it even happens. and that's kind of what i was alluding to in responding to robert's statement about, well, you know, having content in the curriculum that, um, about these different populations so that people are real. like for instance, in lafayette high school after the department of justice came in and did this massive concept decree, um, to help deal with theirlong history of regular -- their long history of regular harassment against immigrant students. finally in i think maybe the third year of their, um, of the consent decree there was, like, a multicultural talent show and food fair which these are pretty basic things that i think a lot of schools do, but the -- some of the students that i worked with said, wow, you know, this was actually done well here, and this would not have happened a few years ago before this happened, and this actually might help. so i think that, um, a lot of times there's a lot of simple

things that can be done that, um, aren't -- that you don't look at when you're just looking at it through this model of, well, there's an incident that happened, and there's a student that needs to be disciplined or whatever, and then there's a victim that needs services which, you know, some of that may be true, but that doesn't deal with the overall picture. >> and i just want to add that i think your question really helps to underscore the question i introduced earlier that when something like this happens in a school, you need to step back and say, well, what is it about this school that allows this to happen? and i think that's what's going to lead you to really sort of face what you're talking about. so thank you for introducing that. >> are there any other questions? well, then, excuse me. i seem to have a problem with my voice now. thank you to all our panelists, and i hope you enjoyed today's panel. [applause]

♪ ♪ [inaudible conversations] ♪ ♪ >> ladies and gentlemen, please welcome to the stage the director of the office of adolescent health at the united states department of health and human services, evelyn kepler. [applause]

♪ ♪ >> good afternoon. it's my honor and privilege to introduce secretary kathleen sebelius who currently serves as the 23st sent tear at -- secretary at the u.s. department of health and human services. secretary sebelius has led ambitious efforts to improve america's health and enhance the delivery of human services. some of these efforts include implementing reforms via the affordable care act, helping 34 million uninsured americans get health coverage, working to slow health care growth costs, promoting public/private partnerships to bring life saving medicines to market and collaborating with the u.s. department of education to help states increase the quality of early childhood education programs. along with other administration

officials, secretary sebelius is a champion of bullying prevention efforts such as launching the historic effort to stop bull riing in schools and -- bullying in schools and commitments through mechanisms such as the stopbullying.gov web site, a one-stop shop for kids, teens, parents and educators to go online to learn about preventing and stopping bullying. she's truly passionate about helping others. her passion is to make america a better place for all individuals, and as the secretary of of the department of health and human services, she spends countless hours working to improve the health and well being of all americans. that passion is what has brought her here today because she knows that one in three children being bullied in america is simply unacceptable. in order to tackle this problem, it takes a coordinated, well-organized, federal, state, local and community response to

prevent bullying at all levels. and with champions and leaders like secretary sebelius and a hard working public, private and community partners, we can help to make america a safer and healthier nation for all of our children. so this afternoon it is my distinct pleasure to introduce secretary sebelius. please join me in many welcoming our -- in welcoming our keynote speaker, secretary kathleen sebelius. [applause] ♪ ♪ >> good afternoon, everybody, and, evelyn, thank you for that nice welcome, but also for the leadership you provide at the office of adolescent health. evelyn does a great job at hhs. i also, i think -- i can't really see, is katie o'malley

still here? well, i know that you were joined by the first lady of maryland earlier in the day, and she has done a wonderful job, um, not only within the state of maryland, but in leading an effort with governors' spouses across the country to indicate how states can be really involved in this anti-bullying effort. i want to recognize deborah temkin, i'm sorry, for organizing the summit and roberto rodriguez at the department of education, um, for being a great partner in this effort. and i know tomorrow you're going to hear from my friend and colleague arne duncan as part of this summit effort. i am really pleased to have a chance to visit with all of you and begin really by thanking you for your commitment to give our young people the safety and

support they need to grow and thrive. now, two years ago we came together for the first-ever national bullying summit with about 150 state, local, civic and corporate leaders and began to map out a comprehensive national plan to end bullying. there had been efforts, many efforts in the past to confront bullying. at the department of health and human services, our health resources and services administration launched an education campaign that reached young people everywhere from elementary and middle schools to boys and girls clubs to the 4-h clubs. the department of justice had coordinated and conducted outreach through its office of juvenile justice and delinquency prevention. and fought to protect bullied students' civil rights in a courtroom. the department of education worked with their peers at state departments of education and local school boards to collect better data and develop

anti-bullying policies and curriculum. and we saw private campaign and faith-based leaders and nonprofit institutions step up like pacers national center for bullying prevention. all of those efforts were making an impact and reaching some of the young people in need. and yet we recognized that despite such a wide array of programs and campaigns, bullying still wasn't being treated as a national priority. so we convened the first summit two years ago where we said for the first time that bullying was a serious national challenge, and it required truly a national response. around the same time our nation faced a number of tragic incidents involving children and teenagers who having been bullied felt like they had nowhere to turn and took their own lives.

it seized the nation's attention. and for many it was a real wake-up call. it was a call that said bullying is not just a harmless rite of passage or an inevitable part of growing up, it's a systematic situation that threatens the health and well being of our young people. it's destructive to our communities and devastating to our future. now, spurred by these incidents and a new national focus, cities and states began taking much more aggressive action against bullying. school districts adopted broad anti-bullying resolution that called on staff to intervene when they witnessed harassment ortizing. or teasing. state legislatures passed new anti-bullying laws and strengthened existing ones. in fact, in 2009 and 2010 alone, 36 states enacted anti-bullying laws or amended the ones on the

books. that's a lot of activity in two years. outside of government organizations from the national education association and parent/teacher association to the cartoon network launched their own anti-bullying campaigns. and brave young people began stepping up to be leaders, protecting one another in their own communities. and i know some of those young leaders are here today, and i want to thank you for your bravery and for your leadership. now, all of this momentum is encouraging. but we know that our work has only begun. today one out of five high school students reports being bullied on school property. and as youth spend more of their time on facebook, e-mail and text messages, there are more opportunities to bully each other while hiding it from teachers and parents.

and in way too many communities across this country, bullying is still an accepted norm. more adults may be stepping in to stop it, and more young leaders have stepped up. these actions are important, and they can make powerful and lasting impressions. but if we're really going to prevent pulleying on -- bullying on a national scale, we must take our efforts deeper still and work systematically to prevent bullying as early as possible. now, what we know is that we at the federal government can't solve these problems on our own. there are some steps we can take to give you the tools, especially at this pivotal moment, to translate today's unprecedented awareness into action. and let me tell you about some of the ways we're working to do just that. first, we recognize we need better data. there is a lot more to learn about bullying.

for many years our understanding was limited to anecdotal evidence, and a scattering of state and local surveys. but we've had very few rigorous scientific studies about the specific factors that put youth at risk for bullying or the specific steps that can be taken to protect them. but that's beginning to change. our centers for disease control and prevention have incorporated bullying to its youth risk behavior survey. the agency's biennial surveys of schools across the country about student health behavior. now, with some new questions on this survey, we'll have a good national picture of how many young people actually experience bullying and what the connection is to other risk factors. and since the survey is repeated every two years, we'll be able to accurately measure our progress. now, as we go forward we also

want to make sure we're speaking the same language as all of our partners. so our work at hhs is developing even more closely with the department of education to develop a standard definition of bullying. to get a more accurate and consistent picture of bullying's prevalence in schools and connection to other health risks. ask we hope to finalize that effort before -- and we hope the finalize that effort before the end of the year. second, we want to give people the support to become bullying prevention leaders in their own communities. now, over the years experts from our health resources and services administration have gone out to communities. they've worked to train -- they've worked to train school saf the, to talk to coaches and young people about the best practices of bullying prevention. but we were limited in how many people could actually be reached through those one-on-one connections. we knew that bullying was taking place in nearly every community

in america, and we didn't have the resources to do that on-the-ground training everywhere. we do, however, have the tools to empower community leaders with the best information and expertise to train and lead their own colleagues and neighbors. and that's the idea behind the new training module we're making available for the first time today on stopbullying.gov. over and over again we've heard from local leaders who say i want to establish a bullying prevention plan for my community, and i don't know where to given. now we've given them a great tool for that beginning. they can download this research-based training right from our web site, adapt it to their own needs and deliver it at their own trainings in community events. the training module is also compared with a community action tool kit that leaders can use to develop and roll out more

comprehensive prevention strategies tailored to each community's individual needs. now, this is just the latest terrific resource available on stopbullying.gov which as you heard evelyn say has become the country's one-stop shop for bullying prevention schools. it include more than 100 proven tool kits, fact sheets, articles and program directories. and it's not just for policymakers like us. bullying.gov is a great starting point for young adults, for teens, for parents and anyone who's working with young people. there's also an updated and revamped section just for kids. and for young people who might think about hurting themselves, the web site shows them where they can get immediate help. now, we've also been focusing on the media. for many reporters and way too many producer, bullying is a

relatively new topic. some are informed by outdated notions that bullying may be harmless or unavoidable. others want to focus on the track of a single child victimized by a bully but fail to recognize the deeper impact on public health and safety. so another of our agencies, our substance abuse and mental health services administration, has launched a task force of both journalists and experts in bullying prevention. they're working together to create background materials, guidelines and other resources for journalists, for bloggers, for producers and writers who cover bullying. our goal is to them provide crut information so that americans can understand what's truly going on among our youth and learn how they can make a difference. so, again, i want to close by

thanking all of you for your leadership and your partnership. this they be only our third annual summit, but i now that many, many of you have been working on these issues for years and years. bullying is not new. these are behaviors that have been around far long teem. time. they are attitude that have been handed down from one generation to the next. what we need now are not just stronger programs and more persuasive campaigns. we also need to commit ourselves to changing a chul think that too often says it's not my responsibility. we must do more. building safe neighborhoods and schools where young people can thrive is a job for all of us. not just governments, not just schools, not just parents, all of us. we are all responsible for our children's safety. and no one can afford to be a

bystander. now, as a mother i've seen the awful power of bullying on young people. and i know that any parent would move heaven and earth to defend her child from the pain and fear that bullying might cause. so working together we can all join that cause. we can build a nation where every single child no matter where he or she lives or who they are, gets that same protection and support. thank you for what you do and have a great conference tomorrow. [applause] ♪ ♪ >> thank you, everyone, for pearing with a -- bearing with a very long but very packed day. we look forward to seeing you tomorrow morning.

we will start once again at 8:30 a.m. with a special keynote by acting associate attorney general tony west. i look forward to seeing you tomorrow morning. good night, everyone. prison. [applause] [inaudible conversations] >> tonight and all this week here on c-span2 we'll look back at some of this year's luncheon speeches from the national press club. tonight controlling health care costs with the cleveland clinic's president and ceo, toby cosgrove. on tuesday, the nation's tax system with irs commissioner douglas shulman, and the rest of the week meantal health insurance, the 100th anniversary of the girl scouts, and tennis

champ billie jean king on exercise and childhood. all this week at 6 p.m. eastern on c-span2. also coming up tonight on c-span2, our q&a interview with washington post chief correspondent dan balz. he answers questions from students and talks about changes in the newspaper business. that's tonight at 7 here on c-span2. >> what we've found is that over the long haul the clearing and reallocation of federal spectrum is not sustainable. >> with continuing demands for wireless spectrum in the u.s., presidential science advisers mark gorenberg and craig mundie discuss their report to the president. tonight at 8 eastern on "the communicators" on c-span2. >> congressman mike honda of california, the chair of the congressional anti-bullying caucus, spoke this afternoon at the education department's bullying prevention summit.

[inaudible conversations] >> ladies and gentlemen, please welcome back to the stage david -- [inaudible] ♪ ♪ >> i just wanted to see how long they would play the music. [laughter] i'm going to tell my mother about this. my mother, by the way, is 91 years old. i'm not making this up. i talk to her regularly. every time i talk to her when she's about to hang up, she says, dave, be careful. and sometimes i'm talking to her right before i'm going to sleep. and i say, shirley, what are you talking about? i'm going to sleep. what do you mean be careful? she says don't -- just be careful. it is my great pleasure to now

introduce a congressional champion of all of you, of all of us, of all of our children and colleagues and everyone who's working very hard on this issue. i worked for congress for five years, and i know that congress people are very busy people. there are lots of demands on their time. this is a gentleman who is here today -- congress is out of session, he's here today. his district is in california. he could very well be back in california campaigning. he's here today to be with us to talk o you, to answer your questions and tell you a little bit about what he's doing. when i kind of went through his bio, i was trying to figure out what is it about an individual, a member of congress who devotes so much time to bullying? he's on the appropriations committee, he's on the budget committee, um, he's formed a

anti-bullying caucus. it's a bipartisan caucus. he's devoting time and energy to this, and the question i was asking myself was, what kind of a person is this? so let me tell you a little bit about congressman michael honda and what kind of person he is, and you'll get a feel for why he's doing this, and it'sal a lesson in terms of his personal history for all you young people of what you can become and what you can do. congressman honda was born in california to a japanese-american farm workers less than six months before the japanese bombed pearl harbor. congressman honda and his family were shipped to an internment camp in colorado after the attack. they spent two-and-a-half years there before being allowed to move to chicago when his father joined navy intelligence. the honda family moved back to

california in 1953, and his participants became straw -- parents became strawberry sharecroppers. mr. honda took janitorial and delivery jobs to pay his way through san jose state university. he was one credit shy of graduation when he joined the peace corps in 1965, and i was a peace corps volunteer myself much later. peace corps volunteers in 1965 were the fourth group of peace corps volunteers going out. these were people who were pioneers. um, the peace corps program had just gotten off the ground. sargent shriver and president kennedy's dream of a peace corps volunteer. the individuals who went into the peace corps in 1965 were very unique people. um, this is another kind of dimension to the congressman that kind of fills in the blanks of why a person of his stature

is spending so much time on bullying. after two years in el salvador where he helped build schools and medical clinics, he returned to california to finish college. he took a job as a science teacher, later serving as a principal. the congressman got his start in public service more than three decades ago when he was named to the san jose city planning commission in 1971 by mayor norman mineta. another japanese-american who spent time in an internment camp as a child. in 981 congressman -- 1981 congressman honda won election to the local school board and later to the county board of supervisors in the california assembly before winning a house seat in 2000. the congressman's late wife survived the atomic bombing of hiroshima. so this is a gentleman who

started working -- his family was interned, he started working as a janitor, he's now a congressman. he's an important member of congress. he's a leader in the field that we care so deeply about. it is with great pleasure that i introduce congressman michael honda. [applause] ♪ ♪ >> good afternoon and thank you, david, for that introduction. i could have made it shorter -- how would i say it? i was poor, i was a lousy student, i dropped out of college, went to the peace corps, and i'm here now. [laughter] but it's been a 71-year journey, and i think that this whole

attention towards bullying is probably putting a title to something that's been going on a long time. a real long time. and we're just putting titles and terminologies to it and then trying to figure out what makes it, what's going on. one of the things that i always zero in on is language, the use of language, you know, the level of language, the perception that's attached to the language. and also perceptions of language and things like bullying is something that's learned. it's about power, it's about perception of power. it's also permission, giving them the power. it's about combating it is something like understanding it and it's about self-awareness.

the word that we use all the time in schools is self-actualization. but other things that's been talked a lot about today when i was listening to young people is trust and safety. and one of the things that is interesting to me that here we are in the nation's capital struggling with something that goes on every day and trying to address it, and we should. but address it sometimes through policy. and a lot of times our policy's well meaning, and sometimes we have to look at our policy makers' bill making and question ourselves as policymakers. first off, where is this idea coming from, and what is it that you want to accomplish? i want to do a shoutout to the schools here in d.c. both to the

chancellor, the superintendent and the mayor for having an advisory group here. and i think that a shout out to some of the young people, i didn't get 'em all, but i met the young lady by the name of braxton, another young lady named brooke, a i don't think lady named cherie and a gentleman by the name of joshua, and they all go to different schools. but the articulation of the issues was really interesting because they went into their own personal experiences and tried to translate that into a language that's going to be heard by adults, and they get translated into some sort of action. and i think that that's important, and we need to pay attention to what our young people are saying to us. and if they're pre-school like some young person here said

going to lower generation -- she's probably about 18 or 20. [laughter] i talk about lower generation. [laughter] but she's right on that looking at young people, younger people where, um, you're looking at preschool where behavior's overt and sometimes more honest than anything else, and addressing that at that level and not saying boys will be boys or, you know, they'll outgrow it and things like this. ..

you forget to listen very carefully and they ask what you mean a much you are saying and not giving them the opportunity to say yes or no. i had to learn that as a principle of elementary school i had 750 k. a third of it was latinos speaking. a third of it was vietnamese and another third was cambodian.

and each strand has a bilingual strand so it was a school built for 500 was difficult and the school has something like 300 suspensions prior to bbe may. k-6 -- k. five, 360 suspensions. how do you do to? and when i looked into that, but youngsters who are acting out under the zero tolerance rules you have to do these things. so we have to take the zero tolerance rules and throw them out the window. [applause] and makes it to be easy for us to be able to do what we want to do. for the right reasons. but at the same reason we lose these teaching moments of the learning moment, whether they're

in the classroom or the playgrounds. the other main i've heard from people, being safe. we talk about safe environment and kid. let me rephrase that. when we talk about young people, i've got to learn how to not say kids. kids are bb goes. i think that terminology, they compartmentalize their thinking and solution so i've been trained in not struggle with that word. so when we look at young people and little people, the need to think they have the same sentiments we do. so one of the comments a young person said was the adults on campus went to do some pain, sometimes they're trained and

taught to do something until it's over. nurture words were ever sad. what is the principal at a school, lo of teachers were hesitant to jump into because they were afraid of lawsuits. they were afraid that kids who take them through litigation. identified youngsters who may have been abused and then we pointed them to child protective services. i said you tell me and i'll do it. that was a solution set. but i didn't think how we make adults on campus has a tent and therefore, less able or less willing to do things when it calls for it. one of the things we did and going off my speech now. forgive me, staff eared one of the things we did was we engaged

a whole school in kindergarten through sixth grade and teachers in rulemaking because we have rules in our schools, and we make rules for kid, young people, metal people at doesn't pertain to us enough about power and perception and controlled. those are not bad things to run a school. it's a contradiction there. what if an adult becomes a bully or youngsters and youngsters have no recourse. if we do that with parents. do it because i said so.

we want to raise young people with rational thinking, critical thinking, then it seems like we should be modeling a dig at go. and so, what we did in a week and a half to become with rules for schools for the challenger, the youngsters, teachers, secretary and the principle. no exceptions. and i was difficult to do a first. but to that process a rulemaking, teachers found out that they have the ability to start teaching because all these youngsters are taking apart the rulemaking that they owned it. and the four things we came up with was this simple and node-negative word. we came up with for her.

it was -- well, the first one has a negative word in it. no putdown. no putdown engages all kinds of things. young people appear were attacked and all kinds of things putting them into boxes, keep them in a cause that. not allowing them to become who they really are. active listening. being that you hear what they're saying. you're also hearing what they are feeling and then to reflect back to the last thing, what they are saying that they validate what it is that we heard in validate what they are saying. confidentiality. the child shares some thing, but we share some pain within the group because nobody in terms of bowling, nobody wants to be a snitch, right? how do you create a place where

they can trust you and that trust comes over time in part this. the fourth one man's -- what was the fourth one? active listening, no putdown. i had it here someplace. i'll think of a fourth one. but they all works. and what happened was by the end of the year we only had three snitches. one of them was a repeat. one of them left school. the parents had to come to school and work with us about what we're going to do about youngsters behavior. fourth was the right to pass, the right to say no.

we had the air to say just say no. we've never given time to practice to just say no. especially a teacher or principal. so we teach them how to say can i be at the end of the line when you ask a question, can you come back to me later so i can think about it? student system thing and then i'll know how to say it and be. and so, the right to pass. i've been called in the cafeteria line and i say no, no i'm just plain. you hear the young people, you know, getting involved in each other because when you talk to them you say it didn't mean that. still he put down.

i had to say i'm sorry and they had to tell me what they want to do. they said we want you to say we want you to stop. okay. and you know much how much power it gave them. but still i never last authority. i think that is what adults need and authorities in their respects, but also the level plain field, curling up in having the young people still spread their word. so if i leave you with any message, the message would be this, bullying is intrapersonal. things we learn from other people for society that we

impose upon ourselves that we oppress ourselves as external and interpersonal and can be communitywide, small groups. polling suggests that it could be government. it could be adults in power. it could be superpower. remember the phrase for the only superpower in the world now? the issue is how do we use it or how do we appease the? how do we share it or how do we behave? and how is it perceived? and what i tell people as it shows is working on her own staff are being aware of it, but also being aware that it's seamless.

it's ageless. and when we talk about superpowers, it's about us, too making certain kinds of decisions. you can disagree with me, but there's papers being written about superpowers and some of us in the past have exercised that power and committed a lot of people to conflict. and so, only needs to be addressed from the get go, look in the youngsters in preschool, our children have parents. listening to young people here. some of the questions i always ask myself, if not exempted them for suicide? would extend to them to be of folia not realize that sort of olene? would exempted them to articulate the lifestyle and be here inflators?

and so i would suggest that we invite young pete will -- you know, i started out commending the schools and the mayor, as an advisor group i would suggest to young people that they get their student population together because many will be 18 by the time the election rolls around and they are from 13 to 22. and maybe they should have a seat at city council on behalf of an infrastructure, which is schools and on behalf of young people who are on both sides of the issues bully and believe to be able to help form policies from their goods. and that way i think we may raise another generation of young people who will not take excuses and turn them into positive policies and translate that because i think that if a democracy is all about.

it's not confined to certain age groups are certain behaviors or the environment that requires us to be cognizant of everything that goes on. i told david that i'll stopped early so that may be you might have some questions because it's easy to come by. talk without having to ever been one of your suggestions that gives you a chance to challenge and say yeah, but you said or what you think of this? so why don't they just wind up with this thought? every school, every neighborhood , the route from portal to portal, from home to school used to be safe. there needs to be president, trusted adults who understand what trust is, that it involves listening and confidentiality

and not putting down people, but also being able to be part of the solution and that perception and listening and all those things are important to validate those kids, those young people who are being bullied and begun men who realize that when you become a bully he had to slap himself and change, that realization of learning about yourself is probably the most powerful tool we can give our young people, are little people as the dole so that the next generation confirm a better country and be better citizens than us and also help us form and become a more perfect union. thank you. i'll open it up to more questions. [applause]

>> does anyone have any more questions for the congressmen? we have a few minutes. >> no such thing as an embarrassing question. i'm over 200 pounds. and 71 years old and i'm single. last night i get that out of the way. then we can go from there. or you can shout it out. yeah, thursday night. if you want to shut out from your table and then i'll repeat it. all right. here comes the coaches coach. >> i primarily work with juveniles and one of the statistics that always scares me nationally is that one of the most repressed and often times the click depopulation is the algae btus and juvenile care. one of the chassis systems is

pretty large. they have their own union out there. when we are not addressing this across the national board in making sure the those needs of the sub seven are not, and the students in the thought that situation and are being bullied by the staff, the wardens, pahang glares, the cops because these kids essentially are at the well of so many people from the judges to the correctional officers that they're just not getting the aid that they should. >> and to the other inmates. you're talking about the institutionalized as? you mentioned californians. this past family after three or four years, passed a love that protect the youngsters in high

school and that took a while. i don't think we ever looked at the incarcerated and i think that's something we need to step forward and do some thing about. i don't think it should be any different of the folks who are working to juvenile justice system are the justice system. we have a lot of humor around penitentiary and gays in the penitentiary. but none of us ever thought about taking it to the next step and say wait a minute, that an unacceptable because someone said it appeared. it's humor here but there's always a grain of truth vacuum or. it's the truth that we need to

pursue. taking it that the laws were passed and the policymakers, policymakers need to convert that into policy and expect his training outcome in our schools. that's one institution. by the way, if an institution where kids are compulsory education, so that they determine it contains. right? so that the model, we should take it and apply to the justice system and have a high expectation to the folks that a state fair. it's a good place to be learning and teaching, but also to protect the young people were

incarcerated people who are the lgbt there. great question. never thought about it. that's something we need to do. yes, ma'am. is that braxton or broke? >> yes, braxton. i have a question. why do you feel is so important to equalize the playing field, especially in the school district between students and staff and especially administrators? why do you feel as though it's so important to empower these and give them a sense of self and the sense that what they have especially in their education? >> thank you to the question. is the first time it's ever been asked. the me see if i can answer at the top of my head. people say that we discipline our kids as we were disciplined. remember that old phrase? if it's good enough for me, it's good enough for you. look how i turned out?

but it's really about size of power. would reinstitute corporal punishment, i tried to institute that. we teach us libertad. hopefully we don't teach as we were taught. the authority and authoritarianism is passed on without thinking. i thought the most greatest issues when i became a print to pull and a vice principal at the assistant superintendent. he was on my case all the time. he wanted to come of that and the other written form. is that i'm not going to do it because what you want is a report about a fight between two kids and that settled. i don't know why you want a record of it. and so i started -- when i started pushing back by

employing the jacket was about that thick. so i think as adults we have to model, process and behavior but our young people and engage them. we become engaging, self-actualizing, created people and we have to do that as adults. it would have been five to six hours a day and probably even longer after that. but we have the responsibility to have an environment that's safe, but reflect about the kinds of things we want them to become that we have to do that which we want them to be calm. search amia makes a lot of sense to do that. at first it's a lot of work, but after a while we found that teaching becomes more efficient because everybody -- everybody

is participating in the atmosphere of the classroom in the school. yes, sir. >> by ms. tyler gregory and i'm representing 4-h and the great american double challenge. >> what is 4-h stand for? [applause] i have a question. social media as fires years ago, as far as bullying and staff comments getting way out of hand. how do you think california -- how do you think the social -- how do you think california can get the social media companies located in california to support the digital responsibility?

>> interestingly enough we had in my district is student advisory council and we have youngsters from all the high schools and they picked the theme of olean. and you brought in facebook. facebook participated wholeheartedly and was about cyberbullying and things like that. and they provided a lot of insight and i think what the young people had provided us some of the ethics that needs to be looked at alongside with the responsibility and a privilege of the power, the digital format and from advice. you know, i never thought i'd say this. when i was a kid, i hated when

people say that when i was growing up. when i was a kid, everybody knew my business. you know, but it was a small community. now you can choose to let everybody know your business, right? and vice versa everybody would know your business if you opted in to share your information. so they can direct you to some of the folks at a spoke and most of those digital companies understand and are willing to participate in mass and will see a kernel of opportunities there to make the visual world safer, more usable, accessible and things like that by your involvement and by your interest in having them come in. so i think they're doing some dignity certain level. as you bring it down to your every day situation wold be

very helpful. so we'd be glad to give you some of the things. my staff that they are what give you that information. and i think engaging them, recruiting them is good and thoughtful and it's progressive. serve your >> kevin appling, u.s.a. we have 49 states that are to have anti-bullying legislation. he talked about the national piece of legislation on this arena. since we have local states already with pieces of legislation, one of the things are missing is the enforcement piece. would you see possibly in the national level that she would do something that would have warned horsemen rather than mimicking what has been done at the state level, but also the talks at these conferences is the need for training and the need for funding for some of these?

would that be something in a more national though that she would be looking out? >> now, i didn't know about that. i didn't even think about it until you brought it up and now it's a nice coat. as part of my responsibility you added to it. i would engage you to get used to. we look at ways to make these things happen and not make it all top down, help us define what hazing of polian or harassment, worries that line between that and hate crimes? yesterday we saw it an example of hate crime.

somebody with no hands went in and chat at the place. i don't have all the details, but other instances where john people or until such as act out from behavior that shack says, but we need to go beyond that in terms of trying to figure out what happened, why does it happen and how do we prevent it? be suspect there's all kinds of reasons. everything from bullying, but the other stuff, ignorance, fear. so it's a broad area that the nation has to, within at stake and how we behave as a nation, with acceptable, but it's not acceptable and how we expect individuals to behave in that's got to be all part of that collective consciousness that we

care. dumber still growing as a nation, so we need to address that. i'm not about trying to punish anybody, but trying to find ways to engage the different disciplines. it's not by accident these folks , looks at not only education, but health and human services and other renowned, where all these things need to be engaged and to address it and how to be getting into human behavior that employs power, to put that into the individuals with different characteristics. and so, i think it is a good challenge for us to engage in. so we don't mind partnering with you on not. and by the way, let me just say that this issue in this conference is not partisan.

don black .. [inaudible conversations] >> you're watching c-span2 with politics and public affairs, weekdays featuring live coverage of the u.s. senate. on weeknights watch key public policy events and every weekend the latest nonfiction authors and books on booktv. you can see past programs and get our schedules at our web

site, and you can join in the conversation on social media sites. >> coming up at 7 here on c-span2, washington post chief political correspondent dan balz takes questions from college students visiting washington about how the newspaper business has changed during his decades as a journalist. >> what we've found is that over the long haul the clearing and reallocation of federal spectrum is not sustainable. >> with continuing demands for wireless spectrum in the u.s., presidential science advisers mark gorenberg and craig mundie discuss their report to the president on the future of government-held spectrum, tonight at 8 eastern on "the communicators" on c-span2. [applause] >> the cleveland clinic's president and ceo spoke at the national press club recently about the affordable care act. he says it does a good job of expanding access to medical care but not enough to control costs. this is an hour.

>> presides over a $6 billion health care system comprised of the cleveland clinic, eight community hospitals, 18 family and ambulatory surgery centers, a hospital in florida, a center for brain health in nevada, a wellness and executive health center in toronto and a hospital currently under construction in abu dhabi. his leadership has emphasized patient care and patient experience including the reorganization of clinical service into patient-centered organ and disease-based institutes. he has launched major wellness initiatives for patients, employees and communities. under his leadership the cleveland clinic has consistently been named among america's 99 most ethical companies. dr. cosgrove is a graduate of the university of virginia school of medicine and completed clinical training at massachusetts general hospital,

boston's children's hospital and brook general hospital in london. he was a surgeon in the u.s. air force and served in vietnam as the chief of u.s. air force casualty staging flight. he was awarded the bronze star and the republic of vietnam commendation medal. he joined the cleveland clinic in 1975 and was named chairman of the department of thoracic and cardiovascular surgery in 1989. under his leadership the clinic's heart program was ranked number one in america by "u.s. news & world report" for ten years in a row. he has performed more than 22,000 operations and earned an international reputation for expertise in all areas of cardiac surgery, especially valve repair. he has 30 patents for developing medical and clinical products used during surgical environments. his visionary thinking, medical and business expertise and dedication have earned him numerous awards and honors.

he is a member of both the clearland medical hall of fame and the cleveland business hall of fame. he topped inside business' power 100 listing for northeast ohio and is highly ranked among modern health care's 100 most powerful physician executives. among dr. cosgrove's many attributes, he is known for his ability to provide high quality care while holding costs down. he is also known for his concern that health care reform might stifle medical innovation. we look forward to hearing his views on these and other issues affected by the supreme court's ruling on the affordable health care act. ladies and gentlemen, please, join me in welcoming to the national press club dr. cosgrove. [applause] >> well, thank you very much. that's the nicest introduction i've had today. [laughter] well, i'd like to share with you some of the experience and some

of the things that are going on around the cleveland clinic and how it reacts to the affordable care act. first of all, let me tell you a little bit about our organization. we're a very innovative organization. we're 91 years old. we're a not-for-profit. we have a tripartheid mission of research, education and clinical care. we're physician-led, and all of us are salaried and employed by the institution. there are no financial incentives to do more or to do less which is an important aspect of where we are. we all have one-year contracts, and there's no tenure, and each year we have an annual professional review which is part of maintaining the quality of our organization. now, it's interesting to look at health care and see exactly where we came from and how we are organized. the design that we currently have dates back to 1950, and much of it relates to the hill

burton act which encouraged communities across the united states to develop hospitals and be responsible for the care of that community. since that time health care has improved, longevity has extended, and with that we've seen diseases change as well as therapies change. and it's now we're dealing with chronic diseases, six of the seven major causes of death in the united states are chronic diseases. so it's no longer possible to have all the technology in one hospital, and no hospital can be all things to all people. so what is the crisis that we're currently dealing with that we've heard so much about in the united states? and what do the affordable care act and how did it try to address these things? well, there were three main things that we tried to address. the first is access, and you've heard about how the affordable care act put another 32,000 -- 32 million people who currently did not have insurance currently

have insurance, and this is a major step forward. the other problems that were around quality, and quality was variable across the country. and finally, cost. which was escalating. right now with a $16 trillion obligation that the united states has, 50% of that is related to medicare. and the health care bill will do little to effect that obligation. in fact, we probably will see increasing costs. so how are we as an organization and how is health care as an organization beginning to deal with these issues as we go forward? well, let's take them one at a time, and we'll talk a little bit about how we as an organization begin to deal with these. first of all, access. insurance doesn't necessarily mean that you get to see your physician. one of the individuals in the audience today came to me and said that here in washington it

was not difficult to see a physician. and there's a number of steps that you go through to try and get to see a physician. so we have begun to try to address each one of these. the first thing that we did was we put in place nurse on call. so at 2:00 in the morning when your child has a temperature of 103, you can get on the telephone and get some good advice from a nurse or a suggestion about where you might go to get that sort of therapy. last year we had 20,000 phone calls. this is a free service of the cleveland clinic. the second area that we did is frequently when you call up, it's hard to get through on the telephone. so we put together a call center. the call center now has an average of 40 seconds to answer the phone and only a 3% dropped rate on your phone calls. and when you call to the make an appointment, each time you're asked would you like to come today.

last year we saw one million same-day appointments. the ability to see those appointments, we were able to make 95% of those appointments available on a same-day basis. then there's the emergency room. everybody complained about the waits that there are in the emergency room. we changed our method a year ago on how we see people in the emergency room, and now the average wait is under 30 minutes from door to seeing a doctor. and all of our emergency rooms across our entire health care system. so we've tried to begin to address, actually, the day-to-day needs of access. the second issue is quality. and i would point out to you that quality is really not one thing, it is three things in health care. first of all, a clinical experience, it's a physical experience, and it's an emotional experience. the clinical experience we've begun to address with the electronic medical record.

the electronic medical record now begins to make your data available to you across the entire organization. you can move from outpatient facility to a community hospital to the main campus with your electronic medical record going with you all the time. and so anytime you see a doctor, that information is available at that point. the other thing we thought was incredibly important is begun to have transparency. and transparency comes in a lot of forms. starting some 30 years ago, we began to look at outcomes and begin to try and understand how you understood what outcomes were. and each time we looked at those, we always found that there was an issue that we could do better in. and so starting eight years ago, we said we'd like each one of our institutes to put together an outcomes book and make it publicly available. these outcomes books are

published, and can they're available on our -- and they're available on our web site. and that is part of transparency around our quality and, additionally, we think that the transparency about what's going on in your care should be available to you at any point. so we opened the medical charts, and you can see your chart anytime that you want in the hospital by simply asking for it. further, you should be able to know about your medical history and your medical record when you're not in the hospital, so we have electronic medical records which can be available to you over the internet, and we have almost 500,000 people who now have access to this. interestingly, we now know that people who use this take better care of themselves. diabetics know their blood glucose levels, and can they take better care. so we encourage people to actively participate in their care along the way.

further, we have begun to understand complications within the hospitals, and we've looked specifically and been very transparent not only about the entire organizations, but the individual departments and the individual physicians' outcomes. and we post those publicly for the physicians. now, interestingly, i would tell you there's no more competitive group of people than doctors. and doctors do not like to see themselves on the bottom of a list. and if you want to improve the quality of a physician, all's you have to do is rank them and make it public, and it's amazing how fast things move up. so we've had a lot of good experience that way. the physical part of coming into the hospital is also part of everybody's experience. so we have begun to look at everything as far as the physical experience in the hospital is concerned. from the architecture, from the light coming into the room,

we've increased glass across to bring more natural light in. we've begun to bring art into the hospital. the speakers no longer pend all their time paging people, they play in the public spaces classical music as you come in which adds nothing to the cost, but greatly enhanced the atmosphere of the facility. so, and we bring in art therapy, music therapy and even, amazingly, we have dogs walking around our hospital. i laughingly say there's nothing better than a lick from a lab -- [laughter] and the pediatrics, we see that regularly. so we like to have the physical experience be a positive one as well because it helps with healing. the third and perhaps the most important aspect is the emotional aspect of being in the hospital. we're very concerned about this because anybody of the 43,000 people who work for the cleveland clinic can ruin the

experience of a patient in the hospital. and i had one of those experiences one time when a relative called me to the room, a relative of my wife's called me to the room and said -- very upset family, and i wanted to know why they were so upset. the heart surgery had gone great. they were upset because underneath the bed there were dust bunnies. that ruined their entire experience. so we brought all of our 43,000 people together and took them offline for three hours. we sat them around round tables like you have here with doctors, nurses, environmental service people, people that drove buses, people that worked in the loading docks, and we talked about the cleveland clinic experience. and that has been a major factor in the changing how these people are engaged. and we no longer address them as staff and doctors. everyone at the cleveland clinic is addressed as a caregiver.

and that has changed the atmosphere. and with that we now find ourselves in the top 90th percentile in the country as far as hcap scores and patient satisfaction is concerned. an important factor about people's experience when they go to the hospital. finally, let me talk about cost. and one of the important things we have to realize about cost is we have perverse incentives. one of the major things about reducing cost is employing physicians. all of the physicians at the cleveland clinic are employed. myself included. and i get a straight salary. so it did not make any different whether i did three heart operations a day or four, i got paid exactly the same amount. so there was no incentive to do more. our system really encourages people to do more. essentially, in the trade it's

known as eat what you kill. a little strange. [laughter] but nonetheless, the incentives are wrong, and so we need to begin to move to an incentive that is not, does not incent you to do more, but in fact, incents you to take care of the patient and be paid for that. now, the involvement of the doctors has been proven that the salaried doctors have been proven that it reduces cost. the dartmouth atlas looked at top organizations around the country, and the two that came out with the lowest medicare costs were mayo clinic and the cleveland clinic, both of which employ physicians. the other thing that physicians do is they bring, employed positions, it brings them around to involvement in the organization. we involve our physicians in this everything. we're physician-led, we involve them in our purchasing decisions and our utilization positions --

decisions, all of which helps bring about lower cost. the other aspect of bringing about lower cost is integration of health care systems. we are completely integrated across our organization. and so that has allowed us to do a couple of very important things. first of all, we have reduced duplication of services, we have rationalized services, we have rationalized and gone around and consolidated pediatrics, trauma, rehabilitation, heart surgery, obstetrics and gone to places which do a bigger volume and as a result of doing bigger volumes, they do more. and as a result of that, they get better quality and more efficient. and that, certainly, has been proven to be the case in multiple studies across the country. we also recognize now that health care is changing. where it is done is changing.

the hospital is becoming less and less the epicenter of care delivery. care delivery's going from inpatient to outpatient to home care. and we now can see that hip replacements and knee replacements are done with 24-hour stays, and many people going home the same day as they've had those procedures. it's simply the advance of care. it is also the advance and change in the type of diseases we're dealing with. more chronic diseases, less acute diseases, and acute diseases and surgical diseases are now more taken care of as outpatients than inpatients. now, the other perverse incentives is around all of us. there is no incentive for us to take care of ourselves. we smoke, we become obese, we don't exercise, um, and can we go to get health care and expect to get great care. let me just give you a couple of

examples. first of all, you have to realize that 40% of premature deaths in the united states are secondary to three things; smoking, eating and lack of exercise. let's take smoking, for example. the incidence of smoking in the united states is 20%, and the scary part is it's rising. it is associated with a majority of cases of cancer in the united states. so we began a very aggressive approach to this. we started out by having to o smoking allowed not -- no smoking allowed not just in our buildings, but anywhere on our campuses, parking garages, anywhere property of the cleveland clinic. then we had smoking cessation for all of our employees free. then we decided that we'd make a bold step and stop hiring smokers. we test people -- by the way, it's legal. [laughter]

i checked. [laughter] one of the mart things i've done -- smart things i've done. [laughter] and then we rolled this program out of smoking cessation into the community and helped drive smoking cessation laws in public places in the state of ohio. in chi hoe georgia -- cuyahoga county where we're located, the incidence of smoking has gone from 28% to 15% in five years. so you can make a difference, and perhaps we've saved more lives by doing that than one would in a cardiac surgical career. the epidemic of obesity iser the pieing. right now -- terrifying. right now one-third of the united states is overweight, one-third is obese. obesity is leading the epidemic of diabetes. right now 10% of the cost of health care in the united states

is secondary to obesity. and the projections are in the next ten years that that will go to 20%. so we will not control the cost of health care in the united states unless we control the pandemic of obesity. so, again, we've figured that we needed to begin to address this. so we started out with food. we took the trans fats out of all the food we serve in the hospital. we made 40 changes in the cafeterias of the food that we served. we took the candy bars out of vending machines, the sugar drinks out of the vending machines, and then we turned to exercise. we gave our employees free curves, free weight watchers, free yoga, free access to our gyms, and over the last two years we've lost 330,000 pounds. [laughter] it's a start. [laughter]

but, so these, i think, represent an effort that you can also take out into the country, and we need to begin to address these. let me just for a moment tell you a story. and i think you will understand the reason for this story. two-and-a-half years ago a 25-year-old opera singer was flown into the cleveland clinic in the dead of the night from here as she was end stage lung disease and had she not had a lung transplant, she clearly would have died. she received a lung transplant, double lung transplant, was extremely sick, kept in a medically-induced coma for four weeks, eventually recovered. left the hospital, came back to

sing opera. three months later for the team that had looked after her. that summer she married the man who had stood by her through this entire event. and then she began to get short of breath again. she came back to the cleveland clinic after extensive medical therapy and could not be sustained or improved on that therapy. she was placed on an artificial lung for three weeks waiting for a second set of lungs. she received those second set of lungs and is now living in washington and singing opera again. i'd like to have you meet charity tillman dick who's with us today. [applause]

charity, i think, is here with her grandmother. her grandmother is tom lantos' wife. tom was a congressman, and last time she was here, he spoke before this group. he was a congressman for california for 27 years. mrs. lantos, would you stand up? [applause] i introduce this to you because i think this is an example of american medicine at its very best. and we need to address the three issues that i talked about; access, quality and cost the we're going to be able to continue to drive this 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 experiences. [applause] >> i think one of the main things we've done is we've involved the physicians in the our decision making, and the physicians understand about the things that they can do. for example, they came together around pacemakers, hips, knee replacements, purchasing, and we reduced our purchasing by about

$125 million in the last two years. >> what can be done about the decreasing number of doctors, and who will take care of our growing population? >> um, the number of doctors, actually, is not decreasing. the problem is that we have never produced enough physicians in the united states to look after the demands. we've been a net importer of physicians forever. we're going to have a shortage of about 90,000 doctors across the united states, and we're similarly going to have a shortage of nurses bordering on a million nurses. and so we're going to have to find other people to be the caregivers. physicians assistants are becoming increasingly used. that allows everybody to practice at the top of their lie seven sure, and technicians are coming in to replace much of the work nurses have previously done. no need in order to have a nursing degree in order to take

a blood pressure or record a temperature. >> with do pharmaceutical companies reward physicians who prescribe their medicines? if so, how? >> well, i think all of us have seen many stories about pardon me suit call companies -- pharmaceutical companies and device companies encouraging physicians to do that. i think that is being less and less a issue in the health care world. there used to be a lot of entertainment that went that way. that is almost completely gone to the best of my knowledge. >> is the cleveland clinic more or less likely to hire employees as a result of the affordable care act? >> whoa. [laughter] i don't think we know yet how the affordable care act is going to affect us. we haven't seen net the implications in terms of the number of patients that we're going to see or, um, the -- and figure out how we're going to

take care of them. clearly, um, any health care organization major cost is people. it's about 60% of the cost of running the cleveland clinic right now. obviously, we'd like to do that in the most efficient way we can, and we'll have to see what the demands require. >> tens of thousands of patients die each year from infections contracted in hospitals and doctors' offices. how can we reduce that staggering toll? >> yeah, that's a great question, and, you know, that is one of those things that has been brought to the attention. we've seen probably a 50% reduction in the incidence of central line infections across the country simply by bundling and using standard procedures. and i think that we're increasingly looking at the same thing that pilots look at, checklists. i think checklists have been

particularly effective in medicine. interestingly, now, part of the other major issue and cost is end of life, and we think that there is a lot that we can do to both make that a more civil and kind experience and at the same time let people pass in a less cost will hi way. costly way. and so we're looking at a check list, and the cleveland clinic are now doing a research project trying to develop those sort of end-of-life checklists that will remind people about where you are in the process, have you talked to the family about it, and i might just say parenthetically here if you don't mind, i think this is an important topic. and i would encourage you all to think about this yourselves, and i know many of you have had this experience. ..

i've always been greeted by st. you so much, doctor, i really pleased to look forward to those discussions and i am greatly relieved that you have that discussion with me. it takes -- if she will enter into those as individuals lehman and have that discussion with your physicians, it will be good

for the patient, it will be good for you and will be good for the doctor. >> are there risks from antibiotic back to victory and what needs to be done prescribing antiabiotic process? >> i am in over my head now. clearly antibiotic therapy is something that increasingly people are concerned about getting resistant strains. we've seen this in tuberculosis and staff infections that we have selected 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 increasing the antibiotics and is currently resistant restrains.

>> how can health insurance companies reduce the cost so they can devote more to provided clientele? >> i'm going to plead i'm not on the insurance business. >> prostate cancer is often in the news these days with a different opinions as to watchful waiting versus treatment. tests and surgery what is your take on that? >> it's interesting. now we are beginning to understand the differences there are in prostate cancer and that has been done out of the study that is now almost 10-years-old looking at the genetics of the prostate cancer. we realize that some are very aggressive and some are not aggressive tall and by differentiating between those getting to decide what is the most appropriate type of therapy. >> when the amiga three fatty acids were improved for heart and blood vessel illness some

pharmaceutical companies letter concerned this would reduce heart and blood vessel drugs. has this happened and how does this help improve part health? >> i'm sure you are aware that we have seen about a 30% decrease in the incidence of our cardiac death in the united states in the last 25 years. and i think this has been the result of several things. it's not just coronary stands and bypass surgery. it's about the fact that there's better awareness taking care of yourself and increasing use of official leal etc and a better diet and exercise. and i don't know that any of these drugs have been substantially decrease in their use. >> would you think of steps such as mayor bloomberg to cap bottle sizes or steps to prevent items from being sold? [laughter] >> first of all, i you have to salute mayor bloomberg for many

of his proactive stance is an encouraging wellness across new york city. he's one of the first people that began to take trans fat's out of the food, he raised our awareness on many issues. whether this is the solution to the obesity problem for the size of your drinks and your cup remains to be seen. i'm not particularly optimistic about to leave estimate you said you no longer hire smokers. do you how your folks at the clinic that are obese? [laughter] >> the americans with disabilities act protects -- [laughter] protect people from discriminating as people who are obese and under advisement we do not discriminate against people who are obese. some give a patient to receive scare the cleveland clinic leader sees a doctor is not affiliated with the clinic under

your system of record access will the doctor have access to those records? >> we like to provide access to the records, but without being involved in the electronic medical record it's not possible to extend the electronic medical record but we can give the electronic medical record to the patient and the patient can to get to the doctor. so if you get treated at the cleveland clinic and you get sick and los angeles, you have access and you can take it with you. >> how serious an issue is noncompliance by a patient failing to take the fold dosage of prescribed medications? >> noncomplying ins is a big issue, and we are trying to figure out how we can begin to address this. we realize that just making a phone call and saying did you take your pills today doesn't do it. and reactive lee involved right now and interesting with time-warner cable, who can bring

into people's television set a way to communicate back-and-forth between the doctor. so you can actually say to the patient would you hold your bottle of pills and did you take one of those today? and i think that this is the next step beyond the phone call which started out as a routine office visit and a phone call reminder and a group of ways to do this in a skype sort of fashion and this is the next step for the future to begin faugh >> a news report yesterday indicated that there had been 18,000 cases of whooping cough this year and the original vaccine is not sufficient. but should be done to prevent or reduce further outbreaks? >> you know, i think the concern about full inhofe is a major concern and is mainly driven by the fact that the scare about autism and that mothers and fathers are not giving their children immunized because of the fear of autism.

i think that has been pretty much just proven. i don't think there is a question about that now. but the whole thing, the epidemic wouldn't be had without a continuation of the immunization and i think that is the reason for it. >> cltv is the third largest killer of americans second leading cause of disability in the u.s.. what is the importance of research into long disease and as the polemic plan for such research? >> my father died of c. okay and he was a smoker and i don't think that i have ever seen someone with chronic obstructive pulmonary disease who frankly was not a smoker and the biggest thing we can do is begin to drive smoking out of the general public. this is a huge public concern, and we are not going to get that until we take care of the major

cause which is really smoking. >> how can health care institutions work together to share more effective and innovative processes, technologies or clinical capabilities? >> i'm starting to feel like dr. tawes. [laughter] by collaboration. let me take this to a higher level of i could. we are starting to see now a tremendous change in hospitals across the country. the hospitals are coming together in systems. systems are collaborating 60% of the hospitals now in the united states are part of a system and as we have the systems come together we start to get more standardization of care, more efficiency and more

collaboration going on. >> what more can the media do to educate and motivate the public about better health care practices? >> i think there's a tremendous need for medical and education, and discos television print, everything. and there's going to be a big process of educating people about what the current health care act entails. i think very few people recognize exactly what's in that bill, and what the implications are both through personal care and for the health of the nation so that is going to be a big education for you all, too. but i don't think that you can do too much to emphasize the importance of people taking care of themselves in terms of smoking and obesity. frankly, my major concern is the

public generally hasn't come to grips with a pandemic and to put it out in perspective for you, if you look up the disability, the total disability of employees of the cleveland clinic and you take out people that have cancer, 90% of those on permanent disability are morbidly obese. that is how big the problem is to restore a number of states indicated they're unwilling to extend medicaid as part of affordable health care act. what does this do to the health care system like the cleveland clinic? >> if we don't have medicaid patients covered we are going to have more patience who are not patients currently where the largest medicaid provider in the state of ohio and this is going to have more patience without any reimbursement, so that will

cause the rest of us who buy insurance to have the premiums go up. >> how did your hospital and of a body come about and are you planning other hospitals and more countries? >> it's an interesting sort of history. if 9/11 haven't we were operating about 35 patients a month particularly for the middle east and at that point it went to fight in about two weeks the predecessor said we don't we try to meet it halfway and establish something in london and we tried to buy a hospital in london and of lease a hospital in london, and in the meantime, people began to realize the cleveland clinic was willing to go offshore. we had increase of one type or another from 70 countries, and we looked at many of these and

by far the most attractive was abu dhabi and i think it's important that we point out to you that the arrangement in the abu dhabi is not such that instead of spending money in northeast ohio, we are investing in abu dhabi. that is not the case. they are building the house, the government is building a hospital, they are paying our salaries and they are paying as management and consulting fee. now comes essentially we are using our intellectual capital to drive your dollars backed to northeast ohio. in the bigger scheme of things if you look at what the world wants from the united states right now they are not particularly interested in their refrigerators in many cases or cars, but they do want entertainment, innovation, they want order to the education and health care and our facility is

the first facility in the united states that's taken the challenge of going entirely overseas and staffing the hospital, bringing the design to the hospital, bring the particles to the hospital and taking responsibility for doing it and it's a great opportunity to begin to help design the health care delivery system for a country. >> given the success of the cleveland clinic and being replicated in other countries why aren't there more hospitals like yours here in the united states? >> the cleveland clinic was started as a system that was looked at as a very innovative and radical of the time that it was founded and was employed physicians. in fact they were looked at as medical bolsheviks at the time that it was started. and then that has not been the tradition. it is very difficult to change from the system that is currently existed in most places

to where we are because most of those positions are very on to an aerial. what is happening right now across the united states is changing that 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. so you are seeing hospitals come together and systems, hospitals employee in physicians, and essentially that is looking increasingly like the cleveland clinic over a period of time coming and i think that you are beginning to see that change happening. it will not have been fast, but it is important i think for the long-term affordability if it does happen. you talked about your staff being on salary. how serious are the other concerns physicians can offer to practice or don't find that a compelling and has that been a

problem that you have had in your profession? >> no. it's worthwhile talking about how we pay and how we set salaries. we looked at what the average salaries of the medical center's crossing the united states and we try to play for the department of average in the 90th percentile and that means in the end pediatrician's don't get paid the same as neurosurgeons but we pay according to the specialty, the expertise the individual has in the specialty and with the national standard for that specialty is. >> to what extent as medical malpractice lawsuits and premiums away on places like the cleveland clinic and is the situation getting better or worse? >> welcome toward reform is something that was clearly not in part of the affordable care

act, and i think it is an important thing that we are going to have to eventually deal with. and ohio we have had toward reform and it has decreased our cost of malpractice very significantly. we think that it is estimated that about 4% of the health care cost in the united states are attributable to malpractice and people trying to avoid it. >> what are the costs and benefits of medical tourism where americans go to other nations for procedures that are very costly in the u.s.? >> it's interesting that there's been a great deal made out of people leaving the united states to give care outside of the united states. and the date of essentially looks at medical tourism principally in places like india and singapore. and they always give the data above the numbers that go there. now the vast majority of those are from south east asia and the

middle east and not from the united states. it is a trickle of people that leave the united states for health care out site i think it has almost negligible economic influence health care costs in the united states. >> did the people that utilize the 24-hour call service have to have insurance? >> no. [laughter] >> aren't there other factors beyond smoking and obesity that cause ill health like chemicals, air and water quality and what are you doing about these? [laughter] >> you guys are mean. [laughter] there is no question that there are multiple things that affect health care, but those are the three big ones. the thing that concerns me quite frankly is the epidemic of autism. altus and frankly is something

that wasn't seen when most of us were kids, and now it is one in 88 live births. the implications for that vote for society and for the economics are stunning. at the other end of life, the other thing that concerns us is alzheimer's disease. if you get to be 80-years-old, your chance of having alzheimer's is 25%. the economics of that is now risen into one of the top seven causes of death in the united states. the implication of those things at the beginning and the end of life for stunning. and until we begin to identify whether it is an environmental factor or just other factors and begin to deal with those it is going to put a huge burden on the cost of health care both in the united states and around the

world >> what recommendations do you have to get schools to change their lunch menus and vending machines away from junk food to offerings? >> we are very fortunate that the cleveland clinic to have microwaves and the chief wellness' officer of the cleveland clinic and he has reached out in the schools cleveland, and we have begun to actively help them improve the quality of their meals that they serve and this has been a big effort that has gone on a long time. the other corollary of that is the epidemic of childhood obesity which is strictly related to school grades, and we have done a great deal of research on that particular topic as well. so the food issue in schools is acute. we are trying to deal with it locally. i think that this is when you have to be something taken a national issue probably right here in washington.

there are 30 some agencies by the way here in washington that regulate sood in one way or another at this point. >> how will the affordable care act affect medical innovation? >> i and a little concerned about beginning to look at the efficacy of the drugs or a device when it's in practice to decide whether you're right to pay for it or not and let me give you an example. if you develop a heart valve, it takes you about ten years working with animals and through the regulatory process to get approved by the fda to be sold off its. if you are doing today with one heart valve is better than another its wing to take another ten years to be able to understand that. i don't think their arthenia do recovery many venture capitalists willing in the project so i am concerned

frankly that beginning to fund things on that basis will begin to drive a lot of the innovation out of health care in the united states and you have to recognize that health care and products that are developed are sold all over the world in the major exports from the united states would it be pharmaceuticals are devices or the things that are 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 it is in the united states. we also have to remember sort of on a bigger scale that you can't do anything new without an attendant risk. if a society becomes sole risk adverse, we are not going to see innovation that has driven health care to the point that has doubled life expectancy in the united states in the last

100 years to reverse the republicans in congress talked about the need to rebuild and replace obama's health care law. are there any aspects you would repeal and what would you replace them with? [laughter] >> let me defer a little bit on that. i think more importantly we have to say that where the law as a couple things very well and a couple things it doesn't do quite so well, first we know it isn't going to control cost and we are going to have to do that and it's going to be led by the private sector. one of the things about controlling cost is there isn't a lot infil all about providing incentives to take care of themselves i would like to see more incentives for people to do that, and interestingly just recently we helped senator wyden and senator portman introduce a

bill in the united states senate that would set up criteria for people under medicare to begin to have financial incentives for meeting various milestones. keeping their weight under control, blood pressure, etc., and we found that very small incentives, financial incentives drive significant behavior and by that, we found for example 3,000 diabetics at the clinic. only 15% of those were seeing a doctor regularly and we were shocked when we found that so what we did is put a series of incentives in place now 50% of people in chronic disease and chronic disease management with the wellness i talked to you about before with those financial incentives. we have now seen our cost curve flattened so we are no longer seeing inflation are the cost looking after the patients.

>> which other health care facilities to consider to be innovative? have any of the clinics have ideas you find impressive? >> innovation can happen anyplace. and we see it coming across all sorts of places. i don't think that you can look at health care and expect it to come from one organization. there are things happening on multiple locations. i think the important thing is to go and try to find those and incorporate them boldly into your organization. a number of years ago, i told everyone of the employees, doctor employees of the cleveland clinic i would ask them to take one trip a year to go and learn something new someplace i didn't care where in the world they live and so i thought we were turning at least a couple thousand to go out and find a really good things and so when keefer are lots of places and we have to look at new ideas where we can find them.

>> what is the impact of providing more home-based medical care for elders? >> the thing that is driving health care is the disease people have now had chronic diseases that are not going to be looked at in the hospital and a better be looked after at home. the implications are first of all we have to build a system to do that and secondly, it is going to reduce the cost of looking after patients and they will be better cared for at home. i don't think anybody would rather be in the hospital than be at home and that is the direction that we are trying to move. >> we are almost out of time before asking the last question we have a couple housekeeping matters to take care of. i would like to remind you of our upcoming speakers on july 24th, judy woodruff and gwen ifill covered election coverage on the complex issues and play in the run-up to the november 6 general election.

august 28th general james amos, dawn of the u.s. marine corps will discuss the role of marines as america's price of response force and on september 6th kathleen turner i ron iconic star and a planned parenthood board about tickets will discuss reproductive rights in the state of women's health and on october 2nd, psychiatry arne duncan come u.s. department of education will be here. second, i would like to present the guest of the traditional national press club mud to use the scores for low-calorie beverages. [laughter] and the last question traditional hospital food has been regarded as being pretty terrible, bland and uninspired. do usable patient food and any advice for in the hospital system's? >> i sampled patients' food every day at lunch. [laughter] and thank you very much for the opportunity to be here. [applause]

>> thank you for coming today. i would also like to think the national press club staff including the journalism institute and broadcast center for organizing today's event and finally here is a reminder you can find more information about the national press club on our web site. also if you would like to a transcript of today's program please check out our program. again it is www.press.org. thank you. we are adjourned. [applause]

this week on q&a, dan balls chief correspondent for "the washington post" discusses his decades covering politics and answers questions from purdue university students. c-span: dan balls, what is the difference in reporting today for newspapers and back in 1972 when timm wrote his book boys on the bus? >> guest: i think the biggest difference is i don't think of us as being newspaper people anymore. i think it is just being reporters and news people, and the world has changed so dramatically that we are hosting online and print. we are doing video. we are doing so many different things today and we are doing it around the clock. so i think it is a totally transformed business in that sense, and sometimes i will refer to a work at the paper but in fact i have to remind myself that is not really the case.

that is only one of the ways that we are disseminating information. so it is a much more competitive world and fast-paced world. there is less time for reflection and sometimes less time for reporting. eve ensler moving so much faster. i think those are the biggest differences. c-span: how would you compare the information today with candidates back then? >> guest: i think we know as much as we ever did and in some ways more. i think one of the challenges is to sort of sort out what is important information to know and what is trivial that might become you know, might be fun to know. and one of the things i worry about in the way that we move so rapidly today is that it's hard to sort of separate and we can get fixated particularly people with in the kind of a local community. who, you know, obsess on a lot of this hour by hour. we can get kind of sidetracked from the main issues of the day or the main arguments or the important things that you really need to know. c-span: move ahead to september,

october and you're the moderator for the debates for the candidates to be involved in. what needs to be asked and answered in order for the voters to have the best information going into that election. >> i think one of the things that needs to be answered in a more concrete way and in a more kind of systematic way is what is -- what would they actually do if they were president? we are spending a lot of time at this point for delivery in the past. the president is free litigating the bush years to suggest that governor mitt romney would take us back in those years with his policies and governor mitt romney as of this litigating the record of the president. but - what most people want to know is why has this recession dragged on as long as it has. technically we are out of the recession and the recovery but this is a recovery that has been very slow and difficult and painful for a lot of people and we still have unemployment above

8%. we shouldn't think that because it has come down a bit that we are at a good point in the economy. the economy is very fragile the percentage of people who are unemployed for more than six months is in the neighborhood of 42%. tonishare as and whensot clear hater t peside romney has lout a plan n a kind of co to pple i have a pathre gointo take end of the likely results. sphspecific qutions held ask? >> guest: i think i would askdeh wae oreclosure crisis. whhe various things that nyour tool tre a sas tried n the potential

ty. away fromd from ano small students from purdue rdue universy. en you were there did youhave any idea were you wod end up? like fonstce from 1978 until now the "washiton st" covering all of ese presidential campaigns? >> guest: i have to say i had a hope that i would end up in washington. when i was a sophomore in college on the recommendation of my brother who was three years older than i am and was also at the university, i joined the student newspaper the daily line , and the following summer i did an internship at washington for the congressman that represented my home district in northern ilohn derson, who later an for president as an independent in 1980, nd the so of confidence of working for the student paper and ten being ouhere in washington kind ofooked me on journalismnd federal

government being here in the naon's capital. at that point, i know i really wanted to come back here as a journalist. i didn't know in what capacity. i felt working for "the chicago tribune" bureau or a newspaper bureau i was lucky enough to get a job at the national journal in 1972 and so was able to get him relatively quickly. and then i was there for five yearand i was again lucky enough frankly to get a job at the washington post. and sort of have pinched myself ever since. c-span: over the years which contest, which candidates do you remember the most of th he particularly liked or disliked but that were the most interesting? >> guest: i think that bill clinn sd giftedcaide that i have wahehe i covering politics. and i -- rnald reagan was a

signifant figure. i had very ittlcontactwth hi interviewedhim n 1 project i was doing unrelated to the national journal. i was in texas duinghe first term and then i was the national editor of the post in the second term. iidn't have a lot of contact with him on the campaign trail. i did the campaign in 1934, but the clinton campaign, and bill clinton as a candidate was a whale of a story publicly given all the ups and downs that he went through, and to see that the ability of someone that is under fire which all candidates are at one point or another and his kind of determination to kind of pushed through that what he did kind of free imagining the democratic party after the losses in 1980 and '84 and '88 and tried to rethink what the

democratic party needed to do to bring middle class voters back to their side i thought was intellectually a very interesting experience. but, every campaign is a fascinating campaign. they are unpredictable. the country is always in a different place both politically and economically as we go through these campaigns. the human side of the campaigns is fascinating and one of the things i've always loved about being a political reporter is that it forces you not to spend all of your time inside the beltway and you get to know the country and the politics in different states. you get to know politicians in different states. so as you are following the surface of the presidential campaign, you're getting a graduate seminar every four years and kind of where the country is. c-span: how many people have already made up their mind and in what percentage? >> guest: probably 85 to 90 at this point.

i mean, we are a ver polarized vefor some time as everybody knows and i don't think that there is anything that has happened so far in this presidential campaign cycle that suggests that that is beginning to lose about little bit. if anything i think it is very much so. we are in the middle of the free call battle in wisconsin where governor scott walker is facing the recall on june 5th. everybody that i've talked to about that race it doesn't matter what side they are on or what involvement the have the degree of they have talked to says this is the most polarized state in the country and i think there was a recent poll that came out that indicated in wisconsin on that race probably less than 5% undecided at this point. these are remarkable numbers when you think about it, but in a sense people's self-identification is either republican or democrat and has knocked them into a voting pattern that we haven't seen, we

hadn't seen until we got into this period. i don't think there is a lot of minds that are going to be changed over the next five or six months but enough it could swing the election. >> host: i want to get our students involved. robert coleman has agreed to be the first to ask a question as i come across here and a trip over everybody. >> thank you. i just graduated from purdue in political science and my question is how does fact check change theou do journalist covering politics? >> guest: well, those enterprises i think have had a huge effect on the way campaigns are operating now, and they are enormously valuable for the readers. they do what you're supposed to be doing in the routine course of business but as i was saying at the beginning, things move so quickly and you have to post

something if you are out on the campgn tra and if you are one of the people that is assigned to governor mitt romney were the president or any of the candidates during the primary. something happens essentially you are expected to post it very, very quickly. there is very little time for a reporter who is out on a bus or driving a car in the middle of iowa or somewhere to be able to all the background research the you would do if you're writing a newspaper story. fact checkers have the ability and the brain power frankly and the knowledge to be doubled to go back and began to unravel some of these things. the arguments that were made by the campaigns these days are often over the top. they often stretched the truth. all campaigns do it and it's important to have a kind of rigorous and regular accounting of that and a place that readers can go to because if i do it in the context of the story line

eight fact check in the fourth paragraph and if people read only ten still not going to get to that because we know people's attention spans are pretty short and it's on the web they might clich to the first page and the jury may well not quite to the second page. to have a fact check spot on the web site or the print edition makes a huge difference for the readers. c-span: natalie johnson a freshman. >> i will be going into my sophomore year in mechanical engineering in the fall and my question for you is i.e. understand that you were the co-author lack of two different books. so i was wondering if co offering has altered your writing style in any way. >> it's a great question. i have had two different club authors. i did a book after the '94 campaign with ron brown's team who is now at the national journal and then i did a book after the 2008 campaign with a former colleague at "the

washington post" pulitzer prize winner that teaches at the university of maryland. one of the challenges there are great things to say about collaborating with somebody else. and both of my partnerships were terrific. i couldn't have asked for better collaborators and co-authors. the one challenge is to make a book with one voice. and frankly it doesn't alter the riding styles of either author for author the process it is your trade back-and-forth chapters. somebody always takes the lead on that particular chapter of that chapter then goes to the author kuhl author and they do some rewriting and they do some tweaking and they do some restructuring and some smoothing and out of that, the two voices from bucko authors are in one. you wouldn't have a good book if

it was obvious who wrote which chapters and in both cases i think most people have not been able to figure out which 1i wrote. collaborating is great. i am now working on a book by myself on this campaign, and i wake up in the morning thinking it would be nice to have a collaborator right now. to work through this particular issue and problem. >> i am in political science and communication. going off of that, how do you approach the book interviews differently than news reporting interviews? >> well, they are different. i think that the book interview is as gathering history. i think of interviewing when i am working for the news side s gathering contemporary information. now there is a fine line between that obviously but generally what i'm doing the interviews for the book i'm dealing with several defense. something that happened six

months or eight months ago or three or four months ago and it is really to try to get people to sort of put me back in the middle of that from their vantage point and to tell the story as they felt it and lived in those kind of moments with any campaign the turning point of the campaign. when you are reporting for the post what you're looking for is where is something going today and tomorrow or the next couple of weeks you are always trying to pitch forward as best you can and dig out things that haven't been revealed. there is the essence of what we do day-by-day. we are trying to scoot the proposition and break news and find things out that the campaigns don't necessarily want to come out so there is a kind of a distinct difference in that. >> i am a senior in communications ecology and my question is more in reference to your roots and i was wondering

how growing up in a relatively small midwestern town has shaped the way that you cover and you politics. estimate that as a wonderful question. i don't know that i can answer that directly other than to say we all are products growing up place and years and the people around us. midwesterners like yourselves tend to be pretty nice people. i think that when you grow up in a smaller community 25, 27,000 people, not a tiny community but not a big town obviously, and it was well away from chicago enough. i think they're comes from that a curiosity about the world. what is the rest of the world like? you understand what are the values of the place that you are

in and carrying those with the for the rest of my career has been a valuable one of the things you try to do as a political reporter is to understand sort of why voters are doing what they do. what voters are thinking about and the degree to which you have contact for your own life with different kinds of people is important but as i say the other aspect of that is when your anyplace like shreveport you wonder what is life on the east coast and the west coast and it feeds the curiosity to no more about other places as well as where you grew up. islamic my name is paul reza prieta macina intellectual engineering devotee know how has it from the's campaign compared with the 2008 campaign and what strategies to the way he won this and compared to last time. >> there are a lot of

differences. the biggest difference starts with the fact that he began this campaign essentially as the front-runner for the nomination. he began the 2008 campaign as a essentially little-known governor from massachusetts running against some people who were in essence nationally known and national celebrities. john mccain who would run in 2000 and was a significant figure national the end really mayor judy giuliani was the mayor of the attacks of september 11th and therefore had a national profile. the biggest difference was he had a need early on in that campaign to make a mark to try to convince people, voters, donors, people who pay attention to politics that he could play in the same league as mccain and giuliani and he did some

early fund-raising to create a splash and he did early advertising to drive his number seven on aor. he competed hard in the straw poll and was a way to put himself on the map. none of which gave him the nomination. he started this campaign and said in a sense we are not going to do it that way she didn't put in personal money the way he did the first time. they ran a much smaller operation than they did four years ago. if you went to the headquarters a year ago at this time compared to four years ago, it was night and day. it was a tighter operation. the start of more slowly. they paid less attention to the other candidates and tried to decide if we can run the race we want to run regardless of who ends up as our final competitor we would be in pretty good shape. so there were a lot of significant differences between the two campaigns.

>> and civil engineer. , social media changed your line of work in terms of reporting and getting your news information? >> significantly, and i think that the change in 2008 and 2012 has been one of the most dramatic that we have seen. the internet is obviously over a number of cycles and has had a pretty significant impact. but i think that social networking has been one of the most significant changes. twitter in particular is now a primary new source for anybody that covers politics and anybody that pays attention to politics. atwitter didn't exist four years ago for practical purposes. facebook is important. the obama campaign in 2018 essentially created their own version of facebook with the help of some of the original facebook people.

but now it is the way the campaigns think about doing organizing, creating the community networks so that those two facts alone have significantly altered the way that we approach but we are doing. a real-time example would be when the candidates are having a debate it used to be ase in room. there still is a spin room where at the end of the date the candidates it is a ritual process and we all go through it and is mostly useless but anyway, it's still fun. but the reality is in this campaign because of twitter, the campaigns could see instantly as people watching the the date whether they are reporters for ordinary folks would be tweeting the would be creating the conventional wisdom of what was happening in that debate.

by the time of debate was over, the spring room was irrelevant because people had already kind of come to conclusions as to what were the highlights of the debate. who had made the mistake, what changes were important and that kind of thing. so, you know, that is happening in real time and campaigns monitor that very closely to sort of come to the conclusion we have a problem on our hands, we have a really good night for we are somewhere in between. it's much different. as i say, it is much more real time than it used to be. >> i will be going to buy senior electrical engineer and i am originally from india. the republican primary was the first election process to be impacted by the citizens united decision and the speed and so on and the republicans sitting on

the candidate who didn't completely and there was a lot of debate on that. do you think there would be an effort or is there a consensus that of the money is not a good thing? and will there be any effort to curtail that? >> if you ask the average person would you think about the role of money in campaigns, they would answer, most of them would answer there's too much of it. they would say that unlimited money is not a healthy thing for the political system. and yet, there is no groundswell at this point to change that. as a voting issue money and campaigns really rise to the level of the economy, health care, education, any number of issues. it has been different as we've seen in the question the existence of the super pacs made

it possible for new gingrich and rick santorum to stay in the campaign longer than the a otherwise would have, so it dragged out the nomination battle. on the other hand, it also made it possible for governor romney to put down the attacks and the rise of new gingrich and leader rick santorum. his super pak was instrumental in crushing their hopes in iowa back in december, and when he rose up as a formidable opponent , that in the end brought the nomination to mitt romney. but there is no question that they had a significant effect on the elon dating the process and changing it. win knees you have one family and his wife and others giving as much money as they did to the

super pac command changes the nature of the game, and the other element of this is there is essentially no separation, and people now take for granted that there was no separation. technically the romney campaign cannot coordinate with the super pac that is working on its behalf. and yet, the people that are running it are all of the people, the candidates are allowed to raise money for those. but the president's campaign now is helping to raise money for priorities usa which is the super pac died in the president's reelection campaign. so, the closeness of this is obviously a distortion in the process because of the amount of money. the other element of this -- a low of the super pacs are taking money under conditions they have to reveal who they are but they're taking it to issue advertising quote on quote and they don't have to reveal that,

but i felt over the years there is almost no way that you can take money out of politics no matter what the structure is set up. smart lawyers find a way to get money into the campaign in significant amounts, so it may be that until there is a radical transformation that is a given. if that is the case, then a very strong case can and should be made for as much transparency as possible. we are in the era when it is very easy to do. it can be almost instantaneous and i think that if that were the case, at least there would be a greater check and the public with at least be able to say okay we know where that money is coming from. now in many cases we don't. we can have suspicions but we don't know exactly who is giving it and in what amount and that is an important fact that does have a effect on politics and

also people's perceptions of whether this is an open process or not. >> i am a senior studying political science. will the economy be the biggest issue for the voter consideration? >> yes unless something else eclipse is it and i don't mean that facetiously. if we had been sitting here four years ago at this time, we wouldn't have said the collapse of the economy will totally change the last six weeks or eight weeks of the fall campaign. it's always possible that an outside event can transform things and given kind of the nature of where we are internationally, you could foresee something like that potentially happening. having said that, i think that for -- it is likely, very likely that the economy will continue to be the biggest issue. whenever you talk to people about what is on their mind or what they are worried about, if some aspect of the economy come and kind of this economic

insecurity that so many people feel. some people are feeling a little better than they did a few months ago or a year ago. but they are not feeling terribly comfortable, and in one of our most recent polls, a significant percentage said they don't think that we are truly out of the recession. so, when you have that it is kind of the overriding mood of the country. there is no doubt that economic issues will dominate. >> i will be a senior next year in social studies education and political science and my question is about the whole republican primary process. and how mitt romney had to appeal much more conservative to win those votes and over the nomination so my question there entails have we talked about how even though it is polarized many people have already made up their mind that there is still a little bit left that he can win and certain swing states to win the overall election so where does he go to move back more towards the middle?

>> and for the most part and to try not to focus on some of the issues he ended up focusing on during the primaries. integration flexible a think if he moved himself much further to the white than he probably should have. i think that the problem that he has potentially had with latino voters is significant and could be decisive in some of those rocky mountain states in particular that will be in play. colorado, mexico, nevada, the obama campaign says they are going to try to put a arizona and a plea if they are able to do that but nonetheless, i think that the gatt governor romney's facing among the latino voters is in part a function of what happened in the primaries. you know, his position at this point from the primary to the general election has basically been to try to get back to where he wanted to be when he started

the campaign. if you go back to the announcement speech she made in new hampshire last june that was an economic focus and it was focused on president obama. that's where they have always wanted to run the campaign and if you talk to folks, they will say we have sought to be consistent in the message and to have a message that we started out with that works in the general election. ..

and there's no question that for all voters, no matter how we slice and dice them, economic issues do have a residence presidents. and if he can do that, you successful. the obama campaign as we've seen this week will do everything we can to keep him pinned over any particular place, further to the right than he wants to be and also as having a philosophy of economics that cured towards helping the wealthy at the expense of, or as opposed to the middle middle class. so that's the battle with regard to see unfold and we see that more and more as the campaign goes on. >> my name is ally alan and i just graduated. i'm curious to know how you

tailor your writing style for a poker book audience as opposed to reporting in your reporting on dance and how you maintain what we have not and might miss as opposed to your personal experience. >> the last one on the campaign in the current book i'm working on about this campaign, i think of this is trying to write a narrative about the campaign. when i'm covering day-to-day, you know, i'm taking a moment from the campaign and trying to analyze where are we at this moment on why? what is happening today and why? what is behind the latest attack was the latest mistake? where are we in terms of the electromagnetic? it's a term to best we can step back a half a step and make

sense of it. when you're doing the book, you have the great luxury, and a sense of unpacking everything and putting it back together and get people to understand in a much broader context. there are certain things we don't know it when you're able to go talk to people about what was really going on, you sometimes come away with a better understanding and obviously a lot of things about specific tensions are debates within a campaign. you see things in a different way. when you're trying to write for a book audience, what you're trying to do a series based two study appear burritos you've been a bad minute, newspaper or a newspaper story, but now you can read it and to some extent were put into the side of things that may seem at the moment but

it may have written three stories about, but prove to be significant. in the book you can say we don't have to worry about those things. >> my cross, my question is uncovered an election so diligently, how difficult is it to remain impartial in your reporting and not get caught up in the hype of one campaign or another? >> well, it's not as difficult as you might think. when i learned journalism when i was your age, i had a lot of good mentor is. this was an era in which the idea of being a reporter was to be as objective as you can be. we all know that everybody has biases and prejudices in worldviews depending how you were raised and where you are

based on what your friends where of which are printed politics weren't all bad. but if you come to the political reporting with the idea that i'm going to try to as best as i can a full and understanding of what is happening in this campaign. you put your biases to do side. it was a colleague of mine who covered the white house many years ago who passed away much too young. it was one of the best reporters. her only ideologies were she hated incompetence in government. so she covered the white house and away in which if there was incompetent she would rooted out and bring it to the floor.

peter harp who is a democratic pollster and who does what bill mcintyre at the nbc "wall street journal" poll said something to me when i was just starting out at the poster and political reporting and i think it's particularly happy you in a period in which everybody's trying to be a handy cam per and it's a great sport and we all have a lot of fun with it. he said the job of a political reporter is not to sort of sit there and try to predict who's going to win the senate race in the house race. or who's going to win the presidency in which candidate in the presidency will win ohio and which one's going to win michigan and nevada. he said what you should be thinking about is that when

people are watching an election or wake up the next morning and cnn papers so-and-so declared the victor in this presidential campaign committees to report the hope and understand why that and. not that you predicted it would happen, but they have an understanding of forces out work that were shaping the election. they will have an understanding of the strengths and weaknesses of the candidates that made it possible for them to win or lose. and i only thought that was really founded by us because we look at the presidential campaign, there's a number of different levels. what is the daily back-and-forth, the comment that goes on between the campaigns to put a message out and not get opponents after the side door knock them off their game. external events this later campaign into terminal turmoil

in disarray. others contribute to the character of these candidates and the whole another level country is always moving. this is not a static country. demographics have an anthropomorphic going. the economy has an impact and were going. i have a huge impact on how they got to churn out. we watched different states change over time. you watch a state go back to jersey once was from a real swing state to a state that is predominantly democratic in solidly democratic in the presidential election. how and when did that happen? what were the reasons of that? what were the issues that turned a state like that? why california go to state that often vote republican in the presidential campaign to one that is consistently voted democratic? those sources are up or been one

of the things you're trying to do as all of those things. when you approach a campaign report late that, i think you're not thinking about your own particular ideology. and so, you stand back and try to do it that way. i will say we are in an era where that kind of reporting is less surprised than i was when i first started out and in some ways people are critical of their view is that all people in the campaign should put all of their biases out on the table and talk about it. i disagree with that. i think there is a role for different types of reporting that is grounded in a particular viewpoint, political or partisan viewpoint, but there's a lot of people in this country who simply want us to sell them the

way it's unfolding to let them come to their own conclusions. >> and kyl walker and in the senior in political sciences. in the past americans got their news from print media at the 7:00 news with a radio if it got way way. how do you think the evolution of journalism lost in twitter will change the relationship journalists like yourself and your colleagues have with reporting election issues in a meaningful way? >> if we surveyed this room, i'm sure that half the room would say they get their political news from jon stewart and those who don't would say most of what they get they get on their farms when they look at their phones. and that is the way of the world and we are while adapting to

that. i know at that post so much the energy and thinking and creativity is aimed at, how do we find -- how do we make sure we're delivering information to people the way they want it? and so in a sense, the delivery change is. the news cycle is different. when i started out, afternoon newspapers had the dominant side of journalism. they were dying out because people were working at different hours in the morning newspaper was coming before, but also television obviously was coming dominance in the political coverage. we are now back to a sense with which the morning -- by the time something lands on your endorsement, if you subscribe to a print copy of the newspaper,

but the time it lands on your doorstop, much of the newspaper you already know and you probably are be checked your phone or your blackberry for your e-mail that morning. so something is breaking coming in upcoming or 24 hours or 12 hours ahead of the print edition and yet there's still a material that she didn't know, that we can deliver, whether it's smart analysis, deeper reported piece that was sent based on yesterday's events. but in terms of the flow of information, that is why we do so much more when we do news alerts in ways we never used to think about. not because everything feels irked his earth shattering news, but because people want to know about it. people want to know quickly about it. so i think that just changes. consumers change way to change

with them. how that affects the way political campaigns are run or who wins political camp pain, smarter people than i have to figure that out. we adapt as quickly as we can to the new world and all news organizations are. >> hello, my name is scott oliver and i'm a senior studying communication. in 2008 the obama campaign was successfully able to captivate the younger audience and others individuals will be at the voting age. how is romney going to identify with these individuals and capture the votes? >> welcome i don't know he's going to be able to do it very easily. i think younger voters -- people who voted for the first time in no way were captivated by president obama. i would say they are not as captivated today as they were four years or three doctors and the presidency takes a toll on everybody and is clearly taken its toll in terms of the way

people perceive it. but i think in terms of where he stands on issues, a lot of younger people identify more close the web that governor romney. and now, the younger generation is pushing its way through the electorate in a very significant way. brought in lots of people to the voting rolls who are young for the first time and will continue to do that election by election. the younger generation is a much more diverse generation that has grown up in a world that is far different than i grew up in her brain grew up in or for that matter than barack obama grew up in and different experiences. i think that the hope of the romney campaign is that they will just simply be an overall less enthusiasm among young

voters and therefore will not turn a dissonance between numbers. i don't think there is a belief they can significantly change the margin. i mean, the president and governor romney. but if you are turn out, composition of the lecture will be more favorable to governor romney than i was before. >> yakima name is paul bread and a senior in nuclear engineering. there's been a lot of talk in swing states that if you do play the devils advocate for one of the states that traditionally swings only one way, what would be your for either side of the campaign to flip the state? >> well, flipping states is all romney has to do. the president doesn't need to flip states. at the president were to put the state, they would say in chicago, arizona would be

because john mccain is the candidate four years ago. the senator from arizona didn't put a lot of effort into that. but the populations going to come and therefore they think at some point the state comes into play with the democrats. they don't know whether it's this time or not. the obviously spending time and money and we'll see in the end whether they do that. for governor vomitus a whole slew of state. pollster with karl rove as a shorthand version of what romney has to do called the 321 plan for winning the electoral college. three is to win that three states that traditionally have gone republican that obama flipped last time. north carolina, virginia and indiana and india not almost certainly will go back to the republican column this time. obama thinks they can hold north carolina. they want to play a very small margin last time. that's a tough state for them to hold.

virginia will be the big battleground right through to the end of the election. historically since 1964 until 1967, 2008. but that status changing demographically and so what is the true swing state. we are not, romney has to look at the two states that has often been the key states and win an election in the last decade. ohio and florida. ohio can be tough for president obama. there's a significant that is not a constituency he's done well within the past. that will be a competitive state. florida did pretty well there in 2008, but we'll see whether that is as easy this time. don't be a tough state for him. then it's got to win somewhere else that the president was,

whether it's iowa. the romney campaign says will have michigan in the past of elections voted democratic. the romney camp came thinks because he was born and raised today they have an opportunity to put the state in play. i think a lot of political analysts are still quite skeptical of whether they'll be a will to do it. but as at the obama campaign in arizona, the romney campaign will begin to do it and see what they can do. >> hello, i am a psychology major and senior mm from nature and my question has to do with the candidate for mayor romney. she think after the fiasco with sir palin you have to take special care when picking a candidate? >> yes, absolutely. the experiment with john mccain has made it much more

difficult and really frankly highly unlikely that governor romney both the very last couple of weeks before he makes a decision that says we really have to roll the dice. let's take some of the who's not on anybody's radar and elevate them to place presidential. i also don't think that's kind of in the dna of matt romney. there was a wonderful moment in the mccain campaign. therapy limits on her way up to meet him at his home in sedona, arizona for the interview and he's on the phone with the lawyer who handled the vetting process and the house had just completed the vetting is very appealing. it was done quietly and rather hurriedly and many people think rather through leave. the last thing became sad is hey

give me your bottom line and he said john, high risk, high reward. mccain responded, should've told me that. i've been a gambler on a life, which is true. mayor brown is not the gambler. matt romney is solid, stayed in everything -- every single that has come out of the romney is that they are not going to go that route there, but they're going to pick a governing choice, someone who will be seen as capable of becoming president in the event that something happened if president romney were to win. so i think were looking at a quite different model, influenced both by the problems that occurred four years ago, but also the difference between the two nominees. >> high, 90 watch her come in journal from washington, texas.

i was wondering how to access media coverage has affected the other important political topics. >> i'm sorry -- >> health care, how the fact that other important topics such as energy and educational reforms and things like that. >> well, sometime this summer were going to have health care convoy back to the presidential campaign to the supreme court hands down at decision on the health care law. health care was a significant fact they are in shaping public attitudes about president obama. it was a combination of the stimulus package, but also the health care plan that helped to be polarized very rapidly after he cut of the day. so health care is an important issue to people, simply because of the cost and affordability

and availability of health care and the absence of insurance for roughly 45 million americans. so it's a bread-and-butter issue, but it's mostly politically charged issue. and when the court makes its decisions, presumably sometime before the end of its term, at least for a time that's going to be front and center in again reshaping the way the political debate carries out. i attended up to september, tober, i don't know how many swing voters will have health care for the center or whether there'll be some other aspect of the economy that will drive it, but it is obviously a big issue will have a small but sometime in the next few weeks. >> der leader, professor caroline carroll is sitting

right here. i want to ask her to explain to iranian's discussion of who these folks are. >> it's a very diverse group actually from purdue university and that we have the liberal arts representative communications in psychology as well. we also have a group of engineers the sake of this class. the first year we've had been in the feeling this will have to ground up the education that purdue provides these young people. we also have an international convention. five of our students are not u.s.-born. foreign students, including algeria, china, india and i missed one. which one is that? jordan. thank you. sorry. so the experience that they have been having has been in many

ways what i call washington from the outside and for many of them, a first look we've had meetings at the white house, capitol hill, state department and yesterday "the new york times." an extra hope at the "washington post"'s dan. >> are always welcome. >> you've come to a count obviously very competitive on many levels and made a huge success doing a very tough job, political reporting in a political town eve had staying power, just monumental success with a huge newspaper. what would you decide if the students are thinking of coming to washington? >> hold that thought, what ever it to know that kerry land curiel is a former "washington post" are in "the new york times" a clinton speechwriter and ambassador to belize. go ahead.

>> speaking of success stories. you know, i guess the advice they would give -- i'm not one that's very good at giving advice. we all have talents that we were given and doors that were opened and we all have people who are mentors or just give your push along the way. annihilate back at a succession of people, you know, starting at the university of illinois professors who are just fabulous, some who are practicing journalists, some who weren't, but who were immensely helpful. people that i met in washington when i first arrived. people i worked with at the

post-commit beginning and similes ending with david s. broder, who for years, the reporter in this town who defines what political reporting is and always should be and who was the most generous colleague that any of us ever had, who made time not any kind of heavy-handed way of saying here's how you should do it, but just a time to give you the space to do what you are trying to do and gentle encouragement along the way. i think for anybody starting out -- i was lucky. i had a sense of what i wanted to do. as i was saying at the beginning, i knew fairly early on that i wanted to try to get to washington as a reporter and i was again lucky enough to be a lot to that.

every tour this up and opens other doors. every door closed to new moves you in the direction where another door will open. my first experience as a reporter after graduate school is at the "philadelphia inquirer," 1972. i lasted about 12 weeks. it was not a particularly happy experience. i can say with an understatement or not enamored with me. and he was a difficult summer because it is clear to me this is just not a good fit. it wasn't because i was doing things they shouldn't do and wasn't measuring up, but we kind of had a different world. but it was obvious it wasn't going to work. luckily the national journal came on and had nobody washington and i leapt at the chance to do it.

so everybody has moments of success and momus is either set back or worry. how confidence in yourself. you know, if you don't have confidence in yourself, others won't. believe in yourself. how the sense of what you want to do and also, i mean, find something you really like to do. you know, it sounds obvious and it is obvious, but if you like what you do, it's a lot easier to get up every morning and go to it and he'll do a better job at it. so those are the things to think about. the education you get is important. one of the reasons i always liked them reporting in a sense editing feature constantly forced to learn things. you're always felt learning. the education of any journalist should never stop.

it keeps on for the time he leaves school when you take your first job until the time you quit working. so all of that is kind of the way i approach things. but i feel i've been lucky. you know, i landed at the post as an editor and ended up as a reporter. the people at the post as caroline can attest is it big and competitive place of the enormously talented people. it's competitive against its competitors and competitive internally and at the "washington post" has always been counted as one of the lucky things related. you don't know what the inside of an institution is like when you get there. c-span: dan trant three. carolyn carryout unproduced

events, thank you very much. >> for a dvd copy of this program, call 1-877-622-7726. for free transcripts or to give you comments about this program, visit faq n/a.org. q&a programs are available at c-span