux told me that he called the credit card company and talk to the head of something astringency to what degree that might work here. and often it is a private sector that comes up with pretty efficient ways of doing things. they've got the bottom line to worry about. they've got to compete. like another credit card company, for example. i doubt she'd given a lot of thought to that, maybe you have. but anyway, i was kind of intrigued with this idea. any comments? >> well, actually had a conversation with senator lemieux about this notion recently because as you know we setup our second strike force in florida and it is a hotbed of activities. i think it has some real

interest. we have asked our folks to take -- you've got a piece of legislation to have conversations with them. i think the kind of real-time data sharing that he's talking about, looking at aberrant patterns, the way they identify some of these things in the credit card is 90% of my charges are from washington d.c. and something suddenly shows up where i've never been abroad and something shows up, they fly again. that's exactly what they're trying to do with sharing data with the justice department, watching billing patters and florida senator, just for instance, 10% getting home health care live in the state of florida. 95% of the patients who have $100,000 or more and billing of home health care live in florida. so we matched those quickly and kind of one after it. but that's exactly the kind i hope to learn what the credit

cards are doing. >> i encourage you to pursue this. i know i'm being corny about this, but its taxpayers money here. >> you that. >> amboy if we can stop a lot of this will enhance the credibility. >> and getting out of front of it. >> i appreciate it. >> pan chase does not work in trying to stop it. >> they find ways to cut and run. i know there was another question i wanted to ask you. if you could remind us what some of the early deliverables could be of health care reform, you know, what it would affect what does pass for several years. could you outline smoke less of the early deliverables? >> well, assuming the passage of health reform soon in the year 2010, it's anticipated that we would have stayed put together high risk pools to private

affordable coverage for really the uninsured, chronically ill folks often you don't have coverage at all right now. a number of significant insurance reforms would occur. so, people would not any longer be able to eliminate insurance coverage for children with existing conditions. that has to be covered. you'd have to remove the payment caps that currently interact cancer treatments and chronically ill services for people who have insurance coverage. children could stay on their parent's policies, the twentysomethings. could be covered as a dependent under your parents coverage. we would begin to institute medical loss ratios for insurance companies so you'd know how much they're spending

on benefits for patients and how much is going to overhead and ceo profits which right now is enable it to be determined. so preventive care would cease having co-pays runaway speeeleven >> merrilee deliverables. >> and the fraud and abuse would crack down on this. >> thank you very much. senator carper. >> it is good to be here, i apologize for arriving late. >> we love to have you here. >> i had the pleasure of welcoming to delaware on monday in number of high-school students exchange students from countries all over the world. i was struck at thank you and a session in the state senate of a legislature, general assembly legislative hall in dover and we asked questions. one of the issues was health care. they were curious aboutç health

care and health care reform and curious as to why we spend so much more money than other countries. there are curious as to why we don't get better results and there were three from japan, a couple from okinawa, and i said we spend half as much as you do, about 16% of gdp and in japan about 8%, they said according to a different kind of measurements that we have a wellness, life expectancy, infant mortality and so forth they actually beat us hands down and spend half as much in the cover everybody. they don't do it through like a socialist system, they have private insurance companies. i believe that have private providers. but i was struck by that conversation. today i come down to washington on the train as i do almost every morning of the week. the train goes by york, delaware before you hit to the maryland

line and there is a big chrysler plans to use to be a chrysler plant that is closed or 4,000 people used to work every day. today nobody works there. it is a time when we are really concerned about making sure that people have jobs again, the loss of manufacturing jobs. can you help us, you may have done this but i ask you to do it again,. >> to the dots for us here. quality health care, how does it to have the needed to create jobs and create a nurturing preservation for job creation at. >> senator, i think there is no question we s >> i think there's no question we spend almost twice as much and get worse health results than any other developed nation, and part of it is that we continue to pay more than anybody in the world for health

issues that really don't result in people being healthier. so we overpay for products and services. we pay for procedures, and not for quality outcome, which encourages i think more testing, more protocol, sometimes would suggest even more hospitalizations, but not necessarily keeping people well in the first place. we have not invested as many people have come and health and wellness. and a large part of the health and wellness is a huge gap in who has access to preventive health services, health home, follow-up care. so that when we have 46 million americans without health insurance at all, they enter the health system in more serious shape, and more chronic conditions, and use often emergency rooms as the least effective, most expensive way to get health care treatment. you know, some of it clearly has to do with diet.

we don't eat nearly as much to and as the japanese, and that would probably make all of us a little healthier. but the jobs i thanked recommended because our manufacturing sector has been the first to be absolutely uncompetitive in the global marketplace when chrysler was competing with companies around the world, who were not leading on $3000 on every car sold are not trying to compete. so we have to get to a strategy where we have a healthier nation. and a more equitable share of health expenses, paying for outcomes and quality. and finding ways to lower the deficit in the long run, which will make us not only healthier and more prosperous, but certainly more competitive. >> thank you. i think i've shared this before. back in august, september, i held a town hall meeting, different than anything i've done before.

we did a telephone town hall meeting. the first one we have 4000 people on the call. the second we had 6000 people on the call. i was struck by the hunger of the people in my state, what were we really doing. one of the aspects of the legislation that we are passing is something that is designed to help make better that we go after fraud. particular with respect to medicare and medicaid. it is supported by senator wyden, all my colleagues. we need to incentivize the states. previously the states have 60 days to identified fraud, to go and collect the money and turn over half of it to the federal government. they did almost none of it. if they couldn't all that in 60 days, they just let it go. what we're doing is we do it on the legislation and save you have a year to identify, go after the money, get the fraudsters, then split with the federal government. that's on our legislation that the senate passed it with you

talk about that a little bit, because we know it issued just there and i think we're using private contracts to go and out and recover at least in three states, money, fraudulent taken out of medicare. we recovered almost $700 million last year alone. i think we're taking it to all 50 states. can you talk about that have the resources and partnership will help us get back more money? >> well senator, the president i think takes very seriously that we be good stewards of taxpayer dollars. and certainly anyone stealing out of medicare for stealing him from the state partnership with medicaid is dealing taxpayer dollars and jeopardizing the trust we have with seniors. so this budget has an 80% increase in resources, new data systems, new sharing with the justice department, the attorney general and i at the president's request are now leading a joint justice h. h. as effort when we

now have strike forces in seven different cities to try and not on sending very strong signal that we take it very serves a, but have been enormously effective so far. this will give us a much bigger footprint around the country. i wish and with chairman baucus, shared data real-time, watching aberrant billing practices and go after them. we're going to invest in state partnerships at the medicaid level, knowing that having those footprints on the ground, having u.s. attorneys, as well as the states attorney general, who can be very aggressive partners in pursuing fraud, is all to the good. and we know that there's a huge return. it's estimated to be anywhere from $2 back from every dollar we spend, to $4 back which is what the attorney general says to everyone dollar we spend. so this is money that not only makes sure medicare and medicaid will be there long term, but also allows us to prosecute the

criminals and prevent fraud in the first place. >> one of the things i have infested with, my colleagues have heard me say this before, how do we harness market forces to drive good public lives of behavior. good example, that is the medicaid you. before now, even now under current law because we haven't pass this know, it has not been signed into law, but even if states are not incentivize to go after the medicaid fraud. >> i want to give senator wyden chance your tube spectacles with one. >> he is gracious. >> if i may. there is a provision under current law that says private citizens health care providers are encouraged to report fraud if they see and make it. they are encouraged to report, they don't have to. they are encouraged to. one thing i like what you incentivizing behavior. rather than saying we encourage you, why don't we say we want you to report, you are expected. but also said if you do, just

like we do with the whistleblowers now, we incentivize whistleblowers because we get them to allow them to keep some percent of whatever is recover. the way want to do that in terms of people who blow the whistle and medicare fraud and make sure that we as a vice and. not to do the right thing, because if they did they will also benefit from the financial. >> i think that's a great idea and we will take a look at it. we have a great sort of seniors army that trained volunteers to go into the friends at meal sites and neighborhoods. and have become a tremendous sort of strike force. we figure we've got 20 million undercover cops on the ground. if there's anybody who takes stealing from medicare seriously, it's those medicare beneficiaries who are very aggressive in their efforts. and that's been a huge help for tipping us off, too bad billing practices, to fraudulent activities to people who would steal ids, a whole host of issues. >> keep it a. mr. chairman, thank you.

senator wyden, thank you. thank you. >> senator wyden? >> thank you, mr. chairman. is been a very good hearing. i have gotten a lot out of it and thank you for having it. i will be here with you. thank you. madam secretary, i want to ask you about one other area. and that is an enormous amount of expense and frustration for the millions of people who use our health care system, especially the providers and patients, is a staggering array of different billing systems that we have for american health care. and as you know, getting a standardized billing system has almost been the longest-running battle since the trojan war. i was actually reading some history on this recently, and one of your predecessors, lou sullivan, made this a top 30. this is what lou sullivan, a

wonderful physician, wanted to get done. and here we are, practically eons later, and we are still wrestling with this. i think it would be very helpful if you would do two things. one, give us an update on where we are at this point and getting a standardized billing process. and second, i'm curious whether you all and your staff have taken a look at some of the efforts around the country that look like they are bearing fruit. the one that i i've been interested in is minnesota. minnesota seems to have come up with a standardized billing process. and then it limits the insurance companies from coming up with sort of exceptions, which invariably jack up the rates and make things more competent. but start, if you would, by giving us almost a state of we are, 2010, on getting a

standardized billing process so that we into this bureaucratic water torture for the providers and the patients who constantly tell us about all these forms and different paper and the like. where are we did a? >> well senator, i think the good news is that there is administrative simplification mandates in both the house and senate health reform bills, which i would suggest will greatly accelerate progress in this area. absent some kind of a lever, it is a difficult task. it is one that i know personally well because i've worked on it and kansas. and i think i'm safe in in saying that kansas now, like minnesota, is about to have a uniform billing system. but it is not an easy -- everybody is fine with doing it, wants to come to the table to talk about, as long as you use their system. and as soon as you begin to

deviate a little bit. i am convinced that it is a huge cost saver, and a huge, as you say, torture saver for providers and patients. and one that we have been anticipating implementing through the health reform strategy, because i think that gives leverage to then have a congressional mandate and follow-ups, and make sure that we can get the providers. you need the providers and payers all on the table simultaneously to figure out the strategy of timetables that work. but it's something that i take very seriously and really look for to working with you to implement. >> i think the provisions in the legislation, both the bills, are good. what concerns me is that absent the kind of leadership you're talking about, we'll take another eight, 10 years just working through those models. and somebody else will be in

your seat and will ask almost the same questions. >> they don't intend to take nearly that long, senator. states are well ahead. >> i like that part. thank you, mr. chairman,. >> thank you. it is to we could all time, as do you, that all the paperwork, all the forms. it is a mess. i remember early '90s, 93 or four, during the last health care reform, i just happen to go to a montana hospital one floor was filled with people doing paperwork. i went up to canada to poke around. was at a hospital. there are three people in the whole hospital, much larger than any montana hospital, doing paperwork. three people, that's all there was. and we all know about the administrative cost of the american system. and then in other countries. i urge you to just -- you solve

this thing. won several. so we're not talking about this all the time. and you said states are doing much better. and clearly we have to pass health care reform to make this happen. because once health care reform is passed then it's going to force more segmentation because more insurance companies are going to be, you know, forced to kind of do -- have quite as many different alternatives and options and co-pays and deductibles, pre-existing, all that stuff, frankly. so i really urge you to just light a fire under people. and you just lower the boom. get this done. because we know how bad it is. we know that american people are fed up with it. write a so. so i am just urging you in strongest terms possible to get this done. we want to work with you. it is a shared effort.

>> i appreciate that. >> that we need, together, get it done. >> you bet. >> so you need to tell us what you need. whether it is legislation, but i strongly urge you to do that. now i think we're going to get health care reform passed that i am very confident we will get to pass health care reform this year. but i'm going to ask you this. if you could say on a biannual basis, give us a progress report on standardizing forms and get rid of a lot of paperwork, it would make a huge difference. the point is not to put you on the spot. the point is to let us know what the progress is so together, jointly, we can solve this. >> well, senator, i think he made a big step. one is paperwork, and one is that numerous forms. electronic health records,

standardization, as you launched in the recovery act, will go a huge way down to eliminate a lot of the paperwork and standardizing operations and driving protocol. but that doesn't get rid of the 15 different. so if you fill them out electronically, it still drives them crazy. so we have to do both simultaneously. >> i personally want to quantify it. one of the major drivers of getting results in this, quantify this benchmark, standards quantified numbers. how many forms? how many lines? all that kind of thing. >> a lot. 30 cents out of every dollar we figure. >> i urge you on a biannual basis to get back to us on what your plan is, benchmarks are setting out for yourself, and progress you're making and not making. we just need to do. >> yes, sir. spirit thank you. the second is waste, fraud and abuse. and a lot of questions here.

about waste, fraud, abuse. so i would like you to again, on a biannual basis, just quantify what you think, your best guess, what the waste is, all the programs under your jurisdicti jurisdiction. what the fraud is, and where, but you got to quantify it and dollars. again, we worked together because we get improvement. i'd like you also to give us a goal, zero is unattainable. but if you could give us a goal, what%, by what date is a benchmark. he goes that's how we're going to get results around here. it's one thing to talk about things. it's another thing to quantified, with numbers. because you understand numbers. >> right. >> again, we are working together on a six-month basis. we will be back again i'm sure sometime in the next couple,

three years. and will have a chance to talk about this. >> sounds good. >> we want to work with you. this is not to put you on the spot. >> i look forward to it. >> and i have a last point? i just want to come back to that point. we have a lot of federal property that we don't use in our inventory. senator baucus nose, trying to confirm an administrator for gsa, general services administration, which manages thousands of federal properties across the country. but we have a lot of them that are vacant, not use or underutilized. we pay utilities, security, all kinds of other costs that relate to the facilities. when agencies, even if they want to sell them, they might need to spruce them up or fix them up in a way to them. been the property is sold. the agency doesn't get any money back. they don't get money to pay

their fix of cost that they'll get money to help underwrite some of the programs. so as a result we end up carrying on her books and not just hundreds, but thousands of properties which are really a drain on a treasure that at least one agency has figured out how to use market forces. we incentivize the veterans administration. we allowed them to keep 20 percent of the proceeds of the properties they sell. they use that money to help pay for the fix of cost. they use that money to also go into the programs, to help supplement the appropriate funds. that's the kind of thing i think we need to be doing more of. i think i learned that a new governor school, and you probably did, too. thanks very much. >> i encourage you to break it out according to major categories, department and so forth. so it's not just across number. you know, the tyranny of averages sometimes prevents effectiveness. so don't go across all

departments. i don't want you to overdo it, but figure out some reasonable way to segment each, how much, which departments, fraud, which departments have x. ways, why waste. just break it down a little bit so it is in a manageable way. make you. >> sounds regional. thank you, sir. >> i deeply appreciate you taking time to, doctors. >> and look forward working with you. >> we have a lot of things we needed to. >> absolutely. >> thank you. this hearing is adjourned. >> [inaudible conversations] [inaudible conversations]

>> mr. bernanke says the fed will likely start tightening credit by boosting the interest rate and banks on money they leave at the central banks so consumers and companies would then have to pay more to borrow. the federal government has been close for the past three days. a blizzard in washington today. congress will not be back in session. the house will not be back in

session until february 22. the senate will be into more for general speeches and senate democrats are set to meet on a jobs bill. this amazing tomorrow at 2:30 p.m. with live coverage on c-span2.

>> now food and drug administration commissioner dr. margaret hamburg on plans to improve the regulatory process and product safety. hosted by the group a cadre health. this is about 50 minutes. >> well thank you very much, and it's really a pleasure to be here, and i must say additionally glad that i simply made it here. i have a prius, so in addition to have to deal with the snow i

was worried about the brakes. but i am really delighted to be here and very pleased to be able to follow our secretary, secretary sebelius, who is a remarkable woman. i thank her for her strong leadership and her support of fda, which has been really unwavering in her short tenure. she's already been out to the fda twice, which i think could be a record. i also have to say that i think she probably has made another record in terms of how quickly she came on the job and immediately had to face major public health challenges, first with the global pandemic of h1n1, and also as our nation has struggled to deal with the important issue of health care reform. i also want to thank the organizers of this conference for the invitation to be here today. i deeply appreciate the work

that all of you in this room are doing, to sort out difficult and complex problems as her health care system and with the health of our nation. and to help us to be able to provide higher quality care to patients and to be able to improve the overall health and well being of our nation. i really was not at all sure that this meeting would go forward. i admired the determination of the leadership. i thought snow would probably do us in. and at a minimum, i thought i would be addressing a rather empty room. so when i look out at all of you, i am really impressed by your dedication, and i must say that i'm happy to get a warm welcome here. when i took this job back last spring, i was a little worried about the kind of response, whether or not, that i would

receive when i was introduced as fda commissioner. certainly, too many people offered me condolences along with congratulations when i was first appointed. many wondered why i would want to take on a position like this as the head of an agency that was always appearing to get clobbered. .com in fact, i've been amazed by the support that i've received from so many. almost everyone i've spoken to and met with in the last eight months since i was appointed has shown real commitment and deep interest in the success of the fda, a real desire to help support me in this task. and i think it's clear why. all of us eat, all of us need medicines, from time to time. we all have families whom we want to keep say.

each and every one of us needs an fda that can do its job, and do it well. yet, the challenges are daunting. consider that the fda regulates about 20 percent of every dollar consumers spent in this country. drugs, medical devices, vaccine and biologics, cosmetics, tobacco products now as the secretary mentioned, animal drugs and feed. and even certain products that emit radiation. to add to the challenge and increasing percentage of these products comes from overseas. creating new challenges in ensuring the safety and quality of our food, drugs and medical devices. what i'd like to do today is to describe some of the priorities and perspectives that i bring to this job, and how they are being addressed. the late senator kennedy, one of our nations great champions of

health care, once said that the fda is the most important health agency in the united states. this is a surprising statement to some, but the more deeply i am involved, i learned every day about the complex and important work of the fda, the more emphatically i understand and share his view. congress has given fda strong regulatory powers. the public expects us to take action to make sure the products we regulate our safe and of high quality. but we're also the gatekeepers with a major role in getting new products into stores, pharmacies and hospitals. in both areas, preventing and countering threats to health, and furthering the developer of innovative products, we have a unique role and responsibility. if we cannot do our job, and hopefully do it well, there is

no one else, no one in government, and the private sector, in the not-for-profit world, or in academia, that can step in and backstop behind us. ironically, when we succeed, we are often invisible. the outbreak that did not occur, the dangerous drug that never made it to market, that when we struggle our mistakes are usually glaringly visible. moreover, if we miss a signal that indicates problems with a drug safety, or conversely, if unnecessarily delay an application for an important new drug, patients certainly can suffer. throughout our history, the fda has often been the target of critics who claim that we are too slow to improve important new parts, too quick to jump at the sight of a safety problem. that's one site. the other critics tend to say that we are to industry friendly

and allow too many dangerous products on the market. this is a hard job, and the challenge for fda leadership is how to steer the ship and often choppy waters. my approach has been to use as a compass what is, in fact, fda is historic mission. the promotion and protection of public health. this public health perspective is perhaps not surprising, as i've worked in public health most of my career. though i actually trained originally to be an academic researcher. but what does the public health perspective really mean? the institution of medicine has defined the mission of public health as, quote, fulfilling society's interest in assuring the conditions in which people can be healthy. to be healthy, surely people need access to a safe and nutritious food supply. and to the safest, most effective medical products possible. the fda's role is to support

this access and in doing so, to promote health, prevent illness and prolong life. as i said, most of my career has been in public health. it began nearly two decades ago when i accepted the position of new york city's health commissioner, and that occurred actually rather to my surprise. and at the time my great aunt who was sort of like a grandmother to me was actually very upset by my decision. she complained to my father that she just couldn't understand why i didn't want to be a real doctor, why was i taking on this strange government role? and my father tried to offer her some consolation by telling her that i would come in fact, still be a real doctor, but that now i would have a million patients. and now i guess i have about 300 million. and so, what are the key challenges? in my view, as a public health

agency, fda must work to prevent problems, to balance risk and benefit, and to monitor outcomes. my goals are to modernize fda's work in all these areas and to strengthen the agency's credibility in doing so. these goals are intimately linked. and it is linked, not just a few strengthening the fda and the important work that we do, but also to fda's role in the u.s. health care system, and in a globalized economy. so i wanted to discuss each of these key areas in turn. first, fda must try to identify and prevent problems before they occur. one good example comes from how we address food safety. in late 2008, there was an outbreak of salmonella related to a contaminated peanut. i suspect that most of you probably recall this outbreak.

i know it had a powerful effect on the president, who was just coming into office as this outbreak was hitting its high point. in this case, the fda learned about the contamination of peanut paste produced by the. corporation of america. but the agency did not take aggressive enforcement action until after they were confirmed cases of illness. in the end, eight people lost their lives, and thousands were made sick. by contrast, last april, a number of months after the peanut corporation of america had peaked as a problem, we learned that a california company's pistachios were contaminated with salmonella. this time, the fda immediately warned consumers not to eat mustache is while we investigate the extent of the problem. we soon found the source of the contamination, identified the shipments and the products

involved, the companies issued recalls, and there were no sicknesses or deaths. from the beginning of the investigation, we worked with the pistachio industry closely to identify products, both the products that were at risk, and the products that were safe. within a short period of time, people could start eating pistachios again. the situation were admittedly different but between peanuts and pistachios, as d.a. had begun a shift towards more prevention. we now also have every portable food registry which requires companies to let us know of any safety problems with their ingredients before anyone becomes ill. and we are waiting for the senate to pass a major food safety bill. the bill which has received bipartisan support has already passed the full house and pass through senate committee. this bill is really important because it will provide important new authorities and

resources to the fda for food safety. it will give us the ability to do mandatory recalls of tainted food. gibbous routine access to food safety records at factories and farms. and make sure that facilities develop and adhere to safe manufacturing processes. these are things that are vital for us, especially if they want to prevent major problems, rather than simply to react. most businesses agree and support these measures as well. they understand that when an outbreak of foodborne illness occurs, it is deeply damaging to the food company that is responsible and can hurt the entire industry. the salmonella outbreak from the punic corporation of america not only killed and sickened people, but it shut down plants through workers out of their jobs and lead to recalls that cost the food industry about $1 billion.

preventing problems also applies to medical product regulation. that's the reason for the agency's quality by design program, which aims to build quality into each stage and production process, and other measures to address safety across the lifecycle of products. across all of our regulated areas, we are asking not just how to fix problems, but how they can actually be prevented. we are reorienting are expected to focus on key measures for prevention, not just evidence of current or existing problems. but when we see problems come we cannot be afraid to take the actions necessary to stop them in their tracks. too often, the agency has found itself engaging in back and forth with companies and with lawyers while serious health and safety problems remain in limbo. my view, is that when the health of the public is jeopardized, we have a duty to warn and to act.

for example, shortly after i took office i learned about a growing body of evidence in sync compound in certain nasal products for cold symptoms was damaging the sense of smell of consumers. they were well over 130 cases of people that appear to permanently have lost their sense of smell from using these products. so we took action. we warned consumers not to use these products, and the manufacturer remove him from the shelves a week later. this was a good outcome and will always act on public health is good at risk. that enforcement is only one of the tools fda uses for public health. a second critical task for fda that i want to mention is to fairly balance benefits and risks. where there is much risk and little benefit, and the a should step in to prevent products from reaching the market, or paul

products from the shelf. where there is much benefit and little risk, we should step up the efficiency of our approval process, or actively urge people to receive the benefit as we are currently doing with vaccination against the h1n1 flew. of course, there is that grey area between where products are both serious risks and important benefits. in this case, fda much is all of the tools at its disposal to maximize the benefits and minimize the risks. to maximize the benefits, we can help direct a product to those who can use it most. to minimize risk, we can investigate predictors of problems. today, including such things as genetic markers, and educate caregivers and patients about who should or should not use a product. all the while, we should be monitoring the impact of our actions and using this

information to decide how much more or less we should do to protect the public. indeed, a 30 g. area of focus for fda is the assessment of outcomes. we can't measure success only by the number of facilities we inspect or drugs we approve, or whether we are following the guidelines to the letter. the true measure of our success is the health of the american people. for food we must keep a close eye on rates of foodborne illness, include hospitalizations and deaths. for medical products we must have an idea of the key health needs of the population and whether we are creating regulatory pathways necessary to meet them. we've shown in the past year that fda can clear red tape to get needed products to consumers in emergency situations. for example, as a result of pandemic preparedness planning that actually is taking place over many years now, fda was

ready when h1n1 flew pandemic began to take extraordinary steps to protect human life. we immediately authorize the emergency use of newly developed diagnostics for h1n1 the people could be tested for the disease. as a guide for treatment, and for tracking the epidemic. in addition, in an emergency use bases, we made antiviral drugs available in circumstances for which they hadn't been licensed, but were they might save lives. we base our decisions on careful review of available data, and risk-benefit analyses that came from scientists at evidence developed for these products. we must also be aware of where patients can be suffering adverse consequences of regulated products. last fall, fda launch a safe use initiative to encourage medications to be used safely. meaning and part not accidentally ingested or overdosed, not given to patients

who will not tolerate them, not prescribed in inappropriate ways, and not used inappropriately by patients at home. some thought that this is going a bit beyond fda's traditional role, but we thought it was a vital part of our role. and through this effort we're partnering with a wide range of allies from hospitals to health plans to pharmacies, and will monitor our progress closely to be sure that we're on the right track. we have a lot of important tasks before us. and fortunately though, over a period of many years, fda has not gotten of the resources and other support necessary to fulfill our important mission. but i do hope and believe that we are turning a corner. there's growing appreciation that is in everyone's best interest to have a strong, fully functional fda. we are embarking on a new era of

public health protection with the support of the white house and of congress. last week, president obama released his fiscal year 2011 proposed budget, which contains significant enhancements in some key areas for fda. there's a long way to go, but these are exciting times. recently, as the secretary mentioned, we have been entrusted with the unprecedented task of regulating tobacco products, the number one cause of preventable illness in our nation. we are strengthening the safeguards for our food supply while looking forward to the passage of the legislation that would give a significant new authorities, and some resources to support this area of work. we're implementing new strategies to enhance consumer and patient safety while supporting innovation. and we are working hard to bring the fda fold into the 21st century with respect to two key areas of activity.

science and globalization. before i close i want to say a little bit about each of these key areas of activity. first, with respect to science, we're moving forward to strengthen and streamline the science of our current radio toward procedures. and implement new strategies to guide our work. as you may know, a number of reports and advising boards have warned about the dire state of science funding at fda, now the scientific and regulatory demands are outstripping fda's capacity to respond. clearly, this cannot be allowed to continue. and everything we do, a fundamental priority must be strengthening science. in everything we do, fda must demonstrate that it is a science base, science driven agency. we must ensure that we always use the best possible science and data to guide our decision-making and our thinking. we must get advice from the best

possible experts, and always be prepared to change our mind in the face of emerging science. it's obvious that the agency charged with responsibility of judging the safety and efficacy of drugs and medical products and monitoring the safety of those products and other products, including foods and cosmetics, needs to possess the scientific capabilities equal to that task. but while that statement may seem logical, the fact is that in terms of investing in the kind of science we need to advance as a nation, we are somewhat offkilter. fda clearly needs more resources for science, and the president's budget reflects that. but it is more than that. just as a biomedical and life sciences research has evolved in the past decade, regulatory science, the science and tools we use to assess and evaluate a product safety, effectiveness, potency, quality and

performance, must also evolve. i often use the metaphor of a rower on the potomac with one powerful muscular arm and one scrawny arm, growing with all of his or her might. it is inevitable that the boat will not go on a straight trajectory forward. so it goes with the u.s. biomedical advances over the past several decades. basic science, spearheaded by nih, is pulling hard. but it also takes a muscle to create innovative tools, standards and approaches for the efficient assessment of product safety, effectiveness and quality. without his company are advances in predatory science, promising therapies may be discarded during the development process, simply for the lack of tools to recognize their potential. and outmoded review messes can a necessary delay treatment. conversely, both significant

dollars and many years may be wasted accessing a novel therapy that, with better tools, might be shown to be unsafe or ineffective at an earlier stage. strengthening regulatory science is a vital and urgent challenge for the brightest minds in academia, industry and government. a robust state-of-the-art regulatory science is essential to fda's work. there is no doubt. yet it also represents an important driver of our nation's health, our health care system, and our economy. and it is a gold we almost embrace. i feel confident that if we do so, we will be able to speed the movement of new discoveries to practical applications. and we've seen examples in the recent past where concerted scientific investment led to the development and approval of new drugs and remarkably little time. this has a very personal resonance with me, because when

i trained in medicine i watched the emergence of the aids epidemic. and when i was doing my residency in internal medicine in new york city, during the mid 1980s, i was taking care of a lot of aids patients. at that time, we had virtually nothing to offer these patients, besides supportive care. we had patients with devastating illness, and yet there was so little that we could do. shortly thereafter, i went to work with tony koch at the national institute of allergy and infectious diseases. first as a special assistant, and then as assistant director of the institute. by that point in the aids epidemic in the late 1980s, there were a few emerging potential drugs and there was a huge push to get as many people as possible into clinical trials of the new antiretrovirals. it was the only way that patients could get access to drugs. and every day, we were dealing with desperate people who wanted to live and had little hope.

within a decade, fda had provided a science-based regulatory pathway for companies to follow. and also approved an entire new class of drugs to treat aids, and editors along with the anti-retrovirus. we had drug cocktails that were keeping hundreds of thousands of aids patients alive. the early years of the aids epidemic were my early years in medicine. and they gave me a deeper appreciation of the fundamental importance of the scientific insights and innovative research. but also what sciences, pharmaceutical companies, advocates and the fda can do when working together. more recently, several partnerships with industry and universities to advance regulatory signs are starting to bear fruit. one example concerns new test for kidney toxicity. at the eighth work with european regulators industry and the nonprofit critical path

initiative to identify and evaluate biomarker proteins that could indicate kidney damage from the drug. the idea was to determine whether these biomarkers might signal that the drug is toxic early in the development process, before loss of time and money was spent developing the drug and bringing it in two clinical trials. as a result of this effort, fda now admits new data from seven different kidney toxicity assays that if we can develop a consensus on more such biomarkers, we could make additional progress towards reducing the developer time and cost of the drug approval, and hopefully provide more in proven products for those who need them. similarly, we are working in partnership with others to try to develop new clinical trial and the lettuce, to provide better answers with your patience, and shorter time frames. and by applying new insights from the field of genomics, we

hope we can target cities and treatments in new ways that will be more meaningful with benefits to patient into the health care system in the form of more successes and fewer adverse events, and lowered costs and time required to develop new drugs. we'd like to encourage others to join us in such efforts, and i'm happy to report that the fiscal year 2011 budget for fda include for the first time a proposal for a new effort to support regulatory science at fda. such an initiative will help us prevent problems, that are balance risk and benefit, and create better health outcomes for the american people. as we begin this new year and a new decade, one of our top priorities must also be to update our approach to import safety and it will world. the model for fda's current control system was established in a much, much simpler time. with a modern fda was created back in 1938, only a tiny percentage of our goods were

imported. today, we receive imports from more than 150 countries. and about 300,000 foreign facilities. these are fda regulated products. this year, more than 20 million shipments of such fda regulated products are expected to arrive in the united states. just one decade ago, that number was about 6 million, and a decade before that, it was much, much smaller fraction. so the problem is growing rapidly, and enormously. consider that some 15 to 20 percent of the food we eat comes from other countries. in fact, about 75 percent of the see food we eat here comes from foreign waters. at around 35 percent of fruits and vegetables come from beyond our borders. these are some of the foodstuffs that are most multiple to contamination. somewhere around 40 percent of the drugs americans take our imported without to 80 percent

of the active pharmaceutical ingredients in drugs that we take your coming from foreign sources. so the numbers really are extraordinary. this flood of new imports represent a wealth of new products now available to americans. and many, many benefits, get it creates a whole host of additional challenges. it is clearly impossible to screen out all bad goods at the border. fewer than 500 fda investigates are responsible for monitoring this global goods, and that represents, sadly, and almost insignificant increase from two decades ago, despite the fact that the volume of imports has been growing enormously. as a result, we inspect less than 1 percent of these products before the end of the united states. last week i announced the introduction of a new computer system that's helping fda

investors prioritize the way that they inspect imports. a system called predict. the system allows us to prioritize inspections by risk level. this makes it easier to find problems and to speed the clearance of the majority of import shipments which don't raise rest of plaques. still, we can expect to catch every import problem simply with men and women on the docks. we need a new paradigm for inspections that reaches back along the chain of production to the countries sending us products and to the factories and farms that produce the goods. the only way to do this, is to see our global role as a shared responsibility. this means ensuring that companies their responsibility and accountability for the safety of the products in their supply chain and not rely on the fda to show up and find a problem in the pit. it means building up a worldwide

of oversight, working closely with international organizations and other national governments harmonizing standards, helping to build regulatory capacity and other countries that have less mature regulatory systems, developing third party certification systems, and sharing the responsibilities of inspections and information that comes from them. this is a supreme priority for the fda. and where in the midst of many different initiatives to make it happen. we are setting up permanent offices around the world. we assign more than 30 agreements that enable us to share information from inspections and other important safety information with other countries that have mature regulatory systems like ours. and we are training regulators in countries with less sophisticated systems, and helping them to try to build to capacity. by doing so, we are not only improving the safety of products coming to our shores, we're also

helping other countries make healthy improvements in the goods being offered to their own citizens. this is a form of health diplomacy, and it makes sense in a globalized economy where we are all more connected to each other then we sometimes realize. my first big job in public health was serving as new york city's health commissioner for six years during the 1990s. during that time, my two children were born. and it made an impact on me. on my children's birth certificates, my name appears twice. both as their mother and asked the health commissioner. [laughter] >> both roles gave me a duty to protect them. at home, but also by preventing illness in promoting health for them and the world around them. this second goal wasn't just a duty to my children, but to all children and to everyone in the city.

my job is bigger now and the approach is different, but the mission is the same. protect the public health. is the goal and guide in all we do. thank you for your attention, and hopefully for your support. [applause] >> i talked longer than planned, but i think we still have planned for some questions. >> there are microphones, and i think they are on. if you get to the microphone. >> brad, why don't you begin? >> i will talk loud. peggy, could you talk more about your responsibilities with regard to tobacco and how it compares with your authorities with regard to food and drug, and sort of what you're doing to carry it out? >> okay. this is obviously a very important new mission for fda,

and it is a historic advance. i believe it will make a huge difference and the ability to reduce smoking in this country and help prevent the onset of new smoking. it anyway straws on an existing strategies for regulation, but in many ways it's also quite different and we're developing a whole new approach. the legislation was signed into law in the summer, the last summer, by the president. and it laid out a number of very explicit requirements for us in terms of actions we must take. and we have been moving forward rapidly, setting up a new center, recruiting a terrific center director, doctor lawrence deaton, and hiring up at the same time we are starting to implement important programs.

the law focuses on several key areas. one is really deepening our understanding of the science of tobacco and tobacco products, understanding the components of tobacco products, which now that companies are required to report to us. and really being able to address with a much, much better information and specifics the health hazards contained therein. we also have very explicit authorities to try to reduce the onset of smoking, particularly in youth, and to address strategies for getting people are already smoking to quit. we've already moved forward, as you may know, and banning candy and spice flavored cigarettes, which is something that has been linked to enticing young smokers

into taking up the habit. we also are moving forward with making more explicit warning labels for cigarette and tobacco products, and addressing issues of advertising. we have a big job. in some arenas as i've said we are charting new ground. were also working with regulators from other countries who are already engaged in doing some aspects of tobacco regulation in order to learn from them where we can, working closely with the states and local authorities as well to implement aspects of this law. . .

>> i can't think of any other place that it can be. the legislation came with with a source of funding. which is very, very important. user fees from the industry. so we really feel very comfortable that we are getting the systems in place and the

requirements of the law, as i said, are very explicit. so i think that the -- the great challenge was really to hit the ground running, because we simply had no other choice if we were going to achieve the goals of the law. and i believe that we are well on our way. but it will obviously require continuing effort, lots of attention, real dedication, because what we are doing is not always well received. but what we are doing will make a difference for health, i'm sure. >> back to your comments that the fda no good deed goes unpunished by people who think you're moving too swiftly or not swiftly enough. looking back at h1n1, a vaccine was brought out in record time,

really stunning. it was also looked at virus. if the virus had been more severe or deadly than it was, we could have had a major problem on our hands. what learnings does fda take away? >> we have learnings at fda, and all the overall lessons for public health preparedness. one is that planning matters. had we not the been investing in public health preparedness and flu planning over a period of many years, we would have in much more desperate shape when h1n1 emerged. ironically, i was working and leading the department of health and human services effort at pandemic preparedness planning back in the clinton administration. but at that time, we could barely get anyone outside of hhs to take the threat seriously. when i approached fema about working with us in our plans

efforts, they said epidemic disease, infectious disease outbreak? we don't do that. we do floods, hurricanes, natural disasters. we did agree to do the table top exercise where we unfolded a scenario with their participation. they quickly realized this was a natural disaster on a major scale. they engaged with us, other levels and components, with private sectors, and others have been engaged in pandemic preparedness, public health preparedness planning much more intensively in recent years. i think that made a difference. it certainly underscores the importance of not becoming complacent. right now, i think it's critical that just because h1n1 turned out nots to be as severe a disease as we had initially thought it might be, we cannot take comfort and think, well,

you know, pandemic flu isn't really the big problem that everyone hyped it up to be. now is the time to really look back at the specifics of the lessons learned. and put in place the changes to our systems that will make a difference going forward and we need to keep invegassing in critical research to leverage advances in science and technology to make us safer and more nimble in addressing the threat of the next flu pandemic or unknown. we do not have to be relying on technologies that even under the best of circumstances, and we did produce this vaccine was which was a licensed product and proven to be very safe. we, nonetheless, were relying on

a vaccine technology that reflected yesterday's science, not todays. we need to continue to invest in new diagnostics, with new vaccine platforms, and new antiviral drugs. and fda plays a critical role in helping to support that innovation and translation into real world products. >> okay. thank you. i think we have another question over here. >> thank you for your comments about the ambition for the fda to be scientifically aggressive. in the area of clinical trials analytics, what the fda's thinking is about comparative effectiveness research and population epidemiology and the methodology for that going forward? >> well, i think, you know, the whole way that we address clinical trials and our tools for analysis and our strategies for clinical trial design is

very, very key to enable us to have a more effective and efficient regulatory pathway for new medical products. we are working hard in that area, i mentioned that we have some working partnerships to try to enhance our scientific understanding and we want to expand that work and really implement it in practice. we also see population-based approaches as very, very key to strengthening our ability to monitor safety throughout the life cycle of a product. we are putting a lot more attention now on post marketing survey lens strategies and farm coo epidemiology approaches that will enable us to identify safety concerns once a drug or medical product is out in the marketplace now being used by many, many more individuals than during the clinical trial

process. we can use these population-based approaches in the post marketing arena. also bringing information technology to bear so that we can do data mining and access large ends often diverse database in an integrated way so that we can really identify and respond quickly to emerging safety issues. so that's another important area. and i think very exciting work. comparative effectiveness research obviously is very, very important to deepening our understandings about the relative value of certain products and the role of different products under different circumstances. fdas statutory responsibility is really to review and approve or disapprove products that come before us, not so much in a directly comparative way. we certainly use comparative

information in terms of how we might recommend certain drugs for use of first line or second line drugs, for example, but there are many opportunities for fda to engage more deeply with with broader efforts in comparative effectiveness research, and we actually have received some resources who the stimulus moneys to help us build that capacity. and it really comes by opening up some of our data bases and resources so that people asking questions in their comparative effectiveness research can use that important information to again deepen our understanding indument matily to better serve

people who need access to the best possible drugs for their conditions or concerns. so it's a very important area. i think obviously there's a lot work within the department going forward and of course within the broader world of health services research. >> take a question over here please. >> hi, can you hear me? julie lynch, university of massachusetts boston. i was glad you mentioned biomarkers. my area is in health policies, i'm concerned about the new drugs being developed based on biomarkers with the percentage of ethnic minorities enrolling in clinical trials. so, for example, our lot was approved with less than 4% african-american enrolling in the clinical trials. and it appears that drug is not at all effective in patients with african-american ancestry.

>> well, i think you're question speaks to the point that we need very much to examine medical products in a range of different subpopulations and recognize that there may be difference in response both in terms of benefit and risks. and i think as we learn more about both underlying mechanisms of disease and the potential

>> we know they maybe more susceptible to risk or it may not work for them. but it will also, i think, enable us to not discard potentially useful drugs for certain subpopulations because if you just look at the broad numbers, there are risk that might jeopardize the approval and use of the drug overall. so it's a tie-trading effort that has to go on looking at risks and benefits. it depends on both deepening our understanding of the science and how we use these emerging tools appropriately and making sure that we collect data from all of

the appropriate populations in appropriate ways. and that we're examining the use of medical products through the whole life cycle of the product from the time of the initial discovery through the approval process and out into the marketplace where as i was just discussing, often some of the most important information can be gleaned. we want to be able to glean it in a timely way so that we can product health and minimize risk. >> well, we want to thank you so much. we know you have to get back and protect all 300 million of us. we wish you god speed and thank you for being with us this morning. >> thank you. [applause] >> a year ago this month president obama signed the economic stimulus funding into a law. making $787 billion available.

since then the federal government has committed more than $33.5 billion to states for stimulus project. that's up $1 billion from last week. more than $179 billion has been paid out. you can go to our web site with links to government and watchdog groups as well as lots of video, c-span.org/stimulus. chairman bernanke is outlying the plan on the stimulus money. the associate press said the fed will start tightening the credit on banks on money they leave at central bank. they will have to pay more for borrow. the federal government has been closed for last thread's. congress and house won't be back

in session until february 22. the senate will be in for speeches tomorrow. the senate is in tomorrow at 2:30 with live coverage on c-span2. >> former senator charles

mathias died at age of 87. he served from 1969 to 1987 after four terms in the u.s. house. among those remembering him was his former senate colleague, vice president biden. this portion of the funeral service is an hour. [silence] [silence] >> mr. vice president, distinguished guest, friends and family, thank you for being with us today. we are hear to celebrate the

life of a great man. the public story has been well told. statesman, the conscience of the senate, protector of the chesapeake, steward of the cno canal, friend of nation, fierce advocate for the equal rights of all men and women. ours from a heavy household to grow up in. but through it all, dad was still dad. fun and fallible, and full of love and devotion. and through it all, our life's lessons emerged. dad loved to travel. and he would take charlie or me with him whenever he could. it was part of our education. and a great gift that he gave us. i remember my first trip to san francisco. i was young, maybe 12 or so. dad was there to make a speech, and i was along to see the city by the sea.

one night, we were on our own. we went out to dinner and for a short walk. we climbed one hill and then the next. i started to whine, suggesting that we find a cab and go back to our hotel. just more one hill, with dad would say as we went up another and then another. i learned on that trip that san francisco is bill upon seven hills, each of them walkable, and that my father thought cabs were a waste of money. it wasn't until later that i learned that he and senator pale had an ongoing contest as who was the cheapest man in the senate. [laughter] >> later in life, i was lucky enough to accompany him to the city of light, paris. he was there with some important purpose, and i was primarily along for the ride. now well versed in my father's

aversion to taxicab, i was not subprized to find us on the paris metro. on the particular day, he was wearing his red lapel ribbon. it's small, and going moseley unnoticed expect by a few. as we broaded the metro, there was an elderly gentleman sitting in the seat that is reserved for the disabled, senior citizens, and veterans of foreign wars. the man looked up, and when we saw that ribbon, he jumped up. with great excitement he said [ speaking french] , dad smiled, acknowledged the greetings and much to my horror took the 102 years old's seat on

the train. it would have been rude to do otherwise, he con silled me later. it's great to be great, my dad would say with a smile and twinkle in his eye when we would encounterer such acts of kindness. but we knew what greatness meant in our father's eye. by his example, it was defined by humility, graciousness, and service. i will never forget a time immediately following the 1968 riots when dad piled us into the blue buick station wagon and drive us down to see a movie. at a time when my friends' families were fleeing the city for the safety and security of the suburban countryside, dad drove the other way. he drove us into the heart of

the problem, so that we could see it and understand it for ourselves. it is a lesson that has stayed with me ever since. dad always had room for people from all parts of life. be they the water man, the residents in baltimore, or the presidents and prime ministers, kings and queens of europe and the middle east. this was one of the hallmarks of the slightly round man in a rump thed suit. not only ago, dad was giving my in-laws a tour of the capitol. his beloved foreign relations committee room was locked. he found a key and let us in. while we were inside, some tourist began to push their way through the open door. sarah and i quietly nudged them away whispering the room was closed to the public.

dad caught what was going on and he interpreted himself. come in, he called, come in. welcome. take a look around. let me know if you have any questions. and then he continued with they're his oral history of treaties that had been negotiated at that table. lesson learned. dad also was a great scholar, a lover of history, he was one of the best read people i knew. i often thought that dad was born 200 years too late. he spoke of jefferson in the first person, could resite the federalist paper and had the love of the constitution as a original author. this was all an important part of life with father. researching a paper that was due the next day. there was long before the advent of the google machine.

there was a point i wanted to make. but i needed some historical context and facts to make it. i called dad. my own person search engine. he said that who introduced the first line of thinking and where to start. i said i needed source material and footnotes that night, he told me he would call me back. two hours later, well passed midnight, he phoned can the volume, paragraph, and page number, aa long with the relevant quote the. for the previous two hours he had been sitting in the cold and dark of our attic going through his books to help a son out of jam. stick with dad and you'll be glad is the phrase dad would find whenever we would arrive at

a hard-to-find destination or when the scheme of hit turned out as attended. charlie and i would groan and roll our eyes as any formal sons. stick with dad and you'll be glad is what i told my girls when i deliver them to one destination. i take great pleasure in their groans and eye rolling movement. i guess it's true, like father, like son. dad was fun, and he would be wickedly funny. i love to listen to his tales about uncle buzzy's zest for life. he delighted in trading witticisms with his sister who with always made him laugh. i remember one summer night at the dinner table when dad suddenly layed down on the floor, hands and feet in the air, demonstrating the proper technique for playing dead

ants. something he apparently learned in the navy. then there were the summer visits in maine where dad and david would play with the world war ii walkie-talkies. like little boys, war horse one to war horse two, even when they were sitting next to each other. the portrait of this man would not be complete without a mention of dad as a grandfather. in a word, he was wonderful. he took great joy in experiencing the joy of our children. and from the day of their birth, he treat thed each one with love and with warmth. always with a lollipop in his pocket, he greeted them each with a hug and squeeze and rejoiced in the reciprocation of

that act. from early days at the farm when they were babies to more recent times when he would surrender told trinkets to their hands, dad always welcomed claire and katie into their liar. -- their lives. our children knew their grandfather. for this, i am forever grateful. but dad's life was not a one-man play. he had a wife of 51 years whom he loved with awful his heart, a devote thed son charlie of whom he was so very proud, and an extent the family that supported him always. colleagues and friends who adviced him wisely, and the best staff in the united states senate. all of whom he treasured and all of whom treasured the marks in

his life. i am grateful to you all. patient, humor, kindness, humility. these are all qualities, all lessons that my father taught me. but perhaps the single greatest lesson that he left me with is the power of perseverance, the simple act of moving forward. keep moving, one foot in front of the other, one step at a time, never give up, never lose hope, never lose sight of what which is in front of you. persevere, this really is how dad lived his life from his view of family and friendship to his philosophy of government, to the way he chose to live with with parkinson's disease. parkinson's was the darkest and perhaps most unfair chapter of dad's extraordinary life.

but he never gave into it. he never surrendered to it, and he never once complained about it. he just kept going, one step at a time, one foot in front of the other, every day until the very end. pose say what he choice for his coat of arms. dad, we love you, and we miss you. >> when word of the passing of our beloved senator charles mathias reached me, i felt the

same way winston churchill said england felt with the death of king george vii. the news made people pause and look around them. a new sense of values took possess of human minds and mortals that presented itself to many. the same moment in hissers reasonty and his sorrow and splinter and his pain and it's fortitude and in it's suffering. mac mathias has gone home. and so we gather today to celebrate the life of a many who did his duty by meeting his high calling. he sent out compassion to his wife, who marriage was a love match. a perfect blending of old stock

new england and the highlands of frederick county. and our own compassion goes out to charlie and rob and the rest of the family. here's to a man who's dignity, wisdom, courage, and integrity earned him the respect of all who met him, all who knew him, and a number far too high to measure. still this celebration would be incomplete where it to conclude without a few words about other members of the mathias family who had a much earlier date were also called home from above. first let us speak of shammy. may i see a show of hands of those who recognize the name? for those of who in the dark, shammy played the lead role in

the steven king horror movie " "kuj o" about a big dog that terrorized a small town in maine. scaring the living daylights of capitol hill, police, ends probably even some senators. mac mathias loved shammy, shammy loved the senator. shammy didn't much care for anybody else. shammy's favorite spot in the office was in front of the senator's desk. a sure fire way to keep staff meetings short. when shammy was called to the final own, there may have been weeping in the maathai yours -- mathias household, but in the senate, you could hear thanks be to god.

shortly after the departure, i expressed sympathy for his lost. he said colby, he's up there running through fields of clover, chasing through the rabbits. perhaps so. my imagination is as rich as the senators. i too could see shammy up there, but i imagine him going over to peter's place and paul's and luke's and johns romping all over the lilies of the field. i could see him going into the older parts of heaven, stomping on the gardens of moses. i could imagine the emergency town hall meeting called by the saints. shammy needed a place to stay. despite all of the mercy shown to all god's creatures at all times, no one in the palace

volunteered to take shammy in. thus it was decided that the time had come to call home the blue bomber, a show of hands if you know the blue bomber. a show of hands if you ever rode in the blue bomber. a show of hands if you ever requested a ride in the blue bomber. of course, you didn't. the senator just told you to get in and you got in. for the uninformed, it was the means by which the senator transported himself from his home to the senator and from capitol hill to the farm in frederick and to every corner of maryland, sometimes heavily laiden with the odor of manure. sometimes with the manure itself fresh from the farm. i refuse to call the blue bomber an automobile. i believe it was one of the vehicles that landed at the beach of normandy.

[laughter] >> and it took direct hits all the way to berlin. anyway, that's the way the blue bomber looked with the senator behind the wheel and shammy slobbering in the back seat. so serenity of heaven would be restored by calling the blue bomber home to be made into the dolling place for shammy. the response here on earth was tremendous. from connecticut avenue to reno road from the department of motor vehicle in maryland to the dmv in washington, people could be seen wiping tears of joy and gratitude. the blue bomber was finally off of the streets. unfortunately, the blue bomber landed just outside the gates of heaven. the sight of the blue bomber and

the barking and snarling shammy at the window was hardly a welcome sign to the new arrivals. many of whom immediately started considering the alternatives. simply put, the blue bomber and shammy were bad for business. which brings us to why we are assembled here today. when we speak of heaven, we speak of a place where the sick has been cured, the dead have been raised, they have been cleansed and demons cast out. in heaven all things are impossible, expect, as it turned out, nobody could start the blue bomber. so there was no choice, to get the bomber and shammy off of the front lawn, it was imtive -- imperative that their owner be called home. all of the angels were shouting

hallelujah. heaven is a better place today because mac is there, even if we on the earth are the poorer. it's not unusual to start reaching for experiences. for example, the grand moments that illustrate the achievements of the person being honored. i need not do that. all of us have had the moments with mac mathias. moments when we saw him at his best. giving voice to the voiceless, standing up for those too weak to stand for themselves. embracing the constitution when 'er abandon their documents for personal expediency. we have a memory of mac mathias on the figure floor on senate calling for richard nixon to tell the truth about watergate. helping to staff the civil rights act of 1964, passing voting rights and fair housing legislation, mathias on the

judiciary committee defending the bill of rights preventing warrantless wiretaps. he was a sponsor of postwatergate reforms. putting his money where his mouth was, but running reelection would pac money, and he ran against tough, and how he managed to do that will not be told for 50 years until all of us are dead. and there was mathias in the war powers, mathias on the separation of powers, end of vietnam war, reverence for the earth as god's own creation led him to demonstrate the will and wisdom to preserve the chesapeake day, there's no way to capture his essence. but there is a moment which i will always remember. you don't find it in the congressional record. nor in any of the archives of the speeches, or many of the

thousands of places charles was the center of attention. it was a moment in the senate chamber, a moment as forgettable as obscure as a quorum call. they told me about the man i revere. the issue is not important. at one point, the senator on the losing side of the debate mounted a floor challenge by raising a point of order. the chair with the advice ruled against the point of order. something unusual for that era occurred. an appeal was taken from the decision of the chair. the question before the senate was whether to sustain the chair. senator staff as we want to do was preparing guidance for what was at steak, who made the appeal, how was the senate lining up, how would senator x and y vote? for mac, it was a subtle issue. regardless of whether his

parties or friends may stand on the issue, regardless of the popularity of the issue, all of those things were of lesser importance. participateship, he made clear, would not influence his vote, neither would friendship. he believes parties should not come into play on decisioned based on principal, on rules that bind the institution, on order and fairness also depend. so senator mathias didn't need a briefing. he would vote to sustain the ruling of the chair. that spirit of independence and faithfulness to the principals of good governance formed the life of senator mathias. he saw the place of government as standing behind, not in front of the constitution. to him, the law, equal rights, and the worth of every human being were values that could not be subjected to sentiment. the american creed and his view

allowed no less. someone said he was a renegade. if so, then so were thomas jefferson and teddy roosevelt and phil hart. so was martin luther king. yet, the gentleman could manage to hold his tongue when all around him was louisianaening theres. i once asked him after a meeting with a group of visitors who managed strong opinions on the issue. how he managed to hear them without getting caught up in the argument. senator mathias said he learned a lesson from the late speaker when they served together in the house of representatives. kobe, -- colby, he said, they can't get you for what you don't say. i also learned from our here row that there were other moments. when words had simply failed. times when we just can't make

things happen. when nothing can be done, when places cannot be filled, and things must come to an end. sometimes when that happens, senator mathias, told me, the only thing left to do is to put your leg up on the wagon wheel and weep right along with them. with this celebration is over, when the songs have ended, the joy has subsided, the days slipped into night, when the sorrow and the pain and the quiet suffering of our loss sinks in, the only thing left to be done is to lean against the wagon wheel and weep. [silence]

>> i would like to add my thanks to each of you for coming together. it's a true honor to us and to dad. i know how much it would have been meant to him to see everybody here. rob and colby have done a lovely job of painting a picture of dad that stands for itself. as they noted, dad lived large. but he also knew the importance of detail. so i would like to focus on some details, some words, in fact, some words in french that i came to understand were windows into the person dad was and the type of person he wanted to be. i should explain why these words are in french. of course dad loved his country profoundly. he loved maryland, deeply. and frederick always had a special place in his heart. but you could not find a greater citizen of the world than dad.

he reveled in the world's tropical falls, narrow streets, grand boulevards, he loved the desert ruins, and cities, above all, he loved the open spaces. farmland, anywhere, was precious. when a man is tired of london, he is tired of life. did had a jeffersonian fascination with france, that animated our conversations to the end. this may seem odd, but he was a tremendous student of history. the french history during the years of 18th century was an encyclopedia involving power, personal responsibility, irony, and sorrow that remain relevant to us today. in particular, he thought it was nothing less than a miracle that

the french bill of rights was written about the same as ours without the benefit of telephone, e-mailing with and blogs. thus, there was power in french words. one phrase that dad liked to use was [speaking french] the translation was think in french, but when he used it it meant think like the french in the way they turn the phrase he always admired. initially used to coach an ungrateful teenager, that would have been me. i came to learn after i moved through that phase, or at least after i thought i did, these words were another reflection of the deep courtesy was one of dad's hallmarks. it was the courtesy he felt all people deserved whether at the top of the day, in a debate around the dinner table, or just when one was trying to borrow the car keys. it was also the difficult in

chronic illness. his courtesy was weak need, it was strong and determined. combine with another french word [speaking french] it made him an extraordinary effective person professionally and to his family. it was truly his motto. he understand the power of meaning. it means to persevere, to press on, to keep moving even as the moving gets very tough. this is how he fought to advance civil rights to save the chesapeake bay, it explained his concern for the environment and why he planned acorns that he gathering from the lawn of the capitol. he knew it embodied will to carry on and the trees they have become should be a legacy that will outlast us all. nowhere was his perseverance

than in the way he lived his own life, especially the last few years. he lived his motto, and a i'm sure none of you would be surprised that renewed his passport, and two weeks before he died, dad paid a visit to the senate. greeting the guards, welcoming visitors, and a meeting old friends in a place he truly loved. while dad lived his life with civility and perseverance, he also lived it a little on the fly. when i think of dad, i also think of another french word [speaking french] to improvise. dad would sometimes simply make it up as we went along. this led us to great and memorable adventures, planting pine cones, keeping peacocks, raising gentle giants in

chesapeake bay, scoring five-star dinners without a reservation or turning the errand on the way home from school into a visit with the president and his helicopter. it was quite wonderful. i know a lot of work accompanied with everything appeared to come together. i'm sure there are people that knew exactly what i mean. dad knew it too. this is what our parents did so well. ann mathias, our mother, dad's wife and partner, shared all of the adventure and so much of the work. known to many friends simply as mrs. m, i want to acknowledge all of the love they shared and all she did to ensure his zeal for improve was transformed into a series of resounding successes. mom, we love you for that. we love you for what you did for dad and for all of us. team dad included the rest of

us, rob, sarah, claire, katie and me. he loved us all. team dad also included everyone hear today. it's an amazing group of family, friends, and staff, as well as the people from maryland, across the country, and around the world who believed in and worked for him. i would like to say thank you from the bottom of my heart. dad didn't improvise about today. while he left us with plenty of room to maneuver, he was quite specific about certain thing that is he wanted. in particular, he asked that we all join in a special prayer that gave him great comfort in his last days. so as a final way for all of us to stick with dad, i would like us to say cardinal newman's prayer at night. which is in your programs. let us pray.

o, lord, support us all the day long until the shadow lengthen and the evening comes and the busy world is hushed and the fever of life is over and our work is done. then in thy mercy, grant us a safe lodging and holy rest and peace at the last. amen. [silence] ♪ ♪ ♪

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♪ ♪ >> charlie and rob, sarah, and your magnificent granddaughters' ann, claire and katie, remember what i told you girls, no boys until you're 30. [laughter] >> you had a wonderful grandfather. all of us are here today to celebrate, but i must say also mourn with you.

it's always a tough time to lose a father, husband who devoted, grandpa. the united states senate many of whom are hear, former members and present members, the state of maryland, the entire country mourns with you. for we all understand that we've lost a great man. a fierce leader, a believer in right and good and true and the selfish sense, i lost a fellow who was a mentor of mine when i first came to the senate as a 29 years old kid. i got to tell you you were saying rob that your dad or maybe it was you, charlie, you said your dad taught you patience, humor, kindness, humility, i got most of them expect that patience part. he really had to work awful hard

on me on that one. i serve with mac for 14 yearsing with many served longer that are sitting here. in my first year in the senate. i learned long after he left our chamber that the whole time i served with him, he was truly looking out for me. he had taken my under his wing. and i guess i kind of knew that from the first time i met your mom and dad. it was back in january 1973, ann, you might remember. i had just been add a mitted to the senator, a little the later than most of the colleagues, because i came later. we were riding on a bus, i was riding on the bus with ann and mac from austin, texas where weeing attended the memorial service from president johnson. the bus was heading for the

burial. it was only about an hour's ride. but in that hour, i learned a life time work about the profound depth of compassion and the towering heights. ann, you were so kind. in that short hour, i learned what it meant to serve my country with a keen mixture of both virousty and grace. and i learned what it meant to lead. i remember getting off that bus feeling better about being in the senate as ann will remember. i didn't want to come to the senate. i had just lost my wife and daughter in an automobile accident and two boyed were still hospitalized. but the way you put your arms around me, literally and figtively, and the way mac embraced me, it was when it became clear can to me that charlie and rob, both are dads

had something in common about the words perseverance. when i was politely told, it was about persevering. i remember getting off of the bus as we boarded the plane. i remember thinking i hope, i hope i can meet a lofty standards of the couple who i had just ridden for two hours with, to and from stonewall. but for mac, more than anything else, i learned about courage. both moral and political courage. as vicky kennedy knows, off quote of robert kennedy, i heard teddy use it. but moral courage is more rare commodity than brave or battle or great intelligence. well, you know, mac served this country in the communications ship in the pacific and world

war ii. and yes, as charlie pointed out as well as rob and all that worked with him, we knew he had a keen intellect. gained from the time at yale and columbia. the only reason he's not a democrat is he went to yale, i used to kid. [laughter] >> but it was most of us about mac's moral courage. the rarest of those commodities that made him stand out from many of the great men and women with whom i served. i was telling ann in the vehicle that when i left the senate after being elected the 7th time as the senate historian pointed out to me thinking i'd be flashlightering, only 17 men have served longer. all i could hear is my father's phrase, that's the definition of

misspent adulthood. : everybody forgets as difficult as these days are, as rob pointed out, the 60's were

equally as difficult. as a matter of fact in many senses they were more difficult and required greater clarity and moral courage because we were at one of those great inflection points of american history. fortunately we had men who like mac maffei yes, teddy kennedy and others i won't begin to name because i will leave somebody else. faugh but politically expedience , political expediency in my observation never mattered, never meant anything to mac, and moral compromise meant even less. i will not recount as i had intended to do because the wonderful remembrances thus far but think about, mac voting against and coming out against of the fi and mama war win

incredible pressure was being placed on him as a loyal republican. mac, marching with gloria steinem in the midst of the highly charged atmosphere when most people were hoping not to actually having to talk to either one of them with the cameras on because they were such lightning rods, wonderful, wonderful people. but such political lightning rods for considerable parts of our constituency. and mac just went out and marched with them. campaigning come for the campaign finance reform, god, had he won. but a different country this would be had mac prevailed on campaign finance reform. not a very popular position to be in as a leading republican. i served with mac on the senate judiciary committee and foreign relations committee for those entire 14 years that we served

together. watching him step up issue after issue after issue i wondered how in got's name can he survive particularly with political representation, the party he belonged to at the time. as the bishops pointed out to me it was noted he voted with republicans 31% of the time. i used to kid your data and say that he was a democrat for his pedigree he would be a democrat. all of this french stock through him off. [laughter] and my middle name is roby but i've overcome it. [laughter] to be a democrat. but all kidding aside, you've read a lot since mac's death how he reached across the all. i never thought of mac reaching across the aisle. i thought of mac has never even recognizing there was an aisle.

i never thought of mac as going out of his way to reach across. it was who he was. there was no artificial to fight. there was only principal and he would approach every issue with its principles firm, but unlike many today and even then with his mind open. his principles were firm but he had an open mind. he would approach every issue that way. to mac, right and wrong were not defined by whether or not you had any d or r please after your name. they were defined by what was in your heart. and mac never liked any other force by him but that one. i rely here on the words of ralph who said whatever course you rely upon there is always someone to tell you you're wrong. there are always difficulties arising which lead you to

attempt your critics are right. to map out a course and follow it to the end requires courage. it seemed to me your father never had a doubt about what course he would set. it seemed to me that it was just almost instinctive although he could articulate in the ways the ahmadinejad abilities. mac had his critics. he heard stultz from others. but he harbored no doubt i could observe about what he believed. no reservations about his core principles. three people, fair system, equality for everyone, not just here in the united states but around the world. i remember one time, charlie, i was disappointing your dad and then i realized it was his wisdom carrying him. we had george shultz, and he will remember this encounter, paul. george was testifying before a

committee, a great man, and we were having a hearing on apartheid and secretary shultz was making the administration argument we should not be imposing sanctions and so on and i got very upset with one comment he made and i said very anne gurley i am ashamed. i'm ashamed of this administration. and before paul could get to me, he's using the dee dee could usually my governor, the note got to cross the chairman to me saying from mac, calmed down, big fellow, calmed down. calmed down. like i said, he learned that patients better than i did. [laughter] but i remember, and i will speak to it in a second, i remember going to his office after because i was angry. i was fuming about this injustice and i thought mac mathias along with teddy and others who were my heroes in terms of civil rights, how could

he have not just beaten this guy a life for what he was saying? i walked in that office in the beautiful lovely doll -- dog. [laughter] actually i kind of liked that beast. if memory serves me, mac had a table in front of his desk with a tea set in his rumpled suit and i was still fuming. and he walked around and he poured a cup of tea and said sit down, the show, this will help you. and then he began to say to me and the fact they can't get you for what you don't say and joe, you're saying to much and i went through with me. it not only made me feel better when i was walked out but believed the fight connect succeeded in getting the very objectives accomplished that i

cared deeply about. and one of the measures how much you are in sync with another man or woman is whether or not people you admire the most are similar if they are mutual acquaintances. mac and in my case those people were identical. the times last week listed the senators he most admires. jay fulbright, mike mansfield, fell apart, john sherman krueger , jay clifford case. let me tell you, that is my list, too except the one name i would add is mac mathias. these men formed the intellectual and moral compass of the united states in my early years in the united states senate. they came from very different parties and different backgrounds, but they all shared one thing in common. they all believed in basic human decency, gender and racial

equality. they belong to a political party that there were more patriots first. instead they viewed themselves as i observe them and i knew all of them well kill. they all started from the premise could represented all of the american people. mac was part of that moral compass. his true north is always pointing toward what was best for the people of maryland and our country and for the world. people today think that to march out of lockstep with your political party, to speak out independently is some sort of a new form of courage. well, folks, it's been around a long time. it's just an pretty rare supply these days. but it's always been in rare supply. it was in a rare supply than.

folks, mac was speaking out independently a generation ago. and if he didn't invent what it meant to be independent of mine in the united states senate then he helped define and master it. on top of all, mac was always a gentleman. graceful without pretense, he had as i said he had a way of calming things without in any way backing down from how deeply he felt about an issue or principal. he was called the time, at least in my observation. he was the column in the center of the storm and there were many storms in the 14 years i was around. if he was the voice of reason at times when the reason itself was a very rare commodity. i like to think of mac, though

he suffered greatly from a horrible disease and in a better place now. one day when it is our time to hopefully join him there he's going to greet us with a warm smile, conley stand up in their rumpled suit, support us each a glass of tea and say settle down, welcome. mac, durell readiness. but i suspect you are looking down right now, old buddy, and saying calm down joe. one of the things i hope you are looking down on all of us. i hope you in the war a steadfast belief in common cause and ideals that transcend politics and breathe it into the soul of our friends on the hill and keep reminding me of it as well. may your spirit guide us all, mac. those of us who knew you and loved you will forever be pulled

along by your and dalia indecency that laid at the heart of everything you did. ann, when i think of mac, i think maybe the british poet and historian, thomas macaulay, must have had mac in mind when he wrote the measure of man's real character is what he would do if he knew he would never be found out. mac's is one of them and i'm absolutely confident would have acted no differently under any of the treen circumstances -- trying circumstances even if he knew he would never be found thank god we found out and had an opportunity to know just how decent amount a man he was. but ann, i don't think he could

have done it without you. you are a leedy and i am honored to know you. thanks for asking me to be here. ♪ ♪ ♪ ♪ ♪ ♪

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update on cumbersome putting the jobs legislation from today's washington journal. this is about 45 minutes. >> host: our guest now is even swanson, editor of the hill newspaper. we talk about this jobs bill. give a sense of what is evolving in that. >> guest: what is evolving is a real attempt by democrats and republicans to try to agree on a jobs bill. something you didn't really see with the stimulus bill the last year. it reflects the political reality in washington where democrats can to get a bill through congress anymore just with their own votes with election, scott brown in massachusetts, they've got to give republicans on board and are trying but there are some things in the bill that republicans are not crazy about. there's also just the political

do you want to let a jobs bill go through that could be seen as a good political thing with more democrats in congress, a lot of competitive factors. >> host: your colleague, alexander bolten, whites if the jobs bill was postponed the senate votes on likely the rest of the week. one reason is the weather, but the bill itself is still in draft form. hasn't been released fully yet. >> guest: that's right, senator majority leader reed was hoping to get a bill this week. he probably still hopes to get a bill this week. [laughter] he settled through the day yesterday we were watching for the bill to come out. we have the majority threatening senators we will stay here this weekend if we need to to get this going out, and then as the afternoon turned to evening yesterday he said it doesn't look like we are going to be able to do it. we had 15 senators missing from the vote yesterday having a hard

time getting into town. right now as it stands senator reed asked democrats to come to the capitol tomorrow for a meeting on the jobs bill. but it looks like the vote is going to happen after the recess next week. >> host: phone numbers on the bottom for the guest, ian swanson to read we're talking about congress and its wrangling over this jobs bill. there are lines for republicans and democrats and independent. let's get more of the details as they are coming out, mr. swanson. "the washington times" has a picture of mr. boehner but the title says jobs bill cuts payroll tax on the new hires. take a steeper to the concept. >> guest: the key provision in the bill getting so much attention is one that would give a tax credit to hire new workers over the next year. i believe the dates go from february, assuming the bills pass february to january 1st, 2011, and that is why businesses would get a tax credit for hiring new workers does it have

to be the high years that do not replace existing workers, and there are a couple of republican senators that have been working with us. the idea that emerges from a proposal that originally came from senators hatch, republican from utah and senator schumer from new york, democrat, senator grassley from iowa has also been involved but there's some republicans who have raised criticisms about this kind of a hiring tax credit in the past. it was used in the 70's by the carter at ministration and they sort of said it didn't work then, why are we doing it now. >> host: so the idea is a bipartisan one and initially does that tell you anything about the broad bill? to get back to the earlier comments about the two sides getting together? >> guest: again your going to need republican votes on this. i think that the republican conference is a bit divided on some of the specific policies. there are a lot of tax policies. there is a tax extender package that would be included.

it's generally popular for the business community and members of both parties. the hiring tax credit however is something not all republicans agree on. also today we reported model of the democrats are sold on the jobs bill as it is emerging today. either have a quote from senator brown from ohio. he said he was worried that there were too many -- to many tax cuts in the bill that it was focused too much on tax cuts for business. so this isn't across the finish line. both parties need to come together probably to get it for, obviously with only 15 democratic votes in the senate, but both republican and democratic leaders could have difficulties coming forward. >> host: semidey this isn't a bad thing, gives them more time to work it out. >> guest: or maybe gives more time to decide they don't want to do it. i don't know. it's hard to read. >> host: let's get the first call for ian. robert independent, good morning. >> caller: yes, good morning. i'm just wondering how we in america are going to recreate jobs when we no longer have a

manufacturing base, you know? bill clinton -- this for the country at that time to read those minutes to trim jobs are never coming back. >> host: common point on the manufacturing base. >> guest: and there is truth to it in the manufacturing jobs just being crushed by this recession. it's important to remember the u.s., i believe it remains the largest manufacturer in a world. china hasn't surpassed. it's a special manufacturing ability yet made in the next couple of decades. manufacturing has shown some signs of life, too, in the last month or two come a lot of surveys that have shown more production about u.s. manufacturers to read in terms of the job bill that's going through congress obviously if manufacturing companies are thinking about hiring new

workers they are not sure how to develop certainty on the economy right now, the tax credit could spur them on. again, some might argue however it isn't the best use of taxpayer money. >> host: we heard the gop suggests it needs to be a job generator. has any kind of member been attached to this in terms of the number of jobs that might created or saved? >> guest: i don't believe i've seen that and i think both parties might be careful about doing that now. with the stimulus of course there were a lot of numbers attached. there still are a lot of members attached in terms of how many jobs are saved and created what we have learned it is tough to figure out exactly how to tabulate how many jobs you saved. the economy also has lost a couple million jobs i believe since the stimulus was approved or sent into the law in february. it may have prevented many more jobs from being lost. but that's an argument that is sort of difficult for the

democrats right now. >> host: we will keep digging deeper into the jobs bill, ian swanson of the help. garrey in the meantime, a democrat, good morning. >> caller: yes, how're you doing? my question is about the outsourcing of jobs to other countries. we've lost a lot of jobs companies outsourcing. every time i call my credit card company or cellphone i get someone in india and i want to know if the jobs bill is going to do anything to keep coming to me during those jobs back to the companies to keep stop outsourcing the jobs to other countries. >> interesting thing about that is obviously there are some things in the jobs bill that could convince domestic companies to hire more workers. it's also interesting is the white house yesterday when obama talked to the republicans and democrats one of the things that cannot was there was some agreement on the need to move forward on trade.

three trade agreements pending in congress that were initiated by the bush administration that haven't moved at all, republicans have been demanding the move and they argue this would help create jobs in the united states. a lot of democrats don't think that is the case. they think it would lead to more outsourcing. we've seen some times to the confines of the last month about renewed emphasis from president obama on exports. he taught on the state of the union about doubling exports. as the commerce secretary a week later did a speech on exports. they've been a little careful however in talking about the trade agreement because the trade agreements are very controversial with the democratic party. the party is pretty much split on the trade agreements. going back to your question i think you are going to see this outsourcing debate intensified if this trade debate picks up and the republicans really want to move on the trade agreements and the democrats have divided, obama starting to show some signs me he wants to think about

it at least. >> host: in the past our guest was a treat reporter for a publication known as inside u.s. trade. ian swanson is currently news editor at the hill and also writes a column on economics for the hill, educated at the university of north dakota and columbia school of journalism, new york city. tampa, florida. pat, a republican. good morning. >> caller: good morning. a chant of loves obama. he was down sure not too long ago and he okayed for high-speed transport and we are thrilled to death. >> host: pat, what is the job situation of tampa right now? >> guest: >> caller: 10% three >> host: 10%. >> caller: we are hurting down here and are all looking optimistic that, you know the five-speed real. we figure it's going to provide jobs, it's going to provide health care. i think one thing feeds into the other. it's giving an optimistic attitude here in tampa we are all excited about and when he

got here and spoke to the university of tampa we were elated. he was put on the lion. there were questions that some of our students socked it to him and he responded so well. and nine republican. i'm not a democrat. but you know something? we love obama here in tampa. thank you so much. >> host: high-speed rail, tampa. one of several spots the president made recently in his economic ideas. >> guest: interestingly swing state that we've seen a lot of that from president obama, especially since it stops in tampa and new hampshire, another swing state. >> host: more about the jobs bill, the cost of this jobs bill. any price tag on it yet? >> guest: there isn't an estimate from the congressional budget office get on the cost. it looks like it's 85 billion. we reported today it is 85 million the first year and 19

in terms of costs of the second year of the bill. >> host: how are there offsets' being talked about? >> guest: there are. they are rather complicated in the tax policy and the transportation fund and fuel i believe they would be used to pay off the cost of the tax credits. >> host: clarksville tennessee, and anthony on the line, and dependent. >> caller: good morning mr. swanson. i have a question. it is in this money being reallocated from the t.a.r.p. mauney? i don't see the issue. if the president is reallocating the money from t.a.r.p., the money is there, so to reallocate from the lower end for the jobs, i don't see an issue and i think the republicans should be supporting this. loaning of small

businesses but that job bill paid from a different revenue source. i don't believe that the tarp bill is used for this jobs sector.g#ççó host: any particular economy will benefit from this bill? guest: there is talk about didn't segments of the economy. host: one headline, the senate job bill is a joint effort. they point out that democrats include, republicans backed idea of backing of businesses. florida is on the line >> caller: that's east sparta ohio. >> host: my apologies. what part of the state are you in? >> caller: south of cleveland. football fall of him, bulldogs,

you ever heard of them? >> host: yes. how's the job situation there now? >> caller: it's bad here. >> host: how bad? >> caller: it's real bad. our manufacturing base has almost dwindled to nothing. that's the service history. and plus we bring in a lot of trash from out of state. that's another big issue we're having here in this county. and, well, we don't want other people's trash. money talks. but anyway. that's not the issue. what makes this gentleman think that the republicans is going to do anything other than what they've been doing on this jobs bill? they was for the bank bailout, they was for cap-and-trade, they was for pay as you go, they

backed out of all of them as soon as they found out the president was for them, and on the stimulus thing, every one of these -- you request go to the senate to the congress on the republican side, they all -- the support of this, disapproved of it. then when you got the money in their home district, they praised it like phil of georgia. he said it was a boon dog. then he's seen and taken pictures with the check in his hand. you know, these republicans aren't nothing but a bunch of hypocrites. >> host: mr. swanson? >> guest: i think that's good points. the senate republican leader did give some signals yesterday suggesting that republicans were looking at this pretty seriously and may come on board. anyway watching washington recently probably has complete

justification to be skeptical that the parties are going to come together on anything. all of the major bills of last year have been on partisan lines. however, there is a dangerous politically for the republicans to be seen as completely obstructionist. president obama is definitely making a political -- taking the political tactic right now of trying to reach out, trying to bring them on board. some republicans would say he's not being sincere in that. but that's how the political gain is going to kind of play out. for the republicans, if the american public thinks that president obama is making an honest attempt and republicans are the intransigent ones, they hurt by that in elections this fall. even if they still gain seats, maybe they don't gain as many. that's the risk. at same time, there's the risk for the republicans and being seen as rolling over or as giving new momentum to the

administration and democrats. and that's politics, that's what a lot of people don't like about washington. but it's reality of our system too. >> host: we have a call from brian now. greenbush, michigan. >> caller: hi. don't take this personally. but speaking of reality, here's the reality. the previous caller touched on it earlier, as concerning nafta, how people get large like we mention it as old news. here some news $1.50 to $3.50 an hour between china and the emerging nations. we all want them to do well. i don't hear any senators being asked how the heck are we going to compete at $1.50 to $3.50 an hour for manufacturing. let me state this now, over the weekend, i have great pressure of talking to paul johnson. at least he talks straight. i asked him over the weekend,

how are we going to compete on this? he says new technology in the colleagues and what we're doing to learn for the future. we'll perfect that. what's to stop detroit fight now, we're going to develop the best batteries in the world, we're going to develop the breast drive trains transmission to make everything work right for the new age of cars. once we get this perfected, the swells, the big corporation, all they are going to do is move this stuff to mexico and china. we need to ask ourselves directly how are we going to compete at an average of $3 an hour when they think we are swimming in money now and we couldn't even pay one bill at $3 an hour. it doesn't make any sense. >> well, it's not going to make sense at all, i would say, if you are building, you know, for example, a broom or something. you can't compete with people

who are making less money when you are making low-cost products. the potential is therefore u.s. manufacturers to make a high value products. the -- as many troubles as the u.s. automotive section are having. ford has had an fantastic last we're year. the problems of toyota give all of the automakers an opportunity to increase the share and outside the united states. i think the argument that you see from the obama administration also is that they see an opportunity for manufactured products that get to the new green economy. but the world seems to be going for it. they think the u.s. manufacturers is going to have a leg up there because of technologies that can go into those products. look, i'm not going to -- i don't think anyone would argue that the competition from emerging countries like china and india isn't fierce. not only do they have competitive labor markets, but

they also have huge surpluses, their countries can -- their governments can invest a lot of money and state products at the state companies, excuse me. and they are doing that too. so it's going to be a challenging world environment for u.s. manufacturers. but i think the argument from both the republicans and democrat is that there still is a good shot for u.s. manufacturers as long as they focus on the right industries. >> about 20 minutes left with our guest. >> host: that's one viewers opinion. frank, independent, you're on with with ian swanson of the hill, good morning. >> caller: it should be a box on both of the democrats and the republicans. because they are both not really doing anything to resolve the problem with jobs, hospital care, whatever the case may be. let me give you a for instance,

right after katrina or during katrina when we are having all of the problems with the levies there; right? listen he has a levy problem down in california. i haven't heard anything about resolution there. and, you know, these are the things that should have been like you said shovel ready jobs. these are the things that should have been taking care of before the hospital orb the health care bill or anything like that. another thing is we have to become, unfortunately, isolatist. because we can't pick and choose the industries that we -- you know, you say the high-tech industry. because they will ship them overseas. the american public has to be start buying our own products for the biggest market for the most part. i mean this world financial crisis that we are having, we're probably ending up of all of the best countries around the world other than china. that's because they ma liplated their money. the wan; right? i mean it's crazy.

there's no common sense in the thing there. this gentleman by the name of obama is captaining a ship called the titanic. he fighting the passengers all of the time. he's not going to win. >> guest: a lot of things to go over. china's pegging of the currency, it's currency to the u.s. dollar. what that has done, it has made chinese exports much less expensive to export not only to united states but to europe and all over the world. it also making it harder for u.s. manufacturers to export to china, large emerging market. their products are more expensive. there's been a clamber in congress as well as from the business community for the m to do something about this. there were years of clambering for the bush administration to do it as well. it's something that's difficult for republican or democratic administration. because they need to cooperate

with china on so many different foreign policy things. plus there's the nasty issue of the u.s. debt. which much is which is owned by the chinese. it's exacerbating the situation. i've done a lot of reporting in the last month or so about how economic relations between the u.s. and china are expect thed to worsen this year. and we've seen no sign of, you know, any evidence that that would not be true from googles problem in china to the chinese reaction to the u.s. armed sale to taiwan a couple of weeks ago. the currency debate is going to continue this year. i don't know if we'll see legislation. but i expect that to be a big debate in congress. >> on the jobs front, here's a photo in "baltimore sun" today on the republicans meeting with democratic party the. you see three of the house members here, speaker, john boehner, but seeing the house

members there remands me to ask, what has the house been doing on the jobs front? what have they done in recent fronts? >> guest: they passed $154 million jobs bill before christmas while everybody was focused on the health care bill in the senate. they are looking at doing a smaller that would match up more with the senate and get something done. there's some behind-the-scenes work on that. nothing has been released yet. there has been discussions about a jobs bill. so it looks like the house is moving toward where the senate is going. we don't know where the senate is going to be. stay tuned. >> melvin is on the line now. democrat, hi, melvin. >> caller: how are you doing? >> host: good. >> caller: i've been a watching since '94, and since

i've been retired i've been watching it religiously. one thing you need to do is to audience the audience on how congress works. they have an understanding that everyone comes to the table with no agenda. everyone neat meeting in their own caucuses and then they discuss and try to make the legislation that way. another thing i want to say is legitimate one that he mentioned no money for the t.a.r.p. will be used from the job is going to the banks. that is partially the reason for lending is because you have all of the small businesses that can't get money to hire people because of the tightening up of the loans from the major banks. the money going out for the small bank will be using for hiring people. that's the purpose for loaning that money from t.a.r.p. to the small banks to create more jobs. then the money be used towards a job program. >> host: thanks forker

calling, melvin. >> guest: well, i said the jobs bill that is moving through congress right now, i don't believe that any of that bill is going to be paid for by t.a.r.p. funds. t.a.r.p. funds are going to be used in the new initiative the president announced a couple of weeks ago to spur lending my community banks. lending has been a problem. even though the banking industry, especially the big banks are doing a lot better right now than they were a year ago, the credit still isn't moving through the economy the way people would like to see it, the way of administration and congress would like to see it. and the new effort is supported to help that. it's supposed to help people get loans for small businesses and for homes. the caller makes a good point. >> host: message by twitter.

>> host: what does that mean to you? >> guest: well, it's a good sign. the question everyone wants to know is when it hiring going to begin? last friday we had the latest unemployment report. the good news was the unemployment rate went from 10% to 9.7%. the bad news is the economy continues to lose jobs. it's not gaining. people are continuing to give up and not even try to get a job. which means that, you know, you have millions of people who are out of work and who have given up on looking for jobs. hopefully the statistics you are showing suggest that's going to turn around and there is going to be a hiring boost.

i think everyone is sort of anxiously awaiting. >> host: plug this into the debate? >> guest: sure. everybody wants to cut the deficit. government spending is out of control. nobody likes to cut spending that's going to help their own constituents. that is the story in washington today, it's been the story for some time. it's why it's hard to cut

spending. the caller said a few minutes ago the journalist in washington should talk more about the agendas that politicians have when they come here. that's one agenda that every lawmaker has. looking out for the constituents. that's how you get re-elected. i don't like to see money cut that's going to effect their home trick of district. >> host: what's the effect of the bipartisan fiscal commission that's been proposed. i bring that up too because "usa today" talked about three strikes. what might the future bring? >> guest: the reason they are talking about a commission is because what i was speaking about. they can't agree themselves to spending cut that is would get the deficit under control. so the new idea is to create the outside commission with former politicians who would offer recommendation on how to cut the budget, particularly the

entitlement programs. the idea behind the commission is sort of that political system is broken and isn't going to make the tough decisions itself. so you have to get it outside group to make the recommendations. the problem, of course, is that congress is still going to have to vote on it. and the president is still going to have to sign it. who knows if that'll b really be possible. >> roswell, thanks for waiting. good morning. >> caller: good morning. thank you for c-span. >> host: you bet the. >> caller: i'd like to ask the guest to elaborate a little bit. it's my understanding that we have yet to spend nearly half of the stimulus money the $787 billion, i believe now the estimate is $865 billion from earlier in the year, now we're talking about additional $85 billion for job plant. if we have the remaining funds from the original stimulus, a lot of remaining funds, why are

we coming back to the american people and the chinese in particular to borrow more money to go about setting up a jobs plan? i'll take your comments out there. thank you very much. >> guest: i think that most of the money from the original $787 stimulus has been allocated in a fair share of it is out the door. i'm sorry, i don't know if every penny has been spent. i just saw an update. i believe most of the money was to be spent in 2010 and the -- excuse me in 2009 in the very first part of 2010. the argument for why they are doing this is the continue to see unemployment high. they think need to do more. there's certainly a valid argument to be made that given the deficit situation that there shouldn't be more money spent. that's part of the debate that we are seeing in washington right now. >> robert is on the line now from independence. welcome.

>> caller: good morning. >> host: morning. >> caller: i don't know where to begin. the caller that was on before about nafta, the thing is we're doing these free trade agreements, and like he said, you can't compete with, you know, labor that cheap. my concern is, you know, these -- the corporate sector in this company with their lobbyist, this is how nafta got passed to begin with. they are exploiting these people that live under dictatorship, you know? it's not right. we're doing that in all of these countries. you know? i think nafta is like one of the biggest against this country that, you know, i can't believe it's going on. you know? i mean, you know, you got all of the democrat, liberals, bleeding heart. they ain't doing nothing for

these people in other countries. but we are paying the price for it here. >> host: let's get more insight from our guest. >> guest: it's interesting three callers have mentioned nafta that was signed into law by president clinton and approved by a republican congress in i believe '94. the callers show why it's so difficult for trade agreement to move through congress. it's one of the most devicive issues in washington. it seems again like it's going to come up for a new debate this year. the democrats are divided on it. the republicans want to move trade agreements with columbia, south korea, and panama. there will be an argument over whether those agreements are exactly like nafta, or whether they are improvement to improvement environmental and labor rule that is would make those agreements more fair for american workers.

there's penalty of people that think those improvements will help. there's plenty of other people that think there needs to be many, many more changes to them. >> host: one more twitter message. q. hank paulson has been out there. here's a headline. banks will replay every penny, he says. >> guest: it's certainly possible. i think the big question with the bailout program is whether the autoa toe makers will be able to pay what they owe. the stock transactions took place when the u.s. government

essentially took over general motors. most analysis seem to think with the banks the u.s. is not only getting paid back but it is going to come out ahead because of dividends and such. >> so if it is all paid back or ahead. do you think it'll change the mood about so-called bailouts? does it increase confidence do you any >> -- think? >> guest: it could. the bailout of the banks on some levels has worked and that you are not seeing -- you're not seeing the big banks spiral downward like you were in the fall of 2008. but as we spoke about earlier, we haven't seen, you know, credit. we haven't seen -- we haven't gotten easier for small businesses to get credit. that's what people on main street really wanted. they were sold the idea that was going to happen through the t.a.r.p.. the economy continues to still be horrible. but workers are losing their

jobs, small businesses can't get help. now they read about the big bonuses that the banks are getting. you can kind of look at it. the t.a.r.p. worked on one level. it certainly didn't work if it was meant to trickle down to main street. or at least that would be the argument. until that happens, i think people are going to stay pretty angry about the t.a.r.p.. and in the last thing too is the budget deficit. while the money being paid back means the deficit wouldn't expand because of the t.a.r.p., in people's minds they just see the big deficit and all of the money going out to banks, all of these bonuses, people still out of work, that creates, you know, political hard feelings. and hard feelings just on main street. >> let's get a call. anthony, republican, good morning to you. >> caller: good morning, gentleman. my concern is as an example with citi bank, i called on my

citibank credit card and i'm speaking to the phil phil phil -- philippines or india. they are sending the jobs over seas. there's no reason why college students could not have these jobs. we're here in palm beach, florida. the unemployment is really 15%. it's not being broadcasted to the rest of the united states. but it's absolutely horrible down here. so i was wondering can you comment how these banks were allowed, and it must have taken years to set this up, why were these jobs outsourced to india and philippines? >> host: thanks. >> guest: i'm sure the reason the banks set up call centers in foreign countries was the value

of labor. the labor is cheaper in those countries. that's why they are doing it. they are doing it to drive down the cost. i would assume that most of those set ups took place before the t.a.r.p. money was put out. businesses are free to make those kinds of decisions. the reason that the t.a.r.p. money was -- the argument for why the t.a.r.p. needed to be sent off and aid needed to be given was it you didn't, you'd see the entire financial system perhaps and the situation would get, you know, much worse than it is now on main street if that were to happen. it's -- but it doesn't -- you mean you can't argue that it wasn't a mistake and that companies that are doing that shouldn't get the help. that's why there's anger about it today. >> host: we'll go to charles on the independent line. >> caller: good morning. how are you? >> host: fine. >> caller: i'm going to take a

little time as possible. i do probably about three points to make. it's you all going to come into the job effort that i do have plaintiff swanson. thank you for being here. you guys are talk abouting a lot of important topics. but then what be confused is me as an american is how you can be dividing the topics. you can even look at the phone lines, independent, democrat, republicans, we're not volunteered to help president obama become president obama, one of millions. i worked with democrats, republicans, and independents to get him into office. that in itself -- and the reason i say, it's a segue that you had petty policies and it also brings into the jobs because it's still coming to that as an unemployed american. but because part of our stimulus package. what our president has done to

help many americans see the problems that our country was going into, one caller had even talked about the call center. i believe the call center should come back to america. even at $10 an hour, that's better than the minimum wage and most americans can't pay their bills on that. gas went up to $4 a barrel. as people were losing their jobs, and then still have to even get to work, but still then be told that you're still going to be let go because we're aware the jobs are leaveing. the nafta thing, it does need to be repealed. i love working with other countries. we do have problems here in america, also. >> host: mr. swanson? >> guest: there's a bill sponsored by democrat that would force to renegotiate nafta and every other trait agreement on the books.

it's probably 140, 150 cosponsored. so there's a lot of people that would agree with that point. it doesn't seem like leadership is really interested in moving the bill. but again that'll be a part of the debate this year. >> a couple of other items to ask you about. business section, new "new york times" today. >> host: can you give us a sense of what's he's facing? >> guest: he's facing the federal reserve with hundreds and hundreds of billions that are pumped into the economy over from the fall of 2008 from much of last year. again an effort to help banks, help credit markets, in an effort to prevent the financial system from imploding. they did that from lowering

interest rates to basically zero and through a number of other programs. now they have to pull it back. they have to start pulling the federal reserves sort of investments in a sense in the economy back. and they have to do that very carefully. because they don't want to cause problems in doing so. which is something quite naturally could happen. it's going to be delicate. markets have been watching for when it is going to happen. if he doesn't do it right, we with could see real plunges in stock values. >> host: what's the update? >> the update is last week, senator dodd announced he was an impasse with senator shelby, the ranking reform. not a good sign if you are looking for bipartisan bill on financial regulatory reform. there are some republicans who said that they were committed to still trying to get a bill.