wait a minute. [laughter] >> should we just let him hang? you can think about that some and we can come back to it. >> one i remember was the moment in which we really established the cbo as a nonpartisan agency, which as i remember it was about two years into the cbo's history. we had two years of president ford, and every time we said anything that was critical of anything that the administration had done, like it would not save that much money or whatever, the republicans were all over us.

then unfortunately president carter put forward an energy plan that did not look to was like it would save nearly as much as they were planning, and we said so. although some republicans were saying isn't it wonderful we have a non-partner -- non- partisan congressional budget office. the non-partisanship was established from then on. >> i want to ask another question, and it is taking off from the discussion of tax reform that we just had, and it is partly a political question, but it is partly a policy question. it seems increasingly like many democrats would not accept a plan that such as medicare and social security, and in fact the lesson we are supposed to have learned out of the special election in the buffalo area is that if you touch medicare you will be defeated. republicans will not touch a

plan, apparently, that raises taxes. i am wondering, as alice said it is getting late, i am wondering if there is any way politically to touch either of those things in a way you can actually bring the two sides to agreement. i guess the other part of the question is there a distinction between what is politically feasible and perhaps what is desirable or could we have this happy circumstance of both being the same thing? >> well, from a substantive point of view, there is no way of solving this problem first of all without getting some handle on health cost. if you thought of financing them by raising taxes, you would have to raise taxes every year because they are growing faster than our income. that is an essential part of the problem. the only other part of the budget that is growing and

causing this problem is also security, and it is growing much less fast, but i think there is a lot of room for reform with that, and we hit the two hottest button issues you can imagine. i do not think government has ever invented anything as popular as social security and medicare is very close behind in math, but in my view they do need reform. i do not see an answer to the question without some increase in revenue. of course a ferocious battle on how much, a solution has to come from their purses slowing down spending growth. how do you get there politically is a great mystery. i do not think we do have much -- forgetting about the debt limit debate, i think more generally there will come a time when people will stop investing in our debt, and we do not know when that will

happen maybe it will not happen for 25 years, but i think it very well could happen in two years depending on circumstances. i see this as a race between a political system that is moving glacially toward some kind of solution. so glacially it is hard to see any progress whatsoever, and an economic system that is heading toward a crisis. so far the crisis path seems to be winning the race, and hopefully that will change soon, but i am very pessimistic right now, because i do not see much kind of change anytime soon. >> i think that is absolutely right, but i guess i am less pessimistic. i am always the crazy optimist. i think it depends on a bipartisan group of leaders, and i think it has to include the

president and the leadership of both parties being scared enough that they've recognized that they have to put together a package that they are not going to like, that it will have some things in it that each side does not like. we did that in simpson bowl els, in sitting members of congress and five committee members signed its, and all felt there were things in it that they did not want to support -- simpson-bowls, it and five sitting members signed it, and all felt there were things in it they did not want to support. tom coburn said it best. we have to get that spirit to

come to the forum, because people are scared enough of the consequences and the things we have been talking about appear that they are willing to give up something for the good of the country. >> on medicare and social security, we know the substance of that. that is not complicated. the important thing is for the american people to recognize that the status quo was unacceptable. in fact, as i said earlier, all of these programs are broken from a budgetary, substantive point of view. our obligation to the safety net requires that we actually fix them. that should change the policy of putting them on the table. it does. in polling i have done at my think tank, if you ask -- for example, with the debt limit question, we asked about a clean

debt limit increase and nine out of 10 americans are opposed. they are sick of the whole thing. if you ask what would you put on it to have it be sports -- have to be supported, they say changes to medicare and social security to make them both fiscally sustainable. if the choices presented to the american people, if you do not get to keep what you have forever, if it is not going to last, they will be amenable to changes to the programs. they want them to last. on that front, i think you can get it onto the table. the tax thing has always been problematic for republicans. did i say that right? i think there are two things to recognize about that. one, there is a lot of tax policy that has nothing to do with raising revenue in an efficient action and it does

look like social policy in disguise. -- like spending policy in disguise. and the other is that historically, when they have agreed to both spending cuts and tax increases, and they have been hoodwinked. they have gotten a tax increases and not the spending cuts. i think if this sequencing was right, you would change the tax debate considerably. i am with alice. i am optimistic. this country will get this done. >> no risk of me agreeing with him. i am deep in the camp of pessimism. i would disagree with a lot of the things doug said. the consequences are not real to most americans at this point, and unfortunately, not too many

political leaders as well. they might understand that these programs are broken from a budgetary standpoint and want them to be around for their kids and grandkids, but that is a whole lot different from saying cut my benefits. from a beneficiary standpoint, medicare is not broken. it is a terrific program. social security is not broken. even presenting to the american people that, you know, you're living a lot longer. a larger fraction of your total adult life is being spent on social security. do not think we should raise the normal retirement age along with a longer life you're going to be leading? a huge opposition to that. and you wonder, where can you really start this conversation, because what we have to do is

tell the american people they're going to get less for more. they're going to pay more and get less. we have been in a sense living beyond our means as we look forward, and that is not an easy thing to do. we have been having a great sale on government services for the last 20 years, and you do not want the sale to come to an end. so, i think it is going to be hard to get reason to prevail. in this discussion. the fundamental change that has taken place since the last big budget deals is the communication revolution that we have. cable television was not around the way it is. news broadcasts that were mostly opinion and less objective news did not proliferate. there were not loggers. there were not facebook and twitter and all of these things.

an objective presentation -- where an objective presentation of the evidence could dominate the debate, nothing dominates the debate now. and i think that will make it difficult to come to a resolution without some kind of external crisis. >> others want to respond to anything they have heard? > i thought rudy was going to say he is even more pessimistic after listening to bob [laughter] i have a follow-up which is a question i'm asking to a group of economists who have been around the political process for a long time, which is, what is behind you are all saying is the increasing polarization. that is, there is a gap, it seems to me, between the leadership and the rank-and-file in both parties, and there are a

lot more people who have, i guess i would call it taken the pledge. the pledge on the democratic side is we will not touch medicare and social security. the pledge on the republican side is we will not raise taxes. when i have heard a little bit is maybe we can raise taxes if we can say it is not a tax increase. it is just tax reform or eliminating tax expenditures or cutting back untack expenditures -- back on tax expenditures. i'm wondering if anyone would on how in anent an increasingly polarized environment any sort of solution will involve moving toward the middle? >> it is the major factor. i would put it ahead of the communication revolution. i think it is interesting to look back to the 1950's and see the changes in the two parties. the democrats had

some incredible fiscal conservatives, eastland, dennis, russell. whatever you thought of the rest of their views, they wanted to control spending except on defense. the party ranged from those guys to proxmire on the left. in the republican party had a range of ideologies from one yowho was as liberal as any democrat today to the first stirrings of the coldwater movement. the ideologies of the two party had a huge overlap. that made it a lot easier to cut deals. some of the most difficult things were cutting deals within the party as opposed to cross party. the situation is so different today in that there is essentially no ideological

overlap between the two parties. as i said before, the gap between what the two parties believe i do not think has ever been greater. >> anyone else? doug and then alice. or alice and then doug, how about that? >> in the midst of all of this gloom and doom, i think there has certainly been polarization and there is less of a medal on capitol hill. but i am not sure -- middle on capitol hill. but i'm not sure that we should conclude that the american public is significantly more polarized or significantly dumber either than it used to be or voters in a lot of other places like the u.k. were they seem to be able to face up to these things -- maybe they're overdoing it. but if you get a reasonably represent a group of people in a room -- and this has been done multiple times -- and you sit

them down and say look, here is the problem. these are the spending pressures. this is the revenue side. these are the facts. here are some trends. you get pretty reasonable answers. people can do that, average people, and we should not forget that. the characterization of everybody as having extreme views -- i do not think they do. they're on a city councilor in a city with the budget deficit, or on the state budget legislature, then they managed to come to the metal and make some reasonable -- manage to come to the middle and make some reasonable choices. i do not think that is impossible at the federal level. >> the points that are the same to me and do not strike me as dramatically different are

exactly what alice said. lots of studies have failed to find the disappearing middle, failed to find the polarization, failed to find the intractability of politics in the american people. i agree with alice completely. the bottom -- if the retail politics were strongly enforced all the way through, that is what the american people believe and want. the question is, how does that work? at the other hand, it is still the same. my view is that in this town, if you want bipartisan solutions, that begins and ends with the president. the president is the only official elected by all the american people. only the president has sufficient capacity to provide cover for all of those in his party to cover a tough vote and things like that. congress is a partisan place. it has a chairman and ranking members. it has majority staffs and small staffs. it has majority offices and back

offices. there is a lot of partnership built into the structure of congress. only the president can reach across the aisle. we have had two presidents who are not good at this. i do not know why, but we need more of that, and that does not -- that has not changed. there has been in gerrymandering of district and a safe seat phenomenon. i think that is a real problem and one that merits serious consideration. then there are some of these mechanical things. i cannot speak to the democratic side, but on the republican side, i think there was a vast misinterpretation of what the contract for america meant. in my view, the contract for america was a document hammered out by some very strong-willed individuals who did not agree on everything. this was not a group of shrinking violets and they were not an automaton. they hammered out what they thought they could agree on in a

short amount of time and off they went. it was enormously successful electorally. the mistaken conclusion drawn from that was, hey, if we all say the same thing, we will win. it produced this desire for clones within the caucus, and if you cannot adjudicate differences within your caucus, you're not going to be able to develop their reflexes to reach across the aisle. that happened certainly in the house of representatives for republicans. i think it has had a damaging impact on the nature of the overall process. i think we need the same thing out of the president. the american people believe the same thing. in between, there are some mechanical differences in getting things done. >> i would like to agree with the analysis of the american public, that it is not a whole lot different from how it has been in the past. it is a bell curve more than two polar extremes.

when you sit groups of people down in a room and you have some budget experts or some policy experts describe the problem to them in a sensible way, they come to a sensible, middle of the road decision. but when they walk out of the realm, policy is interpreted for them by interest groups, but bybsters -- by loggebloggers, cable television, and they quickly get polarized and diverted off to the side. we of heard it suggested that we reform the tax code in a way that gets rid of some of the spending funded through the tax could. if we're talking about ethanol subsidies, everyone outside of ohio and nebraska can agree, but that is chump change in this

game. what we're really talking about here are things like preferences that affect health, retirement, housing, charitable giving. that affects the middle and upper middle class of america. you see the tense to describe those situations -- attempts to describe the situation, and it is not as if you can get a large fraction of the public embracing them, even simple things like why should we allow mortgage interest to be deductible for second homes? we might, all of us who do not have one, might reach a consensus there, but you know, if you are part of hoboken or north carolina or new hampshire ies where this is very

important, it is a matter of life and death. >> i would like to know whether anyone in the audience has any opinion on the topics of either taxes or entitlements. [laughter] surely, someone does. let's open it up. >> apologies for speaking twice, but i want to call attention to something. our public opinion wing at the school recently did a budget survey in which we asked 1000 people or so to address in detail, systematically, the discretionary budget, and then also asked questions about social security, entitlement, expenditures like mortgage deduction. the consensus answer with people who were confronted with this

was the people ended up making decisions that would reduce the discretionary budget by about 75%-80%. a substantial share of that was tax increases that people supported. the majority of tea party sympathizer supported tax increases in this particular context, etc. you can say, what does that mean? by itself, it means nothing at all. bob is absolutely right that if you put that against the drivers and the people who support the second mortgage interest deduction because their entire communities depend on it, on the other hand, there might be some potential here as part of the campaign, the sorts of surveys, if the sorts of things were given some publicity in some mileage and politicians could use them to some degree as protection and say we have some

scientifically selected groups of americans who do not like this. they did not say they like a tax increase. they do not like the social security changes. but a majority of people said we could live with this as part of a package. there might be something here in the pr. >> that is a comment. anyone can respond who wants to? other questions? no one has any questions about entitlements? you can ask about anything you want. >> i wanted to pick up on your point about the cacophony of noise and polarization. i do a lot of work on the debt limit, as most of you know. to pick up on doug's point, this is about paying bills you already incurred. my guess is that most of the people who are dramatically opposed to raising the debt

limit think it is the same as a credit card limit, a belief in which they're wildly assisted by most of the press, and i am sorry to say, by many of their elected representatives. that leads me to think about, it is also easy to say i do not want you to cut my medicare benefits if i think i have paid for them and paid enough to cover them. franklin roosevelt was no 80 it. he knew why he wanted to have diot.idual -- no immediat he knew why he wanted to have individual programs so that no one could touch them in the future. how is it that everyone seems to be entitled to their own facts? >> i think as doug said, it really requires a lot of leadership and it has to eventually come from the president. there is no one else in the country --

[inaudible] i think leaders will get the kind of shout from time to time if not outright get assassinated. it takes a lot of courage and strength. i hate to say anything optimistic in this group, [laughter] but if there is any help, i think it comes from the fact that other countries have resolved these issues. you see it in places like canada, australia, new zealand, sweden, etc., where they have come to agreement on some pretty severe austerity programs. they have reform social security. now the thing that makes me nervous is that all of these countries face real or imminent crises. in other words, they did not really act until they got scared, and i think that is a disturbing thing.

but when they acted, they acted quite rationally. you might not like all of the solutions they adopted, but they were not done in a panic. they were not totally mad. so there is hope. i did have a privilege of lunching with the canadian minister of finance the other day and asked him, how did you do it? how did you turn the country from cheering on spending to really being very concerned about deficits? he said, you have to keep a really simple. we convinced people that debt was bad. and that did it. and now, the canadian government runs deficits at their own peril. >> anyone else on that? >> i think we have come down to, what is different about us from the grits or the swedes or the new zealanders, -- british or the swedes or the new zealander, who ever they are?

is it that our credit card limit has been too high for these years? it is certainly partly that. is it that we have a system of government which makes budget making much more difficult and complicated than a parliamentary system? or is it the power of our interest groups and the media exaggerating the horrors of doing the things we know we ought to do? i do not know the answer to this. it is some of each, but i cannot think it has got to be disabling. i come back to the same situation. i was talking to european the

other day and he said, i was reading about you laying off teachers, laying off state and local workers. isn't this going to cause riots in the street? i said no, i think people understand this as an unfortunate necessity of having to balance budgets at that level. or at the city level. why we do not understand it at the federal level is not clear. >> years ago when i was at syracuse university, i became pessimistic about my chosen profession and decided i would be much better served by producing one economically literate journalist than 40 economics majors a year. i launched a program. to cut to the end, the course got canceled. during the exercise, allowed students to turn in their assignments in whatever media they were going to go on to do

professionally. writers wrote. newspaper guys, short. magazine writers come along. -- writers, long. one assignment was to cover the brewers. it was a tragedy. different story. [laughter] he came back to me with a guy trudging along with a lunch box. i said, how can you do this? he said, economics is about taking the motion out. television is about putting the motion in. i remember that to this day.

you have to inject into the debate emotion. we are all policy geeks. we want people to look at debt versus gdp. now. it is about attacking -- attaching fax to a motion. if you do not do that, you will not succeed. s to emotion.fact som if you do not do that, you will not succeed. injectou're trying to emotion into something like that is evil. hasn't that already occurred in some segments of the population, which has generated the idea that we do not need to raise the debt limit? how do you get people concerned about something and at the same time be educated about it? >> i'm going to rephrase.

the observation was made you're not entitled to your own set of facts. not true. but you are entitled to your own set of emotions. you have to trump that with the strong promotion of the consequences of debt and how bad it is. that is the marketing challenge of this moment. >> what you have to say is, i should not be running up debt, but i should pay the bills i have charged. most americans think they do not have any debt because the mortgage does not count, the loan from the car does not count, the loan for the refrigerator does not count. it is, i should not overcharge. i should not borrow more than i can pay. i should make every effort to pay the bills that i have incurred. maybe that is the way you tie

the debt limit to shrinking -- to a path that in forces and lowers the debt. if we had a balanced budget, we would have to raise the debt limit. if h.r.-one had become law, we would have to raise the debt limit. we would need trillions of dollars. >> any other comments? >> i do not think it is going to be hard to convince americans that debt is evil when they have mortgages, as you say. they buy cars. the finance education with debt. they start businesses with debt. you have to be schizophrenic to say debt is bad when it looks like this, but debt is my road to opportunity when it looks like that. >> but that is exactly what canadians do. [inaudible]

they're not the only country that has done it. the swedes underwent a remarkable transformation. >> part of dealing with entitlements is actually understanding the implications of what congress does. all of us have seen pieces of legislation passed in which the scorekeeping roles came up with a set of protective expenses that nobody really believed to be true. the most recent of that is the affordable care act in which now, the cms actuary has said he does not believe it. that is because of the rules that you operate under.

if you're going to make the role of the congressional budget office more effective in helping congress understand what it has done and what it has not done when it passes debt reduction legislation, for example, what rules would you add or change? >> i will be brief. i have two responses. number one, i believe there are rules that should be changed. i think there should be symmetric treatment of spending and taxes in terms of construction of the baseline. i personally would take every refundable credit and count it entirely as an outlay. the moment you make it refundable, it is independent of the state of the world. i do not think that is the problem. the affordable care act, i mean, i think some people believe -- i do not think it is a good idea

from a budget standpoint. it is not a cdo problem. it is a congress problem. if congress wants to gain the rules, congress is going to gain the rules -- game the rules, congress is going to game the rules, and they do. do not blame the rules or the cbo, blame the congress. that is who did it. the congress did that to them period. >> the particular example you're talking about, cms as well as cdo in its baseline estimates -- cbo in its baseline estimates had very similar cost estimates. what the actuaries said was that the payment mechanism for providers was going to be

reduced by about 1.1% per year often to the future, which would make medicare payments to providers a lot lower than those from other payers, private sector pay years, and that overtime, were there not fundamental reforms in the delivery system of health care -- which there could be -- brought about by this pressure and other pressures -- this was unsustainable, probably. some providers would stop serving medicare beneficiaries. there would be an access problem and there would be a political reaction to that. we have seen that in a sustainable growth rate adjustment to the session -- to physician fees were the congress has not adhered to the loss. it hasn't solved the system from the cuts -- congress has not

adhered to the laws. absolved the system from the cut every year. when congress reneged on what should be done, the action is scored again, and has been every year. >> all of that is absolutely right, but i think the dead put his finger on the more profound put his fingeraoug on the more profound problem, and that is that congress keeps skirting rules. what has happened now? congress passes temporary tax

cuts. the number of them is growing, growing, growing. so they do not get into a base line and it is totally unrealistic. they have renewed that tax line how many times? 15 years in a row. the base line has gotten more and more unrealistic, and we debate things though, still, a round is totally unrealistic baseline. i agree that i would do some things to it, but i think whenever i would do to it, congress would figure a way around in a very few years. >> what is the alternative? to give the cbo the power to say what is a reasonable base line and what is a reasonable interpretation of what the congress will do in the future? i do not think so. you do not want the cbo or any group of technocrats doing that. you want them applying the rules in a very straightforward

way. this is what the congress said would happen under this particular law. if it does not happen, you can provide some alternatives, but you have got to take the congress at its word. giving the cbo a lot of discretion as to what it will do in the future is a road to disaster for the cbo. >> i have to be even more optimistic than alice. first of all, i think bob mentioned the fact that we will never get people to feel the debt is evil when they have so much personal experience with it that works out for them.

i think that is not true, because a few years ago, people realize they were sustaining a debt that was unsustainable. people got calls of, you had a credit line for $10,000 but we are taking it away today. i think people kind of appreciated as forced lessons in living beyond their means. now they're forced to live within their means. i think people are more sympathetic these days, having lived through their own private, personal crises of the past couple of years. when they hear that the federal government is borrowing at an unsustainable rate, they have a resonance with that because they understand that personally. i have seen a change in reception to the idea that debt can be an unsustainable thing. second optimistic point. if you look at all of the plans

that various fiscal commissions, task forces, study groups all came up with, if you do a diagram of all their proposals, there is a lot and a lot of money in the intersection of those proposals. it is just that the politicians are not willing to commit yet because they do not really want to have to dive into that intersection. they want to pretend there is nothing in an intersection because they do not want to have to move there. i think taxes have to be a big part of the solution. i actually think, in my glass half full view of the world, that even paul ryan is proposing to reduce tax expenditures. he is just proposing to cut spending before he cuts tax expenditures. i believe we're not that far away from coming to an agreement about reducing tax expenditures

as a significant part of debt reduction. how do we get the conservatives who are wedded to the no new taxes' pledge to better come to terms with the fact that tax expenditures are spending? you can cut tax expenditures and shrink government even as your raising revenue. and getting the liberals on board to, because once liberals realize that it is spending, they do not want to cut it either. we saw that from the ranking ways and means democrat recently. how close are we to making some progress, do you think? what is the key? what we have to tell chairman ryan to get him to like pause after the first part were he raises revenue by reducing tax expenditures but before he spends a dollar lower tax rates. what do we say to the democrats to let them know that there are

progressive ways of reducing tax expenditures? >> anyone? >> i think doug made a good point a while back. my own experience in trying to sell tax reform to republicans is they say, now you're telling us you're going to lower their rates and broaden the base. but if we do that, just wait. pretty soon you will be raising vat rate again in financing all sorts of spending increases -- again andat trate financing all sorts of spending increases. that happened in 1986, so they have good reason to be suspicious. if they do finally agreed to more revenues, you must absolutely, certainly slow the rate of growth of spending some

how. i do not know how you develop that ironclad guarantee. that is the really difficult part, the that is absolutely necessary to making progress. >> one answer is to get them all in the same room and they have to cut a deal because they are scared if they do not and some of the things we have been talking about will be part of that deal -- never mind. >> i agree with rudy. i just want to say, i do not think you can, in this circumstance, pulled one thing out. the lesson is that it is all spending. the way i think about this -- look a bulls-simpson, for

example. that gives you -- look at bowles-since then, for example. that gives you an example -- bowls-simpson for example. that gives you an example that this can be done. everything has to be out there and you need the tax expenditure is to do the tax reform. pulling one thing out is dangerous, and you always have to remember that. >> the other thing is you need a credible enforcement rules. i think the lesson of the budget enforcement act of 1990 was exactly that. the president did agree to some tax increases. he came to regret it, but within the context of spending cuts and strong enforcement rules, and the enforced rules worked and

ultimately brought us, along with a good economy, to a surplus. you have to do that again. >> an important point of that is, i think there rules worked so well because they weren't forcing a major agreement that was already on the table -- were enforcing a major agreement that was r.d. on the table. -- were already on the table. that will be a lot harder to pull off now. >> we had two components to the rules. one was pay as you go for entitlement programs. that said, we have reduced entitlements spending. you cannot pass legislation that would increase it without paying

for it somehow. that presumes we can get together and agree on some big entitlement reductions. then a procedure like that, i think, can be effective. the discretionary spending control was caps. that worked for really one reason and one reason only, and that was that the soviet union fell apart. we had no rational reason for keeping defense spending as high as it was. in fact, over the whole period, real domestic discretionary spending rose during this great austerity. it was because we cut back defense spending so much that we could raise discretionary spending. it was not a time of true austerity, and that is what we were talking about now, seeking

through austerity. >> while we're on that topic, we've not really talked about discretionary spending. i heard earlier, and correct me if i'm wrong, there was a point of view but across that maybe this is a first step. we're not going to do anything about entitlements or taxes, but we will cut back discretionary spending as a sort of down payment. my question is, how much can we cut discretionary spending? i think of is correct -- bob is correct that it is almost literally the case that going back to 1970 we've not really cut discretionary spending, maybe once in the 1990's. how big of a cut can there be -- how big does it need to be to convince people like republicans that they can go along with an

increase in the debt limit? >> if all the commissions have hard freezes and could hold the dollar numbers where they are, i think that is a possible thing to get agreement on. that is tough, but over time it saves quite a lot of money, and the numbers being bandied about now is about one trillion dollars over 10 years. discretionary freezes are common to all of the plans, and some other small mandatory cuts, accompanied by a strong process change that would force the coming to grips with entitlements and taxes within a reasonable time, and i think it should not be too long after you raise the debt ceiling.

>> i think you face the basic arithmetic problem. we all agree that the major part of the budget problem comes from social security, medicare, medicaid to a considerable degree. i think there is general agreement -- too much agreement, in my view -- that you cannot change these programs abruptly. you have to phase in the changes so as to not disrupt the retirement plans of those in or near retirement. in order to -- if you phase in reforms very slowly, in order to show any progress whatsoever on the deficit in the shorter run without major tax increases, you have to hit the discretionary programs.

that is my interpretation of what has gone on in all of these commissions and why they are, in fact, very hard on discretionary programs even their discretionary programs are not the cause of our basic budget problem. >> they may not be the cause, but as you go through them, both on the defense side and the domestic side, you can convince a lot of people that some of this is not necessary and some of it is not high priority, and that we ought to be prioritized. >> that is true, but that is what you see people pointing to as opposed to the programs that do not work. well. uc policies that would -- do not work very well. uc policies that would -- you see policies that would freeze

spending or beat the civil servants about. >> thank you. i am a cdo alumnus now at the center of budget and policy priorities. i have a question on a completely different topic. the federal government does not have a balanced budget requirement. most state and local governments do. at the same time, state and local governments get a significant amount of their revenue in the form of grants from the federal government. do you think the coming budget debate will be a setting for some sort of renegotiation with state and local governments? >> i do not know. i look back to the canadian

experience. lots of people looking different elements of that and pick out the things they like, but one of the things going on was that the federal government involved the provinces of a considerable amount of work and authority, despite the fact that the provinces were in terrible shape. it was done in part because it was perceived that the provinces were more functional, could take on these problems and solve them in a way that the federal government could not. look at our states. they are showing themselves to be much more capable of taking on tough budget problems and getting their houses in order than we have seen at the federal level. i have some sympathy for the notion that in this setting it might not be a terrible idea to really rethink that mix and that the american people might be well served because the changes we now have to happen might happen more rapidly and more effectively. the question is will happen?

i do not know, but certainly, there is some precedent for thinking it may not be a bad idea. >> i just finished a paper on this very topic. i will giveg, you my fearless forecast. i do think we will see this affect state and local governments severely. i do not think, however, that our federal politicians will be ready to devolve responsibility for specific functions downward. they will finance them less generously, but i think they really do like the power that comes from say, the highway program or messing with education, etc. i would not see much outright devolution, but i would see the federal government becoming much stingier in the amount of money it sends downward.

>> i agree with that. much as i would like to see the devolution and sorting out of functions more clearly -- i wrote a book about this about 15 years ago, which bill clinton liked a lot when he was governor of arkansas. when he got to be president, he liked it less. and i began to realize why. i had proposed a balding things like -- devolving things like criminal justice, education, and some other things to the states. if you run for president, you have got to relate to what people care about most in their neighborhood, and that is crime in the streets, better schools, better housing. you find yourself making promises. i'm going to be the education president. i'm going to fight crime on the streets.

no federal president can do that, but you have to promise to do it, and that is how many -- that is how we get so many of these cats and dogs in small programs that are not doing much. there is a feeling that the federal government has to be there to take care of what people care about most. i'm with you in spirit, but i do not think it is going to happen. >> i agree that it is not going to be part of the package of whatever we do in the next couple of years, but it is worth remembering that if you are taking out your public finance textbook and saying, what is federal responsibility and what should be a local or state responsibility, things that deal with income distribution and opportunity, welfare health, education, along at the federal level, because the consequences

of doing them well or doing them badly spillover across the geography of the nation. those things that affect the well-being of a more localized area can be devolved. the problems we're talking about stem from the large redistribution programs. if we want a more roughly equitable treatment of individuals across the country in those respects and in the areas where growth potential is the greatest and the ability to control them the best and do them rationally is really at the federal level, then they should not be devolved. >> i have a final question for the panel, which is, as has been said, time is short between now and august 2nd. i'm going to lay out a scenario which you can decide how possible is. we do not reach a grand deal between now and august 2nd. in fact, we do not even reach a

little deal, in the sense of policy changes being made. but there is something passed tied to the debt ceiling that has some procedural fix, which may include traders, targets, some other kinds of things, promises to do something in the future. in exchange for raising the debt ceiling. is there a way to do that that would be either credible or that would work in your view, or would that just be punting the problem forward and no good would really come of it? >> it will not work, and moody's will downgrade us on day two. on the prospects of something like that happening -- the prospects of something like that happening are quite high because that date pushes right against the recess in august for

congress and there are few things more sacred than the august recess. i think there will be a strong desire to get this over with, if not on the second, certainly before the seventh or so when they go out. >> i agree with that. august 7th, 3:48 p.m., the time of this is easy. >> when did they have their plane reservations to get out of town? but if we go that route, it is likely that this is going to be like groundhog day. the amount by which the debt ceiling is raised will not be sufficient to get us through to the next presidency. it will be six months, come back and we will see what progress there has ben. -- been. >> i can even see shorter,

temporary increases in the debt ceiling that start with freezes and what we went through with the continuing resolution. that will not result in any deals at all just prolong the bargaining process. there is one advantage of a temporary increase in the ceiling, and that is that the deadline is unambiguous right now. we do not really know how many gimmicks they really have. august 2nd is kind of a wish she washy deadline. but if you temporarily increase the debt ceiling, that means that when that expires you have to actually retire debt. that becomes unambiguous, i think. it is a significant amount of money. that could well happen, but i could see this whole thing going on well into the fall with a series of temporary increases. >> as usual, i am a little more optimistic than your scenario.

it is not unlikely that we will get a combination of substantive changes, mostly in discretionary spending, and a process change. i think there is a process change which is plausible and attractive. i have been working with people at the bipartisan policy center. we call it save-go. reminiscent of pay-go. it would involve discretionary caps and a pay-go process that would apply to the the entitlements and taxes. why not just pay-go? because pay-go did not do

anything but prevent the congress from making things worse. now they're going to get worse anyway, so you have to have additional savings that you're committed to in the future. but you would not have to specify initially whether they were on the entitlement side or on the tax side. you could leave that until later with the trigger mechanism that would force you to come to grips with it. i think something like that could get us past the debt ceiling. then the question is, for how long? i think it would actually not be such a terrible thing to have a fairly short -- say six months -- increase in the debt ceiling that would force us to come to grips with these larger come a long run problems before the election.

-- larger, longer-run problems before the election. i think we are getting towards a recipe for disaster with the debt crisis. we're getting towards the spring of 2014. i do not think we have that long. we have to do something within the next few months that is credible and long range. >> for those of you who might be concerned [no audio] these issues will drop off the front page if the debt ceiling is resolved even for six months, remember that the new fiscal year begins october 1st and we will need appropriation bills to keep the government running at that point. we will be back into continuing resolution territory. >> buy your ticket now for the next panel.

[laughter] i for one never worry the budget issues will drop off the front page. we have a few minutes left. i'm going to stop asking questions and see whether there are any remaining questions from the audience. >> what i thought you were talking about was a debt limit not big enough to carry us, but not going to expire. you talked about what we did in the old days which was raised the debt ceiling for six months and then have it drop again. i will tell you, for people in the markets, that does not, is down at all. -- does not calm us down at all. >> i am talking about a temporary increase that would drop. it might not make markets happy. in fact, it would be nice if they were unhappy.

i am not making a recommendation. i am making a forecast. [laughter] >> other questions? >> if i may, what i thought the scenario spelt out was one where we had an increase. we increase -- we agreed to increase the debt limit, but did not accompany it with anything real, just a process. i believe that will be perceived as not real, and i believe that will be unacceptable. i believe moody's has said that in writing. that is my answer, that that is also not the deal i expect to have happened. i'm with alice. we will get a much better deal than that. .> we're about out of time on that note -- which i am sure is with the envelope involves pocket actually said, what we were just discussing, please

join me in thanking the panel. [applause] everyone in the room is invited to a reception which will follow this event in room 121, a cannon, which is downstairs. there will be people to direct you to it. thank you all very much for coming. thank you to the panelists once again for sharing your insights with us.

america's cable companies. >> on your screen right now, the walter reed army medical center. congress authorized the walter reed general hospital and its first authorization had 10 patients. it was named after major walter reed. it is located on 113 acres currently in washington, d.c., which is where we're basing our

live shot this morning. as you follow the course of the history and future, you know it is in the process of being moved to two locations. joining us to talk about that process and other issues is colonel norman kouth. thank you for joining us this morning. >> thankguest: thank you. it is a pleasure to be here today. host: for those of who have not been following that closely, can you give a short history about how this move came to be? guest: we are at 99 days to official closure under the base realignment and closure commission guidelines. this will close down completely, the entire base. we are 51 days from the major

transitional ceremony. we start the actual transitional movement north to national naval medical center that we are partnering with to create the wall street national military center will -- which will be the biggest, baddest military center in the world. a third of my staff transition to the community hospital 30 miles to the south of us which is a bride -- free and new ground up construction. one of the newest hospitals in the military system and what we hope will be the cookie cutter design for military hospitals in the future. host: can you give a little bit of history on each of the centers and what will be focused on at each of these centers. guest: here at walter reed we have been doing for your care. then the law changed to allow wish to do beneficiary care. that is spouses and family members of retirees and military

personnel. that work will continue at each location. right now we are in the 10th year of the global war on terror, and one of the things we have come to be known for the expertise in is for your care, and particularly and beauty care, those who have lost limbs in the conflict and are going through rehabilitation and developing in working with different companies in the design of different prosthetic devices to return folks to some semblance of normal or new abilities out of disabilities. that work will continue to go on, and that has become our expertise to our military advance training center. that military advance training system will move to the bethesda campus on an area that is larger and a little bit better designed than the current design. the weight of warrior care, a particularly in beauty care and those with traumatic brain injury will go on at the bethesda campus.

downtown is a large academic community hospital, so it will care for wounded warriors that are less complex than those severely wounded and injured than those that we have a walter reed currently. host: about 150 military personnel is what is being served at the congress, although it is 35 patients per day. how do you keep the current level of service happening for those who depend on it in the midst of the transition? guest: we really have not veered from the core business. here at walter reed we do 775,000 outpatient visits per year. that is business as usual, and we're very good at doing that. we have been able to do that without a hiccup as we prepare the transition.

we are partnering with the national navy medical center. that is their core business as well. when you bring these organizations together, the core business gets bigger, but it gets better also. then we start to transition our piece of the warrior care over to the north facility, so it is a natural progression. at the national navy medical center, they take care of mostly head injuries, brain injuries. that is their expertise, where as ours is the npt care. we're really tearing them together and treating the whole soldier at one location. host: our guest will be with us for the next 25 minutes to talk about the efforts there at walter reed. you can ask a question by doing the following. call the numbers on your screen. if you have bound yourself being

treated or correctly treated at walter reed, we're interested in hearing from you as well. here is the number -- you can also e-mail as questions at the journal@cspan.org. are you ready for this transition, and if you could, would you need more time or ask for more time? guest: we're absolutely ready. we are on track. and everything that i can control, it is well under control. we are meeting all of the time lines. we are ready. what people do not realize is the organization has been relatively flat since the late 1990's. our staff at both facilities, at bethesda and walter reed, have gone back and forth routinely. this is really a smooth and easy

transition. i do not control construction or the weather, but other than that, we are green and good to go. host: if you find yourself treated at walter reed army medical center, the number on your screen. connecticut on the independent line. steven, you are on with norvell coots. caller: thank you for taking my call. good morning. the soldiers are really strong mentally, but recovering from these catastrophic injuries in some cases, family support is really important. my question is, how do you incorporate the family and to recovery? also, the congress. you have a lot of big supporters. do you guys get eaten up financing? -- get enough financing?

guest: one of the things we recognize is that we have a more varied force than ever before. during the vietnam era, soldiers were not married. they are now. we recognize it is not just the solar -- sailor or soldier or airman that is injured, but it is the entire family. we get the casualties here within 48 to 72 hours of being injured on the battlefield. this is the first place that families come to see their spouse, son, daughter, husband or wife, so we recognize we have to wrap our arms around the family and care for them just as well as we care for the wounded warrior. we like the family members to stay in the room with the patient if at all possible. we like them to be there during their inpatient and outpatient therapy.

we also infiltrates them into the military health system and into the military, because very often these young warriors get married 30 days before going off to battle, and within 30 days they're coming back and that young spouse has never even got military i.d. card. we have an assistant center here that is one-stop shopping for all of those needs to give them ids to deal with the financial issues, because it is a financial strain on family members to come here and be with family members as well. we have very strong systems. we have a family support group and family readiness group. they take care of meeting -- they take care of meeting a lot of the family needs as well. we have more than 570 charitable organizations that support us in some way, shape, or form and do things the federal government cannot do. that is from little old ladies and pennsylvania who knit

blankets to big corporations the provide corthings for room, take them to dinner and local restaurants. there is one organization that lies the family members out in las vegas to get them away. we are very lucky in that respect. as to financing, absolutely, the congress is behind it. the american people are really behind us. i am very lucky as well. anytime i have a financial need, all i have to do is raise that through the channels and my needs are met. host: richmond, virginia. carry on the independent line. caller: i do not know a lot of background with this medical center. my first question is why are you moving? my second question is why it is there two different centers? why isn't there just one big

center? guest: that is a very good question. if you look at the map of the nation's capital you would see there is the walter reed centile in the heart of the capital. about 10 miles from it is malcolm grow air force hospital. there is can grow hospital at fort meade. about 30 or so different support net clinics -- subordinate clinics all in a very small area. when congress looked at it, they realize we need to capitalize on the efficiencies that we have. the closure of walter reed in the middle of washington seemed the logical conclusion. we are landlocked. there's not a lot of opportunity to expand on this campus. when we drew a line down the middle of the nation's capital and looked at the beneficiary capital, there is the same amount of beneficiaries north of

us as out of us. it made sense that when we close things down and consolidated to put a major medical center in the north where there is a large beneficiary population, and that would be the main center for training and things like that. then two and large facility bedded down at fort bellcore 40 miles to the south of us because of the large population living there. as far south as fredericksburg and even richmond, virginia. host: charleston, south carolina. john on the independent line. caller: i was stationed at walter reed from 1970 to 1980. i was part of the transition team from the old hospital to the new hospital. i do not think they should really be moving, and i have talked to people who are not very happy about walter reed coming over there because of the

traffic that will occur. i think they are perfectly ok with they are at. i do not see a reason why they should be moving. guest: i hear that a lot, and we recognize walter reed has been such an important hospital to so many people. there is a legacy here. there are people born here that are still working here. closing walter reed is like the death of your favorite uncle. we recognize it is part celebration, but part week in the general. as for people not being have become the no one is ever happy to lose a family member or lose their home. this is a merger. this is the largest mature -- merger in the history of the military health system. anytime there is a loser someone feels like a winner and a loser. in this case, everyone is a winner because the american service member will get the best

care consolidated at one location in the north, and those in the south will get equal care down there as well. for me, it is a tremendous opportunity to move towards the future and eventually towards a unified medical command. host: how many doctors are currently at walter reed? guest: i have about 1500 doctors. there are more than 5000 staff members here at the hospital. host: will all of those positions be wrote -- be relocated? guest: everyone will leave. two-thirds of the staff will go to bethesda. one-third will go to the south. host: will you have an increased amount of operating rooms and things you need to conduct your business daily or will they stay the same? guest: everything increases in scope and size. in fact, there are renovation programs going on right now for

the older operating rooms at the suspect to increase in size and put towers and that can handle all of the new technology that we are installing in the facilities in an ongoing process. across the street area of operations you will see an enhanced capability for surgical services. one of the things we're also doing is using fort meade and malcolm air force center to use as the ambulatory service center for north and south of the market. we are adopting a lot of civilian practices in terms of surgeries and things like that and putting that into the plans for the joint area of operations here. host: the average patient per day is 200. that is down from the 1990. there are 14 operating rooms and 650 operations per month. as far as that is concerned, 67

6700 x rays done per day. akron, ohio. thank you for waiting. dorothy on the democrat line. caller: i was an officer and commander in the united states military, air force. i have gone to the vet center, a phoenix va, and brett bell, and i would like to know, and also been up to the va ig, secretary of the current the day, on the torturous of use of veterans. i have witnessed it and had it, sir. this includes veterans who are 100% disabled and have been insulted by counselors refuse and are not even say, competent, or qualified to deal with their trauma. this is sexual trauma. i have witnessed of

falsification of records. i have attempted to report to multiple directors in which veterans continue to be of use, and i as a survivor of sexual trauma in the military and have severe ptsd had to intervene to help keep alive a veteran because the va in phoenix would not stop the abuse of her through counseling and other things. host: we will have to leave it there. if you could respond. guest: i could not really respond on behalf of the veterans administration, because that is a separate secretariat, but i will tell you there are important lessons we're learning. we're learning more and more about posttraumatic stress disorder. we're learning about more and more traumas that do occur in theater. the surgeon general's office has put together several study groups that have gone into theater and look at the

operations and interviewed folks. this is a work in progress. it is an ongoing thing. we have created some additional programs and really put a lot of effort into enhancing and enlarging the borough hall capabilities to handling a lot of these issues at the front end. so often a lot of these issues do not materialize until six, nine months, 18 months down the line come in so often they're not in the care of the military system. we're working very closely with the veterans administration to actually work on them as they develop. host: the relationship between walter reed and veterans affairs, are they two ventures? guest: they are separate ventures overall, but we are partnering with the veterans

administration more and more. here we partner with the local be in terms of prosthetics and the care of the npt, because all of these things can be applied to a beauties of previous wars and those that are amputees secondary to diseases like diabetes and motta terry -- and motor vehicle accidents. i think in the future you will see the veteran administration and the department of defense grow closer and closer together. host: for those treated at walter reed -- we are focusing on the work of walter reed army medical center. joining us now for the next seven or eight minutes, colonel

norvell coots. how long have you been out walter reed? guest: i have been here a little over three years now. host: san antonio, texas. go ahead. caller: this will never work. they sent a general down to the army hospital command. in less than one year. nobody won services from their command to take over. they cannot go back. they will be stuck with it. host: next call is boston, massachusetts. democrats line. chris. caller: i had a couple of questions regarding my real

dramatic brain injury. my understanding it is hard to diagnose regular traumatic brain injury in does not show up on a conventional mri or ct scan. i am wondering if the army is looking into new types of imaging techniques such as diffusion temperature imaging, a genetic transfer imaging, magnetic functioning, or functional techniques? guest: well, i cannot answer that question specifically, because i am not the technical expert. i know there were a lot of new protocols using new technology to more clearly elucidate mild traumatic brain injury from the more severe cases. one of the thing that is happening as part of this transition is there is a brand new national interest bird center of excellence for ptsd that has been billed and open on the campus of bethesda directly

across the street from the new walter reade national military center, and they are the facility that has been charged with doing all of the research, all of the four-cleaning technology looks to attempt to clarify these disorders and all of their manifestations in presentations. -- forward-leaning technology looks to attempt to clarify these disorders and all of their manifestations and presentations. the average stay at walter reed is probably about a year. patients have stayed here as long as three or four years. the better we get with the new techniques, the shorter amount of time patients day. we are doing the system of onward movement where the patient stays long enough to get the exact care they need and then we move them forward to medical facilities closer to home. host: what are you commonly treating their? guest: most of what we're seeing

right now in terms of combat casualties are imputations. the signature weapon of the work currently is the improvised explosive device, and because we do not have the mounted patrols as much, we are seeing a extremity trauma. the body armor is protecting the individual and saving the life, and when they get to us, it is our job to reconstruct them and rehabilitate them and give them their lives back. host: in a general sense are advances in technology ending up in the kind of replacement that folks are getting when they get there? guest: absolutely. the work that folks are getting now is incredible. we are partnering with medical centers for the latest in the upper and lower extremity prosthetic devices that can mimic or actually improved the outcomes with our patients. if you aren't upper extremity patient, you leave with at

least three upper extremity devices. if you are lower extremity, you leave with one or two prosthetic legs. the ft the lices allow you to do -- the new foot devices allow you to do things you have never done before. host: the next call is from hudson, florida. for those who have been treated at walter reed. terry, go ahead. caller: i was an amputee from the vietnam war, and i have a son of walter reed army center right now. problem is he is national guard. i was an inpatient at walter reed. we got convalescent leaves to come home. however, he is national guard

and he is outpatient, and he does not get those times to come home. i was wondering if something could be done to make it a little fairer for national guard skies. that is all. thank you. guest: that is a good point. there are different regulations from the reserve component in the national park, but i will tell you the military leadership right now is trying to peel back all the bureaucratic barriers and look at equalizing the benefits they get for patients across the board. we have a really good system for moving patients for full dependence to independence. there are some regular -- regular requirements we have to meet for what we can do for active duty forces vs. retired forces. i think in the future you will see no separation between them. all service members that are here are currently treated equally, and i think that will

be done across the board and services as well. and host: when the census this e-mail. she says what -- sends us this email. guest: that article was about the administrative things. since then we have built the military advanced training center, the first of its kind in the world where we do care for amputees. we built the first ever warrior care clinic, which is a model -- model for other medical centers. in less than a year everything that was identified in those articles was corrected and improved upon, and many things that were not. that gave us opportunity to do everything we wanted to do and said the system of the way we wanted to to best care for those war years.

host: one more call. barber from washington, d.c.. arbra from washington, d.c. caller: could you tell us what will happen to the current campus. guest: the campus will pretty much be split in half. the original hospital in southern part of the campus goes to the district of columbia for their produce. the northern part goes to the state department where i believe they want to create it in the strait of buildings. -- where i believe they want to create some administrative buildings. there are a lot of organizations that want to come in and put health care here, shops, upscale homes, homeless facilities. all kinds of things are being

talk about right now, but that is as far as i know. host: for those currently there, when will they be transferred to either facility? guest: the transition has already started. we have started to move clinical operations to bethesda already appeared in in about 60 days you really start to see the big moves north and south, and all of those will be completed by the end of august. host: that includes patients as well? guest: that is correct. the patients they will move last, and that will be the end of august. host:for the next 30 or 40 yearf

their lives. host: we will leave it there. we're joined by two others from the walter reed army medical center. on your right of the screen mcleana.paul the cleanu can you tell us a little bit about your time at walter reed and what brought you to the center? caller: i was an infantry platoon leader with this ticket and a tree division out of washington. in august of 2009 when we deployed in theater, after being in leader four months i was leading up foot patrol with my platoon and i stepped on an idd in the middle of the night and

lost both of my legs. -- stepped on an ied. i was in patient care for about four months. the first couple of weeks to amount was spent in i see you. a transition toward 57, which is the famous war here at walter reed. i did my four months in-patient care. since then i have been an outpatient. i live on the campus known in the malone house for several months before i moved into an apartment in the town of silver spring where i continue to do outpatient physical therapy. host: talk about the specifics of your rehab. guest: it is a totally new endeavor. it is something i never considered doing in my life. no one ever really thinks they will get seriously injured and

end up using prosthetics, so i knew nothing about it before i got involved with it. i am a pretty tough case. out of both of my legs i only have 12 inches of femur left. on my right side i left the entire legs. -- i lost the entire leg. it makes using a traditional prosthetic device extremely difficult. i spend most of my time doing physical 3 havrehab. we also have to consider how to best fit the prosthetic devices to my body because that is a bit of an issue because i am missing some much of my legs. host: as far as your current date is concerned, tell us about what you do day to day as far as rehab goes. guest: day today is pretty simple. i come in for an hour or two

hours of physical read debilitation. depending on how legs -- how well the legs are working or gained or lost weight, the daily fluctuation can affect a figment of the legs. using to prosthetic legs if we make a correction on 12 -- one on monday, the other leg will be a little off. sometimes it is followed up by another couple of hours working with a prosthetic team. that is my official duty besides coming in for formations and paperwork every now and then. on my own i am studying to go to graduate school next year. i am also a certified pierre mentor. on occasion at a therapist will ask me to speak to another patient. i will talk to them and advise them on the road ahead and see how they are doing.

host: we are also joined by dr. pasadena. talk was about how prosthetics art changing. guest: as colonel norvell coots stated earlier, there have been significant advances and prosthetics over the years, but they have not reached the point where they can replace a human hand or a human leg. so there has been some tremendous advances in the technology, but we still have a lot of challenges ahead of us. host: when someone comes in, what are some of the things that has to be considered when someone is fitted for process that it? fitted for prosthetics. guest: one of the more

challenging areas is when this didn't comes into contact with the prostatic. during the day scan fluctuates in size so how'd you come up with the sock it that will accommodate the fluctuation in size? additionally, if you have an amputation very proximal, there is very little for that prosthesis to hold onto. so we're looking at a lot of different ways, partnering with industry and academic centers, and listening to those users, the customers, but more importantly our service members, and they are identifying their needs and we're trying to meet them from a development and research standpoint. host: how much prostatic work is done year to year at walter reed? guest: we have seen over 1200 individuals that have been injured in either iraq or afghanistan with loss of a major

limb. many of those have lost more than one limb. so quite a bit is done, especially if you start adding on the multiple limbs and the multiple fittings that are involved with finding the right prostheses for the individual. most of our work, if not all of our work, is really individualized. each individual that we see has their different goals and objectives for their life, different challenges as well as an atomic challenges, so we tried to meet each person's goals individually. host: the numbers will stay the same on the screen if you want to talk either of our guests. if you of a question for a specific guest, please address to you want to talk to. gary on the independent line. go ahead. caller: i was calling just to say how much we appreciated walter reed over the years.

my mom that my dad there when he came back from world war ii and was stationed there after he had been injured. i was born there, and my dad actually spent his last year there when he passed a couple years back getting care there for cancer. and i just want to say all the times we came to visit him, spent time there, the care they get to all of the wounded soldiers was fantastic, and we really appreciate it. host: washington, d.c.. sharon on the democrats won. caller: i am ex-military. i am from d.c. i have seen the renovations of walter reed. my statement may be cannot be answered by the gentleman there, but since walter reed has been

reconstructed and everything is up to par and were meeting all of the necessities as far as taking care of our veterans, of our military personnel, with the cost of the economy right now, i tend to find it hard to understand why there will be a need to put all of the money into this new location hostn. guest: how does the press that a court change with the transfer to the new location? guest: right now walter reed has been modified in response to the war to meet the demands of our injured service members. we added on the military advance training center to help supplement a lot of the work that needed to be done, and what we have done with the new bethesda campus is to incorporate that into the

medical center itself so that it should improve efficiencies, as well as offer more services to not only our injured service members, to other beneficiaries as well. and host: you set as a peer you talk to various groups there. -- you said as a peer you talk to various groups there. talk a little bit about morale and your experience. guest: the morale here is very interesting. we have unfortunately a lot of seriously-winded service members, which initially when they learned of their wins a lot of the guys go shortly unconscious after being injured, once they come to grips with the severity of their wounds and what it means for the rest of their life, there is an initial disappointment. at the same time we have a great

mix of soldiers here of wounded veterans, and we're all going through the same thing, so i tell people very shortly that it is like a locker room environment. when i am wearing my prosthetic legs and sweating like crazy and working really hard, i look around and see there are other guys that have been through the exact same thing like me and they are more advanced in their recovery. then i look to the other side and see there are other servicemen that are wounded the same as i am, but they are a couple months behind me so they're going through everything i have already been through. quite frankly i see a lot of guys that are one did worse than i am. it definitely comes down to your individual personality, how strong of a support network you have. whether he still have your spouse or girlfriend or boyfriend, all of those things factor in. my role as a patient is mostly

just to listen to guys and evaluate them on an individual level. some guys i can say you will be fine, work hard, but then sometimes you have to be a little more tender. some of our patients do not come from a good solid support network and they need more care. host: port orange, florida. brian, go ahead. caller: i am watching the program of the sacrifice of many soldiers who have come and gone after i did. in 1991 i spent a year at walter reed after the persian gulf war where i was diagnosed with cancer. i was in a very late stage of lymphoma. dr. nicole lee was my doctor. she was an internship on the oncology war. she saved my life's, and the the sad to see walter reed closing,

but it is just an incredible place. it has affected so many people over 70 years, and i have two wonderful children and have been out of the military some time, but i am humbled by people like this young captain and other people that lost so much more than i did, but it is just amazing, and it is a sad day when it does close. host: for those like the and who come in, what is the prospect of normalcy once they leave the program and fitted and back to being rehabilitated? guest: i think you cannot understate the challenges that our service members and their families face coming back with some very severe injuries. some of those physical, some of those emotional. helping them rebuild their lives is obviously a privilege and an

honor for all of us on the walter reed staff, as well as of bethesda. but as i said before, and as dan just said, every individual is unique. everyone has their own individual social support system. so we recognize that is a very important part of the recovery and rehabilitation, and therefore do our best to incorporate family members, loved ones, into their rehab. our therapy in area, and they -- very encouragement and determination to get through this i think we all find inspirational. host: is walter reed doing the job as far as the mental and emotional needs that those that come in their need as part every have? guest: i would say without a doubt it is. again you have to look at every

patient as an individual. some of us require a lot more help and support than others. i would also say there is quite honestly only so far you can take some people. from what i have seen is the great job they have done. when skies are doing the physical rehabs, if they choose to take advantage of the program, they have all kinds of options for educational rehabilitation. vocational rehabilitation. our guys are set up with internships, both private-sector and public-sector. the physical rehab is only part of the program. the other part is realizing maybe will not be as physically active as you used to be. i cannot be an infantry platoon leader in the war, but i can go to a business school and work in a prosthetic industry and help out other people that are in my same situation, so if our

patients, regardless of rank or college graduates or non-college graduate, if they look beyond their injury and decide i am going to push on with my life, i am lucky to be alive, this will be ok, then if they want to take advantage of what walter reed has to offer, they can. host: those who have -- you said initially those who have been bombed out initially. was that your case? guest: i was conscious for couple of minutes after i inpped on deptthe ied afghanistan. then i was in a medically- induced coma. i had 25 years of a great life with legs. i was very physically active. i did marathons'. i like to go hiking and play soccer. i quickly realized that none of that -- i will not be able to do

any of that again in my life, but i am getting back to realizing there are more important things in life than running marathons and playing soccer. that is where i started to see the lining in the clouds i guess. once i found something i could be passionate about again outside the army. i think my recovery really started to take a turn for the better. host: if you could, would you serve a down? -- you serve again? guest: yeah, without a doubt. caller: i would like to say congratulations to the colonel and a job you guys are doing. i appreciate your service. and i too am a retired military veteran, and a question for the captain is, how hard was it for you to get emotionally back into wanting to get yourself

prepared to continue to serve in the military? guest: to be honest, it was fairly easy i would say. again, i had my dark days early on. i was really disappointed about my injury, but i realized that it is not the most important thing in life, and most of all i realize there are plenty of americans, combat veterans and non-combat veterans have much harder challenges to face than i ever will, even with the loss of my legs. in terms of continuing my are reservists, that is an option for me. -- my army service. i think i could stay in and contribute. it is something i seriously thought about, but i decided the best route for me -- what i want to do is enter the biotechnology sector in prostatic specific

specifically from the business side of things. if i do that, i will be able to help many americans. from kids in car accidents to people with debilitating diseases, and i think that will be very rewarding. host: what is the future hold? -- what does the future hold? guest: having a new generation of people that have lost limbs, bringing incredible intelligence and determination and innovation we will see great things and prosthetics. the biggest movement obviously in the lower lives will be introducing a power back into the lower limb prosthetics. right now the majority of them are passive devices.

they don't substitute for muscles that were lost. by incorporating voters we will be able to see much more -- lasting effects for individuals with lower limb loss. in terms of the upper limbs, the sky is the limit. we can build robots that can do virtually anything. the big challenge is how an individual can control that in a way that is more humanistic. a lot of research is being done. it is very exciting to be a part of that research, but at the same time very humbling to see the injured service members and all of those with when lost. host: what is the cost versus upper limbs vs lower limbs? guest: i have been asked this question all lot. we're very fortunate and uniform, how you put a price on

someone's hand? have you put a price on someone's leg? -- how do you put a price on someone's leg? it is very difficult to answer that question. every individual has the book -- different needs, and we do our best to meet those needs. host: what is the cost for an actual leg and actual arms. guest: you have to understand the billing mechanism that excess with in the united states is probably not an interesting topic for many of the listeners, but when you start discussing cost of a prosthesis, elise and the civilian community, that includes the services associated with it. -- at least in the civilian community, that includes the services associated with it as well.

and then do initial training in terms of use of the prosthesis, so if you're talking about the individual component versus the service, it is much different. the individual component, what you see is as new technology comes on the market, it is fairly expensive. as we learn that technology, as we decide or learn that what components are better than others, then obviously those costs go down significantly. we also have to realize there is a business component to this. we can have great ideas for prosthetic limbs, but we needed industry partners that will fabricate those limbs. you cannot ask a company to start making products that do not have a huge market, so we recognize that, but we are very fortunate that in the department

of defense, department of veterans affairs, we have gone into these things saying we will paid for these things, do not