tv Key Capitol Hill Hearings CSPAN October 18, 2013 12:00pm-2:01pm EDT
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and the agency's, the health care sector achieve those ends. multi payer approaches, and the last area i touch on is any one of these buckets, affects everything, there is a recognition that the turn will exist. and a continuing of coverage and people the specially in lower income brackets do have frequent income changes that result in the eligibility king. and how we manage it. we had less focus in states and renewal, strategies, techniques than we have on enrollment for obvious reasons. now the we had federal guidance
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for the health program, a court of the option, a way to deal with the turn. and tennessee being the first with that but washington state as an apple held plus options they are working on which two each ps will serve as families and individuals churning away there are individuals that don't have different types of coverage. that is my 10,000 foot overview. my colleagues are going to fill in on some of these topics and different topics. un want to acknowledge there are others and some of those i know nothing about, wanted them to cover some long-term, with support being a prominent one, issues of equity, issues around monitoring the insurance reforms that are in place and making
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sure they are really working and a few others i would just name the i hope my colleagues would touch on. >> we will go on to jenny. >> before i launch into the challenges 4 issues that i think are prominent, medicaid programs, we have to acknowledge that we will be in a better position to identify them in a couple weeks and months because we have to go through this initial period and that is really going to affect the stage of the world and where the debate goes but the first observation i would have is patently obvious and it is the nature of the top issues facing medicaid programs across the country are really going to be different in 6 that have an expanded medicare and did the -- under aca the, those who haven't
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expanded by 2014, i think there is going to be a lot of discussion within the state about revisiting that decision, especially depending on the news coming out of the week's, reactions from consumers, providers and steve budget officials. much-heralded savings and economic benefits to the sticks that expand will be important for us to track what happens on the ground. for the states that and not expanding, the extent of the so-called woodwork of fact, the extent to which the eligible but an enrolled children and adults,
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not nationwide, millions in both categories, the extent to which all the not reach enrollment efforts are going on leave more of them to come for coverage will have budget implications. but as caddy said, i don't think the debate is going to be about the weather. it will be about how, as the arkansas waiver was approved recently, reflects a different approach to expanding medicaid. is not clear what that will mean to other states but other proposals in place in iowa, michigan, pennsylvania, ohio, different variants being proposed as cms decides which ones are viable in terms of going forward, that will clarify for other states what the range
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of prices might be. the options don't all focused on substituting exchange coverage or purchasing coverage to the exchange for a standard medicaid plans or other variants that include different cost sharing options. for example. i would just say research we are doing now that explores the extent to which individuals understand basic health-insurance concepts suggests very low confidence in people's understanding of what all of you take for granted as essentials to making good choices about health insurance plans. we are finding particularly lower understanding levels for people who have been uninsured with less experience with health
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insurance coverage, not surprisingly among young adults and folks with less education to the extent that medicaid moved more in the direction of offering more choices that the area along more dimensions. it will be really critical for states to consider the support that families are going to need to help make good choices for themselves. if we think about the states that are expanding medicaid there is a tremendous range of baseline medicaid coverage. in some states, the changes in the medicaid program will not be very profound at all. they see or vermont already has a very expensive medicaid program for adults and of course children. in some of the states that are
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expanding, imply potential new enrollment is quite large relative to the current enrollment days. and that introduces a number of obvious questions with respect to provide air supply capacity and the speed of enrollment increases will be a big factor in determining how fast the system has to respond and this isn't a question just of whether there is enough capacity but whether it is in the right places and the right type of services. when we look around the country, and will in increases are very uneven. some communities could see a doubling or more than doubling of the enrollment among adults
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and medicaid. and the research that has been done on the health needs of the newly eligible population suggests while they are healthier on average than the current population covered by medicaid many of them have undiagnosed health problems or untreated health problems so from the outset there could be a real catching up period and especially we expect in states where pick-up is lower, individuals to come forward first will be those on high end of the spectrum. there is particular concerns echoing what caddy said about mental health services, and whether the base is adequate to meet half those increased demands. you can see a real focus across
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the country on the state control to stimulate more capacity not just on the primary care side but the specialty side as well. i think you are going to see a lot of reconsideration of practice across the country and you are already seeing that in some places and those decisions transcend medicaid so you are going to see that and in the purview of medicaid you will see paula more focus on the reimbursement practices and as caddy said be affordable care act included a primary care rating increase in medicaid but for those who have been following it the implementation was delayed. it is not clear what is happening on the ground in terms of whether primary-care providers across the country have seen an increase so it is going to be very difficult to assess the impact and yet that
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is the two year federally financed policy but it is going to leave states scrambling to figure out if it is something that should be maintained or possibly broadened for specialty access but since so much of medicaid, especially for managed care, the focus is on using managed care contract thing, but address some of the reimbursement issues. as kathy said, and i am old enough to have seen this swing back and forth but we are having another debate about mental health and whether it should be carved in or carved out. that issue is top of mind in a number of states and i think
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that there is variation across the country in all oral health services are being delivered for children currently and some experimentation about integrating behavioral health together and on the adult side some states have opted to include oral health benefits for adults and i think there will be a lot of interest in understanding whether that makes a difference and how best to provide that. for the states that are expanding i really think there is going to be tremendous attention paid to the bottom line in terms of whether they were able to realize the savings in the other areas where they were expected in terms of compensated care, particular early in the behavioral health, mental health substance abuse
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area which had so much state financing over the years and now of federal funds through medicaid, were expected. this is the time of tremendous experimentation in terms of the provider, service delivery and financing of care, and i don't think we will wait for five years. i think there will be tremendous interest in learning from the experimentation across the country and understanding the implications for health and functioning of medicaid and also for the cost of providing care and the obvious targets of the population which is so much state budgets given that managed care has become so much more
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prominent for them, understanding implications of that, held home movement around the country that primary-care, medical home models, all of that is going to be tremendous interest of implications for states deciding whether they want to move in some of the directions they haven't already. i wanted to close with a focus on a population that isn't really directly affected by the coverage provisions of the affordable care act. this is going to be a critical component of state decisionmaking and that is the jules, they absorb large share of the state. spending on medicaid and concerns about fragmentation and service delivery system not
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being optimally constructive, that is a place where we have a large differences in approaches being taken across the country and i think there will be a real interest at the state level in understanding the implications of those different choices and learning from what other states have done so with that i will turn it over to tom. >> thank you very much, pleasure to be here. i usually like to break late developing news. my understanding is there are questions about inconsistent definitions of native americans in exemptions for the individual mandate. the obama administration about to come forward with a new definition that says native americans to not include nfl players on the team in the washington metropolitan area. i am going to stick to the original speaker outline, issued
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spotting. first question requests us to highlight the biggest issues on january 1st and before health policy, health industry crowds tend to be insular but i would think the biggest issue, you need to book a little larger which is in terms of the overall economy are we growing or slowing in the next year? that not only affects the ability to pay for a lot of this stuff but directly ties into the rate of increase of health care spending. recession goes along way bringing down the rate of increase but not recommended medicine on a long-term basis. the second area would be and expectations reset, not just in terms of the numbers, fake, real and imagined for enrollment in the exchanges, but some other secondary issues in terms of whether the benefits are what
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people expected them to be, relative generosity of the coverage in terms of significant amount of out-of-pocket expenses in most of the mental thieu's you will go under, how the medicaid scansion czar working out in practice as opposed to numbers, even though proposed straddled between private insurance coverage and the exchanges and medicaid. a couple states may get their first but most of those proposals have been teasers to bring some marginal states on board with medicaid expansion. i don't think they are a widespread basis as some might hope so is best to get there first before the innovation demonstration, money is quickly gone. the third area is what is going to happen in the enrollment makes, primarily the exchanges. much speculation about that but seems more likely we will get a
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great amount of convergence toward the silver plans, given the tie into our pockets subsidies you only get in that category and not the bronze category and the way in which subsidies are structured, there are estimates for -- the other part of the enrollment is who is actually an rolling, what do they end up costing and we get all kinds of hypothetical projections on that but what turned out to be the case may drive the first year reaction and reassessment as to what happens with that. the second question i had was to talk about some regulatory and fiscal challenges in 2014 for health insurers. there are quite a few. some of them are the obvious one is dealing with complaints and customer service and taking the blame for whatever happens over the next year. you are pretty good at that and you will do more of that again. incorporating regulations. there will be more on the way despite the ones you couldn't
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quite digest and swallow. and the issue of network adequacy probably will surface overtime. there maybe a fold from the edges of what technically might be required. but there will be some questions in the new work insurer plan for ans whether they are stepping up to the plate in order to deal with the affordability issue. they tried more limited networks, provider panels. we will see how that sorts out and whether the ambitions of having quality health providers everywhere to meet the needs necessarily match up with what you can do in the market place. some other issues for insurers, it is a sorting out process because this is rarely but there are a lot of would-be, might be, could bes in terms of the regulatory front. what really does happen with the outside market is probably going to disappear on the individual
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side but what about the small business market? we haven't probed what the take up in the interest and possibilities of the shop exchanges, they have been quietly in the background, getting them under way as originally envisioned. but that will need to sort it sells, similar pressures will come from the move by smaller employers but not tiny employers to pursue the self insurance option. we saw them in the mid 90s. it is a way to shed some regulatory responsibilities and it will be pushed back from regulators on that front so think about what is going on in your 2 or year 3 as opposed to year one as this market begins to revolve. one other wild card which i had some involvement in, the courts. is not entirely over. on monday morning in d.c.
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federal district court, there is a hearing on a motion which if successful would pull the money out from the federal we facilitated exchanges, the pens where the debt is. the old issue between one section of the law providing tax credits or state established exchanges and not doing the same thing for the federal facilitated exchange, another court case we will be hearing in richmond on october 31st with richmond based individual plaintiffs, very well crafted complained and lawsuit brought last week in indiana which played the violin strings with local schools not being able to educate their students and cutting back hours. that story is not entirely over as well as the oklahoma case is still alive going for a motion for summary judgment before the end of the year. that would substantially -- these are less than 50% probability is that upset a lot
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of plans and a federal it is of the faded exchanges out of their misery, and happens to reconsider whether or not you want to state exchange that operate in your state which compared the experience would suggest as a better option. the last area i was asked to talk about trends and themes beyond the initial affordable care act implementation or non implementation or what have you. i agree with my coke analysts it is a capacity issue. a significant one and will evolve and the tensions of the mismatch between simulated demand and lagging supply. i would look for some second best, third best, creative work arounds day. the scope of practice will be on the table but i think you will see a growing interest not just in the conventional public health give them more money but different ways to think about
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changing the demand structure in terms of broader health improvement, whether it is a population wider, early premedical prevention there is more interest in that and it may all of it is hard to think about policy you complain as a politician that gives you credit for doing it may begin to deal with the mismatch between what we have in an expensive system and ability to pay for it. another important area is a blend between competition in our health care markets and increased consolidation. we get pushed in both directions. that is a broader issue in terms of the provider front and in that market but also among insurers. how will it sort out? we have seen a lot of big insurers selectively engage in the exchanges. what will be their strategies in years 2 and free? some decided to buy market share and live with lower prices for the time being.
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is that a good strategy? do the new order insurers whether they are -- don't think there's a long life history, the co-ops or the provider type plans or even the medicaid extensions into the market, how many will survive in your 2 or 3, you have to meet the bottom line. you will also be under the double squeeze of having to provide more generous benefits but having some pressure on your rates through rate review and not as significant am 0 are over time. in addition to that, state policy responses will see changes in medicaid expansion in states that held up the first time. that will take a couple years to play out, 2014 elections could make a difference in the number of states with miss matches
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between republican governors and state legislators, but that will evolve over time depending upon how the first year's experience goes we may see some sorting out who is playing ball with state administered exchanges for what those exchanges look like as to how that is seen as a different political environment. i mentioned the possible sorting out in the outside market versus the exchange market. there is an issue over the next couple years of what regulation 2.0 will look like. not just the ones that are already there. if this is a very difficult process, not dysfunctional, disappointing to patrons and neutral observers, the question would be is in a matter of defending the beach did you have achieved or trying to expand it? let's get more of the marketing to this type of thing and begin
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to -- we have decisions in expansion of the exchange be on the 100 employer march, 2017 to larger employers, can you present them with a straight face? what defensive regs might be put up in your 2 or 3? if it turns out the outside market is still out there, and the back and forth as you are playing the old risk selection game so we have to have some more on top. we don't even pull the know yet how the rules about a single risk pool for the individual and the exchange offered plans, same price, how will that play out in practice in chaldea put that together or do you still maintain outside pressure on that front? another area that hasn't been touched on is how long can the medicare advantage enrollment trend the 5 reimbursement level gravity? those cuts have been delayed for
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period of time and they are pretty significant. looking get united health revenue forecast the next year. there is still the thinking that some of that will come out of the balloon. you can maintain that level of attractiveness as there is the lane moving reimbursement squeeze for the medicated and insurance, a couple others quickly. we have to figure out what finally works. anything the works in delivery system reform and ratify it and say it was invented in washington even though it did not come through the innovation center but that will play out over the next few years. that could be some surprises, not necessarily medical homes which increase quality but don't bring down costs and give the party works it works again but doesn't work on this scale. nevertheless something will move on that front. the final one is talked about
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rhetorically but has to get real in the next couple years, which israel transparency in health care, pricing quality outcomes, significant demand for it but the infrastructure doesn't match up with that because sometimes things are going on parallel tracks, what is being supplied is not what actually people need or want but that is a growing trend that will have to happen not only at the federal level but the state world, that's for stenson come from but we will do a lot better than the current level. thank you. >> first met here for our panelists. [applause] >> that was an awful lot of acumen and insight provided in 45 minutes by our three panelists today. and a lot of food for thought. it confirmed my suspicion we have done everything there is to do and there's nothing left to
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talk about do in health policy. i am going to turn it over. i am going to turn it over to the audience and a second for some questions but i will start with one and start up front by saying it is probably tough, but ticket as tough or is easy as you would like and i will also acknowledge is shamelessly selfish because as i sat here listening to you i started thinking of my conference next year. in the three years i had the privilege of doing this conference and i think back to 200011 i think one of the first things you think about is the specter of the supreme court decision that was coming, 2012 we met a month before the presidential election, this year we convened in the midst of the government shutdown, debt ceiling debate and the start of
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open enrollment. we had bill this morning talking about the fact the we move from policy discussion, feel radical kind of period of time even as we all done massive amounts of work toward a reality discussion of january 1, 2014, coming, what is it going to look like? what is the experience going to be for the consumer and the voter. ..
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you can take it from any angle, whether that's with's the story on the uninsured to what's the story on affordability of coverage, delivery system reform, medicaid, so on and so forth. but i would appreciate any insights there from any of you and, anybody who would like to tackle it first. >> go ahead. >> i'm not going to tackle the whole thing. i'll just say that i don't think there will be one story. i think that the way the affordable care act is going to play out will be very different across this country and so i think the heterogenaity, in terms of enrollment experience, enrollment gains and ability to get care that, given that people that have insurance, that the
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really critical to establish how that's working across the country given the very different ways that is is being implemented. very importantly with respect to exchanges i think we'll see very different experience in the states with state-based exchanges and the states that have expanded medicaid but let's just be honest. we don't really know what the overall experience is going to be right now. it is just, i don't know. i've, i don't have, i don't think anyone has a crystal ball that could tell you, even what to expect in eight weeks, versus a year from now. >> told you it was not fair. tom? >> well i can make one prediction. i think the stories will be
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similar to experience finding your cable news talk show and getting message that you want to receive and people will be tuned into different frequents -- frequencies and hear appropriate matching stories relative to expectations and support level. that is the front end which is not a particularly, not a circular perpetual conversation but there are some broad trends that tend to persist, somewhat evidence in hands but not necessarily relying on that to a great degree. i think though about a year from now, or slightly longer, based on what we've seen thus far and what i would expect, i think there will be a move, you know, not old debate but to simply begin to think, could we do this a little simpler? could we down scale this and not have everything trying to be jammed through the wires of government and various
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instrument altys that don't seem to function very well? for wont of a better phrase, give me the damn money i get the insurance i want without you having to micromanage everything. at least a push, although it is not there on the republican side because they are where they are, to deregulate anddown scale the nature of the subsidiesization and little less regulation. it may cost us a lot but we thought someone else would pay for might be the most popular position. that might be the second best resting place that says this could function but you can't do all of this at this time in this manner so let's get the basics take care of first. >> i don't know that there is much i can add. i will say my prediction more people will be covered. i think that, i mean that is the bottom line, it is a bottom line goal of the affordable care act
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and i think we're going to accomplish that. it will be uneven and it will look different as general any said jennie said in every state. i don't think the law is going away. that would be another prediction. agree with tom, i think i said that, that i think the focus of our time is going to shift to further simplification and improvement. he laid out his vision of that. there are other people that might lay out a vision of a single-payer system. we'll still have that policy dialogue going on what that means but i hope we will be shifting from whether we're going to be implementing expanded coverage to, you know, what are the best ways of doing that are. and we'll have, with people, more people covered, more people understanding what it means to have insurance and, being better prepared to take good advantage of the system. at least, i'm half, half full
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today. >> that's great. questions from the audience. we have a couple of hand up. >> competing for questions over here. chris hath a way, national association of dental plans. a about a week or two ago they released ffm premium rates along with the other data. in the dental industry looking to see what kind of policies do those look like to meet the high low dental av rates. i'm curious if anyone looked at that data and drilled into it because the premiums are significantly, you know, lots of different variations to it. i was wondering if anyone had taken a dive into that data? >> we have not dove into it yet but do intend to do that to some extent. nasby has done a fair amount of work around dental services and oral health and our current initiative that we're working on is focused, in fact in taking a
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look at howdental is or may be working in exchanges trying to identify the issues and i think we know what a lot of those are but more importantly what might be some of the policy solutions implemented at state level or potentially at the federal level. we'll convening an expert panel and coming out with a paper that should be out by early next year >> i guess i will direct the question to you, cathy. to your comment about more coverage, we were talking at this table earlier about those individuals that fall in that coverage gap. i don't know, five to seven million people, whatever the right number is. seems like there could be the potential for a lot of political blowback from, in states when
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people find out they're too poor to get help. so i was wondering if you corks any of your colleagues or conversations with state officials and others, you know, do you have any thoughts about that, how that's going to get fixed? >> i think there's a lot of concern about it. again i think it is, maybe my colleagues have heard more, but i think it is one of those things we're kind of early in yet to hear much about it. there are states as i mentioned that are actually trying to work on their own solutions to the gap group. as i said minnesota being one i think it is clear, that's one of their goals. in aside from whether there are coverage options i think it is one of the reasons, one of many reasons think the health care safety net is still going to be important. i mean there are other options for trying to make sure that those folks get care even if it is not through an insurance mechanism but exactly what that is going to look like, i don't
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know. i think there is of course also, those who hope that some of that understanding, realization that comes to those folks might help increase pressure to close that gap on a policy level. >> but the minnesota example would be, say, the undocumented folks and for, for much smaller share of the population. i think you're thinking about mississippi and georgia and florida and texas where it's a big chunk of the uninsured. i mean we just put out some new research last week that looked at the current profile of the uninsured in every state and assessed what their of shempp would be eligible for either medicaid or exchange subsidies and in states that are not expanding medicaid it is well under 40%, in most of those states. and in the states that are, it's
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over 60%. you have got states like west virginia, kentucky, it is up around 80%. and when you think about that on the ground, if all uninsured folks go to the exchanges or the marketplace to try to get coverage we know the undocs won't qualify in any state. we know, there will be no help for individuals who are above 400% of the federal poverty level. but in the states that are not expanding a very low fraction will qualify for subsidies and i think that is a very different outreach challenge and enrollment challenge. i mean i think there are political dimensions to it but on that level on the ground i do think it's just beginning to be realized at the community level and we'll have to see what happens. >> let me just provide a little bit of a hard-headed political reality check. when you're talking about the coverage gap for folks basically below 100% of federal poverty
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level, this is in states which already had a political equalibrium which determined that they didn't want to provide that medicaid coverage to those people. that was true yesterday. it's true tomorrow. it may change politically as demographics shift in some of those states over time but that is less of a new development. it is more of a continuation of the status quote while other stores are open. those stores are open for folks above 100% of federal poverty for the exchange-based coverage in that state. so although the numbers are there, if you compare it to what seems to be the case just a little while ago, it's not that transformational and that much of a change. >> i think the big difference is the federal dollars. i think it's a really, in those states, the budget scenarios are really going to dominate the discussions more than perhaps the implications for the people.
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>> as well as the politics. i mean we're sitting in a state, you know, the gubernatorial election next month, you know, will determine really whether virginia expand or not. >> with that, i think the conversation up here may continue for a little while, or if you have questions thaw didn't get a chance to ask, perhaps our panelists will stick around for a minute or two but we are at the end of our time today. so i'm going to spend one minute closing but before i do, let's please thank the panelists again for being here. [applause] just a terrific way to end our conference. we have come to the end of this year's conference and i will end where i started with a thank you. thank you to all of you for being here with us this year. we come your feedback. there are evaluations that you can do. you can get the presentations from this conference online next week. i think we spelled that all out in a letter to you earlier and we hope you will be making plans to come back same time next year, back in the district.
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trek"'s george at that kay. he is hat the national press club here in washington to talk about gay rights. that is gets underway 1:00 p.m. eastern at companion network, c-span. back here on c-span2 we're live at 2 eastern with a second amendment conference. paul brady is will find attempts to find common ground on the national rifle association on gun control. live in about an hour or so at two p.m. eastern right here on c-span2. president obama is expected to make a personal announcement later today. he will nominate jay johnson to head up the homeland security department. that announcement now scheduled for 2:00 p.m. eastern. we'll have it live for you on c-span. here is look at some comments mr. johnson made recently about the nsa's data collection programs. >> i think, i disagree with anthony to say the program is
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illegal. in his opinion the program is illegal. in the opinion of all three branches of government the program is not illegal. and, you know, the people's representatives in congress, the court, the fisa court and executive branch all belief this program is legal. and it is important to i think, to put in perspective two things. first, as was alluded to in a question to the prior panel, there is no expectation of privacy in metadata by itself. the fact that 212 of 373-3093 make as phone call to some number in the 202 area code is known to the telephone company and lots of other people, there is no expectation the fact of that call and duration of that call itself. clearly there is expectation of privacy in content for which you need a warrant. second, the reality is the nsa
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surveillance program is probably the most regulated national security program we have. the two programs that have been declassified we're talking about, are regulated by the executive branch. congressional oversight has been aware of how the executive branch has interpreted section 215 and the judicial branch because it has approved it. that branch, that aspect of the judicial branch that has been designated by congress to hear these applications has approved of the manner in which this program is being implemented. so, there's the equalibrium and if our national political leadership decides they want to change the equalibrium, that is their prerogative and their responsibility. >> for guys like us who have been in the game for a long time we already know there are landmines out there that you have to be careful about how you manage your way through these things. issues of to deal with, the
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abortion issue in the united states. guns. race. arab-israeli relations. in other countries and i lived in other countries and worked with cartoonists in other countries they have their own red lines they have to be aware of. i guess what a cartoonist can get away with in san francisco might be different than what you could get away with in parts of alabama. >> i think there are fewer conservatives in journalism period. i think that is reflected among cartoonists as well. generally not a conservative thing. journalism tends to draw i would think, would be fair to say people who are more liberal. >> they say bad news is kind of good for cartoonist, it gives us a lot of fodder. but i would rather, i would rather work harder and have less bad news and know we were going in a right direction. i think we're kind of, we're not boeing in a right direction right now. so i feel very, i feel very, like it is a real calling for me to get my opinions out there.
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>> this weekend on c-span, it is not all fun and games for editorial cartoonists. hear why. saturday, at 10:00 a.m. eastern. on c-span's 2, booktv. mark gardener on outlaw jesse james and infamous james younger gang. saturday evening at 7:45. on c-span3 american history tv, four decade after watergate, a look back at nixon and the saturday night massacre, sunday afternoon at 1:00. 200-year-old clock stops ticking. time stand stills. ohio clock, easy metaphor for the government shutdown. >> we're standing a few feet away from the main entrance to the united states senate chamber in the north extension of the capitol. the clock behind me here is the oldest clock in the united states capitol. it was commissioned for the united states senate in the year 1815, ordered from a
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philadelphia clock-maker named thomas voight. >> one of many reasons why the c-span video archives are so amazing. >> the video library is amazing. you can view and share c-span programing anytime. it is easy. here's how. go to c-span.org and go to the video library to watch the newest video, and go to most recent tab. click on what you want to watch and bless play. you can also search the video library for a specific topic or key word or find a person. just type in their name, hit search, and go to people. go to their bio page and scroll down to their appearances. also share what you're watching and make a clip. use the set buttons or handle tools. add a title and description and then click share and send it by email, facebook, twitter or google plus. the c-span video librariry, searchable, easy, and free. created by the cable tv industry and funded by your local cable or satellite provider.
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>> last week in london former secretary of state hillary clinton was awarded the 2013 chatham house prize for her quote, contribution to international diplomacy and her work in furthering gender equality. the chat house was founded in 1920 as an independent policy institute. prior to receiving her award secretary clinton sat down and spoke with chatham house director robin niblet and discuss ad range of pressing international issues. she commented briefly on the u.s. government shutdown. this is just over an hour. [applause] >> well, ladies and gentlemen, welcome to chatham house, thank you very very much. for joining us today. before anything else, let me be a little boring and as i said,
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secretary clinton, please make sure you don't have your mobil phones on. it would be a real shame to be beeping through this and it would be a shame also if you interfered with microphones and so on. please make sure you have them switched off. and far exit is that door there. i don't usually say it -- >> please don't walk out on me. [laughing] >> no early stepping out. you will be positive if that is done at all. so now let me just say it is my great honor to welcome hillary rodham clinton to chatham house. >> thank you. >> welcome to our institute. pleasure to welcome you here not just as a conversation with us but winner of the chatham house prize of 2013. >> thank you very much. [applause] >> i first say what i like about our prize, even though our board sometimes gets a little nervous, it is from a selection of candidates nominated by our research programs.
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then presidents and down to three people and members vote. the members are here. they voted for you. so it makes it i think a very special prize. as you know it was given to you for your great significant contributions to international diplomacy. also i know this is important to you as well, for your role promoting rights of women and girls and equal opportunities for then in the world. this evening we're going to celebrate the award of the prize at a formal event, which lets us have an informal conversation today. i'm just very glad that you would be so kind in an on the record format. although at chatham house having this conversation with us today. we can go anywhere. what i will do start off by kicking off with a few questions i will ask. hopefully i will leave a whole bunch of things out. people are already putting their hands up. this is very bad sign. [laughter] so hang on for 20 minutes or so. this is way we'll do it. we've got time. i probably won't take more than 20 minutes. hopefully i won't take up all of
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your questions. and, i'll do a fair amount of filibustering so the cameras will get a little quieter in a minute as well. we could go in many directions, not at least i may say, secretary clinton, you kind of played two very fundamental roles as secretary of state strategically and i think the rebalance, let's use that phrase, of american foreign policy in the middle east in particular to the asia-pacific was clearly one of the big strategic calling cards of your tenure as secretary but you're also involved very much in the trenches and having to make last-minute calls, tough calls through the process which is the job of a secretary of state. but to have blended those two things, and we can therefore in our conversation talk about grand strategy with you. we can also end up talking about some of those really tough calls you have to make as you go along. i hope we can draw out insights of your experience for the future and not just for how things went at that time. let me kick off therefore with
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kind of a big question i suppose. when you took up your position as secretary of state, u.s. leadership, this is one of your calling cards, i think the phrase you used there were questions about the future of america's global leadership and you wanted to be able to renew the commitment to the tools of diplomacy, engage with allies, et cetera. today, if i look at the world i would say america, powerful country, probably easily still the most powerful. shale gas, military bases all over the world, strong alliances and allies. at the same time we've got shutdown. we've got the nearly but syria vote. but i would say fears outside the u.s. of neoisolationist instinct perhaps creeping into the body politic. and the fear that america plays by its own rules. the prison intelligence gathering issue is, i keep hearing in conferences keeps coming up in conversations about america's role. in that setup, do you think
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america has the capacity for global leadership today? can it play the leadership role you hoped it would when you took office four years ago? >> first, robin, let me thank you and thank the members of chatham house for this very moving award. i am a fan of your work and i appreciate greatly the vote of the membership on my behalf. and i think the question is one that has a very simple answer. yes, america's leadership remains, not only preeminent but necessary. but the world in which we live poses new challenges to all of us on an ongoing basis. that require a level of, you know, strategic thinking and execution that starts first and foremost back in the democracies that we represent. so, i would never criticize my
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country, out of my country but let me say that it is distressing at any point to see a political system that has weathered so many crises over centuries now be caught up in what are very unfortunate partisan disputes. however underlying them are questions about america's direction at home and abroad and i am confident that we will work our way through this, this latest challenge as we did back during my husband's administration in 1995 and early 1996, but i think that there's an underlying concern and it's not only in our country because we didn't take a vote but you did, that raises issues about,
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you know, what are our responsibilities? how do we projector power in the 21st century which trace additional forms as well as new, so-called, soft, what i like to say smart power? and those are debates that societies have to have, not just inside government offices. so i'm looking forward to talking in specifics with you but i think it's fair to say that the concerns that we have to be aware of when we look at the international position of the united states have to really come from a wellspring of effective decision-making at home and that is economic and it's social, growing in in equality are and, growing that in a sense in the united states and in europe there is a an ongoing debate about how we
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continue to provide the best services at the most affordable costs to our citizens because that after all is really the core of what we can do around the world. so i'm confident but i think that the debate we're having is one that requires some very serious analysis and thought. >> does it, does it cramp the style of a foreign secretary or a secretary of state, the fact that this domestic dimension of international politics is so powerful today? we have publickings who have been battered by global financial crisis but at least not good handling of key international crises, iraq, afghanistan, how they're managed at very least, therefore the room for scope of leadership is minimal. presidents or prime ministers find that they kind of want to do a world of summits take the lead, the role of foreign secretary, secretary of state must be a difficult one to
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follow through and lead. how did you find that kind of a role as secretary of state in particular? >> i didn't find it difficult. i found it very challenging because i took office when president obama was sworn in in the midst of the economic crisis. and i think it is easy for many to forget how close the world came to a much more serious, long-lasting economic recession, even depression. i think it was something that required american leadership. i'm certainly aware that some of the reasons for it lay in american financial decision-making and perhaps lack of regulatory oversight. .
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for an american secretary of state, but it was an important message to send, in part because of china -- which to this day has heavily invested in the american debt -- was raising questions and wondering about the decisions the would be made by the new administration. there was a feeling that because of the war in iraq and the aftermath of 9/11 and then of course of afghanistan, the united states had shifted
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attention away from asia and that was a concern to a lot of our allies. in europe there was a worry that the contagion of economics crisis plus what was felt to be less than an ongoing level of attention from the prior administration. so i went to asia and in europe in part to consult and to hear what people had to say but also to convey a message that we were looking at the entire world. of course we will always be concerned about the middle east. we had a war to wind down and try to resolve so that was very much in the forefront of the national security council agenda. but we wanted to get back into a more cooperative commutative role with our allies and partners. and frankly to send messages to
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others. >> on the point to the trip to asia and the role that you played in the rebalancing of u.s. foreign policy towards the asia pacific. you mentioned china and the need to push this strategic and economic dialogue. you had a strategic part which was important. but that the same time you were a very forceful advocate for the allies in southeast asia, the philippines, singapore, etc.. how do you balance wanting to send a positive message to the allies with the fact that this is pretty suspicious. did you feel this in the meetings with the chinese leaders? >> i did, and there were concerns on the part of the chinese leadership over what
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this meant. but when i planned the first trip and presented the strategy to the white house, i wanted to integrate what were different strands of the involvement. there was a very strong argument that a rising china has to be the central focus of american foreign policy in the asia-pacific and increasingly even globally. the hope being that through that kind of involvement we could move towards china becoming a responsible stakeholder. there were the traditional allies. we have treaty alliances with japan, south korea, the philippines, australia and there was a feeling on their part that we needed to be much clearer about american interest would be in the 21st century that we were a resident pacific power that we
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have obligations and that we needed to more forcefully present those. and then and there were the osean culture is trying to figure out how to their own balancing. so i didn't think that you could pick among those choices. you had to have a more comprehensive approach partly because we have existing obligations. but also because it seemed to me as the charted the course forward with china, we wanted china to realize that we were in the pacific to stay. we were not there as an interloper but and say president therefore we wanted to become more involved in the regional organizations. on that first trip i went to jakarta and signed a memorandum saying that the united states
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had moved towards the treaty and the collaboration. something that we had never done but something that was very important to the nation. and indeed in china began what was a very candid conversation, and i think there were certainly an area of disagreement. we know about china's historical interest to raise with the united states the human rights all of which were on the agenda. but we were looking for through this new vehicle of the strategic and economic dialogue to take what hank paulson had done on the economic side and with tim geithner and by working to together to expand the discussion to stay focused on the economic issues in the early 09, part of that was you are going to get your house in order and you are going to make sure
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that our investments in our good ones that we want to bring the strategics in because there is a long list. claims of the south china sea, the conflicts that have occurred over assets and potential resources with vietnam, with the philippines, the back-and-forth are dealing with japan. the continuing threats posed by north korea which is very much a chinese problem and a potential solution. we wanted to have a broad discretion and make it clear that the united states was there to stay. >> there was a moment that you must have wondered if this was one of those remarkable moments
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of your time a few months in the beginning of 2012 when the vice chair had given himself up and three or four months later when he had to be rescued into the embassy for the next strategic economic dialogue. can you give me a feel if you can for how you managed that particular process. >> well it's always a challenge when things that are totally unexpected happen. i have these virtual in boxes in my head. the immediate screaming crisis and the longer-term crisis try to get a big box of opportunities. but it is a great example of the way that i think the expanded
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strategic and economic dialogue helped us result to very difficult issues because what i try to do in the dialogue is to really in bed in the governments of both the four countries issues that there was a lot more interchange. i came to believe that the chinese for their own reasons and because of their own way of governing believe that in washington somewhere there is a master plan of what we intend to do to try to control their rise and a similar trend in the front row. he and i talk about that endlessly. they do because we have plans and we have all kinds of processes and they've never understood the jazz quality.
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they began to strip away some of the misconceptions. we do have views and interests and values but we are not opaque we want to share with you and you share with us. when you say the police chief sign that i consulate asking for asylum it's quite dramatic about him knowing they killed one of your countrymen. he didn't fit any of the categories for the united states giving him asylum. he had a record of corruption, of thuggishness.
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they had a falling out and now she was trying to get his way to a place of safety. but on the other hand, the consulate was quickly encircled by other police who were either subordinate to or looking to curry favor. so it was becoming a dangerous situation. so what we did was tell them that, you know, he could not move into the conflict to the consulate. there was no ground we could offer that to him but he kept saying he wanted to get the truth to beijing. he wanted the government and beijing to know what was happening so we said we could arrange that. we were very discreet about it and didn't try to embarrass anybody involved in that tried to handle that in a very professional manner which i think that we accomplished.
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step forward, and i get called late one night about jen who has skipped from house arrest quite remarkably since he's blind. had broken his foot in the east cape -- escapes and was seeking asylum and was on his way there. we know of his courageous history of dissident activity. we knew he was a self-taught lawyer who had a very bravely taken on the one child policy in china and others for their behavior. it was as you said a week before the annual strategic economic dialogue meeting this time in beijing. i was very well aware that this would be an issue in the
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relationship, but i also believed that, you know, this was an example of american values and practice. that this was a man who yes, deserved american support and attention and protection and lots of back-and-forth as you can imagine. i made the call that we are going to send people love to pick them up. so we got them into the embassy, the medical treatment and some of the injuries and then had to tell the chinese government. but, you know we were offering hospitality to one of their citizens and would like to talk to them about. campbell as some of you know was my assistant secretary for the asia and pacific affairs immediately got on a plane and we were fortunate the head of my legal department, incredible
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international lawyer with his own history of dissidents his father was not able to return home from his position at the u.n. because of the coup in korea. so he had a feel for this. we tracked him down and he was at one of the economic dialogue working groups. so we got our people to the embassy and they began talking with mr. chen. then they began negotiating with their chinese counterparts. and this is a long story. i don't want to couple of our time. but it was a very touch and go situation. we were able to negotiate with the chinese the safe passage for his family. he hadn't seen on of his children in quite some time to beijing. we were able to negotiate an agreement that he could attend college. something that he really wanted to do and he didn't want to
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leave china. he loved china. and he also very much believed that if he could just get his story to the upper echelon of the chinese government, they would agree with him because so much of the mistreatment he had experienced with the hands of the local and regional officials they had problems that needed further medical treatment so they lost the embassy totally voluntarily and he called me he called me on monday on the way to the hospital and said if i were there i would kiss you i'm very happy you are so happy we got into the hospital and his family showed up and rightfully they were saying are you sure you can trust the chinese government and they can keep their end of the bargain and let you go to college and not throw you in prison.
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so she tells us i don't think that is a good deal to negotiate yes, i know. [laughter] i said excuse me? he said what would you like. i said i would like to go to america. okay. after saying no no-no. so we worked out an arrangement that he could go to the university to study assuming that we could get a second agreement with the chinese. and this is where i think all of the work that we have put into this, all of the incredible planning and one-on-one meetings and very candid conversations that i engaged in with my counterparts and others did with the bears because i had to go to the state councilor and i have to say this is in your interest and our interest and there has to be a way that we can work
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this out. his first response is we never want to talk about this mission again with anybody. we can't go back into negotiations. i said we have to. we need to start now and we need to get this resolved by the end of our meetings. we did it in a way that really i think validated the kind of arrangement and almost the daily work that went into it. the final thing that i would say about it which is very touching to me it was touch and go and one of the things that's i was asked to do because i still had meetings on my agenda with the president hu jintao da silva please don't mention this. we will try to work this out. so why didn't. and we had very for all, very predictable kinds of meetings. and then we were having an event
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about people to people exchanges. again i know a lot of foreign policy experts say that's like the frosting on the cake. what difference does it make put on your formal clothes and go into the meeting. i can only tell you that it's a people to people event. there was a young american man who was studying and china and a young chinese woman studying in the united states. we had picked them out to speak to the group, she in english and he in amber and about their experiences in each other's country. i am convinced that helped to convince the chinese government that we would do this deal. because i said in my prepared remarks this is what the future should be about. about young people like this, working together understanding each other better, visiting and finding a common ground. that is what we should be looking for. later that afternoon we were
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able to make a deal and he and his family were able to leave but i think it was part of a broad story not just one off. >> i think the story, which is fascinating, is an absolute example of that thickening of relationships. diplomacy is about action as well. but to get to then you have to go through such a process of confidence-building. >> we are such an impatient people these days. it seems like it's just a comment about politics it just seems like a goes on and on the tenth meeting and the 18 the dinner. in a way i think it is more important to show up today than it used to be because everyone knows you can communicator for technology without showing up. people would say to me all the time what are you traveling all over the place for? part of it was we had some
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repair work to do to be very blunt. [laughter] but part of it was we had relationships to build and they are worth investing in because you never know what might come from them or what you might stop coming from them. and yet i think in part because of the feeling -- i will speak for my own country. this is like just frosting on the cake. fine if you can do it but not necessary. and i actually think it is baked into the cake so to speak. if you don't do it too will not really understand what is possible in such a complex and fact changing a little like the one we have. >> there has been a discovery of the importance in the diplomacy alongside something i know you pushed a lot as well, the central media, the connectivity etc. if you don't don't do so it becomes a difficult deal of the crisis which is a core part. of course a bunch of questions
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special members that have a chance [inaudible] i think i have to take this person first. i wont get to everyone but i will do my best. i will do one at a time and use my discretion. yes, please. >> [inaudible] in georgia at the same time last year in the pre-election thanks to your huge effort and to president obama we managed to overcome this in the democracy. >> [inaudible] >> it will be huge crimes and the previous regime official.
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our current government is under huge and irresistible pressure from the midwest not to the previous officials or the political persecution. >> questioned? >> at the same time the government's public is for the sake of democracy and rule of law to be brought to justice. hillary clinton, george use are greatly appreciated if you would tell us how we should tackle these obstacles to build a healthy democracy. >> why don't you take that one street up if you wish. >> look, i think that you have a
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very challenging a dilemma facing georgia 80 you have summarized it well because in the progress that georgia has made in the last 20 years is quite remarkable. and many of the people who contributed to that progress are currently out of office and you have a new government that understandably wants to continue the progress and figured out the best way to do that. i can't give you the kind of easy answer that would say x or y because there is so much riding on how you navigate through these next month's before ha in terms of your stability and in terms of whether or not you can as you say protect the rule of law without undermining a lot of the
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progress that has been made. that takes a lot of very careful thought that has to be personalized. you have to think not of the people who you believe may have broken law. but think about the positions that are currently being held by the new government and whether pursing prior office holders is going to consolidate democracy or representative the country into a lot of pieces. and, you know, what i would ask you to do this to try to avoid personalizing it and instead, try to in effect analyze what will be in the best interest of georgia in five years, ten years, 15 years because for
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every person you say wants you to do something, there is a person who thinks that it would be very unfortunate if you didn't you have to sort that out. there's truth and reconciliation models. there are other kinds of inquiries that could make things public so that it would serve the purpose of transparency but not create the kind of instability and maybe even a conflict that could undermine the space project in georgia. >> let me move on. i have 12 people now so i'm just not going to look and catch people's eye anymore. [laughter] yes. a microphone will come to you. just hold on a second. >> use bouck nicely about the jazz quality of american foreign policy. on syria one would think that it's more like a 12 tone scale.
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and i wonder if you thought that the deal however it was reached on chemical weapons was irrelevant to the real problem which is the civil war or whether you think it actually can be a step towards resolving it. thank you. >> at this point it can be and should be a step towards resolving at and i do think that on its own it has a marriage fully acknowledging and trying to contain the chemical capacity is very important for the ongoing civil war but also for the potential dangers to neighbors that can be put into the category of a positive outcome of the ongoing negotiations.
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now, syria is in part such a dilemma because there has not yet been a willingness on the part of the russians to really push the regime to rein in their own support for the syrian military, the opposition to organize themselves sufficiently to present a united front that would provide negotiators on the syrian side. so the fact that russia and the united states and the rest of the world has cooperated on this chemical weapon endeavor is a plus to leading into the geneva negotiations. i negotiated geneva number one for the transition. lavrov was there and agreed to
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it. i know he left the room and went to the russian embassy and made a phone call. i believe that he was authorized to agree to it. and it was our understanding that we would take that and have it somehow blessed by the security council so that it would have not just cerium group which are not members of the security council with the broad members of the community. and, you know, that didn't happen and it didn't happen in part because i think that the russians were not yet ready to make that kind of commitment to a process and the process would be a transition process away from him. but china has passed and more terrible things have happened. the refugee members are skyrocketing. turkey is doing a strain the job
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working with the law of those refugees. you have iraq playing on the side and a sauna that is quite troubling. lebanon has all kind of problems. so you go around the region and you see that we are not in a stable situation. we are continuing to deteriorated in the situation. so i think that this level of cooperation actually just won a nobel prize. so obviously people see it as something worthwhile. but it can lead to a better outcome which might lead to a political resolution. you've got two big problems you still don't have an opposition that controls pretty much. and you have an increasingly well-armed militancy that answers to others in the syrian people which will be the spoilers unless they are reined
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in. so we are a long way from seeing some kind of a positive outcome but i think the chemical weapons peace is a good step. >> could you have a credible part of the opposition which you need for the negotiation without that credible part continuing to be armed? i don't see the credible part for the obvious reasons. and you backed about a year masako general martin dempsey when they were pushing that people were saying no we've lost the bottle, we've lost the moment. do you think can we actually have a credible and more positive opposition without backing them? >> it's public information that i pushed very hard to have a mission on the part of the united states and others to try to work with the credible
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opposition to help them gain some credibility with the other rebels. and that did not happen. i still think there's an opportunity to do that and there is some work again publicly known that is proceeding. about what is missing is a leadership to rally round and then to really work in a concerted way to support both their political track and military track. if i were in sight syria and i were, you know, leading some small group from my village and three others i would want to follow someone who has yet had a vision for a syria that would be appealing to me post-assad but i wouldn't trust them if there were not some guys with our weapons to back it up because there are others there with
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those assets. so i think you have to have an opposition that is not just talking that has strengths behind its position. >> chairman of the ulin association and member. madam secretary, thank you for which the franc is you are talking about this afternoon. i want to ask about the international institutions and whether you feel that is strong enough for our strategic purposes and global cooperation. or do you worry that the world and its national diplomacy is becoming too ad hoc clacks >> i do think that part of the reason that international diplomacy is to a certain degree is because the international
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institutions have difficulty moving quickly on a number of strategic fronts and i think if we didn't have the united nations we would need to invent it. we need that role with the united nations plays that is absolutely critical the important for all the obvious reasons. but it is difficult to get controversial action done quickly within the security council and that's why people go on ad hoc and circle back and that is what happened with chemical weapons. couldn't get our security council resolution on tougher sanctions on the al-assad regime or on the part of all to the scope possible particle seven or the absence of pulling back from the offense and all the rest you know so well.
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but on the chemical weapons piece that is a devotees interest. if you are russia or china or the united states come you don't want syria to have a big chemical weapon stockpile. so you have seized this opportunity and they agreed and go forward. so now i think that everyone that i have spoken to about the international organizations know they have to be reformed and know that there has to be a kind of new global social contract for the 21st century. but it is difficult to actually put into operation. so you've got the imf and the g20. you've got the united nations and regional organizations. so it looks like an alphabet soup but properly managed there are benefits to each of those but nothing will replace a
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global free market and it would be for everyone's benefit if we could put our heads together and then go back to brentonwood and figure out what does it look like for the 21st century. go back to san francisco and say what does the u.n. look like for the 21st century? i don't think that is something that will happen soon but it's something that we should consider. >> i'm trying to move around the room a little bit as well. >> thank you for joining us. line with the program here. i want to take you back to where we started on leadership. the conversations i had people indicating a week america and i am nervous about a weaker america. perhaps they take advantage of what they see as a weaker america the there's an argument that says this could be a new form of leadership for the united states. perhaps to use the terminology
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leading from behind or leading together more of a multilateral type of leadership. i would be interested in your views on is this a new strategic vision, a new type of leadership that obama is trying to achieve or is this more of a haphazard at hawk? >> i think president obama and myself believe that there should be more shared responsibility and more multilateral leading on a range of issues. that has certainly been an approach that we have deployed in several instances. but that doesn't mean that we don't recognize and accept our primary responsibility in any of those settings. libya is an example.
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the europeans came to the united states and said we have to do something about this. the arab league came to the united states and said we have to do something about this and the response was what are you going to do about? our her response was will you do the to we want to know what you're going to do. it sounds funny that the was the first time that there had than any kind of partnership between nato and arab countries and was the first time the united states said we have certain assets that are ours and we will deploy those. you have assets you should be played yours. i thought that was an inappropriate way to respond to a problem that was certainly important to us but critically important to all of our allies.
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i think that you can look at the kind of leadership in a way that is described as networks which i like for a lot of reasons including the and murray slaughter who was my director of policy and planning wrote a very influential article about the move towards the network leadership in the world. it's one of the reasons i asked her to join me at the state department because it's not only round up the usual suspects. there are other organizations and entities that have responsibility for leading. that's true not only in foreign policy but in the development policy where what we are doing now is trying to put together networks and partnerships to solve problems that governments alone and even international organizations alone would and should be as effective in doing so. i just came out of the clinton
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global initiative in new york which was born out of my husband's in sight. we left the white house and there were so many different players now in the world who had a role that could contribute to solving primarily development problems and we needed a vehicle to get them together. the same is true on the security side as well. we are not going to deal with cybersecurity unless there's a partnership between business and government and we are never going to be able to deal with a lot of the trend line problems, whether it's terrorism or poaching or human trafficking without having a broad network of invested leaders. so i don't know that it's a new philosophy but it's more of a recognition that that is the way the world is evolving.
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if we want to stop elephant poaching and murdering an africa we have to use social media to convince them that the tosk doesn't fall off like it to the the elephant has to be killed to get it so you begin to engage citizens as themselves agents as well as principals in making these decisions. i have a number of people waiting and i haven't got into the back of the room so let me take a lady in a checkered shirt because they had their hand up first. i'm from the guardian. do you think it's right and proper debate about the other side of the u.s. and the u.k. --
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>> and the lady next to you, please. >> eni from fox news. i'm curious what you think -- [inaudible] [laughter] >> i love the idea of the guardian. [applause] >> i'm really curious to know what you think about this new momentum in terms of the u.s. and iran and the moves that we have seen happening day by day in these little developments that seem there could be in the not too distant future. thank you. >> these are both very important questions. on the intelligence issue, we are democracies.
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thank goodness, both of the u.s. and the u.k.. we need to have a sensible adel conversation about what is necessary to be done and how to do it any way that is as transparent as it can be with as much citizen oversight as can be. and i think that has to be, you know, the sort of remark because within that framework there are some things i know from my own experience as a senator and as a secretary of state that really are critical ingredients in our homeland security and helping to protect people in other countries as well successful. personal information that is held by businesses and the
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united states and by our government. and so, how do we sort of this out? this is a new problem. it's a problem that grew over a decade old where these capacities have corresponded with increasing out of reach to consumers on the business side and increasing concern about security on the government side. so, people need to be better informed. but i think it would be going down the wrong path if we were to somehow reject the importance of both the the date the date could be date and the kind of intelligence activities that genuinely keep us savor. so, i am all for opening up a more vigorous discussion about it. with respect to iran, i think it is too soon to tell. but there have been no changes in policy yet. there's been no response to the outstanding offer by the p5+1.
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so when calfee brings together the p5+1 negotiating group in geneva next week, i will be the most interested in hearing of the iranians are putting any meat on the bones of their hope that there can be a negotiation that leads to a resolution that is satisfying to them and acceptable to us. we don't have any way of knowing that yet. >> coming down front now. >> that of secretary, former member of the council. can you reflect on the changing nature of leadership and the more vulnerability and the human rights council back in february of 2011 about the new nervous system for the climate and at the level of connectivity no one
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can hide now whether you are in the government country or elsewhere. and of course you mentioned a memory but also alex rauf and the work he was doing in this department. there are enormous changes happening quickly including disruption of the way that the leaders believe leadership should be enacted. what are your reflections now since you left the state department? >> fabulous question. one of the things that i have learned over the years is watch the headlines but keep your eye on the trend lines because they are often much more important. the activity along with interdependence is very much on my mind because the benefits are quite remarkable that so are the dangers and how we balance that
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is one of the challenges of leadership. what transparency can help to fight corruption, can make information more readily available to people. alex rauf was my ally in promoting internet freedom, which we believe is light the first amendment, something that just has to be embedded in the global consciousness but we've also seen the power to corrupt internet usage, to target the dissidents and the figures. so we are in a formative period. the outcome of which isn't yet clear and i think it is imperative that the government's, democracies, of the governments who value free
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speech and open debate unite in trying to protect this value and that is going to be one of the most difficult few years because of the concerted effort by more close societies, more controlling societies. when we talk about leadership, i think it is a great device for learning more about what is going on. but it also can be a device that interferes with making tough decisions. you know, if you are only watching how many followers you have on twitter or whether people responding to your speeches like you or not. that can very much create static in the decision making process. and we have to get back to
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looking clearly that the underlying values that are undergird in our society and government and not get the verdict by the back-and-forth but use it for informing yourself but don't use it as an excuse not to make hard decisions as a leader. >> i'm going to ask three people -- three people. he will take them as you can and try to finish on time. i'm going to apologize. this is one of the people that isn't going to -- using to be waiting patiently. i'm sorry. >> [inaudible] >> russia just arrested [inaudible]
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what would you advise them to try to get from -- how would you go about this? >> i will let you reflect on that. berlin back to syria [inaudible] the question is the crisis started in the middle east turkey was a supporter of the united states policies. however, since they are now coming to a slow motion, do you think turkey has been kicked by use in? >> the young lady standing up.
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i apologize. >> [inaudible] i would like to ask you there are many in saudi arabia what were you like to say to them and would that lead to a change? [inaudible] [applause] >> on the piracy issue there should be a greater international outcry over the russians and arrest and charging the piracy. i mean, you know this is both on the merits and issues that need to be resolved. i know a lot of governments are intervening and speaking out. but this is coming back to the last question. this is a great device or a
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great issue to use the internet over. it's a huge outcry f people demonstrating in favor of these folks and trying to create a new movement on their behalf. obviously president putin will decide what he thinks is in his country's interest but that has to be balanced by a real outcry it raises an issue of the arctic and what is going to be governed and with the rules are and who gets to devise them and enforce them and participate in the council that consists of the arctic nations plus three neighboring nations. we began working on agreements like search and rescue in the arctic, the oil spill recovery. this is one of those issues
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people are going to wake up in a couple years and there will be all kind of things going on and people will say why didn't we do something about this? the answer is yes, countries have jurisdiction in their coastal waters and they can enforce their small but their needs to be more work done on the rules of the road for the arctic the changes in the environment it will become increasingly trafficked part of the world. and we had a great agreement in the 1950's in the antarctic which has preserved its. very different issues in the arctic. but i think it needs to go back to the ugandan question. there needs to be much more intense effort to try to support the council and international bodies and helping to make those rules. i think that the prime minister was a very strong supporter of the seeley in the uprising but i sure as you know he had other challenges at home that he had to deal with.
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but among them were his ongoing efforts inside of turkey and some of the other activities of the kurds in syria began to complicate debt. and there's also as you know a large population in southwestern turkey. the began to complicate. everybody has politics. it doesn't matter what kind of government you have. and his politics became known much more challenging for him. he remains a strong voice for the humane treatment of refugees and i think that what turkey has done and receiving so many syrian refugees and putting them in conditions that were above what might have been expected for the refugees has regained his credit. but he's got to sort out a lot of different challenges and i
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think he remains committed but without a broad base on which to operate i don't think you're going to see and able to do much more than what he's doing right now. and in a thing that is unfortunate but if there had been more movements at the same time a greater international effort he might have been able to participate more effectively. on the saudi women driving, i think it is an issue that is symbolic as you know very well. but it is also from my friends who have lived in the kingdom is a major hassle not to the will to go anywhere, to go shopping, to see your mother come to drive your kids somewhere. just imagine. you can't do anything without
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having a driver assuming that you can afford a driver or having a male relative that has to be around to drive you places. just in today's world it is hard to even rationalize so i am hoping there will be a decision made to let women drive. there has to be some kind of the phasing in as a face-saving way may be that can be worked out. but it needs to happen and it would be an important step for the people as saudi arabia is becoming more competitive and more integrated into the modern world. >> again my apologies for the
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questions i didn't get. certainly secretary clinton you have this mastered and it's fantastic. at the conceptual feeling and humor and this makes you. thank you very much for coming and asking great questions. apologies for those i didn't get to. please, stay in your seats. we have to move quickly. if i go over time i was told i would get in trouble and i did. secretary clinton. [applause]
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we already know there are land mines out there that you have to be careful about how you manage your way through these things. issues that deal with the abortion issue in the united states. guns, race, air of israeli relations. in other countries -- and i've written others and worked with other cartoons, they have their own the red lines they have to be aware of and why they can get away in san francisco might be different than we could get away with and parts of alabama. >> i think there are just fewer conservatives in journalism, period and that is reflected among the cartoonists as well. it is just generally not a conservative thing. journalism tend to draw i would think to be fair to say people who are more liberal. >> they say bad news is good for the cartoonists because it gives us a lot but i would rather work
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hard and having less bad news and the when the right direction. i think that we are kind of -- we are not going in the right direction right now. so, i feel like it is a calling for me to get my opinions out there. 200-year-old clocks stopped ticking. time stands still. the ohio kwok and easy metaphor for the government shut down. >> we are standing a few feet
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