years, and the question is not to we have an only rules based regime or in only description based regime, the question is where on a very complicated continuum the excess of trade-offs on the particular policy questions, and the dodd-frank act i think overall moves the spectrum on most of the policy issues addressed more towards rules than it had been, not in a revolutionary way, but in a modest way. in terms of the 1930's issues, i don't think that the glass-stegall act or the gramm-leach-bliley act universal banking issues were central to the crisis or the path of reform i do think that the shadow

banking system and innovation are at the core of the financial crisis, and i do think that the dodd-frank act addresses those in a way that provides a framework for being safer in the future. it doesn't guarantee that it provides a framework for addressing the needs of oversight transparency and capital requirements in the shadow banking system that are so critical going forward. last, on the resolution of 40i think people can argue both ways about rather the resolution authority should be pre-from the proposed funded. i actually don't think that that is cementer cool question to the resolution. i think that the question about resolution is effective in the crisis management, and the proposed funding i don't view it as a timing consistency issue because the firm that has gone into the resolution is not paying for insurance for

depositors, it is the financial system as a whole that is benefiting from the ability to resolve that firm to having the rest of the firms in the system pay strikes me as not backwards or time consistent with this is an incredibly rich area and one that i think is easy for reasonable people to think opposite things about so i'm anxious for the conversation to begin. >> i'm when to ask a few questions and then we will open it up and give people in the audience i shall have a lot of questions they would like to ask, too. i want to start out with the king upon interesting debate that jamie dimond and ben bernanke had on a conference that the american bankers association was holding it a week or so ago. dimond asked whether regulators have considered the cumulus

effect of dodd-frank and the efforts to raise capital standards across the globe and posed a challenge that this is restraining the recovery. so i would like to hear michael talk about this and then anyone on the panel, too. what are the cumulative affects of the reforms of the financial system, and are they hurting bad economy? >> i do think it's important to look across the range of reforms happening in the capitol rules and dodd-frank act supervision of authority in the derivatives reform and consumer protection and the like and to make sure they make sense together. so i guess i agree with that, but there is no avoiding the fact you have to implement the law so the congress passed a set of walls and you have to implement them, and i do think that financial industry as a whole i don't want to paint with

too broad a brush tops out of both sides of its mouth. the financial industries as we need certainty and these industries say we don't want that certainty, we want a different certainty. so there is, you know, a desire for example to delay the derivatives reform in the interest of worrying about the european competitors in the like. i just think that that card is to continue to mix my metaphors overplayed. whether it is affecting the current accentuation martin and tom may have a lot more to say that i do, i am skeptical of that argument i think that there is some amount of uncertainty that businesses have about the business environment and some uncertainty that financial institutions have about the regulatory environment but they're very different concerns.

uncertainty in the financial environment i don't think is inhibiting major financial institutions from lending right now. the refuge capital cushion and sufficient funds to lend. i think the economic uncertainty for the regular businesses is in having their ability to hire workers, and i think that is harming the economy. >> what do you have to say about this? i'm sure that you are in frequent contact with the business executives. >> yes, i am also mostly mckinsey says larger businesses and they are very low at the moment, so they are not facing -- they are concerned about a lot of things including future taxes, regulation, all that kind of stuff, but i don't think that they are borrowing costs are of a particular concern for them. i am aware of its -- it's harder to get a reading on small

business and one reads conflicting stories about it. i think there are small businesses who would like to expand the or having difficulty getting funds. there's a couple of reasons if you're talking about small businesses or start-ups that is because traditionally the have relied on the family and friends and equity in parnes which they don't have to say that is a fallout from the crisis. >> for the larger businesses there are some that would like to expand five think many don't want to expand because they don't have to demand. not so much because the banks can't lend to them as the premium has gone up. i even hear the baker giver does have become rather more cautious so they're looking over their shoulders of the bank's saying i'm not sure you can make that

loan so we do have a problem. i'm not sure it's associate at this time with your requirements. i want to make one quick comment on the earlier discussion. wiley think it is certainly true the shadow banking system played a huge role in this crisis there are banks that front of trouble, too. wachovia, citibank and others and a lot of smaller banks, state regulated banks that originated a lot of the bad loans. so i think this really was a housing related crisis, a lot of the moral hazard occurred because the small banks that initiated the loans and sold them off to someone so they mixture of the non-bank and the banking sector in this crisis. >> i would like to paint a scenario and hear how you

respond to this. imagine a moment which doesn't seem unimaginable to me which europe loses the political will to continue to fund an unbearable debt, increased defaults this negative effect on european banks which remains undercapitalized, a big bank or to fail. this causes a run on american money market funds which have exposure of about a trillion dollars to the european banks, and we find ourselves very quickly backed at a moment very much like 2008. do you find a scenario like this to be plausible, and if so, what has dodd-frank accomplished? >> first of all, i think it is a

terrific and i think central important question. i do think there is a real risk right now as there has been for many months right now that the crisis in europe hurts not just the european banking sector but also the u.s. banking sector and financial sector. the money market system is still not fully resolved. that is the changes under rule 287 that improve the liquidity position of money market funds is good. the basel liquidity rules will kick into place are good and will help. the regulations of capital martinet collateral requirements in the sector will also help

significantly, but there's still weaknesses, lastly i would point out the significant capital cushion that is built in the u.s. financial system rather remarkably will help a lot. so in all of those senses the system is more resilient and savor and then it was just a short time ago. i do think that we have not yet fully reformed if you will or fully solve the problem of the money market mutual fund system, and you have seen proposals across-the-board for different approaches including either private sector capitalization of a liquidity fund or floating requirements or split hybrid requirements for the floating stable products. i think we are going to have to continue to make reform in that

area to bring more resiliency into that aspect of the system. >> i think -- i agree with michael. i think that in the future we are going to have to see some reform of the money-market industry to bring it more on to the regulatory umbrella. there are a lot of reforms being talked about and put in place. it seems to me they are not quite sufficient yet. although i am less worried about the effect of the scenario you describe for money market funds per say on more concerned about the contagion effect would be for the european economy because right now it is kind of a knife's edge and it really has a view about greece and i don't know of any positive ones.

there are mixed opinions about portugal to have a better program in place. but the big worry is spain and then >> comes under the microscope and italy and there's the potential for major sovereign debt crises, and those can easily trigger an event like the one that we experienced a few months ago. >> i agree with that i don't think that there is a prayer that greece can avoid in some form of default, there is a question of whether that triggers. i think increased defaults by itself it is stopped their it wouldn't be so bad. what ever we do in the united states i think germany and france bailout their banks. they would bail them out, and brought them out to be allowed to greece which has i think it would be a bad idea or they are going to bail out the banks.

it's a bad idea because i just don't think greece can repay the debt in order to service of a foreign debt. has to become a net exporter and it's going to be weigel before they get that part of things in shape and competitive with the euro but if the other dominoes start going down, and watch out, it may be a good time to put one's money under the mattress. [laughter] >> everyone on the panel talked about the disparity between what good policy looks like on paper and what policy gets created given the political constraints policymakers faced i would like to hear what lessons you learned about how to manage the political constraints that one

faces when trying to construct the new financial architecture and also interested in hearing from the panel, this is obviously an age-old problem, but to what extent do you think our political system is more or less capable of producing good policy outcomes in this day and age? >> i laughed i was looking over a amy's crème who joined us here and we had lots of conversations that were about that very topic and she was right more than i was. about the answers to that question. but they are usually pretty pessimistic answers. so, what do you do? it's like any other country. we live in the world we live in and not in a different world,

and the political system is no different from that. and it is much better to design a good policy that works for the world you live in the interdealer in policy that works for a world you don't live in. so i think just not being paid headed is the answer i would guess. >> this is a moment in history when it's hard to be optimistic about policy. everything is so polarized. my colleagues at brookings report congress is more polarized than it's ever been. that is to say the most liberal republican is more conservative than most conservative democrats. so working out agreements in that environment is the difficult. to take a slightly more positive tone we do pass legislation.

we find out how it works there is in a process. it's not ideal and it's got a lot of lobbying but it's also got a lot of politics in and and hopefully things do get better. i'm a big fan of senator sarbanes. he helped me get confirmed twice. the first round that leads to sarbanes oxley was not great. it was extremely expensive to administer and it's not clear to me that it added to the safety or accounting practices of companies, but it's been modified and it is now much better than it was. i still don't think it's great but it's better than it was, so i think we do have to rely on this interest process and hope that it gets us eventually we find out where the problems are in the legislation and then we make changes. >> and slightly more optimistic.

i think in spite of my criticism it really has its heart in the right place and has a lot of important ingredients we need to make the system sound and safe and it is structured in a way that is open to interpretation and improvement and i think it is a remarkable accomplishment. it took the crisis of that magnitude and it really was a severe crisis to get this done. so let's hope that every positive piece of legislation doesn't require such enormous cost to drive us forward. >> we have about 20 minutes i guess for questions from the audience. does anybody want to -- >> i agree there is a lot of

positive -- let me make a general comment about dodd-frank. there's much to admire. dodd-frank into this conversation and others about regulation are very focused on the end stage on the crisis itself and what do we do if we ever get in that situation again? and that is admirable. but the fundamental problem was there was too much borrowing in the united states, and a very lacked lending standards and it wasn't just housing, it was credit cards, commercial real estate, it was everything. we were enormously over borrowed, and i would like a little bit of the analysis from michael and others about what do we do to avoid that again

without going to extremes. martin said one of the dangers of the consumer protection agency is that it might limit access to credit. for heaven sakes we need to limit access to credit. that's the whole point. we don't need to overdo it and it isn't just a question of poor people as often the conversations as well not all poor people should own houses. one of course, but it wasn't poor people doing most of the borrowing. it was everybody. so, what are we going to do about that and how does it help? >> i think that the dodd-frank act is quite focused on setting up a regulatory structure that reduces leverage in the system and i guess i encompass the reforms being accomplished apparel for the basel process. in dodd-frank itself it focuses

on a looking across the financial system not just the banks but looking at improving the resiliency of the system through use of central clearing parties and derivative contracts, the imposition of margin and collateral requirements for the derivatives trade, via devotee to require risk retention and securitization are all eight samples of that kind of focus. >> it wouldn't have all of the derivatives if it didn't [inaudible] >> yes, i'm working my way down the chain. [laughter] starting with the big numbers. and then if you look at -- if you look at the basel process reducing leverage in the system and international leverage ratio, liquidity requirements and capital requirements are all building more resiliency in the system so that is one end of the spectrum. i'm going to jump now to the other end of the spectrum.

so, title xiv there's a fundamental reform of the mortgage market and one of the provisions in which you'd think would not be required that instead we would use common sense the there is a rule that says the lenders have to look at the ability to repay ha. it is now a requirement under the act you get documentation of loans and half an assessment on the ability to pay and you can't pay a loan broker to pay a borrower in a much worse mortgage than a better mortgage. and a number of other changes like that that are designed to go to the front end and a set of rules in between. so the act does get at this fundamental question. >> i agree on the basic sentiment that you expressed which is the promise of borrowing that led to the housing bubble which then got us into trouble and once housing

prices fell system was extremely vulnerable. i will stick by my statement saying i don't want to constrain lending too much to the low-income folks precisely because the reason you gave which is they were not the ones that were doing so much access borrowing. obviously there were some subprimal loans that shouldn't have been made, but the big lending was not to them, it was the alt-a getting boats and that kind of thing. so we do need a policy that ramps back the amount of borrowing that we do as an economy and the obvious way to do that in our current situation would be to gradually limit the tax deductible even trust and make borrowing less attractive because after all, that creates i don't know if it is exactly a

subsidy, but it creates a very favorable circumstance for upper income people to borrow and it does nothing for low-income folks who buy houses and don't get much benefit from that deductible the. so i would do that. that's in the real domenici proposal isn't it? >> so then i got it right. >> question for michael and the other panelists. we see the unintended consequence which is concentration within the banking system and part driven by dodd-frank. they just announced the moving of its retail branches. i guess the theory being with revenue challenges, commercially it's all under the regulatory framework. expense reduction is a principal driver behind many of these

capital deployment, of the capitol to meet the historical levels is also potentially treating more risk into the system, so could you address those banks increasing the risk to get the borrowing levels that have been chopped and secondly concentration within the banking industry that perhaps is leading to the big desk you're so eagerly willing to curtail? >> on the question on the capitol requirements leading to the greater risk-taking, there is this fundamental different set of views about how capital requirements work their way through the financial system, and you have i think some very smart people on either side of this question so let me state of the views and i will tell you which side i'm on. viewed number one is the capitol requirements increase the

resiliency and risk-taking and the system by putting the firm's on the capital press and creating the the failure. the alternative view is higher capital requirements just cause firms to only undertake risky projects in order to maintain the previous roe dever able to obtain the market and so the people that have the second view say the roe don't adjust and have the first view and they say that they adjust to the capitol requirement. you know, this is an empirical question that is tested over time. i think that somewhat better view but not perfectly so is the capitol requirement increased resilience in the system and the ever trivial view as i said lots of smart people have picked. the basic approach was taken

into dodd-frank that basel has taken and we are likely to take in the future and the view i think is a better view suggests roe and the sector will go down as a result, and that risks will go down as well. in terms of concentration, i would not have viewed that as a cause a consequence of dodd-frank. there was concentration built in the system as the firm's dillinger each other's arms of the financial crisis and we are dealing with that. >> there were pushed into each other. >> i think the search for yield has something to do with that as well.

>> so michael, [inaudible] one of the members involved in dhaka project where we try to hold these other professors to do an analysis of dodd-frank and one of the things about the whole process is they kept on changing the act coming to know, during 2009, so the professor would write something and have to e-mail them saying that doesn't hold any more can you read right to that. >> should we get a very small violin for you? [laughter] >> i'm getting to my point. there's a large change in the act. my question to you this during that process what things were you sort of not happy about

being removed and about being put in given that you were involved in them? >> there were lots of moving pieces over time. i think at the end of the day i would give a solid a - in terms of what came out in the final product. a bunch of things were added that were not really i think central to reform. some things got weekend around the edges. i would say one of the things that surprised me about the process was that in the conference when we thought things were going to get much worse they actually got much better so at the very end of the process siphoned the bill was strengthened in important ways especially in the derivatives title, title vii, and the reaper title, title viii, in part of

strengthening provisions for personal clearing and transparency come price transparency, for capital and marginal rules, cleaning out some problems that had built up in title vii along the way there were sort of knocked out and then the introduction of title viii, the backbone provision for the markets we had lost early in the process we were able to get back in the end. so i think that -- i mean, i could go through a list -- i had gone through a list many times of the provisions that changed along the way, but they are not as i think mostly not at the level of the top 30 things most people in the country would stay awake worrying about. they are things that kept me awake. >> why do you think things got better late in the process? obviously we are seeing this now in the fiscal debate, a lot of

policy gets made on the brink, and do you think was luck that things got better at the end of the process or do you think there was something about the process that helped get hard decisions made at the very end? >> first i would say look is always important to have on your side. you can't do anything without it. obviously can't plan for it. .. it was on c-span or c-span 35 or

something late at night so people could actually watch it. i think that helps a little bit. the mood of the country changes all the time. you may have noticed in the mood of the country at that particular time was really focused on financial reform and that helped i think having the sense that the country was watching improved things. we had a very -- i'm not only saying this to up to jon but we had a very educated press corps who has been following the debate on the bill for a year and a half, who were very focused on the details and writing about it all the time so it got a lot of public attention, and i think that helped as well. and then, you know as i mentioned at the outset line block. >> let me just make a quick comment. i do think the leadership particularly arnie frank ran a very strong conference and you may agree or disagree with all

of his causes but he is a very smart guy and really understands the system and i think that made a difference in the other thing i would mention is that they were trying braley right up to the end to try to make it a bipartisan process so i think there was an asset to really listen to all sides and pull it together and i think that was helpful. >> just to highlight the points marked them as making and this is what i was alluding to before that on the senate side in particular, chairman dodd had a very tight bipartisan process for the entire time, and the way we fixed the derivatives bill in and was in a bipartisan bill, a bipartisan set of amendments. >> we have time for one or two more questions and then i think you might take a five-minute right before we get started on the next panel. >> the institute for international economics. one thing that hasn't been much commented on in the discussion so far is the temptation of the

regulations that have been adopted or are in greater volume is being drafted. and my question is why is that? is the limitation regulation the second order of concern compared to the act itself, or what are your concerns about this implementation phase of which a number of pieces have been delayed? >> you no implementation is absolutely critical to the act working. there are an enormous number of moving pieces. i think that by and large the process has gone better than what armor levy expect did. i just may normally in our domestic implementation process, and i think that the concerns i have had has been on not moving

in the same direction as those expressed by the head of chase. they have been mostly in the opposite direction. that is to say there are some concern that budget constraints imposed by the congress on the sec and cftc in particular have slowed the process of implementation in dura for this reform and some concern that it will be hard to get the consumer agency off the ground when you have 44 senators who said they won't confirm somebody to run that place unless they change the law. so that is worrisome to me. but, if you look at the overall picture, both on i would say the fossil process and on fee rule-writing it has gone faster and better than i would have anticipated. >> okay last question and then we will take a break.

>> dennis kelleher from better markets. this may relate more to the next panel than this one but i wanted to ask kind of a macroquestion which is you bring up the limitations of the fed under 13.3 and how it air made him impair its ability to future. that really flowed from the feds lack of information to everybody including the congress. you have to remember the sanders amendment passed 96-0 the senate. unanimity is not common in the senate and bernie sanders will never in his lifetime get 96 posts in the senate i assume so it tells you the depth of which the lack of information and difficultly with that in terms of its bailouts for its actions as the 13 and three and people didn't understand them. that is yesterday but in the future whether not.frankel work will depend on market discipline. market discipline depends on information. the fed in the treasury have a history and a few in the culture and a bureaucracy basically surrounded by bank secrecy and not letting information out. dodd-frank went a long way in getting some provisions to try

and force that to happen but i would like to know a particular what michael thinks about this. how in the features dodd-frank going to work unless we have substantially more quality information disclosed from the fed, treasury and other bank regulators who have a history and culture of not putting information out? >> i would agree with most of what you said. that is i think there has historically been a problem on insufficient transparency by regulated entities and by regulators, and i do think the dodd-frank act moves the needle in the right direction on that. annual transparent stress test i think is a huge change for the financial industry and for regulators and will be a good thing in the future. similarly, the ability to gather and collect information and make it available through the office of financial research i think it's a big change and there are number of others like that but i

do think that you are right that unless the regulators continue to have their feet held to the fire on being transparent their tendency is not to be so i think it is good for, good for the system for the public, for reporters and for the congress through oversight to insist on regular disclosure. >> go ahead. >> i was going to say that perhaps there has been in excess of caution in the past on the part of fed about what it reveals. it has often been for very good reasons and the other issue for them is the extent to which their independence as an institution gets challenged by this. and so they might have been excessively cautious for that reason, sort of fearful of the

assaults on their independence and unwillingness to reveal a lot of the data and i think what you are going to see is a more, slightly more transparent as long as independence doesn't get threatened and certainly the treasury. i think michael is right that ofr is going to be a very positive addition to the institutional regulatory framework in terms of improving transparency. >> i do think ben bernanke has tried to be more transparent in general and fed policy, and has made that one of his keystone things of reviewing the economy and monetary policy. having said that i agree that you didn't get all the transparency around the time of the crisis and i can see the problems with that and the

reaction of congress which said hey we control the pursestrings and you guys are doing all the stuff on we don't know about it. i understand that. i think there was a concern that revealing too much information at the wrong time actually worsened the crisis or that congress would get in their and stop them from doing the things that they felt they needed to do. so it is a question of how we structure our democracy. does everything go back to congress or do we create institutions like the fed and give them dependents and give them the authority to manage crises when they happen? i mean we don't go back and say you know that general eisenhower should have done omaha beach differently even though one could look back and say omaha beach was a disaster. thousands and thousands of troops died in the sort of say he won the war, he got it done, so it is a tricky trade-off i think.

but, i do understand congress' concerned that the fed had this tremendous power over the purse and used it without always revealing what was going on. >> just one additional point. in the heat of the crisis the fed was engaged in what is arguably fiscal policy which is -- so there was a lot of sensitivity about that and i think probably an excess of caution about transparency parsley because they had to get through this period and deal with all of these assets, even though that is not part of their normal. >> i'm going to make one final observation and then we can take a break. i think it is important and instructive that the fed was forced to disclose the name of our worst to its various facilities by not only the sanders amendment but also abide the -- and there are names and

details that have all come out in the world didn't end. we know more about what happened during the financial crisis and the financial crisis -- system is still functioning. i think that is instructive and helpful and hopefully will help push the fed towards continuing to move towards more transparency. we have a whole panel coming up on the set so we can talk more about that. [applause] everyone please, a round of applause. >> here is what is ahead on c-span2. ralph nader, consumer activist in past presidential candidate has a debate on mandatory voting.

the senate armed services committee held a confirmation committee for the tenet jon allen who is credited for guiding the campaign to turn iraqi sunnis against al qaeda.

>> ralph nader consumer activist in past presidential candidate hosted a debate with a center for study of responsive law on mandatory voting. you will hear remarks from norman ornstein of the american enterprise institute and fred smith, president of the competitive and price-sensitive. in price sensitive. this is an hour and 30 minutes.

>> good day. my name is ralph nader. today marks the first debate, mandatory voting patriotic runs democratic. in the forthcoming series of debates sponsored by the center for the study of responsive law. on subjects rendered taboo and political electoral and main media arenas in our country. the second debate will be on july 8, 2011 with the topic being a wall street securities transaction tax. information is the currency of democracy. subjects that are treated as taboo contradict the open debate and discussion necessary to motivate the citizenry toward higher expectations for their society and themselves. this is what a deliberative democratic society is all about.

anthropologists have documented taboos in all cultures. whenever taboos on significant subjects are pierced the matter closed out at the taboo is opened up for examination and the possibility of change. very often in our society taboos become entrenched controlling processes favoring the status quo and its related powers that be. the breaking of taboos and public arenas, for example slavery abolition, women's right to vote and the regulation of misbehaving businesses, allowing farmers and workers better livelihoods, those did lead to debates and change in the 19th century. similarly in our time, taboos arising out of advertising and corporate political pressures regarding the dangers of tobacco use and stagnant lawyered vehicle safety design were

broken in the 1960s. reforms followed and saved lives. breaking taboos on politically challenging jim crow laws and discrimination against and has led to real advances in human rights. but in many areas taboos remain secure and in their service to varieties of concentrated power and wealth they cannot tolerate sunlight. nearly every candidate for public office knows the taboo subjects which are not to be politically asserted and publicly suggested for discussion, off the table. self-censorship is part of a politician's body armor. one example, alternatives to the nation's heart drug are off-limits by the two major party platforms and their campaigning agendas.

political parties tend to have unforgiving hierarchies. legislatures are rife with subjects, the vast majority of lawmakers preferred to ignore. until very recently the two major parties for years took the vast military budget and many ongoing soviet era weapons systems as given and non-debatable. as is the gao's annual finding that it is unable to the pentagon budget as a whole because the records aren't there. in its turn, the media often ditto heads the censorious behavior of the politicians by not asking the inconvenient questions. know here the sunday internet shows and their adroit choice of subjects, guessing questions and more significant, the question is not asked. for the first time before a national television audience due

to the presence of c-span, the subject of mandatory voting is to be addressed in its many dimensions and consequences. we want a flexible debate format that encourages multiple back-and-forth responses on any single assertion. questions by the debaters to one another and questions from the audience submitted on cards. this will be a 90 minute event when the debate starts. now for the debaters. in support of mandatory voting is norman ornstein a longtime scholar on congressional and electoral subjects. he is also an advocate for electoral reform. his books and articles have led him to be widely quoted by media for his insights. his recent book, the broken branch, how congress is failing america and how to get them back on track, co-authored with thomas e. mann reflects his concern about the state of

electoral politics. he writes a weekly column for roll call and is an election analyst for cbs news. he is presently a resident scholar at the american enterprise institute. in opposition to mandatory voting is fred smith, who studied theoretical mathematics at harvard's graduate department until he realized that defending markets was his true calling and he has done it with great fervor and humor. he is the founder and president of the competitive enterprise institute, a free-market public policy group and international non-governmental organization in washington d.c.. fred smith also writes and lectures of bundling. knowledgeable moderators help make a debate moved more precisely and substantive way. mark green is such a moderator. he performs that function weekly

by moderating a national radio program featuring arianna huffington and marry a merry fellow. at harvard law school he edited the civil liberties law review is a public interest lawyer, an elected public advocate for new york city. author of a mere 22 books, including the bestseller, who runs congress back in 1972 and a more recent, losing our democracy, published in 2006. mark green has been a frequent tv radio commentator and an op-ed contributor to leading newspapers. it is with keen anticipation that i turned to proceedings over to mark green to start this first in a series of national debates on taboo subjects. will the debaters come up?

>> good morning everybody. to my right is norman ornstein. to my left is fred smith. we will avoid the cliché references, but i especially on behalf of all of the debaters and the audience wanted thank ralph nader for pushing our imaginations when it comes to taboo topics, a series beginning today. how many times can talk shows and columnists debate budget deficits when there is such a deficit of conversation about scores of other issues? here is one. can america stay a representative democracy, and exceptional democracy, it if nonvoters outnumbered voters? voting is probably the

preeminent trade aspect of what we regard as a democracy. how can you have a government for the people and less people vote as we are seeing now in the middle east. and so historically in one sense, in 1789 as norman recalls, turnout was extraordinarily high, but only white males could vote. now is slightly the reverse. nearly the reverse when there is more universal suffrage on paper, but the turnout is very low in this country. certainly compared to the 80% turnouts of the 1800's compared to the 80% turnouts and western european countries and only one point of personal privilege. iran and in new york city why democratic primary where not 80%, not 40%, but 80% turned out

to pick usually the winner in an all democratic city. having said that, let's turn to the topic at hand. norman ornstein who is an advocate for the proposition. why should there be come and take up to five minutes, one minute or up to five for stating your argument in favor and then fred will make his arguments against. each will have a two-minute rebuttal on what is wrong with the other's argument and then i will moderate a q&a that is flexible. then they will each ask each other questions and the audience can ask questions. america needs mandatory voting. why? >> thanks mark and thank you ralph for doing this. my book broken branch, which by the ways a great holiday gift. i was a little uneasy when i first came in.

when i first came in i thought it said debating tattoos. but we will do this informally with just a couple of caveats. first, i am not for mandatory voting. i'm for mandatory attendance at the polls. there is a distinction and it is one that has been impressed upon me by kim beazley who is the current australian ambassador of the united states and was his party's leader for some years. in australia you don't have to vote. you can go to the polls and cast a ballot were none of the above and in fact about two or 3% do and i think it is an important distinction. the second that i would make is, i decry our low turnout as much as anybody but i'm not for changing the system just so we can feel good by having voter turnout which may ultimately approximate what they have in australia which is about 97%. the fact is voter turnout per se doesn't mean very much in terms of the health of a democracy.

some of the most vicious dictatorships in the world gets get voter turnout of 95 to 95% when they hold elections because the consequences are pretty severe in people don't vote. there are parts of louisiana where turnout is 115%. so it is not just to get turnout up and i want to discuss a couple of reasons why i came to this position. one is, visiting australia a number of times and talking to political figures from all stripes and let me note that the way things work in australia, if you do not vote you are subject to a fine, the equivalent of what used to be a parking ticket here in the district of columbia, about $15. now you can get out of it by writing a note explaining why you couldn't vote. you were sick. you were out of the country are traveling or another reason but as we have seen here in the district of columbia where there is now a 5-cent tax on bags at

grocery and drug stores come anybody who lives here has had the experience of multiple times at people walking out of the store balancing dozens of cans because they will be if they're going to pay 5 cents for a bag. the nudge theory, a little bit of a cause can make an enormous difference and in australia for they do get about 95 to 97% of the voters out to the polls, what the politicians of all stripes tell me is and tell us, is that this is not a system where it is all about ginning up the base. here, political consultants like karl rove make many millions by having expertise in getting their parties base out and trying to suppress the attendance of the other party. tier candidates are nominated and the choices that we have in elections are set by narrow slivers of voters, those parties bases that tend to pull our politics as though we had two

giant electoral magnets that pull us off to extremes. there are politicians know that their party's base will turn out and so will the other side. and the conversation changes. it is not about focusing heavily on wedge issues like abortion or same-sex marriage or guns. that can excite your side or suppress enthusiasm on the other side. it is not about manipulating voter registration are scaring voters when they are out of the polls to try to gin up your side or the other side. is about focusing on the sliver of voters, the important group in the middle who are persuadable and who are persuadable not why using fiery rhetoric which may turn on your voters that they will be there anyhow but will turn off voters in the middle and it is by focusing on the issues that matter the most to them. as i watched our political

system moved more and more towards this monomaniacal focus in the era of the permanent campaign on getting your base out and making sure the other side's base didn't. as i watched a very solid representatives lose, even the ability to run in their parties primaries or for nomination because of slivers of the base that turnout in primaries that may have a voter turnout at of 10% or 15% or maybe up to 35% and as is that i have watched general elections dominated by these consultants driven to try and get referendums on the ballot for example because they will excite your side more than the other side. and as i have had people ask all across the country, what can we do about a political system that can no longer debate these issues in a reasonable fashion -- we have seen the center put completely collapse. the conclusion that i came to us that if we adopted a version of

the australians system of mandatory attendance at the polls, modernized our registration system, we could move away from that and actually get thee to better debate about important issues and have a healthier democracy. >> thank you. fred smith. >> we are very disparate nation in heterogeneous individuals. i come from a liberty seeking group, me and my conservative friends, business types, religious and stability and tradition in order and of course we have calla jerry and friends. we all believe in all of those and our challenge in an election process is to find ways of -- at our core values to things that will protect them. elections are very difficult way to achieve that because the people who purport to represent our values as norm has pointed out the store that. it may not be quite as true in minnesota where norm comes from

but i am from louisiana estate that makes you more cautious about the political process. louisiana's louisiana as many of you know is a state that doesn't tolerate corruption. it is a very different place and i think we have to deal with the world as it is, not as their utopian friends might bring it to be. the challenges is there are people who tend to represent our values passionately are less so as norm mission and there are people who report to be confident that the political process gives us a choice of a rapping, tweedledum tweedledum article via not surprisingly many of us find it hard to discern what these people really are and whether they really represent our values are not and we do what we do in other areas of services where we are not sure. we stay home and we stay home now because we are not interested in the nature of our government but because we find it very difficult to discern where they come from and to vote in the presence of that ignorance would not only be wrong. a would be a moral.

there is a feeling somehow that if we could just increase participation in america the world would be a nicer place. less controversial but australia does have that ballot and as far as i know no one has ever accused on howard of being a nice person. canada doesn't have that and everyone realizes canadians are nice. that is what they are. i mean my goodness there's lake wobegon north. they are really into this kind of thing. there is a principle in all of this that a sickly suggest that loss of freedom and norm mentions that in some of this writings and norm thinks there is a modest loss of freedom but we that we have lost a lot of reasons over the last century. think about even losing one more freedom. how practical would it be? we would have to enforce it. what are we going to do, have voters knock on your door? mr. smith you didn't show this morning.

we have a system that basically realizes voting is a responsible act and for whatever reason, i'm uninformed or i haven't had the time and so on i should not be coerced to make a decision that is life or death for many people go. it would not -- it would be immoral to do that. jurors are instructed about the guilty decisions they make but in the voting booth we walk in and make our decision, maybe we don't. we get at least some civic appreciation because i voted -- norm would eliminate the acerbic virtue and we now get voluntary voting. who is going to get credit? that is not for sure is. that is coercion. a lot of this reminds me of a story of when i was growing up in louisiana. one of johnny's teachers was trying to get johnny out of his shell and she said johnnyjohnny, do you know the difference between apathy and ignorance?

johnny said, i don't know and i don't care. people who are uninterested in the outcome are uninformed about the outcome will somehow produce a better america. it seems to me fanciful and yet that is what mandatory voting is all about. >> thank you fred smith. for a rebuttal on what was wrong with fred's arguments and now he you can be like a positive person -- and what was wrong with norman's argument. >> just a couple of things. as fred said we are not a nation where we all share the same views. we have a lot of very different points of view. what i find reticular lee interesting now given the nature of our election system, our nomination process, if you look at a whole range of surveys you will find for example over half of republicans believe that one way we should do with our deficit and debt problem is by increasing taxes on the rich. you have half of republicans who believe there is climate change

caused in some measure by humans. you can't find members of congress who believe those things or i shouldn't say that. you can find plenty who believe it if you talk to them privately behind closed doors but given a system that is dominated by activists, they are forced to take positions or we choose people who take decisions that aren't even believed by a majority of their own party. we don't have a system at this point where we can actually get the believe that people have which range across the board and which are different for our two political parties but which now force them into little boxes. now let me talk just a bit about the loss of freedom. in australia as i say, you pay a fine but you don't have to pay the fine. you can write a note that explains why you couldn't vote. justice with the 5-cent bag taxpayer are a lot of people who find that a bridge too far and they would rather turn out and

vote. i don't find that much of the loss of freedom at all. you have the freedom not to vote and as i said you have the freedom not to vote for anybody if you show up at the polls. so i think that this is a process that can actually work out in a very reasonable way and strike a very different balance. >> thank you. fred. [inaudible] thurbert user a precious virtue and not only advances the freedom values that we espouse. it also provides a greater greater stability for our society and it also has democratize more the privileges that the elites of europe than anything else so i don't think liberty is a trivial thing to be dismissed as not that important. i do however think the question of when we do you were civic service out of her people liken the jury duty service we do we basically treated seriously. you get informed. you get those sides. you to listen for sometimes long

periods of time and then you can still obtain a band from voting, deadlocked jury. all of the safeguards which occur in the one area where we do have civic duties are not abandoned here. the other civic duty that we did decide as a society to -- decades ago was disservice to the draft. the ability to serve in the military. we did that because we did not think that portion was compatible with our principle government and that was enjoyed by democrats, republicans and libertarians. i think the argument, by god you are going to be forced to be free and we will put you in prison if you don't or find a $20, $50 in in a contest your rights. restricting our freedom not only to speak but not to speak if we wish to do so. one of the greatest things we can do in the private sector is not to show up when we find a company or someone unpleasant to our value structure. we should be able to do that in one of the more more important editions of our society, the voting booth because we don't want to vote for people when

they put tweedledum and tweedledee up there. >> fred, 80% turnouts abroad, 50% usually in presidential elections, 37% in midterm elections, 25% in local elections. what would define something that is not a democracy? you are saying tweedledum, tweedle state parks date parks and all of your houses. what would you call that as a democracy? >> think look more carefully what is happening is it is driving people out of the voting booth. if two restaurants were competing for computing and all of a sudden their customer stop showing up he wouldn't say, why are the customers failing us? you would save what are the two restaurants doing that are creating such bad choices that people would rather not eat at all? >> the difference though is the restaurant is a private indy and if you want to eat at joe or jill's you can eat at sam's and life goes on but if you are talking about electing people

who have the power of life and death over you in terms of war, terms of the justice system, then the analogy breaks down. so do you have a problem since you don't seem to care about the level of turnout, and my a percent in the new york city primary was not hypothetical. does that or a lower number bother you without analogy to the private sector? >> well, all in all, who cares? most people basically live their lives with a political system as a variable they can control. first of all it is very difficult to monitor political actors. as we all know they all say what they want us to hear but reality is they feel to monitor. is always difficult to manner. that is where groups like ralph and others have tried to find out what a vote really means. was a just a symbolic voter was that the critical decision that brought us into war that increase subsidies for corporations, that essentially

did not do something good or bad in our society. politicians develop an incredible camouflage screen between their actions that do affect our lives and a persona which is what we apparently voted for. to stay out of that and refuse to give legitimacy to that fraud is not an immoral act and it doesn't bother me. is 100% of the people who don't show up in america do think that says something i don't think when 100% of people showed up in the soviet union that showed anything at all. >> and so you seem to imply that our electoral system has constituted a fraud for not voting is okay. >> that is not quite fair. i don't believe it is fraud. i think when we self-select whether we know enough and care enough to participate in a process, what is wrong with the self selection process? do we want to induce people who are less interested, less informed to vote for us and us and that we real value of

participatory democracy which is to encourage those who spend the time and effort and who are morally involved in that particular election to vote? if we are not are we doing a disservice not only to ourselves but to everyone by staying out of -- that we are concerned about. >> and your opening statement he seemed to imply that your numbers in terms of turnout are not all that important so is it better for service -- people though. george will said when people don't vote it shows satisfaction with current system or it least not dissatisfaction with the current system but richard and frances piven wrote a very important 1988 book, why americans don't vote. quote, institutional arrangements produce massive nonvoting by lower class and working people in the united states" matt. so does it not matter if more

people voted independent of your focus which is some not just having spaces but nonideological interest? >> and an ideal world it seems to me you have nearly everybody voting because they want to vote and they want to be engaged. i want to get turnout up for other reasons, sure. what the evidence suggest to us is that there is certainly significant numbers of people who don't vote as they don't see a difference or they are satisfied and some who are dissatisfied. all of that is true. but, what we see with the example of australia again and getting back to fred's early point that we damaged the satisfaction that comes with exercising her civic duty, what is happened over six, now eight decades plus in australia is there is an enormously high level of pay churches patriotism that comes with voting. people see it as time has passed as a civic duty. now you can also get some

outlets. fred talks about the ability to, by not showing up to make your statement that you don't like your choices. it is far more effective to show up and vote for none of the above then it is not to turnout. where we don't know why people are failing to turn out and let me just quickly address the ignorance issue. i mean i am as appalled and perhaps more so than fred about the level of ignorance of basics in society and i might make a deal with you. if we could have these tasks were presidential candidates so that we no longer get one who says what we really need is to read the constitution and then quote from the declaration of independence and another one who says the shot fired around the world came from new hampshire. if we could get a better understanding of history from people running for office maybe we could find a different way. >> the that raises an interesting point. since you are announcing ignorant or disinterested voting, should there be than you

know a letter see test so now people have a certain level of knowledge? knowing that the word literacy test is horribly freighted in our society. you made the ignorance.. >> is not an ignorance.. is a rational.. people spend very little time -- we are all busy people. to learn about things in which you can do very little about them which are very complicated is a low priority item. most people have real problems. their 401(k) plan, what the kid should go to college on, what college they should go to and so on. most people and this audience and certainly norman irgle different, most people don't read the federal register before they go to bed at night. they have other things that occupy their time. they are not stupid. what it really means is people allocate their time in ways that they see as having value to themselves and in most situation

doesn't follow that category. norms certainly does and i do more than most and there are people in the city's. the cities are compared to the real world out there but most people in the city to care about politics and think about it a lot but for most people does it matter whether your senators name is murkowski or mikulski? they both sound sort of interesting american names but you'd don't really matter because you can don't know much about them anyway. we occasionally and this is where it is so important now more than ever, we reach these periods, the green party, the bubble grow party, and now the tea party movement, all of them right or left attempt to say okay guys, we do care. we will thought and that upsets people too because they are very impassioned and they care deeply and they vote. nor norm wants a group of people who are sort of boring and spend all their time passionately

voting. i don't think that is a very good mix of. >> norm, fred said it doesn't matter much if your name is mikulski or murkowski. did it matter much if your name was obama or bush? in other words, he is taking -- i have been accused of this. an example in universalizing it to up imply that elections have no consequences and are not important to people because they have private interest. of course they also care about what they pay in taxes, whether their child will be well-educated and what they're breathing into their bodies. >> i disagree with that and of course if her name is murkowski, lisa murkowski was bumped off the ballot from running as a republican despite her enormous popularity in the state because a small fringe group of extreme voters decided that they didn't want her to have the nomination.

there's a real difference it seems to me if your name is rob bennett, a very conservative figure but his instinct was to try to solve problems are the man who has replaced him, mike lee who is less interested in working to solve problems then and scoring points. i think it does matter and i should note a couple of other things. the first is we have lots of research that is done that shows it is not as if nonvoters are this group of apathetic ignorant people while voters are engaged and much more involved. in fact the political differences between voters and non-donors in a larger sense or not much different. the difference once again is we are creating a group of candidates and we are creating a focus on issues that has moved away from what most voters think or want. i will go back to the examples. majority of republicans think part of the deficit solution is an increasing taxes on the rich.

you can't find a single individual and office in congress who believes that now. and we have a process of voter suppression. in fact we have parties actively engaged in trying to make sure that the other side voters don't. >> that is something we probably should've started with. why do people not vote? there is probably not one single reason but fred implied tweedledee and tweedledum and of course anybody is allowed to run if you are over 25 or 30 for the house or senate. i am quoting you, fred. >> the choice is tweedledee and tweedledum. summit difficulty in ascertaining whether ideology is, what their real preferences are and what they really going to do. those are not easy things to do and politicians in the political process i think we can agree with tinted camouflage those and often with a compliancy of the.

>> not to be argumentative, not every election is of no consequence. not every election is tweedledum and tweedledee. every election with high turnout is the soviet union so i want to ask both of you factually, we voted half the rate of western european countries which have some traditions comparable to ours. why? and then i would like to ask you why. >> caremark, i suppose you could call it an ulterior motive. i'm hoping that if we did manage to get mandatory attendance at the polls it but for some other salutary change in our election system. the united states united states is the only significant democracy in the world that puts the burden of registering to vote on the citizens and not on the state and we make it an extraordinarily difficult process. we make voting a difficult process. we need voter registration modernization. we need to change this process

so that it becomes easier for people to register and to vote and among other things, i helped create an organization called white tuesday. why do we vote on tuesdays? it is not because it is written in the constitution. came down from the framers. it has to do with market back in the 19th century. out and like to move our election to the weekend, have a 24 hour voting period from noon saturday to noon sunday. maybe have a couple of days of early voting. you need to make it easier for people both in the need to make it easier for people to register. we need to move away from the notions that there are incentives for parties to keep this limited to a french or a small group of activists and open up a process and make it less difficult for people to vote even as we provide a modest hurdle if you don't vote. >> before asking fred to answer why people don't vote, if those reforms you suggest occurred,

there is we can voting. is a holiday as it is simpler in puerto rico and australia. there is early voting which is a majority of the voting in many jurisdictions. same day registration campaign finance reform. why not try that a critic would say before jumping to mandatory voting? >> i am for all of those things and work very hard and continue to in those areas. in some respects we are slipping further down. the supreme court issued another what i would say it's misguided decision today. them, connors case in arizona basically making a bizarre logical argument on the usual 5-4 vote that more speech suppresses speech because these poor multimillionaire candidates come if somebody else's little bit of money when they are putting their own money into the campaign it will deter them from spending all their money. a logic that just escapes me but we are not moving in the right direction in terms of getting a broader pool of getting good

people to run in some of these registration and other reform areas move very slowly. that is not to say that you shouldn't do any or all of them and it is not to say that if we did all the other things maybe we wouldn't need to move in the direction of mandatory attendance at the polls. >> what norman played raises two questions and take her time and answer it. why do you think our turnout and voting is so low and then would you as a libertarian support some of the reforms short of mandatory voting that norm has articulated? >> i think we are getting now to one of the core differences in some ways, the narrowness of the debate. we are talking about process changes within a status quo order. government is still going to be massive, making decisions and where we will go to war, who will be subsidizing our society, who will pay for the subsidies etc. etc., who gets to marry

marry whom and so forth. when government has those kinds of powers over our lives, massively more than they did back in the founding time, the naturally we engage those intensity and we can -- tend to turn off those that have lesser intensity in those areas. the things that norm is concerned about largely stem from the fact that government is screwing up too many people's lives today in too many ways. on the right and on the left. norm wants wants a world in which everybody gets along nice, sort of a kumbaya world where everybody is nice to each other in congress. i don't know if the world ever existed but certainly is not a world that most of us like. he read lock and difficulties in government getting its critical work done as a problem and i see one of the greatest things possible. will rodgers made that point several years ago. congress instead left. given so many things government does at this time it is done over the last decade that are

essentially taking away freedoms overwriting whatever values we might have, right or left, it is time i think to think carefully about why is it that people vote less? because government is so big it becomes increasingly hard for you and dice voters to montreat and so you and i failed to the best i can on the little item our freedom shrinking as it is and let others take responsibility. >> i hope you don't regard this as argumentative. is pretty easy to say government is too big because none of us know if it should be this big, this big or this bit. may i get specific? he said the governor is more intrusive. >> i'm going to give you even more time. usa government is more intrusive and pleasantly that the founding. george washington didn't know about nuclear power, didn't know about wiretapping, didn't i assume think of same-sex marriage.

so what you are saying is that if you simply shrink government are you saying that we shouldn't regulate nuclear power as externalities? we should have continued to isolate marriage to opposite sex couples and wiretapping is the free market if the government wants to eavesdrop without a warrant, they can get specific. you want the best people deciding these issues or do you want government not deciding these issues? >> i would like to expand the private sphere and shrink the political sphere because the political sphere ask us the kinds of questions we have been discussing here today. people that are less informed, less caring, less concerned making -- being encouraged to make decisions that affect my life. one of the great things about the restaurant ipec is i pick it

are arguments that with greater complexity comes with greater need for centralized control. with greater complexity, we have to use the dispersed knowledge and concerns of more people and that means dispersing power, not centralizing it in washington or in state capitols. politicians are what they are but they are not any more brilliant and certainly not as knowledgeable as we are in our entirety. we need to find ways -- marriage. how did marriage become a state sanctioned value? we created america in particular way from state sanctioned values. catholics and protestants killed each other by the millions in your. america created separation of church and state, privatization if you would. not because we valued religion less but because we valued at more. who can be married to whom as a relationship becomes a question of state power for some states

go one way in other states go the other way. shouldn't that be a private matter? and a contract that came out of it could be handled as a state sanctioned contract that we are so blurred, the personal lives we live with the political power to interfere with those, we end up with the kind of poor were stories that norm and i both agree with. i don't want government making these decisions. >> by the way, i respect that fred doesn't want government making those decisions. that's completely different than the likelihood tomorrow that if indian point decides to build a new nuclear power plant next to you you would probably want to know that they are our safety standards beyond that of the owners. so let's presume that government will continue to regulate and intervene in ways that all modern economies suggest. maybe fred will overrule that. until then, can you respond to his arguments that the answer is

always government is too big and political elections are not important enough to motivate people to learn more about their candidates? >> i must say as fred was talking and i was thinking about his restaurant analogy, i was thinking how much he would enjoy it if we didn't have the plant and animal inspection service, the meat inspection service at the department of agriculture. the fda which is inspecting additives in food's coming over from china, the meat inspection service took 9 million pounds of tainted beef and poultry out of the restaurants and off the shelves. the marketplace could handle that. you would see people drop dead in restaurants and he would say i don't think i will go there any more. i am not sure i would like that kind of limited government. >> a short response. the argument when the fda screws up its budget goes out. it is the difference in the incentive and discipline between a political mistake in a private mistake. >> we have 9500 meat inspectors

and congress with your friends have been ready to/the number of meat inspectors which means many more pounds of tainted meat. >> i believe in meat and poultry and added inspections. >> you believe in e. coli bacteria spreading? yes or no. >> do they do anything effectively to address that risk? look at the data. do they have power or do they subsidize that? >> i don't want to slip into a debate about different philosophies but let me address a couple of the areas that fred talked about. fred suggests that there is almost a one-to-one relationship between the size of government and the drop in turnout. and that hasn't happened. in fact, we have had problems with turnout and the drop in recent decades that actually went up of course and 2008 at the drop has far more to do with

with the regulations of registration that government provides and the enormous mobility that we have in the country. so it is those things. it is not whether in the history of turnout is people getting turned off by the size of the government. and just one other point. fred said i wanted kumbaya world where everybody acts nice. i want to go back to an era where we had orders hardest and shift but where people feed partisans as adversaries, not the enemy. i want to have a rough rough-and-tumble debate in the public square for we share a common set of facts and debate potential outcomes on issues. i want to have a wide range of views represented fewer litmus test. i want to have the public ravi represented in their disparate views in washington, not with groups that are moving off to the left and right which simply don't reflect the larger and more disparate society we have.

.. soviet union that are repressive authoritarianism. than you can have most people think to weaken the government's the articles of confederation which didn't have adequate ability to conscript to fight

the british and it's a tax. one of the universal principles that were distinguished between the government taking away your liberty, the compulsory jury duty, military service, compulsory education, and when it's over bearing as fred and ply as happens so often. >> there is a continuum, no question and you have to look at cost and benefit. i would start with one realization that we all ought to have. this isn't going to happen because americans viscerally react against mandatory things and are going to act against but if you look at this continuum, and at societies in countries like portugal and belgium and australia that have versions of the polls with modest fines, you don't find a significant loss of freedom that citizens feel.

you find instead the opposite reaction. the pride in getting out to vote because it is a civic duty and responsibility, and some i just don't see this when i look at the potential for changing our dialogue and moving from the oppressiveness we have now towards something that might be better. different incentives making it easier for people to vote and broaden the pool of people who are willing to run for office against having to write a letter to get out of paying a $15 fine i just don't see it. >> what are the universal principles since right now someone can inoculate my child, inject them even though i may not want it someone can conscript him or her and forced him or her to go to school, what is acceptable government and what is unacceptable by your standards?

>> that is a question america is struggling with and always will because the society based on limited government and deciding where the limits are as a critical question as you heard, and one thing i think is the problem the difference between the qualitative distinctions made in the constitution and qualitative distinctions which is so often what we seem to be saying today what that limits should exist in the poverty level should be set, who should be subsidized, those are more complicated because there is no principle nobody's going to fight a war or battle of principal over five versus 5.1% change in something. qualitative distinctions of the nuclear power nuclear weapons was not in one sense a very sensible decision because during foot nuclear age is a weapons

over left but it's important because people understood when qualitative lines have been crossed so the interpretation of the constitution concept is to create quantitative barriers for which the government shall not go or must go. it's a black-and-white situation. it's a distinction is to bring something in and put something out. when we don't do a continuum concept where everything is more or less, a little bit more, there is no moral debate going on any more because we are in the world of a little bit more, a little bit less, who cares or what can i do about it? there's a big difference between the coveted government and quantitative government, and one of the things i fear is america's left for my concept of the right to decide the government will be in these

areas, won't be in these and changes to a world where the government can do anything. >> let me put it back to voting because if we have a debate maybe it should be one of your tabu series whether children should be inoculated against disease by the government if the parents don't want it and that is an interesting subject and 99-1 majority but for inoculating children. let me ask you something that norman has answered. he's a reformer. he once early voting student simply on a tuesday as an industrial crimes show up to the voting booth. you can vote before, you can vote by mail, you can register that day, and then there was the whole history of neutral sounding voting standards literacy tests we know

discriminated by race. are you or were you short of mandatory voting? >> of deily voting ought to come back to the registration i don't think it's a bad idea also one of the things he had me read was a discussion of the jesse ventura campaign, and in which signing up people on till last week or so they realized of righetti was going to vote for internal for the council registration program. earlier late registration allows the surges which may or may not reply large on the constituency. the second one was? >> of the reforms. >> that could be early voting. voting by mail. >> that kind off premise voting bothered me in the following sense. one of the great things we have

in our society and many of society's the sacred dollar you may be subject to massive pressure from your friends and family, your union and employer and so on but you go into the booth and no one knows what you're doing and we are pretty confident that happens. if you have early voting what is to stop your friend from coming over? i don't know how that is addressed. >> i'm with you on that when and if the name proponent of the vote by mail because you you lose the privacy and trivialize voting. as for early voting let me say i'm only for early voting for perhaps two or three days. one of the problems some people have is they go away for the weekend or they are not around so i think you can address that by having voting on the wednesday call thursday, friday, where you go to an official place, cast a ballot in secrecy

and then it is secure, another of the problems is you can have weeks of course that's people voting before you actually have all the information from the campaign. hong >> let me ask a more fundamental question at this particular registration or candidate or jesse ventura. let's acknowledge we could have counterexamples easily. >> critics of the current registration system or the entire democracy has a bias against low-income people, minorities, younger voters because they get less money which is self-evident, and suppression efforts work against them as we know historically the civil war reconstruction amendments, etc..

let me start with normal there is a wealthier people for $100,000 vote in twice the turnout all things being equal under $30,000. assumed by this question is that a problem used for mandatory voting or something that the government really can't do much more about? >> i think in that sense if you have mandatory at the polls you're going to do away with most of what would be the class out there. what concerns me now is we are getting all kinds of things going forward like a very restrictive voter i.d. laws that make it much more difficult to people without means or mobility and that includes a number of elderly people who may not have the right documents, and to get those documents you have to pay

money and i am not against voter i.d. and principal, but it needs to be something that's provided to people that is easy for them to obtain they don't have to go 20 or 40 miles. >> mandatory voting as the overall class that may get worse because of voter i.d. law that the supreme court has held largely constitutional in the in any case. >> that is part of and the current system that we have is we are going to get selective voter suppression for reasons of not just class but people are going to vote for. it's not the most driving reason for me to push for mandatory at the polls but it's certainly one. >> do you agree with the argument is a built-in bias because public campaigns are privately funded and poor people have less money and historical it turns out less frequently

alleged over suppression efforts. >> it's quite clear the of strong voter restrictions >> in most parts of the united states we would always do better in those kind of things. but mandatory voting is a way that i think is to have the wrong remedy with this issue. first place in australia we find that the people whose ballots tend to be exactly the people who wouldn't have voted anyway. we aren't seeing the difference in that situation. >> excuse me for interrupting. when they went to mandatory voting went to 47% rate of voting. not if 95%. so, obviously it has increased the rate of voting although there's some spillage. the people whose votes are spoiled our not built in or so-called down the line different reason that most of those, the majority of the reasons i think more of those

better than by those are the people who find it hard or our interest to ask assistance on this things. people would have been excluded if we hadn't had mandatory. we wouldn't have gone to the polls if we didn't have mandatory voting but i'm worried about another form of suppression. if we had mandatory voting, then what would be the incentive of the powers that be to enforce the law is against a nonvoter. would they go more aggressively against of those likely to vote from them and therefore push them to the polls in the larger number of long those who were not prone and let them sit out. it's always a danger in a timely gandy ander intended consequences and i think generally experiments like this which involved an element of coercion and monterey's are likely to lead to unexpected consequences and to get the vote when they realize the with the bidding out work in their slide.

is it likely they would say let's put those people in jail because they are going to vote for ross. >> you will administration could enforce the civil rights lobby and the tax code and get the republicans and give the democrats. so of course there is discretion. trend raises a fair point. clearly mandatory voting will require more resources to enforce to exempt people to the jehovah's witnesses people who are ill or frail to vote are you creative and expensive bureaucracy and is it a risk of unintended consequences that you may be given discretion that could worsen the problem >> we had a lot of experiments out there, we've had brazil, chile, belgium, portugal at times italy and libya and i have

not seen any significant instances where those governments selectively punished those from the other party any more than the governments now which the minister parking regulations decide you're going to enforce parking tickets and scott laws against those who's license plates tell them live in a part of the city that they wouldn't be voting for them. that's not likely to happen. as for the enforcement it costs them money. it's a trivial sum in relationship to a 14 trillion-dollar economy. but, you know, what we also know is if you look to the system for enforcing parking tickets for example, this is not a difficult thing to do. you know who was on your voter registration rules and you know who shows up. you know what they've sent in a letter or found some reason to have an excuse, and it's not just as now if you get a parking

ticket and you don't pay at, a month later you get a notice saying you haven't paid your parking ticket and it works the same way. >> is that different than others? >> what they do in almost all of these it's not true in all the countries and some you have to register to vote but many countries and less than 20% in australia now. what do you do if someone doesn't vote if you have mandatory voting or votive dirty

he would have the voter judy like jury duty. could you have a positive incentive for example there is a country which motivate people to vote you can manage the vote in a lottery, national lottery with a small but mathematically sure benefits of winning. you could say only if you vote can you be eligible for public sector jobs. let's exclude any we do in prison before for not voting were not executing people. >> only in texas. [inaudible] >> and there would be none in texas. >> are there other positive ways to have voter to the mandatory voting so you avoid the problem finding poor people if they

don't vote. >> say if they had a lottery and a billion dollar prize he would probably a pure turnout jury significantly and get to audition on dancing with the stars or american idol. >> let's get serious. is that a plausible positive motivation. >> it's been suggested out there in some localities and when we do see the mania over some of these lotteries perhaps the woodwork. doing something like that does get you dangerously close to officially sanctioning to do that all across the country anyhow maybe that wouldn't be so bad. >> do you have any sense of history in this country -- i read this did of georgia in 1777 had that example you know is not a very current, but fred, what do you think is there any

historical example when this has been tried and failed in public reaction and what do you take from of 30 countries around the world which have mandatory voting only about a dozen of which enforce it because it is it oscillatory. >> [inaudible] there were a number of states that looked at this i think none of them fully implemented it. i think if you municipalities from time to time. internationally it is obviously been experimented with a lot of categories, but he keeps bringing up belgium. does bill shom have a government? belgium does not have a government in place but i spent some time -- >> people suggest they have no government so i don't know what you're not as the voting the fact they have frozen the political presence. other countries, portugal and

others the variation among the nation states in the roane states are interesting. >> do you suggest alternatives we do not consider? [inaudible] >> we didn't take other parts of it. of course there are in any system one knows some people are going to wear sunglasses we talked about wealth is making it easier to vote. but the map of the election in america and the discrepancy between the community and the rural communities. there's always a cap and gown distinction of intellectual distinction and credential distinction because intellectuals are not necessarily from the average american but there are credentials. the distinctions in america but we don't worry about economic voting by a cs. we worry about the wealth to

some extent different people are going to be driven by different intensities have different concerns and different abilities and the best we can do is to make sure that none of those barriers are artificial. >> they were of course in much of america. i came from the segregation period, and discrimination was a state enterprise in those areas. >> we ask questions and then could to the audience to start jogging down on the paper that you have and the name of the delete and then pass it to the people walking up and down the aisle, john richard, since you are here, and who will then turn it over to me. quick questions that are different. norman made the point that if you had mandatory voting would encourage more centrist low-interest voters the current

system encourages parties to appeal the hard core base that think mashaal bachmann and dennis kucinich not presidentially, do you think putting aside a big government aspect that mandatory voting has very good aspect and that of course over people would vote, and would be roughly representative of the whole society. >> that is a very good question obviously, but we notice that if he does have participatory voting ayman mandatory voting and that's not exactly planned politics and it is nice politics i can't imagine a country that doesn't seem more centrist than canada, maybe switzerland which has lower participation rates than we do but it doesn't look to me like a correlated very well between centrists. america is not a country --

look, i'm a libertarian. the problem is to of them are greek and each of the other is sold out. we are a contentious country in lots of dimensions, and that is a part of america. the challenge we are a tolerant country but not a country that demands we all agree to consensus and i think a lot of attention we feel about can't we'll be nice is our unhappiness not everyone agrees. many examples were true. chris got bumped out florida but there are many reasons why i would think any liberal conservative or libertarians would have been happy to see chris bumped up and it wasn't extremists it is that he did some things i think were unconscionable and bad but that isn't the point. being in the sensor consensus is it's the process by which anyone

on any side of an issue gives up the place they hold and agree to some of the number of them really agree with. i don't think that is the purpose of america or the voting process. it's been a you think mandatory voting or voter duty would encourage better educated voters because they know they can't just opt out but have to get a little more engaged because they have to attend and the more likely vote and robert putnam wrote this book bowling alone that there was a measurable decline in many metrics of voter participation, civic participation, attendance and bowling leagues so on like to tocqueville when everybody was hugging in the market square that civic engagement has been on the decline.

so with mandatory voting, help make a better citizen, and lead to more education a point that forbid says often occurs. >> i think there would be a lot of incentives in the political system to change the nature of the the date and for people who are going to spend more time or see more attention, and it might move a little bit away from what we have now. let me acknowledge, first of all let me say again i'm not looking for everybody to be nice. much of the acidity of the difference is you look at canada or some of these other countries is cultural, and you're not going to change the culture overnight. you're not going to make any of these reforms in a fashion that are going to change things dramatically and the political system was built on the deliberation debate in argumentation. there's nothing wrong with arguments of people having

intense views. the problem as i see it is we have narrowed the range of the views in a fashion that turns off a lot of the voters and i think it might change a little bit and might see some different incentives if you move in a different direction. if we can move in a direction weedy emphasize the role of either organizations of people like karl rove who now have the enormous incentives to create a different dialogue and can make money in a different fashion i don't think there would be bad in terms of what it might deutsch mcpeak interest of the voters. >> he made the point about liberty or the loss of liberty which is a powerful principle starting in the revolution, then through the current elections. two weeks ago in fact i have jury duty and i went, and i never called when they see me your hours, but for today's i

sat there, and i actually felt kind of excited. i was part of something. people from all walks of life in a class is for their come and i thought people felt good about it. jury duty for today's minimally come and this was on a criminal trial that would have taken two weeks. >> [inaudible] >> it's far more absorbent and time consuming and liberty losing than a vote by mail or election de especially if a holiday. so what's the big problem when by the way an election you can't educate voters they can ignore it in new york city when california does this if each person for its 100 days word on who they are and what they think the issues are so if a person wants to get educated comes right in the mail.

>> there's a very big difference from the system and the jury duty obligation and of the voting is a would be a and obligation because the jury duty as you point out is a serious thing. we need to have a way of deciding a person who commits violence against another. that is what a jury system trusted. we are human beings. two sides look at each one of us and typically reject both of us. so often you almost have the feeling they are trying to get someone who has no opinion on anything more knowledge about anything when if you go to the [inaudible] when they ask you questions. have you ever been involved in government? have you ever been involved in the occupation of this individual? have you ever had a family member? pretty soon you start thinking about anybody who hasn't had any of these things happen but i

guess those vary from the judgeship to judgeship but if you take it seriously you are going to be there for up to two weeks the grand jury and be instructed by those sites and yes you feel a sense of civic pride because this is a throwaway drive by voting incident. >> voters, tv viewers usually see both sides, depends how much money you raise obviously and you can get in the mail of antioco arguments about a vote and a jury system is very important, life and death and that's true. whom we elect and this in taxing of the decision would acknowledges important even though you would prefer that you do. so if i could -- the student to take days or weeks at the time and almost nobody objects to

that. >> why are you so concerned about the requirement you vote when you can vote none of the above or score the ballot. >> [inaudible] >> you can vote for you, you can write your spouse. >> none of the above essentially says the voters should have the right to reject the current list of candidates coming out of the two major parties. >> with that none of the above to the ballot. >> none of the above would improve a lot of things including the value, but why don't we have none of the above? because the presumption is neither party wants to be endeavored. they liked the idea of the pro-democracy pro legitimization and that is a danger here and i think without none of the above it would certainly be worse.

we can discuss whether or not one of the above would have less opposition. i'm not sure enough to make me [inaudible] >> would that [inaudible] would you like to donate a dollar not all of your pockets to support the political candidacy funding and what is the participation rate? pretty low. do you at this point i don't know what did you have questions of each other. fred, do you feel something compelling to ask? norm indicated friend convinced him we are done. [laughter] let me read questions from the audience. an administrative question. what about the homeless, who decides what is a valid excuse?

this goes to the implementation rather than of a few behind mandatory voting. >> we are going to have some difficulties as a free society does going out and registering people. they are a little bit more difficult in the u.s. than other countries because we have a federal system, australia and canada as well where your residence matters. it's not like you're just voting for a national candidate and a substantial loss of mobility but others are going to slip between the cracks, that includes homeless people and may include some others and what they do in most of these countries is the heavy set of categories of what are valid excuses and that includes of course being ill, troubling, some of the same excuses we have now that our requirements if you are going to do a vote by mail.

those are disappearing in many places as we move towards no excuses absentee voting but that is a trend once again fred and i disagree that's troubling. i don't want to trivialize voting. i believe that if you have mandatory attendance in the experience of other countries suggest that it enhances the notion of voting and becomes a civic duty and that's a good thing but a vote by mail which is the same as filling out a publishers clearing house balad does trivialize. >> the question remains to something mentioned but not discussed which is the why is against the less well-off people. clearly the supreme court in the fight-for citizens united decision now allows corporate treasuries, which raise money from shareholders to give limited liability to economically invest to take

those couple trillion dollars, several trillion dollars and potentially spend politically in elections. so to the extent does it trouble you that this -- you said there's always going to be differences in wealth, but this was a specific decision that made it easier for wealth on the scale. does that are due for some more aggressive voter reform measures possibly including mandatory voting? >> politics certainly we all know and i'm sure most of you know is about interest group disputes. interest groups sort of come and play whereas the two major flavors are ideological or groups who have conceptual framework for how the world should work and economic, groups worried about the problems of governance reducing or increasing the wealth, and good or bad they are good and bad in both of those economic and

ideological camps they fight it out. that's the nature of politics. it's not at all clear to me that economic voices are more powerful. most of the changes in the world certainly the last century came about because of party lost to the coat and a logical pressure. but the argument nonetheless is if we suppress one of those factions, economic voices, drive the market out of the marketplace of ideas, we are left with ideological, and ideological root, libertarian classical liberal and many of the people we work with on the progressive side of and i think our voices are important but i don't think they are any more or less important than those who believe that earnings wealth and keeping it is a worthwhile thing or should be redistributed to them. >> i don't like the corporate crony capitalism but under our constitution and the political system they surely play a role. i wish that other businesses

played a role in countering the capitalism, but that is 80 feet, a challenge i don't think that we've figured out yet. >> i left an instant run off voting from among the many reforms that could occur the arguably could improve democracy in terms of reflecting majority opinion where if you have a multi candidate field not tweedle dum or tweedle dee but a lot of tweedles and maybe roosevelt or washington that no one gets 40 or 50% of the lowest vote-getter is automatically dropped until you get down to four, three, or two people, so someone gets a majority. so, quickly come to either of you have an opinion short of the mandatory voting power instant runoff voting would work with mandatory voting or inconsistent with it?

>> an exclusive possibility and different forms of runoff of voting or preference voting are things that are very much worth exploring, and i would like to see them try in different places in states or different municipalities. along with many of us watching very carefully the california experiment in open primaries which may help as well. >> [inaudible] >> on technology, clearly if a bank's -- records are largely private put aside hacking for a second, we could get to the point rolls are secure and could register online and vote online.

so is that a less onerous alternative to mandatory voting? do you have any problems with encouraging more people voting so long as the ballot is secure online is the question. >> all of that encryption and stuff can be done but how do you know who's in the room with you when you push the key to vote for candidate a or b. they're looking over your shoulder a big sister.org your friend or your boss. i don't know, somehow we need the concept we're going to go to this and there's lots of the advantages of remote voting how do we ensure that when they vote no one is exercising towards them? i don't know -- >> you thought about this more than point >> i draw the distinction between registering on line and we have many ideas for the modernization that include allowing states to share

information about registration, and there are many places now they're doing registration on line in the works very well. voting on line i have the same problem fred does and it's not just your not sure who's in the room but you lose all of that privacy, and what we are now seeing with the sophisticated hacking going on is that you really can't be sure of what might happen in a system of this sort, so i much prefer voting in person at the poll, and we need to make that is easy and convenient for people as we possibly can. >> the transcription of information is via the web, and the web is a big system with lots of points of entry. voting booths even electronic are isolated are not part of the web at least i don't think in the web yet. and i don't think they should. >> thousands of laws and

regulations affecting the economy and families, is it reasonable to require that people participate in who makes those laws, and then they would be more likely to be obeyed because people would understand even if they don't like paying your taxes to stay in afghanistan. there would be greater compliance because everyone would feel like they had a shot at affecting the thousands of rules and regulations, people know you want them to be in the low single digits there are thousands. >> 10,000 commitments which is the number of regulations the government has prepared. we are worried about that and think the question is again [inaudible] government officials protecting us shouldn't it be reasonable to ask people to vote or --

>> anyone is concerned about that process but everyone in this room is become involved in some ways whether they are voting or writing or talking or mobilizing, there's lots of ways you can try to influence those who will decide important things about your life. voting is one of those. i think it's not the most important and therefore, i don't think we should do undue weight on that idea so there's other things you can do and then maybe you're voting encourages others to vote. i don't think the genex -- i mean the new holiday we had a new holiday how many people would just pick a new holiday? with the use it to stay home? it means you don't know the answer. i've done this all my life so you ask what does it mean. is there not experience abroad that if he were -- a lot of people say why didn't you vote and they say i was working, i

was busy, i didn't find the time. but voting increase? >> we have a memorial and veterans day. let's have one of them be democracy, and then people would actually vote. estimate there's evidence abroad that if you have voting on how they were on a weekend there is an increased turnout. we don't have enough of the base here to know empirically what would happen. i am convinced that if we actually did something significantly move to a 24 hour news period from noon saturday to sunday so and for example we move more and more towards the center which is something they've done extremely successfully in laramie county colorado where you have voting places centralized wal-mart's or

kosko or supermarkets where people can park and go in and get an ample supply of machines and workers and the like. you do those kind of things and you're going to get an enhanced turnout. you can make it work better. those things also seem to me to be critical elements if indeed you did move towards mandatory voting. you can't move towards them at the polls unless you make it much less burdensome for people. >> the voter duty on mandatory voting we have spoken about it more than anybody else collectively combined in the last ten years, and so i want to thank norman borkenstein infrared for their participation. [applause] and their insight, and i certainly want all of us to

thank ralf meter for coming up with the concept of debating not tattoo's which could be one of the taboo not sure in the nba, but -- and i want to make sure everyone knows as ralph said in the opening july 8, this year debating a taboo -- debatingtaboos.org the behind me and in front of us. let me just say i am guessing and i think there's a consensus mandatory voting or voter duty will not be enacted this month or this year. susan b. anthony in 1852 said the most important right women could have was the right to vote because it affected every other right in 1882 to constitute a

constitutional amendment which purports to in the united states congress and 1920. >> thank you very much. [inaudible conversations] [inaudible conversations]

now a house hearing on improving medicare and medicaid services for people who qualify for both programs. currently the federal government is working with 15 states on pilot programs and merging both programs. the medicare and medicaid services director and representatives from various state programs for witnesses during the hearing. this is two hours and 20 minutes. >> the subcommittee will come to order. the chair recognizes himself for an opening statement. dual eligibles, there's individuals who are eligible for both medicare and medicaid programs are one of our sickest come poorest most costly and most formidable population. if we are to simultaneously and prevent clore the cost of their care, we must do a better job of

integrating medicare and medicaid benefits and services. dual eligibles aren't unique. while more than half of the dual eligibles live below the poverty line, only 8% of medicare beneficiaries of income below the poverty line. 19 present of the dual eligibles which in an institutional setting while only 3% of medicare eligible only individuals live in such a setting. they are also more likely to be hospitalized to go to emergency rooms and require long-term care than other medicare beneficiaries. according to the centers for medicare and medicaid services more than 9 million people fall into the dual eligible category. 43% of them have at least one mental or caught if impairment while 60% have multiple chronic conditions. according to the kaiser family foundation, durrell eligibles

who make up only 15% of medicaid enrollment consume 39% of the medicaid funding. additionally, the 2,005 medicare and medicaid program spent an average of $20,000 per deutsch eligible, almost five times greater than the average amount spent on other medicare beneficiaries. these individuals who have fewer resources and more complicated health care needs face the added struggle of trying to neck deep connecticut medicare and medicaid. medicare covers the basic acute care services and prescription drugs and medicaid fills in the gaps. redican generally pays the medicare part b premium and the cost sharing for medicare services. for some, medicaid also covers various benefits not covered by medicare including long-term

care support and services, dental care, eyeglasses and other benefits. each state determines its own eligibility standards and which benefits will be provided to medicare beneficiaries. so we are able to watch various states experiment with different models and designs to better align the care of the will eligibles. currently 15 states have been selected to receive funding and data and technical assistance from cms to develop a more coordinated middelkerke for the deutsch eligibles. we can improve the quality-of-care the dual eligibles received and we can make the care more efficient and easier for them to navigate and we can do all this while lowering costs to the federal government and the beneficiary. i look forward to hearing from witnesses today about which models are being tried in the states and what we learned so far. this time i will yield the remaining time to the vice chair

dr. burgess. >> thank you mr. chairman. no other area is the lack of coordination the federal level more apparent than when we deal with people do all eligible for medicare and medicaid. the population, studies of the population make it clear medicaid is actually 56 separate programs administered by the states and territories in the context of the tool and sometimes it becomes a game of hot potato. the data suggests a they're sicker when they are hospitalized, costs are almost 10% greater devotee of more episodes of avoidable hospitalization. symptom of no one being held accountable for their care. a better alignment of medicare and medicaid is needed. unfortunately the accountable care organizations that we have provided a model and a good

place to start seems once again the bureaucracy killed any such help for that happening. the rule produced was virtually unintelligible and most large groups that were felt themselves to be a co have moved away from this. you want to drive cost savings with better care this is a problem that we could solve. 15% of the medicaid enrollees are dual and account for almost 40% of the program spending. the old willie sutton law robbed banks because that's where the money is clearly should apply here and these patients are fully covered by medicare and the entire medicaid benefits package and still five times costlier. these are patients that are defined. we know where they are and who they are and when they are accessing care and why they are accessing it, yet for some reason we lacked fundamental amount of consistency for

coordinating their benefits. i really find myself agreeing with asra claims of the "washington post," but i did last week when he talked with the fact this was an idea whose time has come. i don't understand why it takes an entirely new federal agency when cms has had broad weaver authority and demonstration authority for years to take care of this problem.? i yield back the balance of my time. >> pitcher thinks the gentleman that recognizes mr. bloom for five minutes. >> thank you mr. chairman. i welcome today's hearing on the critical issue of coordinating and improving health care of those dual al-awja zero for medicare and medicaid programs also known as dual eligible and i appreciate my colleagues working with us and preparing the hearing to look forward to the discussion. this is an area of the health care system that has potential for effective change. the reality is they are a vulnerable population their care

is costly and is uncoordinated which results in poor outcomes in many cases. in total there are 9.2 million americans who rely on both medicare and medicaid. meanwhile they are sycophant lipitor and tend to have extensive health care needs. overall they are more likely to suffer from chronic conditions such as heart disease, pulmonary disease, diabetes and alzheimer's. and their care is complicated and too often not receiving the patient centered care they need and deserve. in addition, they represent less than 20% of the medicare and that ticket program but there could responsibility for a significant amount of the program expenses. in fact in 2007 they comprise only 15% but represented 39 per cent of the spending in the medical costs for more than six times higher than the non-disabled adults of the decade. meanwhile, in medicare they represent 16% of the enrollees

and 27% of expenditures compared to all other medicare enrollees the health cost nearly five times as great. these are powerful matters to demonstrate if we can improve care coordination and for the individuals also an opportunity for savings and passing the affordable care act we created if coordinated health care office of the board of health and human services otherwise known as the medicare medicaid coordination office. its mission is to gain much-needed efficiency in the system for this group of beneficiaries. i must admit timing of the coordinated office as well as today's hearing couldn't be better congress and the committee are increasingly concerned about the rising cost of medicare health care coverage for the 45 million elderly and disabled americans and medicaid 55 million poor patients so what better place to explore, understand and address the and the sickest most expensive populations to cover? but we mustn't set a price tag on their care or shape policy

with a goal only a saving money. it's clear we have big challenges and ferry the opportunities in providing care for dual eligibles so i look forward to hearing from the expert panel and specifically would like to welcome the head of the new coordinated office. i know that she has a long history of steaming to restructure the service of the dual eligible, so i look forward to hearing about her work and also about the successful efforts represented here today by the panelists and i hope we can hear ways congress can be helpful in addressing what's been a longstanding problem facing the health care system. and i yield back mr. troutman. >> the chair thinks the gentleman and recognizes the committee chairman mr. upton for five minutes. >> thank you, mr. chairman. according to cms, more than 9 million americans qualify for both medicare and medicaid including at least 257,000 in

michigan. i want to thank the two panels for agreeing to share their expertise surfing the population often referred to as the will eligibles. we look forward to hearing your perspective on the health care needs and barriers that currently prevent them from properly not getting the health care system. this hearing is important for two key reasons. first, we must understand the distinctive behavioral and physical health care complexity associated with the dual eligible population and second, we need to better understand what is currently being done to help the individuals navigate the health care system. by the end of the hearing we ought to be able to identify what initiatives exist to effectively integrate care for the duel eligible populations, what coordination models are working and what prevents the models from expanding and building on the positive efforts already under way we must also look for ways to modernize the structure so these individuals are injured access to quality health care with less red tape.

most americans have uniform coverage that guides them through the complex health care system but for the dual eligible the process is more complicated because they've never get the waters of different entitlement programs that offer different benefits and cover different services and providers and because of that structure we have to come to learn dual eligibles have difficulty finding were to access good quality care. not surprisingly, they frequently in the in er which is harmful to both patient and taxpayers to end up with a cost of present and hospitalization. we welcome you and i yield back the balance of my time to dr. cassidy. >> thank you, chairman. medicare and medicaid are important programs that are unfortunately unsustainable in their current form. medicare for the actuaries who own the program has gone bankrupt in ten years hastened by $500 billion extracted by obamacare.

medicaid is bankrupting states, and this is before the obamacare mandate that usurped state rights. as a doctor who still teaches and treats the and injured in a public hospitals though, my primary concern is patient welfare. and fortunately there's an opportunity for improvement. as we know, the dual eligibles oftentimes have poor outcomes. republicans have proposed be free the states from the rigid medicaid rules which make it difficult to coordinate and medicaid and medicare. we also put forward a plan to save medicare from bankruptcy to preserve medicare as it has been known for those who are on it and to preserve it for those who will be on it. ..

>> i will say the off

assists staged officer like that the one part i applaud even a blind hog finds an acorn now and then. >> riyal recognize the ranking member for opening statements. >> thank you very much. as observers well know by and large democrat or republican we care about the issue of and it is a hearing where we have collaborated to have panels to give us the best information and how we can address the problems of people who are on

medicare and medicaid it is facing both programs by design they should have access to the best each one has to offer but too often and they struggle and fall between the? and cycle in and out of specially care, nursing homes and hospitals without getting the patient focused care that they deserve. not homogenous but they can be considered several subgroups. medicare beneficiaries who were eligible by virtue of age and those because of low income could be in the mid-60s and may not differ significantly from others in the need for care. but others such as adults under 65 with developmental disabilities such s a revolt paul's your intellectual disabilities require more care and resources to live their lives. those with cognitive

impairment such as alzheimer's or another significant and the frail subgroup that we will hear about today come in many of these individuals may require nursing-home level of care or home base support services allowing them to live outside of the institution but a disabled person under the age of 65 cost medicare and medicaid between 25 -- 23,084,000 depending if they needed a nursing home state. this is expensive but not getting the care is worse resulting in eroding health and trips to the emergency room suffering for the patient and astronomical cost to the patient and the taxpayer. these presents a challenge and opportunity to develop and implement reforms over time will simultaneously

improve care to it while reducing cost. a medicare payment devise three commission and the child health program have their commissions as well and all of these have described as a lack of coordination between medicare and medicaid that can create the outcomes and misaligned incentives and nursing facilities may find it profitable to transfer a complex patient to a hospital even if it is capable of managing the patients because of the different payment rates and benefit rolls. we have heard many times problems generated by medicis and that has no core mission of benefits good tool eligible beneficiaries the problems are multiplied because of the care needs.

we face a lot of challenges and improving care for dual eligibles and reducing costs to the taxpayer is important to recognize we shouldn't rush into new programs for purely a budgetary focus and should not assigned a price tag to this population then design a policy of around it. the most successful efforts to integrate care has been local and focused on a small group of beneficiaries. those that were built around intensive interventions with social workers and therapists and others. but these can be difficult to scale up to a large population and renamed to be weary of promises regarding the decade old problem. i want to mention one of the results of what some call

obamacare is to extend the medicare trust fund but another thing to recognize this what some have objected to they took all of the cuts and went way beyond that with the medicare proposal they would transform into a whole different system we have opportunities to save money we spend on new eligibles of looking at part d where we pay a higher price for those levies to pay in the past providing better coordinated care saving money are not mutually exclusive for those dual eligibles this may be the key to improve quality of care. thank you, mr. chairman. >> we have two panels today will ask panel #1 to take

the seat at the table and we will come this bella is the director for medicare/medicaid services ase. your written testimony is made part of the record and we ask if you would summarize your opening statement at five minutes. then we will go to questions and answers. >> >> that could afternoon. to the chairman's and members of the subcommittee. thank you for the different -- opportunity to participate in the discussion prime the director of the federal court in me did health care office for medicare and medicaid services we refer to this has the coordination

office was greater by the affordable care act and our single focus is a topic of the hearing. enrollee is referred to as eligibles low-income seniors and individuals with disabilities as well as those with illness and some start on medicare to have a functional decline the makes them eligible it either way they have needs and three of five of chronic conditions and to a five have one cognitive or mental impairment. not surprisingly given a higher than had higher average health care needs across is significant. medicare/medicaid spend roughly $300 billion per year to provide care to the population. our office works across with the states and providers and other stakeholders to have better care through

improvement and specifically focusing main areas is program alignment then dave and analytics i will highlight a few of the averts today starting with program alignment. better coordination begins with a lineman and medicare/medicaid enrollees must navigate to separate system as part of medicare for coverage of acute-care services and drugs and medicaid and -- medicaid for supplemental services. medicaid provides health with medicare premiums and cost sharing and although they provide both the defense statutory provisions and payment policies. one of the first objectives was to catalog all the places where they bump up against each other. this creates barriers to effective care and through

consultation we use the opportunity to identify places to improve alignment between the two programs. we have published the list and the federal register to invite public comments then this will allow us to identify barriers to high quality cost care as well as areas for improvement. another key objective is to engage the state partners and improving quality and cost of care relies on effective partnerships because we share the responsibility to provide care to finance the care good two key initiatives and for the enrollees and one of these initiatives was lower states to access medicare data and lack of timely data it expressly party has been a barrier for states to

expand care management this provide states with the new tool to support efforts to improve care for the most complex and costly beneficiaries. the second initiative and partnership with center medicare/medicaid innovation it is to integrate care for dual eligible individuals under which they were selected to design new approaches to better coordinate care for medicare and medicaid enrollees through these design contracts they have funding for selected states for those approaches to coordinate care across primary acute behavioral health and services the goal is to an end to five and delivery to be tested or replicated in other states. but our offense serves as a resource and available to provide technical assistance to any state interested in

working to improve quality and reduce cost with the medicare/medicaid enrollees part by higher priority claims that have access to seem as coordinated care is on the rise. get there by a eliminating barriers to integration in partnering with providers and stakeholders developing a new payment model. we expect the quality outcome will results in better care. thank you very much so and i thank you for your opening statement that will begin the questioning and recognize myself for five minutes. director bella in the 2010 paper entitled options for integrating care for dual eligible beneficiaries zero comex the goals should be clear to provide

beneficiaries with the right care at the right time and right places and to give states and others stakeholders the flexibility they need to test accountable models of integrated care. is it fair to say you believe the current system does not provide the stays the sufficient flexibility your incentives necessary to integrate care for the tools? >> as i mentioned states are critical partners. we have to recognize where the states are to develop models to improve care for this population. when i think of flexibility and now think of it in the context of being able to cut benefits or services but we have a population with complex needs we have to adapt to those needs and it allows us to have more cost-effective care than

might otherwise be available with the traditional systems when they are fragmented. we see potential for the corrugated system to take a holistic look at an individual to make sure we get those needs met in the most cost-effective way. >> host: what states feedback have you got from those states about further integrating care for the jules? >> that is a great question. people in those states are strapped and knows that a tremendous opportunity to improve quality to help control costs with a population i see more motivation in states than ever before to understand the needs of the population to develop the integrated sense of care that improves quality to reduce costs over time. >> as you know, there are

various opinions on how do a eligibles should be enrolled in models or coordinated care programs. do believe mandatory enrollment with the opt out policy would increase enrollment? >> certainly enrollment is a significant issue. first and foremost, the commitment of our office is to establish beneficiary protections of the programs recreating are better than what are available today. enrollment is one of many issues we have to explore what is keeping people out of the integrated systems a day and one of the issues on the last we are committed to working with the state partner. >> your office recently announced the availability of medicare data -- data on tools -- duals and why is

that some of imports and and what else can we do to improve the availability of real-time medicare data for states and providers? >> i have of personal interest in this and when part d lost access to pharmacy data it is like to find their hands behind their back it is like taking a tool away so by giving states the data we support the difference to identify high-risk individuals to provide the data to managers who understand opportunities to prevent or reduce errors or medications to have adverse effects. we believe putting the data out there will get them where they need to be. it is timely covering medicare and a way that allows us to protect the important safeguards but

still get the tool tuesday to try to design programs. >> i have time for one more question prepare realizing the medicaid expansion and that does not directly applied to the dual eligibles do believe the expansion could have a woodworking effect on the system to increase the number of the dual eligibles? >> we have not done in the detailed testaments as of the population and the other examinations dead not the of us to believe there would be the woodworking effect. >> the chair recognizes the ranking member for five minutes for questions. >> i was going to ask unanimous consent form is christian sens to sit and on today's hearing. >> without objection.

>> i want to ask you three questions. my first relates to budgetary concerns as you have heard in my opening statement i am concerned decisions about to a knowledgeable sybase on budget concerns not may be for you but i am concerned that is the big factor disproportionate of what it should be. as we said, it is a very complicated set of group there are those with developmental disabilities or under 65 and also those who have cognitive impairment s with advanced stages so they are not the type that ensure they are rushing to sign up before, that is another concern. it is an extensive population. we have to be creative and assertive but also be

realistic and understand it may be costly and budgetary and they should not drive the treatment of the sickest of the city since. could you tell us how your office is thinking of to a eligibles as groups? is it by diseases or by the basis of eligibility for the program and of course, my concern is it is not budgetary driven. >> exactly. it is a diverse group. there is a few different ways of slicing and dicing the population the advantage of the office is to look at the subset analysis. we're looking at the highest level over 65 to understand the care needs of those groups and when under 65 population with a disability the presence or absence of mental illness is the game

change your over 65 the same thing can be said with alzheimer's and dementia up. we look at those levels with the subsets there's also raised a look at the population to understand if an aids are more acute care driven so those who have eight amenities are those who have needs that are more supportive services and some of those are in nursing homes and the communities of the distinguishes subset danes the population in. we tend not to think of conditions or eligibility groups but care opportunities. regardless of the profile what needs to happen is the assessment of their needs which is the availability of care team to get them the most cost-effective services so coming back those are

examples of ways to use information to drive our decisions what types of teams and what we would have been placed. >> mentioning the nursing-home population more than half are doing eligibles in 2007 as 70% of medicaid expenditures long-term care. what can be done to improve care and quality for these people and nursing homes? water the state's proposing? obviously i prefer they not be in nursing homes. or their way to improve care to get them out so they don't have to stay? >> yes. there are many stays looking at rebalancing of words. you will hear about the initiatives in north carolina and particular herb but some examples, we could focus on and avoid a ball

hospitalizations of pressure also is committed dehydration and, those are things that are avoidable and preventable by targeting intervention to those on-site we can improve quality of care reduce hospital transfers and hopefully with cost-effective judges as well. >> third question. i know worrying about passing the buck. who is responsible for their care? s.a., the an insurance plan plan, and lots of times there is the passing of the buck in terms of who takes care and who follows up and to enforces the rights and who is accountable to make sure their needs are met and quality care provided? isn't the planner the state

or the federal government is is part of the mission to clarify to make it easier? can you play a role so it is then passed? sino i am not a time if you could be? >> states and feds are accountable we share accountability the reason it was created to streamline care to help make sure we do keep systems together and improve accountability. >> you try to coordinate? >> yes. >> thank you. >> we recognize the full committee chairmen for five minute. >> we appreciate your testimony of course, you said total annual spending is estimated at 300 billion annually. 9 million medicare/medicaid enrollees accounted at 120 billion combined federal-state spending 2007 almost twice as much

medicaid's been all 29 million children it cover that year. in responding, talking about some savings of targeting certain innovations, what the other ideas to eliminate barriers do you think we could achieve to see some real savings of the program? what should we think about? >> i appreciate the question but unfortunately there is no silver bullet and savings happen over time however if you think of levels the most promises understanding how to recreate systems accountable and coordinated? buy our accounts there are 100,000 people fully integrated programs that i mean there is the accountability for medicaid and medicare. the opportunity for the rest

of the population and absent that coordination, we are not as aligned and efficient as we could be. the great opportunity aces for payment reform models to understand how to create a way to take care of a totalitarian to make sure the incentives are aligned with doing so. >> can we come up with nuts and bolts metal innovations will lead directly to savings'? if so what would the savings be? as a percentage or real dollars? >> one of the first things we did was to engage states in a partnership to work with us to design fully integrated models. 15 states it is working with us to design the nets and bolts and we're in the design stage we don't have savings at this point*. we can expect there will be

opportunities with the avoidable hospitalizations but we also have seen oftentimes there is an increase before of a decrease because there is pent-up demand and new services taking place to reduce other services down the road. it has to balance but we will work on getting concrete testaments by working on the models. >> with those 15 states how long will it take to complete the work that you can look at the accountability? >> away restructured the initiative it is a 12-month design period. >> starting when? >> apr. several states are interested putting something for word earlier. and all states can put proposals together we're just working with these 15. they can come in the center with ideas but this is not a

typical demonstration we are prescriptive about what we want to see it. it hasn't worked so far as we want to design what is effective for them but it is a complex population and we have to do this in a way to make sure we are addressing significant issues around participation and financial incentives and the reason why a we put it through the design phase of. >> i yield back. >> and the chairman recognizes mr. waxman for five minutes. >> there is the interaction between the issues we're talking about today and the medicare vantage program. it is complicated. some medicare vantage special made plans have been around for a long time built around the communities. others have less successful track records and the program has been supported by large subsidies provided

by taxpayers and other beneficiaries. the affordable care act as extra payments to the medicare advantage plans but not to all of them more immediately. of a surprise to find some states are proposing to use medicare advantage benchmarks as the basis for their proposal and they met this stage for those integration so what use of benchmarks increased cost if they were adopted for duels? >> our goal is to get more beneficiaries and integrated systems so there is the opportunity to achieve the savings of is the your pointing out all we have seen with the differential rates but i would come back the purpose is