we're going to read some questions now from our audience. mya rockingmore, director of leadership for healthy communities is in the studio and her question is, how will the commission's recommendations influence the policies that perpetuate the cycle of poverty and disinvestment that undermine health and education? hugh? you want that? or rebecca? >> that's a big one. it's a tough one. >> you don't want that? >> no. i do appreciate it. >> i like it. >> i like it. i thank maya for asking such an important question there about the cycle of poverty. i think as we think about health and we currently are spending one in five and soon to be one in four dollars on health care, we've got an extraordinary opportunity to integrate and to be thinking about these

additional vital signs, to think about incentives methodology that can make sure that health care is thinking about health. the broader context of health. and as we think about the programs that rebecca referenced and the videos have referenced, as you start to integrate housing, education, access to healthy choices, employment, transportation and think more holistically, i do think we've got an extraordinary opportunity to stop that cycle of poverty. but ultimately it will require some level of self-awareness from the health care community and also social awareness about the challenges that exist. and at times that type of cross-cultural communication is not always easy the first time. so when i think about different stages of group development, you think about forming, storming, norming, performing, you don't always perform right away. and so you have to have the

patience to go through those storms. and the ability to get to that norming stage. and then you'll perform. >> i think one of the really critical pieces here is being really honest about what we do and don't pay for with our health care dollar. and for a long time, we've had a hmm system where the incentives really haven't been a lined around prevention. particularly for vulnerable patient populations where prevention is only more critical. the fact that we haven't -- we haven't been really willing to spend our health care dollars significantly around ensuring that folks stay out of the hospital. we've been spending them more on actually reimbursing when they do go to the hospital. but that's beginning to change. and there's a huge opportunity right now to really look critically, again, at where we spend our next health care dollar. and as kyu was saying, how do we really incentivize the health care system to begin to have a set of incentives that are aligned with issues we care about. for example, whether or not folks have access to healthy food. >> did you want to add anything,

mark? >> just to pick up on rebecca's point, the way that we're paying for health care is changing. everybody's getting very frustrated with the rising costs and all the dollars going into dealing with the costly medical complications after they happen. there are more and more clear ways out there to make a difference in preventing those complications in the first place. maybe one way to tie all this together, for example, would be -- this is starting to happen in medicaid programs where they're actually tracking whether kids are in school. or in preschool. as one of the goals of well performing health care system. so that helps reorient the dollars to things like treating the -- preventing the asthma attack in the first place. getting the preventive care delivered effectively. and in turn, that's going to break that cycle of poverty. if kids are in preschool and school more regularly. >> i have another question. this is from jim paran, president of the american academy of pediatrics. and he asks, what is the role of

health care providers in efforts for early childhood and investment? when we talk about health care providers, are we talking about doctors and hospitals? >> not just doctors and hospitals. >> else what? >> but there are a range of clinicians out there who are impacting patients' health. so nurses, nurse practitioners, pharmacists. think about -- >> the whole shebang. >> there's a whole segment of workers in the health care industry that go way beyond just traditional doctor's office medicine. and they can all make a big difference in the lives of patients. particularly in the lives of younger patients as we were just talking about a few minutes ago. >> okay. so what is the role for early childhood? >> i think for pediatricians especially, so much of care for younger children and children -- actually, older children as well, is about prevention. and about setting healthy habits for life. and that's really, carol, what

this whole report has been about. how important early education and staying in school can be. how important it is to develop good health habits in terms of nutrition and regular exercise. and we've identified a lot of examples in the report taking place around the country that are helping -- that can help pediatricians work with programs in the community that achieve these goals. >> okay. thank you very much, commissioners. we're -- we're winding up here now. thanks to everyone, especially those of you online, for questions. and as a reminder, not only is the recommendations report available online, but also the videos that you saw today. now that we've heard the commission's recommendations, let's talk about next steps. commissioner eileen lindner of the national council of churches

usa health task force shares her call to action. >> i hope everyone walks out of this room today and says, here's one thing my segment of the society can do to contribute to the fulfillment of these goals. and i'm going to follow it through. now, whether that's a policymaker who's going to go back to the office and -- and talk to their people about how they might introduce legislation or help, that's -- they know best how to get that done. if it's an employer, for the employer to go home and think, what else could i do to urge good health among my employees? what else can we do as a corporation? if it's a faith leader who can go back and say, i know, life is busy. i've got lots of other pressures. but i'm going to make time for this. because this is going to pay dividends in the most valuable

commodity we've got. human life. i'm going to go do this thing. and so every segment of the society can find that one resolve and follow it through. it'll pay huge dividends for us. >> eileen lindner's call to action is powerful. joining me again, risa laviso moray. commission co-chairs alice rivlin and dr. mark mcclellan. and co-chairs of the commission, mark and alice, what do you want everyone watching today to do next? alice? >> i want them to be energized and to look around at what can i do? everybody is in a community. they're a member of an organization, whether it's a professional organization or a social organization or something -- community organization.

and they can say to themselves, we can have a healthier community here. now, what can my group do? i think if we get people really energized to do that, something good will happen. >> mark? >> i agree completely with alice. and another way of looking at this, if you see the report, is you really can't afford not to do the steps that we've described here in the report. what we're doing now in terms of trying to get to better health by, as reid tucson said, medicalizing it and spending more and more on health care isn't going to succeed. we can't afford it now. we're on the wrong trajectory in terms of getting to a sustainable level of health care costs and enabling us to put more resources into these other priorities. so this is something that needs to change now. the good news is that while this is a big and complicated set of topics, there are specific, identifiable steps happening now all over the country that you can connect to. that you can start taking to

make a difference in improving health and improving the country. >> so you're both saying, everybody get on it. >> everybody, get onboard and start doing it, whoever you are. >> whoever you are. so, risa, how will the robert wood johnson foundation help move to the next step? and get us all involved? >> well, first, let me thank the commissioners for putting together an incredibly thoughtful and comprehensive report. and i have to tell you, we will at the foundation make this our compass going forward. it'll help us understand how to partner with cross-sectors to really create the kind of investment in health that allows everyone, irrespective of their race, their ethnicity, where they're from, to live a healthy life. so we commit to you. it's not going to stay on the shelf. we're going to use this every day. >> do you have any other closing

thoughts? >> of course. >> well, let's hear them. >> you want to hear them. >> i want to hear them. >> and i've taken a lot from these 90 minutes. we've heard a lot of information about what we can do. and -- and how we can actually reduce the barriers that keep people from being healthy. it's been inspiring. but at the same time, i think we have to realize we still have a long way to go. and more than anything, i've taken from this that we have to all come together to make this happen. there's not going to be any one person or organization or community that can do it. so it's really critical for all of us to really think about what our organizations, and as alice said, what we can do today, tomorrow, every day to make this report a reality. think if we do, we have the opportunity to create the kind of culture of health that will allow everyone in our country to lead a healthy life.

and to do that in a sustainable way. and if you think about it, that's what we really deserve in this great nation. so we've got to come together around a culture of health. >> thank you, risa. that was beautiful. it was an excellent report. i'm so proud of the work of the commission and so glad that i was a part of it. and i want to thank our studio audience and our online audience for joining us. and we hope that you're going to share what you've learned. i know i'm going to go right back to boston and get to all those people that i know that work in health care. including my daughter. and see t me [applause] >> well, the u.s. senator is about to gavel in to continue debate on extending unemployment benefits this afternoon. senators are returning from their weekly party lunches, they

began this at 12:30, expected back at 2:15. a live picture now from inside the capitol where we are expecting senate leaders to make remarks about the senate agenda. we typically see this on tuesday afternoons when the senate party or caucuses meet. again, the session expected to begin in just a couple minutes at 2:15. at about 2:30, there will be a round of procedural votes including on an amendment that would extend unemployment benefits through november. a group of republican senators have offered a similar proposal, but it currently only extends benefits for three months. we are looking at cq roll call, the headline to have story, democrats, republicans seeking jobless aid deal on offsets and amendments down in the story, finance committee chair max baucus said that he doubted there would be an agreement before two scheduled cloture votes on the underlying clean

three month $6.4 billion extends of broader jobless aid. so, again, we are awaiting remarks from senate leaders before they begin their session this answer for scheduled to start at 2:15 eastern.

>> so again, we are live in the capitol awaiting remarks from senate leaders as they return from their weekly party caucus lunches. senate session expected to get underway at 2:15 eastern. over on our facebook page we have asked you how long is too long for unemployment benefits? we've gotten a number of responses, and you can also add your comments and join in the conversation. go to facebook.com/c-span.

>> and the senate session has just gotten underway, and we'll take you live now to the u.s. senate as they debate undiplomat benefits. undiplomat benefits. i just want to chair briefly a few thoughts about where we are. we have before us an unemployment bill and the pending business is the reed amendment that would extend -- all effectively, it violates tbj act and it's unthinkable we would pass another $17 billion that would add to the debt of

the united states every billion of it, every single dollar of it borrowed, many from people around the world who are not friendly to us. so this is not a good way for us to start. it's subject to a budget point of order because it violates our spending limits, and that has been confirmed. i know the presiding officer is a member of the budget committee. has been confirmed by senator murray and her staff, the democratic leadership on the budget committee, that it does violate the budget. and so what that means is if it's not fixed, and i understand there is some attempt going on at this time to maybe rewrite it in a way that actually has a legitimate pay-for to provide assistance to those who are long-term unemployed but who -- but pay for it without adding to the debt of the united states. and i would remind my colleagues

that in december, we passed the murray-ryan legislation which did set limits on spending, and the president signed it just two weeks ago into law, and as soon as we waltzed into the united states senate in january of this year, we have a piece of legislation that bursts the budget entirely. is in utter violation of the spending agreements that we agreed to. so i hope our colleagues can present something to us that would lay out a -- an effective way to handle those who are unemployed and would also be able to help us -- be also -- also pay for the legislation. that's what we have got to do. this is how we go broke. this is what is happening. we made a promise when we -- when the legislation passed in

december that capped spending that we would stay with that limit. that's the law that's being violated a month later if it were to pass. hopefully it won't pass. i don't believe the house will pass legislation that extends -- that adds another $17 trillion to the debt and not add -- i just don't think that's possible. so this is a -- a process that's not healthy. so, madam president, i would urge our colleagues to understand that if this legislation is not fixed, if the reed amendment is not fixed and paid for, i intend to move to object to it, to raise a budget point of order. it will take 60 votes to override the budget we just

agreed to, and i don't believe 60 members of this senate will so vote. i thank the chair and would yield the floor. mrs. murray: madam president? the presiding officer: the senator from washington. mrs. murray: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

quorum call:

quorum call:

mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i ask unanimous consent the call of the quorum be terminated. the presiding officer: without objection. mr. reid: mr. president, could we have order in the senate? the presiding officer: the senate will come to order. the senate will come to order. take your conversations out in the cloakroom. mr. reid: what is the issue

before the senate? the presiding officer: the motion to commit is the pending question, sir. mr. reid: mr. president, i'm going to offer a consent agreement based on the conversations i've had with a number of republicans and a long conversation in my caucus just a few minutes ago. we've been struggling to -- and i'm going to speak just for a few minutes. i know everybody's got a lot of things to do. we have all been struggling to find a way to extend unemployment insurance benefits for 1.4 million americans who are struggling really to get by. we have a filibuster before us again. another one. first republicans complained that they were filibustering these essential benefits because the extension was not paid for.

so reed of rhode island came forward with a paid-for amendment. then the republicans explained they were filibustering because they have been not been able to offer amendments. so a proposal was made, and i'm going to do that in just a short time with a unanimous consent request, that would give each side a reasonable number of amendments. five, to be specific. now republicans say they want to have their amendments and have a cloture vote to pass the bill too. it sounds as though republicans want to, for lack of a better way to describe this, have their cake and eat it too. the question is, are republicans filibustering unemployment insurance benefits or are they not? if we have an amendment process and the thing we should get in exchange is an up-or-down vote on the bill, and that is what my

consent agreement will call for. republicans who don't like extending unemployment insurance benefits can still vote no on the bill but we should at least be able to have a vote on the bill. but we can't set up a system where the minority of the senate that opposes unemployment insurance benefits gets both an amendment process where they can offer these poison pill amendments and then the minority of the senate that opposes the bill can still kill the bill. so this doesn't make a lot of sense. so, mr. president, i know that everyone has worked really hard to try to work through this process to kind of thread the needle. i told a number of republican senators, i met with a little while ago, as my democratic senators know, we think there should be a new day in the senate. we think that we should start. whatever comes up next, whether it's flood insurance, unemployment compensation,

whatever, whatever is next, i think that we should start by having a reasonable number of relevant amendments to see if we can, see if we as senators can work our way through a bill doing that. and if we can do that a few times, maybe we can get better and start having some nonrelevant amendments. but at least let's start someplace so senators here can have the experience of offering amendments, both us and the republicans, and try to get some legislation passed here. so, mr. president, i ask unanimous consent that the cloture motions with respect to reed of rhode island amendment 2631 and s. 1845 be vitiated. that the motion to reconsider to commit an amendment number 2631 be withdrawn, that a substitute amendment which is at the desk be made pending, that there be up to five amendments related to the bill from each side in order for the substitute amendment, further that each of these amendments be subject to a side-by-side if the opposing side chooses to offer one. amendments under this agreement

must be offered no later than 4:00 p.m. wednesday, january 15, that no other amendments or motions to commit be in order and that no points of order be in order to the substitute of the underlying bill. that each amendment have up to one hour of debate equally divided, that upon the use or yielding back of that time on each of the amendments offered, the senate proceed to votes in relation to the amendments to the substitute in the order offered with any side-been had i side amendment -- side by side amendment vote occur prior to the amendment by which it was offered that all amendments be subject to a 60 vote affirmative threshold, that upon disposition of the amendments the bill be read a third time as amended, if amended, anded -- and the senate proceed to vote on passage of the bill. if the bill is passed the senate immediately proceed to consideration of calendar number 192, h.r. 20019, that all after the enacting clause be stricken and the text of s. 1845 be inserted in lieu thereof, that the bill as amended be read a

third time passed and the motion to reconsider be considered made and laid on the table with no intervening action or debate. the presiding officer: is there objection? mr. mcconnell: mr. president? the presiding officer: the republican leader. mr. mcconnell: reserving the right to object. we've now been on this bill a week. a week. no amendments have been allowed. it is pretty clear that the majority leader is not interested in having an open amendment process. and of course the consent that's just been offered requires that all of the republican amendments be at a 60-vote threshold and that the final passage be at 51. in other words, guaranteed to fix the result in such a way that doesn't give the minority a fair chance. i mean, who is to say a number of our amendments might be appealing to members on the democratic side. that's probably why the majority leader wants it to be at 60 because he's afraid they may pass.

so this is obviously, this has obviously been fixed to guarantee that you get no outcome. our members who voted to get on the bill, who are anxious to try to improve the bill and find a way to get to yes on final passage have also found this agreement to be unacceptable. so -- so i'm speaking not just for myself but for the members on my side who spent a lot of time over the last week trying to figure a way to get this bill across the floor in a bipartisan fashion that would actually achieve the result and try to get us to some reforms as well. so i ask unanimous consent that once the senate resumes consideration of s. 1845, the unemployment extension bill, that the first amendment in order be a heller-collins amendment related to the bill. i further ask consent that following the disposition of that amendment, it be in order for the majority leader or his

designee to offer an amendment and it be in order for the leaders or their designees to continue to offer amendments in an alternating fashion. the presiding officer: is there objection? mr. reid: reserving the right to object, mr. president. the presiding officer: the majority leader. mr. reid: mr. president, we have seen the last little bit a significant number of statements on the floor, op-ed pieces written about process, process. on this side we have been talking about the need of 1.4 million americans who need some help to get them past the real financial crisis they find. it seems to me the only fix to get no outcome is the republican strategy to find something to object to, no matter what democrats try. a process compared to helping in

a substantive way people that are in deep trouble. the process never wins, mr. president. the process doesn't win. we need to move forward. my friend talks about amendments. democrat amendments. we have five, too. ours would have a 60-vote threshold, just like theirs. this is the new target that my republican colleague, the republican leader, has said we have a new reality around here. it's 60 votes. this isn't anything i invented. in fact, i wish we would get rid of that and go back to the way we used to do things. so, mr. president, i again repeat i think this has been constructive, i especially appreciate the junior senator from nevada, senior senator from maine in working to come up with something. i'm disappointed that we couldn't work something out because it appears from what i have been told that they are

going to object to this consent agreement just as i object to modifying my consent agreement. mr. schumer: mr. president? the presiding officer: objection is heard. mr. mcconnell: mr. president? mr. schumer: mr. president, i would just like to ask the leader a question. the presiding officer: is there objection? mr. mcconnell: i object. the presiding officer: objection was heard from the republican leader's request. mr. mcconnell: mr. president? the presiding officer: is there objection to the majority leader's request? mr. mcconnell: i object. the presiding officer: objection is heard. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i would be the last to criticize the chair, but my friend from new york was standing to reserve the right to object. mr. schumer: reserving the right to object, mr. president. the presiding officer: the senator from new york. mr. schumer: let me just say this. i think on both sides of the aisle, there is a real desire to try and work things out so we can have more debate, more discussion, and it seems to me, mr. president, from the years i

have been here, not as long as either leader, but there has always been a sort of a way the place worked, particularly in the old days when it worked better. the majority sets the agenda. that's their right as majority. the minority has the right to offer amendments, both amendments that might change that agenda and amendments, frankly, that might be tough to vote for so the minority can capture the majority again, and that's been fair. but it seems to me that what our friend -- my friend, the republican leader, is saying is we want all the amendments we want, but we're still going to filibuster any bill you bring up. now, maybe a few have said if our amendments pass on the other side, maybe we won't filibuster, but that's not much of a fair deal. so i would suggest that what the leader has suggested, the democratic leader is imminently fair. it gives the republicans their time-honored right -- or the minority, no matter who it is, their time-honored right to

offer amendments, difficult amendments. that's part of the deal. but it gives the majority the right to set the agenda and not have the things they bring forward just filibustered ipso facto. and not being allowed to come to a vote. and it is, in fact, true, as i understand it, that a couple of those who are offer amendments on the other side of the aisle have stated that if their amendment doesn't pass, they won't allow us to come to a vote, so i would hope that we could proceed along the way the majority leader suggests, but to simply offer amendments relevant, not relevant, germane, not germane, and then make it almost certain that the bill will be filibustered and we won't get a final -- be able to get an up-or-down vote. all we're asking is an up-or-down vote on the unemployment insurance. so i object. a senator: mr. president? mr. mcconnell: mr. president?

the presiding officer: the republican leader. mr. mcconnell: i believe i objected to the majority leader's consent request. the presiding officer: you did, sir. mr. mcconnell: i ask unanimous consent to call up the heller amendment. the presiding officer: is there objection? objection is heard, sir. mr. mcconnell: i ask unanimous consent to call up the coburn amendment, number 2606. the presiding officer: is there objection? mr. reid: i object. the presiding officer: objection is heard. mr. mcconnell: parliamentary inquiry. is it correct that no senator is permitted to offer an amendment to the unemployment insurance bill while the majority leader's motion to commit with instructions with further amendments is pending? the presiding officer: the senator is correct. mr. mcconnell: further parliamentary inquiry. if a motion to table the reid motion to commit, would this still be reid amendments pending that would prevent anyone from offering an amendment? the presiding officer: the senator is correct. mr. mcconnell: mr. president, i have an important amendment that i would like the senate to debate and vote on. the reid amendment is currently blocking consideration of those

amendments in order for the senate to start considering amendments, including the coburn amendment 2606, i move to table the pending reid motion to commit with instructions and ask for the yeas and nays. mr. reid: mr. president? the presiding officer: is there a sufficient second? mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i do have a right to object to this, do i not? the presiding officer: the senator is correct, but the question is on the cloture motion. it takes consent, sir, for the motion to be tabled. mr. reid: i am not objecting. the presiding officer: is there a sufficient second? there is a sufficient second. the question is on the motion to table. the yeas and nays are ordered. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote if not, the ayes are 45, the nays are 5.

the motion to table is not agreed to. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i find ask unanimous consent -- the presiding officer: could we have order in the senate, please. order in the senate. mr. reid: i would ask unanimous consent that the next two votes be 10 minutes in duration. the presiding officer: without objection. the clerk will report the motion to invoke cloture. the clerk: cloture motion: we, the undersigned senators, in accordance with the provisions of rule 22 of the standing rules of the senate, do hereby move to bring to a close debate on amendment number 2631 to s. 1845, a bill to provide for the extension of certain unemployment benefits and for other purposes, signed by 17 senators. the presiding officer: by unanimous consent, the mandatory quorum call has been waived. the question is, is it the sense of the senate that debate on amendment number 2631 to senate bill 1845, a bill to provide for the extension of certain unemployment benefits and for other purposes shall be brought to a close? the yeas and nays are mandatory under the rule.

the clerk will call the roll. vote:

vote: