on time so that is a critical issue for us. >> we talked a lot today about moving good that you and your members are in the business of moving people whether it's the employees to all of the systems, whether it's the customers for them. so tell us a little bit about what's going on how you are thinking about infrastructure. >> it's critical that we took the transportation role in health care. whether we live in that world areas, urban areas or urban ice areas health care touches all of us and we've heard about the facilities located around the country. but the reality is you can't go there and you have to have the transportation infrastructure to get there. you talked about this being one of the sectors. these healthcare facilities need dependable service to get the

workers there every day every shift. there are some large facilities and you see the nexus working really well together. whether it is the helpline and cleveland connecting to the facilities or the line in houston went to the major medical providing that nexus to the transportation option is important. but the transit providers have to look at the functioning alternatives and it cannot just be rail. you have to look at the bus on the shoulder and the lanes that are changeable so we can do the trend toward. as we have different options for people to get to the medical transportation whether they are there to get the service or good job related to care for those patients that need it so critically. where we cite these facilities. to understand the system, the transportation system must work

together so we are excited to see early in the process there is a dialogue of the health facilities and transportation so they can be together and have good access and better access for people to get care not to be for that care in the community and has less burden as a result of that. when we look at the options going forward, you have to look at what is the mobility management and how can we put together the different transportation sectors to serve the communities better? or maybe 60 different funding programs for the medical services in this country so we have the programs put together with our partners at easter seals and the community transportation in america and of the center for mobility management and we are bringing together ways in the community to provide a shared ride together more efficiently and effectively with the better use of the transportation dollars we can serve people better with better health and the communities.

>> there's a lot to talk about and work with. i have questioned to cause that's what i have to do but i also don't have a watch, so someone will, you know, pull whatever it is. let me ask first if any of you have questions for our guests here because it's not going to ask how the medicine is going to change the transportation demand on the healthcare system and does that mean that we are not going to have to worry that much about the transportation infrastructure and how it serves things? >> there's one thing i want to make sure the audience understands and that is the cost all health care is in is that when you see and hear about the price of the cost of health care going down. not the cost of delivering healthcare. everything we are talking about here is the way of reducing the cost of providing health care and the way to do that we have

the rationing shortages and that is what this is all about is just in time inventory and having the employees be able to come economically because there is a manpower shortage in the population for recruiting people and the other care is that it is in its own piece. we have to understand that unless we can get the cost of delivering the healthcare down, to prevent people from getting on the road in the first place to work with the infrastructure that we have, it is to talk about how we coordinate it, but most cases we don't and it is inadequate for those that need it the most. so the failure to coordinate can be going to where people live and about your electricit -- wet people to care when they need it. that is an important aspect of addressing how do you overcome that power shortage and the cost of the transportation and how do

you overcome the inertia patients and the inability to access care. >> it's a compliment for driving down the cuts but it's not ultimately a substitute for needing transportation. >> about telemedicine ithe teleo play a significant role in the future, but i don't think it's going to be able to do is substitute moving the patient to get the care they need for certain critical events. it plays a significant role when you look at a lot of the cost of healthcare where the patients hospitalized and ask how do we get to that point. the patient in the heart failure if they are discharged from the hospital and they are sent home, there are days, weeks, months ago by where they may not have the ability to go in and see their primary care physician or have the transportation needs to get to their dr.'s appointment.

so what may happen over time as they may be slowly retaining fluid and then essentially find themselves short of breath and end up in the emergency department and get admitted to the hospital at a significant burden to the payer whether it be private or government. so where the telemedicine plays a significant role is that it allows us to contact the patient without actually seeing them. so, if we can touch base with the patient and have them weigh themselves and have them check in through technology, then we can manage them in their home. and by doing so, significantly reduce the incidences of them coming and being cared for. >> you are talking about having to move people very quickly. it is a major route down to the gw medical center. every day there are ambulances that are attempting to navigate

traffic and the lights and everything to get there. when you think about the infrastructure itself, what are the changes that could be made that would help you do your job better, help you move people more easily? >> i think regulation plays a big hole into the health care in of where the hospitals are placed and in terms of what services they can provide. when you look at the trauma as an example we have the level one, level two and level three it often provides a different expertise and service and i think that positioning the hospitals so they can be closest to meet the patient's needs and provided the care that they would need in certain circumstances, that would help and this is the one time that i say regulation would help because it is not considered a positive. >> when we are thinking about planning as these new systems are forming new campuses there

has to be integration in the planning and the community that's going on as well. >> for the time sensitive emergencies we have the benefit of the helicopter they can go as fast as 170 miles per hour and gets the patients thget the paty need quickly that even with the technology and the navigation approaches that can help navigate we still can't fly on certain days and so at the end of the day all patients have to or we have to transport all patients. the costs that are often focused on the wheels are have to justify in terms of the helicopter transport and the cost associated with it and the benefits that entails versus the lower cost and i don't know if

we can move to that point yet if we don't have the infrastructure in place to move by ground and then quickly. >> i will just say for our members to get the patients, 934 companiewhy34 companies a littl0 warehouses so we have used geography as a tool to shorten the distance between the distributions into the clinic for the hospitals where they go. you are moving the patients there and we are trying to get the pharmaceuticals so we have moved it out of the distribution centers strategically located in the highways where the product can quickly get out and get to their hospitals. >> part of the solution is to end management.

if we can reduce back then we have fewer people go into disease and the second piece is the telemedicine so we have a very large match in the program, so when they get a stroke they can manage in their hospital instead of having to be transported into the same for managing you can manage them remotely through what is basically the command tower so that you can keep people closer to home longer and reduce the transportation need so it doesn't overcome the limited means to do that. you have to do the demand to address the delivery part otherwise we will never get there. but that is the solution. we wouldn't have a problem today. >> i think they've done some looking in transportation and health itself.

we are here to talk about the transportation and the economy, that the quality of life and giving people transportation options that might encourage them to have healthier lifestyles is something a lot of people talk about. >> we have to have healthy cities for people to live in and we did a session with the surgeon general talking about the transportatio transportatioy component of that and also figuring out the roadways to get them on the public transport that frees up for good service and commerce and people to move throughout. so we cannot add 100 million more people to the population over the next 40 years we can move more quickly and having good health care access is critical to that and if we can have a community where people can have the transportation options and they can take good public transportation and electric vehicles and hybrid vehicles on the 45% of the

alternative fuel so they are working for the healthy city than we can help a better price for people to live and we are doing studies now to quantify those things in other words performance metrics or asset management numbers and making the case better to the story better. >> we are talking about the types of investments all different levels from the community level to the federal level in the public and private to make this decision realized. >> it's about the system they have to work together. >> and a lookout here one more time. >> okay. it is really bright out here. okay. so our friends with the microphones are coming up front. over here on this front side and then over here in the front. >> be sure to introduce yourself as well.

>> i think we do most of the work in the medicaid on emergency medical transportation. which has become a growing source of funding for the public transportation and it may be the greatest source of funding for the dot. as the states have been making choices whether or not to expand the medicare programs under the health reform, a number of the states that have most recently chosen to do that have proposed to the federal government to drop the medical transportation entirely for the population that is covered under the medicaid program and so i was interested to hear first whether you are aware owereaware of this and yon it and whether any of you are taking any actions to address it. >> it is a huge issue.

it's about $3,000,000,000.2 only to the dot funding for transportation in the country. it's detrimental to the health of the communities that it's important to work together to find the solutions and the most effective way to move people in a tiny way -- timely way to their specialty needs. you can get on most of the transportation systems with mobility devices which you could do two decades ago but it's important we find the right balance because there are so many dollars to go around to have those needs and we have to find a good way to do that and you brought up an important point. >> without commenting specifically other programs are in the improvement but in terms of the philosophy, the support in the audience to know 5% of

the people generate the cost of the country. so managing those people and managing well to make us proud in bold is getting us to where we need to be. and so, we can engage in a false economy sometimes by saving the transportation of the hospitalization and the disability. so we keep hearing about this and we have to orchestrate this and obviously getting people where they need to go is an important part of that. a lot of it has centered around the treatment, the delivery of the treatment and the medications. i hadn't talked much about research and development and you mentioned telemarketing. but research into the movement requires collaboration among the individuals. what role does transportation play in the rnd, and what would be your wish in terms of seeing

improvements in the transportation infrastructure to improve the outcomes? >> thank you for that. understanding how to do it intelligently by researching all of this like who the population are trying to serve, one size does not fit all but identifying the root causes rather than just trying to deal with the symptoms. so, for me it is how we have orchestrated the tenth edition system to address particular needs in the case of the hospital and how to get people where they need to be and what are some alternatives to getting in there and how do we use other technologies like the self-management through applications and so forth to the chronic disease management that

again is the demand management. and then the other part is how do we make sure that we get there as efficiently as possible because the remainder in the health care in creation is always the health care system because the cost shifting in the country is enormous and we fail to understand the full effect of that when we keep saying we will pass it on. with price control, you don't pass it on. and that isn't sustainable, and we need to think systematically in terms of the root cause rather than just getting through another day. this has been a fascinating panel. when i saw the healthcare intersection, since i work in the transportation policy a lot, i immediately thought of active transportation issues, which we have gotten around to eventually, thank you doctor

quinlan. and it's from the transportation policy perspectives the traditional transportation community here in washington has made the leap to thinking about demand management as michael was talking about with transit access and trying to create a healthy environment so we have fewer patients to the hospital but you've been describing. but as the panelists talk and debate the topic it's opened up my eyes to the fact that an entire medical profession that relies so much on a transportation system that actually works properly to get your product and your medicines into such to the hospital. i'm wondering if those of you that have not addressed this topic yet if you're communities,

your health communities that you are the most frequently involved with are getting more involved in the transportation or they are just looking at it from the perspective of how do we get of a product to the hospitals as opposed to how do we in fact manage the demand on the entire system. >> so you know, health care is not that affordable, and when i talk about bringing the team out to the patient and bringing them to the care they need, there is the reverse of that and that basically bringing healthcare from the hospital to the patient and treating them there. so in terms of going out in the research and development site at least on the healthcare side and not on the transportation side, we need to be more innovative in the way that we provide care. when you talk about how important it is for the time

sensitive emergency such as a stroke, if we can't get the patient and i'm talking about going bike around, we have a transit time if wherever the vehicle is located so we need to be more innovative. one small example isn't going to be the answer but one small example next month we are rolling out what we call a mobile stroke program, where if somebody does call 911 having a stroke that we are going to send them back critical medical team at the cat scan on board as well as a laboratory command we are going to bring that up to the patient because every second, don't quote me on this i'm not a urologist with 30 to 50,000 year on that die every second involved in a stroke, and that kind of treatment can be from a small delay is can be the

difference somebody walking out of the hospital a few days later with marijuana the impact versus somebody spending the rest of their time in rehab for nursing home with the assisted care facility. so, really that is a big cost on the healthcare end, and so i think that one of the things that we need to do and do well is change our model of not just being in the hospital and center of excellence, but we need to be more innovative and bring that care up to the patient on to some of these high-cost high-value things. it is a small portion of the population. we can't attack it from a different end by giving them the treatment they need quicker. sometimes that does bring the care out to them. >> in the stroke program is a comprehensive stroke program and you get the patient at risk before they get a stroke and make sure you go into their homes and i would like to

address the more fundamental question about how do we integrate the policy on that. i would say it's a region i'm not aware of. healthcare is regarded as a cost and how do we temper rise around the systems of the broken approach to healthcare and the inability to the lifestyle and shift the cost and hope that we work to next year. there is an infrastructure thing and it is positive for this country that we were talking about the airports in the earlier discussion. it is a great gateway for the united states and this notion that we delivered here that's why we have such bad results as a population if only 10% relationship. it's up to socioeconomic factors and the rest of the world if we have a serious problem we have the best there is and when you look across the globe people come here in large numbers and we see a lo a lot of of the medl

tourism and people go to the country but really the influx is far greater and one of the greatest impediments i can give is a specific example of course we know cleveland has done a fabulous job. in 1984, we had 9,000 patients coming into our single hospital for care particularly from latin america adapted by 4,000 simply because of the failure of our airport and as a result, in the regional transfer of healthcare within a particular region in the caribbean or central america has grown in response to increased difficulty of accessing what is enormous medical capital, and the intent of healthcare in the country. we have a huge audience if we can make it easy, inexpensive, and efficient for them to read and write now we don't do as good a job as we can never mind the immigration issue which is a problem for people but just making it easy and effective and getting a one stop here as we do as they often have in the rest

of the world rather than the multiple steps and difficult transfers. >> you have been tackling the question of getting people to your facility. directly i was reading about a program that you all have that allows people to fly or you will fly them directly to the cleveland clinic or hospital of their choice if i remember correctly. i am thinking in terms of the planning is the cleveland clinic sitdown with the regional planning entities in cleveland to talk about what your infrastructure needwith yourinfd whether that transportation water, energy or all of the above. >> i cannot speak on behalf of those in the cleveland clinic in general, all of those entities but from the critical care transport perspective, there is a lot of opportunity to be more involved. and in that regard.

>> the point was made about the trend towards health systems which is something we have all seen. but i'm wondering what the transportation implications of that might be. does that make the trip more complex, does that make them longer, does it mean fewer locations in the destinations? comment on that. over the time of the economics that we may not have the 5,000 hospitals despite the population growth. we are going to see the reduction in the number of hospitals. and so it is going to become that much more evident of how important it is for the transportation to exist. we are going to start transporting patients further

from further distances and to provide them care or bring them to the care they need. >> i spent some time now maybe about a year ago that shows the healthcare reform what is the entire margin today for the hospital system in this country in ten years? the only way out is cost reduction and that is what is driving so much of the agency, but as a result not only will there be fewer but there will be fewer centers of excellence. so that there will be people that have to travel far to get what they need. so there will be regional referrals and stuff just multiple hospitals having similar services. that is particularly in the certain services like the transfer on the critical care, heart, cancer.

>> as far as the hospitals go if there are fewer hospitals from our perspective, that does simplify the number of locations from 200,000 today. but that being said, the trend into a specialty in that area is for the drugs to be in the doctor's offices and small clinics. they are to the multiple doctors offices around the country. country. it's about complexity to the supplthesupply chain may be saln the top end. but with the new types of drugs coming out of the market there is increased complexity for the distribution on that and because we are having to go through more and more locations in the discrete and harder to get to dance a one big urban hospital. so, there is a ying and a yang to this.

>> the drugs come to you at home and getting to a bail themselves out the most efficient rather than traditional. >> i'm with the community transportation association. you talked about how important it is for the patients to get to see their doctors to avoid further publications. what is the entry point for the transportation person such as mobility manager to talk with hospital staff is that the discharge planning level that doesn't become a barrier for them to get to that visit. >> linick agent who submitted,

healthcare is the success of healthcare is the team and anybody in the environmental services to bursting to the physicians we have to work together as a team and anybody that is submitted it to an intensive care unit starting with the care management and social workers getting involved early and actively at the point of contact on the planning process because you're right you don't have the means to have the transportation to get to the dialysis if this is your first time in the hospital and develop renal failure and are going to be on dialysis for discharging someone home without a follow up indicating that the dialysis, i mean, that's critical. every monday, wednesday, friday or tuesday, thursday, saturday, every 48 hours or so someone is going to be in dialysis and if they meet at a point from the transportation perspective we are going to look at a re- admission to the hospital. so establishing that and the

ability for the patient to have transportation is paramount, otherwise we are just going to see them back. .. and the ability to get someone home and to the right place is the leading cause of failure to discharge on time. you can't throw member out. you have to make sure the other end is ready to receive them and there's a way to get there.

>> both physicians talked about, have to drive the costs down, make sure they get there for continuing care. each year we see 3.6 million appointments missed because of transportation issues. so if we're able to enhance and improve the connectivity they can get to appointments and stay healthy and keep the costs down. that's the space that i would hold for them to have an appointment, they don't show up, kuo you're adding costs to the system. so have to get access down to a lower level of missed appointments. >> it would be instructive for all of to us try to live the life that people of very limited means have to get anywhere on time. at age and illness on top of that, it's a miracle they make as many as they too with what they have to over come. so the more we can do make cities more designed around people and their needs. >> are there any other questions

for our panelists? we -- i'm going to ask you to think about one final thing, which is to sum it up for the audience in a few sentences, it's been unique we have actually had true healthcare panel to talk about transportation and to talk about transportation infrastructure. so, i'm going to buy you a little bit of time while i do some summary, but why is infrastructure, why is transportation, so -- inpractice struck -- infrastructure, we have haven't on this panel but with agriculture and natural resources, energy, manufacturing, retail, and the services sector, you have to have the right infrastructure and the right regulations -- thanks for reminding us about that -- to support safe, predictable, reliable, cost effective transportation. you have to have that

infrastructure where you needed to it and have to have capacity for tomorrow. we have laid out a lot of challenges today. opportunities to talk about solutions in the future. now that i bought you a little bit of time, i'm going to ask, sum it up for us. why is infrastructure so important for the healthcare industry and how too we get people who haven't thought about it in this way more engaged in thinking about it? >> i'll just start. i'm on the product said, they're on the patient side. on the product side, we've -- as an industry now need to be a little more vocal than we probably have been about this topic. and the fact remains, given the complexity of the health care system, the null research and r & d and products coming out, it's only going to get more complicated as they require more

special handling. flu vaccine, levels around the country, we're trying to respond to hurricanes and snowstorms or snow -- "snowmageddons." it's critical at that time to the highway frustration for my companies is supported in good repair and usable, because if that breaks down then our trucks don't get to the hospitals in these inner cities and catastrophes have occurred, and the product dries up. so for us going forward -- i hadn't thought about this until you called but the reality is the roads and bridges have to work or else it's going to be incredibly complicated for patients to get the access to the life-saving medicines they need. so that's my pitch from a distribution side. >> so, i think with health care, going back to when i mentioned that we have had hospitals in the community to treat the patients and they've had, quote,

local access to the hospitals. moving forward, we have to realize that's not going be the case. now, health care is often operated within a silo, so anything we need to change about the delivery of health care we can do internally within our healthcare group, but as physicians, as hospitals, we have never had to really depend per se on another industry other than within healthcare, like pharmaceuticals and et cetera. we're talking about the success of something probably more important than anything else to all of us, is our own personal health, and when we talk about the success of healthcare moving forward, this is a first time that doctors, nurses, hospitals, and your outcomes are going to be dependent upon getting to the right place at the right time. so this is not -- this is actually new for us to depend on another industry, another infrastructure, for our success and for our health success.

so, i think -- as i said before this is the most critical time moving forward, and that's why we're so thankful to be part of this because i think we need to put more attention to this particular piece. >> thanks for terribling time away from your patients and team to be here. >> michael. >> we need to try to be successful, and the more we can put enhancements and specialties in a system, the better we can serve those that need more services and i want to thank u.s. chamber not only for the panel but the transportation performance index. helps us tell the story how well we're serving business and the economy through the transportation network, and as we look at trying to reduce the lost attendance, meaning people's appointments, as we find ways to get them more we have to make investments and transportation research board did a study they found the investment cost to enhance the transportation network would be

more than benefits by the benefits of serving the community and would save more money by having more efficient transportation. so we have to put those investments in place, to get people to the hospital, work there, and get them the medical care they need. >> okay. >> the simple truth our industry is extremely people intensive, and anything you can do to make it easier for people to do what they need to do, either go work and get care, the better we'll be. the second part ills you need to understand our healthcare system is in the fight between medicare and medicaid pays less than cost, and the exchanges, cost control is going to be paramount to the degree which we do that, the degree which we can avoid unnecessary closings and rationing of health care, and the part you can do is own your own health to reduce disease. if not, it's not going to be pretty. >> please join me in thanking our panel today.

[applause] >> president barack obama met with the dalai lama at the white house this morning over the objection of the chinese government. the president greeted the tibetan spiritual leader this morning at 10:00. the white house did not announce the meeting until late thursday. china warned that the meeting would if flick grave damages on the u.s.-china relationship. the foreign ministry spokesman says the united states arrangement for its leader to meet the dali would be a degrees interference in chinese's affairs and a serious violation of the norms of international relation. the meeting went ahead and nancy pelosi tweeted saying that president obama's meeting with the dalai lama sends a message of. support for peace and and compassion, and the dalai lama

was at the american enterprise institute. you can find that in -- on c-span.org. tonight is the last night of booktv during primetime, we wrap up with women's professor studies bonnie morris. you can seal the interview with her at 8:00 p.m. here on c-span2. >> the beauty of america is nat this country, we have the ability to write the script of our own life. we are in a sense in the driving seat of our own future. and our biggest decisions in life are made. america creates the sense of possibility, and out of that you can become an activist, a community organizer, in a sense what are you doing some you are living off the great capital list explosion of wealth that you didn't even create. >> so many straw men set up it's hard to know where to begin.

nobody said america's the most terrible place but there are couple of assertions you have to take on faith that are astonishing. one is the idea that america's great invention was wealth creation, not based on stuff at all. what about the effect of the entire continent. that doesn't mean -- applause maas -- 90% of the residents who lived here were murdered. and that was a part of it, too. >> the debate about what's so great about america, tonight at 8:00 eastern on c-span. >> transportation secretary anthony fox called on the public yesterday to push congress for more transportation funding. he spoke at the chamber of commerce transportation summit examining the role infrastructure plays on key sectors of the economy. his comments are 35 minutes.

block. >> ladies and gentlemen, can i ask you to take your seats, please. >> thank you everyone for coming today to the second infrastructure summit of the u.s. chamber of commerce. we're so excited to be presenting a program today that really focuses on the intersection between infrastructure and the economy. you're going to notice from our program that there's not a lot of what we in the transportation will call the usual suspects sitting up here today, and that's because we have been asked repeatedly over the last several years to bring business to the table and talk about how does infrastructure really serve the business community? make it real for people. make them understand why we invest in roads and rails and runways and inland waterways. make them understand why we focus on the need to have both a

federal, state, local, and private partnership to make infrastructure happen. so that's exactly what we're doing. and i'm janet kavinoky i lead the transportation and infrastructure team here at the u.s. chamber, along with drew preston, who put this conference together, and kristina ashley, and we're thrilled to start today with the new secretary of transportation, anthony fox. has been selected by president obama to lead the nation's transportation infrastructure, our planning, systems, air traffic control network, and comes from a place of knowing just how transportation has to work for communities, for rejobs, for businesses and for people. he was mayor of charlotte, north carolina, he was a city council member. before that he was in private law practice. and a good man, knows what he is talking about, and is also very excited that the charlotte

bobcats will become the charlotte hornets once again. that's not really relevant to transportation but a good thing to think about at this point in the morning. so without be bee -- i'm going to intro to us you transportation secretary anthony fox. [applause] >> good morning. thank you very much, janet, for the wonderful introduction, and just as an aside, i took office as mayor of charlotte in 2009 in december, and our football team, the carolina panthers, had some of the most challenging seasons during the time that i was mayor. i left in the summer to come here to take this role, and they went to the playoffs. and so i like to say i left the city better off than i found it.

any how. hopefully we can do that here in washington as well. i come towage after serving as a mayor, and just about every mayor in america can tell a story about a business considering his or her city with hundreds and sometimes thousands of jobs in the balance, and invariably the business representative will bring up a road or a bridge that needs to be built or repaired to make the site work, or under the best of circumstances, the existence of one of those assets that makes the investment sensible. so, i want to start out by assuring you that i understand that first-rate infrastructure and job growth good hand in

hand, and i've seen it in my own experience. and so i want to begin today with a statement of the obvious. that the united states faces a massive infrastructure deficit. and if this deficit is not addressed, it will stunt the recovery we have begun and cripple our economy. i don't have to tell the people in the rom how big this infrastructure deficit is. you're moving goods around america all the time and the people that work in your businesses need efficient ways to get to work. but imagine how much harder that task is becoming. when, as a nation, we have 100,000 bridges old enough to collect medicare.

when we have fallen 20 spots over the last ten years when it comes to the quality of our infrastructure. putting us just behind barbados, a country with just one airport. becomes more difficult when we hear the american society of civil engineers point out that, without investment, deficiencies in our nation's infrastructure will cost businesses more than $1 trillion every year in lost sales. and further, they say, -- and i'm quoting -- that if current trends are not reversed, then our economy will take a $3.1 trillion hit before the decade is out. which is the equivalent of

wiping out the economic impact of an spire state, like the state of virginia. it gets more complicated when you consider that a number of commentators are talking about what happens at the end of fiscal year '14 when the highway trust fund runs out of its ability to stay solvent. little do some of them know -- although i think folks are starting to realize this -- that the highway trust fund is on track to bounce checks before fy '15 begins, as soon perhaps as this august. but again, you all know this. and that's one of the reasons why your president, tom donahue, rightly urged congress to stabilize the highway trust fund just a few weeks ago.

i'm grateful to him and you for stepping up and ringing the alarm bell. on this growing crisis in america. that's also one of the reasons why we at usdot put a ticker on our web site to make sure the american people can track how closely we're reaching insolvency. and that's also why i'm here today. because we need you to join us in raising the alarm bell in calling congress to act. for years, the growing infrastructure deficit has been an issue akin to termites in the basement, slowly eating away at our foundation. and now it is a wolf at the door. and when we add all of this up,

crumbling infrastructure, significant new capacity needs, economic cost associated with not addressing these needs, our congress unable or unwilling to handle business until emergencies loom, a highway trust fund, fast approaching insolvency, surface transportation bill close to expiring, and the rest of the world running faster towards building 21st century infrastructure than we are. transportation and specifically failing to tackle the infrastructure deficit, is the next crisis we're heading towards. now, when i mention this looming crisis outside the beltway, i talk to mayors or governors or business leaders or labor or ngo folks, they are astonished. their reaction to me is, how can

we, they will tell me, kill the golden goose that has laid so many golden eggs. like the transcontinental railroad. like the interstate highway system. some of the most heavily used transit systems in the world are right here in the u.s., built by us, and a significant legacy that we owe a duty to future generations to continue. these mechanisms, day after day, year after year, get products and people where we need them, and they keep the economic engine of america going. so, two things -- one of two things can happen right now. the first is that we could push america into a larger pothole, a

bigger infrastructure deficit, by neglecting to handle our business as a nation. the second is that we can pull together and drive ourselves out of that pothole, address the funding gap and put our infrastructure on a sustainable course. and by the way, if we work our way out of that pothole, it will not be a democratic success or a republican success, it will be an american success. i have reason for optimism despite this dire picture i'm painting. too early to be pessimistic. for one thing it's good and constructive that members of congress are now offering ideas about how to fund our transportation system. it's encouraging that chairman

schuster of the house transportation and infrastructure committee says he hopes to have a bill out before the august recess. it's encouraging when centers boxer and vitter have agreed they want to have a bill by april, and i'm also encouraged by our administration and the president for putting ideas on the table, too, including in his state of the union speech when he put forward a proposal to fund surface transportation with the savings from corporate tax reform. the truth is our problem isn't mass; it's that for a generation, the concept of government spending has been under attack, and it is bleeding into our approach on an issue that has traditionally been bipartisan. but you and i both know that spending on transportation is

really investing in our country. it's -- its economy, its people. this is a rubicon with we have to cross fast. how do we get there? first, we need to aim at the right targets. for years, our national dialogue has focused on how to get the highway trust fund leveled off. to translate that into business terms, we have been trying to reach the same level of sales revenue and expenditures as the last year instead of growing revenue and expenditures to meet customer demands. the plain fact is that the gas tax is spinning off less and less rev knew. meanwhile we're anticipating 100 million more people in the u.s. by 2050 and we're going to have to move four billion tons

of -- more tons of freight by 2050 as well. which i'm told is the equivalent of 40,000 washington monuments. less revenue, more people, more freight, more gridlock. that is not a formula for success. so, in my view, we should stop aiming just to get the highway trust fund level again. we should aim to cut into a bigger piece of the infrastructure deficit by investing more and investing more now. to put this in perspective, the american society of civil engineers estimated that our overall infrastructure needs as a country are $3.6 trillion by the year 2020. now, that is an all-in number. it includes more than just

transportation infrastructure. but that's still an order of magnitude that is far bretter than our investments -- far greeter than our investments. we need more than $70 billion on an annual basis just to bring our highways up to a state of good repair. and if you think about it, every year we wait, it's compounding the investment that our children and our grandchildren will need to make. in passing that along to another generation flies in the face of what every generation of americans has done, which is to leave things better off for those who follow us. second, we need to be reminded that in the case of infrastructure, fiscal -- the fiscally responsible path is to invest now, not later. yesterday i stood with vice president biden in southwestern

illinois to commemorate the fifth anniversary of the american recovery and reinvestment act. this act made the largest investment in american infrastructure since eisenhower built the interstate highway system almost 60 years ago. and it turned out, in making investment at that time, rather than putting them off, with actually the right thing to do. because while we all remember those years, as difficult as they were, the time period between 2008 and 2010 was an incredibly cheap time to pay for infrastructure. the cost of construction had dropped by 18%, and has risen since. and to put it bluntly, we got more infrastructure projects for the dollar as a result of making the investments at that time. you all know the time value of

money being what it is, the same project today pushed out five years, ten years, 15 years, 20 years, becomes exponentially more expensive. unfortunately, given the picture i've painted of our funding situation, the increasingly more typical example is the investment we weren't able to make due to a lack of funding. i'll give you an example. in 2009, norfolk southern, one of our class one railroad companies, decided it wasn't cost effective to maintain 135 miles of track they owned in michigan. so the state of michigan decided to try to step in and buy that track because it was part of a crucial artery connecting detroit and chicago. good idea. the problem was, the funding

wasn't available to acquire that track in 2009. it took almost four years to secure the funding, and by that time the tracks had been neglected so for long that the repairs cost hundreds of millions of more dollars than they would have if michigan had been able to make that investment in 2009. that's just one example. there are hundreds, if not thousands, around the country. at the federal level it is perhaps noteworthy that funding challenges like this -- probably isn't as noteworthy this funding challenge exists. it's balled together with the other challenges we face. but the cumulative effect of years of instability and uncertainty is now creating a massive chilling effect at the state and local levels. there are literally projects that aren't being put on the board because folks don't know

what they're walking into as soon as next year. in fact two weeks ago i was in missouri, and learned that the state department of transportation there has stopped investing in projects that build new capacity. in part because of unpredictable funding. and then there's a small community in texas, i'm told, that began digging up their roads and turning them back into gravel because they couldn't afford the maintenance. in america? folks, that's not who we are. we are a nation that finds a way, and over the next several months, that must be our mission. third, as part of our case for more investment to tackle our infrastructure deficit, we also need to double down on reducing

costs just like any business would. as executives you all know that sometimes when you have a low-performing asset, you can't pass the entire cost of fixing that asset on to your customers to get it fixed. sometimes you have to cut costs to make room for the investments you really need. and as an illustrative case -- i'll use ford motor company in 2006 as an example. in 2006, ford was on the brink. they didn't know it yet but the company was about to lose $12 billion that year and another $2 billion the year after. their new ceo, allen ma laically was tasked with refinancing the

company during the worst -- the money was part of the solutions and in fact in 2006 ford but up nearly all of its assets as collateral, including its logo, and secured a $23.6 billion loan. but that wasn't ford0s only problem. it was also where the cash was flowing. for almost 30 years, ford had been known for its pickup trucks, big cars that right before and during the recession few people were buying. so ford got smart. they streamlined, they shifted their portfolio towards smaller, more economical cars, and they made sure that the entire company, and all of its employees, knew what they were doing and why. every employee carried a one ford mission statement in their pacific. -- in their pocket and they've

turned things around. n there are lots of lessons to be learn from 0 ford and other automakers and other folks in the transportation industry for sure. but the necessity of investing wisely, even if it means rethinking how you do business, is one of the most important and relevant ones to us. while in transportation, we should take that lesson seriously. not damage we -- not only do we need funding but we need, to as my grandfather would say, leave no stone unturned, to squeeze every productive ounce out of our transportation dollars we can. that's one reason why i don't think we should simply let the funding questions alone dominate the debate about transportation. we have a surface transportation bill that will expire

october 1st. and we need to go further than just technical corrections to map 21. we need a bill that reshapes the transportation landscape for the 21st century, building on map 21 but going further. we need a transportation system that is smart enough to plan along economic lines, not just political lines. we need to expand our ability to harmonize building processes prd incentivize states to do the same and i believe we can do so without jeopardizing the environment or project integrity, and in the process, we will save valuable time and money. moreover, when we do so, we create a more conducive environment for public-private partnerships. a recent mckenzie study found looking at the globe, the countries can obtain the same

amount of infrastructure for 40% less spending. just by adopting best practices. sure, we have examples of best practices in the u.s., but i know we can do better. so, just for the sake of argument, let's say we could only achieve half of that 40% savings. if you applied 20% savings to our last funding bill, map 21, that would have equaled $21 billion. that's a lot of additional projects that could be happening all across america. the truth is we can do this work by ourselves. our partners at the state and local level are critical to this effort. we have an agency with a $70 billion budget, but one lesser know fact about dot is 40 billion of that goes directly

to the states. we cannot be efficient if our state and local partners aren't efficient. so new investments could introduce new competitive programs they reward innovation and adoption of best practices at the state and local levels. by taking this approach, we will dramatically increase the value proposition of federal dollars by encouraging investments that help whole economic regions improve mobility and quality of life. you all know how much this matters and i want to, in closing, finish where i started out, because somewhere in america, right this second, as sure as we're sitting in this room, there is a mayor or a governor or a county commissioner or in some cases all three of them, sitting down

with some business representative who is talking about bringing jobs back to the u.s.a. bringing them right into their community. but they need an access road, or a bridge, or some rails built into the right place. and if that happens, hundreds, if not thousands of people, will start working again. i've seen it happen in my prior life as a mayor, and i see opportunities for this all across the country. in due buick -- -- when we did that, ibm moved in and gave the

old factories a new lease on life. you all know this. you get it. you understand it and the chamber has been one of the loudest voices calling for an increase in the gas tax to fund surface transportation. your president, tom donahue, has been a very vocal leader on this issue. prodding congress to be courageous. now, at dot we happen to believe we can pay for infrastructure a different way, but i would much rather see a national debate about how we get there than whether. that's why i'm glad tom is standing up, and we absolutely agree that congress is going to have to show a little political courage to fix this problem. their courage increases when their core constituencies like

the folks in this room, tell them it's okay to figure this out. it's actually the fiscally responsible thing to do. we need you to speak up. all of you can play a role in putting our transportation system on a more certain and sustainable course. we do it by letting congress know that one or two year band-aid won't cut it this time. tell them what is at stake for you. tell them what is at stake for your employees and the products you sell. tell congress to get to yes. i know they care about your priorities. now they care about your companies. i know they care about the jobs you create. and they care when you tell them yourselves. so our mission is pretty clear. we have to create the context for a solution this year. i'd be committing malpractice if

i didn't tell you that. but the truth of the matter is we have a lot of work to do, and you're a critical partner in that work. thank you very much. it's great to be with you. [applause] >> the secretary is willing to take a few questions. with hey roving microphones. please fog down one of the people hold that microphone, and then when you stand up to ask your questions, as tom donahue would say, tell us who you are so we know what you really want. no one has a -- no one has a question for the secretary of transportation. mr. secretary, i have a question for you. >> all right. >> dot has been doing lot of work on connecting the economy

with transportation, especially in the area of freight. tell us about what the department is doing and what your vision is for making sure we can move goods in, out, and through this country efficiently. >> a great question. sounds like crowd thought about that one before. so, one of the really smart parts of map 21 was the requirement that u.s. dot go out and pull stake holders together to develop a national freight plan. and we have a committee of 47 people from all walks of life, all parts of the transportation ecosystem, who are involved in helping us develop this plan. the vision for it is a multimodal plan, looking at how freight actually moves in this

country, where some of the gaps are. what kinds of target investments would be useful in easing the flow of commerce across our country. and i would say that once we have done that analysis and it's in the works -- probably be ready before the end of the year -- once that work is done, we will have identified more or less where some of the gaps are in the system. from there, the challenge is, how do you get those gaps addressed and that's a place where i think a strong competitive program that encourages not just one-off projects but ones that had real scale, would be useful, and that may involve multiple states coming together to solve a particular problem, whether it's rail or highway or whatever. and i think that's what i'd like to see.

so, we'll continue conversing about this as we go through the development process on it. but that's my view. >> we have a question here. stand up and introduce yourself, place. >> good morning, garrett francis with cs transportation. one of the things i'm sure you came across as a mayor -- if know in this when you're trying to get these projects off the ground is the issue of permitting and streamlining, and map 21 did some of that. how would you take that mayoral experience and the business experience, look at some of the issue wes have with environmental and permitting and streamlining when we're trying to get some of these high job-producing projects off the ground. >> great question. you know, i had a similar situation as a mayor. we had a city that permitted everything outside the building

and a county that permitted everything inside the building, and the two groups of people that did that work didn't sit next to each other, didn't -- there was no common platform for these things to get resolved, and a lot of the review processes were sequential in nature and not concurrent in nature. so they weren't all doing the work at the same time. which meant it took longer. one of the things i think is under emphasized in the political words how much president obama cares about making sure government works well and doing everything we can to ensure we getting things done as effectively and as efficiently as possible. the truth is that on a given

project, there will be a dot review, an army corps review, sometimes a coast guard review, and lots of different agencies involved and they don't all roll up to the same agency leader. and what i can tell you is that is a focus for the president. it is a focus that i have, and we're looking at ways we can get things done even without congressional action to get things more streamlined. there's good news. the number of categorical exclusions, the need for processes has actually been increased under this president. so more projects are moving faster. but the ones that aren't moving faster are the big ones, and we have a responsibility to work on making sure we're getting as much done as possible. i'd like to see us cutting the time as close to half as we can get in terms of getting projects moved through the system.

>> great. next question. >> mr. secretary, what's your personal take on the keystone pipeline? >> that's a very good question. i do have a view on that. my view is that secretary kerry is going to be a great figure to resolve that one for us. >> other questions? i see a couple of hands over there. give these ladies a moment to get through the crowd this morning. >> good morning, mr. secretary. thank you very much for participating. i'm hall with balinic in town. i'm wondering given the

challenges any administration has to get proposals through omb and given the fact that senator boxer has announced a very accelerated schedule for moving forward on map 21 reauthorization, how does the department anticipate making itself priorities known to the senator and to the committee on both the house and senate side? it seems unrealistic to think that the department can actually put together a complete reauthorization proposal perhaps some sort of an outline? how do you envision that going forward. >> well in the past, a lot of the policy framework the administration has had on transportation have come through the budget process, and -- but i wouldn't count us out. i wouldn't count us out. and that's all i'll say right now. >> i know we have a question in the back corner there.

>> mr. secretary, i'm joe scully with the truck renting and leasing association. you said that dot believes there's a different way to pay for infrastructure expansion besides fuel tax increase. can you elaborate? >> the basic outline is there's been some fairly substantial work that chairman kemp of the house ways and means committee and chairman bachus, former chair of the senate finance committee, had didn't doing on tax reform and if you look at the proposals there's actually a savings that -- or dividend that comes through doing that, and we believe that some part of that

dividend could be used over a time frame there's paper on those ideas and concepts that have been produced out of congress, and we think it's a good framework for getting past some of the gridlock that's been in place over this issue for a while. >> mr. secretary, i know your time with us is up. thank you so much for your generous time and your thoughtful comments. please join me in thanking secretary fox x and we'll have you back. >> here's a look at tonight's primetime lineup on the c-span networks. on c-span at 8:00 eastern, debate over what is so great about america, with conservative author desousa and liberal activist bill ayers. booktv with author bonnie

morris, and a look at the lives of thomas jefferson at 8:00 p.m. eastern. new jersey governor chris christie held a town-hall meeting to talk to residents about hurricane sack -- sandy rougher. next we'll show you a portion where the governor answers a question from an unhappy resident. >> my name is tom, i am an elderly -- flood victim, sandy victim. my comment is, you're right that there isn't enough money to make everyone whole, and we're not going to get that. but i like to know your reasoning behind privatizing a lot of the grant program? you paid about $100 million to different contracts to run the program. the main one that comes to mind is -- that could raise about a

thousand houses. one of them is hgi -- >> let me stop you for a second. i'll answer your question. what is your suggestion how i should have done it? should i have hired thousands of new government employees to be able to administer these programs? >> well, i've heard you on tv saying you have 60,000 employees and they're hard to manage but new york did it differently. they didn't privatize it -- d. >> that's not correct. by the way, new york is significantly, by a measure of two or three-fold, behind us in the distribution of money to victims. significantly behind us. so, you can't just say one fact, that you like, that supports your position -- you said, new york didn't do it that way. well go talk to the victims in new york like i have, who have not gotten anywhere near the type of aid yet from the programs in new york that the victims in new jersey have gotten. we're trying to do this in a way that gets it out to people as

quickly and as efficiently as possible, and even -- don't take my word for it. the secretary of house -- >> i won't. >> i know you won't. the secretary of housing and urban development in the obama administration has said that this money has gotten out faster than in any major disaster in american history. so, not from me. >> can we just get back to the center of my question. why was hgi fired? why did you pay them $50 million? and why did you privatize most of the grant program? you didn't have to do that. >> i could disagree with you. okay? so, you've say not to privatize it. the alternative is, the alternative -- i'm answering the question. the alternative -- the alternative is to have hired thousands of additional government employees to be able to administer this -- who is going to administer it if in fact -- you know, it is a

rhetorical question. someone has to administer these programs, sir. we do not have -- we do not -- we have a new company in place to run the program going forward. and the fact is that if we reach a point where we believe there's another company who can do the job better than the company that was initial by brought in under the bid, we're going to make that change. i'm not going to hesitate to make change there's an option that is better. so if what you're hoping for is every decision that is made regarding billions of dollars well be made perfectly the fir -- first time, your expect takes are not where they need to be. the fact is we do not have the number of employees, thankfully, thankfully, for you and your tax rates, on staff in the state government, that could run an additional 15 to $20 billion worth of programs, and if we did we would be running your government inefficiently from day-to-day.

we have a number of employees we need to run the $33 billion government that you already pay for, and i am not going to bring on more people who have to -- i have to pay health benefits for, pensions for, to run a program that by its very nature is a temporary program. that's the type of people you bring in private contract ares to run, not something that is going to be a long-term program but something that is a temporary program. that's what this is. that's why we brought in people to do it that way, and the result we have delivered for the people of new jersey is significantly better in terms of the amount of money been put out the door to folks than what you're seeing on the other side of the river. >> the issue of the controversial closing of the george washington bridge did not couple up during the town hall. >> this weekend, american history tv debuts its new series, real america, featuring

archival films produced by the u.s. government, stright, and educational institutions, that taken you on a vivid journey into america's past. this year about the build up in the 1940s. >> industry rolled out the materials of war, a plea went up. the call came clear, docks where idle ships awaited cargo held up by labor shortage. that is the call for help which was still echoing in the detroit area when women began to respond. convinced they could do factory work, or anything within their strength that men could do for uncle sam. listen overhead, your sisters are singing. it is a throng of women, american women on the war path.

>> real america, starting this sunday at 4:00 p.m. eastern on c-span 3's american history tv. >> the all-new c-span.org is now mobile friendly. you can follow us where you want, when you want, and how you want. our new site's responsive design scale dozen fit any screen, from your monitor on your desk top, laptop, tablet, smartphone, whether you're at home, in the office or on the go, you can watch live coverage of washington, check our program schedule or search or extensive video library wherever and wherever you want. the new c-span.org makes it easy for you to keep an eye on what is happening in washington.

>> national economic council director gene sperling says he is cautiously optimistic about the u.s. economy. in an interview yesterday, mr. sperling previewed president obama's 2015 budget priorities and disagreed with the cbo assessment that a minimum wage hike would lead to job losses. politico chief economic reporter ben white interviewed mr. sperling, who leaves his job in early march. this is just under an hour. [applause] >> good morning, sir, thank you for joining us. >> my pleasure. >> first question, is march 5th really your last day at the white house, and tell us about what you're dooring next. i know you're moving to california but what its next in your story? >> i know my credibility has been slightly weakened by delaying twice, but there's a logic to this, which was first agreeing to stay past the state of the union and then pass the budget. so march 4th is our product.

we'll be doing the rollout march 5th, and i think that is likely my last day. remember, i have an excellent successor who is just a fantastic, guy, person, you couldn't dream of having a better successor and going through a greater transition than with something like jim sines, so i think it's for real this time. >> when the budget rolls awful the press, you have the documents and reporters start calling, how are you going to extricate yourself from wanting to talk about what is in the document? i imagine it will be a strong pull to want to talk about it and explain it. >> well, i obviously have that opportunity on march 4th and march 5th and after that i guess i'll be in that very really high high perch of commentator. >> there you go. give us a quick preview of the budget. should we expect any surprises

in here? is there going to be further deficit reduction or talk about the efforts you have been involved in to reduce near-term deficits, which seem to be leaving the short term under control, longer term less. so what should we look for in the budget document? will there be anything more on deficit reduction? >> i think you should look for the constant movement towards the more progrowth budget, more progoing to fiscal posture. than i think we have had. we have made some progress in that way but i think there's three components that help make a budget more pro-growth and do more to support the type of middle class opportunities and middle class job creation that are so important. one is that you -- the most important thing on the fiscal side is to get the savings in the long term. that's what people are worried about. they're worried about our long-term situation. will there be enough revenues? is there enough control over

mandatory spending? so, what gives -- what is important for confidence is, are you dealing with that long-term fiscal situation? secondly, are you doing enough to provide acceleration for this recovery? the economy is getting stronger. when you're coming back from -- you're still coming back from the worst downturn, the worst financial crisis since the great depression. we do need stronger growth now, particularly because of the problem of long-term unemployment. of course it's good to see unemployment go down, i think when i started it was around 9.4. that is obviously a lot of progress, but the issue of long-term unemployment is one the president thinks is very serious, and greater growth right now. greater demand, would make employers reach out further into the work force, give more people that second chance they need. and then third, if you look at the things that are important for investing in our future,

many of those are under the domestic discretionary side, which are nih, research, early childhood, pel grants. maybe there's not as great a constituency because it's about children and the future, and what we don't want is for our deficit reduction to come at the expense of the investments in the future...

and to change the composition of deficit reduction so we allow more investment in the future in education and training in the middle class and that our uppers are more directed towards the long-term and they are a responsible mix of revenues and a sensible mandatory savings. >> there will be further tax increases included in the budget is what you're saying. >> compared to what the status quo is right now, we would have a mix up future mandatory savings and future revenues that could be used to deal with the long-term situation but it would less of a drag on the economy now and allow for more investment and the things that we think are the most important for growth and productivity like research and education.

>> would it be in there as something the president supported in the past? we talk about the grand bargain talks and what you all have put on the table. is that still viewed as possible? >> we are going to be announcing the budget so i think i've given you a good preview but i will let you see the movie when it comes out. i think that in terms of the having the type of future long-term deficit reduction deal would meet those three tests we put forth more growth in the short-term, more ability to invest and more long-term savings. i think the president has to show in that he is willing to compromise to achieve that. and that he is willing to do some things he doesn't personally support in his ideal budget, but as we have seen, we were very close to having that kind of compromise twice. but over the last year even with the president i think going to

the very heart levels to keep his offer on the table we do not see reciprocity in 2013 and a seeing equal movements to reach an agreement. >> let's talk about the president's efforts to address economic inequality on the minimum wage into th and the qus to $10.10. we had this report come out and cbo must be our favorite organization right now in the white house with a report on the minimum wage maybe you could abolish that as your final act as member of the national economic council but i want to talk about the minimum wage peace and their argument it could be anywhere from a few to a million leaving it at 500,000 as the prediction. they came out very hard and said we bb that it would be a mess zero job loss if you raise the wage which i think it's surprising given every time you raise the price you are going to get a little bit less so there

will be some job loss. why so hard saying zero jobs lost since the benefits of raising the minimum wage for the first question is why that approach and second is this something you could get through congress, but $10.10 minimum wage. >> is a great thing. it is a great thing in our country that we have an independent scorekeeper for the budget. we have to live by what the congressional budget office does for budget scoring rate we don't always agree. we have an equally talented group of people that work with counterparts and cbo. so to be serious for a second, fact that we as a country of his scorekeeper that we abide by the rules is important for the budget. i don't think that means people

of good faith have on both policy disagreements cannot express them in ways that are about real policy issues. we were actually joining them in explaining the report showed people would have more choices and not that it would cost that would lead to people being fired or losing jobs. so we worked together explaining something in the report. here we did have a disagreement and let me explain why. what you just said is what we are taught in economics 101. if the price of politico goes up, people will buy less of them so therefore if the price of your minimum-wage worker does hire, people will buy a little

bit less of them and that is the assumption that existed for many years that you have to have the choice and save the benefits of increased wages were worth the fact people might hire less but the best economic research isn't the research that puts in an automatic plasticity and says that is what automatically happened. it's what looks at human behavior and it started around 93, 94 when two of the preeminent economists that rather than accept that, let's look at this interesting experiment. new jersey just raised the minimum wage and it's on the border with pennsylvania and in fact on each side of the border or restaurants that look exactly the same so they went and looked and found that when the minimum wage went up in new jersey not only did it not cost jobs it almost seemed like a like it haa slightly positive effect and

people started to study that and in fact there was research that actually looked at every county in the country. i believe 504 or 288 pairs of counties found the same thing right next to each other with a place for the minimum wage went up it didn't have this job intact so that pointed to other human behavior other than simply what happens to the price for which is study after study shows there was a greater retention, less absenteeism, companies didn't have to spend this much time searching for people caught there was bette bitter row on productivity and so that explains with a tiger minimum wage we have seen through actual multiple analysts is that it actually does not have a negative economic impact and

where we disagree is the gradual increase remember how it works it goes up 95 cents, then another 25 cents but by 2016 doing that, indexing so we have quite a bit of certainty that that is in the range of reasonable increases in which one rely on this body of economic literature. this isn't where the cbo was being devoted scorekeeper, they were expressing a view looking at some of the top labor economists in the country and in our view you do not have to make that choice at a reasonable increase by 1010 you can increase the wages of supporting the budget office 24.5 million people, 16 million directly to 16.5 million another 8 million indirectly litigate a bump up and if you look at this literature it should have no

affect and in fact it could have a positive effect. look at what happened yesterday with a gap in the context that comes out and says that is as we are making a business decision to basically support this idea and they are going to go to $10 by 2015, costco is already there so having a disagreement based on the literature is appropriate, and in this case we bb that that is right and we believe the right and analysis is that the minimum wage will left the wages, left people out of poverty, help people making sure the value to work full-time and you don't raise your children in poverty but also the middle-class families sending back another spouse to work extra an and supported them and it's helpful as well so we bb view can do that and not have a negative impact on jobs at a reasonable level. on the politics, or the

legislation we will have to see. i will tell you that as we have been saying they have been around for a while. in 1996 when th the republican-controlled and gettinand getinto bb there shouo minimum wage at all minimum-wage increase passed, and i think it is because there was such a strong value in the american culture and value system that someone that works full-time should have the dignity of someone that works full-time should be able to raise their children and not have somebody that works full-time shouldn't have to raise their children in poverty, but that it cuts across all day and higher political spectrum so i think people are going to have to think very hard before they say no to the raise for 24.5 million peopl people ap working. so, i know most people are betting on it, but we will see.

>> in the 1010 level it seems you are going to hope for legislation and that would be the result of some negotiations to wind up at a lower dollar level for the increase in the thought to get into that and compromise that's $9 or 925. >> you can't say there's a particular magic number. by going to 1010 you reach a lot more people. we did as you know consider giving it a lower level that's $9 initially, but i think as we do the analysis, we really found that we were leaving off another 10 million people who we felt could get a raise gradually and could do so without a negative

job intact but i will give a reason why the businesses should support this. i think that if you were just to go to $9 it is better than 725 but i don't think anybody would feel like our work is done. you would still be looking at the minimum-wage. there would still be a big movement to increase after that. here you do a pretty serious correction over three years and then you index it and in a way i think for companies they should support this. they should see this as a correction and the chance for this to go up with inflation and the something that they can plan for in the future. at the minimum wage is in real terms what it was 50 years ago. imagine somebody saying we can't afford as a country to have a higher minimum wage than before

world war i. of course you want the standard of living to have gone up enough you can have a minimum wage, so having the minimum-wage as it is right now is not something that should be supported and in more companies like the gap that will build that case and the good policy i think if you went to 1010 that is a significant enough entries that with the index you could take this issue off the table and give more certainty to the businesses and workers going forward. >> you said it was a matter of explaining the job loss but the production employees a song choices they would have under the affordable care act i think thinka lot of the criticism camm the commentators that are doing the notion of giving a disincentive to work allowing someone to make a good lifestyle to take care of kids and parents

in doing that with the support of taxpayers and i want to read a quote describes it this way in the national journal who said i'm happy to finance a subsidy that guarantees access to decent health care for all but not so s are happy to subsidize the retirement or approved worklife balance. healthcare should be a basic entitlements. how do you respond to that criticism? i don't think that you should be aiming far beyond. look at the k-12 education. that takes -- the k-12 education and anti-child labor law gives so many potential workers the option to not work. you may think that is being a little sarcastic, but think about it as you are in an advanced society, you make certain elements tha that give

people inability to have a quality of life. social security allows people to retire with dignity 65, 70-years-old that are partially retired. you could make the same criticism he's making insecurity. >> it gives people the choice not everybody takes it but it gives people the choice. i don't find it as serious as a critique you could have a far more generous program that pays for everybody's health care and then you wouldn't ever have a disincentive but then you would have a huge expansion so the fact is when we get people tax relief for assistance, we try to target 12 and then you try to phase it out. i don't personally believe that people make as many choices in

the way of the technical economist. i will give you an example in the end income tax credit. over my 21 years is how much the income tax credit has been expanded at the various times. so this is a very meaningful assistance for a lot of families who are the most hard-pressed in the country making a teen or $19,000 a year and the cost of going to work often takes up a huge amount of their income. people are really struggling and the earned income tax credit gives them significant support and has a lot of support but it does phase out. you could keep for everyone and say that costs too much. some people say that means somebody's going to work less hard as they get 25 or 30,000

but as you look at the real-life human behavior if it doesn't turn out to be the case. most people desperately want to do better for their families. so i don't necessarily believe that there are so many people sitting with their calculators and say my goodness the earned income tax credit or the affordable care act subsidy is going to phase out at this amount, so therefore i'm going to make all of these subtle and precise choices. i think the best economic research is where people look at actual behavior. in the earned income tax credit they found people don't make those kind of precise trade-offs because they are not just acting like these purely rational economic actors with 100% of information. they are real-life parents struggling to provide security for their family and they are going to keep working harder to do well because they want to do better for themselves and their

family. there are people who i think may be working more than they would like to for their family situation because they have a pre- existing condition or their child does and they are very worried about that. i think that is a type of job and object variable not for people who have a child that has a pre-existing condition or spouse is often afraid to move to a place with a new job. they are often afraid to start their own business because they are worried that if they do, they will never be able to get health care again and then there's people that cannot get affordable health care and they are working, you know, very hard to save money or because they are scared. i think there was more kind of basic choices is what is wrong in the current system and unacceptable in the status quo

so if you take away the barriers to health here and protect people more of their pre-existing conditions you are going to get people who say im working more than i want to. i want to be there to take my kids up from school and now that we know we have affordable health care or now that i know we don't have to worry that if we lose it and we have a child with a pre- existing condition we are going to have a huge amount of savings, ima work a little less. he made a very good human distinction you have to look at certain things where somebody says i am sorry. or somebody says i was able to pull back a little and care into people say that the great.

they would say that's good for you. >> i want to talk about your experience in the healthcare reform in a different era in the last two democratic presidencies and in the 93 and the 94 health care experience, the end result was you didn't get health care reform passed. the price was with the loss of the house of representatives and the future of the affordable care act is not secure at this point should the republicans win the white house and the conventional wisdom is there will be very strong efforts to repeal over the affordable care act. given those experiences, does it seem he would have done differently this time in the passing healthcare reform lessons you learned this time around and do you think that it

is safe legislation that will be the law of the land for the foreseeable future or is there a risk today you lose the senate because of it and the white house? >> this has been the year that of the era of threatening the default of the government is over. ibb by the time this weekend to 2015, serious -- dot era of threatening to completely repeal the affordable care act will be over for serious people. the reason why is because at a certain point you can't beat something with nothing. i mean, the affordable care act is to every woman for the first time ever you can't be discriminated because of your gender. it's over 100 million americans. you can't be discriminated against. the tax credits help more and

more people. we did a study on this and show that over a decade probably half what at some point used a tax credit. there are certain things people may initially think of for other people but they find that over time it can be helpful for them and their family as well so i think that when you have the 100 million people getting protection of the existing conditions i think that when you have the people under 26 on veterans coverage when people are seeing the stories of people who unexpectedly were diet most with cancer and who are able to get affordable treatment and saying we are going to repeal it is going to be less and less attainable. that's my first response. in terms of the challenges of

implementation, one of the things i think that anyone if they are being fair has to recognize the simple victim that hard things are hard, and budget very positive and create change can be hard but it doesn't mean it's not positive and good for the country. look at the status quo. is the status quo great that somebody that worked hard to roll life loses their job and their child gets sick at the wrong time and they become bankrupt is that a system that we are proud of? how are we going to change that? a lot of the criticisms on the affordable care act is why ... all of this good for tens of millions of people there is occasional disruption somewhere so the administration tries to

listen to that and make reasonable transition changes. that's what you were doing any type of reform that's positive for your country and there would be transition challenges you try to smooth out as much as possible, but that doesn't mean that it's flawed. that just means that it's significant and it affects a lot of people. if you look at the affordable care act, i think it is uncontroversial that it's the least disruptive by far of any major healthcare reform plan that has been proposed by either democrats or republicans. and the clinton administration were going to have a plan. let's say that john mccain had won. the plan would get rid of for many of the republican friends would get rid of the employer deductibility for healthcare and then they would take that savings and give it to people a tax credits to buy healthcare. we can be dated dat beta data bt

isn't ebay double is tha that wt has been traumatically more disruptive. you would have had people on the player he could employer provided healthcare and huge amounts of dropping. you can have a debate about whether or not that is a better system or not. when you can't debate is that would have been significantly more disruptive, so i think it is just taking political potshots to look at any area of disruption and say that reflects a flaw in the affordable care act as opposed to that reflects the type of transition and adjustments you would have to have in any major healthcare reform, and in fact most of the republican proposals and many of the proposals on the left would have led to far more disruption than the affordable care act which is fundamentally built on the shoulders of the employer-based system. >> time is flying and i have so many topics i want to cover. you can send me questions. one of them on my list as well

to do with housing reform, legislation. i know that you've been deeply involved in the senate banking committee process to come up with a proposal to reform fannie and freddie and the role in the marketplace. can you tell us the status of that legislation and if we are going to have a product they can put out and give to us relatively soon and what would the role the un it comes out and what is the future of it getting past congress? >> i can tell some. i can't reveal everything i know because we are in the middle of a process. what i would say is this is a place you are seeing in the senate banking committee some bipartisan work happening together. it happened initially with senator corker and senator warner pulling together people, and that provided a good start. ultimately for something to happen, you need an equal amount

of leadership and bipartisanship from the chairman of the banking committee. senator chairman johnson and the ranking member and i think they together with the chief of staff and others have really been working very well together and i think that chairman johnson and senator creepo deserv crapo. i don't know that i'm going to try to legislate -- but this is one place in washington, d.c. right now where there is some serious bipartisan work going on, and i think that there is a recognition from a lot of people that we have to end too big to fail on housing. and that, you know, having a perpetual perpetuating system we have right now is not something that is acceptable and we need

to have a reformed system that doesn't have taxpayers on the hook as it would be now if something were to go wrong that such private-sector capital in front, in other words, that means that other people and the american taxpayers are taking the risk as it should be treated so you don't have a system like we did in the past where it was the investors win, tails, the taxpayers lose. now you want this to be a system where there is real competition and a real ability to measure the risk and price things correctly. i think the challenge is to have a system that does reform. the current system that ends fannie and freddie as we know them and has a system that does create more stability and takes taxpayers off the hook and i

think protect the 30 year fixed mortgage which i think is very important to americans and has a lot of support and i think people realized that in the end as much as you need to put private capital first, you need to make sure that anybody who is playing in this game would lose every penny before a taxpayer would lose 1 penny. even while you need that system you need some form of ultimate backup to provide that a vast amount of capital that is willing to take interest rates could not credit risk. the ability to still invest in the united states housing system, because that i think has been important to us having and affordable fixed on the 30 year mortgages, and i think what you have seen in the senate banking committee is a degree of pragmatism, not ideology that they are tough issues such as importanwhich isimportant for tr progressives to make sure that you have a basic protection of affordability that no one has

discriminated against in the new system or have shut out, and it's going to be difficult, but i think it's been encouraging the kind of good faith work. >> any prediction when we might see something in a matter of days or are we still weeks -- >> i don't think it would be helpful to put that kind of pressure on the system. i would say the following. i think there is a potential, you know there is a potential for bipartisan agreement. it's always difficult to reach. i do think most of the parties involved understand they want to move with some speed because they don't want to lose the window for something this serious to get it done, so i think everybody involved feels a certain pressure to move with some force and speed, but i in