he said he wanted to learn how to walk again and again he's a strange thing happened. he decided instead he wanted to run. he played soccer, he never ran competitively so he started training. 360 days after his amputation he had his first ten k.. ..

>> the congress and the american people are making sure that we maintain our lead role in innovation. today's budget, and this isn't a constrained environment, but we also have to continue to think of new ways to provide health care and research. captain james lovell and chicago is the first of its kind for the partnership between the active military this was a rough marriage to bring together a

manner of just blocks the great lakes hospital and the va hospital are destined to be closed. it's open and they merge together. the battles that we have fought between different cultures and active military versus the different unions, the different computer systems, i want to know if we have learned anything from that. during the course of this hearing. the integrative health record is long overdue and long overbudget. it is time for some questions to be asked about whether progress is being made. finally the budget proposal is consolidating tri-care as well as additional fees and co-pays especially with unsustainable health care costs. this includes any committee that released our military to talk about benefits starting with

tri-care. and i now turn it over to senator barbara mikulski. >> mr. chairman, thank you so much. thank you for scheduling this hearing and i know that there have to be some arrangements made earlier. i thank you for your long-standing commitment to the military. and you are going to hear from penny, who was a young military officer. and there was a tragic helicopter shooting and by her own grid and courage and bravery, she is now a congresswoman and we are awfully proud of her and the health care system to bring her back on.

>> today's we will do the budget, we have to focus on several things. so much as we have silence for fort hood and it shows that we need to have a renewed commitment also to military health. so much of military focuses on acute care and in a way what i ever disagree that we need to support that. this includes the battlefield, the mental health that service has taken, and the mental work that we need to do it if you care. but that is really based upon research and i really believe that we thank you again for what we are putting in the president and let's take a look at our research budget to make sure we're putting resources in the right way for what the soldier in his or her family is facing. and we know the transplant was

performed at johns hopkins. and i will recall another case at walter reed. a young man bending over a table and as he turned to face me and i wanted to shake his hand, there would be an invitation right above the elbow in both arms. because of an ied in iraq. i started about back i for a number of years as we have worked on this issue. so when i went to hopkins to hear about this, it was stunning. and the fact that they can do a transplant of both arms and muscle and nerve endings was phenomenal. it takes a lot of work of gifted scientist and it takes a lot of money to do that.

and the other things that i'm going to focus on are sometimes soft. but there's nothing soft about it. this goes to the areas of public infectious disease and adopting best practices. right now we are worried about russian troops on the ukrainian border. i worry about that as well and if it could sweep right into our country. and i know that as we stand is a global network of public health and biosurveillance, when a disease like ebola, they are doing it at the cdc and write up for deacon in maryland, where they have seen it and they know what to do and it is even had a movie been made about it. no one thinks about that. yet the consequences to our society could be something. infectious disease, public

health. last not least, best practices from the civilian domain. i was appalled to read the data of the number of military personnel that are now on food stamps. mr. chairman, i know that you and my good friend from the agriculture committee is shocked at the fact that there has been a gimenez increase in the number of our military and food stamps. right now there are several thousand. can you believe that? not only is there the stress of the battlefield that being the a soldier. so then we wonder why do they smoke them out why do they overeat over eat the wrong foods and why aren't they doing broccoli and kale and key we and watching doctor oz and the people that i love and adore. why are they not eating whole foods? they are trying to get through, let alone all fruits. so i think that we need to look at this. the fact that now we actually are going to cut the commissaries. can you believe that? we will spend millions and

millions and billions on many of the things that we do that are important. we need to be looking at what we do to support the military families. i know that we have embarked upon something called a healthy base initiative, which, i frankly, i am very excited about because it is the best practices coming from the civilian domain to support the family. when everything on the base from what goes on at the day care center to what is being sold and the commissary. so i don't think we ought to cut the commissary budget. i really don't think we ought to cut the commissary budget. i also don't think that we should have military when we are on food stamps. and i think we really need to look at the stress that the families are facing in their military. the everyday stress and we have to look at their activities to support them and have a more holistic approach and a more integrated health. so we have a lot to go over and

it ranges from acute health care to mental health to research, to infectious disease that could sweep the nation, including really looking at our family across the stovepipes. because i know the commissary budget doesn't even come under, yet it is one of the most important tools that you have on the health and well-being of the military families throughout our country. so we thank you for your service. let's look forward to how we can work together and mr. chairman, you now know that i would like to get a doctorate in public health. >> we all know that your efforts are as much of the help as a doctorate. thank you. senator baucus, do you want to say a word of opening? >> thank you so much. let me say that i am going to recognize patricia, surgeon general of the army. each of you has a written statement which we have

reviewed. it has been put in the record. take five minutes and give us the highlights and the summary. >> thank you, sir. chairman dick durbin, and chairman barbara mikulski, and senator roy blunt, thank you so much for the opportunity to tell the story. on behalf of the 156 dozen dedicated holders and civilians, i extend our appreciation to congress for their support. recently our nation felt the weight of another tragedy at one of our military post. my heart goes out to their families for their loss. they are demonstrating courage and brazilians through these difficult times. for supporting and tracking the progress of the survivors and providing longitude and support throughout recovery, just as we continue to do for those who were impacted by the 2009 for

the tragedy. and i am extremely proud of the teamwork of the compassion displayed and i want to thank the members of the committee who have reached out in the communities that were hard. i want to also recognize beyond the 30,000 soldiers deployed to afghanistan, the additional 120,000 soldiers deployed in support of the national defense strategy and we continue to focus on the total army force. our medical and dental readiness of us are at the highest since 2001. health care has increased from 900,000 encounters in 2007 to almost 2 million encounters in

2013. since having behavior help into our brigade, access outpatient behavior more frequently has occurred and we had fewer acute crises and required approximately 25,000 fewer inpatient psychiatric days in 2013 as compared to 2012. to expand the use of complementary therapies, integrated team management and clinical pharmacist and our medical homes, we saw a decrease in polypharmacy by 50%. our performance triad of activity and nutrition is spreading across our total army force. another army wellness centers, 62% of the individuals saw a 4% decrease in their body mass index and a 15% increase in cardiovascular fitness. these successes are due to a comprehensive system of care that stems from a deployed environment across a medical

commands and into the white space. this translates to better health and improve readiness, lower health care costs and a stronger army. but there is more that we must do. as a leader, i get asked what keeps me up at night and i worry about the long-term repercussions of these wars on our veterans. i worry about sexual assault and sexual harassment occurring across our nation and the department of defense. i fear that in the times of dynamic uncertainty, military hospitals are viewed through the lens of a civilian health care system i worry that our nation doesn't understand the vital connection between the battlefield and i worry about this with the american public the confidence to allow their sons and daughters to serve.

and we train more than 35,000 students annually at our center and school and we have almost 1500 positions in graduate medical education where our board board pass rates are higher than the national average. i'm concerned that a program ranks number one in the nation in a physical therapy doctoral program ranks fifth nationally remains connected to our readiness platform. our wartime lesson learned led to more than 30 military practice guidelines for saving lives and improving outcomes. during the last 10 years there has been over 450 patent applications for inventions that involved medical research and material command in our labs and hospitals. we are more than health care providers in the hospital who are robust and interconnected in the system that has accelerated research, academics, and innovation for our nation.

and we must preserve these medical capabilities to meet our nation's mission. what is at stake is responding to future missions at the level we have over the past 13 years. we must aggressively sustain our readiness platform's and maintain trust with the american people. though we live in uncertain times, one thing is certain. a healthy resilient ready army will be as it always has been, district of the nation. i want to thank my partners within the department of defense, the va, my colleagues on the panel today, and the congress for your continued support. we are truly proudly serving to heal. thank you. >> thank you. >> chairman, vice chairman and senator, i am grateful to appear before you today on behalf of the dedicated men and women and we would like to thank the committee for the outstanding

support and confidence that you have maintained. and i can report to you that we are mission ready and delivering world-class care anywhere at anytime. our navy medicine remains quite high, protecting and promoting the health of sailors and marines deployed around the world and all warfare domains. especially still in the area of conflict in the middle east these responsibilities requires us to be agile and xp mary medical forces are capable of meeting the demands of crisis response and the global maritime security. our planning efforts must always be synchronized with the navy and marine corps. it reflects purpose and commitment with the work and investments we have made. our strategic goals remain simple but complete, readiness,

value and the polls are critical to sustaining these readiness missions and this includes fiscal challenges as well as a managing our resources. they also leverage the use of technology and tele-health, helping to standardize and improve alignment. we are achieving measurable progress and i am encouraged by the fact that these penalties are taking hold throughout our enterprise. by leveraging the capabilities of our patients medical homes, which is known as medical home court, we have an optimization plan and we will have more workload into our facilities and we are going online and rebalancing our staff this includes overall expenditures. just as all, are programs remain second to none and our provider team sustains the clinical currency to always be battlefield ready.

strategically i am convinced that i believe we are stronger than the other services and the interagency partners, meeting academic and private research institutions and other experts. these collaborations are vital as we leverage efficiencies and best practices and clinical care research education, global health engagement and support for our wounded service members. after cawley, when something happens to any of our sister services when they are in pain, it is an important part of overall protection. we recognize that prolonged operational stress can have potentially debilitating consequences. we continue to have our operational units and primary care to identify conditions before they manifest. this priority is part of suicide prevention where we train

sailors and marines to recognize operational stress and use tools to manage and reduce the facts. and we focus on every sailor, every day. particularly those in transition with professional adversity. we know that this is an important protective factor in preventing suicide and we must remain ready and accessible to those who need our help. these are transformational times for military and there is much work ahead as we navigate important opportunities to keep our sailors and marines healthy and maximize the dollar for all of our patients and leverage the joint opportunities. i'm encouraged with the progress we have made that i have not been that of eid. we continue to look for ways to remain on the world front of delivering care and thank you and i look forward to your questions. >> thank you, admiral. general travis?

>> chairman durbin, senator blunt, thank you for inviting me to appear today with my partners. our military forces have benefited and have jointly made in deployed care since the beginning of the current war. with this winding down even with fiscal challenges, we now have a clear response ability to make sure that military medics are well-trained and well prepared for whatever the future brings to include combat operations and stability operations, humanitarian assistance, or disaster relief and to enhance our core competency to provide care both on the ground and in the air, we have to make sure that we have robust opportunities to practice our skills and that we continue to pursue critical research and modernization in the future. we very successfully leverage civilian partnerships to

maintain this in our platforms, one of which is in the trauma. i am convinced that we will live more strongly on these relationships to help us train and include this. so the way that we provide this is also a a bombing. this includes common ground patient and cyberoperations in those including special operations forces all phase distinct challenges. these types of injuries are stressors both visible and invisible to members and their families. we must provide medical support in different ways and than we have in the past to address what we have described is a next in a deposition definition of operators and step up to our roll of practitioners.

not only will this be more customized, but so will prevention. and we have included this with several remote units to be readily available including those that could affect their emphasis. they may not have otherwise thought here. i've got it two days ago i'd visited the intel where you have hundreds of airmen were watching this 24/7, 365 days a year, and they are convinced with what we have done to prevent suicide in the last 10 years and i am as well. the air force is committed to the reorganization of the military health system to include establishment of the defense health agency. there are many changes in the works for how we will operate and we are excited to be fully engaged and it is tough work as

we continually focus on providing trusted care and maintaining a fit and healthy and ready fighting force i have been in the air force for many years and in my career i've never seen a time when it was more evident when it was so important for the operational capability of this nation. even in the face of budget challenges we have to be as ready as we can right now at the end of the current war. our nation expects that in our members and their families deserve nothing less. your continued support of military medicine and our missions are greatly appreciated. thank you for that support them for your invitation to be with you today. >> thank you, general. mr. miller? >> chairman, senator blunt, chairman cochran, thank you for being open to having us today and for the openness and

accountability. i was appointed in my position last september. i am the senior official responsible for electronic health records and the civilian partners. i also have the privilege of representing the dod interagency program office or the ipo is the acting director. my job and singular focus is to provide health care i.t. solutions to america's finest that support and defend this great nation. as you are aware, in 2009 we were called upon to work together and build a seamless system of integration. to that end the department is assuming complementarity efforts and the departments are working to provide seamless integrated sharing and standardized health data among dod and private sector providers and modernize our electronic health software and system supporting our clinicians.

the respect of these tuples can be seen in three distinct programs. first, in january 2013, the secretary has committed to executing several opportunity initiatives and we knew that we could not wait to modernize our electronic health record system to see your care improvement. we are currently working in partnership with the va and among these efforts are the joint legacy viewer and improved data federation which combine access to an integrated view today of dod and va health records. we also work to establish a medical community of interest network that is designed to improve how we exchange information. this will continue continue to work to expand a level of interoperability and among the dod over the next year. this includes 1.2 million

correlator health records between the two departments. they have also achieved greater levels of operability in north chicago. we completed this that will improve operability. one of them is creating an efficient va health care system to share laboratory radiology and they continue to be a pioneer in interoperability and operability between the departments. second, in may of 2013 secretary hagel announced her decision papers you a full and open modernization of the health care system. this was based upon a comprehensive analysis of services and this also is part of the technology and logistics to a consumer's possibility for the program. in october we have established a

comprehensive plan and have posted every industry days to open dialogue about the program and we have also worked in january 29 which is released on march 28 and there is one remaining plan later this year which will ultimately culminate with fourth-quarter and 2014. we have also finalized our strategy as we are developing at the right cost for the american taxpayer. a critical component is the need for open standard platform capabilities and we are employing a modular system to ensure that we have the capability needed to prevent rapid insertion technologies. we will chart the way forward as a way to have a clinical data

standardization and this includes outlining this new strategy. making it responsible for establishing and monitoring and improving the process to create seamless immigration of health care data. it will support both departments endeavored to the certification to include health i.t. and its applications. these standards are key in our requiring our long-term support a commitment. we are on a track with our package later this month. senators of the committee, our collective effort of congress over the past six months have been met with the utmost dedication. further, we have met the first of the three were wired and we are on track to meet the requirement for out the rest of this year. we briefed the committee on this progress and had submitted our

strategy. the ipo also is submitted quarterly briefings to congress. providing high-quality health care is among priorities. this is a key component and it is important that we get this right and we never lose sight of our mission and who we are supporting. so i look forward to the dialogue today as we exchange ideas. >> thank you very much. mr. miller? >> general, let me ask this. i am concerned as to whether or not we have adequate behavioral medicine resources for active military. and this includes the number of behavioral health provided. most of them are the billions,

43% between 2009 and 2013. this includes the numbers that you gave us that have showed an increase beyond 43% and are we bringing in enough behavioral health providers to meet this need? the army's goal has been to recruit 10 psychiatrists anyway. in the last five years have they created this. is there something that we should be thinking about importer to a entice the very best professionals to help our men and women in uniform? as we look at the big picture, we realize that we are facing challenges and i can recall that where he leaned over the bed and

slept a soldier and said i don't care for if your nerves are shot, get back with your unit. and how we have come so far not to understand those dramatic stress and what it can do to a person. so what can you do? army recruiting and enlisting adequate behavioral health providers and why are we falling short when it comes to recruiting psychiatrists. >> thank you, senator. when he brought up the story, my dad fought world war ii and he's 89 years old and still living today. undermine the daily what we didn't do in the past and how differently we are doing it today. but we are also in an area where we don't know what impact 12 years of war has on an individual and their family. there has been an aggressive movement to increase health care capabilities that really

breaking down the barriers between psychologists and practitioners as well as her behavioral health missions. so we have looked at what is the behavioral health capabilities and we have increased this with a number of members. so we are up to about 5500 right now. will we ever have enough? i don't think that we will because we have increased the number of providers and we have decrease the stigma by vetting a real health where our soldiers are working. so we are seeing an increase in demand to do 2 million visits per year and it's really shown us that this is starting to decrease the amount we are going to write them and ask them for their observations. particularly regarding psychiatrists. so it seems it might be an enticement for the best psychiatric professionals to

come join us because we need them. so we need to get back to you on that particular issue and mr. miller, the federal government is not that good when it comes to computers. and i just have to tell you that. and there are some agencies that are disappointing. this includes the affordable care act and since 9/11 hundreds of millions of dollars have been an on the federal bureau of investigation to give them the best computer system and i think we are almost there. and there is a lot of angst and failure and the president challenged the veterans affairs and defense department integrate their health records. the cost is $4.2 billion and the cost of $4.2 billion and we

should be able to get it done. we spent $28 million basically abandoning that approach. and what is the goal now? the goal is seven or eight years from now to have an integrated health record at the cost of 13.4 billion. why is it that two major airlines can put things together in a matter of weeks or months and when it comes to merging systems and government it take so long and we stumble so often in cost so much. >> have a comment on a couple of ways or it i with they first off that i think where we are today is we are bringing in we have had activism professionalized

and i think we have a mixed track record at best is how we address these systems. and secondly i would offer that we are spending a lot of time in this industry. we are highlighting this and we want to learn from the industry and figure out how we should be approaching this problem and how it can go as quickly as we possibly can. i would say that i spent a lot of time talking to the industry and they don't go as fast as we may think. and i think that we do have the ability to aggressively attack that problem. but i think that we are going to get there. and i think that we are going to do it in the most cost effective way. i've spent a lot of time talking to industry. in this includes what we have now, this is not an i.t. problem. we don't focus this is a

business transformation and dona business transformation and i have a lot of support coming from the people on this panel and other people to get this right. the id by itself will not fix this problem and this has to be where our functional leadership in our medical leadership comes together and we collectively work to provide a solution in the most rapidly than that we possibly can to leverage the industry. >> i'm a liberal arts lawyer, didn't go to business school and not a computer expert. what you we me that this is an i.t. problem? you say that it is a business transformation problem. translate that. >> what i mean, sir, i can go out and buy commercial software and i can buy the software and try to implement. but the reality is that that software is designed to help our clinical community do jobs. and so how those jobs get done in terms of what steps they must

take and what they need to see, is what has to be geared out so that when we deploy the software that is being done in a way that meets the army from the community. i think oftentimes the department of defense has failed you can look at many of our systems and we have not had the right partnership and the right effort between our leadership to understand exactly what they want the system to do. so i would give you an example of microsoft office. there are probably five or six ways you can do certain things and that we we make sure that meets your requirement and we are making sure that it works. so i think that sometimes people think that it's just as simple as going out and buying some of these large complex systems, and it is not. we are really trying to change how we deliver health care and this is our opportunity to standardize and the truly care as part of this acquisition. >> all is well and good. i'm not a business expert. but i can tell you that

continental airlines, they were to miserable weeks when emerged for everyone. passengers a will is their workers and staff when they decided to go to one common computer system. at the end of two weeks it was done and i'm just curious as to why it is taking seven or eight years at a crack. >> it took them over seven years to deploy their electronic health record we have a number of different systems and a challenge and they all have to be trained and they all have to be taught how to use the system. in your example there is

probably a handful of people and we have a lot of people and locations around the world at all have to go into this effort. so i think from the initial baseline you are going to be by the end of 2000, we will have initial capability. it will be up and running and we have to operate forward and this includes how we approach this on a global scale going forward thank you, senator. >> mr. chairman, i am pleased to join you in welcoming a distinguished panel of witnesses today to the defense subcommittee. we are reviewing and considering the budget request and we appreciate the important work that we are doing to provide

services and information and contributions in this includes others who are eligible as well as their families at home at home and around the world. we have seen a lot of positive impacts that have come from specialized information from those who have had experiences in combat. the medical group in particular has accomplished a great deal in helping us to understand in a better way the disease research and treatment opportunities that are available to expedite treatment off the battlefield and into the hospital.

and like many other department of defense, many don't have the ability to identify as we do, what the higher priorities are, in you have programs that will be helpful as we make our decisions of funding throughout the different activities that come under your jurisdiction. but thank you for your good work and thank you for helping our committee do our job. >> senator? >> thank you, chairman. general, yesterday we had a talk with secretary mccue and the general and he both said that when a service person, and this may have just been an army, the

next question is is this service wide. and there are many health records are not available to anyone in the command structure. and is that your impression as well? >> senator, right now as a soldier is screened at high risk and is receiving behavioral health treatment gets put on medication, there is a code that is put in the system that keeps them from being able to go to it different station and a stable point. when that individual is then able to move to another place,

there is a behavior health provides men for continuity of care and we are losing the behavioral health conditions and there is a notification to the command and also from that we have different levels in this includes the type of behavior health and the status of where they are at. >> is not the same admiral in the navy and the air force imax. >> yes, sir, it is very annoyed. i ain't that the challenge is that anyone who has fairly debilitating or remarkable issues, and this occurs if they

are allowed to transfer. and this is including those who are deemed to be not fit for service. when they challenge one base to another and they follow a routine metal health disorder, the current commander, and this is what the army chief of staff was referring to, the current commander will not necessarily know their mental history because it is not answering your impact of the mission and the commander can only have insight into eight airmen's condition if they are deemed unfit to perform this and they are entitled to know what is going on with that person otherwise it has to be voluntarily given to them. >> general trust, is that the same? it is the same, sir. >> okay. in this case with the exception that term we use is at risk and is the health record treated the

same so the commander also wouldn't be the other health record under any circumstances unless there was one thing and that record that indicated that the individual is not ready for certain kinds of duty? >> out of your microphone is on. >> the time when the commander gets to know this, it will impact the mission if there is a concern. then the provider, whether behavioral health for a general physician, they will give that information for the commander to know. >> they are treating this the same way as a physical health concern. >> yes, sir. >> okay. we are treating this in the same way. do you all think that the current system creates a gap that was problematic?

>> sir, the only comment i would make is we wrestle with how much to share with commands because the individual service member may not come forward for routine or otherwise troublesome symptoms or issues if they believe everything that they will tell someone will be given to the commander are given to other people. so we have commanders who sometimes they, please tell me every individual who is in my command who has been followed for mental health care issues, civil or severe, the answer is that that may help but we worry about the individuals who won't step forward and say that it will be part of that. >> one form americans has diagnosed with health care challenge. any reason to believe that

number is significantly different than that of the military in a. >> i do not believe it is different because we recruit from the united states. so if i could just add one thing on this purity quentin is a good example, there was tremendous concern when you had to notify and stacy were getting health treatment. so many soldiers would not get treatment based on that because they didn't want her to be ruined. when that was taken out of the question, if it was behavior health related to some type of trauma or deployment, they did not have to answer yes to that question and that help to actually increase soldiers seeking behavioral health care. >> i think that is probably right. and we have sort of an in-depth news article lately on veteran suicides and many of those

veterans have been in a combat situation and many have not. and we don't want to assume someone without multiple employment or posttraumatic stress syndrome from having been in a different combat environment and they don't want to assume that they are the only ones who have a problem with separation from the military and there are so many ways to deal with this for what we need to do and we are helping you get the professionals that you need in the health service that can be there to deal with the societally in the military and we need to deal with this and a

better way as well. >> thank you, senator. general, let me ask you this question. i believe the medical research and i have a bill relative to the nih and i believe it not. but my experience in the houston senate is that we are inundated with people who have special please including those that have turned with all high murders and those that have medical research. obviously every one of us will do the same and they used to say i would love to do that, that's not the way it works. we send the money to the nih, and they make a decision in not a political the ocean. let's talk about partner defense medical research created by congress and sustained by

congress to been enhanced by this committee. there are two different approaches here, basic different approaches. the houses pacific and they talk about specific areas of research for specific diseases. and we have a peer review of research program. to get priorities and we don't put that next to it. we won't let the peer review process develop and let them determine which are the most promising areas. so i think the bottom line here, and you can tell me if i miss in this, is that the nih is basically committed to basic research. and what we are talking about in the department of defense's translational research and taking out basic research and applying it. all of the research, which we had a double hand replacement

had to be done to reach the point where it could be translated into a surgical first teacher. and so that is how i kind of see a line being drawn between basic research and the department of defense translation. in sweden we take a look at where we have this research each year in medical research, for you to evaluate where we said we would have the $10 million more we are so close to some one who could be historic. >> thank you for the areas of some ordinary search.

and we have the funding that was given 21 years ago and it's long and i think there are a couple of things. as generous as the research budget is, there is never enough that his there. and so we use a tremendous amount of partnerships with a certain point and we do these partnerships to allow it to continue. and i think it's important that we continue that. i think there is properly opportunities in which you can all ask questions in which we can give these research projects and i think that that is something that we can absolutely explore in the growth that we

have had over the last several years is really looking in name what is the military relevancy of the research that we are doing and how do we make sure that all three services are much more integrated as the dollars get tighter and then where can we partner with the civilian health care system and researchers to really actually tackle some of these questions. >> we're looking at some recommendations and it's a good reason why it is on the list. if you said to me that we hope next year we will be able to put more research into this because we are close to something that could make a date difference in the lives of those who have been

burned victims in combat, for example, that would help, it really would help if the input could be given to us and i hope you will consider doing something like that as well. >> patty is exactly right. and we have done that for years. and that is part of our research and on the other hand coming on the heels of this one we have supported this to survivability and we will give you a better example. we have a very direct relationship when we do trauma

care and teaching our airmen we have to get access to those, patients and that allows land to use that university expertise as well as her own. to directly search efforts to support, care. and this has benefited us a lot in the past and this includes benefits around the nation. >> how is that marriage between ms. bethesda and mr. walter reed? [laughter]

>> we have integrated walter reed and bethesda together. it occurred on my watch and it really is a anarchistic relationship. and i think that if i could very quickly, secretary panetta asked me how is it going and it's sort of like those taking care of the patients and those are throwing people out and catching balls and the parents are in the stands talking to each other. and it took a while for the leadership to come along to follow the lead of the doctors and nurses and those who are taking care of the patient and we are now seeing what we thought we would see, which is without we would learn a great deal on georgia avenue at walter

reed and we have air force providers were also season into the mix there. so i'm very encouraged with the cultural integration that has occurred to preserve its tradition and he does. and they're still amount of this during the army navy football game. so i think that it will be the biggest challenge to close this right now in the biggest challenge is that it's going to have to recruit a population of patients as it did with private managed care in the area. and it will have to recruit the patients and i don't think that the fact that we have built it means anyone will come. so i think that this feeds the magnificent judiciary care facility and continues to maintain it as the flagship

military facility of the country. there are thank you. senator cochran? >> mr. chairman, i think that these witnesses may be aware the institute of research is working on finding new treatments for malaria prevention. and i wonder whether or not we have what you can report to the committee to help with these programs and whether or not there has been progress in the department of defense to treat or prevent malaria. can you tell us anything to bring us up-to-date on the map. >> in short, yes, there has been significant progress made. just in the last year, both the

academic sector that you allude to as well as the joint research facilities are preparing a vaccine which is being readied for human factor trials. the anticipated date, the release would be three to five years to have it ready and it is going to be vaccination, it will be the only thing comparable and so i think that we are not going to see something in the next 12 months to make a huge impact for the next three to five years. >> is this a legitimate and worthwhile investment of taxpayer dollars?

>> we asked more soldiers to malaria than we did to the combat wounded individuals. we still see them in far-off regions. and we have the number one killer in the world and so i believe that this military research in partnership is not only going to make and this will make this with a tremendous ambassadorial capability that america generates for the rest of the world. >> thank you very much, and thank you for your leadership. and thank you for your help with this serious problem. >> general, i want to talk about military hospital there. i understand that the command is at least the army command, in

the process that will assess all the army hospitals across the country and when will that city be available. >> senator, there are a couple of things over the last two years, we've been we have been looking across all of our military treatment facilities to see where we can recapture care within the care within our facilities and then how do we standardize care and that has been going on as we make some changes there and we also have been part of the osd study and this has been evaluating across all of our platforms and portable we have to do is include our decisions of the

final state is the only reduces down to 450 cave right now. so that is driving some decisions based on the reduction of the population. so it has been a ongoing and we know some of our areas where we are starting to say that we will maybe need to move some of our capabilities because we have to recapture and we have some of this the civilian sector. >> the general leader, at least that was ranked before number two construction project in 2010. ..

are they available to the community or only to retires and veterans in the community? >> the rules of engagement is for active-duty military their families retirees and their families. >> and there are some communities where you would decide the better way to do that might be to take care of that in the community hospital and pay for that rather than have a hospital? >> what we have looked across is to say in certain areas based on the funding is can we recapture care based on the rules of engagement within the area and if so then we are doing that. if we find no matter how many

providers and clinicians we put in the area we won't be able to recapture because of the number of retirees that live in that area or the active-duty then that is when we make a decision to only have x number of providers and support staff so we right size it basically and then we moved those clinicians to another place where we would be able to bring in more care because that's tied to readiness and skills sustainable. >> let me make sure i understand. the army hospital is number one on their list but the army would not have made the final decision as to when the hospital or where the hospital should be because it is now placed outside the fyfit teen/19 program objective memorandum but that would not have been a decision any longer made by the army itself for the defense department. >> yes sir. >> thank you chairman.

>> thank you mr. chairman and i think each of you. sorry i missed the earlier testimony. i wanted to speak about an issue that i have raised before this panel i think every year since i have been on the appropriations committee in part of the subcommittee. that is where we are with research on als also known as lou gehrig's disease. we all know that we haven't made any progress in finding a cure and the treatments that are available out there are very limited and yet one thing that we do know for sure is that in our military and their veteran population they are more than twice as likely to come down with this horrid disease than any of the other populations out there. given the cost of care as individuals live and ultimately die with als the cost to our system is just going to see further increase.

given that we have currently $7.5 million in the als research program through the department of defense the question that i would have a few general horoho is whether or not we should be doing more in this area in terms of research or perhaps if there were an ability to prioritize in certain areas it's been suggested to me that one thing we could do is to direct further focus or closer focus on therapy development within als itself. can you speak to the issue whether you feel we are making any headway whether the resources are adequate or whether we need to be doing more >> thank you senator.

60% of our servicemembers are at risk for some type of neera genitive -- neurodegenerative disease that we have had als research and 7.5 million this year. we have also just venturing into an unprecedented consortium where we have $62 million that is going to be the department of defense with the va to actually look at neurodegenerative research. i think we are starting to move in the right direction of really honing in and studying this particular area. i don't think i can say whether or not that amount of funding is the right amount of funding to actually tackle their research projects but i do think there is a concerted effort moving in that area. >> well i would suggest and i would offer this up to the chairman and vice chairman that there is more that we can be doing than $7.5 million appropriated for peer review medical research on als.

it's not that we are ignoring it but in terms of i think the impact that we clearly see as it relates to those who again are just so susceptible apparently to this horrible disease that we need to be doing more in this area. and if it's something that i can work with the chairman and the ranking member on count me in doing just that. i would like to speak for a moment here about the tricare changes. i understand that you have expressed support for the tricare changes in the fy15 budget as a means of modernizing tricare. i guess i'm looking at it and i'm thinking that it actually takes us back in time. all i can see is that you are making servicemembers and our retirees pay tricare prime

enrollment fees but we are only giving them tricare standard services. it seems that you are getting more efficient from a budget perspective by charging more and streamlining services but how can we really make the claim here that this is a more effective health care operation for military members for our retirees and their families? and when we step back and we look at the average annual loss of purchasing power from all of the pay and the benefit cuts that we see in this budget proposal was there any formula, when you are formulating this was there a thought given to the cumulative effect of all the proposed cuts on the paychecks of our servicemembers of our retirees? was this more of a budget driven

exercise in the context of defense health care? i'm looking at it and i can tell you the folks that i work for in alaska are not excited about this. so i'm trying to understand whether or

a they live pretty much with a flood cowan m. budget for 10 years. we are doing a lot of great things as you are well aware. maybe the concerns even though again in isolation looking at the cost of the tricare fees themselves are not exorbitant. on the other hand when you are a young airman or soldier or sailor and e.u. are in error about location and we have a lot of bases that are remote where

there perhaps may not need an impact in many cases are not in a specialty care. the issue is okay then that becomes a have not assignment. in other words the assignment to those young airman are going to barrymore as a financial verdon. it's still a burden and especially the things that you mention. so that is the worry. >> we are out of time. we have a vote on the floor and we have a vote on the floor that is just about ended. >> thank you very much senator and thank you for the witnesses for appearing. we will have questions sent your way and if you could respond in a timely fashion we would appreciate it. thank you. [inaudible conversations]

>> i'm very careful about what i commit to and what i promise. i can make you in the members of this committee one absolute commitment which is there is nothing in this transaction that will cause anyone's cable bills to go up. i have a nasty little habit of telling the truth and when i was asked our people's cable bills going to do go down i said i can't make that commitment that between the synergies in the steel and whatever marginal additional leverage we might have him programming and equipment supplied purchasing whatever economic benefits are generated we will ultimately in order to the benefit of consumers. let's face it, consumers today

are in the drivers seat both for broadband and in particular for video. there are vast number of competitive choices and that is why the scale we are trying to get here to stimulate investment to provide a better experience for consumers is so important to us and the american consumer so i'm just going to take off the litany of what consumers will get as a result of this transaction. faster broadband, greater network reliability and security, better in home wi-fi, access to a more ubiquitous national wi-fi network, access to comcast revolutionary new x. one video viewing experience, access to greater on demand choices, 50,000 on demand choices, access to, industry leading tv experience where people can view video live and on-demand on portable devices inside the home and outside the

home. at the protections of the no blocking and nondiscrimination provisions of the open internet order. a more generic public interest benefits life extension of the internet of essentials program to low income customers of time warner cable extension of our diversity and community investment commitments across the time warner cable footprint. i think consumers are the big winners in this transaction. >> you have also said that you applied the fcc's open internet rules to time warner cable until 2018. will you do it beyond 2018? >> i think the answer to that is we will be doing that between 2018 because we at the fcc have started a proceeding to put in place industrywide open internet protections and i can imagine that the commission is not going to have those rules in place well before 2018.

>> host: congressman bill pascrell is back at her table democrat of new jersey sits on the budget committee ways & means. we will begin with a budget which kicked off debate of the house republican proposal yesterday on the house floor. what do you like about paul ryan's budget? >> guest: well as eisenhower

said if you give me a few moments i will think of something when asked about richard nixon. not too much. it really is a duplication of the 2012 budget which they ram on and you saw what happened with that situation. it's light on investment and providing relief for the upper 5%. americans more than they are divided right now. our previous guest said that investments means tax increases. guest: education, food stamps, which are necessary. that is a very important program that has been proven to help a lot of americans over and over again. we are trying to get any fraud out. jail,s have gone to

people have gone to jail. we are not for fraud. we are trying to reduce fraud. there are certain things the government has a responsibility to do. that is why we pay taxes. we respond to the needs of americans. we have really turned our backs on the long-term unemployed. we have said, you are unemployed because he wanted be unemployed. i don't think that is the case. most of the people in my district do not want to be unemployed. they want to bring bread home to the table. during the time that you are and you were laid off after 15-20 years, who do you turn to after your benefits run out? investments are very critical. we are not asking for an increase in taxes for 98% of the american people. we are simply saying that if you are making a lot of money, over $1 million, you should pay a few

pennies more. that is the nature of the beast. that is so america developed the graduated income tax. if you look through the republican budget, what you do see is that the benefits go to those people who they say develop the economy, those people who invest in the economy. we tried that in 2001 and 2003. she was asked about those tax cuts. balance that clinton left us when he left the white house. he did not do it himself. i am just saying that when you look at the numbers, there is no proof that the republican agenda , which is based upon make the top strong and the rest of us will be stronger, that has not worked. we have heard from the

congresswoman as well that washington does not have a revenue problem, it has a spending problem. guest: how many times have you heard that? come on. host: that is what republicans are trying to do in the house budget proposal. deal with spending. guest: let's start with what has happened over the past few years. there is been the sharpest decline in our deficit year-to-year than since the second world war. we have cut the debt in half. -- the deficit in half. we have the debt. the war debt was unnecessary. president obama becomes the president. he becomes the president not in good economic times. he becomes the president which a a large debt- with

and an obligation to people out of work and a financial system without regulations. when you are sitting here and are thepeople that we place we are because there are too many regulations and too many taxes. look, nobody likes to pay taxes. it is our responsibility. we should be concentrating on having our tax system be a fair system. we have cut the deficit in half. i think we are going in the right direction. not does not mean we have obligation in investing in our infrastructure and education. if we have to put a few more pennies into taxes at the gas pump, what our roads going to do? they're going to fall apart. they do not fall out of the sky.

you have to have the revenue theire to do this. we are on a trajectory to bring down the deficit and reduce our overall debt. that is the agenda i want to see. host: one of the spending areas republicans want to address is medicare. i want to show you what paul ryan had to say on the floor yesterday. [video clip] >> we end the raid on medicare. the other side will not want to talk about the fact that they turned medicare into a piggy bank for obamacare. they rated $716 billion from medicare to pay for obamacare. we say that those savings from medicare need to stay with medicare to make it more solvent and if some of those savings from medicare are doing damage to the medicare provider network , like reducing access to medicare advantage, that we have a mechanism in here to make sure that we can fix that, just like we did for the sgr.

we think we need to save and strengthen this program, not for so that it is there those near retirement, but also those in future generations. second, we don't/the safety net. -- we don't slash the safety net. we strengthen it. this administration has made also to promises that it had no way of keeping. it has made all sorts of promises and it has not told us how they will keep them. it has promised major expansions and medicaid and pell grants. -- they pan to play for it plan to pay for it, we have no idea. paul ryan lives in an echo chamber. i personally like the guy. i think he is bright, but i

think he drank the kool-aid. this demonstration, which you just showed your audience, he is looking into the camera while he is speaking on the floor of the house of representatives. he is not telling you that they want to dismantle the affordable care act, they want to repeal it. they are going to take the savings in the health system and use it to fix their budget. their budget does not balance without the affordable care money. that is hypocritical, it is total nonsense, and the american people saw through it in the 20 to elections and they will see through it this year. host: let's go to charles. caller: did you happen to hear tom from florida call and while you were waiting to get on? host: remind us what he said. caller: everything he said was spot on. there is no way we are going to

get out of debt with the attitude of the democrats. the republicans put us in debt, but when they do want to stop spending -- i will give you an example. i am 80 years old. when i retired, i received all of my social security back and six years. the kids have been paying my social security ever since those six years were up. everything that the government has run, has run the same way. johnson took the money from social security and put it in the general fund to do nothing but make the books look better, so basically he could get a vote. the top 10 states are run by democrats. new jersey. the state that you have been in is in debt up to its ears. they cannot get out of it. you people will not let anything

be changed. we have ast of all, republican governor in the state of new jersey who is ringing up the debt just like other governors. he inherited a terrible situation. it is not all his fault. it is not a simple either/or, charles. reduce theng to increase in programs which we think are vital to america. we care about the debt just as much as anybody else. you are not going to scare people in america simply because of doomsday just around the corner. your guys want to privatize it. blockuys want to medicare. who knows what they really want to do with it. we need to change both of the programs and we have in the past , under republican and democratic presidents. we can do this together. it is not the one side has all

the answers, it is that america needs to come together and resolve its problems. we always do better in a kind of a situation, don't you think? host: steve is next. jersey shore, pennsylvania. caller: i am calling about this unemployment problem. i have a job. i work on construction roadwork. i have worked there for 10 years. i have not got any unemployment this year because pennsylvania started some 49.5% and you take her highest quarter and the other two quarters you work in the year and it has to equal up to your highest quarter. if you don't, you do not get unemployment now. it is something new they started for pennsylvania. i fell into that category. i have a job to go to and everything. i work every year and i cannot

get my own money that i paid in four. -- in for. guest: long-term unemployment is a very difficult situation. republicans cut it off and stopped it. so many people in my district in new jersey were unable to get any benefits. these are people who have been working like yourself. these are not people wandering the street looking to get into trouble. the people who are long-term unemployed, we have a long-term obligation to. i support extending the program for at least six months. give people a little bit of an edge. this is what government should be doing what folks cannot do it for themselves. if you have a job, you are not thinking about the person who does not have a job, probably. that person paid into a system and he should be able to take advantage of it when he is out of work. i agree with you.

sometimes we are helping the wrong people. when people who most needed to not get anything. host: this from the "new york times" this morning. a new study looking at the earliest of the health-care law and rowley is -- enrollees. the study is to be released today. the study showed a higher use of specialty drugs. what do you make of that? if these people require expensive drugs? the demographics are such that, in the beginning of enrollment -- which did not go too well -- in the beginning of

the enrollment, older folks got involved in the aca. as the enrollment process evolved over the last part of last year and into this year, then we saw the demographic spread out. when folks need drugs that are life-saving and are more rare, whichnd more a is a serious problem, i think the government has to step in and try to facilitate with the private sector those drugs to make them less expensive. i think the aca is on the right track. it is going to change. social security changed. medicare changed. this is going to change. host: do you think premiums go up because of this type of person who got insured? guest: it is interesting that

you ask that question. premiums have been leveling off in the last two years. when you look at the graphs, the premiums are leveling off. they are still too high. one of the purposes of the aca was to bring down the cost of health care. we cannot afford to sustain the system, which is too expensive. that is why you are moving away aom a freee for service to results-oriented health care system. brian in gilroy, california. caller: thank you for good program this morning. my 17-year-old son just walked in the door. he commented, who is this gentleman on the tv?

i said, it is a congressman from new jersey. he said, he is talking like there is nothing wrong with this country and that congress cannot do anything and on and on and on it goes. i said, i appreciate what you are saying. congressman, he is the epitome of every problem we have in the congress and the senate and with the president today. they are lying to us 100%. everything this man has said. everything he has said has absolutely no truth. host: can you be more specific? guest: what is not true, sir? caller: you made a comment about

why are the americans paying taxes? you commented about it in such a flippant way. the government, you pontificate that the government has all of the answers. guest: i never said that, sir. caller: you sure imply it. i will speak and then you can speak. guest: i want to talk to you. caller: i don't have much to say to you and your response. in reality, i am assuming at this point that you must be up for reelection because you are here talking about specific things that are these grandiose things. the answer of the government is to give them more unemployment? jobs.out we give more

come on, dude. question?t is the host: when politicians in washington are talking about all of the issues we have discussed and not talking about what he cares about -- guest: he used the word lie. it is dropped on the floor many, many times when you do not agree with someone. that is a lot of baloney. he cannot give us one instance. about the unemployed? i have spent 18 years in congress fighting for those people who do not have, trying to make them, provide them with the opportunity so that they can make it for themselves and their own family. that is my mantra, that is where i come from. i come from a city that is poor. patterson, new jersey. people have problems. anthey do not have education, the opportunity for education, if that is a lie, i will stand for it.

why extend unemployment benefits rather than trying to create jobs? guest: you ask this republican majority the same question. they have not had an idea on the floor of representatives that we voted on to help jobs. they stopped all the programs, most of them anyway, that would by trading for jobs. this guy better take a lesson and start looking at what is happening in his own government, rather than just pontificating about what he hears and tell us. we do not have all of the answers. we know the deficits are not good. we are not going to be scared by the deficits to stop with the responsibilities to the american people. host: richard, myrtle beach, south carolina. republican. caller: i will not call you a liar. i will talk about your deceit.

10% of the united states population does not pay 51% of the taxes? i don't want you to interrupt me. tell me if social security and medicare combined are not the debt? tell me about the health care plan that you had? you make $171,000 per year. cadillac that i would die to have for. you have patted yourself up there for so long. i have a solution. everyone of you on both sides of the aisle have to go. you tell me that i don't know what i am talking about or what i just said is not true. you people have padded yourself for so long. you have deceived people for so long. about, id me any crap am going to do this and do that.

you have been selling that kool-aid to people for so long, you have it -- are believing it yourselves. i do not participate in the government plan. i am 77 years of age. i'm on medicare. not padding are themselves. many of these folks in the last four years who have come to the congress are trying to make a living and serve their country at the same time. they do it every day. they work hard everyday. i have disagreements with the other side of the aisle. there is not one that i know of who does not work hard for the constituents in their district. i am not on that. check your facts before you accuse people. you are right. there is wrong on both sides. there are mistakes on both sides.

go on the website and see what my record has been. i have tried to fight for better environment, regulation when we need it, less regulation when we do not need it. -- point i am trying to make i do not think it is wise. host: the house ways and means committee is going to be taking lois lernerarging with criminal charges. what will you be doing? explain this vote. guest: this was put upon us at the beginning of the week. , and toearings on this whether the irs was biased -- biasedether the irs was during the what he 12 elections. he 2012 elections.o

we are looking at classified documents, her own words, and we will make a judgment. host: have you seen these documents? guest: not all of them. we are talking about a lot of pages of documents. there was a lot to go into here. i have not seen anything, so far, that would indicate that criminal charges are going to happen. host: should she be held accountable in some sort of way based on what you have seen? guest: i think she should be held accountable. i have found no prejudice in the irs response. of the aisle,ides organizations that call themselves tax exempt, that are involved in campaigns. this is the kind of political system we have. this is what the last two folks should be talking about, money

in politics, where it is coming from. whether organizations that are exempt and that providing dollars for candidates, be they democrat or republican, have no accountability. it might be foreign money. we don't even know. this is how wide-open the system is. she is in the middle of it, being the head of the irs. we are looking at it and we will look at it objectively. -- theemn the democrats democrats on the ways and means committee have condemned anyone, regardless of the politics, if they have committed wrongdoing. host: how will you vote? guest: no, from what i have seen

so far. right now, it is a no. host: democratic caller in virginia. caller: i had to comment after the last two callers. i forgot what i was thinking about. it was disturbing how they treat people. anyway. i have been unemployed for the past year. i worked at a small business for 20 years before they shut down. they had been in business for 70 some years. tried to get us insurance and health care and could not afford it. i would like to know when they are going to get this unemployment thing settled? watching c-span and i can see with the democrats are up against it i always try to keep an open mind and not just go for party but after watching c-span, and it able would watch

c-span more they would say exactly what the democrats are up against and who is for the american people. i had so many comments but after the last two callers it puzzles me how people think. but i just want to thank the congressman and the democrats for what they are trying to do and some republicans. it is not just the democrats. but we just need to get along and try to help one another. but i can see now it is not going to work that way. i had a lot more comments, but like i said, after the last two collards it is amazing how people think. host: all right. , there areou know many democrats and many republicans -- because, don't forget, this passed in the senate and they needed republicans to pass it in the senate. so there are moderate republicans, believe it or not. there are few of them. fewer of them than there were. a very interesting

what you said about your boss. about affording health care. or close tothat 40% 50% of businesses that went bankrupt in the last seven years went bankrupt because of health care costs? we could not sustain that system. and that is why we pushed and finally voted on the aca. but unlike what happened 10 years ago when we passed pland for prescription drugs, democrats, most of them voted against that plan because there was the doughnut hole, as the coldest, a huge area where people were paying premiums and not getting benefits. we changed for the aca. that is not the reason why i brought it up. what we did after we lost the vote is go back to our districts and help and educate people to sign up for plan d even though we voted against it. when you compare that, the last

two callers, god bless you, but when you compare that to what the republicans did this time, the governors, most of them did this time, this is a total disgrace. so when you talk about compromising, when you talk about coming together, that is a perfect example. we did the right thing. many times we don't do the right thing. but we did the right thing there , and we would have a very different system right now. and i will push as much as i can for us to make sure we have long-term unemployment benefits for our citizens. you worked a long time. you deserve it. that is the role of government, to do for people but they can do for themselves. host: dana on twitter asked what is the democrats' budget? guest: i am glad you asked that. infrastructure, that will create about 700,000 jobs. $76 billion for early childhood education. don't talk to me about what we are giving our children and that

20 years from now if we can find opportunity right now. protect the middle class tax players. -- taxpayers. expand critical tax breaks including enhanced earned income tax credit. -- enhancedarted by by reagan. very important. these guys on the hill want to change that. then, of course, immigration reform. let's talk about that briefly. very much a part of what our budget is. let's stop hiding under the covers. let's come out and open and let's have a real transparency. let's have a good comprehensive immigration bill as the senate passed with republicans. host: frank is next. ohio. independent caller. good morning. caller: yes, good morning. host: you are on the air. caller: i want to tell you what is wrong with medicare. i am a world war ii disabled veteran, 100% totally disabled.

i used to go to the da for all kinds of different problems. .he v.a. paid for everything but now because of hillary reevaluate theto there are more non-veterans in the v.a. system. now to get help for medical any other reason, medicare is the one to pay for it. the v.a. don't pay for nothing. ed to the doctor, i needed a new pair of shoes and the doctor says, medicare will not pay for that. i says, wait a minute, this is v.a., i am a disabled veteran, what does medicare have to do with this? clinton did this. host: can you explain that? the title hillary clinton?

to hillary clinton? caller: clinton appointed her to reevaluate the welfare system -- she put off the dead pete deadbeat fathers into the v.a. system. right now when i go to the v.a. they have services -- they don't pay. medicare pays it and that is what medicare is going broke. host: congressman? guest: no question medicare needs to be tweaked as it has been in the past, by democrat and republican administrations. i will say to this gentleman, if you are living in my district, call your congressman, call me if i am -- you are in my district. but i don't think you are in jersey. call your congressman. there is no reason why your services cannot be responded to. not sure about, by the way. i am a vet myself, and i am not

sure -- if they are special wear shoes that you need in terms of your health, that's a different story. but i would call my congressman and get on it. jersey,office in new even though i am not your congressman, i would aren't well be trying to help you. because i am very close to the veterans. you serve. we thank you. and you need more than a thank you. host: any chance of adding high deductible savings accounts to medicare? some of us like shopping for procedures and i keep down costs. guest: i think it is a good idea. we are looking at that. one medicare comes on the table as an entitlement and we examine it, there are a lot of aspects we start to talk about. we find many agreements between democrats and republicans on revitalizing medicare. as you know, before the congress right now, mr. ryan wants to raise the age on medicare. i would be very careful to do that. that is a temporary solution.

he referred to on a speech on we floor on the sgr -- didn't fix that. it is a temporary patch. we had an opportunity to fix it permanently. get it out of the way. but we chose not to do it. why? we don't want to find how to pay for it. we need to pay for these things. we are in the battle of tax extenders. 50 of them around. which ones are we going to continue and which ones that already expired that we will bring back to life? which ones are about to expire that we are going to keep going? a very difficult question. interesting, the ones we are putting up before the congress in theow is involved ways and means committee, they are all dealing with those in the one percent and two percent bracket. they are set to reduce your ability to place on your tax tax, estateperty

taxes that you pay. that is a deduction. they want to take that away. they want to take away the deduction for your mortgage income, the mortgage that you pay for your house. we are going the wrong way on that. host: how is that part of an extender package? guest: it is an extender. if you are able to deduct that, it hasn'tevenue -- expired yet. we are just talking about that in terms of what the future will be, which taxes we should continue, which deductions we should continue. very important part. not giving them much publicity but it is a very important part of what we are doing. host: when might the tax extension package come to the floor? it.t: we started to discuss we did seven of the deductions yesterday, whether they should be continued or whether they should expire.

we didn't vote on them yet. so we are right there. ofave to give camp a lot credit, chairman camp of the ways and means committee. at least he has put before the floor. of course, it has a tilt to it. but i think he is doing a good job in putting in front of us to decide just because -- now, we've got extenders to get deductions for guys -- sports boats, forces. give me a break. i want to help those people who need help and that those people who don't. host: the mortgage interest adoption, a big one. a loss of revenue for the government -- the mortgage interest deduction. guest: and i do not think that is the way to give the government more revenue for what is needed in other responsibilities. it helps a lot of people. it is not the reason why you buy a house but it is the reason why you sustain yourself in a house. host: harry, pittsburgh, pennsylvania. republican caller. you are here with bill

pascarella. caller: one of those got forced on obamacare. you may -- terry meet -- harry reid calls people like me a liar. he says we are all lying. he makes statements about tea party people being anarchists and traitors and obama does the same thing. calling tea party people tea baggers. can you see how despicable the people are becoming with this kind of language and you have the nerve of calling people saying lighter to you that they are hypocrites and can't do that. what is going to your brain? i am watching. i have seen you before. you are against drilling for oil in alaska, the pipeline coming down from canada, we can get it because he will not bill for oil here and will not bring the oil down.

people are seeing this. i know personally how many people are offended by the language by obama, harry reid and nancy pelosi and you are going to get offended when somebody says liar to you? host: i will have the congressman respond. guest: all i can tell you is you are singing from the same songbook as a few people today, which is what america is all about. that is your prerogative. i will protect that to the end. --if you are talking about the keystone line, i have not made a final decision on it but i already voted for it on the legislation that was put before us. you are talking to me. i don't like calling people names. i like debating people. i like controversy. i think that is good. it is important. you try to come to some resolution to the problem and not just let it fly up in the air and move people to the extremes of situations. i get republican, independent,

as well as democratic votes. why? not because of what i look like, not because of my name. because i am willing to sit down and compromise. that is what i believe in. and that is what i believe you can believe in also. host: a few minutes left ear. wayne is next. new jersey. independent caller. caller: how, i'll -- how are you? william paterson graduate and cut my political science degree there. i would like to enlighten those folks out in california and also where i happen to be right now. i him in south carolina. -- i am in south carolina. if you want to create a million jobs in each state, bring back the gas station attendant. we have them in new jersey. if you gave me an opportunity to be a part of your party, i am with you. we could pass a bill called the wawa bill. their gas station attendants $12 an hour and also

gives them health care. can we do that you california? can we do that here where i happen to be in south carolina? that would be great. wawa is a responsible proprietor of their people who are not. i am glad you brought up the subject of minimum wage. you know the minimum wage, would it is right now, trying to bring it to $10.10. that is not a radical idea. people to help those hold onto the few dollars they are earning right now. why do we have this dramatic gap were 20 of where we years ago with income and productivity and where we are right now? the income level has changed. the rich got richer. i am not saying that in terms of being jealous. and the poor got much poorer and the middle-class is evaporating. that is the things we should be addressing. i don't say there is a

government answer to every one of those problems. but i think the government has some darn responsibility. the rails maybe get rid of the congress. we don't need a president, we don't need the congress, we don't need anybody. that is not the country i know. host: democrats. tim from beaver falls, pennsylvania. pascrell.llo, mr. i don't see how anybody could call you a liar when you have been so honest. the thing that bothers me is the lack of knowledge of the american people. it is not the congress. we don't seem to understand that what one president does affects the next president. line --ke they draw a obama is horrible because bush left him a mess. i don't understand this kind of thinking. our schools, something, something is wrong. i had a lady say to me the other day that obama is going to change the constitution so he could run for a third term.

is a complete lack of knowledge of how this government works. that is what is wrong. it is not the congress. it is not the president. it is the people. guest: tim, we need to educate people on all levels. whether it is health care. people have crazy ideas about what health care is all about. story. complicated it needs to be addressed. people need help. people should be ensured. everybody has to be in a touation where we are trying reform the entire system, trying to change how health care is delivered in this country. it is fine for me if i get it all the time and i am covered. what if you can't get the insurance? it's not fine for you. but what you do is going to affect me because when you go to the emergency room -- i used this as an example -- who is paying for this? the money is not falling out of the sky.

we need a system which is more on a level playing field. would be blamed for the next play. you know it and i know it. there is nothing he could do about it and nothing i could do about it except folks educate themselves. i am trying to educate myself on the issues that i have to face every day. the average congressman faces about 28 to 30 issues every day. we are trying to stay on top of them. this is in defense of the congress. i have seen nothing but negative things whether democrats or republicans the past three years. people joke that the only thing we are more popular than his cancer. that is not a joke to me. this is an institution am i have a great respect for the institution. it is a place for government. it can't solve all of our it, don'tut damn knock it down just for the sake of it.

>> do you continue to send people here who have no real world experience, no real hardship, no real difficulty no real successes in life outside of politics you will continue to get the same results. that is why i think we need a constitutional constitutional career limits. the other thing that will open up lots more seats for a lot more people who actually have real world experience to be competitive in terms of coming up here to fix this. that's on