he previously served as director

of communications, and prior to that he was heritage's director of relations. please join me in welcoming my colleague, mike franc. [applause] >> thank you, and welcome to the heritage foundation. this is something we wanted to do not immediately after the elections but a few days for all of the results to come in, for people to form some thoughts about the significance of what happened last tuesday, and we want to invite three folks who will set an awful lot of light on a historical collection. we had a couple of markers for discussion that point to the

significance of were the two party has come from. if we did this a couple of years ago, people would ask what tea party? now everyone has an opinion about the tea party movement. there is very little trust in the major parties. approval and disapproval of the democrat and republican parties were both negative 10. the tea party was 39 approve, 32 disapprove. the rest were neutral. they actually had a net positive. at the state level, there were some cases where there were more questions as the bulk ked e tea party and the other major parties.

teh tea parhe tea party is net e in 17 states. also interesting to me is that there were 11 states where the tea party had and a higher approval rating than one of the major parties. in california, ohio, washington, and orgaorigen the tea party was more popular. having it is obvious that where we are at is -- i'd think it is obvious that where we're at is a major for. we will look at major prospective scope of questions relating to the sustainability of the two-party movement. how will the two-partea party ey

and passion find its way in washington? we have three terrific speakers. billie tucker, executive director of the first coast tea party in florida. she served as ceo for 20 years and her former role as executive vice president of tec florida. she has spent her entire career working with ceos and executives, earning her reputation for the teen understandings of motivations to become more effective. we need a lot of that here. she will be our first weaker. billie is representative of the leaders that have emerged. there is really no one leader of the tea party movement.

it is the spontaneity that came out of almost nowhere to have their voice heard. billie does a great spokeswoman for that dynamic. our next speaker launched a political blog in 2003. he helped create a model for success and expansion. his pieces have appeared in "the daily standard" and "the new york post." his commentary is widely sought after. 25,000 daily visitors to his daily readings. he will address some of those aspects today. our cleanup speaker is byron

york. he provides conservative commentary once a week for the examiner, which is a terrific column. i encourage you to read it. he previously was a white house correspondent for "the national review." i want to read the title of his book that i thoroughly enjoyed. "the vast left wing conspiracy." that is the title of a great book. you could start off, and we look forward to going ahead. >> thank you. i want to take this moment for saying i am here to represent a lot of people that set up on november 2 and before that to take our country back. everyone says they get back to

waake it back to what? i will do my best to represent each of you. there is no leader in the tea party movement, and that is what makes us unique and so different. most of us did not know we would be in this movement. that is exactly my story. it is really interesting because we are all being asked what now? it is like we're setting up a secret room. it did not happen that way. we were all call to this through a movement inside a parked at that told the sunday and was seriously wrong in this country. -- we were all called to this movement through our gut. during this election campaign --

when the movement first got started, we were really focused on the issues. that is what the tea party is all about. we have a lot of issues. we are in serious financial trouble. we are in a lot of ways we are in a decline that we have never seen in our history. this is why people are waking up, because we know it. there are a lot of smart people in america, and i am so honored to have worked with them. i have worked with ceo's that have brought huge organizations to our country, and i thought they were smart until i started working with people in the tea party movement. americans are very smart people. they have known for a while the something was going on in our country. what happened last tuesday night was so great.

our founders created this whole process by which we could do that. we put it into action. it was so cool to be a part of that. it was so phenomenal to be a part of it. listen, we are not smart enough to figure that strategy out. our founders did it for us. and it worked beautifully last tuesday night. i am here to tell you that people say what now? we do not know. we did not know what was now for the tea party when we got involved for it. we know one thing, we're not going away. we did not give our lives of foufor two years -- and that is what most of us did. a lot of people gave up careers, walked away from any kind of

financial way to create wealth for them, and they created an organization of loosely- connected groups all over the country without any big money. there was no big factor. -- big backer. we paid our own airline ticket to comee here and say no to this. we wrote our congressman. we activated our citizenship. we did this in a robust led by paying for it at our own pockets. we are all grow. -- broke. we are all trying to regroup. tuesday night we had a great night. i am from florida, we had a super night in florida. marco is coming to washington, d.c., because of the tea party.

we are all about telling the truth. the gop did not get behind him when it first came out. there were standing behind our governor who ended up being -- we do not know what he was. they did not stand behind marco. he showed up at the tea parties. he had no money. i remember hearing a radio show where he was talking about he had no money. the gop did not get behind him, but the tea party did. all of a sudden, the gop realize we have put our faith in the wrong person. they had to scramble. that is who is coming to washington. the gop let him do his address on saturday.

he has not even got here. after obama's address, she did his address. we have a governor in florida that the gop did not support at first. the tea party did. we're not blaming the gop, we're just saying we stood outside. we kept saying no because we are smart. we put fpressure on both parties. now they are saying now what? we're saying we're going to keep pressuring you. we're going to make sure the democrats take their party back from the progressives. we have to come back together to our parties. that is what we want. we are so thrilled about it. i am not the expert. i am not the queen of the tea party. i am just one person in america

that is standing up. before i came, i said i am going to go to heritage, tell me what you want me to tell them. i am disappointed quickly go through this. -- i am going to quickly go through this. we had 90 people telling us what you can do. i am going to share a few of these things with you. this is america. number one, we're not going away. if you think we are, we are not. we have to have garage sales to fund this. [laughter] we will watch each and every new member of congress to make sure they are not going to be corrupted when they come to d.c. something happens when people come up here. they seem like a really great people, and after a while they do not look like the same people we sent here. heritage, you are up here. we are born to ask you to keep an eye on them.

-- we are going to ask you to keep an eye on them. i cannot tell you how much i have learned in the past few years. here are the issues we are concerned. the decline of the dollar. the over-reaching federal reserve is another one. the debt. out of control spending. they want you to balance the budget. hello? this is common sense. we do not want any more pork, earmarks. we want you to keep taxes low. tax reform. keep it simple. repeal the health-care bill and finance bill. we want congress to get back to working on the constitutional ways. this is craziness that went on. how about reading of bil a bill?

we did. they said read the bill? what are you talking about? it is all just craziness. somebody put something in the water. [laughter] national security. it is a big deal. we do not feel safe. we do not feel safe with our money. we do not feel safe with our security. our borders. we of terrorism going on. when of terrorism with our money. -- we have terrorism with our money. we went to algor builcreate a nd of communicating. and it is important that the people we send up here stay connected to those of us back home.

we also want you to check on the regulatory agencies, make sure we know what they are doing. we did not trust the epa, the department of energy, any of the bureaucracies. there is a huge level of stress going on. we will stick connected. there is no big organization, no big leader or board that tells us what to do. we like it that way. we have done a pretty good job without being managed from the top down. one thing we are doing, and this is florida. the florida groups -- how do we communicate? we google. we were divided. we were divided when we had our governor's race as to the gop candidates or the tea party candidate. we came together and we said we're going to get behind mr.

scott and we did and he won. in florida we decided we will create our own organization so that whenever we want to talk to marco and our governor, they will hear from all of us as a coalition. it will be a coalition of tea party. we are organizing in a little way, but not top down. we are encouraging people to run for office. we will fight the liberals. we will focus on education. ithese are little things. we will use technology. and we will broaden our base by using other organizations. we use heritage last year. we love heritage.

other organizations that helped us, liberty central helped us understand the issues that were going on. we have a lot of partners out there. and i know i am talking too much. the other thing we want to focus on is the media. they probably will not like me for saying that, but the media really did not tell the truth. not all of the media, but there were a lot of lies out there. the people in the grassroots movement knew it. we want the media to be held accountable as we move through the process. are we going away? no. do we know what we're going to do? no. but we didn't, and we won. [applause] thank you very much. >> first off, i want to tahnhan

heritage for inviting me share. this has been an amazing couple of years. mostly because it really reinforces the special nature of american politics. it is incredibly dynamics. american politics are incredibly dynamic. sometimes we forget that because we operate with a paradigm of a two-party system. in most cycles this tends to cover most of the basis. with some people they feel the two-party system is constructed and does not allow for honest grass-roots movements. the last two years proved that. i think the american system is healthy and really worked in the last two years.

you had a mass of people who were very dissatisfied with not just the way washington was working, not just the way the economy was working, but the options that were being offered by both political parties. instead of checking out of the system, instead of staying home and being silent, what you had was a nationwide movement of people. it was really started by -- inspired by a two-minute rant on nbc. it energize people to go out and demonstrate -- it energized people to go out and demonstrate and demand change. i have been on the side of being part of that, of watching it in writing about it.

incredible movement. it is really like iunlike anythg i have seen since 1978 in california when the tax revolt began. and that was a grass-roots- fueled citizen movement to increase tax rates in california. it was on a specific issue, but it with a grass fire that went across the nation. it said not every solution should involve taking more of our money. in some ways it is very similar to what we've seen but thwiththa party. i think you have to look at the proposition 13 fight in 1978. that is really an analogy. that was not a moveon.org type

of organization. there was an organization that formed in created organization thought got people out in the street. the people went out in the street first and then u.s. leaders that emerged. provincial you have ronald reagan and republicans in the 1980's. -- eventually you had that ronald reagan and republicans in the 1980's. it did peter out when we got othe idea that thae era of big government was over. then people got comfortable. the anti-tax movement, which was an insurgency, became part of the establishment, became part of point in but what we didn't

-- became part of what we didn. this is the same type of dynamic. you are seeing people get out in the street and looking for leadership. they are not going out in the street because people told them to go out into the street. they are not going into the street because someone created an organization that had a nice website and was pushing back against an unpopular congress. this was a populist revolt in the clear sense of the word. without organization -- obviously there will be some limitations, i will not even sit limitations. there will be some issues that the movement has to overcome, organization being one of them.

it is very easy with a grass- roots movement to simply peter out. especially after an election. this was an extraordinary set of circumstances. you had an extraordinary economic upheaval. a congress that absolutely refuse to listen to the people that sent them to washington. in such an arrogant manner that i am not sure that even has a parallel. it was an incredibly arrogant congress. at the same time you had this encroaching regulation that was being part of that arrogance. all of those things tend to motivate people into action. now what you have is a republican congress, at least a republican house, that will be able to address some of the spending issues. hopefully as a consequence we

will see economic improvement. hopefully we will see a reduction in the regulatory environment. the question is, how much success will it take to take the steam out of the tea party movement, if you can? success may be the big issue here. let's say the republicans get into congress and do not do what they promised, do not slowed down the regulatory expansion, spending the -- i do not think there is much of a chance of that with the people we elected. john painteboehner will force ud alona stand-alone issue on whatl be the debt load. it will be very easy for the tea

party to maintain momentum, but also grow momentum. once again you have more arrogance, people who are not willing to listen. the question for the tea party in the next year will be as the tea party succeeds, how you keep the momentum moving and build on success and how you keep people like billie who has sunk an incredible amount of sacrifice and to this movement, how you keep folks in the movements and working and sacrificing like that as we succeed? i think that really is going to be the big question in the next couple of years. [applause] >> i want to thank you, mike, and everyone at heritage for inviting me to speak. i hope i have a little bit to

add after that. just before the election i gave a speech at the federalist society. the deal was for me to talk about some of the candidates i have met during covering the campaign. i talk about what i thought was are really high-quality level of a number of republican candidates. it was a very good class. these were people who were successful in their private lives. they had never thought about running for office, many of them, until the spring and summer of 2009 when they watched barack obama and the democratic leadership in congress to enact one enormous government initiative after another. they each came around to the idea of running and they aspired to be citizen-legislators. they did not want to be professional politicians. it was a touching story that i told, except the three guys that i've focused on all lost. -- that i focused on all lost.

rob steele who ran a good race against john dingell in michigan. the last was a man named john dennis who challenged nancy pelosi. after i did the speech i went back out and did the final trip for the campaign and went to illinois, wisconsin, and ended up in nevada. i think the most impressive person i saw during that trip was a man named ron johnson, the senator elected from wisconsin. very happy in his life as ceo of a plastics manufacturing company. never thought of our running for anything. is appalled by what happens in the first months of 2009 and invited to speak at a tea party rally in oshkosh where he lives.

after he speaks people come up to them and ask them why don't you run? he began to think about it. after a lot of thought he gets in the race and runs on an admirably simple platform. everywhere he goes he says i only had two things in my platform, i want to repeal obama care and reduce the size and scope of the federal government. obviously he will have to do other things when he gets here, but was an admirably simple platform. he is a very serious guy and is going to do what he said he is going to do. i would expect that he will devote a lot of his energies to repealing obama care. the question would be what would be the tea party's role in

policing ron johnson? the bigger question is a are all of the republican candidates going to be that way? the one thing we heard the most was we have learned our lesson. we really have learned our lesson. we're so sorry we strayed from conservative ways, but if you elect us again, we probably will not do it again. -- we promised we will not do it again. i give them some credit for that. i think some of them have learned their lesson. it seems to me they have gone about their business in a pretty sober way. i think the question for the tea party is the future of the party is in the hands of the congress. what if republicans really have learned their lessons?

what if they've performed admirably over the next -- they perform admirably over the next two years? try to bring federal stimulus back to pre-tarp budgets? i think if that happens, a lot of the passion with saul and te saw in the tea party rallies will dissipate. i think their actions will be seriously constrained by an energetic house of representatives, if that is what the republican leadership of the house chooses to do. i suspect that if republicans

perform well, we will see a dissipation of the energy that took place, which will be compounded by the beginnings of a 2012 presidential race. there is no clear, single person that every tea partier would get behind. i think it will disappoindissipe of the energy as well. and there are born to be performance monitors. they will keep their eye on everyone. i suspect that will take place, but i think you may have a situation where the success of the tea party creates a little dissipation and their energy. thanks. [applause] >> now we can go to some questions. i thought i would start off by asking billie, in terms of

expectations, how do you think the two-parea party support woud define congress and the next few years? where would they set the bar? >> we certainly want them to look at the health care bill. we want to see that actually take place. we want to see limited government. we do not want them intruding into our lives. we want our taxes to be less than what they are and what they're going to be. we want to see them do the things they said they were going to do. and we want them to fix the mess we're in financially. we are in a pickle. there is an article that i wanted to read. we have passed a milestone that is negative beyond the pale.

the u.s. now has exceeded this level. they have work to do. we are scared out there in america, and we want this congress to fix this mess. we will see if they are successful if they can fix that. >> questions from the audience. yes, sir. everyone identified themselves. >> [inaudible] if you look at the last 100 years of government, it is hard to argue that congress alone can't solve the problem, because we have periods where conservatives may be in charge and where liberals are in charge. where is this tea party

movement on the the idea of constitutional reform? this is a question for anybody. where do think the people are on the idea that we need a constitutional reform if we are going to permit -- permanently limit the idea of fiscal responsibility? >> balance the budget is a big deal in the tea party movement. and we want to go back to our constitutional foundation. the big government is not working for us out there. we want to go back to where we used to be at some point in our history. you know more than we do. we're not exports. but we know it has to go back to wehrwhere it was. >> i do not necessarily think you have of a balanced budget

amendment to have a balanced budget. the problem is congress. congress writes the budget. they are responsible for writing the budget. they are not going to balance the budget or lower debt just because there is a constitutional amendment to balance it out. it will just keep raising taxes. it is more incumbent on american voters to send people to congress that will spend less. he raised some very good questions, because a lot of the spending right now is automatically triggered. a key part of this will have to be entitlement reform. we will have to fix or replace social security and medicare. until you do those things, i am not sure a balanced budget amendment is going to address the actual problem. you can balance the budget and still exploit it.

>> i think if you did a poll of supporters, they would favor a balanced budget amendment. i think that they would be happy just to see significant progress in this area, because if you talk about some hazy, lovely time in the past where things were better 2007 might be a place to start. in 2010 that total federal expenditures are 3.7 trillion dollars. prior to 2007 the glut may be 100 billion per year. -- they go up maybe 100 billion per year. if i could say one thing in semi-defense of republicans, if the economic conditions that pre-date tarp and stimulus of

existed, i doubt many of them would have very passionate about being tea parties. -- tea partiers. the federal deficit is $160 billion. things were not nearly as bad. that is why i think the republicans got all lot of mileage by saying if we can just go back to 2008 spending levels. balancing the budget is certainly of gold, but making it better is probably something that would really satisfy most two-parea party activists. to>> you both talk about success

dissipating in the movement. i thought opposite. i think that tea party members usually look -- term. -- usually look long-term. i was wondering if success would help create the long-term of more conservative-leaning of the republican party if they could do some of the stuff you just talked about. >> first of all, there are zillions of ways for republicans to fail, some of which we do not even know about. [laughter] i was actually serious. if they fail to reduce spending, in other words, if they keep to their ways, and like i said, their old ways are not nearly as bad, if they keep

to those ways, i think the tea party -- there is a serious decision to make. there are other issues that the tea party is much less clear about. obviously the president conducts foreign policy, but if there is an enormous foreign policy issue that arises in the next couple of years, what is the tea party's position? what is the tea party's position on afghanistan right now? they have been extremely focused on budget, and not as much on the entire spectrum of issues that face government leaders. >> i want to disagree a little bit with that. and people tend to think of the tea party as focus on fiscal issues. that is really what brought people together.

but because of my background and leadership i always found out that there will be one thing -- how many of you are in relationships? right, and when you are in a fight with somebody in a relationship, it always starts with a surface issue. what you have to do is dig deep to find out the real issue, the one we do not want to talk about. that is what happened with the tea party movement. we started with the monetary issue, but the more we work together, the more we found out it was a deeper issue in our country. the deeper issues we have in our country is one word, and it is corruption. that is it. we have been out there working, we have been out there doing our job and sending our money to washington, and the political class corrupted our money. that is the issue that is going on in this country.

to>> the issues you're talking about, dustin, armonk-tee long-m issues. repealing obama care is not something will happen in the next congress because it cannot happen. when she is talking about with corruption can also be talked about in terms of trust. the reason you had depth tea the tea party erupts because of trust. good start counting. i think that is something that we need to make sure we acknowledge. if you have republican congress that starts working on rolling back obama care, serious

entitlement reform, serious structural changes to the budget, including the budget process, i think that is a good start and people will reward them for that. >> our country was founded on a good start. it started with a tax on tea, but the reality was taking our freedom from us. that is the same exact thing that is happening in our country again. >> [unintelligible] my question is it is very easy to win an election -- >> really? [laughter] >> ross perot did this 15 or 20 years ago. newt gingrich did this 12 years ago. the point you are trying to make is many organizations in washington who are fighting for reform but did not happen.

the people that are reflected in congress --[inaudible] i am from pakistan. we have like 50%. here it is very different. you did not have that type of corruption. my question is, i am republican. one person said we should defeat a congressman because he is muslim. if this is the substance of the party -- >> it is not the substance of the party. at the start represent the tea party -- it does not represent the tea party movement in america. if somebody said that, shame on them. [applause]

>> jeff fox were the, you know what you are a republican when you threaten the life of jim demint. i wanted to get the panel's call on the conventional wisdom in the establishment circles that the two-parea party cost the republicans the majority in the senate. >> they would of had to completely run the table to win. it was theoretically possible. i do not think it was realistically possible. i think what you had was the tea party. a former senator explained this to me, and i think he is right. you had existing candidates and existing politicians who latched onto the tea party because they

thought it could get them support that they cannot have. christine o'donnell had run to for office before. neither was a good candidates. ron johnson is a more pure tea party candidates in the fact that he had never thought about running and that is because he saw the energy and concern that he began to think about it. to me, candidates quality mattered more than anything. there were a couple of races that republicans may be could have picked up that they did not, but if you look at nevada, for example, i was out there and i got the sense that angle was going to win by a tiny amount, and that was wrong. if you look at the three finalists, i do not think any of

them would have been a great candidate, nor would they have been carriharry reid. >> the gop never offers poor- quality candidates. and [laughter] got that stuck in my throat. sorry. billie knows that better than anybody. athe whole establishment got behind charlie crist. he was a terrible candidates. there will always be candidates to fall short. -- who fall short. just to give you a perspective on the actual idea what happened, in 1974 after watergate, when the republican party had to go to a midterm election three months after

their president had to resign on national television and then gerald ford pardoned him after that, the democrats picked up 49 seats in the house and three seats in the senate. granted they were the majority. this was a fairly-monumental win. you can go to any election and say that there were poor candidates in good candidates and that election cycle, and i think when you take a look at the totality of what happened on tuesday, you cannot walk away saying somehow the tea party costs as something. you can quibble about nevada or delaware, but with although tea out the tea party we would not be having this discussion. >> i would like to save the gop cost us some races.

-- i would like to say the gop cost the summary says. [laughter] i had to go home and tell my dad that. i thought he would throw me out of the house. i supported republicans my entire life, but i am a tea party person now. there were many states where we heard the stories. we talked. it there were some -- there were some goper's that would not get behind the party. you do not want to make hazmat and florida. when mama ain't happy, ain't no bodbdyody happy.

they could have taken more seats had to work with the tea party and the local races. >> i think other countries are looking very rigid were very interested with what will happen in congress. -- i think other countries are very interested with what will happen in congress. you give the long list of guidelines. had there been any discussions on the ground about the issue of dissipation, whether you can keep the momentum going? also, the relationship with the gop going forward. what about 2012, the presidential race -- have there been any discussions on the ground about this? to go where it after the election that everyone might go away. -- >> we were read after the

election that everyone might go away. but we all have our individual sites and we are all reporting people are still joining. we're still steer. -- here. >> your relationship with the gop going forward. >> we love the gop. it will be one of cooperation and working with them we are here. if they do not call us, we will call them. we have people better already starting to get out there in america. we have that all kinds ohad alld teams reaching out to us. we're waiting to see who the candidates are. we will be part of the 2012

election. >> there has been a lot of analysis and talk about the ability of the tea party candidates who are now in congress to govern, and a lot of analysts are saying we're just looking at gridlock. what is your take on this two- ea party block in congress? >> i did many of them would be gridlock as progress. [laughter] a lot of the platform was negative. it was to repeal obama care and stop doing what the administration had been doing. they certainly believe if they can get a handle on spending, make sure tax cuts are extended that they can make a difference

and bring around jobs. we will see what happens on that score. i sthink if they see leadership working hard and passing things in keeping up with issues, if not all of them get through the senate, they will understand that. they understand the way the system works. the question is will house republicans be working hard on their issues? >> if you go to heritage.org you will find a checklist that will hopefully guide the next congress. it involves appealing -- repealing obama care, and reining in government, mostly on the regulatory side.

you can go to heritage.org to see the details. >> all three of you have mentioned that in order to have a niche of reform, we need to cut back on entitlements. if they are the motivation, the courage, and the desire to go into that fight to cut social security, medicare, and all of those programs? >> yes, and we have had discussions about that, because we know it is a problem. again, the american people are smart, and the tea party members are smart. we know we cannot do away with spending without looking at the entitlement programs. the word we do not like is to say that social security is entitlement. people are sick of that, and it want that changed. they paid into a system that was set up by this government, again, sort of like this health

care. it was not entitlement. the problem is corruption happened and it did not do with the money what they were supposed to do with the money. we are willing to work on that issue, but we're not willing to give it all up because they screwed it up. does that make sense? when it comes to entitlements for people that are not willing to work, absolutely we're willing to talk about that as well. there are a lot of good people that can get to work, but they are on the dole of the government, and we cannot have that. we're willing to negotiate. we're going to take care of the people that paid into the system. i have an 85-year-old mother in law that paid into the system and she will get out what she is entitled to. she is willing to the of a little, and not everything for people who are unwilling to work. -- she is willing to give up a

little, but not everything for people who are unwilling to work. >> medicare is an utter disaster just waiting to happen. adding obama care to it made it even worse. you cannot get around that. it will be a measure of the seriousness of the people we just sent to washington whether or not they will address that. people like paul ryan who are willing to address it in stark realistic terms. people were willing to talk about what you actually need to do to restructure the system, otherwise it will -- go to heritage.org for the list -- but otherwise it will eat up trillions and trillions of dollars. everyone knows that.

that was not sort of wisdom i got off the internet. every single person in this town knows that precisely. whether they're willing to do something about it or not will be a function of people holding them accountable. >> there was a debate as they drafted their pledge to americans about what to include about entitlement spending. it did not end up being in. my guess is you will not see any serious action on entitlement reform. >> we have time for one last question, and we will go to the very back. >> a question about 2012, the presidential candidates. will the gop and tea party candidates be behind the same candidates? >> i cannot speak to that.

it depends on who the gop gives us. >> i agree. it depends on the candidates. i think there will be a number of interesting candidates, that we've seen before. i think you will see fresh faces come out. >> [inaudible] [laughter] >> i will ask two questions, who do like in the 2012 field -- who do you like in the 2012 field? . .

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for some, our discussion maybe eye opening. while for others, it maybe an opportunity to spell some of the many myths and misunderstandings about the aging driver. but even more significantly, this forum likely represents a collaborative launching point towards improved highway safety for us all. now for a few housekeeping items. as a reminder please silence your cell cell phones and famile yourself with the emergency exit that is are available in the front of the room or behind you. we welcome the public to view the forum, both those in the audience, and those viewing via webcast on the ntsb web site. companies of the agenda are available outside the board room and the information of the participates and descriptions of the parties is also posted on the safety board's web site.

so we've invited 20 panelist and over a dozen organizations to take part in this forum. notably, there are more organizations participating as parties that is typical at an accident hearing. this stems from our desire to fully air the range of voices on the topic. i urge you to work through your spokesperson and rotate the spokesperson as we move through the panels. you will find question cards on your tables. you can pass your questions to the spokesperson on those question cards. because we have such a full agenda, we appreciate your cooperation in helping us keep on schedule. and ask that panelist respect time limits and keep discussions focused on the subject at hand rather than slip into topics covered by other panels. we recognize that all stakeholders are not represented in person at this forum. because it was not possible to

accommodate everyone who wanted to participate, those individuals and organizations who wish to submit written comments may do so until november 30th, 2010. finally, i'd like to take a moment to thank the ntsb staff for their efforts in organizationing and preparing for this forum. undertaking of this scope do not simply happen. they are the end product of many months of long hours of meticulous preparation and planning. thank you to the staff for your hard work and dedication. in particular, i'd like to recognize the technical staff who made the forum possible. dr. deb bruce, dr. molloy, and janice colins, dr. mitch garber, dr. ivan chung, and dr. poland,

steve and dave from the office of communications. we also have some excellent technical and administrative support by avis clark, michelle hall, robert turner, and bridget. with all of that, we are ready to begin. we will begin with the first panel on safety, data, assessment, on transportation risk and aging. we will begin with the metrics to help qualify what we know about the risk of aging drivers. because past forecasts that have projected an increase in accidents and injuries associated with aging drivers has not materialized, we would like to understand why. this panel will examine the demographics of the u.s. population, at fault accident rates by age, the injury data

for drivers, passengers, and pedestrians, the discussion will factor in consideration of exposure measures, such as the number of licensed drivers, active drivers, and trips or trip miles traveled by age group. we will also discuss how crashes differentially affect aging travelers. my colleagues here at the safety board, dr. deb bruce, and dr. braver have organized the panel. dr. bruce, would you please introduce the panelist? >> first, i'd like to introduce the four panelist. then we'll return to the comments. ann mccartt from the insurance institute is the senior vice president. dr. mccartt recently co-authored a study with dr. chung in 2010. we've asked her to talk about some of those findings today.

we received her b.a. from duke and doctorate from the state university of new york at albany. our second panelist, dr. sandra rosenbloom is a professor of womens studies at the university of arizona. she directed the roy b. drakeman institute, a research and public service unit of the university from 1990 to 2004. dr. rosenbloom has a masters in public policy and a phd from california. dr. bonnie dobbs is at the centering for disease control. she's a professor in the faculty of medicine and dennist --

dentistry. she has a phd from medicine from the university in alberto. ann dellinger is at the centers for disease control and prevention. the center he's affiliated is the national center for injury prevention and control. dr. dellinger conducts research in safety focusing on older drivers, occupant, and injury risk behavior. dr. dellinger received her bs in biology from the university in san diego, her masters degree from the graduate school of public health at san diego university, and her doctorate in epidemiology from the university of california at los angeles.

we've asked each of you to get started this morning in summary remarks in your area of expertise. we'd like to take about 20 minutes to cover that. i'll help us do that by sort of stepping in and introducing the next topic as we go along. dr. mccartt, would you begin by talking to us about the trends and limitations of safety data and within that context, tell us what we know about the safety of drivers, 70, 80, and 90 years old? [inaudible comment] >> anne anne -- there's a green light. that's it. >> the crash rate beginning to increase at age 70. this is true for fatal crashes and for crashes of all severity. as we've heard and know, the population of people 70 and

older is increases, and is supposed to increase dramatically soon. by 2040, it will have doubled. when we look at the percent of the population with licenses, if we look at middle age drivers, we can see for about the last decade, that percent has been pretty stable. when we look at older drivers, these are three, 70, 79, 80 and older, you can see very dramatic increases and the percentage of people holding on to the licenses, the oldest drivers 80 and older. when you put the things together, when we expected to see when we look at crash test of older people was an increase, in fact, weave seen just the -- we've seen just the opposite. when we look at crash tests from 1975 and forward, after a study, they peaked in 1997.

then they've been coming down and coming down very strongly. two points that i want to make about fatal crashes of older drivers, first, most older drivers involved in fatal crashes are driving a passenger vehicle as opposed to more and more younger people driving a motorcycle, for example. and in a fatal crash involving the older driver, the people who die are primarily either the driver, the older driver, or the older driver passengers, who also tend to be older. we wanted to look at the trends. first the fatal crash license for licensed driver. we looked at the middle age group for comparison. you can see for this group in the last couple of years, their fatal crash rate has some down. when you look at the older driver trends, you can see again, especially for the oldest driver, a very dramatic decline. so for drivers 80 and older, the

crash rate has come down by half. we had two questions. after the initial study, one was two things could explain this. one is that older drivers might be getting into fewer crashes. and the second thing that might explain is it maybe they are also doing better at surviving crashes when they are in one. so we turn to the best data that we could find to look at nonfatal crashes. we weren't able to do that using the national databases. we went to 13 states database, when looked at the prolicensed crash rate, these are nonfatal. we did see a decline. again, when we look at the older drivers, their decline was larger. when we look at property damage on the crashes, these are the middle age drivers.

their crash rate went up a little. we look at older drivers, there's rates for down. so the answer to the first question is, yes. the crash risk overall for older drivers has come down. to look at the second question the survivorrability, we again look to these 13 states and we measured survivorrability in the terms of the percent of older drivers who died in a crash and compared them to middle age drivers. these are the middle age drivers, slight increase in the percent who died in a crash. looking at older drivers, down. so the answer to the second question is, yes, there are less -- there are crash risk has gone down. when they are in a crash, older drivers are less likely to die. and a stronger way than compared to middle age drivers. we can -- i think in the questions we'll talk more about this. we can't -- we don't have good explanations yet for this.

these are some of the high pot sis -- hypothesis that we have. there maybe indication that that is the case, older drivers are healthier and better physical condition, emergency medical and services may have proved -- have improved especially for older drivers. we think there's probably some travel patterns, looking at the latest national travel survey, older drivers are driving more in the aggregate, and also on average. and we know for drivers of any age, drivers who don't drive a lot of miles have higher crash rates. we think either the quantity of the patterns of driving may help explain some of this. finally, it maybe that we know that roller drivers tend to self-regulate. at least some of them. if they are doing this, if there's an increase in the self-regulation, that might point to some answers.

and then finally, just a last point, again, i think we'll talk about this in the questions, there are some really important limitations in trying to take a look at understanding why older driver crashes are down. we don't have, as i said, a good national sample of nonfatal crashes that would allow us to look in detail at the crashes of older drivers. we don't have perfect licensing data. we know they maybe critically problematic for older drivers when the state has a pretty long renewal period. it may be that the numbers may over estimate how many older drivers are licensed. finally, as i indicated, we do have a national household travel survey.

the sample is still being weighted, but we only have these surveys every few years. they could be more detailed than they are. and, you know, i certainly would like to make the point that's really important exposure measure for any age group, but maybe especially for older drivers is their travel patterns. thank you. >> thank you, dr. mccartt. our next panelist, dr. rosenbloom, what do we know about whether older people live and how that affects their travel patterns? [inaudible] >> now i have two mics. and soon will electrocute myself. about 75% of older people either live in suburban or rural areas nationally. but they are over represented, for example, in rural areas where you could have -- we're

talking about one in five drivers might be over 65 nationally. but it may well be 40, 50% in some rural areas. and folks as old as 80, 85, 90 can still be driving. that's their only option. one the issues is if folks are living in low density areas, their alternatives to driving is this. there's significant differences between women and men. women are substantially more likely, women over 65 to live alone. so they have no other driver in the house when they start to have problems. they are significantly less likely to have financial resources, to allow them to purchase services or alternatives, have goods delivered to them when they no longer feel safe in driving. we know that older women generally seize driving much before older men because they don't feel comfortable, it's

often not some kind of sharp medical reason or because they've had a crash, but because they don't feel confident. but at the same time, we know that over the last three or four decades, older people have been driving longer, they have longer trips, they make more trips, and the folks who have driven their whole lives will not have made the kinds of -- will have made the kinds of life decisions about where to live and so forth, based on the convenience and access and flexibility of the private car. it's hard to see how we can substitute for that. so there's a tremendous tension between mobility and safety. i know we are focusing largely on safety. i think we have to deal with the fact that a lot of people will keep driving, maybe when they no longer want to, or when they are no longer safety because they simply have no other alternatives. it's very common, i speak on this a lot, that someone will

get up in the audience and say, well, my mother won't have any problem when she stops driving. she'll use one the community resources available to her. later on in our discussions, if we have time, i have some slides that show how unlikely thereby enough community resources to deal with the vast number of older people who might want to cease or reduce driving. the resources aren't there. if we want to talk about safety, one the things we have to talk about is how to provide mobility for people that want to stop driving or should stop driving. in addition, i think there are important issues about self-regulation, but they -- we have tremendous evidence that older drivers in particularly, women self-regular -- self-regulate. self-regulating can impact your quality of life and your mobility. it's one thing to make three

right turns instead of making a left turn. that doesn't have a lot of impact on your life. it's quite another to avoid all congestioned areas, to avoid driving in the morning peak, the noon peak, or the evening peak, it's quite another to avoid certain brutes or so forth. :

>> one of the things we know is once they retire they tend to make longer nonwork trips than younger people. we think that because you remove the constraint of having to shop or take care of activities near your work location, once you're freed from those, older people are interested in going to different places to shop and different places for socializing. i think these patterns interact with safety issues in a profound way, so what i want to leave the panel with is you cannot address safety issues independent from how people live their lives and where they are living, and we have to deal with them both. mobility and safety are two sides of the same coin and often we are forcing older people to choose between them, and that's not acceptable. thank you. >> thank you. next return to dr. bonnie

dobbs. we asked you to help us understand aging from the driver's point of view and for that matter, the traveler's point of view. what are the special mobility considerations for an aging population? >> thank you, deborah. i want to talk about an inte greated -- an integrated approach. the approach has relevance to the older driver population in terms of enhancement in safety and mobility. the framework is relevant to the topics i'll address today and that is what the abilities necessary for driving, the impact of medical conditions, and premature driving sensation. the framework that is on the overhead is the focus integrated approach that i used as my

approach to research, and the three pillars is how do we identify older people, drivers in general who are at risk because of red call condition -- medical conditions, and once we've identified them, how do we assess them for driving competency, and final though who are determined not to be safe to drive, how do we support those individuals? i'm going to spend a brief moment on the three pillars. in terms of identification, we know the changes associated with normal aging are unlikely to affect a person's ability to drive, but an illness plays a critical role, and that's important for the older driver population because of the age association of many illnesses such as dementia. because of the privilege of --

prevalence of medical conditions, it seems we need broad involvement of the medical community, law enforcement community, the individual, the families and friends, the community at large, and certainly licing authority -- licensing authorities. to assist the communities, we need evidence-based screening tools, and we also need a coordinated system, so we need the community, the medical community talking or working with the licensing community, we need individual families coordinating or talking with the medical communities, so we need to develop a more coordinated system. as i mentioned a key component is it's one thing to screen or identify someone who may be at risk, but because of the importance of driving for mobility and independence, we want to ensure that when license is revoked, that the person

really is at risk, and for that reason we need evidence-based standardized protocols, and those protocols are important because what they do is that they protect those who are safe to drive. in other words, ensuring that we're not revoking driving privileges from those who are still competent, but we're also protecting not only the individual, but other road users from those who are unsafe to drive. it's politically unpopular to talk about revocation of driving privileges, but my view is if someone is no longer safe to drive, let's remove their license, but let's support them, and that allows me to talk about a third pillar in terms of support. when i think about support for the medically at risk driver or for any driver, it's in terms of psycho, social, and mobility. we know moving from the driver's

seat to the passenger seat is one of the most difficult transitions that an individual will make. there's a psychological component, and we know from our research that we have to assist the individual and the family with that transition. we have developed evidence-based driving sensation support groups to help people make that transition and help their families. we also know that mobility is critical, and often if you look at mobility in the community, we tend to think of mobility in terms of public transportation, bus, lrt's, and taxis. unfortunately, for the medically impaired driver or the frail older driver, those forms of transportation are simply unacceptable, so our focus has been on developing more responsive alternate models of

transportation to keep people mobile and independent. thank you. >> thank you, dr. dobbs. >> one of the findings from the iihs report that was spoke about concerning the increase fatality risk for the very old driver. what can you tell us about crash involvement? >> thank you. it's a pleasure to be here today and speak about this. i'm going to give you my bottom line message up front, and then i'll explain, and i think that the issue of crash involvement and fragility or frailty is trying to answer the question of responsibility. the main question around the issue of crash involvement or frailty is older drivers have higher crash rates when you take into consideration how much they drive. is this because they truly have

more crashes or is this because they're more likely to be hurt or killed in a crash? then they end up in our data bases and they appear to be more of a problem than they are, or they appear they're a problem, and they're not. that's the issue we're trying to get at. the answer is critical because if you're causing say more than your share of crashes, maybe the safety measure that we need is to take you off the road. in short, you're responsible, but if the answer is that you're just more likely to be hurt, the safety answer might be to improve vehicle safety features or roadway safety features. in short, you're physically frail, you're not responsible. research has investigated the factors affecting crash involvement, and i'll mention a few on the slide here. how much do you drive?

so the low milage bias mentioned, drivers who drive a lot tend to have fewer crashes, and drivers who drive fewer miles tepid to have more -- tend to have more crashes. is this because they're self-restricted to speed on urban roads where there's potential conflicts and crashes or is it because of a reduced driving ability, so they drive the minimum they need to get by? crash involvement may not differentiate between a cause sal action that you've sewn, you've caused a crash, and your responsible or crashes someone else caused, but you couldn't avoid it. factors affecting whether your physical frailty leads to injury or death in a crash include whether you were buckled up, how safe your vehicle was, and what kind of medical care you received. that's a mix of factors that you

have control over, and factors that you have no control over as a driver. part of crash involvement is whether you're a risk to yourself or others on the road or both. researchers have quantified this risk in addition to quantifying the proportion of excess crash involvement that can be explained by fragility or frailty, and i keep using fragility and frailty at the same time and people typically use them interchangeably, it's just interesting that the medical people say frailty and the traffic people say fragility, but from the literature, they normally are used interchangeably, so if general when you whsh in general when you look at the data, there's risk to typically older drivers who are in fragile

health, but the risk is small when you compare it to say teen drivers or young adult drivers. the contribution of frailty to excess crash involvement is interesting to quantify, and in fact the proportion has been estimated at 60-95% of the exceases crash involvement and it's been estimated that half the crash involvement, it's hard at this point to put an exact number on it, but it is a significant portion of the excess crash involvement among older drivers. when you take into consideration frailty and fragility, a low milage bias and maybe the types of roads that older drivers are driving on, it makes a difference in your consideration of how much of the excess crash involvement the responsibility

of the drivers themselves or not. i think i'll stop there. thank you. >> thank you. the way we've structured the format for the panel this morning, we're going to now take an opportunity between dr. braver and myself to ask you questions. i've targeted these questions to individual panelists, but i want to take this opportunity to encourage you all to step in. there is met to be an interactive discussion at this point, and by way of foreshadowing, we'll do the questions to the panelists until 10:20 giving us a half hour to set your time. thank you for the timing on your opening remarks. we really appreciate your respect of the clock. after we do the question and answer from the front of the table, we'll turn it over to the parties, and you will have 50

minutes or so to ask questions. we will help rotate that through the different tables, and again, just to reiterate, we've asked that one person from the table be a spokesperson for that table and that the questions you want to ask you write on the question cards to make the questions sus together when they come around. >> i'll turn to dr. mchart. the earlier studies warning us we were facing an older driver problem and your june 2010 report tells us those drivers are not the drivers we anticipated. what might have changed from the earlier studies to today? >> well, i think that the challenge in this is we can think of lots of things that have changed, but our study for safer vehicles, for example, we

know through research we have done and others have done, we are driving safer vehicles than we used to, but the key in the study is whatever explains our findings is a factor that has affected older drivers more than middle age drivers. you think about vehicles, for example, it's a challenge to look at that, but older drivers tepid to drive -- tend to drive older vehicles. we know they are buckled up, but it has to be the key to answering our questions that comes from our studies are these factors have to be something that affected older drivers much more strongly than middle-aged drivers. you know, i talked about a couple of possibilities. certainly improved health and basically, you know, better physical conditioning of older drivers stands out. how we do the studies to see

whether that's a part of an answer, we're not sure how to do that, and again, i think travel patterns are important. when we get the data from our latest travel survey, again, the preliminary findings show older drivers are driving a lot more overall and on average, but we need to look at beyond just the quantity of driving. we need to know if it's been suggested, for example, we know older drivers tend to have certain kinds of crashes. they tend to crash at intersections and that is particularly high because they tend to drive in more urban areas. has this changed? are they driving on high speed roads that would have a lower crash risk and are safer if you crash? these are the things we want to try to take a look at, but

again, it's very challenging to figure out how to do the studies to come up with the answers, so basically, we're not sure. >> thank you. you eluded to this in your opening comments, but i want a question answer to the question. people worry about older drivers posing a risk to other road users. how do older drivers compare with teenage drivers, those in their 20s and those middle-aged 30-60? >> older drivers do less harm to other road users compared to teens and people in their 20s. >> thank you. >> they are, you know, again, they are mostly a danger to themselves and to their passengers who also tend to be older. >> and then the last of my three questions to you is self-restriction such as limitations for time of day of

travel or avoiding unknown routes appear to be common in older drivers. does this get rid of the excess risk of them being involved in crashes? in other words, does self-restriction solve the right they pose to themselves? >> well, i don't think we have the answer to that question. i think that it leads to a series of other questions. do the right people self-restrict? you know, we're doing a study now that's following older drivers over a five year period asking them about their imperments, physical ability, and their travel patterns. we have a couple questions, but one is does it look like the right people are self-restricting? these are self-reported

impairments, and then to see whether people report increased impairments over time, does that translate to increased self-restricted driving? so i don't, i don't think we know the answer to that question. another thing though i will point out and there may be other people talking about this later is there are state programs, and we looked at one in iowa that have -- that attempt to identify drivers of any age, but especially older drivers who maybe should be restricting their driving. iowa administers a road test and can remove the license, renew the license without restrictions, but some drivers have restrictions. we interviewed drivers in these categories, and we found that the drivers who reported the

greater impairments were the drivers that iowa was identifying for a road test and then getting restrictions. another thing that we found was that the older drivers complied with the restrictions, but they also in general affirmed or strengthened their restrictions the older drivers were also making. there is a lot of evidence that older drivers self-restrict, but whether it's the drivers who should always be self-restricting, i think in the long run that would not totally eliminate the higher crash risk. >> thank you. so, anne, you've been showing a very dramatic increase among drivers who are 80 and older, and you've said these drivers

are driving more than in the past, but i'm also wondering whether this age group might contain a lot of people who are holding on to their licenses because we use licenses for all sorts of purposes at the bank, airports, and so forth, and whether you might have a larger proportion of people in their 80s holding on to their license, but in fact, are not active drivers. is that one possible explanation for that very, very dramatic decline? >> well, i keep pointing to the national household travel survey. there may be other surveys that aren't national that might answer some of those questions, but that's one of the questions i think we could answer when we have travel patterns, although i should point out that survey does not specifically ask if someone is a licensed driver. they ask if they drive, but that is a possibility.

i would guess that would not fully explain the large declines, but, you know, again, without travel, without a good survey with detailed travel data, i don't think we can answer that. >> with a follow-up question, do you expect the national household travel survey when the latest version is available to provide adequate data on the amount of driving and type of driving performed by older drivers? >> well, i'm a researcher, so i'll never say anything is adequate, but i think it would go a long way. for example, talk about the numbers of trips, the length of trips, to some extent the types of roadway circumstances for older drivers, so i think it, i

think it would go a long way. >> it has information on the vehicle being driven for example, but it's a sample. it's a very large sample, but still whether for the very oldest drivers there will be adequate data to look at everything we want to look at by state, for example. in our study i could mention in our study in our models that included the 13 states we controlled, but we did find differences among the 13 states, and so one of the things we'd like to look at more is, you know, whether by state, whether by urban rule, we'd like to look at the geographic component of what we see in crash trends. in a national sample, even a very big national sample quickly becomes problematic when you get down to a state level or, you know, a city level for example.

i wanted to point one more thing out because a couple people have asked about the question of gender in our study. we didn't -- we did a couple studies, but in the second study we didn't specifically look at whether there were differences in men and women in the trends that we saw, so we did take a look at that. my co-author took a look at that, and we found the declines for women were somewhat stronger, but not significantly so, so whatever is explaning these differences is it's not the answer, the answer doesn't seem to lie in differences among the genders. >> thank you very much. that's very interesting. i'm now going to turn this over a deb bruce who's going to ask questions of dr. rossenbloom. >> hi. i can't do this without my glasses. what's that telling us?

where people live dictate their travel patterns, and so the first general question is what do we know about where seniors live, and i'm curious what kinds of knowledge we have about the types of trips they take and where that trip information comes from. >> could i have slide number two? thank you. well, as i suggested, older people live in low density places. these numbers are from the census, and one of the problems with the census is determining what's suburban. you can live 30 miles from downtown houston, downtown tampa, downtown phoenix, and be considered in the central city. these numbers actually underestimate the percentage of older people living at fairly

low densityies, and i invite you to read this chart from left to right because the younger cohorts are very suburban, and they're moving through, and the cohorts behind them are even more suburban, and so what we're seeing as people age in place and they mostly do age in place, the largest percentage of older people live in very low density areas, and some are around a little less than a 4th living in rural areas, so what this means is the car is really the only feasible mobility option in many of these areas, and we have to be looking at -- and people talk about well, what if older people move back to the central city, but that's not what they're doing. let me see chart -- could you put up four please?

this is brookings institute data. the census does not every year figure out a one-year move rate. these are people who moved home, and these are in thousands, not a per percentage. wait a minute, that's not -- well, leave that one up. okay. you can see older people are substantially less likely to move than younger people. they are substantially less likely to move states. they're not moving very far. we think that a lot of movement at older ages is into care facilities. the idea that older folks move from chicago or detroit to tucson or tampa or houston actually they're less likely to do that than they were 20 years ago, it's just that there's so many more older people, so those of us living in the sun belt states, we see older people coming in, but it's a smaller share of the population.

most stay in the home where they were when they were still in the labor force, and what we need to talk about then is talking about mobility and access to ability and walk ability in those communities because as older people encounter difficults with driving or don't feel lie driving, there's few options in those communities. we're seeing people staying in low density communities. in fact, for every person in 2006 and 2007 which is my slide number four, but apparently not this anymore -- there it is. for every -- now remember not very many older people are moving, but for every older person who moves from suburb to central city which may not -- i need to remind you moving to much higher densities, there's two people moving the other direction, so the stories about older folks moving to the downtown of an area and you see

those in the paper sometimes, those are what we call man-bites-dog stories. they are reported on because they are unusual. in fact, older people that do move are going the other way. let me show you something else. could i see number 8? no, it's a map of tucson. there we go. that's it. i'm sorry, this is a really terrible picture, and i'm not sure the colors are going to show up. in the sort of to the left is tucson, arizona, the shaded areas are the city of tucson. the little map that you can't see on top is north of tucson. the map to the side is south of tucson, and those red dots which are hard to see are active adult retirement communities like web,

and inform mall groupings of folks who moved out in trailers. if you can see the red dots, you'll see almost all of these are on the edge of the moe -- metro area. they moved in largely from the snow belt to the sun belt. they didn't -- when they moved out of detroit and chicago and cleveland and came to places like phoenix and tucson and tampa, where they move is to the edge. most older people don't move their aging in place in low density areas, but those who do move particularly out to other states are moving out in the boonnies, and they are moving to communities, many of the communities that have no resources for transportation resources whatsoever.

no bus services, these are people who move when they have a car and don't have it in their mind they won't have a car in the future. >> thank you. i have one more question. i hope it's on a positive note. can you give a urban planning for aging communities? do you have experience with public policies or transit systems that you know of in other countries serving as examples for us? >> well, yeah. i agree with my fellow panelists, public transportation is not generally the answer. traditional public services are not met for older people, but the commuters. they report frequently that they don't, they don't like the vehicles starting before they get to their seats and all the

other inconveniences that the rest of us put up with when we use public transportation. there are some services that have been tried abroad particularly in scandnavia where there is smaller vehicles, and they like them being closer to the driver so if they have a problem, the driver can see they have not made it to their seat and they are rooted to the test destinations that seniors are more interested in. they are successful in europe. they are more expensive, but they're not more expensive than doo-to-door services. can you show me slide 20, please? this is when it comes up, this is i just took some public systems at random, and you may know the americans with

disability act requires public transit operators to provide curb-to-curb services or door-to-door services. i didn't cherry pick these. i was looking to get those sun belt and rust belt cities. the first column is the annual number of trips that are provided by the transit operator in that community in their ada service. if you look at the next column, that's what percentage of the total system ridership of all the services each provider provides, and what percentage are the ada trip, and you'll see it's very small. the highest is miami at 2.4%. looking at the next column you'll see what a one-way pair of transit trip costs. if you take mrs. jones to the

doctor in boston, that costs you $33.21. if you take her to the doctor and bring her home, it's $66.42, and in fact the number for the largest 50 systems in the country is about $37 a one-way trip that explains the 4th column, the total percentage of system costs these ada systems require. miami is spending one out of every four transit dollars to provide these ada services to a very percentage of the total ridership. it means these systems are not very likely to -- this is today, these systems are not very likely to expand. i wonder if i could see my slide 22, please? >> this is a study that i did a

couple years ago for the institute on medicine who was mandated by congress to look at the extent of disability. now, these are not just older people. these are all people who reported to the census that they had a serious disability, and all i did was divide the number of trips by the number of people who might be eligible for those services. in chicago, for example, the average person of any age with a serious self-reported disability got less than one-fifth a trip a year. now, in fact, what happens is the overwhelming number of people eligible for the services never use them at all, and a small number uses them frequently, but the last column call calculates for each system their 2004 costs that was in the previous chart somewhere between $25-$45 a trip in 2008 data.

i said, well, what if the transit operator provided for every person with a serious disability of any age, just provided them with one-round trip a year? you're talking about in atlanta, for example, $290 million a year just to provide people with various disabilities with one trip a month. so these options are not going to be -- these are not realistic options for the large number of older people who are not going to be able to drive. i do think there's public transit options more geared to older people, but i think the answer really is to use the underunittized seats in cars and i'm a big advocate of volunteer driver programs which are much less expensive than these things and are a way to provide services in the low density areas where public transit and

these kinds of services are not going to mix in. thank you. >> thank you very much. this is very interesting, and we really appreciate you covered the questions we were going to ask. i'm going to now move on to ask some questions of bonnie dobbs. i know that you have an expertise with the area of premature driving sensation, giving up driving even if the person drives well. i want to ask a couple questions about it. you know, what evidence is there that safe drivers are misjudging their own skills? >> thank you. >> the issue of determination of driving competency particularly self-determination driving competency is an interesting area, and when i think about the

senior population, it's often -- people think of the older population being homo genius. when i think of people assessing their ability to drive, i think about a framework. if you think about a person's real competency and their perceptions of competency. if you look at the framework on the overhead, there's four cells, and if we look at the combination between real competency and perceptions of competency in the first upper left cell, you can see that there are a group of people that are come percentage tent to drive, and they see themselves

as competent to drive and those individuals will continue to drive and appropriately continue to drive. the next cell in the upper right corner is when individuals do not perceive themselves as being confident to drive or sorry, thanks, deb, sorry, where the individual is no longer competent to drive, but see themselves as competent to drive. in this case, the individual will continue to drive, but that's an inappropriate continuation. in the lower left cell is where the person is competent to drive, but they perceive themselves as incompetent to drive. the likely outcome would be inappropriate driving

cessation. where the person is no longer competent to drive, they recognize they are no longer competent, and there's appropriate driving cessation. house does this -- how does this have relevance? if you look at the first upper left cell, that likely represents the majority of healthy older drivers perceiving themselves as exe tent to drive, and they continue to drive. the upper right cell represents individual with dementia. they perceive themselves to drive, but they are not confident but continue to drive. research indicates if you ask them to rate their driving competency, they likely will overestimate their driving competency such they perceive themselves better to drive than their age-matched individual, so using screening tools in this

population, self-screening tools is not going to be helpful at all. they perceive themselves as competent to drive and will continue to drive. interestingly, the lower left cell where the person is competent to drive, but they perceive themselves as not, that's representative of older females. we know looking at the data older females often engage in premature driving cessation. i think this cell is interesting in that we can do interventions to have them continue or to give them training and increase their perceptions of competency and keep them mobile, and then the ones that appropriately restrict their driving, those are the ones we have to provide alternate transportation for. >> i read something i just wanted to lead you into a quote because i like it so much. how much longer can we expect to

live than we drive? >> thanks, deb. this is research done by foally, and men outlive their driving careers by six years, and females outlive their drives careers by 10 years. >> thank you. so most of us should prepare for the day we will longer drive. >> there is truth in that. >> you have been the cleanup panelists for two rounds in a row. i'd like to turn to you and i thank you for your opening remarks. they were right on. a recent study from cbc shows the annual average costs of traffic accidents are $500 per licensed driver, and older drivers have an average annual cost of $118 per driver. that's such a difference. why are the costs so much less

than licensed older drivers? >> right. if i could explain to the audience what we did in the study, and i think that will make sense. i'm from the injury center at cdc, so you'll understand when i tell you when we do cost studies, and in this one in particular, we added medical cost, medical spending, and productivity losses. what did you lose because you couldn't work? we're less concerned say with property, damage, costs, travel delays, that's not what we're about. we're more about injury prevention, so it's a very conservative cost estimate of motor vehicle crashes in the u.s., so to tell you that first. we estimated $99 billion a year, and to cover that cost because it's a great way to get people's attention, that would mean $500

every licensed driver would have to pay to cover the medical and loss productivity costs of all driver crashes, and it would be fatalities, hospitalizations, and if you visited the emergency department. we captured those cost plus lost productivity. this human capital approach, one thing that it does because of the lost prubility -- productivity, the work part of it, it undervalues children, women, and the elderly. why? because we either don't make any money as children or as women, i'm sorry to say we make less money than a lot of men, so the men's cost will be higher. the $118 per capita for older male drivers was an average, and for older women it was $67, so the difference is here is largely due to the methodology

which takes the medical spending plus the productivity losses, and the productivity losses are a bit skewed i guess. does that make sense? >> yes. >> and also as an aside, deaths usually don't cost as much as hobility decisions, -- on the hospitalizations, so if you die, you're a less cost than if you're in the hospital. >> thank you very much. we're running a little bit low on time here. we want to allow the parties time to ask questions too. i would like to ask the entire panel to make some brief remarks about their recommendations for future research bearing in mind we want to leave time for the parties to ask questions.

since you've been last, you start out first, dr. dellinger. >> okay. one question that might have come up that i think we've discussed were what of risk to other road users and what kind of research in that category do we need and what are the exposure measures? my point there is there's been several studies on risk to other road users by older drivers, teenage drivers, and i'm not sure we need to do that again. the results are fairly consistent, so my answer to that is we probably don't need another study that shows the risk of older drivers to older road users. i think we have that covered. >> thank you. dr. dobbs. >> thank you. i guess when i think about the older driver population and an

area of research that is thoroughly needed is in terms of providing alternate transportation. we know right now there are challenges in providing transportation to seniors, and that's going only to grow over the next two to three decades. when i look at the research that has been done on alternate transportation for seniors, and that's transportation that's outside the traditional public system so bus, taxis, transit, we know that there are a number of organizations in the communities that are providing transportation for seniors, but there are more gaps in that transportation provision than there are strengths, and research that we've done in alberta indicates that in order to build a responsive model that will meet the demands today and in the next two to three decades, we need leadership that

both the local and state and federal level. we need a need for more intersector cooperation for seniors. there's a need for the identification for new funding streams to start building the alternate transportation models needed, and we need implementation of innovative, sustainable models. it's interesting when you look at alternate transportation for seniors, most of the organizations are working tire leslie. they do a lot of work for fund raising providing transportation to seniors at a cost that is acceptable, however, that approach often ends up being a barrier in that they spend most of the time fund raising so they can't afford to provided transportation. i think that when i look at transportation for seniors right now, there's a lack of capacity

building and there's a lack of stainability and research is needed and implementation in order to address those needs. >> thank you. your thoughts dr. mccart on research? >> i have three. first is following on our studies to dig down deeper and look at geographic differences for example to better understand why we're seeing this very positive change. the second would be, and i know you have a panel on this, has to do with vehicles. you know, i think when you look at highway safety, # one of the real amazing things is how much better we were doing in protecting people in crashes, and of course older drivers benefited from that as have other ages, but i think all we

can do to look at the particular issues of older drivers in terms of crash ratings, and a different thing about vehicles are all the new crash avoidance technologies which people are looking at in being promises from preventing crashes from happening at all. it's hard to research on this about how older drivers may either find them confusing or how will they benefit compared to younger drivers? i think that's a promising area, and then finally, i think we need to continue to look at restrictions by states because when there are bad crashes involving an older driver, it's always the first thing to figure out a way to impose restrictions on older drivers, and i think there's still a lot we don't know about visual requirements

or other special restrictions that are placed on older drivers which in the end affect their mobility, so that would be the third area i would suggest. >> thank you very much. dr. rosenbloom, you know, your brief thoughts on directions for future research. >> well, one, i'm very interested in the whole issue of premature driving cessation. i do a lot of work here and abroad, and the whole issue of women, it tends to be women giving up driving earlier than they need to and they have fewer resources to fall back on, and increasingly women are entering their senior years living alone with no family members. i'm interested in that and in the issue whether men and women receive safety messages differently. there seems to be evidence about that and that may be related on how to keep women driving safer

longer and men who are unsafe to stop driving. we need to look at the range of how women who are likely to accept rides from other family members and friends and people in the neighborhood so i'm interested in seeing what kind of alternatives might be more appropriate. it may be that the systems that we look at will be very gender based because women will be willing to look at options that men aren't. i think we need to be looking at that, and i want to disagree a little with dr. dobbs. i'm not sure we need a lot of research about why things are expensive. they are. i think what we ought to be looking at is how we can develop a package of options including people moving to facilities that serve them better. i don't necessarily mean assisted living or nursing homes, but find a way for people

to live in their own neighborhoods, for example, but not in the same 2500 square foot house they lived in when they were in the work force. >> thank you very much. this has been a very interesting set of presentations and questions, and this is going to continue. i'll turn this over to the chairman to work with the parties. >> wow, this is great, and you certainly helped me understand my parents better by explaning what to give up when. would you like a short break? okay. we'll move to the parties, and we're going to just go in a round-robin and allow each of the tails to do questions. we'll begin.

>> good morning, and thank you for the presentations, all very interesting. looks like we have a couple questions here. question for you, dr. mchartt. you thought the national data bases were not sufficient for answering these questions. are there other data bases in other countries or insurance data bases or others that would be useful that we should look to for comparisons? >> well, i have to say i'm not really familiar so much with data bases in other countries. we do, as yo know, we have a sister agency, the highway loss data institute, and we get claims data for something like 85% of the insurers, and we do studies looking at older driver trends using this data. the difficulty, the limitations to the data are that they, it's

a huge data base, huge sample size, but not a lot is known about the circumstances of the crashes so without doing a special study, there's no issues that can't be studied very well, but it is, it is a data base that we use. >> okay. do we continue with our table? >> sure. go ahead. >> thanks. this is a question from john king on the national institute of aging. pardon me, my throat is a little sore. what's the best estimate of premanyture driving cessation in older driving given just the cost of transportation and goods and services to older adults in their homes? should i repeat that? [laughter] >> well, if that's directed to me, i don't know what the dollar costs are, but i think if

someone prematurely stops driving, they probably don't qualify for most of those community-based services. you have to be fairly significantly disabled to qualify for ada service, and i think it's hard to quantify the social isolation and the lack of interaction, and i think there's a lot of evidence that those kinds of symptoms lead to earlier to morbidity and i think it's tragic, but i don't know that anybody can put a dollar figure on it. >> thanks. how do the demographic changes related to people staying in the labor force longer affect older driver issues. that's not addressed to anyone, so if anyonements to take that -- anyone wants to take that one? staying in the work force

longer. >> well, actually it's women staying in the labor force longer, so i don't know. presumably they'll keep their driver's licenses if they have to keep working and don't have any alternatives, but i think that's an interesting question, but one that i don't know that anyone has done in the research on. >> we've got one last question. someone, and i don't remember which panelist it was that seat belt usage rates for older drivers is perhaps different. how does it compare to the average age driver if you will, and then secondly, does seat belt use rate change for drivers who are under restrictions? restrightded driver -- restricted drivers? >> my understanding -- i may have mentioned that, but if i did, that's not what i meant to say. i don't think the belt use for older drivers is problematic

compared to younger driver, and i don't know about belt use and how restricted drivers, how that relates to restricted drivers. i wanted to follow-up on the insurance data base. i should have mentioned that. when we did our study, we did in our discussion to the paper, we do talk about when you look at trends in the insurer claims data base, they aren't seeing the lower -- they're not seeing the decline in claims rates for older drivers compared to younger drivers. there are some differences. their data really relates to newer vehicles, and these are crashes reported to insurers not police-reported crashes, so those are two different reporting systems. it is different, and we tried to figure out why that might be, and we're not sure why.

i should mention that that it does present not as positive findings you might say for older drivers relative to younger drivers, and these are crashes of all severities, and the data are dominated by very low severity, noninjury crashes. >> could i address the issue of restricted driving? the issue of restricted licensing is interesting in that i think most often it's predicated on the issue that mobility is central to our mobility and indpeps, and -- independence and restrictions in driving are necessary for some segments of the older population like visual impairments today time only -- daytime only makes sense, but they are extended to individuals with cognitive impairments, and

in those instances, it's inappropriate. my analogy would be we wouldn't think about letting an alcohol impaired driving drive within a 5 kilometer radius of their home or let an alcoholic impaired driver drive within 10 and 2 in the afternoon, and that's what we doing to an individual with a cognitive impaired individual. the difference between the two is the alcohol impaired driver may sobber up, and the cognitively impaired driver won't. i think the reason that the restricted licensing looks so attractive is because of the awful inadequacy of alternate transportation to allow these people to stay mobile. i prefer we put our efforts

towards developing responsive models of transportation to keep these people mobile as opposed to using something like a restricted license and keeping our fingers crossed that they're not going to crash. >> that's all ours. >> thank you. we'll move to the back table. do you have an appointed spokesperson? please, go ahead. >> good morning, and thank you. at our table our first question has to do with again the premature cessation of driving, and are there other sources of premature cessation and ideas on addressing these? things like doctor orders to stop driving that may not really be sub substan united. >> in terms of the medical

community, to my knowledge, there are no data that indicate what the prevalence is in terms of doctors advising those in department of vehicles of driving cessation when it's inappropriate, however, i suspect that does occur. what that suggests is that we need to provide the medical community with better tools to help them identify people who may be at risk and then we have to do a better job of implementing the protocols that allow the person to be referred to or assessed in the motor vehicles or through an evidence-based driving assessment to ensure that when physicians do identify people as at risk, that they are aseesed using evidence-based protocols, and that we're revoking privileges of those people who

are unsafe, but leaving those people who are safe still on the road. .. where they have the men who went through raise themselves before the program as good drivers and after the program has good drivers. the women rated themselves worse

before and better after, and what seems to be occurring is that women are getting -- are seeing okay, this is what good driving is and i'm doing it, so i feel better now. so why can't that we need to be looking at, in terms of premature driving -- if we can get some evidence based things that tell safe drivers i am a safe driver and here's some proof i can say to my husband or just to myself to feel good about writing. >> ok. thank you. our next question is for anne mccartt. is it true despite the number of fatal crashes among persons aged 70 and older, the share of all traffic fatalities the order of this age group is increasing? and when you pulled this latter step from a recent paper written for the trb conference that was held this past summer i believe. >> i'm not sure i follow your

question. you're saying that even though older drivers fatal crashes are going down at a faster rate than middle-aged drivers, they are an increasing percentage of all of the deaths? >> correct. >> i don't know if that's the case or not, because i know that we've seen very strong