>> doesn't come with a curse at times? >> no, it comes with so much love. >> we should enjoy it while it lasts. >> they're frustrated, angry and saying where is the hell. so, where is the help? >> how you can help. please, please do your part. >> do you agree that was a holocaust? that's a simple yes or no. >> a piece that would give us -- >> what happened with the sobering? >> it sunk. >> what were you thinking as you walked? >> land of the free, home of the brave. is that what it says? land of the free, home of the brave, so let's be brave. ♪ ♪

>> don't injure time think about when it is you're going to die. >> but you learn that the stuff in your life is not the definition or the absence of your existence. it's the relationship with people in that room right there. so that's what i can honestly say i am a lucky man. >> oh, boy, if that's the word, lucky. anybody who is successful in any business doesn't use the word luck is a liar. luck plays a part in it. >> i don't know what to say except to you, my audience, thank you. instead of goodbye, how about so long. [applause]

>> as i said, presidents, kings, chairman of the board, they all came to the table because of what larry king brought to the table. and those numbers again, 25, 40, 50,000. tonight, ladies and gentlemen, join us in congratulating larry king, lifetime emmy award winner. [applause]

>> i'm supposed to read this inscription before i shut up and let you deliver what i assume will be remarks. with his global audience, formal interviewing skills and authentic engagement with viewers and guests, larry king is one of the most influential talk show hosts in the history of television news. ladies and gentlemen, of larry king. [applause] i really don't know what to say. i've never been at a loss for words. but i thank you, brian williams, for coming over and doing that. he is a special guy. as are all the people here, because i was lucky enough to be

in a business where i really didn't have to work. it was a joy every night, radio or television, to go in and meet people from all walks of life and ask them questions, to get paid for it. it was unbelievable to me, to appreciate, i didn't own the camera. cnn own at the camera. mutual broadcasting owned the radio broadcasting but gave me the privilege, the privilege of sitting there and being seen around the world. i'm a little jewish kid from brooklyn. my father died when i was nine and a half. my brother, marty, is here tonight, we were raised by our mother, took care of us. i went to college. i always wanted to be in radio. i used to go to the bathroom after radio shows and imitate the radio. a tale well attack you laid to

keep you in suspense. [laughter] who knows what evil lurks [laughter] who knows what evil lurks in the hearts of men? the shadow knows. i wanted to do that. i wanted to do that. and i got to be on the radio. and then television. and i never thought i would be seen all over the world. who could imagine that? who could imagine the privilege of doing that? and do raise some wonderful children, larry junior and kia are here your and my three little, two little boys are home, chance and cannon, they are 12 and 11. my step boy, danny, who is in utah, and my father-in-law and mother-in-law, my brother marty and ellen, my cousin arlene. who is left? my friend kurt, my staff.

oh, yeah. my wife. behind every man there's a woman pushing him aside, getting all the attention. [laughter] stand up, sean. [applause] my wonderful executive producer, wendy walker, who was there with me all the way. [applause] thank you. and the staff, greg christiansen and nancy baker, jason robo, bridget banneker and allison marsh who just gave birth to a first little baby, couldn't be here. i want to thank executives at cnn who are here, jim walton, scott, rick davis, mark whitaker, i thank them all. for making all of this possible, for hitting me the privilege of

being in this fantastic business. and to be honored by the people in your own business. what could be better than that for a kid from brooklyn, who dreamed a dream, and had a dream come true. i can't end with not doing something a little humorous. there's an annual dinner in washington, d.c. every year, washington touchdown club, and they give out awards for everything, this teacher, worst teacher, it's an endless on night of award. and then a ghost like one, 2:00 in the morning. in each year they have a man of the year, and that's what everybody stays, to hear the man of the year. frank sonata, johnny carson, unbelievable. and one year danny k. was the honoree. so he was the speaker. everybody state. i was the mc.

and all we heard was i want to thank my brother can't to thank my father, i want to thank my sister, want to thank my producer, thank, thank, thing. i thank everyone. thank, thank, thank, 20 to two in the morning, danny kaye gets to the mic and says i want to thank my urologist. [laughter] doctor harvey quite a bit of the hills for make it possible to sit through this crap. [laughter] [applause] i also want to thank two of my favorite people, dan rather, brian williams, and also rig for coming by tonight, supporting his friends, to all the staff, two friends have been here, my brother marty. thank you all. what can i say but thank you.

thank you, doctor skip holden of beverly hills, california. thank you again. [applause] >> please welcome the host of msnbc, the last word with lawrence o'donnell, lawrence o'donnell. [applause] >> thank you. there is, of course, nothing you can possibly say when you follow larry king, and so i will not attempt to say anything, other than getting on with the presenting. the next category we are to present the nominees for

outstanding interview -- >> and the award goes to "60 minutes" medal of honor. [applause] >> accepting the emmy, jeff newton, producer. >> i'm average. i'm mediocre. >> he may consider himself mediocre but this tuesday at the

white house he will receive the military's highest honor. tonight you'll hear the story of his hair of his heroism while fighting in afghanistan's deadly region. but this is the single greatest honor that the military and the -- this does on itself and it comes from the president of the united states. [applause] >> a couple more guys coming, greg. well, lower is not to deny, she is on assignment but she really does deserve to be a. she did a great interview that really, that really did stand out. but i know that she would be probably the first to say that the interviewee was fantastic. sal giunta was one of really the most outstanding characters we

have seen in many years of covering this war, and an american hero to do. so we would like to dedicate this to sal giunta, first living recipient of the medal of honor in a generation. thank you very much. [applause] >> and now the nominees for outstanding continuing coverage of a news story in a newsmagazine --

>> and the winner is dateline, america now, friends and neighbors. >> accepting the emmy, the senior producer. >> feeling poor and powerless, the stress was often too much but i don't like to see my kids country. i hate asking others to do stuff for my kids. when you're so poor, it really makes you feel like crap come you can't do anything for you on kids. you feel, you feel really bad. if you like everybody else is doing everything for your kids and you can't get a job to have money to get what they want or need, and you beg everybody you know to take care of your kids. that makes you feel really crappy. [applause] >> thanks everyone. it's a real honor to be standing here tonight, my name is justin

balding, i'm one of the producers on the story. and out of fairness to sunny who was the late in the clip, she had a lot better days than the one where we conquer that day. there's a lot of people to thank in this story. most of all perhaps david corvo who launched the american now series on dateline, allowed us to go and shoot this story. this call executive producer at dateline now, and korea, of course, has been a lot of time with us in the field. my coproducers, carol, and katie, who really shot most of that story. and our excellent team of editors were coming up right now, and. [applause] >> i would like to also say

thank you to a lot of people in southeast ohio, and a lot of journalists in this room, probably over many years. but most of all i would like to thank the people who are allowed us into their lives. most of all perhaps lisa roberts who is standing here tonight, who runs a food pantry in southeast ohio, and around who we built the story. thank you very much, everyone. [applause] >> and for the next category, the nominees for outstanding investigative journalism in a regularly scheduled newscast --

>> and the winner is cbs evening news with katie couric, photocopiers hidden danger. [applause] >> accepting the emmy, michael rey, producer. >> until we unpacked and plug it in we had no idea where the copiers came from or what we would find. we didn't even have to wait for the first one to warm up. >> there some documents here. this machine came from the city

of buffalo, new york, police sex crimes division. >> this machine has to wonder for 9000 copies on it, total copies them apprentice for 2000 prints on it. it was used as a fax machine. [applause] >> i'm producer michael rey. thank you very much to the academy. i would like to thank -- keith who allowed me to do an investigation on a plastic box, and my associate producer emily who is out there, and producer joe bennet, who should come. thank you very much. [applause] >> and for the next category, the nominees for outstanding continuing coverage of a news story in a regularly scheduled

newscast -- >> and the winner is cbs evening news with katie couric, afghan bomb squad. [applause] >> accepting the emmy, pat sheldon, executive producer. >> as the initial wave enters the town, sergeant jones was wearing a helmet camera to see the first bomb exploded. >> is everybody all right? >> they examined the device that

has gone off, and then find two more bombs that are ready to explode. they slowly unearth them. as they prepare to cut the wire to a detonator, they break the tension with a flash of humor. >> this is what i love to do. [applause] >> thank you. i am not pat. that is that i'm the editor, one of the editors who have worked on this piece. hey, guys. it's not often that we, unicode i am honored, you know, to accept this award for all the people that really did all the work, people that went out. in war zones, you know, the soldiers, and, unfortunately, some of the producers, the correspondent, could make it but he did ask me to read this, so, randall joyce wrote this. terry and i would like to thank

the 31 marines who offered us extraordinary access, and even when things went tragically wrong, capped their end of the bargain by letting us do our job. we hope we keep our part of the bargain by telling their story as fairly and as honest as we could. thank you very much. [applause] >> the nominees for outstanding informational programming are --

>> and the winner is, he'll be food inc., pbs. [applause] >> accepting the emmy, robert kenner, director/producer. >> you have a small group of corporations who control the entire food system. from seed to the supermarket. they are gaining control of food. >> this isn't just about what we are eating. this is about what we are allowed to say, what we are allowed to know. it's not just our health that is at risk. >> companies don't want farmers talking. they don't want this story told. [applause]

>> we had no idea when we started out making food inc. how difficult it would be to tell the story of how our food gets to our plate, what's in it, what it does to us and what it does to our environment. we also let no idea about the growing food movement which could help bring about changes, inspired by such good rate books as michael -- numerous wonderful films. i want to thank diane for having the crazy notion to finance a theatrical film about where our food comes from. i want to thank b-to-b and everybody there was action at p.o.v. that we first got the idea to do food inc. i also want to thank them for their uncompromising manner in showing it despite certain food corporations that wanted it done

differently. and also want to thank my co-filmmakers for their insights, their brilliance and the kindest. unless i want to thank my wife whose love and support i could make films without. thank you very much. [applause] >> and the nominees for outstanding research are -- >> and the winner is explorer,

chemical to survive? national geographic channel. [applause] >> accepting the emmy, chesapeake sacks. researcher. >> national geographic cameras have gotten access to a place almost no outsiders have been permitted. >> and to be peace command for capping the well. from this 800 square-foot room known as the hive, engineers monitor over a dozen life feeds, streaming from the ocean floor 5000 feet beneath the surface. >> welcome it's looking like a national geographic researchers didn't get tickets. oh, here they come. [applause]

>> thank you. in a field where we still don't know how much oil came out, find information with an incredible challenge, and it would have been passionately not been possible without these guys. and todd who can't be her tonight. also want to thank the other producers on the film, joe eaton, jonathan gruber, melissa everly. national geographic magazine who was intimately involved in the collaboration. national geographic channel, kathleen crumley, michael cassio, who supported us as documentary filmmakers in a way that is unimaginable in breaking news environment which is not something that we normally ever do. and, of course, also national

geographic television, and michael rosenfeld, and on behalf of all three of us we want to thank our mothers. thank you very much. [applause] >> and the nominees for outstanding writing -- >> a writing award that aaron sorkin didn't win. first life with david attenborough, discovery channel

is the winner. [applause] >> accepting the emmy, anthony geffen, producer. >> from the moment they appear to the time that they took their pioneer steps on land, we can deduce how animals acquired bodies that moved. eyes that saw, and mouths that eight. and we can understand how those first organisms laid the foundations of mammals -- animals as we know them today. including you. and me. [applause] >> wow. i think this is incredibly satisfying, but really a very satisfying, most satisfying in a way because this is the writing. and you haven't actually heard

david attenborough's words spoken by david attenborough for a long time. you do get them if you buy the dvd, but his words are magical. and the thing about david is he may be making programs for 60 years, but he has a craft of storytelling and an understanding of the story which i don't think, and i've been lucky enough to work with many of the greats of broadcasters, he has an understanding that is unparalleled. and he managed, he always wants to tell the story that occurred for 500 million years ago, but he couldn't tell it because he didn't have the fossil record. when we had fossil record was complete enough he was able to embark on a. he laughed at me, he was 85, you know, he was hoping that they would -- of course he's not retiring. anyway when we take the three in his back to them in richmond in

london he will retire now. he is brilliant, and this, so i think it to the academy because this one means a lot because it is david attenborough at his best. his words, and, of course, he speaks his words, and there is no one taking who speaks quite like that. thank you very much. [applause] >> please welcome the chairman emeritus of the national academies news and documentary emmy awards, bill small. [applause] >> good evening. as many of you know, until i stepped down last september, i spent the last decade as chairman of the news and documentary awards, and someone asked me, of all the presenters, which were your favorite?

which stood out in your mind? and many of them, witty, witness brian williams tonight, a few have been wordy, no names please. but the first one that popped into mind was the late ann richards, one time governor of texas. my daughter, tammy, says she's the last good governor of texas ever had. [applause] .. there was a governor called pa

ferguson. he was a crook. unlike some other elected officials we've known, he got caught, and he was impeached. being impeached in texas means you can never again run for state office. so what did he do? he ran his wife's campaign, and ma ferguson became governor of texas. he is only remember for one incident when some of her colleagues said, you know, they are trying to start a movement to teach spanish in our schools. she said, not while i'm around. it's english. we are given -- good enough for jesus christ, it's good enough for texas. [laughter] the other one that popped into mind was my old friend joe hero was president of university at the time. he said that, looking at the nbc

seat, i have television experience. i was on the today show not long ago. he said it was early dawn, and i'm sitting in something they call the green room. the only other person there was a french actress. she said to me, good morning, father. i said to hurt, good morning. that is all that was said. there was electricity in the air. anyway, my job is to introduce the first two of three categories that began best of. if you have been watching these entries, almost anyone could sit this category and, indeed, many were injured. i salute the judges who went through this mountain of material to come up with

nominees. the nominees for the best story in a regularly scheduled newscasts are -- [applause] is there any in the room who would be surprised if nbc wants something? [laughter] the emmy goes to nbc nightly news with brian williams mexico, the war next door. [applause]

[applause] >> accepting the emmy, mark connor, correspondent. >> the savagery is hard to imagine the headings and corpses strewn in public as traffickers lash out against rivals and the authorities. the horrific violence here in juarez and elsewhere in mexico is directly linked to the united states as they fight for control of smuggling routes to the united states. anyone standing in the way is a target for murder. there are 20,000 children living on the streets just here in mexico city. almost all of them are brought into a cycle of drug addiction and prostitution, and they are also extremely vulnerable and dark and private -- recorded by the drug cartels. >> thank you. [applause] we are humbled by this award and thank you very much. the mexican drug war is a tough

story, often hard to get to, but its importance. it affects this country directly. for that reason we would like to think the people at nbc nightly news for their unending support as we covered this story over and over and the continued to support us as we continue to look into this very, very important story next door to us. i would like to thank my colleagues here, bob wondering, erica and, richard ankle, bob epstein, brian williams introduced it and supported it fully. i think them from the bottom of my heart. blessed with like to thank all of our colleagues at our sister network for their very important work in mexico. every day, and we thank them. we are humbled by them, and we thank you very much. [applause]

>> somewhere another envelope is coming. while we wait for it right before i came on, no one has ever asked me what was the best acceptance speech. my favorite and the shortest of all was a young writer from cbs news who had been fired several weeks before the in the dinner. and his acceptance in its entirety would like this. it to my former bosses at cbs news. [laughter] okay. the nominees for the best report are

[applause] >> i am now told, and i know this will come as a great disappointment to 60 minutes, that there are -- there was a tie. two awards. and needless to say the first goes to, if i can get it out of the envelope, 60 minutes with a blowout. [applause] >> accepting the emmy, scott belly. >> take your breath away.

shake your body to the court. >> mike williams was the cheap electronics technician on board the deep water rise and, one of the last to escape the inferno after the blowout in the gulf. he believes a series of mishaps may have led to the catastrophe and his story which may be critical to the investigation has not been told until tonight. >> all of the things that they told us could never happen happened. >> what he is saying is very important to this investigation. >> who is responsible? >> we think. [applause] >> don hewitt always told us, find characters you can tell the story better than we can. that's a hallmark of 60 minutes, of course. mike williams, the chief electronic technician on the deep water rise and was certainly one of those

characters. here comes more of our team. you missed the deadline. this story represents one of the most difficult things and potentially one of the most dangerous things that any of us in this room ever does, and that is serious investigative reporting on deadline. this team was able to pull that off. as you can see, it's a large team. we broke his investigative projects out into various aspects, and these people attacked it in various ways all at once, and we were able to turn this story about what actually happened on the deep water rise in in very short order at the very time that the country was eager to hear more and then the answers. so with great thanks to the academy, with great thanks to bill loans for leading such a great shot like 60 minutes, we thank you very much for this. [applause]

>> the second 60 minutes emmy goes further the lost children of haiti. [applause] >> accepting the emmy, scott belly. >> thank you so much. well, thank you. >> it has been ten weeks since the earthquake in haiti, and we were struck by what is still an apocalyptic landscape. one of the first things you notice is the children. there are half a million of them living on the streets and crowded orphanages or in makeshift camps. untold thousands of kids are threatened by hunger, disease, sexual assaults, and a modern day slave trade. we found that even a man rescuing hundreds of orphans was at the same time searching for his own missing 8-year-old son.

[applause] >> thank you. the careful observer of these proceedings will have noticed that you are seeing a lot of nicole young and sally gradstein on the stage tonight. both of them were associated with a great deal of our best work on 60 minutes all last season. once again, ladies and gentlemen, we are terribly grateful to the academy and all of you for supporting our work. thank you again. [applause] >> go get it. i don't want you to panic when you see there are still half a dozen emmy's left. the academy always had, we don't know. well, no longer with the

academy, but those still there do not know how many are times. there are always a few more. none of them are engraved except for larry king. the voice you have been hearing introducing we presenters and voice overs, steve cramer. [applause] i ask if they would let me introduce the next presenter. is for the category, the best in documentary. sheila nevins, who is the head of documentary at hbo for many years is really one of the most remarkable people. she and i think 2005 received a lifetime achievement or so. she has been the overseer of

over 500 documentary's. she has been the recipient of two dozen news and documentary emmys and another ten or so primetime and lesser awards like eight oscars. but -- thank you. she is truly the first lady of television documentaries. my great pleasure to bring in sheila nevins. [applause] >> thank you. there have been so many men in suits tonight, and so many sad stories. i thought i would think my gynecologist. [laughter] i tried it. it wasn't bad, was it? anyway, the best documentary, the nomination.

and the winner is pov food, inky. >> accepting the emmy, director and producer. >> the fast-food industry fought against giving you calorie information, fought against telling you there is trans fat. the meatpacking industry for years presented country of label

they fought not to label cement to the genetically modified food, now 70 percent of processed food and supermarket has some genetically modified ingredient. [applause] >> wow. well, i have to say, i am a lucky man. and for many reasons. one is, well, i think there are so many wonderful film makers who are in this category, and it is such a great profession to be an. i am lucky to be part of this world. i think we can make differences in people's lives, and it is just -- and you get to work with some many wonderful people. elise and melissa and dick and cynthia. so i am just so honored to be here amongst all of you, and hopefully we can go out and keep making the world a better place. thank you so much. [applause]

>> please welcome again to a chairman of the national academy of television arts and sciences. [applause] >> thank you very much. you must be so happy to see me because i am the final act. i just wanted to thank all of the nominees and congratulate the winners and everybody have a safe trip home. thank you very much. [applause] ♪ [inaudible conversations] >> senior white house officials are saying that president obama will use a recess appointment to name richard scored ray as the nation's chief consumer watchdog despite strong republican opposition. we expect the president to make that announcement today during the plan to parents and ohio. you will be able to see that

live at about 115 eastern on c-span. that will be followed by your phone calls. again, president and about half an hour. and with the iowa caucuses complete, all political attention now turns to new hampshire. jon huntsman, who chose not to take part in ohio, holds a town hall meeting in manchester. that will be at about 430 eastern, and you will be able to see it on c-span. late this evening rick santorum who finished second in iowa by only eight votes will hold a town hall meeting with supporters. that gets under way at 730 eastern. you can also watch online or listen on c-span radio. new hampshire holds the nation's first presidential primary next tuesday. a discussion now on national innovation policy at the university of colorado law school. teen fill wiser spent the last two years in washington first working in the antitrust division and later as the white house technology and innovation

adviser. he recently spoke to students and community members about his experience working for the white house. this is about an hour and 15 minutes. [inaudible conversations] >> all right. if i could have your attention. tonight is a special homecoming for me that brett had requested. we have done a series of these. usually it is me interviewing brad on different topics. we have him on line. we had some great discussion. brad said, so when you come out i need to turn the tables on you. then i said, all right. all is fair game. i will start by giving a little bit of a presentation so i can give out some of my thoughts and then let him have at me. we are going to be on c-span, or

so we are told, which has have you implications for you wall. there is a chance he will be on tv. if you deeply object to that and want to remain anonymous, said in the back of the room behind the camera. however, if you are in front of the room then all ferris game. also, your questions, to make sure they can be heard, we are asking you to fill out these cars that people collect in the aisles and then bring them up to brad said that he can ask the questions that he has in the questions to you have. two other notes, first we have a lot of sponsors who have been very generous. this community has continued support. i cannot thank you all enough for that. you're different firms and companies are listed, and we thank you all so much. those of you out here and you're for more companies not listed in you want to be a sponsor, there is always room for more.

finally, i don't know how she does it, but ana has put together a set of programs for this fall that continues to raise the bar. there is lots to come back for. please don't be a stranger. i am personally looking for to all of these events next monday. if you want to you can see brad and our entrepreneurs unplugged series. so this is mr. weiser goes to washington. i have been there before, so i kind of knew what i was getting into. there is definitely something powerful about if you're asked to serve your government. it is hard to say no. it is hard for my wife to say yes because she knew how to -- how disruptive it would be to pick up the family for two years. the first reaction is to does this? then we get to washington and realize there are all sorts of people who do that, that leave their lives, whatever they're doing, and go work in the

government. that is what we did for the last two years. all focus on the last 15 months in the white house. a little more no would be. before that i was at the department of justice, which for brat's purpose, is most interestingly captured by npr which referred to me as the top cop on agriculture. i was the point person on agriculture competition policies for doj for which brands view was you would be better off playing farm bill. [laughter] brad was happy when they asked me at the white house to come work in the national economy council. here is what i want to visit with you about today. what policy 101 is about, entrepreneurship, wireless broadband, and innovation and national priorities. last december and now little-noticed speech president obama use the following phrase.

we are now facing our generations but that moment. many people are not students of history, meaning they did not understand what the lacerations but that moment was. for those who are not familiar with the concept, there was a time in the late 1950's when the soviet union were to be beating s in the space race. and that the vote and existential fear that the soviets are going to be ahead of us. they were first in space in the sense that they had sputnik. was it manned or unmanned? amanda in space, and that was a scary thought we had not done that and they had. that led to a national consensus and commitment to invest in science and technology. in the 1960's levels of r and d from the united states as a high water mark in our nation's history, both public and private put together. we are facing the lower levels

of r&d spending, which is to use the term i first heard, tamara's innovations. the amount of innovation that has happened because of 1960's and 1970's basic research and development of the internet is one of the greatest contributions to above creation probably in world history, but for that sputnik moment we would not be in writing on that platform. similar areas in history, the transcontinental railroad gave rise to huge industrial growth. interstate highway system. president obama had earlier in the fall of 2009 and explain the recovery act as having a pro investment mentality offered the following perspective on innovation policy. this was updated in a report around the state of the union with the concept of this but that moment was developed in the concept of out innovating, out

educating, and of building the world. the court is the building blocks of innovation. r&d is essential, basics the corn. without a commitment the types of innovations we have seen and a variety of sectors would not happen. there is also a critical need for an educated work force. that means a couple things. we need topflight k-12, and it means that people come from other countries who are educated here and want to find a way to keep them here and not have them be sent back home where they may start companies abroad. we also need physical and 90 infrastructure to support a 21st century economy. that includes, for example, wireless spectrum. market based innovation, the american system is from the very get go, a transcontinental railroad, telephone and telegraph, the government did not take the view we are going to build the infrastructure

products and services. we will facilitate private sector deployment and development of those products and services. and that is part of what has made this country great in terms of its entrepreneurial spirit and risk-taking. it is not ashamed to fail. it is a shame not to try. now, the of the panera system needs some basic rule of law values. obviously protecting property rights and contract law is a key value. it also needs to have the right competitive because system. so in rail, for example, the monopolization problem was a concern that came. in other industries monopolization concerns happen. at&t most recently. all about preserving open competitive markets. finally the government can categorize national perris. clean energy is one that talks a lot about educational technologies. health care and space.

so the commitment to figuring out strategies, to drive innovation policy was embodied in among other places the america peace act. the original came after a report which was rising in above the gathering storm i think is the name of it, or something to that effect. the concern was that our country is falling behind in science technology. called for investment in r&d, education, and infrastructure. the second american peace act established an advisory body. members are shown here. there is me standing behind secretary gary lauck. unlike some people i was not strategically placed to be by the highest-ranking official. others include irwin jacobs of qualcomm, are levenson, chairman of genentech. there is going to be a meeting

actually in boulder coming up soon and a conference on september 203rd. it will have some of these folks talked about innovation policy. entrepreneurship, so as i said, innovation, allowing the seed corn technological technology developed is essential, but the really exciting economic growth job development happens in entrepreneurs building companies around these ideas. so there is something called national entrepreneur state. we had a get together in washington. myself in between steve case and in east toper. he is the u.s. chief technology officer. he will be with us here in november to launch something that i will talk about in a little bit cold start of colorado. little known. the reason he follows me on twitter. brad's recent post, a double by twitter followers. thanks for that. what's interesting is if you go talk to them they will have ideas, and it is not an easy

relationship. one of the key lessons is probably humility. obviously government cannot manage and plan, despite some aspirations of government officials to think that they might. if you listen you can come up with some helpful strategies, so here is one example that came from this open forum. lots of people selling web enabled services around the world might be worried that they're breaking the law. the department of commerce has a specific technical assistance unit to help those entrepreneurs the challenge is how does that method get out? that challenge was set up, and we were able to connect the person. this effort of start up colorado, startup america that was launched after national launch burners stay involved a series of road shows. here is brad and i hear in boulder, literally year. and we were joking. i'm not sure about what.

mocking that much value could come out of government discussions about an entrepreneur should. you know, it is yet to be tested whether this effort around startup america and the listen can yield value. there is a huge institutional disconnect and challenge because government has not been set of, oriented to listen to my dad, and support entrepreneurs. operates very different. this is not a small challenge. one thing that is happening, and i was able to say in my one white house block post, was noticing of entrepreneurial communities. this is an emerging policy agenda around innovation clusters. not at all settled how to understand them, how to support them. one concept that i played here was there is a lot to learn from boulder. now, there are some ways that

the government does support entrepreneurs that are worth appreciating. one is government has a lot of data that it can liberate to allow entrepreneurs to create companies around that help consumers and create economic growth. one such data set was for 01k plans where they're is a report done within the department of labor by all companies as to what administrative fees their employees pay. ..

in paper form and the hat to scan them very carefully and try to migrate it into a usable data set. those days are over. it's now available electronically anyone can grasp. president obama here visiting in silicon valley. this is after the state of the union looking for ways in which the government can help to support innovation and promote private sector job growth. as i said earlier, this is a problem easier described than taken on. one way that government plays a crucial role is infrastructure. spectrum is what you might call our invisible infrastructure. we have a legacy problem in the united states. a lot of businesses and governments who have their customer relationship management systems or employee benefits software that goes back to the 1960's has legacy problems

because sometimes the stew of systems that were built on coble and they have to keep people around who understand how to use it. the government's legacy problem is a delicate spectrum when it felt that the best use of spectrum was over the air broadcast tv. we have 300 megahertz of spectrum allocated to the over the air broadcast tv in this country. that's more than any other country in the world. we made the decision to double down on over the air, and that trouble down over the air broadcast spectrum to support uhf stations, those are the ones that were on the other part of the donelson those of you that are my age and older, other people will be meaningless concept but think channels 14-50. those are uhf, and most communities don't have a lot of uhf programming and those that do, a lot of it actually is because if you are a uhf tv station you get a must carry right to be carried under cable systems or on satellite systems and 9% of the u.s. gets their tv

through those connections. meanwhile, the lawyer and wireless abroad and is an emerging infrastructure. here is a map showing where it is in the u.s. and where it is not. one challenge that i had written about in the paper was how do we transition from spectrum given to over the air broadcasters to wireless broadband? interesting that story i wrote that piece per for jason who was then the director of the hamilton project. jason went on to be the deputy director to larry summers of the national the economic council, and when he called me up when i was at the justice department to talk about spectrum, i, you know, gave him some ideas and would you help make this initiative real, and so after consulting with a number of people i said i've got to do this, and like i said, it was a great experience. this is where we are according to cisco, global ip traffic. and what is interesting and worth noting is the wifi traffic that is spectrum that is

unlicensed. so one of the greatest experiments and interesting case studies was and 1985 mike marcus at the fcc said there is a band of spectrum used for heavy machinery. its so-called junk spectrum. what if we let people use low-power applications and not regulated? and a regulatory chairman said at the time it appealed to him so sure, let's allow that unlicensed use of the spectrum. years later the technology for wifi was developed. that was a test ban and it had become a revolutionary technology that it's fair to say saved at&t iphone and at&t went from doing unlicensed spectrum with suspicion to great sport because that half of the total traffic on at&t's wireless networks and iphone users is on wifi networks. and if you wonder why your iphone is so darn aggressive about asking you at every moment

in time to go on to any wifi networker around, it's to get around the band width challenge that the cellular networks have a larger area they are less efficient in terms of the spectrum we use, the concept el will be happy to walk you through if you want to get so it is a valuable part of our wireless ecosystem. and so, the challenge is making more spectrum available both for that mobile traffic, that's the small craft, as well as for the wifi traffic. now, i came to the national economic council and larry summers was talking to me about this and try to understand can see right that if we free up the spectrum from the broadcasters by giving the broadcasters money to essentially give up their spectrum rights the government can take a cut of that money and users are better off if they have less congestion on these networks. that sounded like a win-win-win.

the government is better off. its revenue. and consumers are better off. and the economy is better off, too. there's job growth associated with it. that is the four times over a win and he thought this wouldn't be an easy initiative to pull off but it was important to me and here is larry's mantra about public action and private investment. again it is a type of public action that titles the investment with the government playing this coordination role. now, for those that don't fully understand or believe me in the following point, you can talk to del hatfield afterwards come and get some people in washington say why couldn't we just what the broadcasters, you know, least of their spectrum to wireless fraud and providers? broadcasters and high-powered transmissions, cellular networks are more compressed, lower powered. del taught you can't put low-power next to high-power, that's like boiling water because you get challenging interference problem. you need to zone the spectrum so

that you can have the like use is next to each other. it's much more efficient way and that is the will of the government here. so, larry summers ways out this idea of the spectrum initiative, and six months later after the state of the union the president puts a little bit more meat on the bone about how initial will take root. he does it going to market michigan in the upper peninsula where he opens the speech by saying we are not just here because it is beautiful -- and by the way for those that have never been to the upper peninsula, it is beautiful and the people are nice coming and the people by the we are actually nice. it's because the northern michigan university set up called advanced wifi at work and thinks for the effort on that, that gives the students of northern michigan university access to distance learning over these networks. it is a demonstration of what can happen with wireless broadband. i got to go on this trip, again,

with anish and the chair of the council of economic advisers to the bible say i actually never traveled business class before, but air force one for having seen the business class is much better. [laughter] and i get to to come some souvenirs from my kids. it was an experience of a lifetime. there is carl levin, those who don't know who he is a senator from michigan. it's common that senators and congressmen will travel with the president on air force one like myself, and senator levin with his integrity was mostly interested in talking about the war in afghanistan. he's the chair of the armed service committee and was touching on that he had no personal agenda, he was just concerned about the war he also wanted the president to autograph some books for his grandkids. [laughter] to we are in the auditorium at northern michigan university, and the president believed was a demonstration of the learning and here is the wireless innovation initiative about

these voluntary spectrum auctions, setting up spectrum that's also be used by the government, making it more in 50 the coefficient, investing money to spur the rollout of the 4g spectrum nationwide and building a network for public safety comes to public safety can have also advanced uses of wireless connectivity. historic the public safety has lived, if you will, about 1990's technology. the iphone that we all use as the new york kelly said is much more than public safety generally has and finally innovation and r&d received for the future investments. so finally, i will sum up on the innovation national priorities. government 2.0 deal indeed is generally involved with an innovation. government does not have all the answers. there are lots of the developer as with issues on energy country's tradition, government solutions can take that data and

develop it in interesting ways. it's one thing the administration has done exceptionally well. more importantly it is called out for in using often case is called the challenge where a certain amount of money and recognition go to people and we are very fortunate tonight because one of the i would say shining stars of the challenge was the usda healthy kids act which is something the first lady has taken a great interest is the the cut in. kirchen founded a company and she put in her own money, or no effort to develop an application to help kids eat better. and for those of you not familiar with childhood obesity, you should be afraid, very afraid. the statistics are terrifying and the impact on our health care system is also terrifying. we can and should use technology to help kids make better traces. this application is something you all should have on your iphone and something that we are lucky to have for living here.

one of our own, congratulations to you. [applause] one other important challenge that we as a nation have to show is how we use energy. david, the predecessor who passed away recently has the same in all his energy conservation lifestyle i think there is huge opportunities by giving consumers more information about their energy usage. one of the taxpayer company's single energy is focused on the part of this pity we as a nation have a challenge because the infrastructure is built up by regulated utilities whose economic incentive has not generally been to save energy. they get paid more when they sell more. so, turning that around is a

regulatory challenge. the technology to use energy more efficiently sometimes on the smart grid is still emerging. one of the great leaders ten is here. another great entrepreneur in our community. the nationwide leader and the technology to enable the smart agreed framework. i should say another event, which i didn't put in here but is a blast is joining the vice president coming to this feature about innovation policy where it was actually shot it out for only developing the great technology but exporting it abroad, which is one of the of these benefits of the more innovator you get to sell it to the world. and in telling consumers with this information is a challenge. it also can make the grade more resistant and resilient. so, when we teach spurring energy innovation it is an open question. the budget pressures we have our true. we have a long term fiscal challenge that is scary, but we also have a long-term innovation challenge we should be scared of, too.

this was some of the recommendations you can see for investing in energy innovation. not clear where we will end up. it has been one of the very exciting efforts to spur and to see the emerging technologies and clean energy that can really give life to the next generation breakthroughs. building on the basic model that to be successful to help to fill out the internet. another opportunity in this area would be technology. this is a much we haven't cracked. a very depressing article in last sunday's times about whether it is succeeding. one of the challenges we have is can we come again, see the development of these technologies as a concept in the president's budget was for education to help develop this area. and finally, this is a thank you that everyone in the white house gets. the president i can say firsthand loves kids and is great with kids. my son was stepping on his foot the whole time.

she tried to the president something i worked on he said i have business here to do meaning talking to my kids. so, we had a blast and it really was an experience of a lifetime. so now is the fun part. we are glad to follow-up and you all should have your cards. >> we will take a short introduction break before we get started. for those of you -- [inaudible] >> okay. now on. sorry about that. so, for those of you that have cards, kind of send them up to the front of the room. is somebody going to grab them?

okay. second, preston, who is a good friend, is very interested in this because he's tired of not having blond hair. it's good. you look kind of like jason. [laughter] a joke for those of you that have seemed like rock star partners music video. >> so we will go on for about a half hour, and then a round of questions. we will stop, and if we don't we will go until we get tired. first question, which i've been asked to ask you is boxers or briefs? >> boxers. >> okay. got that out of the week. [laughter] >> is that really a choice? it is a choice. it describes a typical day that he would have. >> so i am not sure that i have a typical day. a clerk's challenge, to spare me

will of my current job, is you can easily go all day and be in meetings stacked up. and one of the challenges is being mindful about what meetings to take. and that takes some affirmative effort on your part to make sure you come here from a lot of different people so i have efforts to make sure i met with consumer groups and entrepreneurs. there is a phrase the vice president used on del hatfield which is the future doesn't have a lobbyist. and so, one challenge anyone serving in government has is how do you make sure that the information perspective you are getting are wide-ranging? so, one huge swath of meetings i would always want to make time for his meeting with outside people who are across the range of different people. and when i would do so, i would try to be as transparent as possible with all of them so they could give the effect of information i could use. number two, internal in the white house you would have different meetings where you could coordinate. some people say the white house

is like in many congress because you have a domestic policy congress to the council, you have a national security staff who views things through certain lens and certain policy, the capitol environment policy and flexible, if the smart grid is conceivable that all five of those areas could have different perspectives on the same emerging technology. and you need to spend time to get to know them. and i will say one of my big lessons that's motivated most of what i did is how much relationships matter. i was fortunate to have a lot of those living in and develop more while in the government. and then finally, the white house can only be as effective in how much it catalyzes and in powers and works with other parts of the government. and also, in these areas. it takes margaret as an example many different agencies might be giving their own thing. obviously the department of energy would have a huge interest. that's the department of defense with the military base looking at the smart card technology. and the national science

foundation might be funding research and in the department of commerce is helping set standards. so i have to meet with them. so you have to figure out to balance the different meetings. and then manage your lights to catch up on e-mail, read and write. in order to be effective and to keep moving along different initiatives. so, i'm not sure they ever want themselves into, "easy and obvious boxes, but they are sort of a different type of meeting obviously. >> you gave i think to words for examples of ideas that sort of germinated and sort of summarize it the policy dynamics as the sort of idea on the next policy. obviously there was a past. what us through what that might look like including the sort of texture about all the different people involved in the front end of the process. >> great question let me start with smart agreed as an example.

and i would have to say and thank you all because i could not have done this job without the ten years i have here first. in so many different ways. flexible, you'd be surprised how much, like a silicon office is workable in the white house. so first of all, being willing and able to call something out bs or not is really important. and having a relationship with people over years where you got used to saying come on, be real. and that labeled me to cut to the chase of an issue. and it's really important if you can't cut through the rhetoric you will never get something done. so there are people in the world and the policy who are good that they're talking points. but can never make progress if you're just talking to each other's talking points. you need a level of discipline and understand where the challenge is really are. now in this martin grid i mentioned one of the challenges which is the state electric utility industry has had a business model the and a set of incentives and set technologies

that were built on a certain set of promises like energy was very always plentiful, and we didn't worry about using it ever. second promise might be that people can't or shouldn't manage their technology time intensive. now when the law changes you have to see how to reexamine the policy. we see those conversations here. when i got to the white house licet who is working on this margaret? and so we had a meeting where people from different agencies can and we said is there an opportunity for us to train our agenda? and by the way, the fact that a lot of money from them is going to investing and catalyzing this margaret employment needed all the more important to call out, particularly for the states who have the most power in this area because most of the utilities are regulated not by the federal government but by the state utility commissions. so, can we get on the same page? and let you are getting at, which is important to explain, is what is a policy process? what people often in the

government don't readily appreciate is you can't just get the president to give a speech or issue a report on why and have a be done like a business plan by entrepreneurs on the startup weekend. it's very different. so, you need to start by getting the people in the room many of whom have different perspectives and say can we start working on some principles together and if it is a document let's say the report you have to build consensus in the interagency group and we did as the lashawn under the offices of the national science and technology council at the committee on technology that myself and aneesh chaired and we get a report we have to get all of the agencies to clear and then it is ready for release. then the question is how are you going to roll out the reports? and so we did go ahead and issued the report in a rollout which turned out to be the last i was in washington. and there was an effort to frame a discussion and move the policy

for word. and one challenging policy is that we don't necessarily always get clear wins and milestones okay you've done it because it's an ongoing journey. and the goal i would say is often can you shape the the date from the debate in terms of moving the right direction. so this is another one and worked on. that 1i had mentioned written this paper before which people said to me at that time that is a nice academic idea. will never happen. the president might have said that actually. so i felt okay i'm an academic. it would be a good idea. the white house looked at this and so we are looking for the pro innovation policies. this also could generate revenue in a time when the government revenue. can we make this happen? so literally, we talked to all sorts of people who were involved. so we would go to talk to senator jay rockefeller of the

committee to save your thinking about announcing this what you think? we go to henry waxman, chairman of the energy committee, what do you think and we talk to the broadcasters and say what do you think etc., etc.. and we help shape what we saw as and hn we rolled ou we didn't rule it out with all the details worked out, and this is an interesting part of the story. many times policy needs to evils and start putting some stakes in the ground. and making and building on it and in this case the first was by larry summers and the president in the state of the union and michigan then a senator rockefeller introduced a bill which passed 21 through 04 in the senate commerce committee. the policy evolves over time that you can see some pretty constant principles and the way that it's being discussed now in the super committee because it would create money that would help to deal with our long-term fiscal situation. so there is that half of the policy process. they have a great quote on the politics of the location that says it takes both passion and

perspective. and he says the slow boarding of the hard words. if you are not able to have that passion and perspective and stay at it it's not going to happen overnight. i was there long enough to see a lot of things make some progress and someone said to me it's hard to know what will be most important because we look back now and say this thing i worked on the nanotechnology could have a huge difference in how the government did technology and i never would have guessed today that was the thing i worked on that made the biggest impact. >> you touched on a little bit sort of in that interaction with congress, and i know sort of your lens to some degree from where you were in the white house. what was the interaction with congress at what level, and what kind of expectation to you have about those interactions? >> so, i have never worked in

congress and a largely have that as the grant that i am least so i kind of get to do this and work for years in the executive branch, likened it to the executive branch to some degree. congress is still somewhat of a mystery. i will say in my time in the white house i was impressed with some of the people i worked with more on capitol hill impressed by how much they care about ideas and how much impressed by what they knew what they didn't know and our ability to work productively was one of the things i really cherished. i always -- maybe this helps is the student of the constitution and article 1 comes before article 2. so it is a symbolic gesture but i never asked them to come to me. i always went to them. and i tried to be extraordinarily diligent about returning phone calls on the e-mails, helping them however i

could come and they were extraordinarily interested in hearing what we have to say. and in all of these areas which are to brief the congress so that nothing we were doing was a surprise because i think that often is what gets sometimes the administration in trouble people say why didn't you tell us you blindsided us on this or told us xy ian c. that you might not have gone that way. and i think it was nothing that i worked on where i ever got that sort of call. i was lucky the in the issues i worked on were low profile so less likely to get the attention. if we were going to meet with a member that was generally something that larry summers or gene sperling would do, and i would go along to brief them. but a lot of the work as people probably know the staff level to really develop the details. so, that was something of the things i didn't expect to i didn't expect the working for congress, but i did spend a good bit of my time particularly the specter initiative that had to go s. con. res. and working with them and then also there is

working with other people who are going to be talking so if someone has concerns, if they are a tv broadcaster you have to listen to them because if you don't then they took to congress and congress says what about these concerns and you better have a good answer to it. >> somebody asked from here it looks like policy makers and legislators are making decisions on issues they don't really understand. did you find this to be true or not? >> i wouldn't say i agree with it. i think there is generally a reasonable humility and caution about the technology policy. it is very hard because it's moving quickly and its complex. so it does require people to take the time to understand its and there are a lot of people in the government who did that in ways that are under appreciated to take cybersecurity for example there are people in the government and someone i worked within the department of homeland security who is now we to be the chief information security officer for sony and is

someone who knows cybersecurity. he is an authority in the field and understands those issues and make sure it is an approach of lubber security i was able to work closely with phil on that. i would put him up against anyone in the private sector. no it doesn't mean that it's easy to know what to do. it's two different questions. one is you know the field, you know the technologies and you know what to do about it. i wouldn't say that people didn't know the field. i would say, you know, it's often these are not easy issues to understand what to do, and people's level tolerance for government is often low. and so you have this in eight conservative, you know, orientation, which is understandable, but also is somewhat at odds with technology policy. since margaret is another of sable. state public utility commissions are among the most conservative in the governmental actor ecosystem. and here they are engaged in the technology innovation policy overseeing this margaret so they are widely televised and one of

the challenges on the federal government is to use its greater resources to help educate state regulators so they can make informed decisions. >> what percentage of your individual meetings were held at caribou coffee? [laughter] for those who don't know me or you missed the going away party, the casual fast food dining establishments would miss the. they did. i would say that it's fair to say every single morning after i came into work to have a call or something and then i would go to get my coffee and oatmeal at caribou coffee and invariably i would see someone there and in the afternoon i would get coffee and meet somebody there. but again, i mix up my casual fast food dining establishment so i had a rotation. they're scared abu, there was also across the street where we spend many times.

there was a starbucks. that is probably the least popular and then for lunch by the way when i go to lunch there is one down the street which is a really good casual test for defining a solution i would recommend in the rotation. >> which one did you miss the most? in boulder? i would say and chipotle are probably personal favorites. there was a aaa in d.c. the was further away to put it an era in dupont circle. >> progress, progress in washington. >> soared on the same lines of the meeting, how you allocate time, etc. it's just a percentage. what percentage of time did you know enough advance? >> that is a great question. i took virtually if not every single meeting everyone asked me and it was only one meeting that

was a complete waste of time. i met with someone who went on to network. as the worst networking i ever had from students who don't network without any real purpose whatsoever. on a kind of was light i just want to get to talk to you. i don't see my family enough. i can't talk to a random person who wants a meeting. and this person by the way the sad thing was he would hang out at caribou coffee every morning just hanging around, so that was the only time the was a total waste of time. almost always there was something of value. another thing by the way the was good about it is that caribou you can always leave when you want to. you can be more aggressive about cutting it short. bob dole told me that. part of "the new york times" someone said while it's also how you would always go to the senators to talk to them that shows such respect for them. he said that isn't it at all i

can get up and leave any time i want. [laughter] >> we saw at least to pictures of you with president obama to read describe your first meeting with him. >> so, the first time i met him was actually here during the coming you know, the talk and the people may not realize him in person and my wife when she met him was like she's act of the more physically intimidating presence than you might realize. he's somewhat all, very firm handshake, definitely a raspy voice. so, maybe it is the fact that the president helps but i will say that he is a more in post -- he's an incredibly lucky would see with your kids playful and kind person, but i would say, you know, i would be much more intimidated in that sense than what joe biden who has this is michael that's all in a much

more engaging and disarming way almost. >> an entrepreneur in the audience selling concerned about the war where somebody who doesn't have to develop the technology has a patent for an idea that i came up with. doesn't ask the question at the tail end of it but he's concerned about it. you have any sense that there was any real change happening? i know that there's patent reform going on and i have a plate of view about it but i'm curious as to what your view of is congress really doing something substantive here or are they going to pass something that is essentially kicking the can down the road? the pass patent reform but it doesn't have an impact. >> there's two problems. i briefed larry summers on this it was one of the highlights. he is so smart and he gets to the heart of it. it was like justice ginsberg where somebody's just doesn't know the field, you know, if you go talk to them and their general sense is so good that if

they understand it really well. so the first problem is the patent office. given that the patent office is an innovation policy, you'd think it is a crown jewel of government. it is treated in a way with respect and support so that it does its job extremely effectively. if you thought about you would be wrong. instead the opposite. there have been people appointed to have no understanding of the technology or patents whatsoever that our former congressman looking for a job. they are at regular times where the revenue it gets from the is that people are paying to get their patents are funneled away from the office to do other things thereby leaving the office understaffed so they got a backlog of the patents and finally there is a technology itself to the office used which was nothing short of a disaster in the administration people could fly all the patents electronically they would have to literally print them out and

re-enter them into a different system. so first problem which is a real problem in the office is can we aníbal our patent system in the office to operate more effectively and by that i mean issuing higher-quality patents? that's obviously one of the problems of the system, issuing them quicker making a decision, enabling people to review their decisions more quickly and shapely in the post to grant review. the bill and the congress and the leadership we get to the capitol is set up to me very good job on those issues. there is a second set of issues that are not unrelated to the bible, but the patent litigation mess. to those who haven't seen the diagram of all of the smart phone patent for the become nervous, it's scary. for those that haven't read brad and other discussions of this, obviously the phenomenon of the non-practicing entities filing cases in texas is hard to square

with anything we might call, you know, useful progress of science. the story on that is really good. now, question, how much allows you to deal with that problem? the answer is in so far as the first problem less that patents, cheaper review helps solve the second which would be somewhat. but given the magnitude of the challenge, it is only somewhat. how else can we get there? there are a few different things i would note. one is something that we are focused on you can enforce particularly in software and it the written description and enable it requirement so you are not supposed to be able to file a patent that is the prospect for something that might be invented someday. that is and with the patent system was meant to be. you're supposed to have to invented it, describe it and enable it to be put to practice and then you get a patent.

if you did in force that requirement the patent office finally for the first time a year ago has now 2/4 of that requirement you can get rid of and not enforce a lot of patents that should never have been granted which are a has said able to be used strategically in litigation and that are not about motivating invention. so that is a promising doctrinal tool. i think we all should be nervous about this problem because if we don't make progress on it is going to continue to be attack on innovation, not spurred innovation. >> you showed a picture of president obama meeting with a bunch of folks in the silicon valley lysol wifi -- zuckerberg,

twitter, all of the firms, levenson was at the dinner was there any sense of any feedback with the sort of cycle back through around innovation, innovation policy that came out of that particular meeting? any meetings like that have real impact other than the sort of obvious? >> i think the impact that i would say, and we take for granted if we get used to what we have come accounting the president interested at the level of the emerging technology trends that we have is a new thing. i don't remember other presidents -- gloor is the vice president i would say this isn't true about him but obama has the president has a deep interest in technology understanding it, understanding what makes these technologies great, what role the government plays, so i don't know how closely related it was, but i do know one of the topics at the dinner was high skilled immigration and the president's position has gotten i think

pretty clearly behind to start as one of the instruments that can help free us from what strikes me as one of the most crazy policies we have painted ourselves into which is, like i said, having great minds come here to get educated, one tuesday in those companies being forced to go home. that is a part of the job agenda that is creating jobs at low-cost to the government. he has heard a good bit about that from some of the people, and i think that this influence thinking and generally it is good like my experience obviously a different level it is a good outlook once in awhile. i think the problem that we all should be conscious of is that washington is a bubble and it takes discipline to get out of that bubble and get the broad perspective whether you are the president, the director of the economic council or the staff and the economic council.

estimate to talk about margaret a little, you talk about innovation policy around government investment and, you know, smart crude energy technology. the doe had a problem to become program of the original stimulus. there is a company recently and last week that went bankrupt called solyndra which i think they raised half a billion dollars from the government, the loan guarantee and another half a billion dollars worth of private equity type of investments. do you have a sense that something like solyndra will have impact going forward on how these types of investments are made? you know, the gap between what the house wants, with the president wants, the agencies want, it is boom, boom and we are in this position where the investment in those sorts of things is so small relative to the expense and waste and other things. are these neutral, positive or

negative and how do they play out over time? >> it is in the following sense. the power of the talking point sometimes is so much more so i wouldn't have ever guessed that someone could have said a champion republican proposal to give people information about choices of the end of life care, the republicans have long proposed that be put into the budget. if that could be put into a health care reform bill i wouldn't guess that would be the talking point that obama was and have the impact on the course comes of this talking point in becomes the government is throwing away money on a losing companies. that is what this program is. that could decline even though this program by the way is a different loan guarantee program and has a different purpose there is sometimes in the world of talking points a lack of and

it's hard to control the narrative once it gets out of control. so, a real hard challenge is something that the vice president, you know, was trying to get to is how we frame of the narrative arnove investing and innovation that can have some of the same impact on the narrative and the discourse the way that the moment of yesteryear did. because one thing that is probably true, you can go back to the 1960's investment and the basic research or even applied research and point to fill your. now if you let those failures define the whole program you have some failures but you can't let that define you. look at the whole portfolio and from the government's portfolio if you look at darpa over its entire history coming and you said if every single investment made was a total waste of money except for the internet, i think

it is still an unbelievably good thing to have done because of the internet. i don't know how the dod profile in its loan guarantee is going to realize and facilitate but it's possible in the portfolio we will say they were able to change how we use transformers in the electric grid in a way that made them much more effective, cheaper to create and putting advanced manufacturing in the u.s. and ensure that that one was so valuable it's great that we did it. devotee great to have that perspective and that discussion and judge it on that marriage on that stability that happens all the time and try to define it by that one fact. it's been a key made me think about something that allan sloan of wrote a very disheartening

case in the fortune about both republicans and democrats in the communication and the white house and congress and essentially the communications mess underlining all of the bald mess and he gives a number of examples, and one of them was kind of check stockley that point around t.a.r.p. which is a positive message is that it actually looks like t.a.r.p. is going to end up making money. and it's so buried in the discussion about the bailout dynamic of was so negative versus what actually plays out. >> it is a challenge and i have limited problems in the communications. so i don't know how this is obviously a frustration. but i think some high percentage of americans believe that t.a.r.p. and stimulus for the same. they don't differentiate between the two of them. the kind of run together. i think a limited number of americans know that a huge portion of the stimulus in the

recovery act was tax cuts that obama cut taxes like 52 times. so, i don't quite know, you know, what people's character of the stimulus is, but like you say it ends up with a very unfairly the stimulus was wasting money on the bank bailouts. it wasn't the bank bailout and t.a.r.p. actually did in the costing money. but unfortunately sometimes these narratives get set and get repeated and it is hard to turnaround and the challenge for policy makers is you can't create a narrative that makes sense to people and they understand ultimately the policy won't be sustainable. so we originally were scheduled to go to 7:30. i would be okay for be also be okay to go for another 15 minutes. as a free video caliph of? >> if you get bored, just leave.

[laughter] you won't be offending anyone. especially the people on c-span. watching you leave. you mentioned it here in the trip you were here we were both involved in and there was a breakout session for the afternoon a big part of it was actually sort of real engagement with people that have come to talk about things. this happened in eight cities. had there been any action that came out of that, had there been any real fallout? secures the challenge of the way the government works for my personal stability is when you leave you leave so the honest answer is i don't know we have this like may, right? so they get all these ideas come have been funneled into both to the president is going to go in and its way to feed into the

larger innovation policy process which would include the meeting in boulder and having the conference here and at the end of the year there will be a report to congress on innovation policy. so, i think when i was here i tried to make the point judge whether they got by that policy proposal to congress at the end of the year in. there may well be things in the president's speech to talk about job creation and entrepreneurship that emerged in the process. part of the challenge in the policy-making is the different streams of information come in and sometimes different ideas get reinforced in different concepts. so i do know that people were heard. i don't know exactly what the status is and what we will see emerge on the other end. >> talking about and talked, when you think about your time in d.c. including the

agriculture [laughter] mabey you to buy it in all the money can go. if you got too much market power it didn't work that way. it made your corn grow faster. when you think about your efforts, what was the thing that you think from today and not ten years ago from today the thing you did that was the most impacted? >> i think the specter initiative if it happens is an unbelievable achievement i'm thrilled to have played a part in. the levels of benefit that could come from that. so, i don't know exactly how much we as a country benefited

by getting more spectrum out to enable the so-called qg technology that happens. initially there was one area of technology the were a few licenses for spectrum in the 80's and 90's there were new license is that cannot that were then all digital networks. the volume and the job creation in this country in the one your list that took off in the 90's was because you got more spectrum out there. the best spectrum that wireless broadband folks want is in this band would be like 600 megahertz right below the 700. the reason that at&t and verizon are in good shape to offer their 4g servers as the cost about the spectrum of the 700 megahertz. so for t-mobile, sprint, whoever, they are celebrating to the spectrum of the 600 megahertz and by the way at&t advertising don't have enough spectrum with what they want to give in the demand. so, what can happen in that

ecosystem before spectrum is, you know, the key point. that key point too is on the public safety. public safety officials today are operating with yesterday's technology to make the transition to today's technology and public safety is going to take a massive coordinated effort. part of the challenge of public safety for example is that every single jurisdiction has made their own purchasing decisions. so if you imagine federal express as a confederative set of distinct entities each of whom decided on their own equipment and communications technologies they wouldn't offer a together which has been a key problem and you know, they would not have the economy of the scale. the wouldn't be the cutting edge of technology, and that is what the public safety is. and so, the benefit of the public safety is if we can do this right is also enormous and then if you are able to do support from innovation in the wireless this is another area where the u.s. can be a leader, has been a leader and also a great benefit to there's.

i would say and obviously there are some personal interests because the was the whole take but there was a particularly significant effort. i don't know how much i can be comfortable yet because, you know, we just got one committee and one house of congress that was able to get behind on a bipartisan basis and it took a lot of people to do that on kay bailey hutchison's staff as well as senator rockefeller were extraordinarily hard-working and as i mentioned. we will see where that goes, but that could be very big deal. >> i know that you are pretty tune in to the sort of education work force k-12 stuff of which obviously has sort of broad reaching implications. the question here specifically is what is being done to promote the rise of the number of women? i brought in it do you have the

sense that -- >> this isn't lucey's creston chris and the founder of the national center for women and innovation technology. they're doing unbelievable work on this very issue of when and where they've been underrepresented among almost all professions now, law, medicine, business, women outnumber men to a technical and engineering, still very much the outfit. >> thanks for the commercial. >> the question is do you have a sense that both the white house and congress really understand the issue here and the severity of the issue going back to the feed corn construct and sort of our generation? i know a lot of kids that are, you know, nephews and cousins, friends, etc., a better bridge

leading from college, and if they don't have a technical degree they are not running into a situation at 10% unemployment. they're running into 50% unemployment. there are just no jobs for those kids whereas the science and technical kids are almost fully employed because there's such an imbalance between supply and demand. is that will understood? >> the second problem is people who don't get to college. the number i saw is college-educated folks are 4.6% unemployment. but other parts of the population that are not educated is much, much higher. so, this for me is perhaps the most terrifying issue which is education in general in particular. are we doing enough and i would say the least bit of effort which also came out of the recovery act made a huge impact on some of the broad education reforms. there is a lot that needs to be

done on the education technology for civil. a lot of jurisdiction. they have to purchase textbooks with their budget. they can't purchase, you know, the ipad applications or other means of teaching kids. the other challenge here is can we create role models, because i think obviously if every kid wants to be a basketball player that's great, but it's not going to happen. president obama has the first ever science from the white house and as i said he loves kids. he had a blast and was likely to do more of this. so there is this whole effort of the public partnership called educate to innovate about getting companies to commit to supporting. the president called for the union like 100,000 new teachers because they are supposed to be able to teach stem, so i am worried about this. i think one of the challenges we have right now is building a national consensus around these ideas. and this is something where

people really matter in terms of developing awareness and a constituency because and said kids don't have a lobbyist for the quality education. and one of the challenges in some of these areas, education and health care as an example, we haven't totally cracked the code on how to do things. so one of the josh lynch can be a great experiment to try to see what works and then scale that up. >> how has the social media shaped policy? >> that's a great question. the true answer is we don't know. there's a great critic what do you think of the french revolution and the response is in the detail. [laughter] stomach but the art other part of the question is how can she policy. the first is this point about building come understanding, and a narrative around innovation is certainly something we're it matters to get people engaged

and informed. i will say to those who haven't seen the work that brad has done, the effort around the start up was a social media grassroots effort that has gotten traction and got attention. so, you should not underestimate the importance of that. the ability of the social media to create the court. part of what was valuable there, getting back to the public discussion is the narrative is so powerful, creates jobs, no cost of the budget, and we are essentially eating our seed corn. if you filled the high quality entrepreneurs and give them the values began to take the lead for the company that just strikes people as crazy. why do we do that? and you are able to tap into that. so i think as a tour of mobilization and education, now, in terms of the dark side, i mentioned about these talking points. so you can also use talking points on the social media. a number of characters you have to be able to put it in the

terms. that can undermine the discourse because if you think about it you have every newspaper a certain amount of information. what an evening broadcast information. if you go to twitter there is a dark side here which is people are getting information sources that are compressed it may elevate the debate but it may compress it and i sort of hope we don't go that direction. >> the next couple of questions. i should have asked this earlier but i think it is a useful one because i don't know the answer to it. what power does the national economic council really have? >> first off, and this is a very important question. a policy that runs through in the policy process that gives the president has to go through a policy council. so i mentioned a few of them before. domestic policy council. talking about criminal justice

policy for example the would run the policy process on behalf of the president. a gun policy for example. talking about the national security policy what are we going to do on libya? the national security council from that policy process. if you're talking about the economy, so for example we are concerned about unemployment or we are concerned about technology sector or we are concerned about the financial market, the nationally, households runs that come in and what is not fully appreciated is how thinly staffed the economic council is. there are about 12 people like myself who were planted people on a policy area financial-services, health care. they were in on employment, etc.. and if there was a set of policy issues in your area, you were in charge and was your responsibility to watch it for the president. now that has a proactive.

i mentioned a number of the initiatives we talked about, smart grid spectrum. such and such issues came up in congress in which we reported on what should the president say about it and we have to brief the president and counsel, so the power of the legal pitfalls informed the council and the administration position on a given issue by the secure dispatcher and what have you is shaped by the national atomic council -- economic council. >> other than the president, who is the most inspiring leader you worked with and why? what was powerful and inspiring? >> the first person and it's important because it runs against some of the characters as larry summers, and the reason is we're really cared so much about the purity of ideas, and as an academic like myself, that was for me a wonderful floor to be in which is a form of

principle. what he cared about was testing ideas. he did and what the administration to do stupid things. and so, if you came up with an idea, this specter initiative for example he wanted to kick the tires on it and make it better. so, we work on the innovation policy report that came out of the state of the union. when we believed leary on it he said this report isn't as good as the frontier of science. ..

>> there is a place not far from the white house called founding farmers, often play on words, which, you know, if you go to denver, you know, it's sort of a more fancy version of that. we did go there. another one to put on the list is nora in dupont circle. a musher but compared to around here, but an extremely fine restaurant. >> founding farmers. >> last question, what did you miss most? >> the people. and i will say the culture here, you all know it. people here are rooting for each other to succeed. in washington. that is not the case of all.

>> well, on behalf of all the people there, welcome back and we are delighted to have you. [applause] >> we do have a request for those joining us for the reception. for those who are not students, will you please talk to the students. they really do want you as role models and mentors. please make the effort. thank you. thanks, everybody, for coming. [applause] [inaudible conversations] [inaudible conversations]

>> president obama is on the road this afternoon in shaker heights, ohio, and he is talking about the economy. during his remarks he appointed former ohio attorney-general richard coeur great to head the consumer protection bureau against the wishes of congressional republicans. they're outraged. morning of a court fight. the president says he has an obligation of action when congress refuses. we are showing it on c-span and taking your phone calls right now, and it's happening right now on our companion network, c-span. and with the iowa caucuses complete, all political attention is now turning to new hampshire. john huntsman chose to not take part in iowa, a town hall meeting in manchester later this afternoon. for 30:00 p.m. eastern. you can see it on c-span. this evening rick santorum finished second in iowa by only eight votes and he will that town hall meeting with supporters in brentwood new hampshire.

that begins at 730 on c-span. you can also watch on-line are listen. new hampshire will hold the nation's first presidential primary this coming tuesday. the thelon must announced his company's plan to develop a fully and rapidly reusable launch rocket. talk about the future of human spaceflight. rockets and vehicles for missions to orbit the earth. the national press club. this is about now are. [inaudible conversations] >> good afternoon and welcome to the national press club. we are on the broadcast and on-line journalist covering businesses and financial news. in this capacity on the 104th president of the national press club. we of the world's leading professional organization for journalists committed to our professionals feature

programming, events such as this while fostering a free press worldwide. for more affirmation about the national press club we invite you to visit our website to and to donate to programs offered to the public there are national journalism library. you can visit that on the website as well. on behalf of our members worldwide it would like to welcome our speaker here today and those of you attending today's event. our head table includes guess about speaker as well as working journalists. you are of club members. if you hear a pause in our audience who would like to note that members of the general public are tending today, so it's not necessarily evidence of a lack of journalistic conductivity. you also like to welcome our c-span and public radio audiences. a lot since our featured on a member produced weekly pot gas which is available for free download of itunes. you can also follow the action on twitter using the had stag hound nbc launched. after our guest speech concludes it will have q&a and as his many

questions as time permits. now it's time to enter this our head table guest. please note that a journalist present at any head table, particularly during this political season does not imply or signify an endorsement speaker. ascii's of you here to please stand up briefly as your name is announced and will begin from your right. we begin with paul shipman who is a reporter with wto p news, and we might know that their generation press club member. a special thing. heather for screen is a free lancer, and she is with our book and of the committee leader. ron bass inns of the kuwait news agency, by the way, he yells from the u.s. of. he is a chair of our newsmaker committee in doing a great job there as well. kristine grantham is communications director and a guest of our speaker. welcome. angela graves and king is the transportation reporter at bloomberg news and our secretary on our board of governors. tim hughes is general counsel.

skip over the podium for a moment. news of media is our fantastic speakers' committee chair, really doing a wonderful job for us there this year. thank you so much. let's get over our speaker. director witt ian ps, associated press. the speakers member. organized the event. thank you very much. george dewey, senior vice president of marketing and communications. a guest of our speaker. welcome. frank mooring is deputy management editor for aviation week and space technology magazine. robert solicitor is opinion editor, u.s. news and world report. adam, is vice president client strategy with the anti-government, vice chair of our broadcast committee here at the national press club. please give them all warm round of applause. [applause] one might be inclined to call our guest speaker today a renaissance man.

but to do that would be to set him back several hundred years, so that would not be fair. with south african and canadian heritage, he is an engineer his passion for solving problems necessitated that he become an entrepreneur and inventor. we are told that he multitask, is a workaholic. we're told to get in at 3:00 a.m. this morning. he probably drives fast, but with a preference for energy-efficient vehicles. he thinks a lot about life in space. from sulfur businesses to the internet, let's not forget about electric cars. solar energy and space rockets. his friends say that our speaker today does everything with absolute conviction. even when he believes in something, when he believes in something he is unstoppable. it is said that if he thinks the stakes are important enough you will do it whether the odds of success are high or low. interview our reforms magazine ranked him as one of the nation's 20 most powerful ceos 40 in number. last year time listed him as one

of the 100 people and most affect the world. esquire said that he is one of the 75 most influential people of the 21st century. there have been many other awards and recognition along the way. he bought his first computer at the age of ten. he taught himself how to program that, and by the age of 12 he sold his first commercial software as base camp for the commodore 64 platform for about $500. at age 17 in 1988 he left his native south africa to western canada to live and work with his mother. in 1992 he won a scholarship to the university of pennsylvania where he received an undergraduate degree in business from the wharton school. he got a second-best a degree in physics. he headed to stanford and the graduate program and applied physics and materials science, the goal was to create all capacitors with enough energy to power electric cars. after two days left to start a company with his brother, which provided online content publishing software for news organizations and in 1999 malta

vista acquired that for $341 million. next target speaker co-founded an online financial services and you help him a company. you have probably heard of it. in 2001 that became paypall which was acquired by ebay in 2002 for one half billion dollars in stock. he used the proceeds to help start space exploration technologies in 2002 where he is ceo and c. teel. in 2008 spacek won a nasa contractor replace the cargo transport function of the space shuttle and support the international space station. astronaut transport in mind. in 2009 the top one racket became the first privately funded liquid fuel vehicle to put a satellite into orbit. he is known as an original investor, chairman of the board, and eventual had a product design that tesla motors where he led design of the all electric tesla roaster. today tesla also sells electric

powertrain systems to a diner and toyota. the primary investor and non-executive chairman of solar city. our guest speaker has been compared to henry ford and howard hughes, and even the fictional town in stark, iron man. he has been inspired -- appropriately enough this basics factory was used in the film. he is not without critics and skeptics, including some who doubt the space sex can sustain the low-cost business model that he insists he is proving them wrong today. so the founder of paypall, the world's largest internet payment system, ceo and product architect of tesla motors manufacture of the all electric does the roadster and non-executive chairman of soul city, a leading provider of solar power systems in the u.s. is here today, and we are grateful for that, to talk about the future of human spaceflight

as spacek said. our best to use space exploration as a key next step in preserving and expanding human life and has promoted making live multi planetary, starting with mars. it is inappropriate follow-up to our lunch in the summer that featured nasa administrator charles bolden. all of this serving as proof that you do not need to be a rocket scientist to the national press club luncheon speaker, but it helps. please give a warm national press club welcome to one of the most interesting personalities and entrepreneurs of our day. [applause] >> thank you for having me. it is an honor to speak here before the national press club. i have an exciting announcement with respect to space. and i think one which should be

providing some inspiration and some believe that the innovation is alive and well in america and pulling in really interesting directions. before i -- i'm going to get to that, but i'm going to up process that with the logic that explains why such a thing is important. it may not be immediately obvious. so first of all, the -- going back to why am i in space and electric cars and solar power and internet, it goes back to when i was in college and that was trying to think of the most important things that would affect the future of humanity. and that three things that i came up with for the internet, sustainable energy, both production and consumption, and

the space exploration. but specifically making life more the planetary. i did not expect when i was in college to actually be involved in all three of those areas, but as a result of some success in the internet arena, that gave me the capital to get involved in very high capital endeavors like cars and rockets, which really are very high capital. so the reason for -- i mostly going to talk about space. i want to explain why i think space is really important. end what about space and i believe from a rational framework of logic. you start with how you decide that anything is important. and i think the lens of history

is a helpful guide. and things that may seem important in a moment but actually aren't that important in the grand scheme. over time if you look at things over a broad span of time i think that lets it fall away. and if you look at things from the span of time as it relates to life itself, the evolution of life is ben -- primitive life started around three and and a half billion years ago. and one of the important steps in the evolution of life, obviously the advent of symbols of life. there was a differentiation between plants and animals. life gone from the ocean to land. there was mammals, consciousness , and i would argue also on the scale, should fit like the command of the planetary. in fact, i think if consciousness -- if the next --

actually, you really kind of the consciousness to design and vehicles that can transport life over hundreds of millions of miles of irradiated space to an environment that they did not evolve to exist in. it would be very convenient if there was another planet to slight curve nearby, but that's unlikely. as it turns out not the case. so you could not -- by natural selection, get over to mars. in the consciousness. it is the next natural step. so if one could make reasonable argument that something is important enough to put on the scale of evolution, then it's important to.

and may be worth a little bit of our resources. and one can also think of it from the standpoint of life insurance. there is some chance either as a result of something humanity did or as a result of something natural like a giant asteroid, that civilization and life as we know it could be destroyed. clear evidence for life being destroyed multiple times in the fossil record. so this is something that and keep -- can occur. it has occurred. and the permian extinction being a particularly interesting one because i think that destroyed somewhere between 90 and 95 percent of all species on earth. we could not tow the full story because most for many species were flung back. so you're out of luck.

so you know, if we think it's worth finding life insurance on an individual level, perhaps it's worth spending more than -- spending something on life insurance or life as we know. and arguably that expenditures should be greater than zero. then we can just get to the position of what is inappropriate expenditure for life insurance? and you know, i think it probably if it is something like a quarter of a percent of the gdp lbo kate. that's not too bad. you wanted to be some sort of number that this much less than we spend on health care, but maybe more than the spin on lipstick. you know, something like that. and i like lipstick. i'll have a thing against it.

so i can't wait for that, to go out there. [laughter] so that is kind of the thing that i think is important. we give a little bit of the space toward. and i think it's also one of the most inspiring and interesting things that we tried to do. one of the greatest adventures that humanity can ever embarked upon. and you know, life has to be more than about solving problems you know, if all that life is about to solving problems why bother getting up in the morning? there have to be things that inspire you and make you proud to be a member of humanity. and, you know, certainly an example of that. only and full of people went to the men. and yet actually we all went to

the men. we went with them vicariously. we shared an adventure. i'll think anyone would say that was a bad idea. that was great. so you know, we need more of those. we need some of those things. and even if someone is in a completely different industry and in a different state, it's still something that's going to make you feel good about the world. and that is why -- that's another reason why i think we should do these great things. so let's get to the question. how do you do -- how you make? one of the fundamental obstacles it's all well and good the federal and agrees it's worth doing. if we can't do it doesn't matter. so the pivotal break through

that is necessary, that some company has to come up with to make less malta planetary is a fully and rapidly reusable or the class rocket. this is a very different -- difficult thing to do because we live in a planet where it is just barely possible. if credit were a little lower it would be easy, but if it was a little higher will be impossible . even for an expendable launch vehicle where you don't attempt any recovery a lot of smart people have done their best to optimize the vehicle and the efficiency of the engine and the guidance system. you give me to do 3 percent of your liftoff wait to orbit. that is not a lot of room for error, so if your rocket in that being just a little bit heavier you did nothing to orbit, and this is why only a few countries have ever reached orbit. now you say, okay, let's make it reusable, which means you have to strengthen the stages, and a

lot of thermal protection. you have to do a lot of things. they add weight to the vehicle and still have a useful payload to orbit. this is -- that meager to the 3 percent, maybe if you really could get it to four. you have to add all this necessary to bring the rocket stages back to the launch pad and be able to refine them and still have a useful payload to orbit. a very difficult thing. this has been attempted many times in the past and generally what happens is people see that success is not one of the possible outcomes. well, some government projects kept going. but then eventually they get canceled. so it's just a very tough is their problem. it was not something that i

thought -- i was not sure for a while. but then i think just a relatively recently, and the last 12 months have come to the conclusion that it can be solved. and i think we're going to try and do it. we could fail. i'm not saying we are certain of success, but we are going to try to do it. we have the design on paper during the calculation and simulation. it does work. now we need to make sure that the simulation and reality greece. generally when they don't reality wins. so that is to be determined. and this simulation that you may have seen in the lobby coming in , closer to our website ride around now is to five will show

you a simulation of what we plan to do. now, that simulation is mostly accurate, but there are a few errors which are inaccurate. in some cases just to to timing constraints are were not able to work with the simulation of people to get a completely accurate. in some cases we're keeping a few technical things under our at. but it gives you a pretty good idea of what we intend to do. which is to land basically for the first aids after stage separation, turned the stage around, read that the engines, push back the launch pad and possibly land on landing legs to read and then with the other states, after dropping out the satellite or dragon spacecraft, to a deorbit -- deorbit burn car re-enter, steer aerodynamically back to the launch pad.

you don't actually need wings. a common misperception. you just need some leftover drag never been the factor. and the launch pad. then blend with the upper stage. and so we will see if this works. it's going to be an exciting journey. and if it does work it will be pretty huge. because if you look at it the cost of a delta nine rocket, which is quite a big rocket, and a million pounds of thrust, the -- and it is the lowest cost rocket in the world. and even so, it's about 50 to $60 million. and that the cost of the fuel and oxygen and so forth is only about $200,000. so obviously if we can reuse the rocket said thousand times then that would make the capital class of the rocket only about

50,000. there would be made in some other things that would factor in there. fixed costs, overhead. but it would allow for about a hundred fold reduction. and this is a pretty obvious thing has applied to any other motor transport. you can imagine that airplanes are not reusable very few people fly. 747 is about $300 million. you need to them for round trip. and yet i don't think anyone here has paid half a billion dollars to fly. and the reason is because those plans can be used tens of thousands of times. and so you're really paying for his fuel and pilot cost. you know, some incidentals. the capital cost is relatively small. that is why is such a giant

difference. put it another way. we can probably afford a quarter of a percent of our gdp for making left malta planetary. that is the cost if you have a fully reusable rocket. the cost if you don't have a fully reusable rocket on the same barometer would be 100% of gdp. that would mean no money for food, health care, or anything else, and obviously that's impossible. that's why i think the fully and rapidly reusable system is fundamentally required for of life to become of the planetary and for us to establish life on mars. mars is the only realistic option for another planet. evita's being too hot. jupiter being and gas giant. end the marriage of jupiter are a possibility, but it's much further out harder in a lot of different ways.

the moon is too small and a resource for -- to make left malta planetary. not just have a little base. of the base is not that interesting. the self sustaining human civilization upon multiple plants, much can continue even in the event of a calamity on earth is the real thing. yes. so i think this is pretty exciting. and i think everyone in america and arguably the rest of the world should be pretty fired up about what were doing. hopefully was as well. we will do our best to succeed in this regard. yes. definitely going to be an adventure. and also one final thing, which is what is the business model

for mars? and sometimes i think a lot well, can you mind mars and bring things back? that's not a realistic business model. far cheaper to buy things on a trip to mars. but i do think that there is a business model or if you can reduce the cost to a flight to mars are moving to mars to around the cost of a middle-class home in california, it does seem to be rising. maybe not recently, but certainly. maybe to around half a million dollars. then i think he would have enough people who would buy a ticket and move to mars to be part of creating a new planet and be part of kind of the founding team of a new civilization. you don't have to have -- you obviously don't have to be willing to, you know, have an

appetite for risk and venture. but the 7 billion people on earth now, parlay 8 billion. so even if one in a million people decided to do that, that's still a dozen people. and that they probably more than 1 million. so that's what i think is the business model, if you will. ultimately must come probably export intellectual property like software and things like that. you can sort of be back with photons. that's a better way to go. all right. i'm happy to answer any questions. [applause] >> thank you very much. >> well, thank you very much. obviously given the diverse nature of your own interest and pursued we will ask you to stay here as soon as you grab a drink of water, which is required on

earth if you went to the moon that might be more difficult. so we're going to start with space. if you'll just end up here read by my side we will just sort of when it won by one. talk about how you see the practical application of the technology you just described, sort of in the near and intermediate-term. >> well, in the near term the technology will be applied to launching satellites and to resupplying the space station, taking cargo and troop there. as the near term thing, and that is what the current business is predicated on. we're doing okay in that regard, we have about $3 billion. >> that's better than abcaeight. >> to spread out over the next five years. we do have lots of things to get that money. but that's not bad.

and so we have been profitable for the last four years, not easily profitable. we spec to be the same this year. so i think it's someone necessary. a lot of money coming in. we have to make sure there's more money coming in and going out. but that seems to be going very well. >> and you described to me earlier the right now you are the leading, essentially vendor for launching satellites into space right now. >> well, if measured by launch contracts awarded, that is correct. and the united states has been uncompetitive and international laws market for a long time, and russia has actually been a leader in that regard followed by europe and then to a lesser degree india and china, although china is grow rapidly.

except in the last few years when the united states has done the best. >> so obviously you are a person very interested in performing innovation, and that is something it seems the united states does well. in this space specifically how can we maintain a competitive edge, and are we maintaining it in this sector generally within our nation right now? >> well, as far as launches concern that think it's fair to say that the united states has one of the most competitive launch capabilities as a result. the only realistic potential competitor is china. these days than competing with national governments which are heavily subsidized. and they certainly have set their sights on us.

but that's okay. with respect to china we have a conscious strategy of the absolute minimal number. foul very few patents. very careful about server security and physical security. there's obviously a history of intellectual property in china. the enforceability of parents against the chinese government is zero. so that is a -- contrast that. files lot of pants because pattons, pressure companies. not to worry. >> come back around a little bit to maintaining a national standard, as you know. there has been an active debate in congress. in washington. what is the appropriate role for government to?

of course there was a different proposed were times when cash was more flush. there seems to some degree or great degree, beneficiary of that in the sense that we are outsourcing some of this within our own country now. is the inability, the apparent inability of the federal government to spend on this going to be an inherent problem for our country? >> we do spend a fair bit of space, it's more than any other country. so i think it's will continue to be the biggest spender on space is the note states. but i think the budgets and at some times will decrease because of the impression on the federal budget. we have a huge budget crisis and largely have our head in the sand or are ignoring the reality that we are spending far more than we are brilliant.

twenty-five bringing in. so i think we can expect from the governors and plunges because we'll have any other choice. >> i want to give more to this basics peace. since you just have talked about the way you should do business as a government there is obviously a political issue right now is out there about the appropriate role of government encouraging job creation. yeah 1500 employees. you are having those jobs in the united states. we have allowed facility. >> rear building alongside. we're not currently using the marshall islands launch site. we did use it initially, but it's just too difficult to get out there. what a world out there.

so it's convenient in some ways. so did canaveral. we are also establishing a commercial launch site which we are -- because there for spaces, concentrator force and national business of those two facilities and then concentrate that a commercial launch site. >> what's your sense in the political debate here in washington. do you have trouble creating jobs within your company because of the way the federal government is operating currently or would you envision as the policies managed general? >> well, there are -- i should first of all say that we would not be where we are without the help of nasa. distort the the great things

that nasa is done and currently prefer to business that nasa gives us. so i should make sure to very strongly credit nasa in terms of how awful they had then. we do have a bit of a challenge with the airport. this is something where i'm sort of surprised that there is not more journalistic interest. the air force currently proposing to extend the socialist monopoly of boeing and lockheed until 2018. and the reasoning given to that is preservation of the industrial. although for some reason on the enough free and not included. and this is doubly on because the main rocket is the alice five which has a russian-made and to. the interstates and a forward

air frame which is made in switzerland. so which industrial base we talking about preserving? the one in russia? that does not make much sense. >> he says that is a political problem. >> you know, we had 1 percent of the power boeing and lockheed. >> that's a political problem. >> if this decision is made up as a function of lobbying power we're screwed. [laughter] >> i think you just turned. let's give a little bit more to the space visit here because we do have a lot of questions. a lot to be fair to our audience to get in as many of those questions as time permits. obviously these are far-flung questions, literally as well as figuratively. someone asked what will today's announcement -- how will today's announcement divert resources from sending humans to the international space station. i would probably add if at all.

>> not in any way conversion. this is a parallel effort, and so it's not really impacting the space station, nor is it affecting human spaceflight and development activities aware during, which is going on renewal. think of this as the pearl lang. it doesn't really affect me. the descent phase. that is actually what happens. >> that's a good goal to keep. given the grounding of russia's rocket fleet, are you in discussions with nasa to exhilarate the international space station mission and what happens with your schedule november launched with the possibility that the imf as may need to be evacuated? >> that could reasonably -- it

actually is likely resulting. pushes up the other mission. nasser wrigley was to have the appropriate level of astronaut -- the right astronauts and number of astronauts with the right training and everything on board the space station and arrive. so it looks like things will be more like january 4 launch of the space station. and that is contingent upon the russians meeting the schedule that is currently stated. >> out you evaluate the fact that we are using russia as an important partner and i ran right now? that you feel about that? what other risks? >> i think despite the recent failure, it is actually a good vehicle and a good track record.

a think there may be some concerns going long term with russia and that a lot of their experts rocket engineers have retired. it's much more compelling financially to go into the oil and gas ministry that is. so you sort of, that expertise is tailoring off. it may lead to decreased reliability for russian rockets in the future. hopefully it doesn't, but -- >> does that give the advantage to china? >> i think long-term china is the serious competitor. there -- if you look at russian rocketry, the soviet union has really been. the technology. it is fairly progress. no new rockets of launched since the soviet union. so what that means is a sin as

that technology level is exceeded and they're rendered redundant. that is likely will occur. >> how much longer do they have once this debt during some serious work? >> does that mean then that china was sicily in the space there are occupying? >> i'm quite confident we can take on china. >> that's it to another question. >> i would rather be and that the agenda. >> year on the record in the think you have a lot of people cheering for you. obviously will see what happens. we'll invite you back. >> famous last words. >> given the failed progress launch and the risk of trusting the very survival of the international space station entirely there is something of a state of emergency and u.s. crews began. can you fast-track development

and human rating to begin crude launches, and if not can you speed up the process? did you watch in an emergency? >> yes. well, it's important to clarify what can the system to? what can i do? if the degree of safety required was equivalent to that of the silicon actually launch astronauts on the next flight on the one going up in january. the system is fully capable of carrying biological cargo. people. so what it doesn't have is a launch escape system. this also does a of a launch is consistent. so nasa and we agree that it's a wise move. so we are -- it will take us

about two years, maybe at the outside three to develop and qualify dsk system. and the lawyer during launches bid systems is significant innovation. escape thrusters. so you can actually use those same thrusters for possible landing. we're actually talking about potentially during missions to mars and other places using dragon this kind of a general best, a general science delivery platform to various places in the solar system. so that is an important distinction. we could launch satellites. if the requirements, but before going to add to with three years.

>> assets as a legacy of openness and transparency of private companies. well you're applying private villas the private model continue to work. however, was the american taxpayer starts putting the bill more aggressively what assurances can you give this basics will be as open and transparent as nasa and other aerospace systems or needy b? >> well, relatively speaking it was a pretty open company. there are some restrictions. there are restrictions that we have any choice over because the advanced rocket technology is considered protected technology. so you could do more with those. >> right. we can't give -- we can sort of just published to the general public details analysis of the investigation that contains secrets on how to make rockets.

that is actually a violation. but we -- all that information is available to nasa and to the faa. so for missions that we do for nasa nasa has a lot of detailed oversight. the faa as well. if you're comfortable flying commercial aircraft emmy's to be pretty comfortable in what you doing. >> it would nasa there is obviously any number of tragic events that occurred. and this is that obviously they are using private companies as partners, but essentially it was under the nasa and government brand. essentially flying the american flag. can a company like yours sustain a loss like that as a private enterprise? would people be willing to give you as much dare i say space in the event of a tragedy that there would be their own government? >> i think that will be okay.

if you look at all the other modes of transport, aircraft and boats, cars. there are -- every mode of transport, and if one set of standards, could not have a loss of left and there would be no transport. you're not even be allowed to walk. so you have to allow for some amount of risk. and aides to be a reasonable and measured, but you have to allow that. i don't think -- the commercial company arguably would be better able to deal with that than to a government entity. governments, congressional hearings and a test to become some does little football. >> congress as a willingness to investigate as well. >> sure. yeah. but i think that certainly

occurs where we have a violation of the rules as a bit like that. something within the rules. obviously failed car accidents every day. >> a sense of being responsible or import for your future business. >> certainly nasa's largest customer. if elected our watch manifest we had over 30 delta nine missions in the contract. thirteen of those with nasa. effectively we have a 40% of a business with the government. but so you made pencils.

of 40%. there's not a reasonable number. >> fair enough. fair enough. we are getting to the work force issue. someone writes in the audience today my son not me is the mission controllers at houston's johnson space center which is relevant to the future of your business as well. betty a difference a been let go and their interference in the video. any suggestions on what you're looking for? >> sure. well, if you look of the amount of money that is allocated to commercial space relative to the overall nasa budget, it's a pretty small number. the last fiscal year was split over four companies. we got about 75.

that is, i guess, about half a percent of the nasa budget. we would love to hire a lot more people than we currently have, but we also can't run out of money in die. the kelly air few people. in terms of what characteristics we look for, we generally acquired engineering centric. we are big fans of what the people of down from a hard core engineering standpoint. no, what tough engineering problems the assault and sort of less interested. more of a paper oriented role that they have had. >> are you more demanding the message? >> well, that's a tough question

to answer. >> i think we're probably more demanding. i guess nasa is a large organization. the level of demand people face in different parts of nasa varies considerably. i'm sure they're parts of mass of which are very demanding. but it is an extremely demanding organization, and we expect people to work hard and be very good at their jobs. >> given that tesla and solar city are your response among other things to climate change how you answer politicians who say that they're not sure it's actually happening? >> okay. well, i think climate debate is an interesting one. if you ask any scientist are you

sure that human activity is the cause of global warming, a scientist should say no because he cannot be sure. so on the other hand if you said the think we should put an arbitrary number of trillions of tons of co2 into the atmosphere and just keep doing into something bad happens it would probably say no. we are essentially running the experiment. that experiment is to test the current capacity. now, that experiment may turn out to be fined. it may also turn out to be really bad. in its just, i just don't understand why. particularly when you consider that at some point we have to get to something that is sustainable. we have to have sustainable production of energy and consumption of energy. of course it's unsustainable.

you will run out of it. and you can certainly said, well, let's say hypothetically co2 was good for the environment let's say hypothetically the united states left all the oil in the world. well, you would still have to get oil because it's a finite resource. as you start to run out of it yet economic collapse. so why not do it sooner? and not saying that there needs to be a radical or immediate change. people need to know in dicta great deal of misery into the lives to avoid co2, but we should lean in that direction. we should late in the direction of supporting technologies that are sustainable and mean said the gates to technology. that just seems pretty sensible.

even if the environment as a factor. and, in fact, my interest in the electric vehicles predates. the llamas are talking about global warming. it was the obvious means of transport. so i do think this urgency, and i do think we will see quite a significant increase with the cost of oil, just from a demographic standpoint. china, india, countries the represent almost half of the world's population and of very few cars in the road to the rapidly added. the doubling of demand and a ticket's going to be difficult to see the doubling of supply. >> have you tasted thing in the wake of the federal solyndra investigation? do you have any concerns about an inquiry into government loans in contrast?

will the doe loan application stand up under such scrutiny? >> yeah. i mean, so in the case of solyndra, solyndra has become somewhat of a political foothold here. and the doe program to that unnecessarily our portfolio programs where some number of things that are funded there going to fail. that should be huge. it should not assume that a 100 percent success. and in the case of solyndra people forget that private investors lost twice as much as the government did. there were some really first-rate venture-capital less than solyndra. is not as though these were suckers. some if you get first-rate venture capitalists who lost twice as much money as the federal government have to say,

okay. it was a bet. the debt to not work, but that does not mean something really bad will happen to be the most you can say is that solyndra executives were too optimistic. you know, they presented a better face to the situation than they should have been presented in the final few months. but then if they did not do that it would have become a self-fulfilling prophecy. you know, as soon as -- and not sure. so you know, i think people are making too much of this. and the thing parallels, i mean we have to learn. from a different program i should point out. but in our case we have significant capital reserves and more money than we need to

complete the program. and we don't face the same issue a solyndra faced. extreme competition from china on the modern-day product that drove the cost of solar panels down to one. that is the fundamental reason. it would have been no kaytoo ellis, but not one. and that's it. and here's another thing. how much money do you think the chinese government with print? estimates are about 40 billion. so with our team a birdie on a pittance, china operating and 40 billion, that should be no surprise. >> to you worry that has tarnished the view by the american public? >> is probably a little bit of

tarnish, but in no it's unwarranted. the cost per watt, it's something that i expected would occur. somebody asked me, you're going to get your kicked. so the city works on the system where they do everything except the panel. it's kind of like a bell or apple. diller apple domesticity -- cpu with the memory. it is either the overall system and it provided to customers to sales and marketing service. that is what solicited did. did during super well. they're growing and at 52 under% to year with positive cash flow which is pretty incredible. and, yes.

i just showed a significant news. .. that's the fifth of tober in that event is sold out. we just announced a tober 24th , tnt's harvey levin will

talk about the changing landscape in entertainment. before i get to the last question, come over here and we present our speakers on a routine basis with our token of our appreciation and thank you very much. our national press club coffee mug. >> thank you very much. [applause] >> will see if we have time for more than one question. these are on a lighter side as many of you know in the audience. what is the one great idea using from somebody else. as the slogan goes, i could have had a v-8. which it does blow largest in your mind? a great idea he saw someone else had any wish she'd had it yourself. or express that idea. >> there's lots of great ideas. i don't necessarily wish i had them myself, but certainly what

mary and sergey come up with at google with the backward marks, facebook, twitter, great compliments to the internets. >> those are american companies. >> anything apple, google, facebook. you're sort of like his competition? were not even sure. >> how is that america is able to innovate so i'll given all the challenges that we have great companies like that? in other words, in many ways the nation continues to be a great innovator. how do you explain that? how does that continue to have

been? >> well, it is kind of like thinking about democracy. it's bad, but it's the least bad. welcome to the united states is the least bad. in the silicon valley is particularly good at encouraging innovation. the third -- silicon valley is better than anywhere in the world for creating new companies and the innovation is quite remarkable. so i don't think some other country out there out innovativeness. almost all innovation in the world comes from america. it's true. i mean, a ridiculous percentage. but that doesn't mean it couldn't be better. we need to be concerned about excess regulation, a tax

structure that potentially doesn't promote innovation. just thing to remember when companies are little, they are like tadpoles. they die very easily. we need to have an environment, which tries to protect little companies and help them get thicker. silicon valley does that very well. but most other countries tend to foster and protect the big companies. it's a big companies don't need protection. >> very well thought out. how about a round of applause for a guest speaker. [applause] thank you to all of you for coming today. i'd like to thank the national press club staff for organizing today's event. find more information on our website. get a copy of the program. please check it out at

www.press.org. thank you and we are adjourned. klatt back [applause] six [inaudible conversations] >> on the use of antipsychotic drugs on dementia patients in

nursing homes and long-term care facilities. the fda said the strokes would cause serious or life-threatening effects. this is about an hour 40 minutes. >> good afternoon to all of you. we appreciate your being here today and we will commence the hearing at this point. today we will be discussing the widespread and costly and often inappropriate use of antipsychotics in nursing homes and efforts to find safe enough that alternatives. antipsychotic drugs approved by the fda to treat an array of psychiatric physicians, numerous has concluded these medications can be harmful when used by frail elders with dementia, who do not have a diagnosis of serious dental illness.

in fact, the fda issued to blackbox warning citing increased risk of death when these drugs are used to treat elderly patients with dementia. despite these warnings, there's little impact on antipsychotic prescription rates on long-term care facilities for dementia patients who do not have a diagnosis of psychosis. the most recent data indicates increasing usage of antipsychotic among nursing home residents with dementia, that more than half of these patients have been prescribed these strokes. improper prescribing not only puts patient health at risk. it also leads to higher health costs. today will hear testimony by the hhs office of inspector general that the use of antipsychotics in nursing homes for patients without a diagnosis of mental illness is costing taxpayers

hundreds of millions of dollars every year. we know that we can do better. our second panel features experts, including tom hlavacek from my own state of wisconsin who will discuss safe and effective alternatives using antipsychotics to deal with behavior issues and older dementia patients. the properly prescribed antipsychotics can offer beneficial treatment for individuals suffering from mental illness. however, we have a responsibility to patients and to their families to whittier that residents are free from all types of unnecessary drugs. we have a responsibility to taxpayers to be sure that they are not having to pay for drugs that are not needed. for that end, i will continue working with my committee colleagues as well as the senator grassley to address these issues. so we thank you all for being here and we will turn to our first panel.

our first witness today will be daniel levinson, the inspector general of the u.s. department of health and human services. we thank you are being here. our next witness on the panel will be set up to patrick conway, chief medical officer for the center for medicare and medicaid services and director of the office of political standards and quality. we thank you for being here. mr. levinson. >> good afternoon, chairman kohl. thank you for the opportunity to testify about the use of typical antipsychotic drugs in nursing homes. these terms are powerful and misuse poses a risk to the elderly. two recent oig reports raise concerns about the use of antipsychotics to elderly nursing home resident, particularly those with dementia. we hired psychiatrist, expert in treating patients to review a

stamp was medical records. their review revealed the following: in 2007, 14% of nursing home residents are nearly 305,000 patients medicare claims for antipsychotic drugs. half of the stress claim should not have been paid for by medicare because the drugs were not used for medically accepted indications. for one in drug claims, nursing homes dispense these drugs in a way that violated the government standards for their use. for example, prescribed dose was too high or residents from the medication to the. finally, prescription drug plans sponsors black access responsible to reimbursement of part d drugs, including antipsychotics. what did these findings need? too many institutions fail to comply with regulations to design to prevent

overmedication. medicare pays for drugs that it shouldn't. why should we be concerned? these powerful and at times dangerous drugs are too often prescribed for uses that are not approved by the fda. and they do not qualify as medically accepted for medicare coverage. the fda has been posted but box warning, emphasizing an increase of risk of death when used by elderly patients with dementia. 80% of the time, antipsychotic drugs are prescribed to elderly patients with dementia. physicians can use medical judgment to prescribed drug that appears by the fta, including for whom the black box warning applies. and most antipsychotic drugs up to best interest of patients in mind. however, it is concerning sony elderly nursing home residents

with dementia are prescribed antipsychotics. for instance about a medical workup, one patient was given antipsychotics for education. a medical exam would've detected the patient's tract infection which may have been a source of the education. how can we help protect this vulnerable population? cms should want to consider enhancing claims data to ensure accurate coverage determinations. for example, a diagnosis quotes could help determine whether it's appropriate in that the claim is payable. two, in whole nursing homes accountable for unnecessary drug use to the survey and certification process. and three com to explore other options such as incentive programs and provider education to promote compliance with quality and safety standards. for example, cms could require nursing homes to reimburse the part d program went claim drugs violate these standards.

the government must also monitor the marketing of the antipsychotics. there is ample evidence that some drug companies have illegally promoted these drugs for use by the elderly with dementia. drug manufacturers have paid billions of dollars to settle allegations of off label marketing of these drugs. it is difficult to undo the influence of such marketing campaigns. top areas, nursing homes and pharmacies can all help by carefully analyzing the patient's best interest from prescribing our defense and antipsychotics. in partnership with medical professionals, families can support loved ones by learning about appropriate use, proper dosages and side effects. my office continues to examine protection and quality of care for patients receiving antipsychotics. we are reviewing whether nursing homes are repeating assessment

and pair of pants that these presidents and we've issued guidance to nursing homes about compliance risks related to the use of antipsychotics and other psychotropic drugs. over the next 18 years, 10,000 americans will become newly eligible for medicare each and every day. as the baby boomer population ages, it is imperative to address the use and misuse of drugs among patients. thank you for your interest in this issue and i am happy to take your questions. thank you. >> thank you very much, mr. levinson. dr. conway. >> chairman kohl, thank you for the opportunity to discuss. the cms is committed to ensuring every medicare and medicaid beneficiary receives appropriate high-quality health care. i left the private sector should take on my current career six months ago in order to improve

the care delivered to all americans. this topic is a significant opportunity for improvement in our nation's seniors deserve our collective focus. i appreciate the efforts to bring attention to the issue. cms is undertaking a multipronged approach to eliminate inappropriate use of antipsychotics in nursing homes. i'll briefly summarize multiple steps to take in our plans for the future. i will highlight some component or approach. serving certification, training and education, updating rules, research quality measure development and transparency, perking estates and collaborative quality improvement. first come in to help ensure they meet federal and state standards they conduct -- cms is implemented substantial improvements to address concerns about voter utilization of medication. cms provides guidelines for necessary medication come including a required providers to use non-dermatologic conventions for issues such as increasing exerciser time are

planned individualistic duties. cms is working to enhance implementation of the financing utilizer quality assessment and performance improvement programs better. surveyors or armies of quality assurance staff in the field, so we need to focus resource on appropriate behavioral interventions. second, cms works to include training to provide patient centric identified with nonpharmacologic interventions appropriate pc method languish in the operations needed to make dementia care and abuse prevention issues a mandatory part of training and displace ms produces educational dvds that emphasize nonpharmacologic intervention. this would be distributed to all nursing homes and state survey agencies. finally, cms at dated the use. third, cms is that it was regarded nursing homes in antipsychotic use. cms proposed changes that require long-term welfare of this to be independent from ltc

pharmacies, pharmaceutical manufacturers and distributors. the goal is to share recommendations are good for you for a possible financial influence. cms will open other rows for nursing homes are forthcoming connecting research findings into this. for example, cms has awarded contract you cannot study in 20 to 25 nursing homes that evaluate decision-making of that is influencing prescribing practices for antipsychotic medication. this, cms is seeking to encourage development of quality measures addressing antipsychotic dedication is once developed and validated in the cms with plan quality measures and nursing home to compare. six, cms is interested in partnering with states to address this issue and help identify and spread practices. for example, cms and abc's enhanced nursing home and monitoring issue for antipsychotic use. finally and perhaps most importantly we've recently engaged in a collaborative multi-stakeholder quality improvement initiative focused

on reducing antipsychotic use in nursing homes by eliminating inappropriate use. a person let them participate in national quality improvement issues i've seen their power to transform health care. efforts are most not successful in they engage in a garage range of stakeholders including frontline clinicians, patients and families. there for a few months ago to be and proactively of the american medical directors association, american society of consultant pharmacists, and reading each consumer voice, professional societies, current partners and others to participate in a national collaboration. responses are positive where in the process of developing national action plan. are committed to working collaboratively to publish our shared goal. i'll briefly share three guiding principles in the cms office of standards and quality. first, constant focus on what is best for the patient. second can of been a catalyst for health system transformation improvement. third, collaboration across hhs and external stakeholders and

partners. this is or approach going forward to dramatically improve the care patients at dementia as well as other issues are tackled. cms speaks to function as a major force in trust for the part for continual improvement of health and health care for all americans. as a practicing physician incentive a medicare beneficiary take this commitment very seriously. for nursing home residents suffering from dementia, this most comprehensive behavioral health by an interdisciplinary team who are knowledgeable in the use of nonpharmacologic intervention inappropriate judicious use of medications when indicated. we hope members of the committee will serve as an important part in a separate senate i look forward to hearing suggestion and comments in answering questions. as you noted, i have to mention my wife just gave birth to her third child, alexa dan conway. so if i see the sleep deprived in answering of questions, i apologize. thank you for your time. >> thank you very much, dr. conway for being here.

mr. levinson, your study found that about half of the 1.4 million atypical antipsychotic for claimants for nursing home resident did not comply with medicare reimbursement criteria because they were not used or medically accepted indications. so how can we increase medicare's access to the information that it needs to ensure appropriate reimbursement for drugs? >> well, report included several recommendations. in my summary statement, was including some of the options but i think cms needs two -underscore. first and foremost, if we could have diagnosis information as part of the prescription, that would go a long way. it wouldn't necessarily solve the entire problem, but having to type us this information available on the prescription could make potentially a significant difference in being able to ensure that the sponsors actually understand that indeed this is for a medically indicated application.

>> now, in almost every case, prescription cons from a physician, correct? >> yes. >> well, the physician understands how we used to prescribe for dementia and how he is to prescribe for mental illness. so how is this mistake he made? after all, it is not just anyone who decides whether to administer to a patient. it is a physician. so how does this happen? >> well, we are focusing on cms review need to require the pdp sponsors to ensure they have the exact diagnosis information available. because if you are reimbursing only half of the time accurately , that is a problem that cries out for the need to ensure that cms is seen, we need to ensure we are only paid for

those prescriptions we can support, either fda or off label, but medically indicated applications. >> and i appreciate that. i'm trying to somehow understand the medical part of his because it is dangerous and prescribed inappropriately, right? i mean, we are talking about patients who are at risk from inappropriate prescription. >> you know, medical expertise -- there is a doctor at the table, but i would indicate that these are free to prescribe for any indication. >> sure, dr. conway, do you want to help us understand that? >> we agree with the point that we have a shared goal of appropriate prescribing. i think her view is a multifaceted approach for prescribing and we think about it in the course of all of our lovers, on one hand is education

and training so i agree with you that decision should be between a physician and patient, but there probably is additional education and training for nursing home staff on this issue, especially when nonpharmacologic interventions. secondly in terms of measurement and data, we agree with oig on the important for data and measurements as i alluded to, looking for additional measures to track this information. i won't recount everything i went through, but uncertainty and certification, if they're a layered nursing homes homes of potential issues coming up, we are working to a process to make sure we have appropriate quality assurance in ascending for this nursing homes. >> do you regard this as a solvable problem, perhaps uneasily, but a solvable problem? let me put it another way. is there any reason, other than our inattention, for patients to

be prescribed improperly? >> so, i do believe it is a solvable problem. i think it is a complex problem, exactly as he said, senator. addressing complex problems, such as this, especially with the symptoms are sometimes difficult to distinguish as opposed to some other disease cross the seas, with more obvious than i can type more across that if you want. it is a solvable problem, moving collaborative quality improvement, a collaborative focus. i think one of the major keys is focused on nonpharmacologic treatment. so we educate nursing homes and patients and families about the nonpharmacologic options to treat dementia and behavioral disturbances that patients at dementia. >> do you agree with that, mr. levinson? >> yeah, i think i can be extremely, extremely helpful.

it is very important. again, what is truly appropriate as a matter for the doctor to decide, perhaps in consultation with other medical professionals the concern from the inspector general standpoint is that cms is reimbursing half the time, we just can't establish that there are actual medical indications that cms manual requires for there to be appropriate reimbursement. >> okay. senator manchin. >> thank you, mr. chairman. dr. conway -- if he said this before it got here, i'm sorry. the inspector general's report had about 723,000 out of 1,000,004 for the residents do not comply with medicare reimbursement criteria, which is site and put mr. that just was speaking about here and that is

an alarming rate. what authority do you need to create the incentives are improved or promote compliance within the rates of noncompliance you have now? >> so he agreed that cms should not be paying for medically inappropriate uses of medication. i think it is inappropriate payment issue. it's also the quality of care issue. as i did allude to in the survey and certification of quality measurement in which he touched on that we measure quality which historically have not. working to do that as early as spring comes to that the critical factor transparently sharing information with beneficiaries and their family and nursing home compare. in addition, with her party colleagues, we continue to work with pdp drug plan sponsors.

we recently asked from where we could do in this area in terms of input air. so it is a multifaceted issue. we agree we should not be paying inappropriately. i think our current authorities achieve that goal. we would survey on certification and reports to me. i would reiterate the president put an asked why total budget for certification to support the budget that allows us to the important work of serving certification nursing homes, but i think we have the appropriate statutory currently and we will take a multifaceted approach to address this issue. >> along with the state -- a lot of states have their own controls or oversight on budget and deficit disorder. are you all exchanging your information freely? because i have looked at just the figures of 2000, $309 was spent. half of that was spent,

150,002,007 money. so how do you all interact with the state? >> so we work closely with states now and we think we need to do more in the future. so we are partnering with state. illinois, we are working with them on analyzing data, identifying what may be inappropriate uses of antipsychotics. massachusetts' can begin a multi-stakeholder group to address this issue. we are closely working with states and including the state a survey agencies in terms of addressing the issues. >> states during my visitations in nursing homes, then what you say you're able to do quite >> yes. >> the state surveys these will serve a nursing homes. >> have they been trained properly to the other types of so-called overprescription? >> it is a great point, so one of the aspects that we are trying to address is better training. so we have started after a

series of, as an example, educational dvds on this issue, direct training the surveyors. so teaching surveyors and providers in nursing homes about nonpharmacologic treatments and we think that's a critical point, exactly as you outlined so those providers of care and surveyors understanding the kerry as president understand inappropriate use of antipsychotics and also understand the nonpharmacologic interventions possible to treat these problems. the mac i was reading this treatments are administered despite fda boxed warning concerning who could increase risk of mortality when drugs are used to behavior disorders to patients with dementia canseco says. is this the way, out of sight out of mind can keep keep them calm? >> said i would not be our goal. >> i know that's not your goal. it's the result of the.

>> as you know come in many medications are prescribed off label. however, would always on appropriate use of antipsychotics. such of his intangible examples. if a patient with dementia has hallucinations or is serious until disturbing as, then i can be appropriate use. but would like to have the nonpharmacologic treatment of these more often. the mac let me say, sir, it is a great shame in this country is much money we spend a nursing homes. it's really just not excusable. >> i agreed its a shame and i agree we need to do better. >> thank you. >> thank you, senator manchin. senator grassley. >> i appreciate the opportunity to come and participate in this hearing. i have just one question for each of you. ours are the general levinson. you have the extensive evidence that drug companies have

illegally marketed or antipsychotics for off label use. he mentioned one company that used the slogan high five and to promote their powerful antipsychotic as a sleep aid for patients. eli lilly sales representatives told the.karzai giving five milligrams of their drug zyprexa at 5:00 p.m. at helping patients sleep. in 2009, this company pled guilty to illegal promotion and paid one and four tenths billion dollars drug lawsuit. that large number becomes less significant as the cost of doing business. as you described, it is a profitable investment because even after government action stops illegal marketing, their effect on prescribing patterns may be long-lasting and difficult to want to. so, my two-part question, general levens then, is there a

system currently in place to educate prescribers in response to this misleading promotion of drugs? >> provided training is absolutely essential, senator grassley. whatever is in place now needs to be far more robust. that is the key take away, i would hope, from what has been examined and what has been reported on is that there needs to be far greater understanding of the potency of these drugs in their appropriate application and how if you are going to the.door as opposed to the front door of advancing this kind of drug regimen, it really needs to calm was a really good understanding of what people are doing. it's hard to believe in the past that really has been effect is, just giving the litigation. we've had not just that case, but nearly half a dozen major settlements that drug companies over the past several years,

totaling billions of dollars back in one way or another involved antipsychotic drugs. so it is a very important key part of the puzzle, if you will, that needs to be really made far. it really needs to be strained. we are doing our part trying to advance the training initiatives and will continue the quality of clutter but understanding individual plants have cared to see how nursing homes are actually trying to remain a far more effective plan for patient safety. >> okay, if there is such a system, it is inadequate you just said. it needs to be improved or maybe even replaced. do you have some idea how that system should be? and is it possible at the knees

by money, using a portion of the settlements of off label marketing? >> well, we could certainly stand very ready, as we always have, to provide the type of assistance that we do day in and day out to cms, which really has the programmed responsibility to design these kinds of efforts. we don't run the program. we evaluated. in terms of a kind of a counter design, my chief concern would be how he would oversee how the government would act to please seek to provide some kind of counterbalance to it. wearing the oversized hat, that present some challenging issues about how it will level the playing field, making sure people understand pros and cons comprehensively. so that would be a significant oversight challenge and therefore would be important to get the details of that decide right and we will stand ready to certainly help.

>> dr. conway, you mentioned proposed changes cms is considering to long-term pharmacies to be independent for pharmaceutical and choice. 80% of the consultants, pharmacists have long term care facilities are employed there is obviously a clear potential for entries. one large long term care pharmacy reported to me and i won't get the name of that group, that all of the antipsychotic recommendations by pharmacies, 99 and seven tons% of those recommendations were to reduce or discontinue the antipsychotic dosage. one, they presented was these recommendations were rejected by prescribing doctors who believe high dosage is appropriate. each is made by consultant

pharmacists and whether or not they are implemented? let me ask at the same time, to cms require justification from a prescribing physician when they choose not to follow recommendations? so two questions. >> yes, sir. on the first question, we are not currently capturing data on recommendations because that's within the nursing home care setting. as i alluded to earlier, the education component is not in the pharmacy world. it's also to two positions. i was safe to patients same only if, cms, so the whole nursing home community, if you go, which we think would make it a much more reset his audience to recommendations. on the long-term care pharmacy issue, it is a proposed change. as you alluded, the proposal was

an attempt to ensure that financial arrangements aren't influencing the recommendations from the long-term-care pharmacies. >> what about -- i hope you didn't answer this. if you did, i didn't get it. to cms require justification from the prescribing physician when they choose not to follow recommendations click >> i apologize. i didn't answer the second part. we currently do not require justification per se. it is similar to other prescribed medicines. the physician and the patient and the risks and benefits with the family and that's case. the prescription, either the increase or decrease the dose or stopping a prescription would take place. like other prescribed medicine, there is not a justification captured for the prescription. >> thank you.

match. thank you, witnesses. >> thank you, senator grassley. >> thank you, mr. chairman. first of all, my thanks to our chairman, senator kohl for having this very important hearing and for senator grassley's can give you an investigation into this issue, which has been very, very important. overusage most of the people who were attending are a form of tawdry abuse, plain and simple. if it views of people who often have no idea what is happening and even families may not have a clear unformed idea about how ideas are prescribed in applied. it occurs not just an occasional or isolated case, but as a routine pattern and to assess some of the statistics show. i don't know how many of them

had been cited here, the ed 3% of claims for use of these antipsychotics to medicare were associated with off label can dish it that dementia. 51% of medicare claims for these drugs were erroneous and of course millions of dollars wasted. so, the question is at the outset. if there is off label marketing, which is plainly a violation of current law as opposed to off label prescriptions, which may not be, can you give a specific instances of abuse cited cited in your testimony of off label marketing occurring, what companies, what drugs? >> we'd have a number of cases

end of the 18 sentiments we've had, senator bloom in all, i believe size in the past few years have involved antipsychotic drugs. >> i am thinking more going forward of what is occurring right now. >> well, i could give you past cases, but in terms of current investigations they certainly wouldn't be any position. it simply wouldn't be proper to talk about whatever current investigations might be ongoing with us as investigators in the justice department's prosecutors. the wii is certainly a record of the kinds of cases you describe that i think are very important body of work that really underlay the power of valuation work that we undertook to see further exactly how extensive the problem in the nursing homes that the percentages and to build on that work by working with future plans of care. so the litigation work that we

have been involved with in partnership with the justice department laid the foundation for the report that is now before you, at least in part. and that is to report that is now before you will add further information and understanding to what is actually going on, if you will, on the ground and will lead to a further investigation of plans that cared in nursing homes to see how the mechanics of this is either operating or not operating appropriately. >> are the penalties for off label marketing sufficient to deter in this area? >> well, based on the record, it looks as if we are still facing a significant health issue. >> exactly right. the answer is probably no. >> that might be for others to answer. >> well, you are in charge of enforcement. >> we have quite an enforcement record at this point.

>> which is why i'm asking a question if anyone is expert on the issue of deterrence, it gives you your pet is like asking you the question. >> well, we certainly view these kinds of returns. we're talking about billions of dollars as a considerable amount of money. what happens with respect to the kind of cost-benefit evaluations that are undertaken by others, it is certainly very, very troubling that we have not just a case, but a string of cases and therefore, you know, they need to do more. >> in this area, which you suggest that there are to be specific prohibitions applicable to the providers in addition to the company for off label use in the area east of antipsychotics, for nursing home treatment?

>> i mean, and the contacts of anti-kickback statute and we have been cases in which we have actually pursued at the provider level. i do think everyone needs to take ownership of the problem throughout the health care system and it's not just a matter of the folks producing the drugs so perhaps in the area of nursing care, penalties for marketing should be also applicable to providers or their sent institutional responsibility for off label use. >> the institutional responsibility, one of the chief concerns reflected in this report is running 20%% of the time, even when the drugs are

used for medically accepted indications, they were being used for too long there is a lot of a lot of misapplication it's actually going on within the nursing home setting itself. >> thank you very much. thank you, mr. chairman. >> in testimony that you have both made, it's been noted the post of combat time referred to as chemical restraints had been in place for many years now. so then, why are there still such high rates of over utilization of medications that appear and medicaid used as a shortcut for improper care by well-trained staff. what's behind this?

>> chairman kohl come about so you need to further examine and that's why emphasize the follow-up are going to be doing and i certainly will refer to dr. conway should get his medical perspective on it. but we do not begin this kind of evaluation within a goal of what is the right number of dosages or prescriptions should be allocated to this particular part of either the drug world where these kinds of issues. we look at what cms requires in terms of wide as reimbursable and what isn't in that kind of gives us a roadmap. it obviously concerns considerable percentage of elderly nursing home residents with a great deal of money involved in sa topped the last

few minutes about the enormous investment of dollars from the pharmaceutical industry. there is a lot at stake here. given how much is at stake here, both in terms of patient safety and financial investment, i think all of us as public officials see to do our part to make sure there is a much better transparent and accountable understanding of how these powerful import and powerful drugs in the right setting need to be used >> in the year to come is going to be significant improvement. i'm very careful mansard or general should not predict what is happening and certainly tried to enhance recommendations that will provide positive outcomes of the future. and in terms of what people do in response to this report, we hope they will take action to fulfill that kind of a

prediction. >> what about you, dr. conway? were going to make some significant improvement in the next year? >> there's room for significant improvements. specifically, geisha multi-collaborative approach whether it's leading some of the other folks in the room here, i think we've had a very receptive audience. behavioral changes complex and were asking for behavioral change away from a medication based regimen in many cases during nonpharmacologic treatment regimen. as i outlined, if we aligned the levers of serving certification and education and training collaborative focused on this goal which we have drafts of actual plan working on it stakeholders we have potential for significant improvement.

>> better answer. >> thank you, mr. chairman. and if i could just ask the question, this didn't just happen overnight. you see the telltale signs for quite some time, the increased amount of reverse and probably are making for these types of drugs and how it's grown in rapid succession. does anyone alarm go off that something could be wrong >> also returned to that question. >> when i look at the years and increase of reimbursement, that means increased usage. are there other things that would be a total signed of abuses that basically haven't come up to the forefront that you all can see the changing reimbursement that should have told us something needed to be done much sooner than this. >> go ahead.

>> all-star. certainly this is an issue i've been on this roll first six months i can't speak to the history of specifically prior to that, but i think this is an issue there was awareness does. the awareness has a ground. at cms we have done some things already in terms of guidance, serving certification. we have much more to do, so i think on this sort of coverage and reimbursement issues they largely defer to my medicare endorsement and colleagues on the coverage of the issues. >> the kind of reporting we did does take time. we are looking in our report the first half of 2007 and asked medical experts to do the medical record review. and therefore we are looking at

information that is now exist team for several years old. we have been involved in the cases that resulted in significant summits of pharmaceutical industries on these kinds of drugs for the last two years. this has been a large issue for us on that litigation is part of the corporate integrity agreements these companies have had to sign with robust compliance requirement that we interred are in the practice of monitoring. >> do you all have any litigation going on with any companies you know as for you probably expected any type of fraud? >> by counseling office of investigations or device may not to talk in public about ongoing investigations and i try to hear to their guidance. >> that's a good policy to

accept. feel a thing that bothers me more than anything is that but if anyone's budget if we see a spike in reimbursements -- it on that something is wrong. it's a easy way out and the most profitable way for your sweet command rug. i don't know why someone's evaluating the medical staff. where does the five go up? to keep asking the same question, i know. but maybe we need to change your overview or oversight. >> i do think there is considerable promise in the initiative of accountable care organizations to get health care in the health care industry doing business with each other

any more integrated way that has existed in the past. that does have promise to an effexor is a very useful way of people being able to understand what kinds of therapies, whether it's from a logical or otherwise make the most sense to the patient. of health care providers are honest are professional. they are people who we cannot do shaker of us in our families. the great majority of the time they do so. out of the system entirely or at least it tastes so that it issues as serious as this on safety and financial rounds.

connecting that a good positive development that i no cms and other parts of hhs are now in the midst of unrolling and i'm hopeful that it will have benefits on the health care fraud and abuse as well. >> we thank you both for being here today. you've added a lot to the discussion of this important issue. thank you so much. we will now turn to our second panel. on the second panel, we will have four distinguished witnesses. first we'll be hearing from.or jonathon trent and, who is the incoming president and the american medical direct terrorist association. -- medical directors association. next, will be hearing from tom

hlavacek. mr. hlavacek serves as executive director of the alzheimer's association of southeastern wisconsin. our third witness will be trained for, senior policy at senior medicare advocacy and then we'll be hearing from that are cheryl phillips come up with a senior vice president at that because the the teenage. we thank you all for being here. dr. evidence, you may commence. adding a mac >> out of my testimony is quite personal, i also represent the professional society for long-term care physicians whose mission is to improve the quality of care for seniors. my personal story says. i am a doctor who specializes in the care of for others.

i practice in nursing homes and other long-term care settings or positions are frequently absent. they do use antipsychotic is to treat a small number of patients with long-standing schizophrenia or bipolar disorder. i do not prescribe antipsychotic drugs for treatment of agitation or other behaviors than patients with dementia. the entire leadership acknowledges the use of this medicines and paces only as a last resort and only when all else has been tried and failed, which is rare. i and other like-minded doctors face tremendous pressure in all care settings to prescribe medication to make these patients behave. most of the time commit this equates to chemically restraining the patient. this pressure comes from frustrated caregivers and family members have been that they other health care professionals to believe that these drugs are essential. an large number of patients i see where started on antipsychotic drugs in the hospital for reasons that are entirely unknown.

i routinely stop these and other unnecessary and appropriate drugs in patients admitted to medicare. nevertheless, my efforts to avoid or eliminate antipsychotic drugs often put me at odds with facility staff, patients and families and other health care professionals. the rate of off label antipsychotic drug use varies greatly between facilities and prescribers and based upon their culture and attitudes and not based upon medical diagnoses that very and symptoms. regulations regarding antipsychotic drugs, chemical restraints only apply to nursing homes, but the problem of overprescribing antipsychotic drugs exist in all care settings. the majority of off label antipsychotic drug prescribing occurs outside of nursing homes. there is a firm fixed belief among many health care professionals that undesirable behavior is cause for medication and medication will be very likely to work. that firm fixed belief is false. but it is based in part on an adequate training to understand

behavior and care for computes patients. most doctors treat unwelcome behavior in all settings of the disease that requires medication. these tracks are used as chemical restraints. the real concern should be for improved dementia care and all settings that focuses on understanding behavior and its meaning in order to meet the patient's needs. most of the time time using drugs to staff behavior isn't doing the right name. using drugs is a set of the right thing. using make people behave creates unrealistic expectations and distracts caregivers from solving the underlying problems resulting in these behaviors. behavior is not a disease. behavior is communication. people love us the ability to communicate with words, the other way to communicate is through behavior. good care demands we figure out what they tell us and help them. undesirable behaviors usually react to that occurs in response to a perceived threat or other misunderstandings in patients who buy the very definition

their disease have awesome ability to understand. these behaviors represent a conflict between a patient and their environment, i sped off and we have to change our behavior in order to prevent an undesirable, but entirely predictable response. said three police and a multidisciplinary approach and is working with others to change the culture of health care in the united states. a minimum requirement of patient centered care is informed dissent. patients and families must be afforded to die like to make appropriate treatment decisions regarding potentially harmful medications. likewise, we respect and strongly agree with existing regulations regarding avoidance of chemical restraints and unnecessary drugs. we develop core competencies for physicians and long-term care and raise the bar for caring hoping dedicated and individuals to leap over the fire. we are educated and empowering physician medical direct there

is an attending physician to long-term care and we believe these efforts will lead to the health care quality we all want without increasing costs. there's no substitute for good doctors anytime with patients and families the time they need to solve problems and really suffering. doctors more often present an engaging nursing facility carries fewer health care resources if you're antipsychotic drugs. training does work to reduce antipsychotic drugs and aim to provide training on dementia care and works to provide more. we acknowledge virtually every dollar of health care spending at some point occurred as a result of a doubt her. being a good position requires a good sturdy scarce resources and focusing on what works. with the money is spent on should be a reflection of what we value most as a society. but my colleagues and i value most is loving care. thank you, mr. chairman, members of the committee. >> thank you very much, or evans. ..

and 80 year-old gentleman with playstation dementia who exhibited challenging behavior's and a long-term care facility. after being at two hospitals in an effort to have his behavior is treated with anti psychotics he was placed under guard to see the tension and was transferred by police in a squad car in handcuffs so that walking canny be a health crisis unit. his family found in their tied in a wheelchair with the jacket or shoes. in spite of his family's efforts to intervene and seek better care of you very quickly develop

pneumonia, was transferred to a hospital, and died. richard peterson worked hard all his life, raised his family, and contributed to his community in many ways. he did not deserve to die in the way that he did. mr. peterson's death was not an isolated incident. it was the latest in a string of incidents in southeastern wisconsin that involved tragic outcome is related to all sorts behavior's and anti psychotic medications. in response to the drawing behalf -- the growing problem the alzheimer's association of sparrow and other stakeholders. the task force. our local task force eventually included 115 members from all perspectives on the issue and published and -- airports that provides a basic understanding of issues surrounding behavior's and approach to addressing the problem. in wisconsin we found a reliance on a typical anti psychotics that were sometimes very poorly

describe been administered. we found examples of untreated medical conditions such as urinary tract infections, tooth decay, and the three paint that led to agitated behavior's. of course, a typical rent as the cutbacks will do nothing to treat those underlying medical conditions. we also found negative outcomes from the relocation of individuals in and out of hospitals and long-term care facilities. our experience indicates that these transitions can exacerbate behavior's and often lead tech escalating drug treatments. the task force is one local example of how the also our's association as a case for quality care across the country. including the reduction of an improper use of antacid products recently the national alzheimer's association board of directors approved a position statement titled challenging behavior's which discusses the treatment is being rivera and psychotic symptoms of dementia otherwise known as the pst.

the association maintains the position that non pharmacological approaches should be tried as of first line alternative for the treatment of ptsd. i have included handcuffs and the board's statement with my written testimony. the alzheimer's association strongly believes one mechanism for reducing transitions and improving overall care for residents and long-term care is to raise the level of expertise of facilities after training and education. the alzheimer's association has developed to dementia care training programs specifically for staff, the class from foundations of dementia care, and the on-line care program. both of these training programs of been identified as options for nursing facilities to satisfy the requirement of the section 61 to one of the affordable care act which calls for dementia care training course certified nurse's aides working in nursing homes. the cares program has a new module, damage related behavior that focuses on non-farm a glut

of strategies for reducing or eliminating challenge behavior's . local also dissociation chapters across the country are excellent resources for these and other training programs to enhance care and support for persons with dementia and caregivers. the all sources association also developed the medicare practice recommendations for assisted living residences and nursing homes. these are the basis for our campaign quality residential care. the standards of care will improve quality of life for people with dementia. the alzheimer's association is committed to ensuring people with dementia have access to high-quality care and strongly believe that non-farm lot -- non-farm logical approach is to be tried as a first alternative for the treatment of the gators. senator kohl and mr. bentsen, thank you for the opportunity to address this issue. we look for to the opportunity to work with the committee in the future. >> that you very much.

>> thank you, senator. congressional attention to the misuse of mantissa connexes longstanding. in 1975 this committee issued a report. the misused cost of kickbacks. in 20 years ago the committee, there was a workshop of reducing the use of chemical restraints in nursing homes the identified many of the same issues we are discussing today. the misuse of drugs and the need for staff tessie residents behavior's is communication and the problems. the inspector general is very important in the report actually understating the extent of the problem because it focused only on a typical anti psychotics taught not conventional antacid conduct as well. nursing facilities self reported data indicate that in the third quarter of 201026 percent of

residents there received anti psychotic drugs in the previous seven days, approximately 350,000 individuals . facilities reported to cms that they get into a psychotic drugs to many residences he did not have a psychosis, including almost 40 percent of residents at high risk because the behavior shoes. i want to make several brief points. first, federal law prohibits the into a psychotic drug practices we see in many facilities. second, while antacid other drugs some is used. third, the high financial cost of these drugs and finally some solutions. the federal nursing-home reform law since 1990 is limiting the use of pharmacological drugs, implementing regulations and cms guidance to surveyors. very strong but emmitt -- inadequately in and effectively employed. second, while there are many reasons why these drugs are inappropriately prescribed the most significant causes serious

understaffing. most facilities don't have enough staff and enough staff with specialized a professional training to meet the residents' needs. in addition the enormous turnover and lack of consistent assignment means that staff don't have the residence there caring for. they're less able to recognize and understand residence nonpro communications. they could more inappropriate care intervention. a second key reason for misuse of these drugs is the aggressive of the marketing of into a psychotic drugs which would cost about today. to give one example in 2009 the level the company paid one-half billion dollars to settle so -- settle civil and criminal charges as a treatment for dementia. eli lilly has trained sales force is to promote the drug is a treatment for dementia, anxiety, as the problems.

a third concern is that many pharmacists who are critical to implementing the federal provisions have not been independent. another false claims act against johnson and johnson judge that facility was paying kickbacks to the largest nursing home pharmacy so that the pharmacist would recommend its drugs, including use by residents. the consultant pharmacists was part of the sales floor. there are other reasons as well. replace physical constraints and and the sec audit drugs are protected class under medicare party and they're generally not subject said legalization control mechanisms. i would like to discuss briefly the high cost of rent as a cover drugs. very expensive. the top-selling drugs in the united states generating annual revenues of $14 billion. the cost, of course, extends far beyond the cost of the drugs themselves. residents who were an appropriately given these drugs experienced a number of bad

outcomes that are expensive to try and correct. false, hip fractures, urinary incontinence, each with a high price tag can be the result of these misuses. millions and billions of dollars for these poor outcomes identified in the 20 year-old report by the senate labor and human resources subcommittee on aging. these issues this past april by consumer. for solutions will we recommend implementing with virtually all commentary on all sides of this issue agree that not pharmacological approaches should be tried first. to achieve that end we recommend a number of approaches. slow down the process of prescribing these drugs, teach better not drug alternatives and create and impose stronger sanctions for inappropriate use. finally, i want to describe what and eliminating anti psychotic drugs can mean for individual residents.

a researcher working in new york to try to translate the research literature into of kraft at nursing homes said me an e-mail about a small facility she has spoken with. she says the director of nursing heard her speak, and although she had been skeptical see involve the medical director and consultant pharmacists and there were left with only two residences using into a psychotic drugs, both with the diagnosis of schizophrenia. this is where she said. one man they found had severe back pain from a spinal injury from a car ride to years ago that was never addressed. his dementia prevented is communicating, and they had him in a deep-seated jerry chair which only exacerbated the pain. he had behavior issues and was on antipsychotic mets, could not communicate or free himself. now he is such that dining room and converses with his wife and participate in activities. they're taking away the into psychotics and replace them with pain medication. once or makes it all worth it. i would add that the stories could be replicated hundreds of

thousands of times in nursing homes across the country. drastically reducing the use of untested other drugs will improve the lives of residents hundreds of thousands of residents and save hundreds of millions of billions of dollars. after 35 years of steady reports and hearings it's time to eliminate the epidemic use of anti psychotic drugs. thank you, sir. [applause] >> thank you. >> thank you. thank you for addressing one of those critical issues and for involving all of us as witnesses because there is an important story to be told here, and we appreciated. as way of background my name is cheryl phillips, a trains geriatrician and i like my friends and colleagues has been several decades in clinical practice predominantly a long-term care setting. have the privilege of being the senior vice president formally known as the american association of homes and services for the aging. the 5700 members of leading aids

serve as many as 2 million people a day through their mission driven not for profit organization that offer a spectrum of services across the post acute and long-term care continual. together we advance policy, promote track to the practice, promote research commendable and empower people to live as fully as they can. not only do we embraced this issue as a critical and important platform, but we are going to talk a lot about how both are members are participating in how we are offering some solutions. we have heard a lot about the demographics and it is worth noting that seniors 80 years and older with a diagnosis of dementia 75% will spend time and long-term care settings. this is an important and relevant platform conversation. even by cms on report 575% of lost in a nursing home residents have some degree of dementia. as i say that it's important to note that this is neither just a nursing home issue number just a u.s. issue.

part of my testimony i include some materials that were shared from the united kingdom and energy look that the problem of both medication used and appropriate care of dementia the 11 recommendations that despite the large pool of water between our two countries have a lot of applications that we can take and do in our thinking today. i would start with the use, and we have mentioned it, but it's worth noting again, the use of anti psychotics is related to a much larger problem of how to best care for people with dementia. medications are most often used as a first line of option because quite frankly families, care givers, nurses, doctors across all settings of care are not aware and don't even know of alternatives. they do believe that they're doing the right thing for the person that the love of the person they're caring for.

i'll also add just a note of caution. if we merely target this as a one class of drugs in one setting we may have some unintended consequences. for instance, if we look at just one narrow scope of drugs will happen is that progress will then shift to other equally inappropriate drugs such as bins of diazepam, sedatives, hypnotic, and of little use of that decision madisons kamal of these which carry a risk of falls and decent and death. so the bigger than a drug problem, although the drug becomes the tip of the iceberg of what the underlying issue is. we have also addressed that it is not just a national problem, and if we focus just on the solutions in a nursing home i do caution that we don't create inappropriate barriers to access for people who desperately need appropriateness not care. i think there is a short-term solution that is not a short-term solution but a two fold strategy that ties into a longer sustained culture change.

first is the application of want -- non pharmacologic interventions. talk about behavior therapy, and second is when medications are used for close monitoring of appropriate and limited use. we have heard from cms that there are existing regulations. i won't go over them again. i will distill them because when i worked with my own patients and staff and nursing home we really narrowed it down to five simple questions. what is the specific indication? now what you want to use the drug, but for that person but is a valid indication? if there was inappropriate indication, is is still appropriate now? maybe the issue was a day ago, week ago. the transition happened, the agitation, the pain has been more appropriately addressed. if the person is on an antipsychotic, is it actually working? what you're trying to address, have you documented it? and i always use the standard, if the person is better able to function in their environment.

fourthly, has the family or caregivers been involved in the choice? are they aware of the indications, the risks, and potential benefits of having been engaged in that discussion, and if there's a history of appropriate non pharmacologic intervention unless this was a short-term emergency? so the answer to any of these questions is no are unknown then the mets should not be started discontinued. the long-term answer because we know that dealing with the massillon is not the solution, it's much like public debt physical restraints reduction that my colleague to be referred to. it comes from a sustained campaign where caregivers focus on real person centered care alternatives, including direct work force training, evidence based tools, dissemination of knowledge to nurses and physicians regarding true effectiveness of non pharmacologic intervention, and an interdisciplinary team true monitoring when medication's argued to ensure appropriate indication duration and response this will all take a collaborative partnership. it includes a cms, staff,

physicians across the health care continuant, not just the nursing home. pharmacist direct care work force and caregivers. we need accurate data to look a timely information to is be back the pri scribers. we need large-scale applied research to look at how these models can be disseminated lively. recently need enhanced surveyor training as was mentioned, and many investment and meaningful work force. we talk about some solutions. again, the not-for-profit difference. convened the workers already looking at exciting models. a couple that i will mention, elisa jennings in cleveland and minnesota that are taking that same philosophy of medication free treatment to dementia working through horrible behavior interventions and alternatives. lastly, i want to ignore is a leading aids is a container of a dancing excellence and represents a truly a multistate : coalition that is committed to improving quality care for life and for people in nursing homes.

so in summary, yes, we have a significant problem with an appropriate use. the solution is how we better take care of persons with dementia, which includes focusing on dignity, compassion, having across the board approach that embalms direct care givers, staff, the scribers, physicians, nurses, and families and they're loved ones as all part of the caregiver team. and we set the challenge that actually nursing homes should not be the problem, but we believe they can be the centers of excellence from proving dementia care and the learning laboratory for the rest of the health care setting. thank you very much. >> thank you very much, dr. phillips. dr. evans. >> sir. you argue that using it as a cottage for patients with dementia should only occur as a last resort. and only when all of those interventions have been tried and failed. all -- in your experience behavioral interventions failed. what is your estimate of how

commonly into psychotics would be used if health care professionals were trained and how to effectively and efficiently deploy the range of behaviors. >> well, as was mentioned earlier in so many words, if all you have is a hammer everything looks like a nail. that's the problem we're dealing with now. i don't use these drugs. these drugs study after study has shown are ineffective in treating behavior, and i believe that if appropriate steps were taken or even if they weren't taken the use of these medications could be reduced to pretty close to zero in a variety of settings. that being said, because only a small proportion of the use of these medications happens in nursing homes, it may not have

the huge impact in europe for. $8 billion is spent on the of the abuse of these drugs currently per year, and based on the zero ig report bust and a fourth of that is nursing homes. >> so, what is your answer? >> my answer is close to zero. >> zero. >> zero. in my personal practice zero, and other doctors would give you a different number, but there are so many other things that can be done. this really does not represent good dementia care. >> mr. peterson's tragic-seems to be a wake-up call for the need to find better ways to provide care for individuals with dementia. the also rest community and wisconsin promoting education and training programs throughout

our stay so that we can prevent others from suffering the same misfortune. how can we hear help promote these turning programs? >> several answers to your question. we have to national programs, the foundation of domestic air which is the sort of classroom approach for direct air staff and supervisors, and we have the on line care program which has a number of modules that are designed to train on a number of different facets of quality care . and the person at the leading edge was absolutely correct. this is a problem that's in the middle of a bigger set of problems, nested within a number of other problems around quality care. we certainly believe with staff training and education is critical. we think it should happen at all levels of the facility. certainly for the cna is as seen

in the affordable care act, but really oftentimes it is the janitor, someone else in the facility that picks up on behaviors' earlier and says something is wrong with that gentleman down in that hallway. we should check this out and not wait for the problem to take place further. on our chapter level we have a 16 hour dementia care specialist training which is highly in demand across wisconsin. in many of these cases we see through the application of these training programs and staff have a lack of call and have new tools beyond just the hammer and nail to address some of these difficult issues. a further problem just to complicate this a little bit is staff turnover in these facilities, which is very, very rampant. you can go back to the same facility that you trained in a year later and see a whole sea of fresh faces that or not there before because of staff turnover we don't really value these physicians and jobs to highly in

our society. we need to, perhaps to look at that is why we are providing a better standard of living for people working in those facilities. >> thank you very much. what type of staff training would you recommend that cms required to help curb the over utilization? and should similar training provided also in the assisted living facilities, hospitals as well as other health care settings? >> it would be extremely important. the model we have had with physical restraints when the reform law was first implemented in 1990. cms develop a training about how to remove physical restraints, and person turning attended. now cms does a lot of training with satellite broadcast. can do that, send out the word from a train of kinds of people all over the country in better care practices.

one of the organizations that i have a market with very closely on the into six other drug issues, california advocates for nursing home reform, are conducting a series of training is in the state. they had one a week or so ago with several hundred nursing-home residents, nursing home staff members, and they are having people who have done what dr. evans described and i provide here to people with dementia, providing care without chemical restraints, and having people who have done it teach others how to do it. it's very effective. it's definitely working physical restraints commander should work with chemical restraints as well >> that's good. thank you. dr. phillips, hostels and the nursing homes working together to reduce the rate of vat as a cut its use, and if they are not that the nation should commit to helping make this happen. >> the short answer is no, and that's unfortunate. there is a chasm between hospitals and nursing homes in a

variety of problems, and i think the appropriate care of dementia is but one of them. the opportunity certainly through some of the new models of integrated care provisions is an excellent starting point. it will take more than leading aids alone, and that is why we're working so closely with collaborators such as to advance and excellence because we recognize that as we provide that basis of both those learned -- learn from people who are doing it well and how to replicate, but also to inform the clinician's across the continual that there are valid and real alternatives. lastly, i want to put in an important issue that we talked about, staff turnover. one thing that advancing excellence has applied is when you have consistent staffing so that the same person as often as possible is taking care of that same resident. the behavior issue also tends to decline. so that is another area that we

have leading age working with advance and excellence are working on better understanding of the staff turnover but also staff consistency as probably a key quality measure, and that relates to falls, pressure ulcers commence and the behavior management and persons with dementia. >> you talked about informed consent. do you believe that the family members of emancipations understand and of little use of typical anti psychotic drugs can be quite harmful and if not what can we do to ensure that family members understand the risks of these drugs for their loved ones who cannot communicate their needs clearly and to what ought to have behavior problems? >> well, sir, the process of informed consent very seldom occurs in prescription and administration of these medications in any setting

wintery be here. part of the reason for that is that the use of these medications very often represents a great deal of frustration and caregiver stress, whether it's in the hospital or nursing home or elsewhere. there is a sort of fantasy really that if somehow there were just a magic pill that would make it go way that all would be well. and so often times these drugs are initiated in kind of crisis situations where it is considered by the people involved to be urgent and therefore often times family members are not notified. i think that in that particular situation what is going on, these medicines and others like them, other class of drugs that dr. phillips talked about are really being used as

tranquilizers'. and you know, there really are diseases that i know of that only occur on one shift or on saturdays only your, you know, between -- and they are given report at the hospital or something like that. the pattern under which these crises develop often are related to other things going on in the environment. and, frankly, i think of this problem we're talking about the same way that they give up -- it has been used everywhere based on what may be at one time seemed like a good idea, but now we know it's harmful and we have to get rid of it. it's a rather expensive proposition. but informed consent, at least

it includes patients and families in the discussion. i mean, it's one of the fundamental bases and certainly one of the most basic ethical principles about care in this country and autonomy. and so, you know, i really can't defend not getting patient's permission to be provided treatment, certainly we would not stand for that if it was a surgery, but the risks of we are talking about are of comparable magnitude. you know, having informed consent as part of the process in some ways allows for a little bit of a cooling off as well in that those conversations should happen in the light of day. but i'd the reality is what is

easy inconvenient. so sent to london during change requires changing what is easy and convenient. >> thank you. >> this, sir. >> your testimony notes that 40 percent of nursing home residents are considered to be at high risk of receiving a typical anti psychotic drug due to behavioral problems which, of course, is astonishingly high. is there evidence that behavior problems have somehow become worse over time? >> i don't know that we have any evidence the behavior problems have gotten worse. i think that residents have behavior issues and there is not staff there that knows the residence and knows how to deal with them. general recognition that nursing homes are understaffed, and so they are not dealing with the problems as well as they might. nursing homes may be to have residents who are more seriously ill. we do have a whole new

alternative assisted living. some people with lesser problems although they are beginning to look more and more like residents of the time. they take more drugs the nursing-home residents. it's hard to say, i think that there are issues that people have. they're not being dealt with. >> dr. phillips. >> the clinical history of dementia, usually the behavior is when they are problematic are basic. early on in the disease process, somewhere in the middle phase and not for everyone and usually by outside, what i mean outside to the person turn of events, either too much noise or fatigue or paint. something that creates an agitation. quite frequently, in fact most commonly in advance to mention it.

so even if one argued that occasionally the medications are appropriate for short-term use another piece to the problem, it's like barnacles. once people are on these medicines that don't come off. they tend to just a on and move from setting to setting with these medicines as part of the package. so when we think it's not just the behavior's get worse over time. in fact, there may be worth somewhere in the middle of the person clinical course with dementia, but not everyone with the mets as difficult behaviorist, and certainly the vast majority of difficult behavior's are triggered and therefore resolved by an outside environmental issues that can be much better addressed through intervention rather the bills. >> dr. phillips, other behavioral medications and anti psychotics for individuals with dementia who are paying? if so tell what are they?

>> to address specifically pain we have another issue and the nursing home that i no you're very familiar with and that is the appropriate treatment of pain for nursing home residents. it has been noted by several studies that even the use of medications like morphine when people are in pain, their confusion gets better if their confusion was due to and treat pain. what i am cautious about and have mentioned early in my and intended consequences is we don't substitute and as a college or other inappropriate drugs. having said that, sometimes the very best management for a person who is acutely agitated you cannot give up their story through words is to look and see if pain is the underlying problem entry with pain. in fact, some nursing homes have now routinely looked at low dose medicines like acetaminophen to use in persons with dementia who have risk for pain to see if that does not rather than waiting for the behavior is to escalate, if that doesn't

modulate some of the agitation and . i am certainly not reporting the we just give madison willy-nilly to everybody without being very careful about what is the appropriate occasion for a medicine, including pain medicine, but part of one piece to this problem is that we don't appropriately tree paint we see it resulted in increased agitation and what we label as difficult behavior's in persons with dementia. >> ms. edelman. >> may i say something? the researcher that i talked about at the end of my testimony in new york has done more, and i will try to get a copy of this has submitted for the record. she has let the residence to have dementia and whether they get as much pain medication as residents without dementia with the same physical diagnosis, the same medical problems. she has found that they don't get as much pain medication as a non dementia residents get. that is a very strong indication that a lot of the problem is people are in pain, and it's not being treated properly because it is not been identified.

now, cms is trying the new assessment process which is known in for about a year, over a year, has changed the way facilities assess residents' pain. in the past the staff wrote down whether they've of residents were in pain. now the staff is asking residents to fair and pain. the numbers should really be considerably higher than we have seen before. most people think that maybe 50 or 60%, 70 percent of residents have some pain problem. now if that gets identified and treated there might be -- this could really be a very important way of getting around all the into a psychotic drug use. the residents are in pain. is not being identified and treated. >> any comments you wish to make to the panel? >> once again, thank you so much from this hearing.

one of the things that was touched upon was the whole concept of care transitions, and i think that's a very important piece for the committee to consider going into the future. we have definitely seen a broad telecommunications between nozzles and nursing homes. people get transferred out of the facility into a hospital. the dead may close behind the individual. the hospital may have a difficult time getting the person place back in the community that's appropriate. and the hospital on the other hand may say we send them back to the facility and they show up back here again in a few days, and we can't have that happen because of the medicare readmission. so i think that looking at those care transitions in light of this particular issue would be very informative because of the fact that our experience, that is one place where the use of those medications can truly escalate. we have heard a nursing homes

say they come back from the hospital and there are more medication that we know what to do with. we of her hospital say when they come here there on 12 different medications. had as a nursing home allow that to happen? so it's a complex issue, but i think there's a lot of room for both hospitals and nursing homes , long-term care facilities and including assisted living to have a strong vested self-interest and fixing the problem. it does not work for anybody, and so i think that will be a great area for further development of policy and collaboration. >> thank you. anybody else like to add to this very informative discussion? if i could just add that we have a huge problem in this country with extraordinarily defensive care and significant concerns

about health care quality such that we are out getting our money's worth. doctors unfortunately as this hearing has described have a large share responsibility for many of the problems exist in health care, particularly with regard to prescribing medications. and i believe that doctors have a responsibility to be part of the solution. my colleagues and i are very committed to solving this problem. i also would just like to say that good care really should not depend in this country on where you go to get it. people should have reasonable expectation of good care anywhere and everywhere whether it's a hospital, nursing home, office. and so i've -- it's my hope that in my lifetime i will see the

standard of care being applied equally across all care settings and have shown to be successful and effective the one setting. >> thank you, dr. evans. >> think that we -- as important this training is and as important as it is for the facilities to be trained at the scars to retrain, it's also important that cms strengthen a little bit the very excellent regulations that already have and the guidelines. but but some attention on it. so if the survey made sure to add to the residence sample at the sec added tracks, focused attention on this issue. it will beery helpful and the enforcement could be strengthened. a couple of decisions from the a

minister of law judges where unnecessary drugs and anti psychotic drugs have been cited. the civil penalty was $300 a day. $3,900 penalty for over medicating residents seems like a very inadequate penalty. and finally i think there are couple of laws and regulations that can help strengthen what we have is a very excellent base of law and regulation. six and seven of the prescription drug cost reduction act you introduced last month would require a physician's certification that the of level prescription of an anti psychotic drug is for medically accepted indications. that would be very important and we would hope that would get enacted. cms recently proposed amending the consultant pharmacists regulations to make sure that their independent. that is very important. independent consultant pharmacists can make an enormous difference in call to the positions attention that there is a problem with the prescribing of the drug.

the positions are required to respond to the irregularities, not that they have to keep records, but there are responded are required to respond. finally in 1992 cms proposed very comprehensive regulations on chemical restraints which would strengthen their requirements on informed consent. those regulations have never been issued in final form, and we would encourage cms to do that as well. >> thank you all very much for being here. this is obviously a very important issue, and you did shine a lot of like as we move forward to improve. thank you so much. [inaudible conversations]

[inaudible conversations] [inaudible conversations]

>> this evening c-span road to the white house coverage continues with republican presidential candidate rick santorum. he finished second in the iowa caucuses by only eight votes. tonight he will hold a town hall meeting with supporters in brentwood, new hampshire. the in the 730 eastern on c-span. you can also watch on liner listen on c-span radio. new hampshire holds the nation's first presidential primary next tuesday. >> because i did not speak and that did not get really a window into my life. i had become a kind of an evil cartoon. and it did not help myself wearing a hat coming out of my case the court, but i have become kind of balance. wanted to show people and not an evil person. i don't have a tail or horns.

i grew up like everybody else. >> this weekend on c-span2 book tv, power and corruption on capitol hill, once the most influential lobbyists in washington, convicted of mail fraud and conspiracy and two dozen six. his story saturday night at 10:00 eastern. also, from news for all the people, one gonzales on the role of segregation in the way it is reported. last year of white house national drug control policy official urged congress to continue funding for drug and veteran treatment. they testified in front of the senate judiciary subcommittee for about 45 minutes.

>> the hearing will come to order. this morning's hearing will consider an important and growing component of our nation's criminal-justice system . there are over 2500 georgia courts in our country operating in every state and territory. many jurisdictions, including my home state of rhode island also are developing veterans treatment courts. today's hearing will closely examine these intervention and treatment courts and the role they can play as cost-effective solutions for protecting public safety and reducing recidivism. as many in the audience know a drug court is a specially defined calendar or docket that addresses the case of nonviolent drug offenders. these courts require participants to commit to intensive the substance abuse treatment programs, generally for your more. drug courts will participants

accountable through frequent court appearances and regular random drug testing for drug use . individuals going through drug courts are rewarded for doing well but sanctioned if they do not satisfy their obligations. they have worked in my home state of rhode island. as a rhode island attorney general and work to establish our state's first report. we now have ten. drug courts take many forms, but a consistent element in their success is the close cooperation of many players in the criminal-justice system including judges, prosecutors, law enforcement, defense attorneys, probation or corrections officers, and the community at large, including mentors, treatment organizations , and counseling services. this cooperation and support a bipartisan and even reaches as far as capitol hill. i was pleased, for example, to join with senators that cochran this morning and representatives chilly berkeley at an event in the warmer outside weather

today. special judicially supervised court dockets that provide direct services to a particular set of offenders. their response to the fact that many veterans who have sacrificed so much for our country return from combat suffering from posttraumatic stress disorder or other trauma that can adversely affect their behavior. the transports were to identify and address the underlying causes of this behavior by referring veterans to treatment programs or providing other alternatives to keep him out of jail or protecting public safety. whether a functioning within a drug court system were based on a drug core model these courts team with the v.a. health system volunteer mentors and veteran support organizations to assist veterans in resuming successful roles in our communities. there are not at least 50

veterans courts in operation around the country with dozens more being planned. last month i had a great pleasure and privilege of welcoming attorney-general eric holder and assistant attorney general or robinson to rhode island half-hour round-table discussion focused on the pilot program serving veterans in our state. i came away from that discussion deeply impressed by the hard work, of planning, and extensive community participation that has gone into the project. i'm glad that we will later be welcoming chief judge of funds to of ryland district court who was leading the veteran pilot program and will tell the said about our state's important work in this area. as my colleagues know the budget constraints confronting our federal, state, and local governments demand we marshal resources we devote our criminal justice system as effectively as possible. today's hearing will allow congress to consider the role of drug and veterans courts in such a smart and cost-effective criminal justice solutions. i think the witnesses for joining us today and i like ford to working with senators on both

sides of the aisle as we continue to support these cost-effective solutions that protect our communities. i am not delighted to welcome the distinguished junior senator from minnesota who is a honor remember this committee, subcommittee to make a few opening remarks in join the hearing. >> thank you, mr. chairman, for calling this very important hearing. you're right. i'm not actually a member of the committee. every member of the committee is invited to attend each subcommittee's hearing, and i wanted to be here because this is effectiveness of a drug course than the veterans courts. in such a great new development, and i am a strong supporter of these problem-solving courts, and i believe we should be doing everything we can to promote

these programs which are extremely fiscally responsible. as we have the debate over budget a think it's very important that we understand how cost-effective these courts are. first of want to take a moment to recognize and welcome judge robert rand corporation who is attending, not testify in this hearing today, but he is attending. he is french's sun go county minn., and i just learned that he is the incoming chairman of the board of directors of the national association of drug core professionals. i want to congratulate him, and i'm very pleased that he is here joining us for today's hearing. in 2007 minnesota adopted the statewide drug court standards with the goal of enhancing public safety plan, ensuring the participant accountability and reducing cost to society.

i'm pleased to say that the adult treatment court family dependency court, juvenile courts, dwp mccourts, and our first veterans court are all doing exactly that. helping to prevent future crimes committed participants in the treatment that they need, and saving money, saving money in the long run. judge john houseman who presides over the handling county adult drug courts misstatement of his program that i would like to submit for the record with your approval, mr. chairman. he writes the participants in his court are subject to intensive probation, press and urine testing and counseling. also required to appear in his court every other week to update him on their progress. judge close a letter that he received from the parents of a

graduate from his drug court who wrote, and ', thanks to you and the county court system we have our daughter back. she is conquering her addiction to alcohol and drugs. she has attended every court session and sees what happens if these perot. without a program like yours a lot of young adults would not give second chance and wood waste a lot of time in jail. i think this statement perfectly sums of how effective drug courts can be, no afford to hearing more from our witnesses about how we can continue to improve and expand the success of these groups programs. thank you again, mr. chairman. >> you're welcome, senator. delighted to welcome senator kohl to the hearing. all take this opportunity to introduce our first witness,

benjamin tucker. deputy director of the office of national drug control policy overseeing el in the cp high-intensity drug trafficking areas, a drug-free communities, and national youth anti-drug media campaign programs. previously served in numerous positions in federal and local government including deputy director for operations at the u.s. department of justice office of community oriented policing services and with the new york city police department. he received his bs in criminal justice from the john jay college of criminal justice and is j.d. from the ford university school of law, and we are delighted to have mr. tucker with us today. please proceed. here entire statement which appears redwood to considerably more than five mets will be made a part of the record so you can make a short statement orally. >> thank you very much. >> chairman, ranking member,

distinguished members of the subcommittee, thank you for this opportunity to testify here today on the importance. as a director for office of state, local, and tribal affairs it is my job to work closely with the state, local, and troubled communities in support of prevention and law enforcement initiatives to develop a policy and programs. i understand tow a board is to identify and support alternatives to incarceration. having walked the beach as a new york city police officer and working criminal-justice for the past 35 years, it is clear we cannot arrest our way out of the nation's trade problems. the obama administration recognizes that addiction is a disease and the prevention, treatment, recovery, innovative criminal-justice strategies and law enforcement are all essential elements of a comprehensive strategy to reduce drug use. just last week the administration released its 2011 national drug control strategy. articulates a balanced approach

to drug control while identifying and addressing issues of concern to specific populations confronting unique challenges relating to substance-abuse issues, including active military service members, veterans, and military families. college students, women and children and those involved in the criminal-justice system. i am here today to discuss one of the administration's one into policy objectives, stopping the revolving door of our arrest, incarceration, release, rearrest through effective interventions and alternatives to incarceration. according to a 2007 justice to part report reflecting on the success of drug courts we know that of the state prisoners who were dependent or abusing drugs, 53 percent had at least three prior sentences. these numbers have basically gone unchanged since 1997. drug courts have existed for more than 20 years, as you indicated earlier, and their effectiveness in reducing

recidivism and lower criminal justice costs as well documented . while over 20500 drug courts -- with over 20500 drug courts an operation today approximately 120,000 americans annually receive the help they need to break the cycle of addiction and crime. the drug court movement continues to grow. they help participants recover from addiction and prevent future criminal activity while also reducing the burden and cost of repeatedly processing drug involved offenders to the nation's courts, jails command presence. drug court participants receive intensive treatment and other services for a minimum of one year. there is subjected to frequent court appearances and random drug testing with sanctions and incentives to encourage compliance and completion. most importantly graduating participants gain the necessary tools to rebuild their lives and reenters society as productive law-abiding taxpaying citizens. drug courts rely upon the daily communication and cooperation of

judges, support personnel, probation, treatment providers, and other social-service providers from throughout the community. the successful collaboration promote the overarching goal of improving public health and public safety. in recent department of -- in a recent department of justice to the hard-core participants recorded 25% less criminal activity and had 60 percent fewer arrests than comparable offenders not enrolled and drug courts. in times of serious budget cuts the drug court model also offer state and local governments are cost-effective approach when developed and operated within longstanding proven standards. the success of drug courts as lead to the development of other specialty course like veteran treatment courts as was mentioned, family treatment courts, jim brown reports, and travel on us courts. veteran tree mccourts are a priority for this a ministration , and as americans we must keep in mind the enduring debt we owe our country's active duty military and veterans'. the serious challenges that they

face when returning home, particularly substance use and psychological problems often go entreated. sadly, these challenges can sometimes lead to criminal and other disruptive behavior. according to a recent justice department survey of prison inmates and the estimated 60 percent of the 140,000 veterans and federal and state prisons are struggling with the substance used disorder. approximately 25 percent reported being under the influence of drugs at the time of their offense. there are now over 75 operational veteran treatment courts nationwide showing significant promise in successfully promoting sobriety, recovery, and stability for our nation's veterans. consistent with drug courts veterans treatment corporate -- combined rigorous treatment of personal accountability with the goal of breaking the cycle of drug use in criminal behavior. however, in addition to the traditional partisan drug courts they incorporate the unique capabilities of federal and state veterans services.

in doing so they connect veterans court participants to the treatment and support services that they need, such as treatment, medical benefits, home loans and other services intended to help facilitate their reentry to the community. in conclusion i would like to take a moment to acknowledge and commander entered "professionals, judges, law enforcement officers, a treatment providers, and others who have dedicated their time and talent to helping others break the cycle of drug use and crime to become productive members of society. again, thank you, mr. chairman, for allowing me to testify here today. i look forward to working with you in this committee to address these challenges -- these challenging and important issues, and am happy to answer any questions you may have. >> thank you, mr. tucker. ciate that you have takene taken the trouble to attend. everybody is very busy, and, take your being here as a sign a very keen interest.