.. [applause] >> good evening. how do i get quiet and jane

harman, first president and ceo of the wealth of banner who happens to be a one man. [applause] and we are delighted to welcome honored gas democrats from congress and the diplomatic corps, secretary clinton and some very special gas, to carl stanley. it was very important to me because geraldine ferraro was a mentor to me to have don vaccaro and thomas occurred to me. [applause] so i'm about to tell you something henry kissinger wouldn't. where to begin with? trajectory of hillary clinton's career stunned and i am pleased to have known her and i worked with her throughout much of it. while this isn't a retirement dinner, here that hillary? or retirement dinner. tonight we honor you for the entire arch of your career from

sure of the legal services corporation during the carter administration, a white house were hillary and i served to first lady of arkansas and first lady of the united states to u.s. senator from new york and of course secretary of state. i was in beijing in 1995 and part of this small delegation on when and when first lady hillary clinton had erred the iconic rally cry for eval quality. you just heard it in our film. that same year, the formation of the council and the only organization for women who had countries and that has 47 members and just last year we located where else? to the wilson center. with strong support and her magic our magical ambassador at large for women's issues, who is

senior. [applause] we are building it to a platform to build mentor a regime leaders. i spoke personally to all six living secretaries of state to just start in that charming film, each as he saw applies the extraordinary accomplishments of secretary clinton, but also for humanity and her humor. a couple of personal finance. one, most of you know that my husband sidney died a few days after our last big washington gala. in early phone call came from hillary who had lots of time to chat and then came a personal dinner. two, in 2000 southend, one of the wilson center stars, holly

s. bundy ra who is here was imprisoned in iran for eight months, including 105 days in solitary confinement, and heroic efforts to achieve her release -- occurred and of course the bad senator clinton were involved and senator -- secretary clinton just recently recalled the event. few can match secretary -- secretary clinton screwing us schedule -- secretary clinton schedule, but in "time" magazine's current issue of the 100 most influential people in the world, something mac mclarty just mentioned and thank you for cochairing this gala. it pains me of course to give well-deserved credit to newsweek's rival, but i messed. [laughter] of course, i'm talking about the first imf nerd who happens to be

a woman, my friend christina let guard. [applause] christine rearranged her travel plans in order to offer tonight's introduction before they been on yet another foreign trip. not long after i joined the wilson center, christine honored us by making her first public remarks in washington as imf director and a morning speech at the center. in that speech, she credited woodrow wilson for sowing the seeds that underscore the need for bold collective action to achieve global economic stability. surely, woodrow wilson would be proud of her. before that speech, i invited a group of former female colleagues from congress to breakfast with her. i keep a picture of that meeting in my office. there she is, towering over the vertically challenged senator barbara mikulski and me.

[laughter] one senator present said something i haven't forgotten. sad thank you for doing this. we never talk to each other anymore. many former colleagues in this room will agree. our current exquisite congressional dysfunction highlights why the faith political space at the wilson center is so critical and why it is so critical to salute problem solvers like secretary clinton and director let guard from synchronized swimming to strategic networking, christine lagard if law firm, finance minister of france now head of the world financial institution and maybe a little later

president of france? [laughter] she is a bit player with big ideas, with courage at the women in the world summit in new york last month, she observed that we might have avoided financial melt down if lehman brothers had only been leman sisters. [laughter] you should applaud that. come on. [applause] at the first spring meeting of the imf last week, director lagard gave a mixed report on the economic climate. she said we are seeing a late recovery blowing in the spring wind. but we are also seen some very dark clouds on the horizon. those dark clouds of course

include massive protest worldwide disconnect between citizens and their government, great threats to stability and stubbornly high unemployment in many countries skyrocketing energy costs, things like that. well, if the problems facing the world economy are dark clouds, christine lagard said funding from imf members, including japan and korea, which i visited earlier this week is like an umbrella. well, thanks to her fund raising prowess,.umbrella just added $40,430,000,000,000. [applause] even fred malik can't do that. so what an honor to introduce this powerhouse and great

girlfriend come in the first woman in charge of the world economy, imf director, christine lagarde. [applause] >> thank you ever so much, jane. it's a lovely, lovely introduction. i know there's a few ambassadors here in the room. salsa excellencies. for inside it is my great, great privilege to an immense privilege to introduce to you tonight, secretary of state, hillary rodham clinton. not him, i have long been an admirer of yours from afar, but now we both leave that work in the same town, washington d.c. and we both have the same goal,

trying to make this world a bit of a better place. and we traveled the same journey. but although we've been traveling the same journey, we are a little bit alike. were both lawyers. we both served our respect if government. we both had deep ties into chicago. [laughter] which might explain our very, very soft and gentle personalities. [laughter] of course, she was the first lady, get into politics real quick. but, what ever happened, i've always found secretary clinton, hillary, always a little bit ahead of me come a few steps. and i give you a couple of examples. we were both young political

animals in 1973, 74. i was for bill colin and spending most of my time dealing with this post, his male friends french speaking constituents north of main come in peach -- don't impeach. for it, against. and all i was dealing with was french-speaking constituents in the darkroom at the rayburn building. there she was. hillary was in the nick of the action. she was on the case, on the impeachment inquiry staff and really driving the house judiciary committee to face them. we both served cabinet level in our governments. i was most recently at minister of finance for france and of course as the beautifully showed is still today saving as one of the most outstanding secretaries of state of the united states of

america. [applause] always ahead of me. secretary of state, madam clinton, you have shattered the glass ceiling like no one else with 18 million votes. [applause] and i was struggling very hard with the euro vote when i last saw hillary, she was being introduced by meryl streep, the women of the world summit in new york. and marielle actually handed her a nice guy or. i can surely say that nobody has ever given me a nice car. although, although inside job cuts at documentary films.

very, very teeny bit. now, i thought maybe i can out do not in secretary of state, so i worked really hard on my twitter account. i even turned it into a way vote by having thousands of chinese followers. [laughter] but you know, that tweaks from lagarde can possibly from hillary. and there is the photo, hillary, sitting in a military plane with dark glasses on counterfeiting her messages on black berry, surrounded by a very tense anxious men, very cool, very cool. my favorite textron hillary is the one way or rachel mondo asks

her, who runs the world? 140 characters response? forget it, one word, girls. love it. [applause] albright, let's be very serious for a second. hilary rodham clinton is not only a very intelligent, very witty, very charming and very beautiful woman, she's also a great public servant, great global leader, great inspiration to women all over the world, some of you might remember beijing 1995. i do. a great inspiration to people everywhere in the world. so of course, she is the i.t. of recipient for the woodrow wilson award for public service. we all know that president wilson said, quoting him carefully, there is no higher religion than humans surveys. to work for the common good is the greatest creed and hillary

has devoted her life to this common good. she has been incredibly progressive from an early age. when she was at wellesley, she was the first student to deliver a commencement address and she received seven minutes of the shame. excels at his school at a time when women made only about 15% of the class that lasts. she was called a star at yield by young fellow student called bill. hillary actually had to slow down a bit to be with bill, choosing to take an extra year to graduate. hillary always cared deeply about public policy. she was in the white house, she made her mark through the commitment on the issues that actually mattered most. education, health care,

children's welfare. she was. it takes a village. after having remarkably served new york and the country, at the summit, look at what visions, what inspiration, with incredible energy she brings to her job. her job? no, her mission. a secretary of state. she has made usaid worth it to her in, hoping people everywhere. she has cost many borders and built so many bridges. and pakistan, she shattered a few minutes by meeting with youth leaders and a broad section of pakistani society. and who can forget the iconic photo of her and hong kong's

suki. a few months ago, and a moving testament to the power of leaders, the power of women who have devoted their lives, energy, brainpower to public good, good of humanity? that ladies and gentlemen, makes history. now, let me conclude with one more point, one more quote. president wilson also said one court judgment is worth a thousand councils. the thing to do is supply light and not keep. how perfectly this sums up. i'm trained to recipient tonight at the woodrow wilson award, madam hillary rodham clinton. ♪

[applause] ♪ [applause] >> my goodness, while i'm incredibly touched and grateful and a little embarrassed by the

extraordinary outpouring of very kind words this evening. starting with fred malek who i greatly appreciate for reminding us that we are on the same team, namely the american team and my longtime friend, mack mclarty and his wonderful dawn. and grateful to all of you. i want to thank kristine for that introduction, but more than that, for her leadership at the imf, for extraordinary strength and vision in the uncertain economic times. and for her bear a steady hand as she is trying to help lead us through them. i also want to thank all the members of congress and the

diplomatic corps here tonight. it is very good seeing a lot of my former colleagues getting to sit with my friend, susan collins. and of course, i want to, along with all of you, salute our host, jane harman, when a fire country's most articulate thoughtful leaders on foreign-policy and national leaders and now is later to woodrow wilson she is still shaping public debate. [applause] and in addition to that, she is devising a lot of that's been helping to make sure that the scholarship we need for better informed decisions is being done. she provided advice and counsel on a great range of issues. and i love the fact that jane

was just referencing that under her leadership the wilson center has become the home of the council of world women leaders, the only organization of current and former women heads of state and ministers. they are working together with the state department to organize a summit in the united arab emirates on the arab world and jean joined me last summer to launch the women in public service project to identify, train and mentor emerging women leaders around the world, founded in partnership with the seven sisters colleges. jane and i are both proud graduates. she and i have wellesley and including many domestic partners and i think it is exciting that we are working on these kinds of

things together in addition to all of the difficult problems, both those in the headlines in the trend lines that we confront every single day. i have to say that film was hilarious. [laughter] i have to say that jane was stagemanaging every bit of it, but i cannot wait to see all of my predecessors to think them for participating. and you know, george shultz with his "don't worry, be happy" song actually gave me a little bear that i keep in my office that i keep one of these buttons when you press it it seems "don't worry, be happy." so i figure that's good enough for george shultz, it's good enough for me. so i was glad to see him sharing that with all of you tonight. the thing about henry kissinger is with that accent he can say anything they think it's really smart and witty.

[laughter] and so he and i have had some of the most amazing conversations, but i'm never quite sure i've understood everything that he said. [laughter] for me, the men and women use on the screen have become great friends, whether i need someone like a good of course but it do your madeleine albright or news them from afar or reputations at events like this, all of them have been extraordinarily helpful to me and i'm very grateful they would come together to be part of this evening. well, i know it has been, for me a reunion. i've had a chance to see so many of a lot of my friends and colleagues over the past evening. and i want to make just a few serious points because you have been very, very patient. they think it is both jane and

christine suggested in their remarks tonight, we are very fortunate to be in the positions we are in in today's world and were very pleased that in our own ways we can be trying to help chart our path through what is a very difficult dangerous tumultuous time as the film seem to suggest. that we are trying to look at economic policy and foreign policy in new ways because the problems really demand back. you know, when you think about it, a fluent canton can become an epidemic in chicago for a protest into niche i can reverberate through latin america to east asia. or when a housing bubble or some las vegas, you can unsteady markets in london and mumbai.

the world has changed. the amount and velocity of change is breathtaking. technology and globalization have made our countries and our communities and are dependent and interconnected. and citizens in nonactors like ngos, corporations or criminal cartels and terrorist networks increasingly are influencing international affairs for good and ill. so we face these complex challenges that are crosscutting that no one nation can hope or expect to solve known. so how we operate in this world must obviously change. when i became secretary of state, people were questioning, if america was still willing to shoulder leadership, it is not hard to remember why. two wars, and economy in

freefall, diplomacy, emphasize traditional alliances, the international system that the united states have helped to build and defend over many decades seem to be buckling under the weight of new threats. and so, what we've tried to do on the last three plus years is make sure we sure death and secured america's global leadership, knowing full well that it is going to take more than military solutions. we needed to be sure we were using every possible approach, breaking down a lot of the old bureaucratic silos engaging not just with governance, but with citizen, this new citizen empowerment and the bottom up, finding new partners in the private sector, harnessing market forces to really be part

of the solution to some of the strategic problems we face. leading by example and bringing people together on behalf of supporting universal rights and values. we really were having to breathe and how we did business, business and government as well as business in the private sector. now if the government, we are calling what we are trying to do smart power. at the bottom was an effort to integrate diplomacy development and defense. and i was so privileged to find allies, not just among my colleagues who are former secretaries of state, but in the pentagon. secretary of defense bob gates and leon panetta and shares of the joint chiefs have really

been advocates for development could help prevent conflicts then we build shattered societies that would in turn might not load on our military. and so together, we are making sure that our soldiers, diplomats and development experts are working more closely together, listening to each other, contributing to being part of a non-hands on deck: of government approach. but we're also trying to make sure we get our bureaucracies in washington trying to do the same. by next january, when we will have traveled i guess a million miles or more, i will look back on this. as one that has been a great privilege and honor to serve. but i will also know that we have a lot of work to do.

and when i came into his office, i knew we're going to have to confront a lot of difficult problems. i'll just quickly mention a few. one, iran's nuclear activities. how are we going to confront what was it clear threat. it's an international security are trying to undermine our diplomatic efforts. so what we did was to first decide, we had to give diplomacy a real chance and president obama extended an open hand to the iranian people. at our public diplomacy we used every channel from satellite tv and twitter too old-fashioned snail mail. we cemented our partnership with our european allies and reengage with institutions like the

international atomic energy agency. but convince the security council, including russia and china to enact the most onerous sanctions that ever had then and to keep up the pressure. and then we added to that through unilateral sanctions and the e.u. sanctions. we work directly with banks and insurance companies to make sure sanctions were implemented. iran's tankers now sit idle. it goes unsold, currency has collapsed. the window for engagement is still open and we are actively pursuing a diplomatic solution. but we know that we have to continue to demonstrate that we are making progress diplomatically. it is too soon to know how the story will end, but the fact we return to the negotiating table makes clear the choice for iran's leaders. we are also looking forward how

to operate multi-dimensional diplomacy at all times. building on holding a coalition to pressure and isolate iran is one example. but there are others as well. our willingness to engage, show good faith cannot willingness to listen shows humility. our willingness to hammer out the kinds of solutions that would be acceptable beyond the usual suspects who always sympathize is paying off. it is not just with china and russia, but other rising powers like india, turkey, south africa, indonesia and brazil, where intensive diplomacy is absolutely essential. a line in with these rising influential nations is not always easy and in syria we see

first-hand how it difficult it can be. but it can and has been working. iran is one example, but we are also trying to come together around other global challenges from working with the imf and others to manage the international economic crisis in securing loose. are also putting more attention into regional and global institutions that mobilize, and action and help to settle disputes peacefully that stands for upholding universal rights in standards and open and free transparency and having security that promote stability and trust because i don't believe. in fact, the rise of these

powers is in part as a result of american leadership of the stability and prosperity we brought two and fostered since the end of world war ii. this is not the 1812 between a rising germany set the stage for global conflict. it is 2012 and a strong america is working with new powers in an international system designed to prevent global conflict. we have to update that system. we have to continue to act ourselves how could we make it work better and we cannot do it alone. but he also turned to a second example. early last year when citizens took to the streets across the middle east and north africa demanding their dignity, human rights, those protests caught by and caught most people by

surprise. we saw the beginnings of responsiveness and accountability in egypt and even in yemen. but even in libya, gadhafi responded with for the first time together, asked for the international community support. so we did put together a broad coalition led by nato with the u.n. security council. the arab league not only called for action, but members of the arab league participated alongside nato. without america's high-level diplomacy cajoling, handholding and occasional arm-twisting, that coalition would never have come together or state together. and now we are working with new partners to support emerging democracy, but to help build credible institutions. i was just in brasilia with

dilma rousseff, with an effort by the united states to bring countries than to the fight against corruption, a push for openness and i was so proud that libya was represented at the conference and made a speech about the kind of future, democratic future they are seeking. we all know that this is a difficult transformation and we see countries like theory that are trying to hold back the tide of history with brutal, orwell and pat on innocent lives. but a situation is complicated as the arab springs demands a multifaceted response and so we have to marry all of these tools together. old-fashioned shoe leather diplomacy and the use of social

media, using every partner that is willing to work with us and bringing disparate stakeholders together. only the united states of america has the resolve, the reach and resources to do this on a truly global skill. and that doesn't mean we go it alone. and actually means the opposite. america cannot and should not shoulder every burden ourselves. as we saw in libya, our european and nato allies remain our partners the first resort, but new partners like the arab nations that flow the era todd and helped with the maritime interdiction really made a difference. so we have to work on how we keep building does not work and how we give capability and credibility to these coalitions

that, to promote regional stability and security in a lot of hotspots. do we pay particular attention to the asia-pacific and the multilateral organizations there to build a new architecture of institutions that will serve as a bulwark for continuing security and prosperity and to deal with disputes like the territorial disputes in the south china sea. because after all, the asia-pacific region, which stretches from the indian ocean all the abu agent assures that the america's is a key driver of global politics and economics. so we are engaging in a wholehearted way. we are working on new trade agreements, educational exchanges and updated military force posture. we are looking to bring the

leaders together from across the asia-pacific. and just recently, last september in san francisco we had a gathering for part of the preparation for the asia-pacific economic community meeting in hawaii and we talked about something which i have talked about for a long time, which is really getting traction now and that is improving women's access to capital and markets, building women's capacity and skills, supporting women leaders is important not just because christine and shane and i are women, but because they know the more women participate in economies, the more they will -- successful they will be. [applause] so we are working all the time on the full range of issues. you have been very patient tonight and very kind. my friends who have bought

cables to support the wilson center and come here and be here this evening. and i want to just give you a short overview of why we believe that this kind of full engagement on all levels in our diplomacy and development work is the only way for us to move forward together. so as i look now at the work that the wilson center is doing and will be doing, i am encouraged and grateful because there are no doubts in my mind that we need this public-private not-for-profit partnership. the government can't do it alone. business can't do it alone, civil society can't do it alone. we need to be sure that we are all on the same side and, in my view, all on the same team.

and i was thinking a lot about this because we are coming up on the anniversary of their trade that kill bin laden and there will be lots and lots of wall-to-wall coverage about it. and it was an incredible moment for me because of the extraordinary personal commitment that i felt. people ask me all the time, what was going through your mind on that date and really what was going through my mind were other people in new york that i served in represented and what they had gone through, how much they and our country deserve justice. and i thought about how important it was to make sure we did everything we could to protect ourselves from another attack and certainly thought about those brave navy seals who went down on the moonless pakistani may.

but i also thought about how important it is that we don't just focus on the threats. we don't just focus on the dangers. we have to keep reminding ourselves on the opportunity and necessity for american leadership. it is in our dna. it is who we are and have one in this room already knows it is a little bit like preaching to the choir. but we have to keep telling that story. i want to end up where fred began the evening. you know, i love politics because they think it is the way people resolve problems and issues between then and it's not just elect or a politics. if you've ever been in a church you know about politics. if you've ever been on faculty know about politics. electoral politics, which is the

lifeblood of our democracy is something that our country has been doing for longer now than anybody else in the history of the world and we have to set an example as to how it is done. it doesn't mean we have to always agree with each other because we will not. but it means we have to show what it means to work together, to compromise. when i go to burma, as i did at the end of last year and may go to their new shiny parliament buildings and may meet with people who are trying to figure out, do they really want to try this thing called democracy? and they ask me, can you come help us? know how to have a democracy? i realized that our ultimate strength as it always has been vast and our values, who we are, what they represent.

we can't ever lose that. so we will need the help and partnership with everyone here. we are grateful for the wilson center, which is the wonderful resource for a lot of the work that we do, but mostly we need citizenship to push and hold accountable our leadership regardless of party, regardless of whether it's in government or business, is to make sure that we never, ever lose what makes our country so special. when i get off that plane representing the united states, i am so proud and so honored and i want to be sure that whoever is the secretary of state next and next and next for 20, 30, 50, 100 years into the future will always be viewed as the same level of respect and appreciation for what this

country stands for. and i need to be sure that all of you share that mission as well. thank you very much. [applause]

>> where is the national public radio table? [cheers and applause] you guys are still here? [laughter] that's good. i couldn't remember where he landed on that.

>> now, house ways and means subcommittee on health talks about how to control health costs at a premium support model. former federal reserve vice chairman of white house budget or, à la rivlin and former u.s. senate committee chairman breaux. this is an hour and a half. [inaudible conversations] >> the subcommittee will come to order. we are meeting today to examine proposals to reform medicare through premium support and the

bipartisan support for set proposals. first, i think it should be made abundantly clear that despite what some on the other side might say, republicans support the medicare program. the program serves as a critical function in our society, ensuring that american seniors and people with disabilities have health care coverage. unfortunately, the program faces significant financial challenges and is slated to go bankrupt in 2024. we cannot keep tweaking here and tweaking their, hoping to kick the can down the road for a year or two. as the medicare trustees again stated in their annual report, congress must act sooner, rather than later to reform the program to ensure its viability.

the medicare program is in dire need of reform and improvement so that it meets the health care needs of its beneficiaries in the 21st century. the traditional medicare benefit was created in 1965 and it really hasn't been reformed sense, despite the fact that the delivery of health care in the private insurance markets have changed dramatically. the medicare fee-for-service benefit design with its array as confusing coinsurance undetectable levels and silo delivery system has not kept pace with the rest of health care. can you imagine buying your hospital insurance from one insurance company? your doctor's office insurance from another insurance company, prescription drug insurance from yet another country and

catastrophic spending protection from a fourth company. that is exactly what the majority of medicare beneficiaries to today. this outdated design creates confusion, waste and even fraud. medicare's and antiquated design also inhibits care coordination, incentivizes over use and has led to financial challenges throughout medicare's history. so what is to be done? simply hoping to make the medicare program solvent by cutting payments to providers is unrealistic. the chief medicare actuary has warned that the cut already enacted as part of the democrat held law which i've medicare

payments below medicaid levels, which could resolve and quote, severe problems with the access to care. close quote. further drastic provider cuts may make medicare appear solvent on paper, but it would do so at the expense seniors and people in disabilities instead, we should examine reforms that will protect and improve the medicare program, the premium support is one way to do that. the term premium support was coined by henry aaron, one of our witnesses here today and robert reischauer, both democrats has received bipartisan support, moving to a premium support model is

advanced by the national bipartisan commission on the future of medicare, which was cochaired by democrat senator breaux, another witness here today, writing in support of the proposal, senator breaux and former ways and means chairman bill thomas stated that they believe medicare quote can be more secure, only by focusing the government's powers on ensuring comprehensive coverage at an affordable price rather than continuing the inefficiency , and equity and inadequacies of the current medicare program, close quote. premium support is also a key component of the recommendation for the bipartisan policy center cochaired by senator pete domenici and former cbo director and clinton at demonstration omb

erred, alice rivlin, who is also testifying today. it is in this day and that the 2013 house budget includes the premium support proposal. we had drawn upon the ideas that are witnesses have proposed over the past two decades and put forward a plan to protect medicare for future generations. there certainly will be different opinions about how a premium support proposal supporter. that is a healthy discussion. however, simply hiding our heads in the sand is nine. house republicans have made it abundantly clear that we will not simply watch medicare become insolvent. by friends on the other side may not like our proposal to protect the medicare program, but

where's yours? relying on 14 billion in savings from so-called delivery of reforms and health care law is not going to save the program. they are already built into the medicare trustees estimate that predict medicare's demise in just over 10 years. they were sometime time before medicare faces dire shortfalls that would jeopardize access to care. however, we would be wise to heed the charge given to us by the medicare trustees then began to work together now to place the medicare program on financial ground. it is my hope that today's hearing would be the beginning of this effort. before i recognize ranking member stark for the purposes of

an opening statement, i ask unanimous consent that all members written statement be included in the record. without objection so what are. i now recognize ranking member stark for five minutes for the purpose of his opening statement. >> type like to thank chairman herger for holding this meeting. i think it is the first meeting that republicans have held in the ways and means committee to advance their plan to end the medicare as we know it. basically republicans want to take wayne medicare's guarantee benefits and replace it with a voucher and put the insurance companies back in charge. i don't like their plan. i appreciate their honesty and plant a flag to dismantle medicare high and proud. the suit they modify their plan by saying that traditional medicare would remain an option. that promise is that worth very

much. traditional medicare might be theoretically available, but would be out of reach of many because the voucher would not be guaranteed to cover costs. traditional medicare would have sicker patients and quickly enter into a death spiral. our republican colleagues don't like the sound of voucher to describe their planned, so they've made up a new term called freedom supporter. they also displayed in the sole owners of this planned, so they're holding this hearing today. they want to share the blame and try to overshadow the fact that every procedural democrat in the house of representatives voted against their budget, which includes the medicare voucher proposal. i can count on maybe one hand the democrats who support vouchers of similar proposals. dr. aaron has the dubious honor of coined the phrase premium

support, but he has written testimony today makes clear he's no proponent of the ryan plan. the only democrat i've heard say nice things about previous support is ron wyden and he quickly disavowed the ryan budget, saying he didn't write it and i can imagine this scenario where i'd go for it. i'm going to go on record again making clear the strong opposition that democrats have two good or postal by any name that would be devastating to medicare beneficiaries by raising their costs, negating the gains made from medicare that ensures that all our seniors have quality, affordable health care. instead, they would return us to a time when private health insurers would control whate'er seniors kicked and what price they're forced to pay. cbo has said it would lead to an increase in overall national health and name as seniors and

people with disabilities are moved into less efficient, more costly private plans. it simply takes us in the wrong direction. now, i have to agree with my chairman that there are reforms that we can and should continue to meet to medicare. i'm proud of the provisions were included in the health reform bill that are already moving forward. payment and delivery system reforms are reducing overpayment to private health insurers and their plans that cost taxpayers tens of billions of dollars each year. adding years of solvency to the trust fund through our recent legislation. we did this while preserving and even improving medicare benefit, proving that she don't have to kill the patient to save it. with that i look forward to

hearing from our witnesses today. thank you, mr. chairman. >> thank you. today we are joined by four witnesses, former secretary john breaux to join the commission on the future of medicare. alice rivlin, senior fellow at the brookings institution and cochaired at the bipartisan policy center's task force on debt reduction. joe aaron it william h. taylor scholar -- the williams h. taylor scholar at the american enterprise institute and henry aaron, senior fellow at the brookings institution. brookings institution. you each have five minutes to present your oral testimony. your entire written statement will be made a part of the record. senator breaux come you're not recognize for five minutes. >> thank you very much, mr. breaux for inviting me.

ranking member p. stark and i have been involved in this for many, many years. thank you for inviting me. jimmy turman tonight served a great capacity with the national bipartisan commission on medicare reform and many of you who have had the privilege of working with in different capacities thank all of you for inviting me to talk about one of the most important issues. and at the same time, one of the most divisive issues either party is going to have to face them that is what do we do at medicare reform? let me say have the privilege of serving in this body for 14 years in the house and 18 and the senate are other body as we likely have called them over here in the house. i think i fully understand difficulties as each member from each party has been addressing the very difficult issue of how we continue to provide quality health care for our nation's seniors. ..

>> the best of what government can do in that legislation is one he'll pay for the program which government can do through the taxation system. second, government can help set up the structure of the program with standards the government would put into place. and third, government can make sure that private sector and companies do not scam the system.

and can actually deliver the product. on the other hand, the private sector needs to be involved. the private sector can create competition among competing plans. government doesn't create competition, private sector can to that. secondly, private sector can bring innovation and new products to the market. and third, the private sector can deliver beneficiaries choices to allow them to select the best plan for themselves and their families. now, our current medicare program, as all of you know, was signed into law by president lyndon johnson back in 19645, and the model chosen to deliver those health benefits 47 years ago was the fee-for-service model. to control the cost, the government for examples the price from -- fixes the price from bedpans to brain surgery. the program has remained much the same as it has for 47 years.

a former colleague of mine in the united states senate was harris wallford, a great guy from pennsylvania. he was a truly committed liberal who served with great distinction in the kennedy administration as well as in the senate. he argued very strong isly that american citizens should have access to the same quality health care that his or her member of congress had. if it was good enough for members of congress, it should be good enough for all americans. now, what each of you have and your staffs and millions of other federal employees and myself included as a retired federal employee, is a health plan that does combine with the best of what the government can do with the best of what the private sector can do. enacted in 959, it required that the federal government write the regulations that set up the program and then pays up to 75% of the cost of the health benefits. the beneficiary pays the rest based on a formula set by law.

over 350 private health plans are offered, and 14 or so are fee for service, and the remainder are what i'll call premium support plans. premium support plans, the government approves a group of private plans that employees can choose from that are required by our government to deliver the services. and all of this is implemented by the office of personnel management. when i carried the national -- chaired the national bipartisan commission on the future of medicare back in 1988-1-9d1999, e offered several options. no one on that commission wanted to end the federal medicare. and a strong majority, 10 of the 17, supported a new delivery system where for most seniors the premiums they can afford would be set at about 88% of the standard plan. unfortunately, the statute

created at our commission did not require a majority to report, but a supermajority, so our commission's plan was never formally submitted to the president, nor to congress. however, what happened next was that then-republican leader bill frist and i developed complete statutory language -- not an outline, not just a britain, not just talking points, but complete statutory litigation -- which incorporated the fundamental principles the medicare commission proposal. the full recommendation of our bill was not to end medicare, but to, rather, restructure medicare using what even of you have today as a model. under our bill, beneficiaries would be subsidized by the federal government for participating in any competing private or government plan offered under medicare, including the existing fee for service program. the contribution amount by the federal government would be based -- and this is

important -- on the national average of the premiums for a standard benefit package. weighted by plan enrollment and adjusted for risk and for geography, not some arbitrary growth rate like gdp. that standard benefit package would be all services guaranteed under the existing medicare statute, part of the legislation. appropriation-frist set the overall contribution at 88% of the national average cost of that standard benefit package, and under our plan the amount of medicare's contribution would be guaranteed. also importantly under our plan for rural areas, many of you represent, where competition is less likely, beneficiaries would be protected for paying premiums that are higher than the current part b premium. and finally, we established the medicare board, and this board would oversee competition among private and government-sponsored fee-for-service plans and would be the equivalent of the office of personnel management which

today manages the fefhp program. it would exercise its authority by regulation and negotiate with the plans. overall, the commission estimated the proposal would reduce the medicare growth rate by 12%. one might ask the question, why tamper with medicare at all? why change a system that has worked well for 47 years? i used to drive a 1965 chevy, too, but i would hate to be driving it today 47 years later and keeping up with the maintenance of that car, and i think none of you would want to do the same thing. perhaps a better answer is a statement made by rick foss who is, of course, chief actuary for the medicare and medicaid services just this past week. mr. foster said in the 2012 trustees' report on medicare, quote: without unprecedented changes in health care delivery systems and payment member chips, the prices paid by

medicare for health services are very likely to fall increasingly short of the cost of providing these services, unquote. in addition to the important changes made in the affordable health care act, obamacare, made to those under 65 in the private insurance market through exchanges and other things, it also included promising reforms, moving away from traditional fee-for-service medicare but still under the fee-for-service program. things like value-based purchasing and bundled systems where cms will try to reimburse doctors and hospitals for the quality of the care they provide and not just the quantity. under the affordable care act, cms has already started testing new and innovative payment and delivery programs through the center for medicare and medicaid innovation. the goal of all these payment reforms and demonstration products is to improve patient outcomes while lowering the costs. in the event that we move to a

premium support model where there is more price competition, the whole system is going to be better off if these, if these promises fee-for-service -- >> senator, if you could summarize. >> i am summarizing. last paragraph. i used to say that all the time. [laughter] the great challenge, the great challenge i'm suggesting is, yes, both my democratic colleagues and my republican friends and former colleagues is how do the both political parties bridge the gap between the differing political philosophies and produce health care reform for america's seniors? 1965 a bipartisan congress said that fee-for-service was the best delivery system back then. let me suggest that in 2012 the best delivery system is, was still what is contained in the breaux-frist proposal. if i can be of any help to any of you, please, call on me, and

thank you for your attention. >> thank you, senator. ms. rivlin, you're recognized for five minutes. >> thank you, chairman herger and ranking member stark. i'm delighted to have the opportunity to testify on reforming medicare through a premium support model. medicare is a hugely successful program that has dramatically increased the availability of health care to seniors, increased the length and quality of life of older americans and greatly reduced their fear of being unable to afford care when they need it. we need to preserve medicare's guarantee of affordable health care for older and disabled people and make sure the program is sustainable as the number of beneficiaries explodes and upward pressure on health care costs continues. medicare reform is not just about medicare. medicare plays a crucial role in two of the most daunting challenges facing american

policymakers; the relentless increase in the proportion of total spending that americans collectively devote to health care, and the unsustainable projected increase in publicly-held federal debt. medicare reform represents an opportunity to turn this large, publicly-funded program into the leader in increasing efficiency of health care and private -- of health care delivery for all americans. i believe that a well-crafted, bipartisan bill that introduces a premium support model while preserving traditional medicare can help achieve these goals. i'll focus my remarks on the plan that former senator pete domenici and i devised at the bipartisan policy center, but it is very similar to the plan offered by chairman paul ryan and senator ron wyden.

our proposal would preserve traditional medicare as the default option for all seniors permanently. it would also offer seniors the opportunity to choose among comprehensive private health plans offered on a regulated exchange. these plans would be required to cover benefits with at least the same actuarial value as traditional medicare and would have to accept all applicants and would receive a risk-adjusted, annual payment based on the age and health status of their beneficiaries. the regional exchanges would collect and manage the prices and terms of competing plans within a designated region. and the, those plans would include a traditional fee-for-service medicare as well as qualified private plans. the government's contribution would be set by the second

lowest plan in the region, summit to their -- subject to their having sufficient capacity. with more accessible information about costs and patient outcomes, cost-conscious consumer choice will lead the providers to emphasize preventive measures, managed care coordination of people with multiple chronic diseases and adopt more cost effective approaches to the delivery of care. however, we don't know in advance what consumer-driven competition will do. so we have introduced as a fail-safe which we doubt will be necessary a cap on per-enrollee government premium contribution over time at the rate of growth per capita gdp plus 1%. there are lots of questions about how well this would work.

one is, can't medicare beneficiaries already choose among private plans under medicare advantage? they can, and a quarter of them do. but medicare advantage wasn't properly structured to give full competition among plans. and our plan, we think, would structure the competition so that it actually lowered the rate of growth of cost. and people question whether there is evidence that competition leads to lower cost and better quality. actually, despite its perverse features, medicare advantage provides considerable evidence that competition works. the impression that it is more expensive derives from the fact that medicare often pays plans more than the cost of fee-for-service.

but under our plan that would not be possible, and the competition -- we think -- would hold plans down. finally, would older and sicker seniors end up in traditional medicare and raise its cost? this fear is based on the assumption that risk adjustment can't work and rules against cherry picking will not be enforced. but, in fact, we believe that these rules can work, that they're working better in medicare advantage than they used to and will work still better under a new, a new system. we believe that health care policy is far too important to be driven by a single party's ideology. no matter how the 2012 election turns out, the president and congressional leadership should

strive to find common ground on how to cover the uninsured, how to reform medicare and medicaid while stabilizing the debt. we believe that our plan contributes to that end. thank you very much for having me, giving me the opportunity. >> thank you very much. mr. antos, you're recognized for five minutes. >> thank you, chairman herger and ranking member stark. medicare's a vitally-important program, but it is living on borrowed time. medicare's part a trust fund will be deplete inside 2024, as you said, and the program faces $27 trillion in unfunded liabilities in over the next 75 years. with the retirement of baby boomers, the program will consumer an ever-increase share of the federal budget unless policies are adopted to bend medicare's cost curve. rereform relies on market

competition among health plans to achieve high-quality coverage at low cost. that is potential if we are to protect the medicare program for future beneficiaries. i will address four points about the design of a premium support reform. first, should traditional medicare be offered as a competing plan option under premium support? i think that's the most reasonable course. perhaps as many as 57 million beneficiaries will be enrolled in traditional medicare ten years from now which is when most proposals would start competition under premium support. traditional medicare will not disappear when premium support begins, even if we do not allow any new enrollment. moreover, traditional medicare's likely to retain a stronghold in rural areas and other markets dominated by a few providers.

for that reason, we must find ways to reduce unnecessary spending in traditional medicare in the near term as well as after premium support is in place. premium support does not need to exclude traditional medicare. premium support lets consumers decide for themselves which plan provides the best value and gives them a clear financial stake in that decision. second, will premium support shift huge new costs to medicare beneficiaries? let's be clear, the affordable care act already shifts costs to beneficiaries. the law imposes unprecedented cuts to generate $850 billion in medicare savings over the next decade. according to the actuary, these payment reductions mean that 15% of hospitals and part a providers would lose money on medicare patients by 2019, that figure rises to 25% in 2030. large, across-the board cuts

threaten access to care, and that is a real cost to patients that is not reflected in higher premiums. this contrast, premium support changes the incentives that have driven up medicare spending. plans that hope to increase their profit margin need to seek more or efficient be ways to deliver necessary care, rather than adding another test or procedure. there is plenty of room to cut cost, and plans will lose their market share and see bottom lines shrink. if private plans fail to offer a good product at a good price, beneficiaries will move to traditional medicare which remains an option. this is an important safety valve that insures that seniors will be protected. third, what index should be used to limit the growth of medicare subsidy? an index that ties medicare spending growth to the economy, provides some budget discipline and helps with the cbo score. but let's not fool ourselves into thinking that the spending

target is what produces the reductions in the cost of care. efficiency and innovation in health care delivery determine whether medicare savings can be sustained in the long term. finally, what other reforms are needed? we, obviously, need a modernized medicare. we need to make the program fair, reduce unnecessary spending. that means we need better information, clear financial incentives and a reform subsidy structure that reinforces rather than undercuts efforts to slow spending. in my written statement, i list a number of reforms -- there are many that need to be done. certainly, reforming the confusing structure of traditional medicare's cost sharing to make it more clear to people what they're paying would be a good first step, and giving people good information about their health plans so that they can make good choices is absolutely vital. so in conclusion, there is broad agreement that we need to bend the medicare cost curve. the argument is only over how to do it.

premium support is not an academic theory, it has been effective in lowering cost and enhancing value in the federal employees' health benefits program for the past five decades and in calpers since the 1990s. a well-designed premium support program can take full advantage of market competition to drive up unnecessary spending and increase medicare's value to beneficiaries. it's about time we tried it, and i think we can find bipartisan agreement about moving forward. thank you. >> thank you, mr. antos. mr. aaron is recognized for five minutes. >> thank you, mr. herger and ranking member -- thank you, mr. herger and ranking member stark, also special greetings to congressman price with whom i've had the privilege of working in the past. um, you have my written statement, and it's, i understand, going to be entered into the record. i'd like to begin with what i think is the central issue that

divides those of us who are opposed to the premium support idea from those who are in favor of it. i think all of us recognize that there are reforms to the existing medicare program that could improve its operation. all of us would like to see cost competition play an enhanced role. all of us would like to see delivery system reforms that result in better quality and lower costs. and we hope they will work, but maybe they won't. if they don't, who bears the risk of costs rising faster than projections? under traditional medicare those risks are pooled broadly across the population and over time, across all americans. under premium support those risks are shouldered by medicare

beneficiaries who will be faced with higher out-of-pocket costs themselves. that is the choice, i believe, the fundamental choice that needs to be made in determining a position on this issue. now, some years ago bob and i, as you noted, coined this term premium support, and we did so with respect to a particular plan which was more than vouchers and, actually, incorporated one of the features that senator breaux mentioned just now, that the index to which bin fits are -- benefits are tied should be a health index, not an economic index. and i would note that none of the proposals now under discussion meets senator breaux's standard in that respect. in the 17 years since bob and i put this idea forward, i've changed my mind, and i would

like to just list a few of the reasons why i've changed my mind, and i think i would urge you to consider them as well. the whole environment of health care policy has been transformed. we wrote in the wake of the failure of the clinton health reform effort and at a time when projections of the insolvency of the medicare trust fund were becoming steadily worse and were very near term. both of those elements has changed. and in particular, the passage of the affordable care act means that we have put in place a key element of the premium support idea for the rest of the population, namely health insurance exchanges. we're finding those are difficult to implement. they're politically controversial. i think they will succeed, and those problems are solvable. the medicare population is vastly more difficult to deal

with than the population served under the affordable care act. we should prove that the medicare, that the health insurance exchanges work, get them up and running before we take seriously, in my view, calls to put the medicare population through a similar system. the regulatory climate has changed. it is far more hostile to the kinds of regulatory interventions -- pretty aggressive regulatory interventions -- that bob require shower and i thought were essential to the functioning of a premium support plan. the, we, at the time, said that no premium support plan should move forward until risk adjustment was good enough to discourage competition based on risk selection. at the time, like alice, we thought, oh, well, doable,

sometime it will happen. alas, it hasn't happened yet. a recent study has shown that the risk adjustmental glit m used under medicare advantage actually has increased the degree of risk selection that occurs through medicare advantage. we're not there yet. when we are, that would be the time to consider whether premium sport merits -- support merits consideration. and finally, the idea that competition is going to save money, as an economist, i really want to believe that. i got my degrees in that, and i was pledged to like markets. i really do. the evidence to date is not encouraging. the higher costs of medicare advantage are not attributable to the extra -- solely to the extra costs, extra payments that are made to them, nor is it attributable to selection of patients. after controlling for all of

those factors, medicare manage plans are more expensive than is traditional medicare. furthermore, even part d drug benefits which have come in below cost have come in cost -- below cost by less than other drug spending outside the medicare system that was below the projections made about the same time. so i want to believe that competition will work and save money. the evidence is not supportive at this time, and given the risks involved, it seems to me important to continue to spread the risks from rapid growth of health care spending across the general population rather than to impose them on a very vulnerable group of people, the elderly and people with disabilities. thank you. >> thank you, mr. aaron. senator breaux, i think it's important to get this out of the

way right at the beginning of this hearing. do you think premium support will, quote, end medicare as we know it, as some have claimed? >> i think the whole debate politically about ending medicare as we know it, i think we want to change medicare. we want to keep medicare. i think we want to improve the delivery system. i think everybody's committed to having the federal government provide add quality -- adequate, quality health care for our nation's seniors. we don't have to do it under a delivery system that was formed in 1965. just like my chevy, too, things have changed, things have improved. so our recommendation is keep medicare, of course. it's a great program. but change the way it's delivered to our nation's seniors so they get a better deal, a better product and a better price. >> so then you would say that premium support does have the potential to improve the medicare program and shore up

its long-term finances by harnessing private sector innovations? >> yeah. my answer would be, yes. but you don't have to take my word for it. look at the areas where we've implemented premium support. medicare part d is a classic system. the government helps pay for it, and they help set it up, but the private sector compete for the right to deliver the product. it's a -- let me suggest it's a program that is more popular today than the congress that wrote it. and i include myself in that group, because i was there. [laughter] the seniors love it. secondly, the second example is even better. every one of us up there and me have a premium support federal employees' health benefit plan. that is a classic premium support. people can choose from the continued fee-for-service if you want to stay there, but the federal government setses up a premium support. we have the office of personnel management guaranteeing that everybody that participates can deliver the product and negotiate for the price.

that combines the best of what government can do with the best of what the private sector can do. so don't take my word, look at the two times we were able to do this, and i would think you would agree it works very well. >> mr. antos, i think it's important for all of us to focus on what the medicare program is face today. -- facing today. the medicare trustees released their 2012 report just this week. when do you expect the medicare hospital insurance trust fund to go bankrupt? >> well, i, i rely on the trustees who are the secretaries of treasury, labor, hhs and public trustees, and they rely on mr. foster who is the chief actuary. if current law is actually implemented which means major cuts in payments to hospitals

and other part a providers, then their projection is that the part a trust fund will run short of funds by 2024. however, under other assumptions it would be much earlier than that and, in fact, under the so-called high cost assumption that the trustees also present, it's 2016. >> so by the -- even with the projections that we were to make these major cuts which most doubt very much we would make to hospitals, what was the bankruptcy -- you say 2024, what was the bankruptcy date in last year's trustees' report? >> 2024. so we've -- some people say that we've held our ground. another way to look at it is we're one year closer. >> in other words, we're one year closer, as you mentioned, to this looming, addressing this

looming problem. the trustees stated that congress and the executive branch, quote, must work close hi together with a sense -- closely together with a sense of urgency, closed quote. in other words, now is the time to address significant reform, the medicare program. do you agree with this assessment? >> yes, sir. it's absolutely vital. >> ms. rivlin, the plan you worked on with senator domenici is similar to the 2013ous-passed -- 2013 house-passed budget, it has private plans that compete against traditional fee-for-service medicare. can you, please, explain how this competition will control costs not only for the beneficiaries enrolled in the private plans, but also for traditional medicare? >> yes. on a structured exchange where

you can really see, where the consumer can really see what the choices are, the plans that participate would offer their wares, and they would have to agree to take everybody who wanted to join their plan and to give actuarially-equivalent benefits to fee-for-service medicare, and they would be competing directly with fee-for-service medicare. there are lots of new innovations in how you treat people, including people with chronic diseases. and there's evidence that plans can offer better services and bring down the cost of treating medicare beneficiaries.

and we believe that would happen ask that through the -- and that through the bidding process the cost of the plans would maybe not come down, but not increase as rapidly as they otherwise would. and that fact that the government contribution would be slowed would be a benefit to everybody including those in fee-for-service medicare. >> in other words, quality could be higher, service could be higher, but the costs could be more efficient -- >> yes. we think that would be true. fee-for-service medicare would compete and would probably get better over time because otherwise people would leave it. but there is, there's a lot of evidence that fee-for-service doesn't coordinate care very well. i'm a medicare beneficiary, i

watch this happening. [laughter] and the coordination among providers is terrible. if you're looking at comprehensive, capitated plans whose responsibility is to take care of everybody in that plan, you're likely to get better results. >> thank you very much. mr. stark is now recognized for five minutes. >> thank you, mr. chairman. um, the -- mr. aaron, would the medicare trust fund become insolvent sooner under the republican plan to repeal aca? >> [inaudible] the aca contain many provisions that extend the life of the medicare trust fund. it was a major improvement in the financial status.

there can be -- is grounds for legitimate debate about whether every element of the aca is going to be enforced down the road, but there are additional revenues and a host of payment reforms that are designed to lower cost with scoreable savings and others that while not scored by cbo contain virtually every idea for payment reform that analysts have come up with. >> i have have a letter from cms that indicates that without the aca the trust fund would expire eight years earlier. and i'd ask the chairman to make that letter part of the record. >> without objection. >> if, if we had vouchers or whatever you want to call premium support things, the

medicare would stop being a defined benefit plan and become a defined contribution plan, would it not? >> that was exactly what i meant when in my opening comment about who bears the risk if costs rise more than are anticipated. could i inject one comment which i -- >> please. >> -- think is important? the statement has been made a couple of times that medicare is the same as it was 47 years ago. that just isn't true. >> you're right, i remember >> it has evolved, it has pioneered with the perspective payment -- prospective payment, and as various people have noted, it does contain in one form or another, we may like it or not, the options for individuals to choose among a large number of competing private plans.

>> i, i've always suspected it was republicans, but, you know, these guys who march outside with the billboards over them saying the world's going to come to an end, they've now crossed that out and say the medicare's going to come to an end in 2024 or whatever, 12 years. i can remember when those signs said it was going to end in one year, and i can remember years when the trustees' report said we had 20 years. but the fact is that to change the existence, the life of medicare costs relatively so little to the population at large, i believe, that the figure to extend the solvency of medicare beyond the 75-year target that people have talked about would cost less than, say,

a 3% total increase in the premiums or lifting the cap or doing a host of those types of things so that it hardly seems -- unless you're so strenuously object to anything that sounds like a tax or a fee, which many of my colleagues do -- but if you're willing to ask the public who will benefit from this plan to pay a reasonable amount over their lifetime, i see no reason that it can't be extended forever without hurting job growth or putting the country in further into deficit. does that make sense to you? >> yes, it does, but i would modify it in one direction. i haven't a clue what's going to happen in the health care world in 50 or 75 years. what is science going to produce, what will be the impact

on longevity? in my view, trying to look 50 or even 75 years ahead with respect to health care -- >> right. >> -- pensions are different. with respect to health care, in my view, is a fool's game, and it was a bad day when the actuaries were required to look 75 years ahead in the case of health care. look 25 years ahead. that's quite a long time, and a lot of uncertainty within that. over that period you could close the part a trust fund gap with an increase in payroll taxes of .35% each on workers and employers or more cost sharing on some medicare beneficiaries or additional payment cuts through what would hope backed up by improvements in delivery which is one of the goals of the affordable care act. so i think the idea that

medicare is standing on the brink of a dangerous precipice for as far ahead as it is reasonable to look is simply incorrect. >> thank you. i, the 75-year target doesn't bother me much, but i'll come back and ask mr. herger. he'll find out what it's like. thank you, mr. chairman. >> well, i would agree to a degree. we have a tough time estimating what's going to happen next year, let alone five years 25 years, 75 years. but one thing we do know, 10,000 baby boomers are now going on medicare every day, and that is something we're aware of and be, again, we have to -- hopefully in a bipartisan way -- work together to solve this so it does remain stable for our children and our grandchildren. with that, mr. ryan's recognized. >> thanks, chairman.

you know, i hesitate to say this, but, dr. rivlin, i think i agreed with everything you said in your opening statement, and the reason i hesitate is every time i say something nice about a democrat, it gets them in trouble. [laughter] they get viciously attacked. so in light of mr. stark's opening statement and comments, i'm considering making really nice comments about you. [laughter] see if i can direct it over from alice you. [laughter] -- to you. so i'll be working on this. look, there seems to be this attempt to undermine premium support and how it came to be. let's remember it started as a democratic idea. we have the grandfather of the original idea here, the author in congress of its last iteration here, and so there is clearly room for the two parties to talk to each other about this issue. if we could just calm down a little bit, we might be able to save this program. recently, i worked with ron wyden. i probably got him in trouble

right there saying that. here's what ron wyden tells me. first of all, i think if we want real, lasting medicare reform, in my judgment, it does have to be bipartisan. so here's what a democrat, ron wyden, tells me. he says democrats can't support a proposal that does not have an iron-clad medicare guarantee. it must maintain traditional fee for service as a viable option. it needs to guarantee affordability for the medicare consumer and protect the low income. it must have aggressive risk adjustment to protect the marketplace. so this is what a democrat in good standing a member of the finance and budget committee in the senate tells me are sort of essential principles for premium support to move forward. that seems hardly irrational to me. that, to me, strikes me as these are ideas we should talk about with even other, and -- each other, and there's plenty of room for conversation with one another, and we ought to have that conversation. so, you know, i think we need to put this in perspective. this is a program that's going

bankrupt. we have the actuary come here all of the time, whether it's budget committee or ways and means committee, telling us providers are going to leave the system, they're going to stop seeing medicare beneficiary, the trust fund's going bankrupt. all those things are known to us now, and it's just so much smarter given the 10,000 retiring every single day to get ahead of this problem and prepare the program so that it can be a goon tee that's not only there for today's seniors, but for tomorrow's seniors. there's one thing, dr. rivlin, that you convinced me of from all of our conversations over the years on this that we modified our plan for this, and that is competitive bidding. it seems to me a far smarter way to set the rate system. give me a quickie knop sis of why competitive bidding is superior, what are the attributes to it and how you propose to set it up with, you know, the second lowest plan bid and the like. >> yes. i think competitive bidding among plans, including

fee-for-service medicare, in a regional exchange -- and by regional we mean a metropolitan area or a large rural area -- how this would work is the plans would offer their plan and bid on the opportunity to serve medicare beneficiaries with the same benefits, and the second lowest bid would determine the government contribution. if you chose the lowest-bid plan, you'd get the money back. if you wanted to go higher up the scale, you could. you could choose a more inefficient plan or one that offered additional benefits for higher cost. but most people would look at how can i get these benefits at

a cost that i can afford. and the government contribution at the second lowest bid would then mean if you're in fee-for-service medicare, you'd have the option if that plan was higher of moving to one that cost you less and getting the same benefits. there would be parts of the country where the fee-for-service plan might be the best plan. and you could, you could stay there, or other people in other plans could move there. but it seems like a good bet for offering seniors comprehensive services at the best possible price. >> could i add something just really quick to that, senator -- congressman ryan? i mean, that is the point that in some rural areas you may not have competition. >> right. >> so you have to take steps to protect rural areas where there

may not be any competition, and we did that by saying no beneficiary would have to pay more than the current part b premium for a standard plan. so you can take care of those areas to really create a competitive model. >> five minutes goes fast. thank you. >> thank you. mr. giewr lack is recognized for five minutes. >> thank you, mr. chairman. dr. rivlin, looking at your testimony and specifically quoting you to say, i believe, a well-crafted, bipartisan bill that introduced a premium support model while preserving traditional medicare can help achieve these goals, and you go on to say that the.comny chi-rivlin proposal is very similar to the proposal presented by paul ryan and senator ron wyden in december 2011. so as a result of that testimony, i would take it then you consider the ryan-wyden plan to be a premium support plan, is

that correct? >> yes, i do. >> okay. and since the ryan-wyden plan was incorporated into the house republican budget and passed a few months ago, therefore, that plan as passed by the house is a premium support plan. is that correct? >> yes. i wouldn't -- i think there are some differences between the plan put in the budget and -- a budget resolution is just a budget resolution. >> right. >> it isn't a draft of -- >> correct. >> -- of a medicare law. >> correct. >> so it's a bit elliptical, and i would stick with my statement that i support ryan-wyden. >> as i think of the word "voucher," i think of a situation where the government would provide a payment to a private citizen, either cash or some sort of check form of payment, and that citizen would take that and then purchase a product or a service with that money received from the government. is that a typical or rational

definition of what a voucher is? >> that's what a voucher means to me, and premium support as we define it is definitely not a voucher. >> okay. >> you don't get a check from the government. you get a choice among plans, and the plan gets a risk-adjusted payment; a payment that reflects your age and health condition. and you don't even know what that is as the individual bidder, the individual beneficiary. >> okay. >> that's between the government and the plan. >> okay. so the domenici-rivlin proposal was not a voucher program, correct? >> no, it was not a voucher. >> and the ryan and wyden proposal was not -- >> not as i understand those terms, no. >> okay. thank you so much. yield back. >> thank you. mr. thompson's recognized. >> thank you, mr. chairman. and thanks to all the witnesses for being here. i'm a little heartened, actually, to hear about -- there seems to be a lot of agreement. everybody agrees we need to fix

medicare, we need to make it work, and so that's the best news i've heard on this topic for a long time. i would submit, mr. chairman, that it might be helpful as we're looking at this if we had a plan in front of us. we've heard a lot of criticism about mr. ryan's plan, we've heard criticism about the ryan-wyden plan, we've heard of those who are proponents of that suggesting that maybe it's not what the critics say it is. it would be good if we had a plan we could actually see the details of that plan and be able to get down in the weeds and look at it. until that happens we're just going to maybe spin our wheels. but i do know a couple things for sure. i know that as i travel my seven-county district that includes both rural areas, senator breaux, as well as urban areas, i hear a lot from the people that i represent about

medicare and what they think about medicare. and i hear them tell stories juxtaposing the medicare they have today vis-a-vis what their parents or grandparents had, and it's clear -- and i hear it all the time -- they like what they have now with medicare. they like that. now, i hear criticism of medicare, i hear people say don't cut my benefits, and i also hear people say keep your government hands off my medicare which is one that i always kind of chuckle out of because, i guess, everyone hasn't gotten the memo yet that medicare is, in fact, a government program. but i've never heard anybody say, please, please, go to a voucher system, do away with my defined benefit program. so -- and i don't think i'm in the minority there. the kaiser family foundation did polling on this, i think it's

70% of the people agree with that. and i think we really need to keep in perspective the fact that providing health care to seniors and to people with disabilities isn't a huge moneymaker. it's not a huge moneymaker. and i think that it's important that we note -- and i'm glad mr. antos pointed out the fact that he puts great belief and credit in what the trustees say. i want to reiterate what mr. stark said, the trustees just said that the accountable care act lengthens the life of medicare by eight years. and they said that if we, if cbo has said that if we put in place my friend, paul ryan's, proposal they project the total health care spending would grow faster

under that proposal. and for the typical 65-year-old, there'd be an increased cost between 50 and 66%. and, mr. aaron, could you comment on the effects to society of health care spending growing that fast and what would it do to the not only health care, but to the greater economy? >> i don't think there's a lot of -- i don't think there's a lot of difference among the four witnesses on the fact that rising health care costs are a problem in this country. they squeeze public budgets, they squeeze private compensation. for that reason systemic health care reform is the key to moving ahead. i think there's a serious risk of trying to screw down on the costs of just one element, even a large and significant element such as medicare while not attending to the rest of the health care system. for that reason i think that the

key now, the most important thing to do now is to move ahead with systemic health care reform. the law of the land is the affordable care act. nobody, i think, regards that law as perfect in every way. we're going to learn new things as it is implemented, and we will probably change it down the road. but the first job is to make to the best of our ability, to make that system work. to the extent that we do that, we then should, in my view, be in an open-minded and willing to come back in future years and consider whether changes such as the ones that are being proposed here today should be enacted and implemented. but i think now is not the time to do that. >> thank you. my time's expired. yield back. >> i thank the gentleman, and

i'd just like to emphasize that as our witnesses have pointed out, the trust fund is going bankrupt in 2024. the trustees indicated it was going bankrupt in 2024 last year. that means we have one year less than we did a year ago. so this is something the sooner we begin on a bipartisan manner working on this and not using, hopefully, scare terms like "voucher," i don't know of anyone except for a few people on the other side that are using that term. the purpose of this hearing is to talk about premium support which is a bipartisan suggestion on how we might be able to fix the system and reserve it. -- preserve it.

is i'd just like to make that point. with that, mr. price, dr. price is recognized. >> thank you, mr. chairman, and i want to commend the chairman for holding this hearing and want to, also, recognize and commend the chairman of the budget committee, mr. ryan, for his work within our conference in educating people about the need for reform but, also, the positive nature of premium support. i also want to thank each of the panelists. you all have put, really, a life's work into many things, but not the least of which is positive suggestions and reforms for our health care system. as a physician, i can tell you that folks are hurting out there. not just, not just patients and not just doctors, there are real challenges in the current system that we have. by way of clarification and to make certain that folks understand that our proposal is a guaranteed proposal for

seniors, it's stated in all of, all of the communication that we have, it's also stated in the legislative language. it's a guarantee. and so seniors need to appreciate that what we're trying to do is save and strengthen and improve medicare in a positive way. there's been some talk about what's medicare going to look like in 25 years, in 75 years, what the finances are going to be. i want to just share with you what the current system looks like out there in the real world. status quo is clearly unacceptable. already new medicare patients, we talk about 10,000 folks reaching retirement age or getting on medicare every single day. if you're in a community and you are currently a non-medicare patient reaching medicare age tomorrow and you are currently being seen by a physician who does not see medicare patients, the challenge that you have in finding a doctor to see you as a medicare patient is huge.

the difficulty of new medicare patients to find a physician seeing new medicare patients is massive. the physicians out there are going crazy with this current system. doesn't make any sense at all, and it's more and more onerous, more and more difficult to be able to just care for patients. one out of every three physicians in this country limits the number of medicare patients that they see. one out of every eight physicians in this country sees no medicare patients at all. that's not a system that works. so we need to find a positive solution which is what we've been trying to put forward on our side of the aisle. ms. rivlin, i want to -- i was encouraged by the tenor of your testimony and commend you for the work that you've done in the area of premium support. you mentioned that your proposal

differs some from the ryan-wyden proposal, and when i got to that area of your testimony -- which wasn't in your spoken testimony, but was in your written testimony -- one of the areas that you differ with the ryan-wyden proposal is that you believe we can move to a premium support system for seniors sooner than is in our proposal. is that correct? >> that is correct. >> and would you expand on that? tell me why you -- our concern was that if we didn't what we called grandfather the grandfathers, that we would not only take political heat, but the challenge of moving in that direction that quickly would be too great. please, help me understand why you think we can move there sooner. >> because we preserve traditional fee-for-service medicare as the default option. i mean, it does grandfather anybody who's in it, and it's a permanent option. if you reach that age, you're in

it unless you opt into, into something else. and we believe that the changes that would take place in the competitive building are substantial challenges, but they could be met by, say, 2018. we'll have some experience in setting up exchanges under the affordable care act by then. and there's no reason not to start sooner. and let everybody have a choice. you can view this as a, an improvement on medicare advantage that makes the competitive building, introduces competitive bidding and makes medicare advantage more accessible and better, and if you do it that way, it's not such a big deal. ..

that doesn't help anybody and you'll be credited for speenine and trade change. thank you very much. >> assayed attributes onto the category. if i said nice things about you we may all be in trouble. >> is your kind is recognized for its >> thank you, mr. chairman. i want to thank the witnesses for testimony.

it's always a delight to hear you and your comments peerages for the record i still have a 60s chevy malibu convertible that i love to drive around. as one of those cards get under the hood and the road to not do you want to be a ways to do it. if you has to see her in daycare they feel comfortable and they think it is essential to the quality of their life and they want to see improvements made, but they also don't want to see it decimated. i'm one of the dwindling breed to be in congress these days at a moderate centrist member of congress trying to find different pathways forward. hopefully in a bipartisan fashion to address the challenges of our time and i can't think of a bigger challenge than the dysfunctional health care system and the impact it's having not only in people's lives, but also on the budget. and the national find tenses. there's agreement on the panel today that a lot of the tools we put into place in the affordable care act the time to move forward. delivery system reform.

we are better integrated, coordinated care leading to better outcomes, patent reform that's value-based, not volume-based antibodies hearing the discussion we have that is premature. the affordable at correcting chance to move forward to see if stuff works before you can have a serious conversation about a vulture or premium support plan and who ultimately is going to bear that risk? for those interested in three things that comes to to health care reform. at her quality of care for better bang for the buck, making sure all americans have access to that type of care in this country. and how we get there is something we have to continue to talk about. one of my concerns with republican budget proposal and their vulture of premium proposal is the risk and who's going to bear it. but a bit of a parochial concern i have from the state of wisconsin is we have traditionally come historically

been one of the lowest medicare reimbursement states and the entire nation. we share that with the pacific northwest and in other regions and under their proposal, apparently the rates look at lot din at the lower of either the current fee-for-service reimbursement rate for the second lowest plant in that region. which would guarantee in wisconsin that providers are locked in at the lowest medicare reimbursement rate, which they are struggling to live under today, which tells me that they're going to have to continue to cosh at the inadequacy of medicare reimbursement onto the backs of businesses large and small. under the backs of private health care plans. in a second so i can make my point. this will not only continue the the death spiral or health care providers are experiencing the city was calm and put the deathspiral businesses in wisconsin are facing with rising health care costs because of the cost shifting currently impacting them come and make it harder for them to compete not only at home but globally. it does not make sense that we go down this road.

not until if we find out whether the delivery system reform and payment reform have a chance of work in. i have tried in my way to work in a bipartisan fashion on this committee. and mr. aaron pointed out these exchanges have a chance to move forward and show whether they are viable or not. i've been authors which is the basis of the health insurance exchanges and every year i introduced the proposed 100 equal number of republicans and democrats on that bill. we put in the affordable care to my republican colleagues ran for the hills near those one of the authors of mr. blumenauer on reimbursing providers for advances on direct electives and every year we introduced the bill in five or six members who were on that legislation. that was put in the affordable care to not turn into depth panels on our republican colleagues ran for the hills. so having a bipartisan conversation is difficult to have when you've got principles are issues that we have

previously predawn suddenly divide us today. i agree with mr. thompson had to have a serious conversation with me to play in. we need words on paper we can actually see because we don't know a prone on this would agree that devil is in the details. structure. and we don't have that. i talked to ron wyden, too. sometimes i feel like i'm talking to two different people who embrace the same type of plan. what paul understands what the plan would mean and what ron wyden understand the sometimes talking past each other. so unless or until you put something on paper that we can truly analyze the impact of what this is going to be installed this is theoretical. >> i will send to you and mr. thompson the plan that senator wyden and i co-authored with her adventures and i'll send it to your office. >> i think i hear from you and jon i think you testified that

it's important delivery system and payment reforms as part of the affordable care trait not a chance to continue to move forward and if for some reason supreme court or this body decides to overturn everything, i think that it's going to lead to an absolute state of chaos in the health care system that may take a generation to recover from if we go back to square one again. thank you, mr. chairman. >> mr. pascarella's recognized. >> thank you, mr. chairman. thank you, pls. i have heard and i said many times health care reform entitlement reform. folks on the other side don't want to hear that. we have had to entitlement reform and health care bill. i think that is utter nonsense. one third of the health care bill is devoted to medicare and medicaid. it is very specific about the recommendations and those are recommendations that we should be considering if we weren't trying to suffocate this legislation before it breeds fully in the next two years.

not only did -- we're going to reduce costs for medicare, but also health care act reduce costs for beneficiaries. unless you don't agree with the cbo numbers. the majority's attempt to repeal reform and turn medicare into let's not use a voucher program, let's not use that word, i call it the war out of your own pocket folks program. i think that will hurt beneficiaries. and there is no doubt about it. this is going to mean more money out of pocket. no one has denied that. no one. so according to the cbo, the republican budget will automatically cut spending in medicare for new beneficiaries by more than $2200 per person per year. that is what the cbo says and we

conveniently used the cbo when they support our position and then we tell them that they don't know what they're talking about when it doesn't support our issue -- our position. starting in 2030, by $8000 by 2050, you want to talk about the future, let's talk about the future. we don't have to scrap the current system. in fact, as we are sitting here today talking about strengthening medicare, the health care reform bill is already hard at work actually testing new payment and delivery system that will lead innovation not only for medicare, but for the entire health care system. what talk about the health care system. you are talking about competition. let's increase competition in terms of medicare. we cannot competition in in the health care system. many states have only two or three companies who bring health

insurance. why don't we do something about? if i want to foster competition, let's foster competition. we don't really mean it. this is empty. these are words we use back and forth. this is one upmanship. that is all we are after. the basics of health care will be changed by the health care act for the better of american. it will not be a socialistic system, think that we graduated from that, since more insurance companies will be involved in order for us to gain favor with the people that we're dealing what. this is -- you know, we're heading back to 1964. i am convinced that the direction we want to go in. but senior poverty was that the greatest since the great depression, that is where we want to go. why don't we just say that quiet

reason a lot of pretty words. you may shake your head, but i'm telling you, we are marking time and place, where many seniors have been stopped at the door because they are under medicare. that is what we should be addressing. that is what we should be seen. enough of this. the health care system is not working. the health care system has been totally taken over by the health insurance companies of this country. you know and i know it. we don't have competition. new jersey went through for companies that write health insurance? this is competition? what is this competition? maybe next year will have three companies. maybe companies he will takeover company d. how many states we have only three or four or less companies writing health insurance if you want to put our seniors into that situation? that is not competition. that's a joke.

you know it and i know it. by the way, mr. aaron, i want to congratulate you on the work you've done. i know since i've been here for 16 years you've been at the forefront of talking about these issues. these are critical issues for all of us. i know that it's not very popular to try to hold down out-of-pocket expenses. that is not a popular position, mr. aaron. but i don't care whether it is or isn't. you've done the right thing. i admire what you're doing. we've got enough to work with within the legislation to change medicare. but let's not throw away everything because we want to get to a few who will profit only. thank you, mr. chairman. >> dr. pisani is recognized. >> thank you, mr. chairman. thank you for holding this hearing. this is a nice reprieve where we

talk about policy and i want to thank all of the panelists here today for the serious work you have done over many, many years to advance the debate concerning health care. senator breaux, let me thank you for your many years of service to the state of louisiana and our country and your continued willingness to do this and to serve in a public capacity to advance the debate in health care. mr. aaron, you raise the point about competition and the fact that it has not lowered cost. i would submit that we are really stuck right now between a price control system and vastly imperfect competition. we don't really have the kind of competition necessary both in the health care financing arena as well as in the delivery system aspect of this. i think if we could get the more perfect competition there, we

would see the advantages of lowering costs and enhancing quality. and that is coming from someone who has had many years practicing in the health healthe system of the position. i have some really deep concerns about the tilt towards price controls ms, which i think is pretty indisputable that is what we operate under right now. the problem is we already have a serious shortage of position and nurses in this country. and if we continue on this path where we had seen -- we are facing the cuts and sequestration, we've seen cuts europe to year two providers, what does this really mean for access? because coverage is not people are weak way to access to good high-quality care. i know senator breaux come even before i got two congressmen may be fed concerns about trends in the medicare program whereby, for instance has a heart surgeon

and see a patient in the emergency room into a emergency coronary bypass and in the aftermath of all that we can find a primary care physician to take care of the patients basic health care needs. i'd have to get on the phone and start taking, begging positions in my community that i knew well and worked with to take on a new patient. coalition was the cause. the cost of care and the cost of these physician practices is not being met by reimbursement. so if we can get to assist them that brings us back to real competition, i think it makes a difference. i want to compliment chairman ryan. i know he what outcome that he's taken a lot of the work that dr. rivlin and senator breaux and mr. aaron and put it into a body of work along with senator wyden to try and get us to that. i don't know of any other alternatives. so what anyone? is there another alternative other than the premium support

model? >> i think the key to solving the problems you have described and quite eloquently i believe regarding the fragmentation of care comes in some of the innovations in the affordable care act. in particular that i would focus on, when is the the creation of accountable care organizations, which are groups of providers who would be paid to assure the health of people and roll with this natchez health maintenance organizations do in the second would be bundled payments so that in the event of a coronary artery bypass, graft, surgery case, a pain that would be made not just for the active surgery, but for the follow-up as well so that you together with the primary care physician and perhaps under start tichenor who would regularly contact the patient to make sure that he or she was taking recommended

medication would all work together. >> what are the fundamental problems not addressed in the accountable care act -- affordable care act is in the context of accountable care organizations as we saw several barriers in place that prohibit physicians to integrate care with hospitals. that has not been addressed adequately. we need statutory relief in that area for going to see those kinds of innovations. >> i agree with you completely. how the law may need to be amended. >> alternatives, i think senator kline pointed that out. the client packed about the demonstration programs in the accountable care act. i remember when i was in congress and wanted to stop sending would have been nice to offer an amendment to do a study and do a demonstration program hoping it never got completed. and i think that things in the

accountable care act, the demonstration programs are very important. but she can be for both going to agreement support system and demonstration projects in the accountable care act. if the demonstration programs work, it will improve the fee for service delivery system. if you have premium support, they will be better competitors and that is so we try and bring about. i think the demonstration programs are helpful, important, but not an either/or situation. but who premium support system and support the demonstration projects and hope that they work very well. >> dr. rivlin, do you want to comment? >> yes, i fully support by senator breaux just that. it's a mistake to think of these as alternatives. at least our plan envisions that the affordable care act continues, that the demonstrations in the various institutions that were set up to improve the delivery system go-ahead and we hope that works.

we are only saying there ought to be another way to get these innovations into use then that would be competition. >> thank you. mr. antos. >> papers that appeared to be a mistake to think these will materialize overnight. as someone said, the devil is in the details and the accountable care organizations are devilish. >> thank you. i yield back, mr. chairman. >> i want to thank our witness is for your testimony today. this has been an extremely interesting discussion, one a highly running for congress to act soon in order to place medicare on sound financial footing. premium support proposals like those we heard about today hold promise to improve how care is

delivered, better protect beneficiaries against medicare's cost-sharing requirement and utilize competition to control costs for the program as a whole. as a reminder, any member wishing to submit a question for the record will have 14 days to do so. if any questions or submit it, i asked witnesses to respond in a timely manner. with that, subcommittees adjourned. from mark [inaudible conversations]

>> next, journalist talk about what it's like to cover the white house >> if the affluent can routinely and systematically buy their way out of public service is and publicly provided goods, don't they lose the state in the public sphere and the quality of those goods?

>> lee fights in the overline campaign, but what happens at the end of all these things? you still lose. what happens? your pushback and then what happens? what kind of operation occurs that place while the federal advantages? >> next come you cannot white house reporters give information for their stories and whether

the obama administration has kept his promise and granting more access and transparency. you are from correspondence abc news, associated press, "usa today" and "the wall street journal." white house press secretary jay carney talks about his life is a reporter before becoming a spokesman for the obama administration. this is the white house correspondents annual student scholarship luncheon in washington d.c. it's just under an hour. >> thank you all for coming. we have a really interesting mix of people. we have scholarship winners and a lot of editors and journalists that we have worked alongside and were privileged to have jay carney giving remarks at the beginning of this. this event actually is one of my favorite events of the white house correspondents association weekend. one of the reasons is the scholarship winners usually have a lot of interesting things to say about journalism and how

they use media and how they read news and we just had a really interesting fashion a little while ago where they talked about twitter and how they get their news and that is incredibly interesting to all of us who are always trying to stay on top of our game to keep up with changing elegy. another reason that i enjoyed this event is bad it is a time to talk about journalism. i think sometimes people get caught up in the red carpet and the movie stars of all the glamour associated with, but at the core of it really is journalism and what we do. and we are especially privilege today because we have a panel of journalists who are really the best of the best. i can't wait to hear what they have to say about what they do. and moderating this panel will be julie mason. julie and i have worked together since way back when in the first administration.

julie, as we were talking with the students about multimedia and how we are all having to be multimedia now. and julie s. someone who covering the white house for the "houston chronicle" had a very unique print voice and then created her blog, a very popular blog. and now she uses that voice in radio. she's got a really interesting program where she interviews a lot of us. another multitasker here is jay carney who has been on both sides of the fence. as a longtime reporter and correspondent covering campaigns and covering the white house. as though, we are very privileged to have him here to make some remarks. mac

>> well, thank you. it is my pleasure to be here. i'm very glad to be here. i chose not to travel with the president today who is with the first lady in georgia at fort stewart. not so i could be with you, my son who is 10 and half finance games on friday evening and sunday afternoon and i try whenever i can during the spring with the permission of the president who understands being a father himself to not travel on fridays at all possible so i can catch a baseball game, which i'll be doing later today, very exciting. one result of that as i can be here to talk with all of you, both young journalists to be and grizzled veterans appear with me. you know, as karen said and i appreciate the introduction, i

looked at my life after college as a reporter. i graduated and went right to work for the "miami herald" found in south florida. i did the kinds of things that covered borders used to do, which is listened to the police radio in chase stories down that way. wrote a lot of pieces for the "miami herald" and because i had the accidental good fortune is studying russian in college and graduate at the right time as a russian speaker in the late 1980s. "time" magazine hired me with the idea of the soviet union becoming an interesting place of mikhail gorbachev among story short and that the moscow for "time" magazine during the collapse of the soviet union. i can after that uncovered the first term of bill clinton's presidency and congress for a while which was enormously entertaining. it was the gingrich congress.

more recently gingrich was running for president. george w. bush's presidency and moved in that time. right after the election in 2008 through serendipity really to go work for the white house that the vice president initially i was your chief for "time" magazine and has done for a number of years and was a terrific job. i didn't leave journalism because i was looking to leave journalism. i laugh because my personal feelings about the 2008 election made the somewhat accidental opportunity to go work for this white house is something i couldn't say no to. it has been an incredible experience. four years ago if you would've said i would be working on the white house that would've left it i certainly would've never expected to be doing what i would now. i worked for joe biden with the first two years of the white house and the president asked me

to be his press secretary. as mike mccurry, one of my predecessors caused me to tell me at the time when i was announced there is 44 presidents but now only 29 press secretary is. it's an even more verified field. there's even press secretary before. so having said that, i'm not the first reporter turned press secretary. i think i may be the one who has had the muster of experience covering lighthouses. and you know, i think i bring to that and my colleagues, former colleagues and now people i work with what i do my job as press secretary give their opinions of this. but i understand what they're doing. i've been there.

i know the pressures and intensity of the competition. i think what i've are not appear almost understand that i get frustrated sometimes at the coverage, i tend to start from a place where, as some empathy where i think in politics sometimes if you've only worked in politics and on campaign you end up working for someone in congress are fortunate enough someone imminent ministration come to your view the media are understandable experience can sometimes be one of total -- completely adversarial view and relationship and i think it is -- the republican is off on a sacred truth for them that the media is the enemy here for democrats is more nuanced than that, but they get to that point eventually. if not the enemy, then an entity that you should be very weary of and is a challenge that must be

managed. not that it's all true, but i think what i do bring having been on the other side and understand the motivation and when the story is either wrong or off for just annoying that for the serious professionals who do their jobs covering the white house or campaigns, it's not agenda driven. it's not a bad story because they're out to get you. you have to make your case and explain why you think it's wrong, why they should see it the way you see it. but i do appreciate certainly the people here and a good portion of, if not all of the folks who cover the white house com2 up with a professional focus and not an act is the focus that a lot, not least because that is the way i try to do it when i was a reporter. you know, there is a comment saying in the verified world that it's not an accident that

the press secretary's office in the west wing is someone on a triangle about halfway between the oval office and the briefing room. it's a very small space if you've never been in the white house. my office is about 15 paces from the oval office and maybe 20 paces from the briefing room. and that symbolizes what he press secretary's job is. i am the principal spokesman for the president. i defend him, speak for him and explain him and the administration, but i don't also do that. i tried to dash into a knot, i am even more than i., everybody who works in the pie shop at the white house tries to help the journalists who covered the white house to what is a very difficult job. it is a title that is glamorous, white house correspondent, but a job that can sometimes be pretty

unpleasant. it is highly competitive. you sit in a booth without sunshine, terrible food, sometimes the basement flood where they fit adjacent to the briefing room. they spent a lot of time in advance, motorcades game waiting and fighting to get the story get it right. i know that is what it's like and i appreciate it. some people ask me, you know, now that i know what goes on on the inside, spending so many years having found now, do i miss the crisis about, g.i. no thing that i would want to know if i were reporter. i do know a lot of things i would want to know if i were. an old hoss once told me that when you cover the white house come you have to understand have to understand and will they know 10 what going on.

and partly because there is just so much going on. partly because obviously you can only be affect to that governing you're able to make decisions with some degree of privacy in the process, which allows for open debate. and 10% maybe not that i'm on this site, unfortunately a little bit of an understatement of how much reporters know it's probably more than that. it's certainly sure to 50%. the best reporters take that and filter it through everything they have experienced and run it by their sources and think about it and work through it to make judgments about what the remaining 98, 80, 50% of the truth is. cannot quite think experience is important in this job. no matter how smart you are, how good you are, how excellent your prose is, if your reporter, if

you don't have experienced, if you don't build experience covering washington and developing sources and high maintenance to tuition all, not just an intellectual understanding of how the place where it's coming you're bound to get it wrong every once in a while and everyone get it wrong occasionally. so i don't have this all at the crisis very much. credibility is enormously important. i'm a living press secretaries i spoke with all of them. i knew all of them already. and whether they were served a republican president or a democratic one, they all taught about the need to maintain your credibility, which means when i go and stand up in the podium in front the white house press corp., i never lie. i never say something that i know it's not true. that is what i don't go the

extra something something i say i don't know and i take the question. that means when it's often the case i know more than i can say. i answered in a way that is truthful without obviously be trained to things that i can't say for national security reasons or rather reason. but you know, it's a fundamental principle of doing the job for the folks who cover a president. they have to have some faith -- substantial faith that while they know that i can see everything and others to speak for the president can say anything, do what we are saying is true. and that's key. so that it's kind of in a nutshell how i look at my work and the work that i used to do. and with that, i'm not sure what the next stage in the essays. [inaudible]

[laughter] already been introduced in great detail, but julie if c. you want to come up and take over year, it greatly appreciated. thank you all for listening. if you want to ask questions, i'm here. thank you. [applause] >> great. thanks, jay. were all grateful to jay carney for being here. it's really great. got to introduce the panel before we get started. i meant that, jay. i thought i heard some stickers. i was entirely sincere. we never get to talk to you about yourself and not her job, so his great insight. our panel is about access and transparency in the president. russert going to be talking about campaign staff. am j-juliett mason from sirius xm radio. jackie kucinich on u.s.a. today's covering the 2012 campaign. she'll get all the romney questions. we'll ask the white house staff. she doesn't cover it.

ben feller -- no, she's coming. [laughter] ben feller is the white house bureau chief for "the associated press." carol leigh covers that and jake tapper covers nbc news. we want to make sure the scholarship students ask a lot of questions. this is for you. we want you to participate, so don't be shy. anyone in this or we'll tell you ask questions for a living and often the question you think is or uninformed elicits the best answer. i'm the smartest, most detailed question what do you a yes or no. saddam even be shy about feeling like -- just ask away. when president obama took office, he promised a new era of government transparency. this is a big priority for him, something they really wanted to highlight. among his first acts as president or pledge in this new love of unprecedented openness. first the question becomes, how

has he performed on this promise? has he lived up to this record? one promise not kept with a plan to allow public comment for five days of nonemergency legislation that the president planned to sign and also those health care deliberations never made it onto c-span for which i was grateful. didn't want to watch it. how significant is this? are these trivial matters were these promises he should have followed up on? then, would you make make of that? >> any specific promises important to this posting legislation, access to the health care debate at the time that it happens. people people want to know whichever party he's from or she is from the president's going to keep his word. there is a broader issue of access and jay articulated well from his point of view and of course run the other side every day and it accumulates. i want to see access and transparency in how mckenzie posted blogs and how many names

are on that. but it's more of a collect its sense of what is our access to the president? >> how do you feel? how would you react? >> i'm frizzled now, so i'm feeling crystals. i think we get frustrated. it depends on the day is the honest answer. of course there's times as news conferences for the president takes questions and makes the story here dissectors many wartime so we could have access to the president. if you do basically fast-forward a day and he took a question and that we have more information on the issue it's fine, but we try to get the question was a wife in question the white house as part of the 90%. they have their own thinking about it's not a good day to put them out. we're focused on why that's not the ratesetting. would be inappropriate with foreign leaders bear. if it's a constant battle is supposed. a

>> jake. >> the white house likes to say this is the most transparent administration. that might be the case, but it also sets a fairly low bar because previous administrations were not transparent. i generally agree it's not inconsistent to think it's the most transparent administration in history and it's not very transparent. it's not inconsistent because the previous administrations have been opaque. there's a difference between posting all the names on the visitors logs can be in want to answer questions about people in the visitors logs. >> does that happen? >> to answer them in interesting ways that don't address to the people are.

>> i think the health care deliberations being broadcast on c-span which president obama did promise that obviously did not happen. he himself has acknowledged that was a mistake and created misimpressions or correct impressions about the deliberations in a health formed cornhusker takeback and the like and ultimately probably did not help himself but the legislation as effectively as they could have. that's an area where not only did he break a promise but it may have hurt him. i'm generally of the mind like any reporter that it does want to know everything going on. reporters as you all know are tremendous gossips and share information all the time. whether it is about our kids or anything else where matters of national importance.

but i'd like there to be a meeting of the promises. i'm the only one on the panel who covers obama's candidate is that correct? there was a lot of lofty promises. jay, you are covering it, too. and he fulfilled at all, i'm sure. i'll answer for him. there were a lot of lofty promises and i was sad that has been one of the stories at the administration as the rhetoric and reality. >> carroll, the choice to add that? >> reporters are never necessarily entirely happy with the access they get. they always want more. i think it is a bit of a give and take that and was saying a daily struggle in terms of how much access you get caught

matches president and his senior staff and people actually know things because there are very many people who know things within the white house because it's a very small group. the one thing i sorted find very interesting and strange about the white house be as unlike any other beat uconn or in the sense you really are covering an image and not necessarily a person because you don't know the person or have access in a way as if you are covering governor in the of access to senators and members of congress. so it's a sort of strange place to be from a reporter to because you rely on people him a while have an agenda which is to report an image that they want the president to have. it's very rare and difficult to get us into -- the sense of who the person as you think about

pretty much more than you think about yourself. >> then come you covered george w. bush. did you feel like you to do better than barack obama? cynic at this point now that we're closing in on for years by the sense about it i came in last years of president bush. one big abstract by listening to this debate if every time i had an interaction with the president does not a press conference. something informal. >> something organic. >> something in the pool spray with the press pool is broad and and we see him in the spontaneous environment. purchased a conversation with a few of us. and invariably what well. i don't mean like i got chat, but we can understand the president. they're all confident in their views. and certainly talking in the press because they know they run the conversation and have more information about it.

i i would think that what one of them came out happy about the information, let's do it more. i had the conversation and they said we don't like them and news conferences because they get so caught get the happenings in the life and you guys and it's just better in other settings like the one we just had it in. do that more. he said well it's not that easy. that's where breaks down. >> that's interesting because president obama doesn't like questions in the oval. president bush did. president bush signaled a press conference because he thought we were all thespians asking 20 minute questions and it was nice. president obama seems to like the formality. who better serves access and transparency? which do a better or is that a false choice? >> is a false choice in the sense that we just want the questions answered. >> any setting will do. factory floor, oval office.

>> to carol's point, it's more about what is your stand about what ahmadinejad said today. that is transactional. we are covering the president, the president of the leader, family man, politician, someone for reelection. so that affects your coverage because you can write with subtlety, contrast, richer flavor of the person. so we do want all of that. you do get a better and more settings than more formal setting. they call a news conference, were outgoing. >> one thing about the news conference though is the president doesn't particularly like to do them frequently and i find that when there is -- because there is no small exchange of questions in between this bit from a conferences, the press conferences can be like a fire hose and 10 stories coming out of it as opposed to

consistent getting your questions answered option, which i didn't cover bush, but he seemed to did a little more often. >> i think george w. bush had more press conferences than president obama has done exponentially more interviews. is that right? [laughter] >> i will start by saying i completely accept what i think everybody here is that, the three of you that more is better from your dave and i understand that. and it was an interesting comment that been made or carol made about the image rather than the person can especially on the campaign you didn't spend time with the candidate and it is always often the case that in the early stages of the campaign you get one of the regulars

covering a campaign span off the record with the candidate and get to know that person in the way he would make you come into the white house and the person is already president of the united states. i'm trying to help address that for people you don't know him very well on a variety of ways. some of the regulars on the white house to allow for more exposure to him and get a feel for him. that is important. it does inform a positive with the way you cover a president and i obviously think he's pretty good and comes off well in any kind of encounter come included with the price. jake is right. having covered the first term of george w. bush and also the first term of clinton, i think it's different than the last years of administration at the white house that by year seven and eight was lighting himself on fire ticket on the front page because there is so much attention on the bush

administration -- on the campaign emerging to succeed president bush in a first-term presidency. or having covered george bush, we provide a great deal more access to our officials and the presidents than george bush did. president bush came back on air force one on his first trip and that was it. and he did give over the course of his presidency did more of the brief press encounters when he had a visitor in the oval office and they would come in and do one or two questions. we give more than twice as many solo press conferences where there is a series of questions that doesn't scare the press an opportunity to follow up but been asked a question and carolyn jake on the same subject and really forced the president to take a number of questions on the same subject. and i get that all of that from

a white house reporter perspective is better, but we have to rationalize and we make judgments about when it makes sense to have been taking questions on the subject or not. but my principle from nasa's having him out there when it makes sense as often as possible is a good thing i'm trying to work to make that happen. >> thank you, jay. feel free to jump up. you guys have any questions? anything? no? were going to move on. jackie coming for this discussion about the white house. how does that compare the romney campaign? is to make pronouncements like i'll have a press conference every week? tourer john mccain said that? like yeah, whatever, dude. >> i come from covering congress to covering the campaign.

so this is my first presidential campaign, said that learning and listening to my colleagues here because that's the best way to do it. as long as the campaign -- the romney campaign has been different than other contenders were even on the rick santorum campaign early on you could've ended up sitting in the chocolate amaretto pizza ranch in iowa whereas the romney campaign, that is one of the things i think is a pretty open secret or not secret at all, that the avails are few and far between. they're usually announced kind of like a pop quiz. you'll be an event and all of a sudden this week there was the press conference with rubio. they can be a month between each other. so there is a nice match. it's not as frequent as we would like. >> is there the idea of press

availability? >> they've done a lot better. lumbar response and a lot more engagement with press from the advisor stand point. i think they candidate, not as much. this interview is for certain people by certain networks, but not as much the normal arousal. i don't travel with romney and a lot of my colleagues do. so i think there has been the occasional poke him back on the plane and say hi to everybody. i chatted with him from iowa to new hampshire and there is little interaction there. >> to be in no cookies? >> there is a birthday cake at one point for another reporter. but the interaction is very limited and it's been a professional campaign from the get-go. >> this is the first real campaign that is played out on twitter and other new media. the white house has made great

use of youtube, twitter, flickr page is a matter contention. the pictures are great, but some say no substitute for photography. to politicians embrace new media, does this enhance coverage or is this an ayn rand around the press? what do you think? >> i can't wait to hear tapper answer this. >> he is tweaking now. [inaudible] again, certitude that responses. the first is more is better. as more information gets out to more people through twitter and facebook and photo sharing site, then that's a good thing, but you know, i don't agree with the premise that there is ever sort of going around the national

media because we are still covering the president. we are still there every day. even when the president as regional interviews, we've seen this several times. part of the strategy at the white house is to call and select increase through correspondent through different through just that through up asking him about something in the national news and it always kind of comes back to a national story because he's a national figure. one of the first times the white house put out an announcement about a press conference was through twitter. and also i thought okay, i've got to get on this thing. because it is a newsmaking vehicle. that was not very long ago and now it's commonplace. as commonplace. dishonesty is to following it for news, you're okay. i think there's a whole separate category about whether the white

house and reporter should be sorted sharing opinions and bantering and all of that by twitter and that is more of a personal choice they been. either way, we still end up covering all of it. they think if there is some systematic use of using technology of regional media they didn't have access, that would eventually come to the floor with an challenge. >> jacki weaver dispatched on the romney campaign and other campaigns that they monitor twitter feeds of reporters covering campaigns. what is your experience of the media covering the 2012 race? >> i actually love twitter. it's a lot of fun on the campaign because you can chronicle everything going on. whatever that you're going to do can cover a lot of candidates. it's pretty cool because you could really keep people informed on what's going on. yes there were complaints about certain things reporters were to

team and they would be some back-and-forth and that is one of those mediums where it's easy to forget that there's still a level of professionalism that need or could be there if you choose to. >> to the campaigners use it to get their message out? >> yes, definitely. i think newt gingrich tried to launch his campaign on twitter and no one noticed. it didn't work. bless their hearts. but yes, a lot of campaigns use that to circulate messages to circulate new initiatives they are launching that week i'm all for the hashed out for us to try to pick up each other's hash tags to circumvent an affair from the other camp. i think there's a story in the post today that this is just

beginning. >> carol, what do you make of that? >> i think it's a little bit about, meaning that in some ways that things like the flickr photos that we get every month, west wing week or whatever, as long as it's not a substitute for getting access, it can give you a little bit of a window but should otherwise make it and obviously it's very controlled and those don't just pop up on the way. take approval process and screens. but you can get a little bit of a sense of who's in various meetings and things. sometimes they think the internet which has covered itself goes a little father after the president nominated eleni cake into the supreme court they posted a video that said we caught up with elena kagan. reporters can't get anywhere

near the colonnade and she was obviously talking to any of the media, but was sort of amusing and the sense that it was -- only they could have gotten that idea. >> to having a new senate? >> that's the other thing. you wind up reporting on days. >> is basically right enough the press release. >> jake, i know your thoughts on this matter. >> i think when the white house and teacher white house's use this to bypass the media is dangerous and can potentially be pernicious. they could be a way of avoiding accountability. i didn't cause so there are things the white house -- this white house does that honor complimentary that we would have access to anyway. and so when they post videos from their videographer for a

white house photographer, those are things we would never get access to and here it is, here's a picture picture of the president and this war theater and his wife or whatever. that's nice and i understand this to their own particular lens. the problem is when it becomes a substitute. when the president signed the bill may don't bill may don't let white house camera people in. they have their photographer take a picture and send it out and it's an illusion of accountability and that i think could be potentially dangerous. i'm sorry. but the second point on twitter, it's become a real way for campaigns to attack each other without being too aggressive because it's just twitter. so it was a way for axelrod to introduce the shame is the dog story. ..