would be here. i present the guest with a mug to be used for low calorie healthy beverages. and last question. traditionally hospital food has been regarded as being pretty terrible, bland, and uninspired. do you sample patient's food and any ore advice for hospital systems? >> i sample -- [laughter] i sample patient's food every day at lunch. and thank you for the opportunity to be here and the mug. [applause] thank you for coming today. i'd like to thank the national press club staff including journalism substitute and broadcast center for organizing the event. here is the reminder you can find more information about the national press club on the website also if you'd like to get a transcript of the program please check out the website again www.press..org.

thank you we're adjourned. [applause] coming up on c-span2. a hearing of federal forest management and preventing wild fire. followed by the president and ceo of the cleveland clinic talkingbt controlling health care costs. it was about those men and women who are almost mortally injured in war. who because of the huge advantage that have been made in medical trauma treatment over the last ten years. that was being saved. incredible number of them are being saved. almost everybody who falls on the battle field is being saved. i wanted to write about what life was like for these people. i started off with a question, vk seen some people who were

pretty, pretty grew gruesomely maimed wouldn't it be better off if they were dead? don't they wish if they were dead. >> "beyond the battle field" in the subsequent e-book he spoke with vets and the family as well as surgeons, combat medics, therapist and nurses on did the ily struggles on the severely wounded on the military operation. learn more sunday at 8:00 at c-span q and a. this weekend on american history tv. 30 years of the administration's of ronald reagan and bush and clinton and bush have done more to confirm marx predicts of rich getting richer. than the soviet union. from lectures in history socialism in america. colombia professor on the rise

of socialism of 20th century in america. sunday more from the con ternsd the series on key political figures who ran for president and lost but changed political history. this week thomas due wee. he rose to frame prosecuting gangerrers. he would lose to fdr in '44. american history tv this weekend on c span 3. insurance industry estimates wild fires in colorado have -- wild fire prevention and forest management. members are testimony on three bills focused on forest health and the role of local community on federal land. the hearings is a little over two hours.

[inaudible conversations] service meeting hear today just diction and deal with the significant issue of our national forest and public lands catastrophic wild fires from happening in the future. since we're not doing a very good job with the present meths of stopping them in the present time. under the rules of the committee, the remarks limited to the ranking member.

and the chairman, i ask you unanimous consent to include any other opening statement in the record if they were submitted to the clerk by the end of today. hear nothing objection, i ask unanimous consent for my member who wishes to join us to participate in the meeting today. and once again, without hearing that will be the case. i realize that we are in the crappy situation as far as time is concerned. we have flights you need to make this morning. i also recognize we have brought people in across the country. i appreciate them to coming in to witness. my opening comments i'm going submit on the record. we can move forward. ranking member, do you have any opening comment miss. >> i wanted to say good morning and thank you for joining us. and welcome the witnesses especially those who have been wild fire firefighters. we respect and thank you for

your dedication. to be brief. i yield back my time. >> all right we'll start with the group of witnesses who will talk. we'll talk about the first three bills here. and we give the sponsors. rerecognize you first to talk about 5744. then talk about 5960 and there tip ton if you go through 6089. you have five minutes. go for it. >> first, thank you for holding the hearing and coresponse sour the bill the catastrophic wild fire act. my thoughts and prayers go out to the constituents who have suffered from the catastrophic wild fire. i express my appreciation to all the men and women working to protect the lives and property of our neighbors. i have a slide show on the screen now though to some of the devastating impact of the fires. district i represent arizona's first congressional district is one of the largest congressional

districts until the country. compassing eight of 13 rural counties. contains over 37 million acres of land mored by the federal government including over 9 million acres. that acre include many of the apache, tonto, national forests. last year our communities were victims to some of the largest wild fires in recordly history. the wallow fire grew to over 800 miles in a few weeks. tearing away some of the most treasured fire. the horseshoe black end another 200 acres. this year fire season has not been better.

it is clear that the process of planning studying consulting with litigating appealing and collaborating are failing us in the forest. the frequently of the fires and mag attitude are increase since 1990. the five largest wild fires in my states history. the road and in 2002 though at cave creek in 2004, the willow in 2003 and the fire have occurred in the last ten years. prior to 1990, the largest fire was fire in 1970 which burn 57,000 acres. our ecosystems are suffer candidating. we had once had ten to twenty five we have over hundreds. roughly 80 million acres are overgrown for catastrophic wild fire according to the data base. our forest have been mismanaged for a long time. it's past due to change the strategy. they prioritize fighting fires.

we need to press them. it we must shift priority toward a proactive management. we can't afford to do otherwise. catastrophic wild fires difficult to control and cost the federal government millions of dollars and immediate fire response. and many millions more in restoration and rehabilitaion. the western forestry leadership coalition a state and federal government partnership estimates the cost two to three times the report of sprugs cost last year they spend a record total of $48 million on burned area recovery work. $25 million has been spent to prepare for the immediate aftermath of this year's wild fires putting the u.s. forest service on track for another possible record. what is the dispanding in the way of the fiscally sustainable forest management? red tape is preventing us from participating.

my bill authorizes the forest service and department to implement wild fire prevention projects including timber hair harvest and grazing. the focus on surface, reduction activities. in other words, dop indication and sets firm time frames to bring more accountability to the process. forest thinning works. in eastern arizona the areas that were treated as part of the white mountain project contract design to thin the forest and white mountain triable lands, the area managed locally by apache tribe were cleared. today there are healthy trees with burned underbrush. in a land that were untouched by

thinning practice. the majority administrated land in the state left scorched stuff behind. we need to make restoration easier. this common sense approach garnered strong bipartisan support. the legislation has 32 cosponsors from 23 different states. utah senator has introduced companion legislation in the senate. many of the supporters represent states or congressional districts with large swath of national forest land. not massachusetts. in short, they are people directly in harm's way not safely tugged in con vote junk l. thank you chairman for the leadership on the issue. i look forward to the committee action on the floor. i yield back. >> thank. it we will let him whenever he appears. mr. tipson, if i can turn to you now for h.b. 6079.

>> thank you for including my legislation h.r. 6089 in today's hearing and the support of the bill. i'd like to thank my fellow members of the colorado delegation. thank you for the common for l valuable cron try biewtion to the effort. the em demic -- [inaudible] devastating wild fires of the in colorado and throughout the western united states this season. they are detected state and private lands, the damage is oftentimes more heavily concentrated in federal lands where a lack of active forest management has allowed it to spread to catastrophic levels. of the 6.6 million acres infested in colorado over 4 million are on the federal land. federal efforts to responsibly manage our forest and prevent

the con decisions of the fire ravaged colorado and other states have been it prevents progress. the health forest management act gets greater control to the state and communities most directly effected by the conditions. and provides a pathway for and local emphasis. this legislation build on bipartisan healthy forest restoration act of 2003 empowering states, counties and tribes to be more active in addressing these emergency circumstances we can proactively manage our forecast forrest, produce fur direction safe guard water supplies and promote a healthy environment. utilizing the tools in the health forest restoration act which proven to be effectively to reduce the cost imposed on taxpayers due to litigation

procedures and restore forest before they go up in flames cost far gather. h.r. 6089 priority disietions conservation by making public private partnerships for feasible. this bill is result more than year committee work. meetings with the bureau of land management and other agencies meeting with county and state officials constituents as well as congressional hearings on forest management. everyone we talked to agree more needs to be done to be able to manage the federal forest. this legislation is the outgrowth of the stakeholder engamement. the further -- [inaudible] support we have received for the legislation from colorado and local state and national groups and organizations on both sides of the political spectrum. since the bill was introduced this week. it em powers governor to be able to work with county commissioners, tribes to be able to identify the most problematic areas. the spots that pose the most

risk of fueling a wild fire and take action to be able to manage the risk by removing hazards things. it allows them to take proactive measures to mitigate the wild fire. this bill isn't a talker, it's doer. for this, the healthy forest management act received the support of the colorado timber association, the colorado association of cons violation districts, commissioner from around -- also given their endorsement. so have other places and other things. i'd like to urge my colleagues to join us in the strong

coalition of support for common sense bill that takes action. to be able to fix the problem and seriously address the critical state of the western forest. thank you, mr. chairman i imreeld yield back. >> thank you. i'm -- we have several witnesses who have traveled great distances. i'm aware of the travel plans back home. i'm going get you done in time. some of the witnesses witnesses are dressing the bills. i'm going to make sure we do those who want to address all three bills at the same time. mary weigher wager from the forest service. ed who will be addressing all three bills. can i also invite, there is where we're going make the change here, my second panel?

commissioner beginnings, joseph rome. i'm sorry about it center of american progress. you can speaking on all three bills. if i invite you. and invite hank from the national association of forest service of retirees and tom. the commissioner from garfield county in colorado. actually, if you are coming up here to be the first panel. i appreciate that. i was excited for awhile when i saw garfield county. then i released it was in colorado. not in utah. disappointment reigned again. already. if i can ask you -- am i missing somebody there? oh. good for you. if i can you once again if you would address the first four witnesses all three bills. and then the last two witnesses, the commissioner and mr. cashton from the retirees if you would

talk about 6089. once again, i say we're on a short time limit to make sure everybody gets their available time. you have five minutes. you know the drill. most of you have been here before. we have your written testimony. it will appear as written in record. this is an oral testimony. hit the highlights. it comes within the five minutes, make sure. when the green light is your free to go. when the yellow means less than a on in the sum up. i apologize now. when it hits five minutes i'm going cut you off. i want to get the testimony so it can be heard and get through these issues and get people to meet their deadlines they have in here. so i appreciate that. okay. i think everybody is situated. we realize you're happy to be here and thank us. don't do that. you have five minutes. i'll start with you mrs.. >> mr. chairman, i'm going to offer a few remarks this morning and note more detail in the

written testimony that's been submitted. drought species loss of open space, severe wild fires devastating outbreaks of insects and disease. all these are affects america's forest on an huge scale. 82 million acres are in need on restoration. 85 million acres at high or high risk of large wild fire. increasing the pace of restoration of the nation's forest is critically needed to address the forest of the ecosystems, water sheds, and communities. in fiscal year 2007 we accomplished 3.11 million year. we are on track to accomplish about 4 million acres. we have increased strides working with community organization and environmental groups forestry, local government and community, state tribes and other federal agency we have demonstrated forest thinning reduce the intaiskt of

fire. we have more to do. i want to offer my appreciation to members of this subcommittee and other members of congress for your interest and action on the issue. i want to compress my condolences impacted by wild fires today. this is the reason our work needs the best. before i address the three bills. i want to tell you about some of the work we're implementing in many cases new authorities and tools from congress has made this work possible. we have investigated in restoration projects through -- these projects stakeholders can facility large landscape scale restoration. the land scrape strategy developedded alone exceed 16 million acres in the footprint. and the strategic placement will help build more landscapes. states are foached partners in many of these projects. under the 2008 farm bill, state

forest action plans required. we partnered with the state and coordinated across boundaries for the plan and in process of implement them. we have the bark strategy focusing priority treatment areas to ensure human health and safety. we have used tools available toot agency such as god neighbor authority to go on nor treatments. prongses bill congress provided resources and authorization to implement integrated resource for three pilot regions in interior west in the united states. irr is going to bring resources necessary for maintaining ecosystems under one item give us a lot of flexible to do the necessary work. we have worked hard on improving

the efficiency for restoration. a couple of examples were closed to issues two new category exclusions for soil and restoration activities and we're increasing the use of landscaping skill. larger acreage two examples of that arizona forest initiative the document that is covering the restoration plan for the rage is 750,000. covering over 250,000 acres of mountain pine beetle at risk or impacted landscape. lastly, we're work as parter in on the cohesive strategy through the flame act the asked the agencies to put together a trait -- optimizing coordinated response to wild fire. we are working with a host of

local municipal state other federal agencies players to respond to that strategy. a critical part of these efforts is building public support for forest restoration and management activities. department imposes h.r. 5744 there are elements bill we support and like to work with the subcommittee and sponsors in billing language that meets the objectives. we support the bills we would like to have further discussion on some of the almost we do support good neighbor authority and reauthorizing stewardship authority. as well as fires impacted lands across the west we recognize the interest, urgency and willingness to tools for to apply restoration principles. we look farred to working with you on the issue. >> thank you. thank you for watching the clock so diligently. i appreciate that. i saw speed up.

>> from the department of interior. same drill. >> thank you, mr. chairman. for inviting me to testify this morning. department of interior and fire strategy is working toward maintaining resilient landscapes create fire adapted communities and managing wfort response in the complex environment. and agency of the department of interior management is committed to sustaining the health diversity and productivity of the forest and woodlands which together comprise 58 million acres of the public land which we manage for the american people. the mounts effects of insect disease outbreaks prolong drought climate change, innovation of harmful species about accumulate of fuels generate increase risk of catastrophic losses including risk to life, and property and

that may result from before. wild fire. to protect lives and property wild fire habitat an other resources from wild fire. toward this goal, bl mr. last year treated had 400,000 acres. guiding off the management actions including forestry and fuels management is the agencies land use planning process. the blm uses a planning process no include public input and analyze the effects of proposed actions. we value this process, and the information it provides for us. the two of the tools that we have used effectively in our fuels management program are stewardship contracting and the good neighbor authority. to date blm successfully use it in over 100,000 acres reducing hazard fuels restoring habitat and protecting commune tries

wild fire. they use the good neighbor authority in colorado to partner with the state and gain some efficiencies in achieving restoration goals there. with reg toongressman go czar's bill h.r. 5744 it requires the blm to authorize wild fire prevention projects life stock graze and timber harvest around public comment. it would allow timber harvesting and would impose strict time lines for public review and analysis. it deems the process as compliant if time lines are not net. the bill also requires fair and fuel research prior to endangered species act listing. critical hat tat. they are committed to use the fuel reduction treats to maintain the to protect it from

wild fire. we do not believe that h.r. 5744 will help achieve the goal of mitigating the risk of wild fire damage. the bill will curtail the use of some of the most vawblg assessments and analysis, the bill strict time lines for public review and environmental analysis coupled with the fact that the legislation deems project compliant if we don't meet the timelines would not enable sufficient analysis. the department imposes the bills provision and the provisions that change eas. regard to 5960, it amendments the healthy for rest restoration act to provide for enhanced work and research and authorizes stewardship contracts and good neighbor authority. the bill supports the authorization stewardship contract and expansion of good neighbor authority in the legislation. these authorities will enable blm to better achieve land and

forest health goals in coops with the partners. department of sports h.r. 6960 and would appreciate the opportunity it to work with sponsor on technical improvements. we defer the forest service on the portions of the bill that relates to the national forest. with regard to 6089 it authorizes the state governor or secretary to designate areas of public lands that as high-risk of current and future damage. for areas designated as high-risk, the bill requires blm to implement projects in those areas under reduced environmental analysis. the bill also extends stewardship contracting and good neighbor authority. department imposes 6089. the definition of high-risk areas outside of the normal planning process particularly by governors without consultation without federal land managers prevents public involvement,

environmental analysis, and makes those designations and further the time frame for designating these areas and implementing proposes project is not sufficient for our analysis. ..

restoration act, which has helped expedite forest restoration act. however, there is much more that can be done. as can be seen from the fire that destroyed 100 dirty three homes across 43 million and suppression costs in 2002 and many like it, the cost of fire is vastly exceeds the cost to treat forests. over 80% of which national forest land from 146,000 acres that dead trees near communities need to be thin. the challenge in finding resources for projects and existing regulatory systems. we have treated 3800 acres in the urban interface currently under have for a traditional 13,200 acres have been approved for future work. however, we attempted thousands of acres that need urgent treatment within the urban interface. as a result, some have additional resources here to do decimate some voters passed a

measure which authorized the tax levy for wildfire protection, which could generate up to 500,000 per year. in 2012, the county was able to apply $300,000 from the spanish words for 12 projects on 140 acres on private land within the wild urban interface. the color radar restoration act, a bill he passes out bush to grant program made available $1 million annually from straight revenue and watershed protection. these funds were available for a statewide ingrates applications far exceed their needs. the tone located within summit county was the recipient of some of these grants used to treat forested areas along street and major drinking water supply for the town. the town was rightly concerned that a fire would greatly impact watershed. these grant funds were used to treat 64 acres. so long with the tony tax while

they were able to get the projects done. but again we still have thousands of acres to address an area slake street creeks and homes. that's why if you're interested in but more congress can provide and the bills before the committee today have provisions that would help in this regard. generally speaking the projects i mentioned would be enhanced by these provisions. let me highlight these concepts. first, we need more funding. the task of removing hazard entries is daunting and state and local communities can only make a dent in the effort. i understand the bills you're considering in this committee are not primarily about funding, but he or she can make this a priority. second, designating areas impacted by insect and disease would allow the service to focus attention on resources this area. we welcome designated areas as emergency or critical need in playing the provisions to these areas and appreciate them

consulted in the designation process. third we strongly support the good neighbor authority, which allows state to performance federal land and authorize this program and make it permanent and expand to all states. fourth, we support permanently authorizing stewardship contract he and mechanisms that help make the projects more economical for entities to bet on them, especially in partnerships with private contractors. these provisions provide tangible and important assistance to reduce the diversity of wildfires and promote a more sustainable forests. we need assistance of these policies to augment state and local efforts. we have undertaken vigorous efforts to mitigate threats every services through collaborations between state and local government, private industry and land owners. so, were not able to address without further assistance. we urge both sponsors to come up

with a single build an inclusive concept to negotiate compromise resulting in a bill and get past with a single sign law. the communities and resources, especially the drain on the federal treasury with an ever-increasing wildfires demands that congress come together for a nation's well-being. thank you. >> thank you, commissioner. mr. romm. >> thank you for inviting me to testify. former act and secretary of energy and climate expert who runs the blog kind of process. for scores in seven years ago our grandfathers and mothers were enjoying life and now imagine you are in congress back then and imagine the nation's leading scientists are warning that human act diggity inures a bad land management practices have left or top soil vulnerable

to the forces of the wind and the next time a major drought is, much of our farmland will be dust in the win. you will take action. over the past two decades the nation's scientific issues stronger and stronger warning that human activity, burning fossil fuels and deforestation will lead to longer and stronger drought, the dry topsoil and timber grading conditions for multiple multi-decade dust bowls and wildfires. in fact, were already topping dustbowl temperatures in many places in the earth has warmed only one degree fahrenheit since the 19th 30s dust bowl. yet we are poised to warm some 10 degrees for night this century alone if we stay on her current path of good admissions. i repeat several studies now project the world may warmed 10 degrees fahrenheit this century for doughnut and that is the average warming of the globe. much would see far higher

temperatures. the recent heat wave would consider pleasantly cool summer. another study looked at midcentury warming are just two degrees fahrenheit and from the wildfire damage in many of your home states, utah, colorado, nevada and washington would double, triple, even quadruple current levels. imagine how big the government would have to be to deal with the rear but wildfires in the dustbowl choking the bread basket of the world. a lot bigger government than today for sure. so of course this body is to avoid this catastrophe with carbon solution. except it isn't. we are here discussing bills aimed at fuel treatment from a euphemism for cutting down trees. annoying carbon solution and focusing solely on fuel treatment to academic of bark beetles, epidemic of drought and wildfires is like rearranging deck chairs on the titanic or

more precisely like earning some of the deck chairs on removing the umbrellas on the titanic. same outcome, more time wasted. as explained in the journal nature last year, what we discuss here today is the single most important question facing the nation. can we prevent the extreme drought and wildfires ravaging the country today from becoming the new normal? the real question i am addressing myself to the members of the majority now, is how you want to be remembered. you want to remember to say herbert hoover who sat facing obvious calamity or an abraham lincoln who took every measure to save the union? lincoln said at gettysburg the world will little note nor long remember what we say here, but it can never forget what they did here. that of course wasn't true of his speech. but after testifying to congress nearly a dozen times since 1995 when i was secretary of energy

i'm quite convinced that nobody remembers what we say here and in the case of these bills, everyone will forget what you did here. are you double chamberlin or will you be when churchill who worked tirelessly to mourn and prepare written for what's coming to the house of commons in 1836 the air for procrastination of measures are baffling expedients of delaying and coming to a close. we are entering a period of consequences. the consequences are here and now, just as climate science. if we fail to take action, many scientists will ruin for large part to the contrary, ruin the last 50 generation. americans have fought for generations to defend government of the people, by the people and for the people in the hour of crisis to the government to do its job. now is that our. thank you very much.

>> commissioner jankovsky. so i say that correctly? welcome. >> diane thom jankovsky -- >> in my kitchen make sure that is on them by your mouth. >> you hear me now quick >> i'm thom jankovsky, garfield county commissioner, garfield county, colorado. i worked in the ski industry 40 years and general manager of the not resort, local ski area in colorado. i've been on the forest in colorado traveled here to speak in support of h.r. 6089. this bill is to the health of the colorado forest to improve safety and stewardship of the forest and provide benefit for local communities. first of all, the health of our forests is at risk and deteriorating pier colorado forest are extremely dense

because of what i believe is misguided management practices. currently 30% -- currently our forests are easy to 100% canopy. also the bard will epidemic has deteriorated the evergreen forest and drought conditions have impacted our forests. the nation watched the recent tragedies in colorado in the wallow kinnan and hide park fires. as on the denver post yesterday at $450 million in private property laws as well as lots of lies. current federal regulations fail to recognize the importance of our forests regarding water conservation, water supply, recreation, economic asset and multiple uses and environmental health. h.r. 6089 improve safety and strength and stewardship. this bill expands stewardship beyond the current healthy forest restoration act and not

the 20 year life. he gives us the ability to expedite hazardous fuel, reduction is also gives us the ability to manage and restore forests. this bill empowers the governor and state and local communities to designate and cooperate with federal land managers to develop emergency hazardous fuel reduction projects and also gives the benefits were federal land managers, another tool to work with local communities. the bill supports an emerging forest restoration industry, which is clearest tarting twos innings treat, which provides tools and manpower of forest restoration. through this as we've also an increase from our natural resources for lumber mills, lawn furniture making, firewood sales, biomass energy and wood

pallet. and so, this bill although it doesn't say it directly does provide some economic impacts as well to a communities. h.r. 6089 allows for creating and funding as well as private partner as private public partnerships to reduce hazardous spill mitigation. also, i would just like federal land managers know the high around areas. i mention this earlier, but it gives them a tool in working with local communities to address those risks. one thing not in the bill that i would like to talk about that i think is very important and we continue to educate the public on defensible space. we have a lot of communities and homeowners -- homeowner associations at the forest right now in colorado citizens can be reimbursed up to 50% for the cost of the improvements of the

space. local.regarding public land use is important for us. nearly 70% of land in garfield county, colorado is owned by the federal government. it really helps us have the ability to talk to those and be empowered to work with the federal government. indeed the vitality and strength of the western united states closely tied to the health of our public lands and for those reasons garfield county, colorado supports h.r. 6089. thank you. >> thank you. i appreciate that. mr. kashdan. >> mr. chairman, on behalf of the florida service retirees, we appreciate being here. our comments are specific to h.r. 6089, healthy forest administrative act, but want to

notice the attention given to all three bills is important in bringing attention to continued degradation of america's forest and range land. the cause by insect infestation throughout and other actors. this is a serious threat to america's public lands, communities on an adjacent to those lands and our infrastructure. as retirees are clearly feel action is needed, action rapid, efficient, collaborative and pushes the envelope in terms of procedures and authorities. we all know increasing budgets is not a fixed and we also accept the potential for budgets to be decreasing. in a legislative approach has to be a focus on public-private partnerships, reduce process and much greater recognition of this crisis. we think h.r. 6089 supports this approach. i want to acknowledge the excellent work of the agency so far in addressing this. the forest service approach with

the bark beetle strategy and the restoration program in use at the integrated resource restoration budget pilot should go a long way towards increasing the accomplishment. for joint work and use of stewardship contract team release of the cohesive strategy are all important. these are steps in the right direction, but we do think more is needed and we think h.r. 6089 will really help moving process forward. with the exception of a minor reservation, we strongly support this legislation. for the stewardship contracting legislation, let me just a thank you. that tool is an essential part of future accomplishment in working with communities. the contract term extension to 20 years we think is helpful in incentivizing investment in the business capital and building long-term community participation in decisions about the adjacent watershed. the good neighbor authority

being made permanent is a critical need. the inclusion of categorical exclusions for projects within 500 feet of infrastructure is important and we like the governor's authority to designate high-risk areas. now we understand some reservation on that part. i remember distinctly when the good neighbor authority was implemented back in the late 1990s there was some concern about what i would call shared authority if you will. well, concerns about that have not come to pass. as we look at the expedited procedures called for on this though under the healthy restoration act regarding analysis and judicial review, we think that the governor's high-risk designation making those procedures applicable is a good part of this legislation. we also very much appreciate the application of those same procedures to non-urban

interface lands that are also important to addressing degradation. i mentioned one reservation. let me just say that provision calling for project implementation within 60 days of a governor's designation, even in the case where the secretary may not have designated area as high-risk, we are concerned that my raise the national resources in terms of budget will be shifted to those projects. across all public lands, there is very good work being done by the agency hasn't been done with a very limited funding level. so to think that there will be a shift like that is probably not realistic and where it has been attempted in the past is with little success. so we do think retaining the federal agencies authorities over the program of work is

important. i meant also don't want technical correction dealing with the section six prohibition on clear-cut relative to hazardous the election, large amounts of species that requires openings in order to effectively regenerate. so we think there might be some in the should be considered in the final bill. so with that mr. chairman, let me include my remarks and look forward to many questions. >> i think all the witnesses for having come here and given testimony to date within a five-minute level. i'm aware of flight plans everyone has. i am going to yield my time. i will ask the panelists if they would limit their questions to 5960 and 6089. once we have a round of those questions i have two other witnesses talking about 6744 and i'll bring them up and ask questions on that bill by itself. the representative noem, if you'd like to take my time

first. >> thank you, mr. chairman. i have plenty of time because this is an important issue, i thank you for yielding and allowing me the opportunity to ask a few questions and make an opening statement. my question is for ms. wagner. or maybe how many acres specifically have the bark beetles impacted since the epidemic has begun. >> i think the number in your testimony was around 18 million. >> i've got corrected information for that. across the information, impacts the bark beetle in all jurisdictions over 43 million acres. >> and you also discussed in your testimony to 65 million acres are at high risk for wildfires. that is a number that not necessarily are all impacted by pine beetles epidemics. it's a very high number, even if you took the 18 million number. i was running numbers while i was sitting. it appears to me would have been

treated and addressed is less than 2% of the lands which you have jurisdiction over have actually gone in and been dealt with and treated for fiscal year 2011. is that accurate? >> for the bark you'll strategy that we created and implemented in fiscal year 2011, we've treated over 300,000 acres to increase resiliency, reduce public safety issues. relative to the size of the impact of the pine beetles i agree that's a small amount of acreage. overall were trying to upscale treatment, landscape and address priority areas ms were the 3.7 million acres resort in fiscal year 11. >> for me that's a very disappointing percentage. we have obviously a lot of testimony today we have a critical situation on our hands and when the federal government has jurisdiction over land, it is my anticipation may be responsible for maintaining and

taking care of those lands, especially when private lives are at risk. this is a very timely and incredibly important issue for states across the west, including south dakota. i got you in chief tidwell have had conversations with me in my office regarding this and how south dakota is impacted. this is one of the hottest record on number. forests across the west are turned to the tinderboxes and we've heard testimony today. one fire in the black hills claimed the life of four national guardsmen in the carolina. so my hardest and going out to those families as well in fighting the fires going on. the outbreak of the beatles has changed our landscape. iphoto zero pass around to other members that can look at what's going on in south dakota. what is so interesting when you look at this picture and i'll let everyone on the panel look as well. you could see the vast difference between what has been treated by the state and what

the state is taking care of them the difference on the forest land and home the pine beetle is out of control next to words state has gone in an address. i'd like to think my colleague for introducing legislation. i'd also like to thank everyone for being willing to tackle this issue. it underlies the importance that we have people on both sides of the aisles looking to find solutions that's not republican, not democrat issue that impacts all americans who care about our forests and livelihoods of thousands of people across the nation. one other question for ms. wagner as well. have you been out to colorado or to the black hills and visited to see this with your own idea? >> i have not personally. i know the cheapest many times in the field. we spent times with many members. >> about to personally invite you to come to south dakota and bring achieve tidwell. he came and visited with me and i appreciate that. there is an urgency on the

ground and i would like to bring you to south dakota and show you around. if they say something about, you know, we certainly have cooperation that is potential there i certainly would love to have you envision not in the that together how this could work and how these bills could work on the ground for the benefit of the people. so with that, i yield back. >> thank you, representative. let me turn to the ranking member, mr. sablan. >> thank you, mr. chairman. them to stay with ms. wagner. almost 15 years ago, the forest service began the process of reviewing management in this area. in 2001, the forest might dominate issues regulations to protect these areas and recognize one of the most far-reaching conservation by

federal government since it was passed in 1964. after a decade of litigation, systems of aircraft provide protection. h.r. 6089 declares an entire national forest system and even endangered declaration weight this area protection in colorado and every others date. >> the position of the administration as we support the roadless area rule as an act to amend review by the courts. so there are 58 million acres under that management strategy identified across the nation and then specific conservation in the state of idaho and one under way for the state of colorado. in the case of high-priority need for fuel treatment and fire

risk, the majority of those acres are outside of roadless areas, and so we think we can abide by provisions of the roadless area conservation rule and work on forest restoration with even inspired a landscape. >> thank you, but let me get back to my question. section three of h.r. 6089 declares the entire national forest system and imminent threat. plus, this declaration, section three ways the protections in colorado in every other state. >> i believe the word. >> thank you. >> mr. roberson, two of the most important environmental laws make it difficult for the public to engage the federal lead managers. can you give us an idea and make

it short, but how many hazardous spill projects to plan management implements every year and how many of these projects are repealed? >> we have treated in the last 10 years 23 million acres that fuels and hazardous full reduction projects of stewardship contract. and in 2011 -- >> i can't hear you. >> okay, over the last 10 years we have treated 23 million acres of land. we restored grace anhalt and forest health of those acreages, using fuel projects from a few reduction projects. we've also in the last year as an average treated 400,000 acres. and we have less than 1%, half of 1% are actually protested and appealed.

these are projects the community support that we've worked on with the community and they've not been appealed. >> thank you. mr. kashdan, let me ask you this. do you think all 193 million makers of the national forest system lands are in imminent threat to health and safety so that roadless area protections should be suspended? >> well, let me address that this way and then moore's the keen on my own behalf because we have an taken a position as a retiree group. the concern is that roadless lands are essentially lands in limbo and when he told shall he make some determination as to how to assign those management status. that would be as far as i go i'm not.

>> already. and so in your testimony, are you concerned about the requirement for agencies to implement projects? governors within 60 days. due to, or why don't you have the same concern with the requirement to implement projects i.t. agency within 60 days? quickly, please. is that a realistic timeframe? >> if i am following your question correctly, let me just say that i mean that provision, although it has -- tends to get a lot of the at tension and is presidential, 99% of the benefit derived from this bill is not germane to this issue. >> thank you. i appreciate that. mr. tipton. >> thank you, mr. chairman. at night to give particular things to mr. jankovsky for

being here out of my own home district. can you give idea to the county commissioner, schenley spent dealing with issues relating to plan management? >> well, land management in general -- and the new county commissioner. i've been in office for two years and i thought i had a pretty good idea, but i'm spending 50% of my time or more on federal issues concerning our county. and there are numerous. this is one of them. >> should federal agencies engage county commissioners quite >> there is no doubt. i think the benefit to this bill is there creates a working relationship between local communities and federal land managers. i think it's very important. i had the highest regard for federal land managers in our area, but i think there could be a great improvement.

>> rate, thank you. mr. roberson, i'd like to ask the restoration act of 2000 or eight for public input with respect to projects carried out in terms of the act. >> yes, sir. >> they do. those are authorities were using here, so don't worry about the public input you are concerned about in your testimony and opposing the bill. we have provided a public input. thank you, sir. i really want to build a visit with you if they can for a moment. i appreciate your candor and 6089 and i recognize the fiscal constraint faced by the agency. with your extensive experience, do you believe there's efficiencies within the agency that could be pursued that would help prioritize the approval of the reduction projects and be able to actually help meet this fiscal need?

>> yes, sir, i do. i also think the provisions in 6089, specific to the healthy forests restoration act of 2003 regarding appeals analysis and judicial review will greatly enhance that. see you combine those efficiencies. you find the non-wildland interface and use of the existing tools of stewardship contract incurred will go a long way towards improving the accomplishment. i think there's examples of how far you can go when you're encumbered by minimal analysis. i think are very emergency rehab is a a program rapidly executed, delivered with good results and done with a wide demand on the part of the public regardless of where they stand on the environmental spectrum to get worked done, to stabilize after catastrophic wildfire. it's an example of how far dollars ago when you're not encumbered.

>> appreciate that. it would bring common sense to the process analogy with common sense to address the problem, will be able to achieve an actual win-win. they appreciate that, sir. ms. wagner, had the opportunity to go into archuleta county and toured area being treated a bad ministry and he was talking about. we were talking about water table in croesus 15% hike being able to thin the forest. all the trees were able to survive and be able to grow. is it pretty much your estimation that when we see the tragedy of these fires moving to areas like south dakota, colorado impacting watershed, impact to wildlife habitat and impacting streams and endangered species, that is a good sensible approach to be able to bring together tools and local commitment of working with

commissioners and local governors, working with the tribes, the people who lived there among the most to be able to make the simple determinations of where the real risks iraq? >> yes, we are keenly interested in working in an environment in doing our part to sustain our nation's forests. >> rate. thank you very much for that. i would like to come back to you. in your testimony you mention the great success of the neighbor hood policy that the efforts that are going on. given this, do you believe it might also be beneficial to expand adaptability to the land as well? >> definitely. i think a good neighbor authority as well as some of the other efficiencies modeled similarly. there was similar authority in oregon and hazardous fuels money is authorized to be spent in a similar nature.

it works and to apply to other federal agencies they could think to do. >> thank you. >> mr. kashdan, i apologize for cutting you off twice. >> i want to explain what i want to get done. the ranking member of the full committee is here as marks of this particular bill. and two other witnesses but also have plans to catch. >> you have any questions specific to 6089? and if not, mr. gardiner, i assume you're here for 6089? when i turn you for questions on that, we'll finish the questions while our two witnesses are very specific for that bill. bring the other two were for 6744 and then we can do it that way.

>> europe. >> thank you, mr. chairman. members of the house resource committee for allowing me to join you today and participate and thanks in particular for the work on this legislation in the work he's doing to help protect the united states, one of the most incredible resources it has to offer. and also i want to welcome the witnesses from colorado. thank you, commissioners. commissioner, kids, good to see you. thank you for your work here. i am stunned by the callousness of the department of interior's objection to the forestville 6089. big situation were washed in this fiddling ahlers states are burning. and your testimony, you state governors can require to meet

the governor subject is or if you return to the american people. if you returned to the american people? i have over 200 homes burned in my district. tens of thousands of acres are burned. you want to protect wildenstein or rivers? we have ash and debris contaminating the river. drinking water systems overwhelmed. you want to oppose this legislation because it gives the governor authority to save his state? blm's ability to manage resources protected by federal law. do you believe that beetle killed areas are high risk? >> yes, congressman. >> do you believe we ought to

get the states the tools they need to protect their citizens and their state? >> we believe that we in the state should work together along with the local counties together. >> do you believe you know better than the state? >> now, i wouldn't substitute my judgment. >> why would you oppose a bill that gives the state the ability to protect its citizens? >> we are managing national public lands intern to do that to achieve because of political balance the nation. and to provide for jobs and opportunities as well. we believe in the principles that were outlined by congressman dinh just raised and mary wagner just agreed to. we believe we should work in concert and we do that at the state and local level with the governors are cohesive fire

strategy will allow us to continue to work on building the site landscapes are working together and fire preparedness. >> is 90,000 acres of burned forest rizzoli? >> 260 homes resilient? >> are your forest policies working? to prevent this from happening? >> dipper of land management has approximately 1.3 million out of the 58 million acres we manage. we are focused on that issue. we have a plan for infestation in colorado and other areas and we are working through our local plan and offers with county commissioners, state forrester is another land managers to address the issue, including the state government. our plans are reviewed by the governor said the state.

>> the bill provides high-risk areas designated for 20 years and we project that. hard beetle killed areas going to be around for 20 years? >> 20 years ago in my experience we did not anticipate the level we have now. >> class that again. will they be around for the next 20 years? >> i can't project, sir. >> i am saying -- >> the dead trees won't be there in 20 years? >> i'm sorry. my statement is that 20 years as a designated high-risk area is too long, we believe. >> how long does it take to reach a catastrophic wildfire? >> pardon me? >> how long does it take to recover from a catastrophic wildfire? 20 years or less or more?

i yield back my time. >> thank you. just one question on this particular bill. let me just ask mine and i were going to make the switch. i think they also would deal whether they can fit in a concept as well. i just have one bill specific to this. you said to distinguish a high-risk areas not enough time. how much time is enough? how much time do you need to make that designation? >> we would normally do that working with county commissioners and the state and the state forrester's. we would work with them to death at a high-risk areas. >> i'm not sure how long it would take. i think the level and the magnitude of the multiagency. i have no estimate.

>> i will tell you my frustration is simply not just with you, but with almost every agency around here. i'm a schoolteacher which means you have nine months to do it and it was over. by i princeville came to me and said the final test was on tuesday and i simply said look, can't cover all the material by tuesday. i'll get back to you when we are ready to actually take the test. you can imagine what would happen to me. in my profession is trained you have to get it done when the deadline is fair. yesterday we had another hearing. same situation. there is no deadline that happens to be there. another hearing said it would take an agency for years to do a study. those are frustrating to those of us not inculcated into the climate of washington d.c. 60 days is not enough. that presents an illusion of a problem. that is difficult for me to wrap my mind around it because i'm it because understanding deadlines and i had a choice in that matter. without i appreciate that.

i want to thank dashti of the questions? sorry. mr. markey for this panel on 6089. >> mr. romm, do you think climate change is -- >> mr. markey, can i interrupt? i asked if i could do just 6089 so i can get these two witnesses on the way in number and the other witnesses that i would appreciate that. >> now, i do not have any questions. >> commissioner jankovsky, i appreciate your attendance here and flying all the way out here. you can go back and enjoy yourself on this particular stage for the game. i can invite david cook from the

arizona cattlemen's association -- i'm sorry, the national beef association and toil shamley to come and join us at that panel. and while they are, not, cannot give you time to introduce your piece of legislation. the other two would give you time. >> thank you, mr. chairman. i just want to make sure that the list of organizations concerned citizens in colorado and throughout the united states is supporting the 6089 to be able to submit letters of support for the record. >> thank you, mr. chairman. without objection so ordered. i apologize for shifting gears whenever in here, but i'm trying to get everything to move in the proper order and one of you i now have the flight going out this afternoon.

we would issue their there on time. mr. markey, can i give you five minutes to address your legislation? >> thank you, mr. chairman. very much. i first want to address congressmen gosar's earlier comments about the ability of people who live in the concrete jungle of massachusetts to be able to understand wild fire and forest issues because that's an ironic comment coming from a gentleman who lives in a land locked desert state, voting this committee just two days ago to authorize trolling for oil and gas off of the ocean, off of the coastline of massachusetts. said the gentleman should probably square at where he thinks coming in now, he has expertise to be able to vote because they should never be old

to vote on anything in the oceans or country. although let's be honest, our job is to vote on everything. we are to represent everybody. it is absolutely inappropriate on to allow most numbers for most subjects because their stay would not be the center of the issue. we are here because taxpayers of america fund it all, including respond to fires and what happens after the wildfires is completed. it's a national issue and the taxpayers help out the taxpayers of arizona and colorado taxpayers of colorado and arizona half of the taxpayers of massachusetts when they need it. that is the essence of what this institution is all about. but as with the low resolution was about, including the civil war to finally resolve that, but it's not separated, isolated states, but all of us working together. i just wish the gentleman appreciated that.

much of thank you, congressman bishop -- chairman bishop for holding this hearing to combat wildfires. i'm glad the full committee will be holding investigative hearing next tuesday. today we are considering a bill he cosponsored with mr. grijalva, mr. lujan, mr. napolitano, mr. costa, we have a very serious problem and i'm really to name it. the problem we have impacted lands across this country is climate change. if you think storms and drop conditions of catastrophic wildfires are random feet prevent coming you are in deep, deep denial. when sigmund freud said a denial come he suggested when people are forced to face unpleasant facts, they are prone to deny the reality of the fact outright. to come them in a may seriousness of the issue. or three, project responsibility

of the unpleasant situation of someone else. this is an apt analogy to how the climate deniers have chosen to deal a severe weather events, drought and wildfire. for months the majority has denied that there is a problem. not the majority apparently is willing to accept part of the reality that we are approaching dustbowl like drought conditions and fires are becoming larger and more severe, but they still denied the group cause of the push to the extremes is actually caused by climate change. instead, they are going to project the responsibility of wildfires on to environmental laws, land management agencies, litigation, and dangerous species and emigrants. if we are serious about reducing catastrophic way must admit there's a link between climate change and wildfire. the undersecretary of agriculture, harold sherman has submitted the link exists.

the chief of the four service has admitted the link exists. they have proven a link exists. earlier this week on a massive chunk of ice twice the size of the island of peterman glacier in greenland and scientists point to warming ocean temperatures as the culprit. i suggested we rename it to mira island, with those who question the science behind global warming can spend the summer cooling off at escaping the heat waves of the drought and the wildfires that have beset the united states. they seem to be legislating from denier island. the goal that i have is to introduce legislation that will make it possible to recognize we have a problem without forests. it also recognizes we don't have scientific certainty to lock-in

gazing projects for 10 or 20 years late the other measures opposed. instead, my bill allows the bureau of land management flexibility to do thinning and areas impacted by insects and disease without waiving environmental laws enforcing federal agencies to make decisions on projects and unrealistic time frames. my bill also recognizes our constrained fiscal environment and gives the federal agencies additional authorities they desire to stretch their federal dollars for the rest we will hear from both the forest service and bureau of land management stewardship contracting authorities very helpful by allowing agencies to buy trees. i thank you for the opportunity to make an opening statement and i appreciate the piano that will be here to discuss the subject. >> thank you. mr. shamley, and understanding of the first white thingies to go out. i ask you to make the first

statement and then mr. cook and i will open up questions to mr. markey's bill. so if you would, please. >> patsy county, arizona. i also do work for many other entities like state legislator other counties, et cetera appear the need for sweeping a massive reform and the mechanisms to expedite forest management projects to reduce hazardous fuels, increase for essay on economic element cannot be stressed enough. the current system in place is heavily laden without a date along with uncleared conflict in and made upon the land management agency slowing down an already cumbersome system even more. many more roadblocks to feel reduction stewardship activities by county so i went pre-and post-fire activities need to be addressed and removed as well and there is no doubt in the minds of apache county and elected officials around the western region that something drastic has to happen.

unless we have drastic sweeping changes made, we will lose our great western timber stands. those will affect the very cultural and historic uses other people, the people's ability to derive economic benefits, recreational abilities along with the massive amounts of habitat and wildlife and nature of 5744 to go along with getting mad because we are at a point where emergency measures are needed now. having this week just to 10 of the meeting of the national institute, illumination of catastrophic wildfire keynote address service completely evident, illumination of catastrophic wildfire keynote address service completely evident with experience on the land to the threat to evident with experience on the lands to the threat to our nation heritage. the bulk with prior plan management agency people have come together alongside old school phd scientists research professors in college to address

these issues. one thing notable during the saddam was the multiple instances in which presentations and conversations turn to the issue of catastrophic wildfires on our forest and what to do with the forrester of the country and mainly especially in the west. this is the overwhelming evidence of the current estate affairs with nothing but irreparable damage. another topic that needs to be highlighted and address the goes hand-in-hand with catastrophic wildfire prevention is the necessity of the road networks that cannot be neglected. those roadway networks proven time and time again after the wall of fire. and remember, we just went through the last summer. eight over 38 square miles destroyed. those roadway networks are a critical part of the wildfire prevention. those have to be integral with

their future plans, including but this bill and mr. gosar. sweeping changes are necessary to the stewardship of our land in the county stewardship by apache county, arizona needs to be replicated throughout the united states. h.r. 5744 would allow county stewardship and others to more easily move forward with wildfire prevention and protection of health safety and welfare and office areas under our jurisdiction. post-fire activity almost next to none if you want to know the truth, been on the ground. post-fire recovery programs lost shortsightedness manager misguided to be useful to the very people and resources they were meant to be helping. multiple programs came down and many of us have to ask after going through the conundrum of bureaucracy and red tape and see no outcome. agency after agency, dollar up on dollar was in front of the big ones of these fires with no

outcome whatsoever. where did the money go? many of us have to ask. millions of dollars and absolutely unusable by anybody affect it. unless the very fabric for the practice is on the national resources in this country, our review of the best available science will occur in these times to call for immediate action. excuse me, unfortunately these bills and questions can make in that attack these problems. we need to remember, too, that this is the catastrophic wildfires are just a symptom of the disease and that is to a great extent is management by federal land management agencies of our land held in trust for the public. with added like to remind everybody of a little historical note the way to get those back in control. the government and fire. george washington alluded to that when he stated the mechanization of the government,

how they were like fire and was a dangerous servant and a fearful master. >> thank you. i appreciate your testimony. mr. cook. >> chairman bishop to members of the subcommittee, thank you for inviting me to testify in the house resource bill 3744. n. david kerr,, rancher from arizona, where my wi-fi along with son and daughter bond a cow and calf operations on private lands. vice president for the national cattlemen's beef association today in representing the public lands council of arizona cattle association. livestock grazing represents the earliest use of western lands as their nation expanded westward. today those lands and resources found on them continue to be essential for livestock, wildlife habitat, open space and rural economies of the west. however come a hands-off management approach by the federal agencies have led to severe damage of the resource.

by often shutting down logging and continuously reducing racing on public lands, multiple use industries are suffering. this mismanagement is causing a buildup of fuel that leads to catastrophic wildfire. when catastrophic wildfire breaks out, there are no winners. not the wildlife, not the communities of the taxpayers. that is why we are here today to discuss real immediate relief to the dangerous situations on a near our public lands. last year in arizonaalone with a million acres burned up impacting 100 ranching families in displacing 18,000 head of cattle. as of this week, over 1.5 million acres have burned this year in the west alone. the overall cost of wildfires ranged from three to 10 times fire suppression costs, not counting property laws, personal injuries and death. for ranchers, the cost includes just with cattle, loss of

infrastructure and livestock. what's the cost of this destruction? we should start by looking at me that. agencies face a tremendous workload of hourly analysis with other regulations. they planned, study, get sued for months and even years on end, creating backlogs. extreme anti-logging an anti-grazing environmental groups within the rings to file suit on procedural point blake missed deadlines often times collecting attorneys fees. in doing so, they had to agency workloads and further worsen the backlogs. the result is tremendous economic uncertainty. the forest service estimates the backlog of 26 grazing allotments. i've personally been involved in a year process to redo a simple 55 c. per mat. how is this acceptable?

we should also take a look at another environmental law added greatly to the problem of the endangered species act. it poses a huge threat to many wildlife species, yet you say is often used on the duties such as timber harvesting and grazing. the very activities should be used to reduce fuel loads and diminish the threat to wildlife. the spotted owl has all but wiped out the timber industry in the west to drastically reduce grazing. either way, over half of the mexican spice were destroyed in the wildfire allowed. how long do we have to watch everything from wildlife habitats can the subdivisions to natural resource go up in smoke on the nightly news or for a country calls for a start to the mismanagement of these public lands. the catastrophic wildfire prevention act goes to the heart of the problem. regulations that have led to overgrowth of fuels will expedite grazing and thinning

projects and encourage free enterprise solutions on federal lands to reduce the threat of catastrophic wildfire. ultimately reducing threats to communities, landscape and endangered species. if a special focus on two priority areas. the wildland urban interface and endangers he sees habitat. if the agencies missed the deadline, it automatically dooms projects compliant underneath. it does not wait for endless deliberation in high-risk situations. neither should we. the bill allows for a 30 day public review and comment period. no wonder what environmental groups hold off until the last minute to bring projects to its knees. finally, but requires use use of existing esa emergency provisions to allow for informal consultation capabilities common sense and will put people to work and helped countless communities while improving the health and safety of our forests. thank you for the opportunity to testify today and i look forward to any of your questions.

>> thank you very much. i appreciate how both of you hit the mark right there. that's very kind. you're watching very well. we are now hoping to question of mr. markey's bill, mr. gosar's bill. i know you're probably on the same airline that mr. shamley is going on. we'll talk to you about how you should be using dalzell later on. ..

>> to find the tools to be most expeditious. >> i am ltd. on my time. give me a time table. we said the 60 days. >> 60 days four governors to identify? there is nothing wrong. it would be advantageous to look at the state action plan. >> in good stewardship you

should argue to do that. >> absolutely. >> you are not in favor of the time table. give me your specifics. >> i a.m. in agreement with chief wagner. we need to look at the local plans and the cohesive a fire strategy. and together we identify those high risk areas. >> i don't see a problem with 60 days. i see a lack of trust with counties and states with the federal government. that has to stop. i don't see the federal government keeping their promises. there is limited finances. when we look at the zero widespread swath it has to

reinvigorate the private sector to return on investment. mr. cook, give me your experience. this wall of fire was a disaster. >> it is not returning but it has affected families of would give the total of $56 million to revenue growth in in the communities >> to have a stewardship with the environment? you have to watch this carefully. >> publicly and ranchers are one with the land. we are stewards. many times agencies tied our hands. right now the number one threat to to the spotted owl is catastrophic wildfire but

they do not want to address it was grazing. >> enterprise creates money and royalties going to our education system? >> i agree. i saw the information secure schools act but in the west we want to be put to work. we don't want government handouts we want cattle on the way and and manage in our state. >> i know you just got back from a conference. you have amazing intermission? >> yes. there essayed growing movement in academia former employees of agencies that

it is the disposal of the public lands back to the state your cannot manage the forest as the system is now broke a weevil destroy massive amounts of habitat. we are hamstrung currently to do anything about it. the county's stewardship program is sold and it is working. >> you are blazing a trail that is common-sense. >> yes. we have created a lot of jobs already. >> down south near florida half of the island is lost and green and the other half

is dominican republic. there must be something wrong. you know, your business better. their places in the world to see the consequences. to understand the science budget with issues of climate change might invite to youtube coconut trees inside a water and at this time i yield my time. >> 2012 we emerge from the

great recession but the drought is threatening the maturity of the country. the dust bowl losses due to a space but also with poor land management. has the rain dried and the winds came the flash drought not because we failed to learn the lessons of the land, but because we failed to heeded the warnings of nature. with another can of climate catastrophe.

with the fires in the west? how much can we attribute to the rapid the changing climate in the united states? >> the question of the day. with the next dust bowl it is the most pressing problem. wayne no global warming makes extreme weather more destructive. the analogy is a baseball player on steroids. you know, it was breaking records then you know, this is what is going on. scientist knew there were

three reasons global warming would make wildfires worse. the polymer index is based on soil moisture how much it evaporate span and how much comes down. if it is hotter you have more evaporation. global warming makes the drought's longer and you will get to earlier snow melts. we had no winter. winter was like spring. summer is hellish. that is global warming. colorado had a staggering loss. i've lived in both your

district and yours. with the rocky mountain institute. i know what the place looks like 20 years ago. with the earlier snow melts many does not get precipitation it requires the stream of flow from the reservoir of snow and ice. the second impact is you lose the snow belt earlier. and global warming changes the climate and shifts the drive belts and when you expand that belts it hits the southwest with less precipitation that is the

double whammy like colorado. more soil moisture evaporation. and the bark beetle. >> the gentleman at yielded to me and i am appreciative. >> we will come back. >> thank you, mr. chairman. to go back on topic of the hearing, as simple question is the bark beetle been amended to threat? yes or no? >> can we start with you? >> there is concerts -- concern for the impact. >> yes. >> >> guess. >> congressmen, yes.

i brought some samples. >> keep them captive. >> it is the -- it is a long-term threat to it is not yes or no. it is invasive species because the climate change. it will keep invading it is the threat to from 20 years from now. >> absolutely. >> yes. absolutely. >> the senator from our state had requisitioned a steady coming at the request to the u.s. forest service the primary reason we see the bark beetle infestation is because the forest service actions with active management, drought, lack of

a allocation, limited access to areas due to the inability, federal land designation as the primary contributing factors to the rampant bark beetle outbreak. since this was a report that came out from forest service do believe it expedited approval could help us to do that to given the permission we receive from southwest colorado to thin out the devastated areas we increase the water table and the health of the trees? >> we would like to do more with the bark beetle restoration. >> i'd like to yield o the rest of my time. >> ms. wagner we have the pandemic. not just the bark beetle but others.

somebody here who has the measles and we are stock here so they are more contagious. we have different species with different requirements like the ponderous of pine. we want the 25 trees per acre instead of 600. we have to address the problem. may just aggressively creating the pandemic? >> yes. we have serious concern because it is hot and dry. >> so that jar is a focal point* for the disease. because they create the infestation? >> yes. conditions are right. >> the longer it stands the bigger the problem? mr. cook? >> i ranch in the ponder rows of pine area.

i see what you talk about. with the drought you have the trees competing for the same drop of water. the forest and needs to be thinned out. why can't we agree with that? >> i agree. i could take anybody here to go see our once great forest and the forest service personnel that indicate due to it being too thick with the lack of activity there weekend because they compete for water is when the beatles move been spent go back to the rodeo >> recede mitigation by the tribes to we have that problem on the tribal land? >> not at all.

they are treating the land with proper its two words and thinking of conservation and preservation. >> they think about conservation things the forest? it is the oxymoron. >> it came to a halt at the apache reservation with treatment. >> is it all old-growth? >> it is awful next year. >> thank you very much. i have more questions. i know you have a flight. it will not be offensive if you leave. we're happy to have you here. please leave when the witching hour hits. >> just to come back to

you, trying to be reflective to explain the bark beetle and why it is reproducing twice per year with the change of temperatures causing that to happen. why it is expanding its footprint because of climate change and changing temperatures and tried to explain that scientifically with the metastasizing of the problem. in england to the winters are 4 degrees warmer. now the maple trees go north headed toward canada with the change of climate. we barely had a winter last year. the maple trees are going

further north. the bark beetles reproducing twice three-year able to cause more damage and the climate is at the heart. it is a big change. i don't know why we cannot agree. not just the west but a common problem. you can put to a band-aid on it but you have to step back to look at the larger climate cancer and what can we do? i think that is what you bring to this discussion. thank you. >> as a wildlife and -- wildland firefighters how effective are geared tinkers to address the situations we saw in

colorado springs? >> the utilization of bear tinkers is important. it is most effective with resources on the ground with defensible space but single and gin is the positive the heavies could carry more but the single engine air tankers have more versatility and dart easier to get around. the big heavy cannot fly if it is when the. the single engine are more first tile -- vs tell -- bourse a tow. >> whether a flash flood or lightning or a drought climate change is increasing

with all parts of the country. what happens in the midwest does affect massachusetts there is the food tax. it is coming because of the drought us $7 a bushel we're looking at real consequences with the impact on every american? >> every american is concerned with the zero wildfires 1/2 read many articles five believe it is through food prices from climate change. people can adapt we can go into the air-conditioning room but the farm is out there exposed to prices are

stuck at levels we have not seen in 20 years. food prices are projected to double or triple spinnaker you concerned about the impact on grain and other price is? >> absolutely. the cost association with food prices affects the feed of the cattle moving together and of course, any agricultural producer is always concerned with drought. >> is climate change playing a role? >> my thoughts are different than yours with all due respect. our timeline now is of size of pebble on the stand.

>> not at all. no question climate change makes it worse. people need to understand there is a difference between warming the average temperature and changing the climate. to were three major studies say if you lose the arctic ice you weaken the jet stream then weather patterns are stock. wire they sticking around longer? it is climate change with carbon pollution. >> one quick question ms. wagner i appreciate your service when you are on the

ground. the reference made to baseball bat who runs were the cause some of steroids also of corporation bats but what is the alternative method? one witness dead and there is little empirical research that will work if you will loathsome reduces severity? could you describe the rates with production of wild fire behavior? >> from the and glorify your -- from the southwest we have looked at pre-and post fire impacts of fire as recently as this summer and through visual pictures you

can see the difference list and that this dinner and how fire behaves as it encounters the environment. i would be happy to for that information. >> your testimony with the plane be devastation from section 404. that does allow the secretary to apply assessment on federal lands if it is at risk of infestation with the forest damaging insect. could you define that? >> and believe in term it defines itself.

i think the beetle would qualify. >> you are correct it does to find itself in statute to that does include the mountain pine beetle so how is this new authority if it is already in statute? >> it may have been one of those. >> that needs to be clarified. >> i could get back to you. >> a second round of questions? >> when we have these have the can of the forest fires. they are intense? >> yes. so they sterilize the soil? >> post fire we do the

assessment to determine the intensity and yes we do see some real impact. >> is it easier to mitigate? >> it is tough to recover. >> topsoil is much thinner than it in the east? >> soil types are of concern when impacted by fire. >> meehan the inability with the harvesting process. what part of the road mitigation is tough perth and sterilizing the soil? >> i am not following it the question. >> how is the mitigation worse than the sterilized soil? >> we have the ability to

place the road where it is low impact. >> i a agreed definitively. now tellme other thing is that you drew attention with your most recent speech? >> the multiple counties were glad to hear of the county's stewardship. to protect safety to pass resolutions to bring the fight. after ditching the meeting the locals who icahn and give credit to they worked with us to say you are right

to. you have to treat that it was completely left off any targets by the u.s. forest service for treatment. this town already hath burned down of the other half and the only actions with the spotted owl wall there were no plans by the agency. it was left off the plans and maps. >> with this aspect that we make that shows you could mitigate to take care of forest with increased grazing and in number of different proprieties with endangered species.

the ranch that shows everything? >> but there is a proper balance that shows this working? >> we monitor the spotted owls honor all because agency fails to do so that they monitor but fear of litigation we hire the biologist to monitor ourselves. the owls in my opinion they do not breed and reproduce when the cattle are not present. rehab o lot of science that shows the grazing impact nothing but benefits the endangered species. >> i am about the science.

we have the and felt they should help the situation in danger ring everything. not enough light at the can of the bottom not enough diversification so where herds the spotted owl and the species. >> that is the discussion rehab had. cattle grazing gives a transition zone that is around the wildlife drinkers and that is what benefits. >> you were talking about my district? >> yes. with this discussion about

steroids, of it. the chart is four years old but it still works for this discussion. i had my staff go back to track the number of players in the major irritation major leagues who had home runs. the average was 3.3 players per year over 40. ted williams. then all of a sudden at 1995 and it starts to spike eight, nine, attend, a 11, 12, 13 then it stays

very high and who mob after the congressional hearings decided they would test for steroids. no longer a better diet and the smaller ballparks. then it went back down at 3.3 players per year. by the way the chart looks exactly like this bike with the amount of co2 in the atmosphere with rising temperatures since the dawn of the industrial age when human beings started to inject additional carbon dioxide into the atmosphere. it will take a number of congressional hearings before we realize it is not

the other ingredients the same way major league baseball did from the commissioner down to the lowliest ball player that had a stake in the fake system but a reflection that once we get the artificial artificial -- artificial additional chemicals out of this system the climate will come down so will the wildfires in the drought said. but until the steroids are out and we admit we play a role but all of the other issues are band-aids on the

ongoing basis. mr. romm? is it not a correlation? >> it is causation in. you can with the underlying theory. reno carbon dioxide traps heat they are called greenhouse gases for a reason. of there were none of plan it would be 6 degrees colder and no civilization as we know it. i have learned a great deal on this hearing i am not an expert of short-term management of the forest. no surprise trees compete for water and drought is a big problem and exacerbates the bark beetle problem because trees killed that by

releasing sap but i hear the theory the solution is free thinned the forest so the trees don't compete is we are on a track where your district will see you levels of soil moisture worse than the dust bowl that means more drought and while the fire then another congressman will say we have to thin some more. than 20 years until there is nothing left. that is not a sustainable solution but it is the end of all of your trees somebody who has been in your district i love it. >> i think you. just the way we use the infielders to the outfielders we knew they were not making manteau with the extra row way to lifting

did not make them make a mental. most people know there is something wrong and we're contributing. the beef industry and every other will get to the heart of the solutions we have to put in place. >> one last question. you have a plane to catch. bobby richardson was thus best second baseman. he doesn't smoke or drink and cannot hit 250. i'm sorry. the perfect non sequitur that it could help you live

longer but not have day curve ball. i appreciate that. must there are any other questions, there maybe additional questions that are sent to you. please answer in a timely manner. i hope you make your flights. i appreciate all testimony given today. we are adjourned.

having seen the some people who were pretty gruesomely maimed would it be better off if they were dead?

don't they wish they were erred dead? [applause] today's speaker heads one of the most respected medical

institution of the cleveland clinic. dr. delos cosgrove presides over the $6 billion health care system eight community hospitals, at 18 family centers hospital in florida, center for bring health come a wellness and executive health center in toronto and hospital under construction and abu dhabi. his leadership emphasizes patient care and experience including the reorganization of clinical service with a patient center with said disease based institute and has launched major well this initiatives. under his leadership the cleveland clinic has been named america is 99 most of the call companies broke dr. toby cosgrove it is a

graduate of virginia school of medicine and completed training at boston children's hospital in the hospital in london and serving in vietnam as a casualty staging flight awarded the bronze star and the accommodation and metal. he joined the cleveland clinic 1975 and named chairman of thoracic surgery 1989. the program was ranked number 110 years in a row and performed 22,000 operations ending the international reputation for expertise with all cardiac surgery he has patents use during surgery and his

dedication earned him numerous awards from the cleveland business hall of fame he topped the power 100 listing and is ranked among modern health care most powerful position executive among his many attributes he is known for his ability to provide high-quality care while holding costs down and known for his concern it could stifle medical innovation with four to hearing his opinion from the supreme court ruling for the affordable their act. please join me in welcoming dr. toby cosgrove. [applause] >> thank you very much. the nicest introduction i

had to day. [laughter] i would like to share some of the experience that is going on around the cleveland clinic with the affordable care act. we are very innovative, 91 years old and a not-for-profit with a mission of clinical care research and physician lead and we're all salaried. no financial incentives to do more or less. we all have one year contracts with no tenure and every year we have a professional review to maintain the quality of the organization. it is interesting to see health care. the design we have dates

back to the 19 fifties hill burton act that encouraged communities to develop hospitals be responsible for the care of that community since then health care has improved and we have seen diseases and therapies change. six out of seven causes are now chronic. it is possible to have the technology and one hospital what does the affordable care act to addressing these things? we have three main things. the first is access the

affordable care act with 32 million people who currently need did not have insurance which is a major step forward. the other problems are with quality which is a variable. and cost was with a $16 trillion obligation, 50% is related to medicare. health care bill will do little. we will probably see increasing cost. how is health care dealing with these issues as we go forward? insurance does not necessarily mean you can see

your position. there is a number of steps you go to. so first we put the nurse on call. 2:00 in the morning you can get on the telephone to get advice or where you could go. last year we had 20,000 robocalls. it is a free service. we put together a call center. the rate is 3% drop rate with 42nd average. if you make an appointment

each time you are asked would you like to come today? we saw a 1 million same day appointments we could make 95 percent of those. vendee emergency room. everybody complains about the way to. we've changed the month said one year ago now the average wait is under 30 minutes with all the emergency rooms we begin to address the data they need. i would point* out quality is not one thing but it is a clinical experience, physical and emotional. withy electronic medical

record makes data available you can move from outpatient facility with the medical record going all the time. and a time uc a doctor it is available at that point*. also to have transparency and 30 years ago we look at the outcome to understand what the outcome is. we find there is an issue we could do better. eight years ago reese said we would like each institute together to make it publicly

available. they are published and available on the website. and we think transparency should be available at any point* you can see your chart at any time by asking for it. you should know about your medical history electronic medical records with almost 500,000 people that have access. people who use this take better care of themselves. we encourage people to

active the participate. understanding complications in the hospital we are transparent with the individual departments and out comes a and read post those publicly. there is no more competitive group and doctors. if you went to improve the holiday new just have to rank them and we have had good experience that way. we have begun to look at the

physical experience from the architecture, and we've bring art into the hospital the speakers are not paging people but they play classical music and adds the same to the cost but adds to the atmosphere. we bring in the art therapy and we have dogs walking around to provide lovingly say there is nothing better than um lick from the lab and pediatrics sees that regularly. we like that experience because it helps with the healing. then the last is the emotional auspex to. we are concerned because anybody of the 43,000 could

ruin the experience of a patient. i had an experience when the relative called me to the wife -- called me to the room and were very upset. surgery had gone great because underneath the bet their word dust bunnies. it ruined the entire experience. way to a call 43,000 people online for three hours. with the roundtable environmental service, buses, loading docks and talked-about the cleveland to a clinic experience. that is a major factor how these people are engaged. we no longer address them as

staff for doctors. everybody is the caregiver that changes the atmosphere. we're now in the top 90th percentile with scorers and patient satisfaction an important factor of patients experience. talking about cost we have perverse incentives. is employing positions in all are employed. myself included. straight salary. it did not make a difference three surgeries' or four. i was paid to the same. there was no incentive to do more but we encourage people

to do more in this eat what you kill. that is strange. [laughter] but the incentives are wrong. but one that takes care of the patient and we paid for that to. it has been proven that it reduces cost. the atlas looked at organizations around the country. the two with a low list cost were mayo clinic and cleveland clinic that employed physicians. it also grains them around to involvement. we involve physicians and everything. personal physicians, all of

which but then the emigration of the health care system your completely integrated. that allows us to do important things. we reduced duplication of services, rationalized services and consolidated pediatrics, rehabilitation, heart surgery, a trauma, obstetrics and go to places that do bigger volume and as a result they get better quality and more efficient. that is the case with multiple studies across the country. we recognize health care is

changing. the hospital is less the epicenter going from the patient to outpatient to home care. we can see his replacement, the replacement with a 24 hours day and people going home this same day. less acute diseases and surgical this ceases are taking care of as outpatient. the other perverse incentives, there is no incentive for us to take care of ourselves. we don't exercise, we smoke smoke, we become obese and

we expect great care. some examples. 40% to premature death is secondary to smoking, eating, lack of exercise. incidence of smoking is 90% and rising. associated with cases of cancer in the united states. we began aggressive approach with no smoking allowed anywhere on our campus are parking garage for the property of the cleveland clinic then had smoking cessation for free. then read decided to take a bold step to stop hiring smokers.

it is legal by the way. i checked. [laughter] one of the smart things i have done. [laughter] and then we roll the program out of smoking cessation into the community to help drive and sell losses and in the county relocated incidence of smoking has gone from 20 percent down at 15% in five years. you can make a difference than perhaps we have saved more lives than a whole cardiac surgical career. obesity is terrifying. one-third of the united states is overweight and 1/3 is obese. is leading the epidemic of diabetes.

right now 10% of the cost of health care is secondary to obesity. the projections are that will be at 20%. it will not control the cost of health care unless we control the pandemic of obesity. we figure we have to address this. we started with food. way to look trans fats out of the food in the hospital and made 40 changes of the food we serve, took the candy bars out and the sugar drinks and we turned to exercise and gave three curves come away watchers watchers, access the jim and we have lost 330,000 pounds. [laughter]

it is the start. it is an effort you can take into the country to address these. what to me tell you a story. you will understand the reason. two 1/2 years ago a 25 year-old opera singer flown into the cleveland clinic in said dead of the night. end stage loan disease and had she not had a long transplant she would have died. she recede a double lung transplant and was extremely sick with a medically induced coma for weeks and

recovered and left hospital and came back to sing opera. three months later for the team that looked after her. that summer she married the man who stood by her. then she got short of breath again. she came back after extensive therapy and could not be sustained or improved. she was placed with the artificial long for three weeks waiting for a second set of longs. she received them and is now living in washington singing opera again.

i would like to have you meet her who is with us today. [applause] . . access, quality and cost if were going to be able to continue to drive the sort of quality medicine in the united states and provide quality care so

people like charity can return and sing opera for us and contribute to our society. thank you very much for the privilege of talking to you today and sharing some of our very lives. [applause] >> how has the cleveland clinic mannish reduce costs without sacrificing outstanding care for which the clinic has long been known for? >> one of the main things we've done is symbolic positions in our decision-making and the physicians understand about the things they can do. for example, they came together around pacemakers, hips kameny replacements, purchasing and we reduce purchasing by $125 million in the last two years.

>> what can be done about the decreasing number of doctors and he'll take care of our growing population? >> the number of doctors is not decreasing. the numbers we have never produced in a physicians to look after the demands with the net porter of physicians before. with a shortage of 90,000 doctors across the united states and were similarly going to have a shortage of nurses bordering on nurses. so we're going to have to find other people to be the caregivers. physicians assistants are increasingly used in that allows people to practice at the top of their licensure and technicians are coming in to replace much of the work of nurses have previously done. no need to have a nursing degree to a wet pressure recorded temperature. >> your pharmaceutical commerce

or of physicians who prescribe medicine? if so, how? >> i think all of us have seen in these stories about pharmaceutical companies and device companies encouraging physicians to do that. i think that it's been less a month an issue and the health care world. they used to be a lot of entertainment to win that way. that is almost completely gone to the best of my knowledge. >> is the cleveland clinic were less likely to hire employees as a result of the affordable care act? >> i don't think we know yet how the affordable care act is going to affect us. we haven't seen yet implications in terms of the number of patients that were going to see them figure out how were going to take care of them. clearly any health care organization, a major cost his

people. it's about 60% of the cost of running the cleveland clinic right now. obviously we like to know that in the most efficient way we can and will have to wait to see what the demands required. >> tens of thousands of patients die each year from infections in hospitals and doctors offices. after we reduce the staggering poll? >> that's a great question and that is one of those things that have been brought to the attention. we've seen a 50% reduction in the incidence of such a line infection across the country simply by bundling them using standard or seizures. i think we are increasingly looking at the same thing pilotless that, checklists. columbia was effective in bringing checklists to medicine. interesting that now, part of the other major issue of cost is the end of life and we think

there's a lot lot we can do to both make that a more civil and kind experience are not the same time, let people pass in a less costly way. and so, we are looking that the cleveland clinic to develop those end-of-life check was that will remind people about where you are in the process. and i might just say parenthetically here if you don't mind, this is an important topic. i would encourage you all to think about this yourselves. i know many of you have had this experience. both physicians and family patients are stressed at the end. the worst thing that could happen is to have the discussion

about the difficulty that this represents for most people. i found him a surgical career that if i would enter into the discussion with the family and they would do everything possible to keep your loved one alive and i think they can return to a useful member of society. at the end of the time that i think we come to the point where i don't think that what happened, i will come to you and we will have a discussion about this. and i will not make life go on endlessly keeping your loved one alive. i've always been greeted by thank you so much, dr. i'm really pleased and i look forward to those discussions and i'm greatly relieved to have that discussion with me. if you enter into those individuals and how that discussion with your position, it will be good for the patient, good for you and will be good for the.air.

>> either growing risks or anti-that area products and how serious i do miss him monies to be done in prescribing antibiotic annulment process collects >> and clearly in over my head now. clearly antibiotic therapy is something that increasingly people are concerned about from getting resistant strains appeared resistant tuberculosis and staph infections that we have selected out by our use of antibiotics. i think it's important that antibiotics be used judiciously and the pharmaceutical companies be encouraged and supported as they develop an increasing antibiotics to take care of those firmly resistant strains. >> how can health insurance companies reduce costs to devote more and come to providing medium health services to clients how?

>> i am not in the insurance business. >> prostate cancer is in the news these days with differing opinions to watchful waiting versus immediate treatment. what is your take on this? >> is interesting. now we begin to understand that it says in prostate cancer and that has been done out of a study that is now 10 years old, looking at the genetics of the prostate cancer. we realize that some are very aggressive and some are not aggressive at all. and by differentiating between those, we can decide what is the most appropriate typos serving peer >> when omega-3 fatty acid provided blood vessels, has this happened and how today's fatty acids help improve heart health

quiet >> i'm sure you are aware that we've seen at 30% decrease in the incidence of cardiac death in the united states in the last 25 years. i think this has been the result of several things. this matches coronary stents in bypass surgery. it's about the factors that are worse at taking of yourself, more increasing use of fish oils, if batter and better diet and exercise. and i don't know that any of these drugs have been substantially decreased in their use. >> what do you think mayor bloomberg propose to tabstop your bottle sizes or other steps to prevent items are being sold? >> first of all, i think you have to salute mayor bloomberg for many of his proactive stances and encouraging wellness across new york city. he was one of the first people

to begin to take trans fat out of the food. he raised awareness on many issues, whether this is the solution to the obesity problem with the size of their drinks and the size of your cup remains to be seen. i'm not particularly optimistic about it. >> you said you no longer higher soakers. do you have folks at the clinic who are obese? [laughter] >> the american with disabilities act pretax people from discriminating against people who are obese and under advisement we do not discriminate against people who are obese. [laughter] >> if a patient receives care the cleveland clinic later sued a doctor not affiliated with the clinic on your system of record access with a doctor of access to those records? >> we like to provide access to

the record, but without being involved in electronic medical record it's not possible to send electronic medical record. we can get the electronic radical record to the patient and the patient can take it to the stock her. so if you get treated to the cleveland clinic and get sick in los angeles, you have access to your record and take it with you. >> how serious an issue of noncompliance by patience? had to take the fault visage of prescribed medication? >> noncompliance is a big issue. we're trying to figure out how we can begin to address this. we realize making a phone call and saying did you take your pills today doesn't do it. we are actively involved in interesting discussions with tom warner, cable who can bring it to cable sets a way to communicate back and forth to train the doctor so you can say to the patient, would you hold

up your bottle of pills and did you take one of those today? this is the next stop be on the phone call, which started out as a routine office visit and a phone call reman for ways to do this and i think this is the next step for the future. >> a news reporter indicated there've been 18,000 cases of whooping cough in the u.s. is your individual vaccine is not efficient. what should be done to prevent or reduce further up raikes clack >> the concern about whooping cough is a major concern, mainly driven by the fact that the scare of autism and mothers and fathers are not getting children immunized because of the fear of autism. i think that it's been pretty much to proven and there's not that much question.

the whooping cough epidemic would not have been had we had continuation of the immunization and that's the reason for it. >> copd is the third-largest killer peer but is the importance of research and does that clinic than to increase such research? >> my father died of copd and he was a smoker. i don't think i have ever seen someone with a chronic obstructive pulmonary disease who frankly was not a smoker. the biggest thing we can do is begin to drive smoking out of the general public. this is a huge public concern and we're not going to get that improved until we take care of the major cause, which is really smoking. >> how can health care institutions better work together to have more effective

processes, technologies or political capabilities? >> i'm starting to feel like dr. oz here. [laughter] >> more collaboration. the mutate this to a little higher level. we're starting to see now a tremendous change in hostels across the country. they are coming together and systems. systems are collaborating. as we began to head in just one little fact here come the 60% of hospitals now are part of the system. as we have the systems come together can we start to get more standardization of care, more efficiency and more collaboration going on there. >> speaking of dr. oz peanut popular tv figure, what more can

they do to motivate about better health care product as this? >> i think there's a tremendous need for medical education and this goes television, print, everything. there is a big process of educating people about what the current health care act entails. i think very, very few people recognize exactly what's in that bill and what the implications are for personal care and for the help of the nation. that's a big education process for you all, too. i don't think you can do to match for people taking care of themselves in terms of smoking. my major concern is they have not come to grips with the pandemic of obesity. and just put that in some sort of perspective for you, if you

look at the disability, total disability of employees and take out people who have cancer, 90% of those on permanent disability or morbidly obese. that's how big the problem is. >> a number of states have indicated there are going to expand dedicated as part of their health care affordable ip or bubble this to the system like the cleveland clinic? >> if we don't have indicated patients covered, we'll have more patients who are not patients. currently we are the largest medicaid provider in the state of ohio and this is going to have just more patients without any reimbursement for us. that will cause the rest of us to buy insurance to have premiums go up. >> cottage or hospital in abu

dhabi come about and are you planning other hospitals in more countries? >> it's an interesting sort of history. if 9/11 happened we were operating on 35 patients a month, particularly from the middle east. and at that point, he went to five in about two weeks. and so my predecessors had wedowee try and meet them halfway and establish something in london? who tried to buy a hospital in london, lisa hospital london. and in the meantime, people begin to realize perhaps the cleveland clinic was willing to go offshore. we had inquiries of one type or another from 70 countries and with the that many of these and by far the most good was abu dhabi. it is important that we play not to use better arrangement is not

such that instead of spending money in northeast ohio we are investing in abu dhabi. in abu dhabi building a hospital, paying salaries antagonize a management consulting fee. so essentially we are using our intellectual capital to drive petrodollars back to northeast ohio. in the bigger scheme of things, if you look at what the world wants to the united states right now, they're not interested in steel or refrigerators or cars, but they do want entertainment, and entertainment, innovation. they do a graduate education than they do on our health care. and our facility is the first facility from the united states that has taken the challenge of

going entirely overseas and staffing the hospital, bringing the design to the hospital, protocols to the hospital and taking responsibility for doing it. it's an opportunity to begin to help design the health care delivery system for a country. >> in the success of the cleveland clinic replicated in other countries, why aren't there more hospitals like yours in the united states? >> the cleveland clinic was started as a system that was innovative in a radical time than play positions. in fact, they were let that pass medical bolsheviks at the time it started. and that has not been the tradition. it is very difficult to change from the system that is currently exist in a most places to where we are and most physicians are very ashbourne are real. know what is happening right now across the united states is

changing enormously. right now 60% of the doctors in the united states are employed and 75% of the medical graduates now are going to be employed instead of being self-employed. you see hospitals and systems, hospitals employing physician and essentially that is increasingly like the cleveland clinic over a period of time. and i think you're beginning to see that change happening. it will not happen fast and it's important for the affordability that it will happen. >> you talked about staffing on salary. how serious are the other side of her is that physicians cannot afford to this for delphi and pay compelling? is that a problem we've had in your profession? >> i think it's worthwhile to talk about how we pay and how we

set salaries. we look at what the average salary is across the united states and we try and pay an average of the 90th percentile of that. savannas pediatricians don't get paid the same as neurosurgeons do, but we pay according to specialty gun expertise the individual has and what the national standard for that specialty areas. >> to what extent do medical malpractice lawsuits and premiums when places like the cleveland clinic and is the situation getting better or worse? >> well, tort reform is some team that is clearly not part of the affordable care act. and i think it's an important and we're going to have to eventually deal with. in ohio, we have had tort reform

and it has decreased our cost of this very significantly. we think that there is estimated about 4% of the health care cost in the united states is attributable to malpractice and people trying to avoid it. >> what are the costs and benefits of medical tourism where they go to other nations that are costly in the u.s.? >> it's interesting there's been a great deal made out of people leaving the united states to take care outside of the united states. the data looks at medical tourism principally to places like india and singapore and they always get the data about the numbers that go there. now the vast, vast majority of those are from southeast asia and the middle east and not from the united states. so it is a trickle of people who leave the united states for health care.

it has almost negligible economic influence on health care costs in the united states. >> to the people who utilize 24 hour cause service have you had insurance? >> no. >> rather other factors beyond smoking and obesity that cause ill health like air and water quality what are you doing about these? [laughter] >> you guys are mean. >> there's no question that there's multiple other things that affect health care, but those are the three really big ones. the thing that concerns me quite frankly is the epidemic of autism. autism frankly is something that was not seen when most of us were not kids and now it's one

in 88 live earths. the implications for that, both for society and for the economics are stunning. at the other end of life come the other thing that concerns us is alzheimer's disease. if you get to be 80 or salt, the chance of having alzheimer's is 25%. the economics of that and is now risen into at the top seven causes of death in the united states. the implication of those two things at the beginning and end of life are stunning. until we begin to identify whether it an environmental her or just other fat person begin to do what does is going to put a huge burden on the cost of health care in both the united states and around the world. >> what recommendations do you do get schools to change lunch menus in vending machines away from junk food and drinks to

healthier offerings? >> were very fortunate at the cleveland clinic to have bike race another chief bonus officer at the cleveland clinic and he has reached out into the schools of cleveland and we began to actively help them improve the quality of their lunch meals that they served. that's a big after gone on a long time. the other corollary of that is the epidemic, which is directly related to school grades. magenta great deal of research on that particular topic as well. the food issue in the schools is an acute that we deal with locally. i think this is going to be some pain that will take about a national issue. there's 30 some agencies by the way in washington to food in one way or another at this point.

>> how will the affordable care act of fact medical innovation? >> i'm a little concerned about the beginning to look at the efficacy of the drug or a device when it's in private days to decide whether to pay for it or not. let me give you an example. if you develop a heart valve, it takes you about 10 years of work with animals through the regulatory process to get that approved by the fda to be sold. if you tell where one heart of this better than another it will take another 10 years deal to understand that. i don't think there's very many venture capitalists willing to work in that project. i am concerned frankly that beginning to fund things on that base is would begin to drive a lot of the innovation out of

health care in the united states. you have to realize that health care products developed here are sold all over the world and one of the major experts for the united states can weatherby pharmaceuticals or devices or other things used in health care. and that may well slow because right now we know quite clearly that the regulatory process is a lot faster outside of the united states than inside the united states. we have to remember a bigger scale that she can't do anything new without the attendant risk. if a society become so risk adverse we are not going to see innovation that has driven health care to the point which is double life expectancy in the united states in the last 100 years. >> republicans in cong