re rt idt ealth care spending for obese adults is 56% higher than for normal weight adults. the alliance held a discussion today on the prevention of chronic diseases.

among the speakers come to cdc's chronic disease prevention reirewky' alndie commissioner. >> afternoon. my name is ed howard. i wat to wecome y on behlf ofenat rfe ar s i rgm preventing chronic disease, impact on america's health, what is being done nationally and in communities around the country. acic cicisease that affects 130 million americans, caused a 70% of deaths a accounts for 75% of the spending. those kinds of nubers attract atteievenn atili , e ioavst r 2 trillion.

congress was listening to those when ipassed that health reform law to speak directly to the problem of chronic disease. well before thatrfrm a enacted, communities around the country were beginning to address areas such as tobacco use, obesity, physical activity as a way to improve the health of their population and we ca dascrni das moand won't hear from folks who know what can be done to lessen chronic disease in our population, what is being done d what the ipact of those steps atorl oo el any briefing we have ever done at the long-term fiscal implications in an illustrative stetowards lowering chronic disase.

veelui tlpe amthth nives and a promise they may hold. now, our partner in sponsoring this briefing is the robert woodruff foundation, burg reeragli ortly, helping americans enjoy healthier lives and get the care they need. i want to thank jim marks at the foundation you can join us today and his colleagues for their help ipulling this thing in t ite before we get to the speakers. in your pack is still find important information including speaker bios and the hard copies of the powerpot slides sophie on t cn.eral lor cknd mati and data is available also at all

heth.org. there'll be a webcast available hisbrinmtemd tai foundation website, kss.org. c-span is also recorded in a briefi, not airing it lies. yocan watch for the schedule ifpecnhen it will be rdonpaghw, you can find more resources on our website, including the slides so you can follow along. at the appropriate time, please fill out the green question card chan toawe he o panelists a ua fbe yea will help us in previous programs as we go along. now, we have assembled an incredibly knowledgeable group of panelists today with both exenonal and commuty level

eyiebf presentations that have a chance to join the conversation directly. we are going to start with dr. ursula bauer. she is the director of the national center for chronic disease prevention and health prot within thcenter for secol vioe' epidemiologist witha long background in public health about the state and national levels and she is in charge of strategizing to puue her summer school is a preventing tobacco use, including nutrition andprvnting e cvi. dr. bauer qaeda thank you so much for joining us the money turn it over to you. >> thank you so much, ed and thank you for joining us. you know and you just heard fromed,hoicdi thake progress in reducing rates of heart disease and cancer, which are the leading killers.

chronic sease are responsible for seven of every 10 deaths in the u.s., affet 132 mike 0 iomrsm ivt or chronic conditions. therapy and diagnostic younger and younger ages. chronic conditions including heart dease, diabetes and arthritis use jor ofamand un forrrly 75% of more than $2.5 trillion that the u.s. spends every year on medical care. importantly, chronic diseases are largely pevent. s rd o asat nau b exacerbated by or negately impacted by one or more of three imin that dgo long way towards g

and mitigating the suffering, disability and premature associated. effective preention can reduce kiy aisases early and never progression or complication and constitute a die for the people. her evidence-based prevention strategies are good and wh ventn fails, that is when we fail to do what we know works to prevent disease and promote helth, we cse needless suffering and premature co nusord we encourage needless vis arvi chronic diseases, but for all of those who share a health plan for taxpayers and health insurers, both public and

private. often these payers are businesses and upos e enite expands of paying for costly and preventable chronic diseases and product tv declined as employees become il. many fat there is fact u whaern, education, income, where we live and work and e access we have to quality health care. at cdc, when we look at opportunities to intervene and prevendasendmo leofs.eso and it, changing the context. that is, putting the health of the people's hands and supporting people and taking charge of their health. whether it's opptunities to brthe e air that free from basnaing safe places to be physically active,

choosing healthy food options in our restaurants, schools, grocery stores ad work faces are protecting ourselves and our childrenromta aean flth reat grandparents experienced. public health interventions to change the context and make healthy choices easier for americans reach e greatest number of peole andan hv lstac esteti r often the least costly as well. and they're certainly cheaper and more cost efficient clinical intervention in counseling and educat thepi this period that are not in competition with each other. work in all of these areas is needed to make sure that all americans have the opportuty to be and stayhealthy across

attontorchc asevon health promotion, our water what we do is listed on so et's sided display. how we it is on the bright. that is woing in fr kema. thunons for. we provide data to develop and deploy effective interventions. identify and address program delivery at behner proam dandmanto onlio e it well. we engagein health communication and ensure decision-makers have the information they need to make the best decisio and pbicize detrthtun sts prevention.

environmental approach is, transform the community context in which health occurs to make healthy behaviors easier and hltomtielient foramecans. alr tst ur ol healthier workers are businesses and employers and a healthier population to the health care system. ese kinds of interventions have wide reach and sustn te ct n o rire only modest resources to accomplish, making them high-impact as i said, at best buy for public health and the american people. healthsystemsotteo eti derli evvevices and americans were affect the use and benefit from the services. the results on diseases will be avoided completely and others ll bteed early or

ged ttero ert lionirove health outcomes. innovations like electronic health records, systems that prompt clinicians and deliver feedback onprformanc and outcesh sro f hgorng d sundroportion of the patient population as of today i'm cancer screenings can be motivating to providers and health insurers to focus on e revenvevis. effeive tr ss, to increase effective use for these services is also key as availability of coverage alone will not maximize the effectiv use of preventive services and the associated helpbfi en thapele have access to community resources and

support to manage chronic conditions once they occur. clinician referrals, community dery -p naalbe prevention program and a variety of self-management programs for arthritis, heartdisease and more increase the likelihood that pple living with chronic theottor atall be able to follow get eath. improving their quality of life and verting or delaying the onset or progression of disease. avoiding complications and reducing the need for additional aok ihere will reduce obesity and diabetes, further reduce heart disease and colorectal cancer will come upon attrition tobacco use and ysic inait t ono itln.

blea rbeq multilevel, multistep girl solutions. increasing opportunities require work and at the national, state-owned ocal level and enging public and ters eo how their print resources, expertise and solutions to the table and focusing on those crosscutting risk factors that i mentioned in the evidence-based rategies that adres multiple chrocoio ltus. working together i think in these areas we will improve health, quality of life and life expect to see for americans and mullah reduce the need for help care andtecontrol our healtharess k you. >> thank you very much, ursula.

[applause] >> will turn out to dr. thomas farley, commissioner of the new york city deartmen health an alhgen aso had public health service about the state and national levels, including a cdc d is going to share with us thsuccessful results new york has achieved in lowering the incidence hr condions. anu bewi us. >> thank you in the afternoon. i will take you to ways that we new york city try to combat seases. these are not all the things we are doing but i'll take you to the imprtoc ghts tetive these are the things i'll go through. interventions that are done at the environmental level or what dr. rbara coutu is changing the contextand specifically smoking prevention taf anenum oionsmd

intervention as the health record with quality improvement technical assistance. so let's take smoking first. three majo lmese nerky.g evention program t nsg hiri cettoecse taxes. in 2002, when the bloomberg administration came in office, the excise tax total and a pack of cigarettes was $1.50. at lnns t ia of $1.50 per pack scum which brought it to $3.39. with subsequnt increases at the state and federal level in 2010, the total tax on a pack of cigarettes for $6.86, meaning the price of a pack of cigarettes ret isau w ie esn rin h aion. something we are very proud of. the second element is having comprehensive smoke-free air blogs. 2002, new york city passed a

smoke-free a act that esal restaurants and bars. this idea spread to other jurisdictions but at that time is a pretty radical move. this smoke-free air act was extended i2011 to include yoilvefollowed thes in campus is completely tobacco free. the third major element used to hard hitting meia messages to warn people about the risks of smoking. these re oe nas aplle ct f smoking, using the best modern advertising techniques are messages developed in focus groups and evaluated in surveys. the photos on this craft on the ve are from the mtcn thmo inearnot afraid of dying, but they don't

want to suffer. so this campaign, not to be terribly subtle is called suffering every minute. itemphases nrf a purse with emphysema and another with a stroke. this is the overall effect of the tobacco preventionrogram over the last 20 years. before 2002, smoking prevalence in new york city was 21% for the ca. ce h those who smoke have dropped to 14%. but if you want to decrease the represents 450,000 fewer smokers in 2002. the client is actually larger lehaos n 2002, so theoplecurreng total consumption has fallen by more than 50%. we are also optimistic about the future because the decline in youth smoking has been even

greater. it w abou%aot a en yo city. so moving on to trans fat reduction, we took on trans fat back around005. eio whae s is rif chemical, which doesn't need to be in our food supply, which raises heart disease risk you to give you a feeling for ths, you forgot a lot of trans fat taken every day ofalpa rule thatausk by%. prevented restaurants, which is a canadian new york city from using trans fat in preparing food. that rule is enforced by our restaurants section, wch we otisr general food anw av 95 compliant with the rules. the edge of trans fat in new york city has spreadsheet 16

other around the country. we're also focusing on high levels of sodium consion. clwea cme m diha g for us and is needed. probably at least twice as much. if we reduce our average sodium consumption in this country by 1200 milligrams per day, we would save tens of thounds of disease toka a reded hrt inhe past physicians have recommended people have low sodium diets, but it's clear people individually has little opportunity to make meaningful reductions inconsumption we it.i it's in the restaurant food,put in their basic manufacturer. if you have for the reduction of the population level, we have to food manufacturers to list cdm an the

's ditpole navnaalli called national salt reduction initiative that has a goal of reducing sodium intake by 20% over five years by reducing the sodium content is packaged and processed foodb 25%. auy ia n which health organizations are working with the food industry to make these reductions. the way this works is as follows. we met over a period of a year with representatives of majo foodomied thug h eswdivdag categories -- 62 categories in restaurant food into 25 categoes and within each category we established a target reduction for theears 22 d21whe ge ct ng 25% in the night that the targets out there and then we met the targets in the

sales weighted arages. so far we have 28 mpanies who hagrto et targetsan this is not the entire industry, but many food companies who use the craft, some of the true food giants in this companies as well as major restaurant chains. ha opni w commitd targets in 2012 to see how well they've met their commitments. moving on to clinical preventive services, one thing we know is that there are a relatively small number of services that be nxensive, simple, pren to be effective at preventing disease over the long-term. we have a very extensive health careystem that can be better in thse ric. hve teest in imprg

services in new york city and we try to do this through the project were reestablished a prevention oriented health record. we developed an eleconic prerrohey,d awy l inren ll patients. we have a fairly large reach across the city. health record are many, but the ones most important are wehave clinicalecision support system. th screen were a patient says something like this station is high blood pressure needs to be treated. they are actionable, so this paent has highlood pressure and they can click it. ma eodns but what they could to to do with the blood pressure and in turn provides opportunities to do a change in medication.

the record has the bility to generate cditi specific list foxpl iccayneecr. show me the patients whose blood pressure is too high and need to have it be brought back in for treatment. or shown the opposite diabetes is out ofcontr. so i supports phyawh paofiera t int day. the improvements in quality performance by physicians that are not so much from an individual positi, just thinki more are working higher, but rather chaes in of.welin a psici asstance about how they can ship some of the tasks that in the past they were doing themselves to nurses or medical assistance and offices to do more consistently. reco a eleroniic health inrmae s cic entive services across a

number of categories. the shows and prescription of aspirin for patients to benefit from preventive treatment, blood pressurecontrol and smoking cessation inteti thesimprovemen hb en hmos with a contained organization with their own salarynd everyone is in an organized way improving services, but they haven't been seen in this sting. this is one where the physicians pracces or small group practices. it's an independent syem. it's remarkable wearables to achieve the change in that system. that is far more like what the rest of the health care system is in the united states today. ha hs theipctben t hseonissne wewee t ose news here. this is showing declines in heart disease, the most important type of heart disease and declines and stroke over the last 10 years in new york city.

a 33% and 16% decline in t iswas happened to life expectancy. in new york city the life expectancy is greater than the u.s. as a whole and rises as i read faster and is now more than 2.4 years greater than the u.s. as a whole. anfeepyt birth iscy t t influenced a lot by what happens if infant mortality and brutality in younger years, but also life expectancy at age 40 this would caure morechans occred in conic seas thawoultendki stus h as you can see here similarly the life expectancy of a 40-year-old is greater in new york city than in e u.s. asa whole. driving faster d of urging more new york city than life expectancy at birt letju finh upte thought that diseases that kill us both a mass diseases as

results of mass exposer is in this respond to mass remedies. these are population by problems which demand population might sotis. detrouss,n ab, expensive and we demonstrate we can make them work in new york city. just to finish on a key thought of that. this is the sort of wrk paid for by the pvention public healthd. feb eo esine a o t prevention of public health sign. what is it paying for anyway? these are the things that pays for cme at things done at the population level that have an enormous impact on el. ifwoad rig ke th v much. [applause] >> by thway, i would commend to you in an article that we didn't reprint, but is listed on the sheet of resources from th

lancet, th desibes o tahnttariry had the time to lay out for us, some of the successes in new york city experience. now we are going to turn omtt myer prentcaaignor tobaorkdo un in 1996. that campaign has led to fight for a range of actions, rather designed to control tobacco use and has had a lot more success than almostanyone dt it. wajwain er acers zaidi from the harvard school of public health and has to report to us from the front lines of that campaign. matt, thank you so much for joining us. >>t liht acly t cc e'urntd i o make about tobacco. the first is tobacco is one area

we we demonstrated that we kno how to prevent disease and we have real-life examples to prove oti dene rehabeader last 50 years in a way that's both significant d measurable. third, they are able to show the way we have taken the twehad es reations canproe the s don y i oenle he is. for s, i would like to focus briefly on a couple of specific measures that are the topic of a daysnd thatvatanversation these vbeen able to tease out impact individual from other actions. ..

>> we are at 19%. it isallng,lbsl. coe the 36.7% among smoking rates of kids today committed 18.1%. that is a public success story that is something that very few people realize. if you wnt to understand how it thllg a orth e agic ack cigarettes in the united states -- the average tax is over $1.50. twenty-nine states plus the district of columb provide sehasoehamlkection against ouhe yti.

today, virtually every state provides some form of funding for tobacco prevention programs, if it's the cdc bt guidines toe fondt nisttion comprehensive authority over tobacco products. what does it produce? welcome awakens the is the wines among kids. the job is dramatic. among aults, the dropi miserable and a tetw li,wht de however, as you can notice in the last five years of progress has slowed dramatically as a nation. but, 20 states ha taken more aggressive actalong the lines of whaen thaveen ai years declines in adult and youth smoking in excess of 20%. what it tells you is that the only place these policies are

not working as we -- whee w nooihe e one o ,w ino eeafud major progress that has that translate into issues with people really care about? >> well, i think this is something that is very important to take a look at. we have been able to stud and adonthpoese as eut of nd conry have 7.8% fewer kids who have started smoking. over 10 million fewer adults who us tobacco. what does that translate to? that translates into oe min ran l e prematurely from a tobacco related disease. what it also means in terms of direct health cat it also meanif direct health care costs is over $200 billion over the fetime of those indiduals n health care as. it is a story of prevention that

pays dividends. ifou want to see it in meaningful areas, cancer, the most feared cause of dath n courywe hse ove laeca igca asblec i the incidence of cancer death rates, particularly among men. over 40%, and perhaps much higher, of that decrease in the risk of cer etl latoefa, t is a reduction in tobacco use. if you want to see it on a population basis, california has had the longest-running tobacco control program. when califnia initiated it ram,tencenflu er allghha e on average. as a direct result of tobacco control measures that california has ken, they have seen lung cancer rates fall by four times the national average inthat

sp con.e e isrt shows us that during the periods of maximum decline, we also have the most robust state spending on these tobacco prevention measures. but foeach of the last five in at moyt atresedi what does that translate into? data shows very directly that there is a proportional relationship between the amounts that states pend o thr cco prevtionrogran too.succs ineducg es alaufr ncthat we are no longer doing the things that have had the greatest effect as we move prtiund whti io alou tehcand what a the benefits of actually expanding tobacco cessation coverage to a wider

population. when massachusetts passed a measure in 2006, expanded coverage for medaid nd provpevecssa icorpl medicaid. what we see? a decline in smoking from 38% to 28%. we saw a ramatic decline in the thopior t ckand they have now documented every dollar that the state of massachuset spend in terms of providing these services, it saves over$. reinteo nth s one, too, that relates to the prevention fun what is the value of mass media in reducing tobacco use? we have documented evidence, perhaps the best excess worr

ltstttnt tob cni 98 the american legacy foundation was created -- it was designed to reduce youth tobacco se. the lega campaign. heen idpetl trark maximum spending, that it reduces tobacco use and the number of tobacco users among kids over 300,000, and perhaps was accounting for dee ob umoll dsth years. you don't have to look at a single example. you can look at california, mississippi, washinton, florida, y canind e onof t sta odct e ctthsia ain cce. a much more recent times, the cdc, this year, ran a three

month mass media campaign with funds from the preventionfund. what they want to document as it will probably result in an 500,000 americans making ncrete attpt tqmking it could produce as many as 50,000 americans who potentially quit. exed.ealth care saving will two states provide a good example for california and washington. as said previously, a ntdy documented as

a result of tobacco use in california -- they have saved approximately $86 billion in direct hh carecos bee heatof h ogram, it is quite extraordinary. a program that ran for only a few years,ashington state has documented a saving of $1.5 billion in direct health care costs, and a savingsf $5 for everllset.e issue that i we to mention here it is not only direct tobacco programs, it is the kind of policies that tom talked about in new yorkcity. proton of pele ast secohand mk. nha uletu eonstrate that where you reduce exposure to secondhand smoke, you see an immediate reduction in hospital admissions

for cardiovascular disease. the translates directly io coingsntiirt he r in, this shows is that with tobacco, we can document the benefits of prevention. we can document the les saved and the dollar -- the health care dollaae. thyo uh la [applause] [applause] [applause] >> you have hrd both of them talk about cost-effectiveness wi congressional staffs yes -- that is one of the arease are concerned about, it nig

to be able to show savings in the program. it is quite another to have a piece of legislation that makes it particularly changed and has the cbo scored as either saving money or not savingoy. we are very pleased today to have someo who can answer that question directly. doctor linda thalheir is the shs e story in the courier laid ou. including the cbo debate over the clinton health reformpl sceeer jon foundation. how the cbo scores prevention proposals has been a topic, we hear an awful lot about come in

today, and she's going to try to plaihoeanhe b team examined the effects on the federal budget of policies that might promote health that might prevent disease. k soh, er. wa thank you for inviting me to be here. i have a full cbo team here to help me with these questions that you may ask ed is right. i think one of the most frequently asked qustion-- yoe he impact of a preventive intervention on the federal budget? so, i'm going to try to address that today, and as my of you know, the cbo recently reased a jr .

i wanted to stat aoutowwe ink about en ie ex ted . the first issue, which is really important is tunderstand that there are different concepts in thinking about costs. wh one thinkso h feof peea ivenset prevention or treatment, one needs to think, probably, but what the effct on the costs of health care will be and people looktea cndpe pis asofta. leo t think about the return on the investments that they are making. is this a cost effective intervention and rethink about what is the cost per qualy

just l er tn elsom the congress thinks also, that the budget in the impact. the budgetary impact. that is a separate issue. obviously, itinteracts with the other two cost concepts, but they areot the samend mes weare lookg at w spngrv gnmen it is not just a preventive intervention. there are certain thingshat we have to focus on. gotob.heel ae hve to hnk belis apot in time concept.

it is what we think is going to happen over the next 10 years in the case of the budget window or maybe oger. and what will happen to all the drivers those factors? you have heard today about wht e city of new york is doing, what will new york and the other states do over the next10 years that will affect what other spending would be? the policy we are going to ef riv whaisng have a marginal aeplace rrt law. then to think about what happens as a result, we have to think about the behavior responses t at falican

du the factors.avof we are we're not just talking about individuals and families and households, we are talking that employers in states and we are talking about schools, whatever may be affect by the and ntrcon how they will rct, ahose responses to the policy will affect health outces. then when we have that, we have to decide how this affects federal sendg. arekibooran wekilsou social security we are talking about ssi, we are talking about other federal programs as well. and then we have to think about reve.verslyn s of taxes and fees. and they may be indirect effects, we may see revenue

effects resulting from changes in workforce behavior and pructivity that we have to welllcanngtccount aswl caarthth you think would highlight the effects of policies or eventionatalre another issue that is important that with prevention is that we often get the question how o you square prevention. and prevention is actually a myriad of different types of policies and inteentis of you ha heardtd.

we also think and g asked about euat it i ha, such as .08 blood alcohol, those types of regulations and we see more now and get aked questions now abt rsonal finanal centes tmodiis mathh ra premiums, maybe through cash contributions contributions that people receive a certificate and certain prevented interventions, and honetly, excise taxes on health risks. tas possy relednd so and so, three years ago, my colleagues at cbo decided it was time to start to look at these

issues conference of wy. hoche honykayodeze opt dtakto this. the three leading authors are here. [inaudible name] i am hoping that they will be available to swuensthom thal the policy was to look at the budgetary increase. a very simple policy. thetinseess-ma nse ch i for inflation. what we anted to focus on. there re directxe atwa ec alth effects on us.

we looked at the ten-year budget window, whh is the nmal wiowt cbookeat. isuar a cbo's analysis to do. one of the reasons in so doing was because people rightly say when you thin about prevention, you shou be thinki beyd 10 years d yoshou b ing potiv ime, and so we took up the challenge and looked at it from that perspective. that being said, it is really important to grasp that decions are ntdinb the cbo estimates. policy indicators will indicate many other things into account. they will look at what the health incomes will be. are they going to improve the health of the population? they're going to look at whether

this is a good investment and if it istfee quonoue o vent all of those things go into making a decision of which the budgetary store score is just one component. it is also important to imehatpo haveother picieto very different outcomes. this is jut one particular intervention. one of the reasons we did this, particular analysis, was because of the eviden that you have seen. you have heard from matt about how much e nwabe feof ivens ba h lofformation that we could use, and for many types of interventions, we don't have a strong evidence base. hence, the plea for data so w t the approachto do bett

that we are going towards, we start out with a policy intervention. in this case, the increase in the tobacco tax. look at the nvoiofor e reion min t ho ss how the reduction in smoking will affect health and how those changes in health status affect several faors and how they affect health care spending per cai. anatechevey markets. this is a huge body of research. only when we have done all of that can we then did to these partwhere we look at what en fallta rawh en retirement programs, what happens revenues? so i'm going to give you just a little bit of an oversight of these outcomes here that i

otmphaze r went into getting us to this point of being able to say something about those revenue fes. latwh hnso mortality and life expectations. and what we find is this first slide take your 2035 and ts is the first in 20 years and see hs nrese ite eradpio and notice that the bigger critical increase in the 65 and older population. and that is really important to a lot of these estimates that the full impact omt th a oplon which obviously is the medicare and social securityppulation.

then, we looked at the effects on heah are pendi a rn fdultaffeed thpoli. tsecby oicy, those who either quit smoking as a result of the intervention were never started smoking. and you will s that it takes efs oro.logie o the we had to introduce what we called a helpful lag into our modeling. there is really an expert on this who can tell you about it. it reflects both vectors. first ofll,i sque g pri eowh quit smoking, gain back their health that brings them back almost two the health status of people like them who have never smoked. yo n skgtefc me r

d o gdually, as they age, we get more cohorts of people who have never smoked in the population. thats why you see those lag effectoverm. ekno the effects -- i have the wrong pointer. [laughter] we look at the effects on -- etshe c spending, what you can see a lower per capita health care spending, the effects decline overtime o lo sinru 2080, when we look at the total effect on federal outlays, you will see

that iniial federal outaysae w tnou 2 oso sat seeing the effects of greater longevity, which i remind you is a great health outcome. pulling up the effects o us. all of these are estimates. these lookto be about the center of the distribution of outcomes we should exet. mingck a te mabesee n e that more easily this way, if we look at the effects by individual programs, we will see over the first 20 years or so, the effes o di ate

exgeanwosay that these estimates were done for the spring for decision, so these reflect the mediid and exchange baseline that we had before the supreme court decion. thhohe tth dline e efs wsee in medicaid come from reductions in low birth weght, and so we don'have nearly as much longevity effe in medicaid thsingh we are doing with tunpod e re period. if you look at medicare, you see that initially at outlays ef kd merend as the ngevy ditator thiacu, ee again, rising throughout the period because of longevity, and so the total effect, you can see

that around 202 outlays start to re, whe the dfl ntha perod. i would emphasize that theseare the health related effects on revenues and we're not talking out the effects of the excise yo can see that the first line here represents a switch from a taxcopenstion-th raprms oe end employers are spending less on premiums. workers will get more of their compensation in the form of wages, which are attached. that helps revenues. you will see the effects of greatelonevy,cae woere stin theab efs of changes in earnings

per capita because workers are more producive. the total effects on revenue and improvement of health rise throughout the period, but you will noticthat we are tlkin ales mree emtshr small. we normalized by looking at the percent of gross domestic product, seek an see how this relates to the size of the economy and you can see that they are extremely mall. e ams relk oue em small. if we look at te effects, the health-related effects, not the excise tax, but the healtrelated effects on venues and outlays of the deficit,ou cans heffes oys e ct eue here, in the 20s and 60s, -- you can see the effects the revenues and the health effects result om

improvement in el.

that is nice. it is a return on investment. what does it mean? how mu of a return on investment do you have t have efivfour unique classified cost ouspve es. cost effect it is different from cost savings. not all the vastness and prevention are cost-saving, but of course treatment is went5 liaera. atth ts poor health. we could avert many costs by interventions that don't cost more than a term youcu gt inens ubc how, fluoridation is a great example.

you invest for every dollayou invest in the mechanics of fluorid to people through their water system. you ae 38 n cu ratr ental care e averted. so that is cost savings. they are recruiting more dollars than we're ivsng. quy f life and improved health, avering suffering and certainly as we've heard, there are some costs elated t ditional social security paymentss to the live longer amanedoid warttffve rd thy or sick. d what we would like to pay for a quality of light and health care. imanpthi that is such an

r all looking at numbers. what is extraordinary about population-based prevention issues is they combine the cost beeecti herhopnof gets factored into these things is the death from chronic disease not only takes anyone out of work for us, also being a mother and father were apparent regiver and the' hsf stathcoc necomic, therefore a host of benefits that are noneconomic as well. and as tom pointed out, the programs and policies we are talking about are fairly mdest exrd elt rodu pat f the amount we spend on biological research. the dollar for dollar return for

longevity is quite extraoinary. irouitn was running for medicare program get a seretary for and was ou on the balcony smoking. the secretary said whatou doing,bue khe. s mjstnd e oe t fund. precisely the same point that has been made to this return on investment. the question here for tom faey. oking in new yor hasdop 14% and the question is, is the goal of public health in the city to reach 0% or 14% sounds ettyoode whin between?

>> given what we know about the risk of smoking, they can go as low as they can. i definitely think of to get the more than 14%, and doubtful we can get it down to ro. we certainly hadtronncsinpoo use heroin. we wanted to zero, but we can get farther with them now and if we were to do that, we would have enormous improvement and we should continue to try to reduce ras. >> we have someone come into the microphone. if you have a question can i ask you identify yourself and keep it as brief as possible. >> barbara cornwell, coalition for disability and health i cet --r lawsuit if you're not successful in a lawsuit with having pictures of smoking affect spend the cash registers. at the same time an article came out in a peer-reviewed journal

showing that you had good evidence that that o. so'mderi w poigigtbetotr woitdegome have been put to seeing pictures that come our wish your response is going to be sent to the successful campaign ruld defee ooeow yu >> thanks so much for the question. other people who may be less familiar, the board of health pastoral about two and a half years code that would require retailers to sell cigarett to pose the wangidsgned po frhe about the risk of smoking. but the rationale being the warning signs with cigarette packs proven to be effect is. nonetheless,you dn't get this bupaf cigarettes.

and so when the rule is passed, we were sued by the tobacco industry and ultimely the soup was lost. e tione wathhe ra which give the federal governme powers to determine the cigarette warning packs -- cigarette pack warnings had preemptive brutalities, even at the retail level and somow sen cks parael ternin n'dendweu ga rationale. during the time the warning signs were up, we showed two thirds of people -- two thirds of current or former people saw thsigns and those who saw the signs wereorkely to th wn uig, o defening but this would be fect is. i can'say what our response should be. i can say that we still see smoking as our number one public health problemnd we still

believe thpotenss, loonpl er ngbrmndthre kehat would be valuable and we continue to look at whatever opportunities there are to reduce smoking. >> there is a question that came toerceon a card that had to othk wonder, maybe dr. bauer has a sense -- or not, where elsewhere this likely to be adopted as a ay of deali wit ubc thqe. >> sure. communities are very netware and our communities are often sort of laboratories and innovation, trying new approaches to prevent disee to reducersk ht thinldtheience phe for community prevention.

cdc supports a compilation of that evidce base in the guide to communityprention svice we he a bsthis id-btrviota oue oyt e community level. we also, through our grant program, convening community grantees can a state grant to use to share experiences and best essays so te ealy ac t y. e ti >> i'm sorry, linda, i didn't mean to take the microphone. >> to the extent -- new york is very helpful. st, whe thadoptionrom many e cias en oven to now not only reduce these, but health care costs with medicaid population. the goal is to make sure tt every state has this information

s rea re pntdeon ognize that these policies and programs are probably the most cost effect the way for th to prove the health of their population. we could've shown, either covewnt eres hiun tt-ate pretty well parallel to what state has done with regard to efforts to educetobacco use so in this country today, your risk of cancer depends very much where you live in taepes ticadecions e ere e t s discussed, new york state will become the model for the entire nation. lindau. >> just to follow up on that. what should have disssed here clearly affects use n e th mllng es had less to think what the smoking baseline should be given as you saw on mac slides,

the slowdown in the declneof sming tes ong uli hinesi h mounts that states are spending on smoking and also giving a growing literaturehat i think to referred to of what isknown hardengte tret. pewho will always be smokers which you can't change their behavior. and we really struggled with these concepts i'm trying to make a projection of what health spdingwoud be ot smg a wldn nc hdel law. so i am interested in hearing that -- per sart to do what she would project is likely to happen to smoking prevalence overteet2ys. dyuiteloor

should be tender satyr 20 years that if you're making a big projection. >> i would just jump into that quickly. we a dropping about one percentage point per year righ orkiucssn pe ensmg years ago, if anything it's easier to reduce further now than it was before. it has a social nrm is building on itself. i don't thinwe are anywhere near reaching hardened ag veimc t indee tex years. >> lamy said se did from california were smoking rates are lower than new york, 13% for adul. a stunng figure. % sok in calo e r oigte haatuet we are nowhere near the hardening of the target. there is a very substantial population out there still this

smokes less than tir parents pre tigifefor su ve ceesdo so. >> and do we know the health effects of reducing smoking as opposed to quittin that was another challenge we face. >> yes, i do thi that a chalnge. lo ate number of cigarettes they smoke or smoke each day. but we actually see now is that smokers are often not daily smokers. they are weak and smokers or okocon i inno ruedy so this is sort of challenged our understanding of smoking and nicotine addiction as well. >> as i can ask your forbearance at the microphone, let me just followup. u dilyse he

questioof how strong that strong evidence base is and that you chose this particular example because of the strength of the evidence you have. what was very esesth edonfu rate poses challenges for u and trying to decide what to assam and what ot to assam? >> there were many challenges dlynnd h the -- obviously producing baselines is a huge challenge, but smoke and would like in the absence of a change we tkeond eoke was hugel into account in the past events, but we could onlytake exposure in the home into account that we try to develop a way to measure

that. if you read the report you can see tha. po to cond ske e kpacsin ic place last night with him and lit up in front of me. you know, we could not measure that. we just didn't have the resources to do that. rath utn w uects of reducing ale wede just not taking account of lower tobacco use as opposed to actual quitting. those are some very basic things. meanidon'knth we would be happy to lend to a microphone for purposes of supplementation if you like. if not, let's go to the microphone. whs en to control

sugared soft drink soda consumption in new york city? what is the eaction of the beverage industry and how are other areas was bonding to the w yontiiv >> we try to reduce consumption of sugary drinks at media campaigns, general health education we proposed in the pass, as you may know, tax on gary drinks, stricti on threductobts. most recently as they think you're probably allung to, proposed a cap on the portion size of sugary drinks holder staurant holder restaurant reradebo ocaurant hle health and ultimately will be seen again by the board of health after the public comment period in september. no surprise the beverage industry doesn'tlke itad

suhant tea u ai aorte re would be due by the new york city public health, which is experts that have the authority to act within the hlth domain strictly on health issues wi alth al ftiy fails, they have authorized passé. so are optimistic about it, nd certainly will be enough a lot of strong opinions that you'll hear particularly from the beverage industry during the next fewmn >> for those eople -- i ullk autteana ry dnks are associated with obesity and prospective

studies, cross-sectional studies. something about sugar and butter to mix of people to consume so many calories. consumption of sugary drinks lylsyr ve ge up and so there's lots of reasons to focus on that one particular product. there's also onehat says people are remarkably driven by portion sizes put in front of them. did someone threw twice asmuch inize an adot ucd t ce w weather. give people a smaller portion does not consume out to be just as satisfied. so we think the portionappel have a tendency to have people consume les will still gving pele theredom ocons ch hewn. he an e 64 answers, all they need to do is buy two or by one and put it into cuts. so while sometimes framed as limitation on choice, it's not. it is estalishmetof the siz thomns wisgw

appropriate for a human to the zoom. >> all right. we have a couple of folks at the microphone. who wasfrt >>rafoe e of social medicine and community health. what is the evidence that prevention interventions can save money in the healcar dery stem,hichan tn adto other purposes? i don't hear any attention to actually capturing surplus in the heth care delivery system that can be redirect. it seemso oab relevant consideration. i am wondering what

institutional structures may be neceary to achieve tha ol. ei t indthe special question and that is how many more kinds of things can you do this sort of analysis with? can you do it for delery system reoms? de w tt them. >> i think we have had that question asked of s.b.fer hodou thk a sgs rvnt e plowed back into health care? this is not something that we have addressed and we have not -- i am not quite sure how bu sr o example as this

health expenditures are lower, health insurance premiums are lower and through that mecsm ioiou fte es d'tesly upng back into the health care ystem, although there are probably roots in which it occurred. it goes back into book pockets in the form of higher coensaonoug caheisre premiums are less high. and so they are receiving more of their compensation in the form of wages rather than health insurance premiums. so that is one mchanis h ngom nevens are fed back into come in this case wages, but not necessarily in the health care system.

i don't know what they cide how to get back into theealth s bu oe the em nethalof prevention. so we want to deliver a healthier population to the health care system so that as a society we can actually afford deliver helthcre to er. le aeaerl lat care, last treatment for diseases that they don't care. it becomes very complicated ry quickly when you look at the cost of living longer. but i would point out trg acs5th world in terms of life expectancy. and yet, we spend at least twice as much on health care than any other country in the world. so we are not getting value for ouheal c pdires. the decisions they need to make

are focused on how do we get more health, better health for a better price? i think investing in prevention es i.e of the wayse doa. >> hello. steve redhead from crs. i think farl put upas tenae on -- best to stay clear of economic arguments in talking about prevention because in the end everyone has to die from some fi joti.at will ot eyad d argu that humanitarian argument is better that people be applied to all been sick and die. i have a question for linda if i

may. i confs toeing lite absmg, whichs the number one prevented death in this country. about one in five deaths attributable of all cancer ths biep i hoking tributable room. and yet, your study shows that in terms of as a measured in of the impact on the federal revenues andpending, it's very smal of ngmuc iary impactinters ci is small and seems to be largely propped a by the fact that you have come in because of the intervention you chose, an excise tax icea, you have a stea reliableve. hend ivens aimed at reducing smoking

wouldn't have that, so that might further diminish t effect. my question is if that's what she directedtealaid ad at ilicaones s s gtngth queson from congressional offices were cbo will reply to other features scores of prevention? what implicaonsds tis hae astorethar future? >> good question. first off, i think it's important to note that this was a very small intervention. relibu nt ean se o cigarettes. we are not talking about a comprehensive tobacco cessation policy. we are not talkingabout a $5 increase in the cigarte tax ef.t might ave a much lger

if latt effects on smoking prevalence where, i think it end up that instead of baseline assumptn 1% 3,it bu , thing like that. so we are talking about a small decline in the prevalence of smoking resulting from a small policy intervention. and obviously a larerchb buagain, it is much more difficult for us to estimat just because the evidence base is not strong. i was talking to tom before the start of the meeting about how great itwould be to have data from n yto look athat has yee rgtxcrease on behavior because we only see because of

the research the sll marginal changes and their effects at this time. the other thing that's in terms co oth teti to ac aement. it's really important to understand that. this goes into a much broader range of issues than they wold we in a cbo cost estimate. haeee ff i vat theo er a oad range of programs and having an effect on gdp by lacuna the effects on product to be in looking at the effts on wages and son ng re than we would go into any small cost estimate over a 10 year budget. but certainly we have learned some things that we probably would aply in iott

liomen asi donkayodwants to wait two to three years for their cost estimate they are proposing. >> one i am pleased to note the honorary chairman of the honorary board is a ake rockelleisf esth b produced. and maintains a very strong interest in the outcome of fabric were. the other is i misspoke earlier thatet snor ckanfn set over it. it's canary yellow in color. and actually, let me pick up a couple of questions that kind of continue the threat of foot linda thalheer was talking ou drad e simply asks what is the most promising evidence-based way to tckle obesity. the more specific one notes that

the affordable care act okio rgran alblte f medicaid coverage and wonders whether weight-loss therapy is my, if a prooslwer t foar idem di ble s to e kind of analysis of this. broad uestions, policy questions, methodologil questis. itwaulk. >> i think somebody else should be addressing these. >> chalets jump in? >> is a great question. our toolbox for obesity prevenon is reay not very well-stocked atte oen n rlbortu obesity

reduction or weit loss can't even though a society we have not doubt for a much longer period of time and is even less robustt hs on. vanb roin rvonr it prevention and control unwearable prphesies at cd through a number of grant aclyld encseimplemeting o ob prevention. this is exactly the process that is used to developer tool chest for tobacco control. the evidce really follow the pack is by a decade or even two decades. trin 6 0ftewr by the 90s we actually had the short list of evidence-based strategies college had been very effect did in bringing our tobacco rates tom so

impressively. so the kinds of interventions that we are ooking f es ntonra look at the kinds of foods were eating, how muh food were eating, and availability of healthy foods in our communities across the , ou si darnt schools. we're also looking as tom alluded to, what are the increments in calories that were consuming? it is quite impressive over the 30 years or so of the emergence cobutoseesyic nt lo? t it is the sweetened beverages, for example. so, how do we change social nos? w to me healthodmore ss? co aho to make physical physical activity more available

to people? how do we integte that into daily life and certainly the way we design our communities, the way we ensure there are safe places for eviloe physca t son g the institute of medicine recently came out with recommendations. we've been evaluating promising practices through communy guide process that i rc wee y go.u >> on weight-loss therapy, this question relates specifically to coverage under medicare part b ofweight-loss therapy and removing the eusn igosra simple answer come the questions as to need more data? a simple link there is yes. if we were to be looking at a policy that proposed expanding part d to cover cover

weight-losstea,ewl aleemeaia eato do an effect his job. so we would allow people to research on those questions. woul love to have them love to see the dt. e mcoujuik neatahev ioen and haul with very modest weight loss or no weight loss at all. certainly physical at a city n matter you are on the way expect thems going tomprove your evt n'oe you from the obese cassity to the overweight category to the normal wight category. increasing consumption of fruits and vegetables will improve your health a matter where you ae on e we continue on. sohowe lis rl that carry this extra pounds, especially at the obese level will come from

either your help. certainly regularphysical at cavity well strengthen your health regardless of where you are on the we connue. >> qioel teh he for about are fairly. it builds off your listing their paage their companies and restaurant changes commed o thes ohow did she do that? and what incentives do they have two sign-up? ransack at, h do you increas the inntives tt mr lengthy list of endorsers and participants without moving into the nanny state criticism that is partily avote by the tlpic aeand softrn

federal level as well as elsewhere have been encouraging the food industry to reduce the sodium levels in food for about 40 or 50 years. han't had a lot ofpss hisintiut ge tfoedte model of what we found in the u.k., where they are it was the federal government fta that established targets for companies toi voary us i e ra oend little bit of potential to encourage them to meet these production targets. so we followed the model here wh t a st mstrictlyvlntar oaef companies if they don't make some meaningful reductions that some point, some

governments may say there ought to be regulations to this. thit is farbett for antoe e ge h o eauthld the freedom to produce products that people find tasty, can mark it well without the fine detail involvement of having a government relatory agency in. fiof,teyse do tnttehe problems. we want to do the right thing. i give a lot of credit for having real community concer. to a certain extent they are movated to the ie hat gome action taken. >> i would add that in the area of sodium, dynamic argument is a little bit flips around becaus etlkaouenn kion, retl

about limiting people's choices and people want more choices. the sodium, people have a choice. if sodium is in the foodwe brascr goe itu. am onxpso b er 200, 300 is serving a breakfast cereal. most of us probably cap off that. maybe yu pour on he bow d thmi mof usoub ave eight, nine shakef salt into our breakfast cereal. we could do that if the salt pork or did they or we could decide how much we want in a breakfast cereal, but right now so iod hiet. mpies see th, we actually put choice back into people's hands so they can decide how much sought we want to consume.

>> we are getting very close to the end of our time. fome just reind youha wod lylt lo full evaluation form to get feedback on the kinds of things you'd like to see us do and how we can do better and things were already doing. i have a question here that is aimed at linda bill ytner and thec qion s too wer tycouldo nas ies for the mental health dirt. it does raise the question at two levels. evncu' a t werh on for mental health or other kinds of analyses like this. and second, how about the resources thatcbo itself? if it takes you three years with paul r houionw n u ibo kis of

analysis like this for a wide range of alternatives that are members of congress probably have been there had? >> gd tion rs'm n ry w met t lal care. that is a very, very broad and i'm not sure the policy question we would be looking at what th. what the intervetion wouldbe. lng tdicemai aeder poly coverage for some mental health intervention that is not currently covered by those programs, that might be something we might look at. buit ul reay dend o weldac it.oi but that also said, we wouldn't first of -- yes, a lot of people were involved in the tobacco

studut we wereorki ouhcok. but we would not be underking this broad and analyses of the mental health polic we woudb doig t br rea policy. if there was another type of question that really warrants a bi ovethe srt-tmadfrom multiple mitaheou t it. but we have learned some fragments. we will make some additions to our regular cost estimate in terms of the things we've lened from this, but this not going to be the typeof baudy we undertake onroe t vee oned d benterested in knowing what specific type of mental

health policy you're interested in how they like that. >> well, it appropriate we quona program like this is the thninhe have all the answers. we have covered an awful lot of ground. i want to thank you for your act given very thoughtful participation in this conversation. i like to think ou fido onngi as i said, helping to shape how we put the discussion together, particularly jim morris. please join the bankin our panel for a very thoughtful and useful dcussion about a very toughtpc [applause] [inaudible conversations]

>> carten heroi, ov mli accent. she saw the dominoes start to fall during this time. by 1979 she was a full-fledged opposition to carter and what paul ucins carter is n ec 19, she saw the fall of the shah and nicaragua a couple of cerating experience is for her and people likehr

hepaollection is about 100,000 objects to go through the very beginning of the nation and goes righup to the president. what we are trying to do is keep this largetaitnfl la s oerican democracy. democratic party strategist,

james carville and stan greenberg have a new book about the state of the middle class it"it'thidcl ide a th or fy'asto journal." >> host: i want to welcome stan greenberg, co-autr of "it's the middle class, stupid!" and james carville. thank you vtes are beng thmn tabthok uln b yrd trupoa condi rice short-lived for mitt romney. just go that's the most ridiculous thing. romney w getting it all day because of thebn. tat anhe e. idgood, put condi rice said for vice president. >> guest: that party cannt nominate a p-choicvi itotngha in.dida

probably one of the most things that the iraq war cause i'm sure that's what the reublicans want the election to becnt un ue: jack, on every level. the whole thing was a hedge fake to try to get the super bank. >> host: who does he take? >> gut: w't nw soutic si would do either ryan for christy. i would be someone that the party would find motivati. just ohasruy's a jbo i. l ed rollins. i don't know about the third one, but i certainly encourage him on othe first year.

>> host: i want to talk abou the esids ist a diu write "it's the middle class, stupid!" it confirms what we all suspected. it's really screwed things up for the average american. education costs are ou of sight. effort and ambition have never uere so scantily eed three decade decline in the middle class at the heart of the country. at the heart of what has enabled us to be what we are. it's just too important not to scream about. imantoake the election hmsl c poou eesti statistics. the bottom 10% has gained 10% in real wages in the last 30 years while the top 1% gain in more than 250%. mi 6a gained -- i got

21 or 37. there's a lot of books about income equality. thereis less about the qualy d more abo theack meghi h %, % 60%. and also the number they lost 40% of their net worth in 2007 and 2009. in the book we have two ohe mosttg statistic. powers work growing exponentially. the number of hours people have to work to just stay on. if you look at the 100 million hamsrs just churnig ev way ey co ke the ina'bu orra men middle-class and not going anywhere. the heart of what we do is try to listen to people and that drives the analysis. the wealth inequality is probably the most important me

to at socialoi t ful ppe, what they are focused on it we actually had people across since a look those lines, they just go right to the wind in the middle, the airline, the median family, flat linefr hredas and atttey loo t mi c ho se yoo ter f rld war ii, 1980, it grew by a lot and we grew together. so we look for a different kind of country. >> host: the title of the book clearly came from what you placed in the little rock campaiqer"the lessup" why did you put that sign in the campaign headquarters? was the genesis of it? >> guest: the genes as we had a lot of smart people working and people would come in with a lot of smart ideas about anata rytosfren get the campaign more focused and people in the campaign more focused and it's like, it's the

economy. they were talking about restoring old houses come away itotresh bre space in the united focused. the reason we went to the middle class is because in 92 week that the economy ould be the focus of everything we did then. and as we say should be the oscnuesty ciee,idte e like obama big mistake as president. here's a portion of what he told cbs news. >> i think of my first trip, a cple of years was thikg geg po right. and that's important. but the nature of this office is

to ll s sty tothe ic pletat gives them a sense of unity and purpose and optimism, especially during tough times. it's funny when i ran, everybody bun actlly geerateech, enemy first years i think the notion was, well, he's been juggling and managing a lot of stuff, but where's the story that tells us where he's going? and i think at was a legitimate criticism. soetting ut en mtiite american people, listening to them and also been in a conversation about where do we get together as a country, i need to aetter b of ateb explaining? >> explaining, but also

inspiring. postcode your reaction. u >> guest: really inspiring. reallyisirin. shdnelophe e o dt the economy and health care. people want to know whetr siggins said. people are kind of desperate to know the direction because they want the president to succeed thorat rney,wt where you are now, we are going, people give you a lot of space. they are vy reponsible. they're not looking at it through goodies that ba or theyan kwhyo g t vi cale were right about the essage of the economy and the middle class. you >> guest: i was. i said they arnot driving the narrives. the present said i haven't dren ave

ul jd of r wh h h say that because if you don't do something in the contracts of the story of a narratives, then people can understand if people are not in the context of a larger plan. this is exactly the kis gs n e inour nge. we offer the narrati of what is happening to the middle class. i thought that was one of the most encraging interviews i've seen the presidt given a long . hti hex 250 shfo tttaat middle class. i was just having read as a controversy. this president's economic policy in the recovery act as% tax cut. ch year after that commen is the new tax u. chr ieomic property was tax code. if you never got t250,000 would be in the context of the

person who ever years making sure the middle-class is the workin people, had breakand joy.toth as >> host: and the book, james carville you talk about congressman bryant in his budget. every cockamamie goofball and other words i'm not going to use here with thsidehas come froprestati paury thange uly imral. we have a $50 million debt. how do you bring it down? >> guest: not only is it immoral. it's dishonest and everybody knows it's ihnes doest tus utryg po opndeih le a tax break. if that's not a moral, i don't know what immorality is. if were going to say -- according to cbo and a timer with escalating health costs he cacseo etngsoveralhe

medicare so they can save them and give it to more tax people. it's the essence of immorality. plus that, he is at dedicated to a dedicatedf ayn n mhsea iynndo nethst immoral persons of the 20th century. i'm not an atheist. even if he took a deism away, an attack to just elites in he shouttha gld r baof morality. >> host: how long have you two know each h? caogher on -- beginning of the clinton campaign. just goes 20 years or more. we've been talking every

morning. >> guesta lot about the h too td s mi c, ou guest, carville, stance and three. >> caller: good morning. i have three comments. my first is about alan greenspan tmlaeieh snolhethutw the economy was and that's why he didn't put enough money into the stimulus. and my second comment is at least the presint made a st sauen aie dnak mes. as far as the book, thank you, mr. carville for the book. i know you was a hillary supporter, but i think this book puts the icing on the cake for the election and i know your wife is a reublican. so have a od a. ue: thanyou so much.

>> host: at this point the american middle class, conservatives and republicans care only fothe 2% rich. g: thth he did -- to produce color caller raised important questions about what has beecoming in from this presidency. he had a mess. people know that. it's amazingow the voters themselves when hetrw e oriunta had responsibility, wall street has responsibility, politicians, ordinary voters had shared responsibility. they want erybody to play a part in bringi this ak.d dprt t street ceos to do their part in the process. >> host: tom, fort lauderdale, independen line. >> caller: good morning, thank you for taking the call.

i've two questions. e ontxefneo o te what are his taxes? the guy made $20 million last year and he can't employ someone to get his taxes done on time? he has to get an extension? we had a scretive ident in mixing. th d nd aners t'e 'sng there. the question that clinton is when it's your buddy clinton going to move te unity to the mainstream media? he knows they debate. they are so afraid of the de.ey n't movet ttoe de t e mainstream media immediately. >> guest: maybe i can explain. romney as a guthat clearly feels light, o, sa the taxes, everybody who's run for president has done that. he says i'm not going to do it.

he also says i have an immigration plan, but i'm not going to you but it is until after thect eystpl rzee arthsh che ta % more. he said he was going to pay for them by getting rid of tax breaks. thea d'te

iod m ony. >> i think he is making an absurd argument. [talking over each other] [talking over each other] >> bill clinton has a thousand times more experienced mitt romney had. and h otteydon tll us what they're going to do, get out of here. it makes no sense at all. he's a nice enough guy, smart enoughuy, but it's just an interesting ag >>stg he opanu aes obates about the past. did obama get the economy moving and must be a socialist

president -- the voters think he was handled difficult things -- he was handed very difficult gs they think the middle class is in trouble. the untry is in trouble and they i want to know what you're going to do. what's coming an htcatey dononale hohenecm olos s ce erngt eee every focus group, everybody says that they wantto know what your idea is and what your plan is to get the middle-class moving again. by and larg iale >> when we talk about the balance of automakers and the only thing that the president saved was the unions. that is one of the arguments that the repubcans were critical of the. the tcrisis, a lot

of people losing their houses, small businesses in trouble, even before the election, democrats and repubcans to i sure.tng i'm sure it's the right thing to do but they believe that the president -- this the president had the same kind of worldview is, that we rescue the people that are irresponsible, we don't recognize themdle-c. 'sn ry ifcu >> tre is a supply chain that goes cognos where -- there are a loto hav splc. i a eou industry. and not everybody is involved.

al g morning. mr. james carville, is there really a middle-class? it looks like what we have now is we have the rich and then we have the or >> it's not what it used tob how do we define a class and what does it mean. we go through this, the defining of it. in the n we think it's an astindthit idtyt pe even.

about hard work being rewarded. that is exactly what you're saying. hard work is not being reported. peoplere building of college debt, used to be way to move from one generation to the next to get better and better, and if you talk to people ow, not just ta topn focu pseoling, 10 years ago, 75% thought that there was a decent chance for you to do well. if you do hardware. that is droppingo 50% now. a major drop in confidence. people hoe there is a sense of a dumbing down and you are right. when they talk about jt being rich and poor, making america look like ti odcu i taepe. even though they get to that conclusion, they are not willing to say, all right, let's stop here. no, no, no. that's why people want to know what you're going to do

>> host: i nt ttalkabout james grnberg's s his . biisipthe g issues. social security, medicare and medicaid. you write that the president should make a big part of his argument that the country needs to elect republicans were willing to work together to rescue the middle-class,not suha s.etasto m w thppen? >> guest: it is difficult. i think one of the things, that hasbeen difficult, and it has been backed up by political science, but the way that we draw these congrsional sts. i would like to ask people out there, look at the congressiol districts in your state. the biggest fears to get beat by somebody in your own party as opposed to someone s fe that losing the general election -- as long as you d't

fear that, asou lo at a cib tat we have in the united states. where we draw the lines to protect people. but we do weirdines to epu kn,v h st 8epc moic ere oes kinds of things hem before. >> host: if you look at some of the big pieces of legislation and the civil rights act of the 1960s, president reagan's working wiscal eyad 19anllntore w t on welfare reform, my sister rented a? >> guest: if you take republicans and say what is your ideology? 80% identify.

ita heon yoolog i two thirds of democrats. en moderates and conservatives. we have a very derse body. it is hard to be a governing body because w ar so diverse idgiy.arty, racially and thth rbemimlyon republican side we have uniformity. we don't have that kind of diversity across the board. we have to break that. somehow -- and maybe it's fortunate -- but somehow y ve thaomg g: the better chance that you're going to be in the middle-class, that's just -- in middle-class. >> guest: conversely if you have a single parent family.

>> with a single parent family, you will have a difficult time. a lot of economists stayu nale [inaudible] >> guest: if it's fits in very ll into the whole mosai >> host: let me ask something because rick at this point as well. an genbe dthe est a eio iai ie of the moderate? >> guest: the big initiative, he is saying this election is about the futu of the middle-class. he is identifying why people are untag much -- how

pivotal this moment is for people in the future. i think he has moved a great deal. >> guest: this is something at peop are fascinatedw ed b d america, every stupid idea has been a big idea. the big idea was to invade iraq. it was a big idea, b it was pret dumb. we are going to cut taxes for chop tito ulthonane rn iin hmo al well, that didn't work out. now we must try something else. let's degre the late the banks, they will think of things -- thi ingsoce theo wages of the economy in the housing housing market blew up in her face. as opposed to doing the radical

thing, the whole conventional -- maybe as opposed to one big dumb threkif t s t to copth t tefbcu every time we get a big idea, it seems to blo up right in our face. >> host: if you're listening on c-span radio we are on 10119. we have james carvillea nb waw"'s mi c, i" e less struggling because of struggling wages. it is the three decades of this that turns middle-class identity. they are bng screwed because the country is losino. >> guest: the point i tried to contrast on that is what i found earlier about the reagan democrats when i had previously written about a frustrated, middle-class. it was very much -- wh they lo arod ansi,de-ass,hey

everybody is, you know, rigging the game in favor of black people and critical of the white male. it was very much a racial discussion. what we are sang here is that people now get hat our couny as ranized. acm in the way the economy is organize. we have to change that. >> host: we have a caller on the phone from cincinnati. >> caller: good morning, gentlemen. i am a 41-year-old prso i wfuimall a ydvee d nnsu myself. i simply work a 40 hour work week and i cannot support myself. i live with my mother, my daughters daughter is in college, we both have student loan am making 75 cents more than i went back to school. but i have a job and salary and benefits. i am one of the people you're talking about.

it is disheartening, demoralizing to go toork evry dato getacecan realize that i cannot take care of myself. >> guest: would he do for a living and canasta, to mae annually. >> i work as a production artist, i make about 30,000 i t a fha er it's impossible that i wille paying off my daughter's sudent loans and my own until i die. my mother is 62 years old with sk. e a redsho he seonutywt cut their pension. what little bit she had after she is -- after she cotributed so much. she influenced cntless children. she has worked hard r her ch

we are solid, decent america people. we are not asking for a lot, but sometimes we need help. >> host: deborah, thank you for sharing your story with us stay on your line. [talking over each other] [talking over each other] >> guest: when you hear this, we hear this so many times a year. every time we have -- the only thing tausuay pele t isrythrak unrstand, never has done what we expected her to do it -- deborah has done what we expected her to do. she t traning, she goes to work, her daughter has a student loan, shworki hf, r er62ar old. we are going to give you a voucher that cost her another $6200 a year. they don't have $6200 a year.

period. tharntle od work. who don't train themselves. who are not even willing to work more. i didn't want to say this to on the phone, she is going to have to do wh a lot ofppld - istiwi us? >> caller: you just heard from james carville. >> caller: i don't trust -- i will never vote for anybody tha looks likeitt romney,t lo ba o either. and i am a black american. i'm supposed to be his base. a black, femalvoter. i believe he has helped the economy withte rett civil liberties -- i don't it's worth it. i don't know what to do.

>> guest: i wish i could just tell you something over the phone here. that would make your life a lot better. >> gst: one of thingwe haeeyiososnal is s u hre taken off toll. the story is a multigenerational and long-term event. and we have to fix it in that way. when you think about that, oumot ngnin atrea huta is hr. we have a piece in "the wall street journal", james and i do, based on the book. we have a humanitarian crisis in this country and we have to deal with the cost of education, and the cost of college and student debt. weave deal wi heah ae wee iv t res o he these things can happen now. there are things we can do we can move to address them. i know why you are at the end of your rope. there are things we can do.

>> guest: [inaudible] i know it's difficult, but we are pulling for you and you seem like a strong person and i think you're going to make it and improve your life before it's over. >> host: our next caller is from kingspor ennsse. bl mik wmee ogra. >> caller: thank you stephen c-span. you moderators do a great job and i have admired you for years. for james carville, here is where went and i am not interested in reading any books re i think we know everything we need to know about your views of poor people from your statement. dragging a hundred dollar bill through trailer park and there's no telling what u'll i th w e ft . ha yidf it enea o think -- i mean, i am a southerner born an raised.

we were not raised that way, mr. james carville. i don't know where you got your views of women, until i hear some sort of retraction, i don't think that i'm interested in your book. >> guest: i guess you'll be one of the people not buy myook and good luck to ou. h leflou e a conflict untracked consensus that they have to pay more taxes to address the challenge and the rich have to pay a share because they can afford it and it is the right thing to d fer eiinerate de ie co sse. this goes back to the earlier point with grover norquist and americans for tax reform. >> guest: i'm justryg tell you wt e rey he a significant part of it as

republicans. they have to raise taxes. they're the only ones who can afford it. you can listen to the people on these cal. 75% of those polled say that we should be raising taxes as part of this. >> host: and in today's wall street journal, you and stan greenberg right that he 2 isadf f truck hitting someone suffering from pneumonia. you he won the state in a post-world war ii america, we grew arica and together, going back to the earlier point of that hasot happened in the last thr es >>sters seof nal is came and destroyed the middle class. america's middle class was falling behind a long time before september of 2008.

thame - le ber 2008 -- thatwa eua a k th yevan ghiy a truck. it resulted [inaudible] 40% of net worth. int, wrepceent unnotice e of 1% in a two-year period -- we would've -- we would'e submitted habeas corpus it s uan tragedy as a epe. nation. my god, the wealth creators have lost 40% of their net worth. what's going to happen up at the hamptons? they will haveo drive their own ar. lo%r w ilies in this country yepd dy lost.

>> host: rick is on the phone from floida. >> caller: gentlemen, have a question for you. i would imagine both of you sitting there are very rich man. and in florida, we make $75,000 a year and we are middle class. $70,000 in york city does not make you middle class. >> guest: that's right. yreinfoid- g 67 years old, then i have a condo that i own or whatever house -- [inaudible] i'm doing pretty good. but i live in new yrk itand ihv tkd aki 00a year, it's like making 30,000 in cincinnati. we do talk about the middle class. >> guest: we are very inclusive.

income alo isaout50, w idd class. it doesn't really work. if you take the 60% that call themselves middleclass, and the 6% call themselves working class -- we talk about yone who rks hard and has midd cla lu. >> guest: [inaudible] it's a lot of people. it's just a lot of people. >> host: have you ever counted how many campaigns you've been involved with? >> guest: i have been in 22 different countrs no doubt. prly mean, [inaudible] >> host: do you have a favorite campaign? beyond bill clinton campaign, which play a key role, was there another one that ylie? ueprly c n . whed first one that i have one and just had had

-- still have so many relationships there. helost three times and then, i don' w,-w lay remember. >> host: why did he win? he is the father of -- >> guesti think he probably uld relate to middle class people that are then scranton. ifoumerato w e son of the guy who challenged [inaudible name] for the nomination in 1964. casey was a democrathahad lost before. he was -le. t vra on economic issues, if you will. but there was a cultural class bres -- [inaudible] [inaudible]

>> host: the alabama portion? >> guest: [inaudible] hi pyla,u can go ovhe pen adiaabwit e people. it has now been described as philadelphia is in alabama in the middle. thmos n htter in alban inkt'at u erp >> host: was your favorite campaign, stan greenberg. >> guest: nelson mandela. >> host: caller from nebraska. good morning. >>leoure oeir

>> caller: the way he sees the middle class, i dn't think the middle class is stupid. the problem with t middle classi eiit is country. it used to be years ago caribbean people in african-american, which now you can see they all diagree th -- eboanoe wan to hire awroem t o ie the legal immigrants and they turned away from the caribbean people spending every penny in the united states. today, everybody wants torn ay fm th[di] the middle class -- it is going to reach the middl class. >> host: thank you from the call from nebraska. >> guewhe t toitnd pfu

ones. >> guest: that is exactly the point. when people want to be heard, her, that's why they say the middle class. cr:d in we go to rew in qio fthme that mr. james carville was with the clinton administration to the obama administration, the people that were in the middle class of it educated -- they al got educated and have col degrees,ow uer tba nat tht avt eg degree is now have lost their ability to get a college education and that education has went from the money that was thr forfder frhemdl ls a h tbi tt money. we are now seeing all that money go to the loer class, and we

are losing that ability for that middle class to pull themselves . prm across all classes. working class, the poor, everybody is struggling. it has been driven by -- it has been driven by a failure to get contofrdti de theducation. student loans program was out of control we talked about what has been wrong with the for-profit colleges -- thereis amassi problem. is t ju a pblemt it across the broad middle class, which is in trouble. >> guest: one of the things that has happened is that college has gone very expensive. that happened between the time president clinton, a lotf it, [nle

i think the president di everything in 2000 women. the way they were funded, the studenloans come in federal moy was given to the bank. the vernment assumes the rk fothe lo sntasback nktese they didn't pay it back, the government had failed along. president obama said listen, take the bank out of it. [inaudible] i could be wng on that, but i think that's how its yovelo at how the cost of education is impacting the financial crisis in louisiana at lsu, i wear a cap ontelevisio to show my support for higher ucation in the united tt ad [inaudible] 40% of public funding. it has become more costly if someone wants to go there.

it is a little bit more complicated because the tate pays otiwih n henderng ats happening across the board in higher education everywhere. the job market is not as good and you are having more debt. this challenges the basic sh g good education. we talked about that a lot in the book. >> host: you also write about politics, james carville, d you talk aboutelection 2010. you said there was some sort of colltive amnesia about the state of the coury at the end of the bush administtion. thelcaasvry gianited. they went to the polls. previous presidents, democrat g: pesblican. meg rge as thfoophare tr

the demographics of the people that turned out -- they did anybody give people credit in a democracy when they come together. they've actually had meetings

over i-- they would take over the government is sending wake at oe thappen do us nal isldne of the faires. now what are the chances of some of the blionaires getting together and doing this? castro you know, i'm concerned about him all ittaks. d wlbntr, tim not too concerned about taking over at the levels of government. we should be worried about is having so much influence on the levels of gutterman, but other pirs e wrin this book we've got to get the money under control. you can make government work for the middle class if it is so dominated by obsts moonnde anmore and doing.

that's not the right thing if you have a right to be worried about it. postscript is one in "the wall street journal," you cannot connect for every americans thretre thn. owy'nt. >> that is what drives this book, actually motivates it. like the calls were getting here. that's what motivas this book. they know they're in troule. on oweayca ca ofgaorhis campaign? >> guest: "it's the middle class, stupid!" all e ie. we talk about this is bhainr ngtm. 'rena un solution. if you talk about it, these are the types of naes to do the rebuilding of the american middle class. you get a lot more receptive audice and nusort-term

qukx >>min,ina james carville. >> caller: i've been a longtime democrat and i'm so disgusted with the democratic party. number on,mvicom idise rt at e next four years or more important. i don't see me because our party can't run on the last four years. as a hard-working democra viable life, i am so sick of my thple ty'tat shedn eeal o o t taand from government. every other day the democratic party is trying to pass out this or that to pay for this or that. yeand'tooeshmade $30,000 i pe ng$10 a year and getting by and are happy. so i want you to know that.

just go i'm going to take a wild guess. i don't think th guys really a ikealt anyway. look, $30,000 given to generational responsibiliti come you goto understand what if hn thahi n e pe wngd aliv the edge and i think you've got to recognize these are hard-working people. >> there's a whole dy of people that say you shouldn't worry about i that ad thgtd,b hansio of quality. people 30 ars ago didn't ha thndrss a

be tthrseo would driven 20, 30 years ago. and so it's like, why are you finding out? at thecountry doesn't say aspirational and if we don't move foraao me go radios?a the quality of life is way more than the day you got your iphone. so what do we sy? lashes let th land barons and bberarons take everying tog f that gets a little bit lost but you're trying to educate and you made 30 rand. you're working hard and are not realiving thatmcre rao gvrn. >> host: so this is how the book came about. >> guest: you both worked with hillary clinton.

valley if she were ton,whhe sti bteedbe est? >>stthi se ran and i do not know she's going to run or not. if she's cannot do it, her belly sky to be on fire. i mean, i know she thought long hawhr ote om i think probably the question she had to ask yourself is do i really want to do that at the level it takes and she did. i k lle ou i nid anhi sh give us a shot. >> host: tm so, virgini >> caller:i eems me up decner agenda

and i'm just wondering how much of your book is focused on restoring because it seems also he cin sulus package as far as the agenda is can learn. just go >> guesti dot kn m on i ihe thought machine. it's just a bunch of sign this perspiring to take over. it tctn 1977. thank d and just talking about the middle-class wages in the state they say now,the cell phones,

an's ld things upture whenoe a bit. you know if it clouded up a little bit, people would just be confused and say what the heck. you know, as a result of all of th, and a look at the gallup llil abihin s credibility. it sounds like a bit of a stretch, but people look atthis penn state report that came out. it's a look at power ot helping ordinary people. you have a lot oweul th aaping to a lot of ordinary people and in the interest of protecting power didn't do anything about it. most people to understand that and i am not one of them. most people thik this inerest vrhe h poeti e enormous scandal, which

is nothing else but powerful people, though a lot of other people. and the plan over and over ch.pens nm oa aio t budgetary tatian and trust we have is really wreaking havoc on the country. >> cleveland, ohio, goo morning. >> good moring,jm e n'uno deine to area. i just wanted to know because i believe you are a person than i could ask questions to do won't y to hide anything. buthssbnou areairly hoest s ing about the powerful people you're talking about and how they are dealing with us?

>> guest: the ac alr: the computer chip in her hand, right out of the bible. >> guest: i'll give you an honest answer. i don't know enough about your topic to give yo we apze lle i ain t it is. >> host: you say voters not readers and long-term are suing g: t ibuery tis changes. we have an election that was about the economy as bill clinton pressed that issue. when it was over rude to the state of the union if itpeople are going to fous onlot ecomy. fu t w bree on everybody. the election would come together and figure it out.

>> host: the president did address the naacp. another reference to the 92 mpai foril lnn. melinda kellenberger both famous as a similar moment for mitt romney before the gathering, something clearly expect it. threg o thtepe likely to vote for you when you tell them something they don't want to hear. if you go to people that won't go for you anyway and tell you something they don't want to hear, it doesn't match up late vempnt ease'e rte pele are loong at romney right now, just like bill clinton at the beginning. he went to the unions and said a pro-trade. before jesse jcsonsd

e ere foe hepoo supporters and that independence, you can trust me. romney had something. he's sending them the signal but notdb. ueheonngha hwn ft the nra and say we have to be careful because it's something about gun control we need. iabthgh to vote.sident biden because when you have the right to vote at the right to change things. [applause] actually, th re oht d aa o tuhehoigar xpd, diminished. where racial profiling is a thing ofhe past.

share my where access to the ballot is exnded and i ener e re itinction made on the basis of race or gender access to housing and land team. [cheers and applause] so much mor. osamesce. esde gte idea -- he was having a heck of a time. he was great. he's a good speaker and he gets fired up pretty fast. >> host: before we let you go, thoo er utti rech writing? >> guest: the most important thing is listening to people. you have to listen to ordnary fos. whatever you think about the iso o e fanl trvo tt right.

>> host: has your wife read the book? >> guest: she hasn't. i think ere'someinth yourhe'lagre i >> host: the book is titled, "it's the middle class, stupid!." stan greenberg and arville, thank you both for being wit us.

>>out sed s onndde rofessionally run, but the candidate knows who is helping him and why. ese are al code words for saying we are a fact is i'm ma because we are affected, our orhef carn to be chokedof

er omsion eeo to nuclear energy and to to to pardon this discussion about the future nuclear power. they talked about new nuclear power technogy and how politics have changed is that u sheisr jpn thowe lub of california in san francisco, this is just over an hour. ♪ >> great to see you here. i'm delighted to be here with us to talk about power in california and beyond.

i'egome to the commonal da tk fre narer america. for the first time in 30 years, new plants under construction in this country. two reactors in gegia and two more in south carolina those plans for a billion dors i gas,si o caarmiewnron of safe, clean nuclear power plants come and go. the fukushima disaster in japan in the united statesak new nuclear top to sell. for thnextour 'lscus mmaltuscme s edra l as well bui to an. conversation will include lessons from a wide audience at the mmonwealth club in san francisco and three experts feared i may write is jens voigt retoomiocl iht is that wine --

marv fertel at the trade commission for the nuclear industry. and center for iestigative urnast w cov t cl nuryeael hem. [applause] marv fertel, what's with yo why should the united states build new nuclear lants? >> the firsteaso eg to kesrw nua li eri sy pl pce.l the other reon is we have a society move to a cleaner, less mission, particularly lowe environment, nuclear is right now the only srce elic24ndduno greenhouse gases or other air pollutants. so if you want reliable electricy, we want to make a move to a cleaner environment when we produce it, if not the

only thingbut veryor paf >> new nuclear is intertwined with extending the life of existing nuclear power plants and we'll get into that. but what are issues that should be ca you do when the licensing timeframe for the country's cxisting nuclear power plant reelfef e ic tac tht plans for a license for 40 years in the expected lifetime of all the component of the plan and to extend that mass is happening for another 20 years onehd edeplyntediio patbity to rviv another 20 years to not endanger anyone. with nuclear is very high rewards, incredibly high risk so g ated wh anhinggig wehalo experience with the degradation of material, the almost whole

and head of the davis play and, the problems with the rest and corrosion in a cage d it doesn't e pabo old materials for having linkage in california to two year old materials. celine california is the question. it goes beyond aterials. it goes into dealing witother hrea shcraly eminds us of what threats in active site as is japan. being california and i is the commissioner are the types of games you thik about amry ibidem want toiig deonmofr atllasr california and what we suggested thnrc they think about for a period not a bad idea for the people as well. >> will drill into hs tig

sjg yovhe whre k issues? >> well, i think we are a nation divided and it comes to clear energy. i mean, if you lok atwha' inwterief, owfuimhek e up with recommendations, making plans face her across the country and basically the key is to go the fast approach and the otr commissioners rsedoer ooit tr,mr thcamp of any i. and not completely blew up this year. the other commissioners accused mr. yass go of bullyg. asldba winhons he said basicaly in that what the other

commissioners were doing was putting the safety of the public fundamentally advanced and the price shouldt p ouotaf here. i think the real issue right now is the old pla that we have in this country. the 104 react or is, of which re ionstiote74 mate ha problems such as davis bessie were byron and illinois. instrynd ithin the's stroued nyanntgig in the area of renewables that there's a lot of question marks around new nuclear power. >> marv fertel, troubled industry quick >> no, i don't think so. i woagree wi sof clysftysm.

also to be honest with you, the plants are told in the way they've been described. everything in the nuclear plant that's moving, every pump, every motorist changed out to reproductive preventiveprogr. yoveyoar or airplane. also, issues like both jane and joe reference the davis bessie corrosion were not implemeing the program that the rest of the dustry wasimpleming sereat wheav e problem. the thing is you've got to do it. you've got to do which are supposed to do. you do that, the plant is a very safe operating plan. i totally agree wi hm iduticd wa toho yave to mak su its economi theory to be safe you may decide it may not pay to go ahead and do that and

you may see that at somepoint. right nowhich are doing is suhents eaer to ma 1uc ps he country. there's another 32 under review. so fa everybody who wants a nuclear plants is about to run this for anther 20 years. ont t r dgr than building a e roit pactily lk for problems? is it technically thorough enough? >> it took the nrc tenures to nd the renewalce who lot systems our age degradation programs, looking at things that are being looked at every day as part of the normal stuff. also which you have to keep in mind as you get a 20 year itoeots c at y t wve at

they silicate chew every day to make sure your operating safely. they can shut you down whenever they want to every player as you'll see inthe post-fukushima environment to impose on the ofniettema d otfocommisoners and i would say the chairman called me right after the task force came out. he said we should try and get the high-priority things done in five years. fieaograhply buthe airm wand to do and his colleagues didn't want to do was jump in and say we know we need to do, go do it. they had a report done by seven retoinhn fut xpse wted it to be fleshed out a little more with input from not only nei, the stakeholders that concns scientists and others and that's what they've done and issued orders another thing

subsequent to last year's an es stake, perhaps innovative regulatory agency and then it changed. tell us where the nrc is today. dreoif .as per racki re wit your introduction. what is wrong with the nrc? well, they're not the unaggressive agency they once myn taton emredt issues are rapidly enough thoroughly enough. the int i want to make them safe in issues here in california. when weraise te qestioabout , wh ren fly men one utilities at will relicensing the others everything in about it, we began

to raise the iue of the additional seismic studies that ould be done, the most current seismic technologies. aftel i on o $500 million, $5 billion because they had to design, rebuild when they discovered. as we are good another was weuest h rbds. lat at tv bere you realize they said we do not consider seismic issues and relicensing. >> is this before or afer fukushima? >> befor is e a osekosde mi because under the ongoing provision that get anything going on. if somebody bring something to her attention, we look into it. i only come back before the u.s. senate committee with the

chai sng hao avenliou for years, was published in its documents, former commissioner tease men who say mean in the rang out published the first in liiao ess rd. mdo ntow you need to look at soe pains and yet they didn't? so to me, california was on its own to look at california's issues nd see something done? i don't think th are captive of industry or anyones juhi' ina bureaucratic maze of regulations that have eliminated their youthful faker when they were against agency that would pursue a more rigorously thin going . >>t peaf fukushim if they said we've got to pay attention to the seismic risk that created this?

>> they certainly dove in with what it represented ended their and seisis cin parofndatns recoenon rss ct k he et time and they may know more with authority with regard to the seismic studies at california says need to be dne. what fukushima did for carn wasross uli is mong fwardith e sesmi hethee t done. but whether nrc takes that into account and relicense, that remains to be seen. >> joe rubén, what are you doin to prevent fushima from happening here? are they on thew t ia nrc. there's about 4500 employees in the nrc and i think we interviewed conan escher