of you how important family is. as a young person grows up his question of identity confusion, asking questions. these milenials are experiencing something that no other generation has experienced. in the context of the post-9/11 world that is why is that the numbers are massive. one fourth of the planet is muslim. 1.6 billion people. 62% at numbers under the age of 30. these are mono-- millennials who have grown up looking at their life in a different way. everybody has an identity crisis. doesn't matter what religion you were but something specific is happening to a generation that has grown up in the context of 9/11 asking questions that their parents and their grandparents didn't ask. and if they are dealing with a sense of identity and belonging they are looking for answers. the answers that they always go who are not traditional necessarily. it isn't the cleric necessarily.

it is not the other person in the village town or city. it is a shake who answers a lot of these questions for them. the reason why women are important is for two reasons. one, as you said the mother said the first in a child's first years. they are seeing things as children. if you are looking at some of these radicalization prophecies and you go back and talk to parents they have seen signs. mothers talk about things they have seen. they influence the ecosystem within the home. but there's another piece of this and that other piece of it is how you use women to mobilize the perspective globally and connect those things. that is where we began to look at models that would work at a grassroots level that are very local and inspired by regular people. it wasn't government coming in and saying something. in the bush administration we looked at the mothers against

drunk driving and asked how did that get off the ground? how do we build this and they began to think about what would happen if we began to build a network of like-minded women who could push back against extremist ideology. sisters against violent extremism was an incredible woman named edith scheffler from indiana. she gave her small seed grant to get this off the ground that it's moving forward. all these years later it's an independent organization. she mobilized and built a network of women to push back, to talk about things and to put the lesson she has learned on the table. that's one piece of the complexity with women and extremism. the other is what's happening to muslim women and that's the other piece if you wouldn't mind out to spend a moment on. >> that was my second question. >> in my role as special representative to muslim communities one of the most

impressive points to me was what i saw that happened in europe this identity crisis wants not just minorities living in europe but oh my goodness this is happening to muslim majority countries as well. this identity crisis from malaysia to argentina matters to us and it matters very boldly. as people are asking these questions as i said the vacuum is being filled by narratives that come from extremists. that doesn't leave women out of the picture. they are connected with a switch on their smartphone getting ideas bouncing around the world. what did i see a special representative? i began to see a change in the way this generation of young muslim women began to think about themselves, think about their role so you are seeing a two-pronged thing. one you can absolutely use women and you should to stop the s.t.e.m. of radicalization and to understand what's happening in the home. the other point is we are

beginning to see women are getting radicalized. >> that was my next question. there's an some irony there. many of these groups women are placed anything but hide the level of power however you are seeing iceland some of these groups use women not necessarily as soldiers that you are seeing them used in social networking, communication and shaping people's ideology in countries where the average age of these countries the average age is 25 years old. if you can continue that was a second i wanted to make. >> you are correct. they are beginning to see they are raising their children in a particular way and thinking about their role in society. either you are going to be open and engaged with the outside are retreating come back and sing you are looking at data points

across-the-board. you are also looking at what they are looking at on line and what they're listening to, how they see themselves. it doesn't take a lot of imagination. this summer isis has an all women organization. if we use our imagination and think of what else comes down the pike it's very scary. >> i would bring 1.0 mr. chairman and that is the point that in the boston marathon bombing it was very clear the effect that tsarnaev's mother had and i won't comment that sense there's a trial pending but i will say clearly tamerlin tsarnaev -- thank you mr. chairman and i yield back. >> thank you for your thoughtful questioning. >> thank you mr. chairman and i thank you both for your testimony. ms. joslyn -- mr. joslyn i think you are right on.

we are seeing this happen right now and you were saying most of the radicals don't come back. we don't need most of them. if we go back to 9/11 there were only 19 people and they had $500,000 but they were able to change quickly. now we have these organizations that have become more coalesced in what i have seen and correct me if i'm wrong is an escalation of the amount of troops coalescing into a stronger force, well organized, well-funded with isil supposedly getting $3.5 million a day in the sale of oil on the black market. we are just going to see more and more of that. in this meeting room here five or six months ago we had a group that was representing somalia that they come to the united states. minnesota's where they were from and i asked them why they came to minnesota. i was born in minnesota.

it's a great state but it's a little bit too cold for me so why would the somalians choose minnesota? they said it was for education and jobs but yet when i asked them what percentage of the male population were employed he said it was very low. there's high unemployment in that group. what percentage graduated from high school? he said it's very low and then i went into the questions of how many are practicing muslim and was a majority and he said yes. we moved on to they follow sharia law or the u.s. constitution? he said we go with constitutional law that sharia. i asked them if they were assimilating and becoming americans and adapting our ideologies and he said we are having a real hard time with that. that scares me because we are growing that type of thing we are seeing now and as you brought out the person from florida and a person from minnesota going over and becoming radical jihad.

we have to have a way and this goes back to a bigger problem with our immigration policy. i think we all want responsible immigration but we have to do it right to bring people over here. going back to the isil threat removing the passports from these people, one of the questions i had is, i lost my train of thought here. how can he was held by european allies defend themselves from the threat of these returning foreign fighters? if they have a western passport they can go over there and come back. if they are u.s. citizen and i think britain has started to take these passports away. is that right? >> that sounds right. they have a number of security restrictions they can put in place. >> with that i'm going to yield back and mr. chairman i

appreciate your time. >> thank you very much. a couple of questions. are these the uneducated people of lower classes who can't get jobs or are they like bin laden from the upper crust who are actually very well-educated and not necessarily just the product of mantra schools but instead people who know the choices and have made the choices that their religion is better than everybody else's. >> it cuts across socioeconomic boundaries. it's not easy to typify. if you look at the common example of the suicide hijack pilot on 9/11, highly educated,

came from good families. bin laden came from a good family and a very influential family. he find us over and over again. as the strength of a ideology that blends together and not necessarily socioeconomic factors. >> let me know before you move on that it is vitally important that we do not try to welcome all muslims into the category of terrorists. otherwise we are doing exactly what the terrorists want us to do which is create a dichotomy between the western world and all muslims and thus expand dramatically their strength and potential danger. so we should make sure we reach out and began ms. pandith you were talking about perhaps an identity crisis with people.

do you think there's a real threat and we could have an overreach here and push muslims into radical terrorism camp and do you see that happening at all? >> i think one of the things that's important for us to understand and what we have learned over the years is trying to look at the radicalization process and what's happening communities and the government and communities can do. how the strengths and weaknesses that played out over the course of 13 years. you asked a really important question about who are these people? how educated are they and where did they come from? one of the things i was talking about in my testimony is a nuanced approach to understand the distinction within certainly here today we are talking about europe. which generation are we talking about? which ethnicities are we talking about how are they looking at the particular issues they are dealing with?

the successful come from the community level and if you look at the responses across europe and how governments are looking up threat there is a wide range of reactions to this growing problem. when you are looking forward, when you are looking at the distance opportunities for recruitment we have to start with the immediate family. we have to start with communities and we have to make sure the communities are getting information about what we have learned about how recruitment happens and we are looking deeply at all of these issues and not separating the immediate from the threat. >> i have to tell you the faced -- the world has faced many challenges from murderous groups over the history of the planet and muslim extremism and perhaps even the word islam is

associated with radicalism. we want to be respectful of their faith that we can't help but notice that the people who are murdering people are doing so in the name of their faith. it pulls on a lot of us because we know, and i know many muslim people who are wonderful people. we never dreamed that and i don't think their faith is doing anything but adding to their life. obviously those people who we are fearing now identify with the islamic and muslim faith as the motivator that is motivating them to do that. they are announcing that to the world. i'm not sure and again after listening to your testimony, you know 50 years ago and 60 years ago the world was threatened by the nazis who had no muslim connection at all who basically

came from a christian country and japanese militarism which had its own -- you could identify addition to religion that they were part of that glorified their ancestors especially the word very militarily successful ancestors. you can see the direct line but to be fair about it i don't think the greatest generation in the united states spent time trying to psychoanalyze why people became nazis or why people of japan backed up their militarist wing. we simply went out and had to defeat them and i think maybe that's where we are at now. we want to understand as you are saying these muslim people who are involved with the radical terrorist elements respecting the fact that most muslims are not that way but the job now is not some long-term analysis but

to try to defeat this evil force that would murder our families. maybe you both would have a comment on that. >> mr. chairman may respond to what you are saying? in terms of the threats that our world has faced in nicely pointed out to ideological examples but our countries took it seriously the ideological peace. we invested everything both hard power and soft power to look at that threat. we have not done that now. >> i don't think that we actually put any effort into denazification until after we defeated them and disarm them. it had an impact but right now i think we are in a battle mode of this fight and maybe afterwards

and that is why we have to support the president and his efforts as best we can. and unite as a country against this because i happen to believe and i think we all agree that yes our european friends are now going to bear the brunt that we are the very next step away from our children and families going to be at stake. mr. joscelyn? >> i don't think it's necessarily either/or. i agree with you that we need to defeat them militarily and jihadist need to be defeated militarily otherwise they will say they are stronger but we need to step back for a second and what's going on here as i find we still don't even understand what they they're all about. 9/11 terrorist attacks weren't and of themselves. they were trying to seek a

political revolution within the muslim world. within the jihadi camp there providing shake means according to -- muslims were no longer waiting for jihad and they need to revive this jihadi spirit across the muslim world. that becomes an ideological battle because if you look at what they are trying to do and a great student of the chinese game where you could convert pieces on your side went to surround them and you can read you can redeploy them that's a political revolutionary thinking about how to convert muslims to his cause. it's had many setbacks in that regard mainly because most of the violence has killed fellow muslims and it's a strategic liability not just for icao th the -- al qaeda but also isil. isolate do you look at their body count right now it's a lot of muslims throughout syria and iraq in a few westerners. i have seen you talk about the

beheading videos of james foley. i can tell you i watched hundreds of beheadings of syrians in iraq but for that. most of them on the ground who are our allies were getting killed. in the military battle we need to figure out who our allies are. we have a lot of muslim allies and we have to identify them in this context. >> i think you, both of you made very good points today and the idea of keeping in mind there have been more muslims murdered by the people that threaten us today then have anglos or european background people read although obviously we are concerned about the safety of our families. that is our job is ultimately to be concerned about our families. hopefully our fellow americans

and i would hope that we challenged, all of this challenge them to step up and back them up in their communities when they take a stand against these types of extremists who would murder our fellow human beings. i was shocked when several organizations that i read some flyers from them suggesting from several muslim organizations in the united states were suggesting their people not cooperate with the fbi. mr. keating i don't know few have seen that or are not but i certainly saw a couple of handouts indicating and i won't name the group because maybe it's unfair to that group. maybe it's a reflexive one or two people in the group who took advantage of the situation that we challenged our fellow americans who are muslims to join us and help us win this

battle. because as we are learning today what's happening in syria is going to be a wave that hit us here in the united states and it's already beginning to be felt in europe. let me ask mr. joscelyn about the shared threat we have with our european allies but do we not also share this threat and i mention this in my opening statement, do we not share this threat with russia and should we not cooperate with russia? mr. keating and i actually went to moscow and matt with their intelligence operatives and got a briefing on those people who were involved with the bombing at the boston marathon. >> i will preface by saying a lot of waves are not

consistently have divergent interests across-the-board i would think but to your point when you study he's in syria right now the chechen jihad is better there now these are not freedom fighters. they are opposed to the russian government and hostile to us. they are very much on either isil side or al qaeda site in stereo. in fact isil's military gains in iraq and syria. one of the top military commanders in syria is chechen known as al shoshone. he was the one he gave them their military victory in eastern syria which is has opened up a pathway into iraq. chechnya and jihadist are the most committed i would say skilled and oftentimes partitions in this fight. they are a threat to russia and so in that sense there is a common threat there. one of the interesting things we were talking about was the radicalization of women. one of the best of the best examples were the chechen black widows committing terrorist of

that -- attacks. these are groups who go on to become suicide amir some operations there. there is a common bond in that sense in terms of the threat to jihadist them. >> ms. pandith would elect added that? >> you made a good point about joining the pushback about the ideology of extremism and what you have seen is since 9/11 an increase of voices that are pushing back that are coming from the muslim communities. you are seeing new networks. you are seeing networks of former extremists that are pushing back but that needs to be ramped up. those are the voices that matter and those are the credible voices. to your point about russia and the black widow example that my colleague has just raised that to me is a great illustration of the worst case scenario but we have to be looking at is not when it's the tip of the iceberg

but what is actually percolating? what is actually happening to get them there and that is where we have to's cuts the radicalization process. if we don't have recruits we will not have an army. >> to be fair i cannot understand why a religious extremist group that appears on its surface to be so anti-freedom of women and so oppressive in terms of saying that women have to wear a garment and hide themselves and can't drive cars and can't can have regular jobs, i can't comprehend how there would be women joining the ranks of people who held those beliefs in order to create a society based, standards. >> mr. chairman there are lots of reasons why the women are joining the fight and i know

there are one or two that are prominent. there are many some of which include some of them married come people who are there that want to be part of the ecosystem. someone who has raised children so they are creating the next army. some do it because they are so invested in the ideology of building a so-called caliphate that they want to be part of it and they want to live there. there are many reasons why. their sense of belonging terms of where they are. if you look at the two teenage girls from austria who ran away from home to join chechen jihadis. i mean this as an illustration of the kinds of things that are happening. how is it possible that two young girls who grew up in an open and free environment chose to do that and how did they get radicalized? what were they looking at on line that moved them in that direction and sir a last point i would say is if the role that women are playing is that

enticement role. if you have somebody on the other end of a youtube video or a chat room that is eager to bring women on board and you are a woman and her voice calling them in its very persuasive. >> obviously we face a major challenge and not just with democrats and republicans uniting in the face of a foreign challenge but also people of various religious faiths including the muslim community and the christian community and jewish community here in the united states and elsewhere. we need to have some unity behind this to help save mankind from this senseless murder of innocent people. when we talk about people being terrorists, their purpose is to terrorize and that means to win the battle through terrorizing the population at two leading them achieve their goal through that terror.

we americans are, we have that americans are not going to be terrorized into giving up our rights and our freedoms and our ability to be part of the world. i think we need to stand with our european allies in this and especially our allies in the muslim world who are being killed and murdered at a much higher rate. the closing statement from mr mr. keating. >> thank you mr. chairman. i think what's interesting with this hearing among many things was how we were dealing with how this radicalization occurs, the stemming of it and how it's nurtured and i think we don't put enough emphasis on that. we are going to have to make you just do it here in the u.s.. we had to do in europe and we have to do it certainly in the mideast. i look at the examples of what they are doing and how

sophisticated they are. they are actually making great efforts whether it's isil or other radicalized groups associated with al qaeda. destroying muslim history in many cases. it's not just orally and passing it on but to the destruction of artifacts and the destruction of antiquities and profiting from the sale of those to help fuel their cause but in the process they are destroying it and creating a new narrative of their own. it's not historical and not historical in its nontraditional and is not religious. we touched on that and as we go forward i think that's something we should put greater emphasis on than i want to thank our two witnesses were touching on those things today in their testimonies. >> thank you mr. keating. mr. yoho. >> thank you mr. chairman. thank you both. as we were talking about, and i'm sure you've read the book by samuel huntington the class of

civilizations talking about the majority of the conflict in the world is muslim to muslim but they come together and we become a common enemy. how much of the growth of radicalism comes from the hatred of the west ideals of freedom versus the western foreign-policy or are they connected in your opinion? >> i would say the ideology is anti-western and a lot of times they view our foreign policy through conspiratorial lens which doesn't impact reality. even though we are on the side of the bosnians muslims rationalizing the critique of u.s. policy because we didn't deliver arms to clean up. it's more than being foreign policy driven. >> and it's mrs. pandith? the girls in australia where they austrailian background or worthy of muslim descent? >> it was austria.

i may have misspoke. i believe they were born there. i can doublecheck for you and get back to you on that point. >> what i see as the lone wolf starting to develop in this country like i think it was how mohammed brown who supposedly murdered for american men in the name of jihad against the west. we just don't want to see that over here so i look forward to dealing with you in the future to design policies that will prevent this. thank you both and have a great weekend. >> i want to thank the witnesses and thank my fellow colleagues. the american people need to know that we are taking this very seriously and that there is a threat that is emerging with this battle that is raging in syria. it will impact on our society

and our safety. we have got to pay attention to it. but the people in europe are now beginning to experience and those people coming back from this conflict, we will experience as well. the wave will hit us and what we do about it, we need to use their heads that we have to be courageous and again we need to make sure that all americans including muslim americans are recruited in this effort. so i want to thank the witnesses in this hearing is adjourned. .. [inaudible conversations]

[inaudible conversations] >> on the next "washington journal", improving economic development from the mercator center and urban institute. and then whether it defends spending should be based on security threats from abroad. gordon adams joins us for that discussion. and damon williams of the boys and girls club of america talks about the challenges facing today's youth and his groups overall mission. we will look for your comments

on facebook and twitter. it all began 7:00 a.m. tomorrow on c-span. >> c-span's city's tour travels to learn about different cities histories. this week we traveled with comcast to a visit to st. paul, minnesota. >> in the 1930s i wouldn't call it las vegas, but the gangsters made it a very lively city. during prohibition you had the biggest jazz artist of the decade here in st. paul. those are very lively because the gangsters were welcomed terror. virtually every major bank robber lived and worked within a three block radius of where we are standing today, john bellinger, babyface nelson, all of them were here and people don't know that.

there is no statute of these gangsters that this was the epicenter of 1930s crime in the era of john bellinger. the fbi and federal bureau of investigation had this building as their headquarters and this is also the building where all of the bootleggers and individuals were tried and sent to alcatraz and leavenworth prison and other prisons across america. it is where it began and where it ended as well. and we are standing here looking over the junction of the minnesota and mississippi river. st. paul is located up from fort snelling. the fort is intimately connected in the creation of st. paul. in the 1830s, there were groups of settlers that were living on a military settlements and finally the army had had enough and they felt that they should

be removed from the military property and the sellers moved across the river to the other side and they formed what became the nucleus of the city of st. paul. when you think about the story in the history of this region they are beyond the walls of fort snelling, that is what we try to do here is push people to think more about what does it mean when all of these cultures come together. what prospectives today have on these historic events. >> watch all of our events saturday at noon eastern on c-span2's booktv and sunday afternoon on american history tv on c-span3. coming up next on c-span2, remarks from cvs president and ceo larry merlo. that is followed by representatives on legislative legislation related to antibiotic treatment. and some of today's u.n. security council meeting on combating isis.

>> the president and ceo of cvs spoke at the national press club on friday about his company's mission and the health care market as a whole. he also spoke about the company's decision earlier this year to stop the sale of tobacco products in its more than 7000 stores nationwide. this is one hour. [inaudible conversations] >> good afternoon and welcome. my name is john hughes and i am an editor for bloomberg first word and that is our breaking news guesser in washington. and i'm vice president of the national press club. the national press club is the world's leading professional organization for journalists and we are committed to programs such as this. we foster a free press worldwide and for more information about the club, visit our website at press.org. on behalf of our members

worldwide, i would like to welcome of our speaker and all of you attending today's launch. our head table includes guests of our speaker as well as working journalists who are club members. if you hear closet could be from members of the general public who attended a luncheon. it is not necessarily evidence of a lack of journalistic objectivity. and i would like to welcome our c-span and public radio audiences and you can follow the action on twitter using the hash tag mpc lunch. after our guest speaks, we will have a question and answer period. now it's time to introduce the head table and asked each person to stand briefly as their names are announced. please hold your applause until everyone has been introduced. from your ride, alison

fitzgerald, senior reporter at the center for public integrity and the press club board member. peter urban, a reporter for stephens washington bureau. jennifer shellenberger, assignment editor at fox business, deena merrin, editor at scientific american and mathieu peron, reporter for associated press. a guest of our speaker and cvs telecommunications officer. and jerry of the press club news. getting of our speaker for a moment, john welch, account supervisor and the speakers committee member who helped organize today's lunch. thank you, john. tom is a guest of our speaker

and the cvs chief strategy officer and general counsel. virgil dickson is a reporter at modern health care and mark keller is a reporter at bloomberg and terrence shea, former editor at hr magazine. please give a round of applause for our head table guests. [applause] rematch here are two things that you can count on. there is no smoking at the national press club. [laughter] [applause] and now -- and now you cannot buy smokes at cvs. [applause] and the second largest retail pharmacy chain voluntarily gave up about $2 billion in annual

sales when it announced this year that it would stop selling tobacco products. the company viewed cigarette sales as contradicting its plans to expand its health care business. for instance, cvs plans to expand in-store minute clinics from 900 to 1500 by 2017. we recently changed our name to cvs health to reflect this shift in direction. the stock market seems to be reacting favorably to the changes in the price of shares fell slightly today the company announced it was going tobacco free. and i saw the shares were down a little bit yesterday. but this week shares are trading at their highest level this year. the man in charge of all these of these changes is our speaker today, the company's ceo, larry merlo. the first person in his family

to attend college, larry merlo graduated from the pharmacy school at the university of historic in 1978. and he took a job as an assistant manager and pharmacist at people's drug store. by 1990 he was a regional manager for the chain and that is when it was acquired by cvs. much of larry merlo's career has focused on acquisitions and job growth that he has long held that cvs would be an important part of the aleutian to repairing a bog down health care system and he joined us to discuss the role of corporate america in improving health outcomes for consumers or it ladies and gentlemen, please join me for giving a warm press club welcome to larry merlo.

[applause] >> thank you, for that warm welcome. today i will focus my remarks on the transformative changes taking place in our health care system and the impact that that of that is having on consumers and employers and health care providers as well as our government. i often describe some of the solutions we that we are bringing forward to address what many have referred to as cost quality access conundrum that helps what we are facing today and i will share more about how cvs health is evolving as an integrated health care company and how that led to our decision to stop the sale of tobacco products. i think that everyone is familiar with our brand. but let me share a little bit of our history because last year we actually elevated a mexican milestone and it was our 50th milestone and we have come a long way since that very first store opened in lowell,

massachusetts, in 1963. all along the way we have work hard to stay true to our focus on the customer and creating value and constantly innovating to meet the customer's needs. i am sure that you know us best per cvs pharmacy stores and we have 700 locations across the country. we actually serve about 5 million customers each and every day. however, we are much more than a retail pharmacy business. we have provided prescription benefit coverage to 65 million people across the country ranging from large and small employers and health plans and government-sponsored care and when you think about both medicare and medicaid. we also operate more than 900 retail medical clinics and our nurse practitioners have now treated more than 21 million

patients. finally, specialty pharmacy is one of the fastest-growing areas in health care and we operate a leading national provider of infusion services and we actually treat more than 20,000 patients per month and we treat them at home or at one of our ambulatory infusion sites. for those of specialty patients were managing oftentimes multiple and complex diseases, we offer a corded case management services and we have 17 specialized programs that focus on whole patient care. so when you think about all of this is mrs. ima it is really the unique combination of assets working together as a single integrated model that allows us to create real value for our patients and customers and our client all across the country. now, i am sure that many of you in this room has dean and work for companies that, you know, have their mission and they have their vision and add cvs health

we work hard to help people on their path to better health. all across the organization, it serves as our guide was as we think about business decisions and focus on health care innovation and i will come back to that in just a bit. so with that as a backdrop i would like to spend a few minutes looking at some of the dramatic changes in the health care environment. what that really means for employers and community leaders and importantly health care consumers, we will start with the current health care environment because it is clear that the system today is stressed and according to the independent office of the actuary, cms, the centers for medicaid and medicare services, the health care share of gross domestic product will increase to more than 19% by 2023. while this is slower than the growth experienced over the last two decades, health spending is

still growing faster than average economic growth. the real world translation to the numbers is the fact that it becomes more challenging for people to quickly access quality care through the traditional care channels. if you asked questions have questions how do we get there and if you look at over the past 15 years, it shows us that health care coverage has been dominated by employer funded insurance and while employers and health care companies have worked to bring innovation to the market in terms of improving the quality of care, we also know that millions of americans remain uninsured and often without needed medications. at the same time there is tremendous growth in medicare driven in large part by what we like to call this silver synonymy and the fact that there are 10,000 baby boomers who become eligible for medicare

every single day. this means over 16 million new people becoming medicare eligible by 2019. and it also means that we are facing a long-term increase in the demand for services and the use of medications. in another challenge is the increasing prevalence of chronic disease. does it surprise you to know that half of all americans today suffer from one or more chronic diseases? this is expected to continue to rise for the next 20 years. chronic disease accounts for nearly three out of every $4 being spent on health care. at the same time the number of people who don't take prescription medications as prescribed, we are calling it an epidemic because there are many studies out there that talk about the act that medication adherence is costing our health care system about $300 billion per year in avoidable and unnecessary costs. so i think that you can see that

there are a lot of factors that are contributing to health care spending and there is no question that we must and can do more to slow the growth of health care costs. now, i think that we can all agree that the health care system is also evolving. first there was the affordable care act and when the law is fully implemented, we will see more than 30 million newly insured americans with coverage provided by americans and new insurance marketplaces and medicaid or other programs and health plans as well as the government are going to play a growing and important role. at the same time with the major thrust of the affordable care act focusing on this, payers and providers are innovating for this cost lemma and they have health plans that are piling on trent piloting new outcome based models and a fee-for-service environment where they are compensated for volume and not outcomes and this is beginning

to change as they now take on more risks for participation in accountable care organizations and patient centered medical homes and as a result, they are now incentivizing to focus on cost efficiency. at the same time, from the is an important part of that equation and cvs health is playing an important health care roll and health care partner to physicians and physician practices. and another important trend, consumers are more informed than they are beginning to play an increasingly active role in health care decisions. when you look at the growth of private exchanges and the emergence of public exchanges, they are putting the decision for planned choices directly into the hands of the consumer and at the same time there is growth in consumer directed health plans that is also driving consumers to be more involved and take more fiscal

responsibility for their health care choices and cost. finally, there is this transition to a digital society and we are all experiencing it, it has transformed how we live and how businesses behave and how consumers act within their day-to-day lives. although this transition has been slower in health care, significant and lasting change is underway and i think the reality is that this kind of innovation is not optional, but there are many that believe the health care industry will change when the next 10 years than it has in the past 50 years. that health care will be purchased and delivered and it will be managed very differently going forward. i am convinced that one important avenue to improve is quality cost and access and that is rooted in quality care. it's one of the many things we are doing to drive solutions.

if you look back in history, people have traditionally thought about pharmacies as dispensaries but we know that a pharmacy is much more than that, they are extending the frontlines of health care to deliver better outcomes more affordably to the people that we serve. and cvs health is driving so many innovative approaches with the ultimate goal is once again help more people on their their path to better health and in the the ways in which we are going to do this, we are very different from how he serves customers in the past i want to talk about a few of those. i think one of the greatest assets that we had to drive innovation lies in our people. pharmacists are in a unique position to help and they are highly trusted resources for patients and the annual gallup poll has ranked pharmacists among the top three most trusted professionals.

pharmacist today help what a broad range of counseling and interventions and one of the biggest opportunities that we can addresses that issue that i mentioned earlier, patients not taking medications as prescribed. now, if you go back to the statement that i made earlier that about half of americans suffer from chronic disease and most chronic diseases are treated with some kind of drug therapy and this is where the statistics get alarming. one out of every three patients who starts a maintenance prescription will decide to discontinue treatment before their first refill is the video. in less than one half of patients take their doses as prescribed by their physician and three out of four people will stop taking medication within the first year of beginning therapy and this includes not inherent and

obviously solving this medication adherence epidemic presents a huge opportunity to improve health and lower costs. we have a solution and we call it a pharmacy advising and it's a program to help people manage chronic disease and it connects patients with pharmacists who help them stay on their prescribed medication and prevent complications and these touch points can range from phone counseling and e-mail reminders to in-store counseling and home consultation for some of the most complex cases. research is showing that it is working and we have interventions for people with diabetes and the fact that they were very effective at not just creasing adherents but a return on investment as well. for every dollar spent there was

$3. a pharmacy advisor is available for cardiac care, to diseases ranging from osteoporosis. we also have another program called specialty connect regarding how patients access to specialty medications. if you're wondering where the specialty is matt, this is action therapies for conquest conditions like hepatitis, cancer and in addition to being very costly oftentimes in drugs were prior special storage requirements and the patient can choose to get prescriptions by mail or to drop off their specialty prescriptions in any cvs pharmacy. this increased flexibility and access makes it easier for people to get on and stay on their therapy.

the clinic is another innovation helping us to address access to care issues that is being created by this influx of newly insured and at the same time growing shortage of primary care physician. the clinic is continuing to stand for print as mentioned earlier, we plan to have 1500 clinics by 2017. and today the clinic provides convenience, affordable, high-quality care for acute and long-term wellness needs for vaccinations, screenings, chronic these monitoring, the clinic is staffed by trusted family nurse practitioners and we are holy accredited by the joint commission and we accept nearly every insurance plan including government programs and we are open seven days a week including evenings and holidays and we see patients on a walk-in basis with no appointments required and you might find it interesting to

know that about 50% of all of our business actually occurs during the evening hours on weekends. and we believe that the clinic as replacing the use of higher cost, such as emergency room care and we are getting access to primary care in both of those activities will help to hold down the overall cost of care. at the same time i want to be clear on one important point. we do not believe that the family physician is going away or should go away. her clinic offering is both complimentary and collaborative and helpful to our health care system of law. finally there is a focus on digital innovation and we are using customers with retail and prescriptions with an integrated view of their medications and the ability to easily resell or

transfer them between the retail channels. we have added features for mobile app, like skin your refill and check drug interactions, giving customers on the go to important prescription information and in the next few months we will be adding additional tools like a virtual pillbox and reminders to help patients and caregivers actually track medication adherence. so i think that you can see how our unique business model is allowing us to deliver programs and services to improve health and income lower cost. these are just some of the ways in which we are helping people on their path to better health. and that brings us to the topic of something and that is tobacco. the numbers here once again are pretty staggering. more than 42 million adult smoke, 480,000 people die each year from tobacco related

illness. smoking today costs 87% of lung cancer death deaths and 79% of all cases of chronic obstructive pulmonary disease. the economic cost attributed to smoking and exposure to smoke is approaching $300 billion per year on an annual basis. and as a company we have wrestled with the inconsistency of tobacco sales in a place where health care is delivered for some time now. at the same time, there is $2 billion in annual tobacco sales yet to be considered and we listen to what our colleagues and customers and communities in which we live and serve are saying about tobacco as well as leading health advocacy groups and we stepped back and we have used that again in helping people on their path to better health and we have brought multiple viewpoints to the table, including those of our chief medical officer and

colleagues from finance, merchandising, human resources, the list goes on. and we have weighed the short-term and long-term opportunity. as you might expect, there was a very thoughtful debate and discussion and as a unified management team along with our people we've made the decision to quit for good. we announce that back the very fifth and six months later we are officially tobacco free, one month ahead of schedule and we are proud to say that we are the first national pharmacy chain in the country to take this action support the well-being of our patience and our customers. [applause] and we engaged leading health organizations including campaign for tobacco free kids, american lung association, cancer society, the ama, the american

pharmacists association. these organizations and so many others have rallied behind the vision of public statements, adding to the course and why retailers should be tobacco free. social media has also amplified the conversation with countless statements and support from consumers and celebrities and political leaders and there is no question that a national conversation about tobacco has been reignited. and we do believe that reducing access to tobacco products will help reduce tobacco use. our chief medical officer recently shared the results of a new study that showed the effects of enacting policies to a limited the sale of tobacco products. in boston and san francisco where retailers are not permitted to sell tobacco, there was up to a 13.3% decrease in

the purchasers of tobacco products and at the same time, including tobacco, we also launched a comprehensive and you uniquely personalized smoking cessation campaign to help the seven in 10 smokers that want to quit and we've consulted with many experts and took their guidance about what works to build a comprehensive smoking cessation campaign and it kept her entire chain of stores in our 900 clinics and leading people, the fact that we have 26,000 promises and nurse practitioners across the country including four critical components in an assessment to determine the smokers readiness to quit and education to provide smokers the information and tools that they need to quit. medications support to curve the desire use tobacco and finally coaching to help individuals stay motivated and prevent any relapse. the combination of medication

and coaching can be very powerful and it can nearly double the rates from percent to 15 might be surprised to know that it takes on average seven times before somebody is successful in quitting and we want those people to never quit quitting until they are successful. so to september 3 was also a historic day for our company for one more reason. it is the day we announced our new name, cvs's and it is inspired by that purpose once again of helping people on their path to better health. i think that all of us have been truly humbled by the out pouring and encouragement and the words of transport we have received since announcing quitting tobacco. and it is vital that the private sector continue to take a leadership role on tobacco, working with nonprofits in the public sector to address and

prevent tobacco related disease. it's the right thing to do, just like our decision to quit selling tobacco products because it has no place in a health care setting including pharmacies. so to sum it up, we don't see the sale of tobacco isn't just an important decision for us but for public health. and so in closing, let me come back to where i started, because as dramatic change takes place in health care, i believe that pharmacies can bring solutions that will make a big difference in the health and the well-being and the financial outlook of our country. and as a pharmacist myself, i know the value that our profession can play in the lives of others and i also know that there is even more at the pharmacy can and will do to improve both care and affordability and our 200,000 cvs colleagues will join us to

continue to provide better and more affordable care to people young and old all across the country and help them on their path to better health. so thank you and i will turn it back over to you and we will open it up for questions. [applause] >> thank you. not surprisingly, you've got a lot of questions on the tobacco decision and initially when you announced the decision back in february, october 1 was going to be the date and when you moved it up, as of this month, you're no longer selling tobacco. why did you move toward a month? two well, when you think about there are 7700 stores coast-to-coast, there is a lot of work to do to transition that states that previously had tobacco. we thought that it would take us until october 1 to get that work done and i have to say that i'm

proud of the team that mobilize and got everything together. it was simply a situation that we were able to execute a little quicker than what we had thought. and i referred earlier to your stock price. to what extent do you think there has been a cause and effect to near decision on tobacco and the company's online and stock market performance, and have all these comments support from the white house and elsewhere, have they translated into helping the bottom line? >> that is a great question, when we made our announcement back in february, we were pretty transparent in terms of the financial impact and the fact that it was $2 billion in revenue. and at the same time we firmly and wholeheartedly believe that it is the right thing to do for the long-term growth of our company and i have talked the about a house some of the things

we are doing is playing a delivery in the health care system. or a, you know, a large health plan and as we engaged in those discussions we saw the sale of tobacco is an obstacle to warming new partnerships. so i think that the financial community certainly understands the value proposition associated with cvs and cvs health and i think it's hard to sit here and say that there's anyone singular event or announcement that makes a difference, but i think collectively as i mentioned earlier, we have been humbled by the outpouring of support and i that collectively it is resonating in terms of whether they are investors consumers or potential clients and the value

dead cvs health offers in the marketplace. >> electronic cigarette and to be becoming more popular. you foresee selling them at any point and will they be treated the same as tobacco products from your standpoint to . >> you know, that's another great question and something that, you know, we are asked a lot. we have never sold electronic cigarettes and we do not plan to. i think one of the things that we are troubled by is if you go in a store later today that sells these cigarettes, you see the devices that are branded as hello kitty or the liquid that is put into those devices, you know, bubblegum flavor or tootsie roll. i think it raises a question in terms of what is the role that electronic cigarettes are playing in this country and who is the target consumer. so we don't sell that to them we have no plans to as we go

forward. [applause] >> how do you assess the risk of your decision going forward? they saw a 7-eleven down the road promoting that it sells cigarettes with an outdoor sign. perhaps trying to capitalize on your decision, as they are a risk out there, do you think giving that up? >> well, i think it goes back to the statement that i made earlier that we think of ourselves as a pharmacy and health care company. and you think about many of the factors that i mentioned earlier like the 10,000 baby boomers turn 65 every day. folks over the age of 60 take three times the number of medications as the younger population. so we certainly see a much bigger opportunity to grow the health segment of our business

and the fact that there are many elements of our pharmacy stores that we have an opportunity to extend the pharmacy experience into. whether it's over-the-counter products or the beauty cautiously felt in our stores, recognizing that there are many more products today and the list goes on. and that is where our focus will be. >> to this point, none of your competitors have called you for forgoing tobacco sales. why do you think they are doing what they did? >> you really want me to answer that question in a different way. well, i certainly can't speak for our competitors and i think that they, they have to go through the same process that we went through. we had to ask the hard questions

and look in the mirror and we have to use our focus in terms of how we saw ourselves as a company. somebody had to be first and we are proud to say that it is cvs. >> as you mentioned, you are branded the store cvs health, but you are still selling things that are not necessarily good for a person. i have been known to go down and back on track by a bag of snack foods are not particularly good for me. where would you go in looking at other products or do you think that other products might follow tobacco he will decide not to sell them? >> either way, i have to say that i love the cupcakes at the table, so thank you for whoever came up with that idea. but no, i think that that is a question we get asked a lot. and we have had many discussions

with leading health experts, whether you're talking about a candy bar or a bag of chips and soda or in some places we sell wine or a glass of red wine, those products taken in operation or the occasional use, if you're talking to your assertion or nutritionist, they would tell you that they have not been proven to cause medical harm. but the emphasis is on occasional and moderate use. you can't say the same thing about tobacco because there's no amount of tobacco that can be considered safe and not the at the same time i do think we have an opportunity to educate consumers in a more holistic way about healthier choices and i think as we go forward you will see the introduction of healthier products and we just launched a new product line within last couple of months and

it's called balance and it is a healthier alternative to some of the products. so you're going to see those things as we go forward and there will be more information at the point of decision when the consumer is picking those products off of the shelf. that is why our focus is that we do not have plans to illuminate other categories within the stored. >> washington dc where the national press club is located in the city that has approved the use of marijuana for medical use, medical marijuana. as cvs and cvs health look at the issue of marijuana being used for medical purposes, how do you assess that? >> we have no plans to get into that and we may find it interesting. i have been asked this question

many times and i think that people believe in some of the states where the law passed because you operate a pharmacy, if you choose to sell marijuana you can do that. but the license that we has within pharmacy does not permit us to sell marijuana and we would have to go out and be relicensed as another, you know, provider and we have no plans to get into that line of business. [applause] >> this question is if obamacare plays any part in your tobacco care products and is it a net positive or is it a net negative and why two. >> let me take the second question first. as we looked at 2014, and this is information that we have in the financial community, we

thought from a business point of view that the affordable care act would be a modest benefit to our business this year. and as we fast forward, we are almost nine months into the year and that is pretty much how it is played out. we are seeing more of a benefit from the affordable care act as a result of medicare expansion than we are from the enrollment in the exchanges and i think that there are many studies out there when folks are trying to, you know, answer the question with the 6 million plus that have enrolled in the exchanges and how many of those enrollees are new to health care coverage? the numbers are all over the board. they are as low as 25% to as much as 80%. so i'm not sure that we know the numbers in terms of what percent of insurance and that's not the

same in medicare and medicaid. and i think that as we think about the tobacco decision, the affordable care act really did not play a role in that decision. i think it goes rack to one of the comments that i made in my prepared remarks. the 30 million uninsured, the fact that they should have this, but at the same time we have to begin to focus on cost and quality and our current health care trajectory, when you think about what percent of health care makes of gdp, it is not sustainable. >> this question asks about the role of prescription drugs in overall health care in coming years and they say that consumers are facing pressure to

rising costs and premiums and co-pays with prescriptions. do you expect that to continue and do you expect consumers to become more cost conscious in their prescription spending? >> i think that some of this goes back to the role that prescriptions play in chronic disease in the fact that it when you think about whether it's someone who has high cholesterol and by the way, when you think about the role that generic prescriptions play and i don't know if you'll be surprised to hear this, but when we look at a prescriptions that we dispense, between 83 and 84% of all prescriptions are generic at a much lower cost than brands and products and as you look across those chronic diseases that i mentioned earlier, i think in every one of those diseased conditions there is a generic drug that is available to treat

a particular disease, whether we are talking about high cholesterol or hypertension or diabetes and the list goes on. i think that we all believe and substantiate the fact that christian medication is very effective from a cost-benefit point of view and then in keeping someone on the drug to prevent a heart attack, i think the average cost of a heart attack today's 30,000 dollars. and so we remember that example that we used. for every dollar invested in keeping a diabetic adherence to their prescription regimen, there is a 3-dollar return in terms of reducing overall health care costs than we were very excited about, less than two years ago, the congressional budget office that actually came up and scored the fact that

keeping people at your into their medications will reduce overall health care costs. so we will work diligently and we were work tirelessly to make sure that our patience and our clients and every one of the stakeholders across the delivery system understands the role that prescription therapy and prescription adherence plays not just in keeping people healthier but at the same time reducing overall health care costs. >> this questioner says that he or she believes that every part of the health care sector is sacrificing and changing to hold down costs under obamacare but he or she does not see the pharmaceutical companies acting that way and treats them as being very protective from change. so the question is do you agree that that is the case and is

there anything that can be done to change it? >> i think for years it has been commonly known that the prices of prescription medication in the u.s., those same products in another country cost significantly less than the fact that the u.s. subsidizes the cost of research and development and what it takes to bring a particular drug to market. as well as the pharmaceutical manufacturers that are rewarded in 17 year patons and i don't want to mislead anyone. by the time they are at the market, they have burned up many of those years with clinical trials and et cetera. but i do think that there is more competition entering the pharmaceutical space, whether it is coming from generic drugs as

the lose their patent protection. and there are more new products entering the market that are clinically effective and thinking of them as products within a clinical disease state. much like all of us here, we are consumers and we choose competition in the marketplace which drives where we choose to shop and i think that we will see increased competition because of more product introductions that will hopefully work to reduce the overall cost of pharmaceuticals. >> you talked earlier about the minute clinics. this questioner asks to what degree might the minute clinics contribute in a tiered health care system whereas those that have the time and resources will

go through their primary doctors while those primary care doctors previously received little or no care will depend on the next instead of a position. will will this result in a kind of a tiered health care system of the haves and have-nots? >> i think that is a great question. and i will give you an example because we have 200,000 of my colleagues. and it's a great opportunity with our lab. so many years ago we worked at our employees that had access to utilize one of our minute clinics and what we have found and that means a percent lower

health care costs. and if you turn on and say what's driving that? remember i mentioned 50% occur nights and weekends and one of the key things is getting that into the clinic with a factor with the average cost of emergency room visit can be as much as $800 even though it varies geographically. and so my answer to that question is in the health care system, someone made a comment to me that quality -- how do you define quality and cost. someone said that it's really health care value and health care value is defined as the intersection of quality and cost. >> so you think about the fact that we are delivering high-quality low cost care at the clinics and across our delivery system would have to

begin health care value is being worshiped the caribbean ministered at the lowest possible cost. and we have performed more effectively and more costly with a more accessible convenient way for the patients and when you think of the way that pharmacists play in vaccinations today. five years ago it was the exception that a pharmacist administered a flu vaccine and it is becoming much more commonplace all across the country. and there is a role for pharmacists plan there is a role

for nurse practitioners to play. >> we packaged movies together. do you think that down the road perhaps cvs could get in the role of primary care in providing primary care and another questioner says access to dental care could be much better from urban neighborhoods and will communities and would they ever consider addressing that need by opening retail dental clinics. >> that is another great question. and, you know, we don't have any short-term plans as we think about the role that we may play in dental. although one of the services that are nursed back to shooters provider, the folks that come in and they might have a dental abscess and it becomes one of those emergency visit until they can get to their dentist or and honest. i think the fact that our health care system is evolving, we

continue to evaluate broadening our services and we are doing more today than what we were doing three or four years ago. i think that there are some things that we will begin to pilot next year that will broaden our services and once again we do not see those services except for being complementary to primary care but we do not see replacing the role of the primary care physician. >> this questioner asked about prescription painkiller abuse is a growing problem nationwide and wonders how cvs health handles that issue and what you can do at your stores to make sure that this problem can be held in check. >> that's a great question that has all of us in the pharmacy profession worried. because there's a number of things that we are doing today

and i think as an industry we are working together across the country in terms of things like shared databases so that we can separate an eye while described as the liars from the outliers, if you will. we are participating in drug takeback oh grams. i encourage all of you. look in your medicine cabinet. how many painkillers are sitting there and maybe you have a dental procedure or a simple procedure and the physician wrote a prescription and you took a few and started feeling better and yet you don't need this anymore but they are sitting there, it's not good to put them, we are working and we need to do it and it environmentally friendly way. one thing as a pharmacist goes, i never thought that i would

see, and there are some licensed prescribers that are not running ethical practices and although they are licensed, they are writing those narcotic restrictions for all the wrong reasons. and today we have stopped filling prescriptions for over 100 positions because they have not been able to validate the legitimacy of their practice and we will continue to work and support our pharmacists so that they are doing the right thing in terms of making sure that the right people are getting the medication they need and at the same time, working with all of that stakeholders, whether it is the dea or law enforcement and others that are involved to make sure that we get rid of this other segment that is really driving this across the country.

>> we saw congress acting in the last few days with a continuing resolution to keep the federal government funded temporarily and you talked earlier about the importance of research to these products. how much do you worry about federal funding pipeline being diminished or cut off as congress struggles more and more to find revenue to balance the budget? >> i do believe that is a concern. i think the folks in this room know that there are many universities across the country that are research oriented grants from other government entities and those grants have led to some terrific innovations in the market and i think that that is certainly something that has those universities concerned and other research stakeholders across the country as well.

and that is something that must continue to receive ongoing attention and management as well and i think that we have to make sure that we don't cut to the bone and that we compromise future research and if you think about it, we have not found a cure for alzheimer's as an example are you so we want to see the research supporting cures for that and this includes debilitating diseases and more to come on that as well. >> what do you see as the role of medicine and technology, particularly in the rural areas where people could be a distance from your store and may not have transportation to get there. do you look at integrating more of those services? >> there is no question that technology plays an important

role in solving the challenges that i mentioned earlier and i have talked about our focus on digital. we are experimenting with telemedicine and we have several sites in southern california and texas and they are staffed by licensed nurses and so if a patient comes in and they are actually through technology seeing a nurse practitioner and assistant. ..

i think we are off to a terrific start. i do believe telemedicine will play an important role especially when you talk about the rural areas of the country that do not have access to a primary care physician. so we are almost out of time but before i asked the last question i have a couple of housekeeping matters to take care of. first of all i want to remind everybody about upcoming speakers. on september 23 we will host former virginia senator jim a web and on october 15, deborah rider president of the john f. kennedy center for the

performing arts will be our guest at a luncheon and on october 20 labor secretary thomas perez will be here. another piece of business, i would like to present you with the coveted national press club mug. [applause] you cannot get one of those at cbi. but you can't have healthy drinks in that mug that are good for you. so the last question. this is the voice of a customer coming through so once in a while these customers find a way to get their voice heard and their questions in. this customer says, how can you possibly run minute clinics when you can never fill any of my prescriptions in less than 20 minutes? [laughter] >> a fair question.

you know i think there are a number of things that we are doing to create efficiency and effectiveness. i think we have done an awful lot with technology and i can remember the early days as a pharmacist where when people came in you fill the prescriptions in the order that they came in. we are doing a better job albeit probably not perfect in terms of being able to separate people that just left the dock and might have a sick child and they want to get home and get started on the antibiotic from someone who is voting in a refill and is going to pick it up tonight or tomorrow. we are doing a number of things with the automated refill programs. i know i talked to some of you earlier and you appreciate getting those text messages or phonecalls reminding you that your prescription is ready to be picked up. so we are working hard to make

sure that prescriptions can be ready when promised by using technology and additional features like that. [applause] >> i was going to say how about a round of applause for her speaker but you took care of that. thank you larry. [applause] we thank you for coming today and thanks to our audience here at the national press club for those wonderful questions. i would also like to thank the national press club staff including its journalism institute and broadcast center for organizing today's event. remember for a copy of today's program and to learn more about the national press club he can go to our web site press.org and find all that information. thank you for being here and we are adjourned. [applause]

[inaudible conversations] [inaudible conversations] [inaudible conversations] >> iowa governor terry branstad is running for a fifth term against democratic challenger jack hatch. the two candidates face one another tomorrow night in a televised debate. here's a look at the ads running in the race.

>> four years ago 114,000 iowans are out of work. unemployment was the highest in 25 years and our state's budget was $900 million in debt. terry branstad came back and said i was. today we have a budget surplus, 140,000 new jobs. unemployment is reduced 30% and governor branstad is just getting started. terry is back. iowa is back. terry branstad is building iowa's future. >> he's honest, he's compassionate. he's a visionary. he is always looking forward to where we can go next to do better, and bring great jobs and grow the economy. we are seeing that. the jobs are there and unemployment is low, seventh in the nation. he brought iowans work today than anytime in our history. i'm optimistic about the future. he definitely has a passion for

the state. it's really fun working with him and i'm really blessed. >> after 20 years i was tired of governor terry branstad. the scandals and the political favors. there's a 110 million-dollar bad deal, taxpayer money given to an egyptian millionaire, an isu economy calling it the dumbest economic decision made in iowa. branstad tried to demolish preschool funding. aren't you tired of terry? it's time for a fresh start. jack hatch for governor. >> here are two men running for iowa governor. terry branstad supports tax breaks for undeserving corporations and jack hatch supports tax cuts for middle-class family. governor branstad has given away tax money to a wealthy egyptia egyptian -- there's only one thing that branstad and jack hatch have in common and for jack that's one too many.

>> i'm jack hatch and like you i'm ready for a fresh start. >> a debate between iowa governor terry branstad and democratic challenger jack hatch airs live tomorrow night at 8:00 eastern on c-span. >> president obama today signed a temporary spending bill that funds federal programs and services through mid-december. the continuing resolution also includes authorization for arming and training syrian rebels in their fight against isis. both the house and senate passed the measure earlier this week. they now stand in recess until november. on this morning's "washington journal" we talked to two members of congress about some of the issues addressed by lawmakers and other legislation that remains to be considered. this is an hour. >> host: joining us on "washington journal" two longtime members of congress

gene green a democrat from texas and phil gingrey a democrat from georgia. dr. gingrey this is your last turn. >> guest: peter it is. this is my 12th year, six terms. i have about three months left and we'll come back for the lame-duck. i am enjoying these last few months and i have certainly enjoyed the past 12 years. it's been an honor privilege to represent the 11th congressional district of georgia northwest georgia. >> host: you are leaving congress. congress is adjourning. what do you think about congress leaving in the middle of september? >> guest: in the years that i have been up here and james has been here longer than i have but i'm sure that's been the modus operandi for a long time. in an election year you have a presidential election year and midterm elections. he tried to get the most essential things done like we did yesterday in funding the government. not having a government shutdown

so members can get back to their districts and do the campaigning they need to do to try to get reelected and then come back and go back to work and roll up their sleeves in the second week in november. let's go gene green you have been here for while representing the houston area. what do you think about running for re-election? >> guest: this is probably longer than usual but normally try the end of september everyone wants to get out of town and go home particular in the house side. we are in the ballot every two years so granted we have an extra couple of weeks now that we normally don't have but that's a decision made by the majority. it may be longer but i'm glad. i ended up voting no on the things that came up in a house. >> host: how did you vote on the syria aid in the continuing resolution? >> guest: i supported it for a number of reasons. the continuing resolution we don't want to do what we did last october 17 days of shutdown but also on the syria issues i'm

convinced it only goes until december was so we have a relatively short time to give the president the authorization to our more moderate rebels in syria and also to do we need to do. i think there were no u.s. troops on the ground except for the ones that are going to protect their our personnel. i don't think it would pass congress. most of us have war fatigue like the american people do. we have spent a lot of lives of a lot of money and injury in iraq and their government could have done much better and dealt with their own issues. >> host: same question. >> guest: i actually voted no and yes. no on the plan for the president to outline to the american people on what to do about isil and i voted like jean yes for the continuing resolution. i don't want to see a government shutdown and i think we need to

get that work done. as far as the plan, i give the president credit for trying to do something but i just don't think it's going to work. until you try to connect those dots you worry about the free syrian army and who they are in which direction they will point their guns. will it be toward isil one day and assad and his troops the next day? i think eventually it would lead to troops on the ground and as the congressman just said the american public is wary of that. we have lost 40 young men and my congressional district of georgia in either iraq and afghanistan and many more injured so i want to take that very seriously. >> host: we invited you to hear to talk about some specific legislation that you have worked on together. we hear a lot about the rancor in congress but this is something you all have worked on for a couple of years. gene green what is the bill that

you are working on? >> guest: congressman gingrey on the commerce committee and we have worked for a couple of congress as if not more on trying to frontload our new generation of antibiotics because we are actually, the current antibiotics are not working. the bugs mutate and they become immune to it. the ebola issue brings it up and we are talking about antibiotic resistant tuberculosis you name it. last congress we passed on a bipartisan basis to front end load some of that research to get that next generation of antibiotics. we didn't get as much as we needed to know we have the adapt actively had a hearing in our subcommittee in 21st century cures. to program our energy and commerce committee is doing and we are here in houston on

october 30. congressman pete olson and i are on the committee to talk about what we can do for health care for the 21st century riyadh part of it is to develop antibiotics that will cure illnesses. >> host: how can congress aid in the development of antibiotics? are we talking money or the fda? >> guest: and our committee it quicker approval giving the fda the tools to do it quicker and get these drugs from the lab table to the bedside. of course nih funding is important. we need a lot more medical research funding that is very bipartisan hearing congress. we also need to make sure we are doing the research to protect their own people in health care. that's our goal and it's a bipartisan goal. we have worked together and their wives are friends and i'm

going to have to find another partner on health care. >> host: to be over antibiotic ourselves here in the united states and is this one of the reasons we are finding superbugs that are resistant? >> guest: there's no question about that. patients go in and they have a common cold and they think they have pneumonia and they feel when they leave the doctor's office if they don't have a prescription or two or three for antibiotics they have not been adequately treated and that's not the case. in many of these cases it's inappropriate to prescribe antibiotics particularly the second and third and fourth-generation antibiotics which should be reserved for a limited population and very specific infectious diseases. so the abuse of the utilization of antibiotics. the president -- you know peter came out yesterday in regard to this entire issue and stepped

right into the wheelhouse that jane and i have been working on for a number of years. i will say the problem with a lack of antibiotics in the new generation of antibiotics, we know about penicillin and tetracycline that but we are talking a long time ago in the 1940s, penicillin and the 60s the tetracycline. the antibiotics, pharmaceutical companies can make a much greater profit on other medications that can be used more broadly, not as expensive to develop and so for the last 20 years you have just not seeing any new or many new antibiotics coming to market. unfortunately as congressman greene indicated these bugs mutate and they develop resistance.

the first thing you know you have people in intensive care units that have these horrendous infections and they are resistant to everything. so the fact we passed in july of 2012 would incentivize the pharmaceutical companies and say look, you develop these antibiotics and we will give you five additional years of exclusivity so that you can recoup your costs and make a profit. many other things, tax incentives so it's really working. american society detects diseases and infectious disease physicians have been really proud. on behalf of our committee and it's not just jean and i but it's been done in a bipartisan way. we have people like henry waxman and john dingell and joe barton and fred upton. we are following in their footsteps.

it's a great committee because we do things in a bipartisan way for the good of all people republicans and democrats. >> host: i will put the numbers on the screen. we have a lot of congressional issues we can talk about. some of the broader issues that have been talked about over the past year with congress. you can see the numbers. ireland and we'll take your calls in just a minute. congressman greene, phil gingrey is leading the congress and the congress is adjourning until after the elections. what's going to happen to this legislation? >> guest: we are having a legislative hearing. the food and drug administrator commissioner was there today. we are going to have a panel. our goal is to have a legislative hearing and this is very bipartisan. a majority of our committees are co-sponsors so maybe even a lame-duck if we could pass something like this. we are keying it up for next congress because these illnesses

are not going away. this congress, i wish we had considered it earlier but again we are not going away. we are going to keep at it because there are a lot of people. phil is correct we do over medicaid with her antibiotics although i was told recently the united states we have a problem but it's really around the world. the antibiotic resistant diseases but we want to make sure we deal with it the best we can. >> host: in a lot of countries including the one near mexico you can find antibiotics over-the-counter and people self prescribe antibiotics. is that a problem? >> guest: i go to mexico a lot and i've had sinus trouble since i was in my 20s. twice or three times a year it will become in effect -- an infection. my daughter is an infectious

disease doctor. i say this is what the doctor in houston would subscribe for me. i can continue to survive. if you have a sinus infection or an infection antibiotics are good. >> host: dr. gingrey my mom and nurse yelled at me about the same thing. if you get a sinus infection as a doctor are you going to grumble at us for doing that? >> guest: i'm going to grumble and grumble to members of my own family as well. we only to be well-informed and be disciplined with regards to this. i understand what gene is talking about. the abuse of antibiotics is part of the problem and what i described a few moments ago as we develop the act to incentivize these pharmaceutical

companies, big pharma to get involved in producing new and better fifth-generation antibiotics antibiotics and incentive -- incentivize them and we also have to look at the other side of it and that's the regulatory aspect. that is our fda. we are working very closely with the director hamburg and dr. woodcock who will be one of the witnesses that are hearing this morning with regard to may be developing an alternate pathway and clinical trials so it's not so difficult when you have an emergency situation to bring these drugs to market. there's always a fine balance here to make sure that safety is there an efficacy at the same time. so we developed these bills and they become law. we want to make sure that the people, the public is safe and

yet they get the drugs that they need so desperately. >> host: we are going to start taking calls. a call from carl and orchard park new york on our democrat line. phil gingrey republican of georgia and gene green republican from texas are our guest. go ahead color. >> caller: gentleman you have just wrestled with the arming of syrian rebels in congress and you made your vote. let me respectfully suggest what you did not consider what you and your associates in congress did not consider and that was international law. now as you gentlemen both know back in nord -- 1945 when he signed on to the charter of the united nations and the senate ratified it, it became the law of the land. therefore how in the world can you and your associates totally

in my opinion, totally ignore international law which spells out that no one has the right to arm and equip rebels and a sovereign nation such as syria? >> host: mr. gingrey do want to try that? >> guest: that is a very very good point and quite honestly it's part of the reason i voted no on that amendment. now andy pointed out serious specifically and i'm glad you did because with regard to iraq, the new government that stood up. maliki is gone and his government wants us, invites us, needs us to come in either with airstrikes or training in command-and-control and special forces if necessary but without boots on the ground. syria is a different situation

because as you alluded to the fact that as much as we seem to despise bashar al-assad he is not specifically asked us to come in and help them deal with isis. i am sure the united nations is going to come forward and say you can't do this. i want to go back to my initial statement. i do commend the president for trying to do something. i'm just afraid that something is going to be turn out to be wrong and that is why voted no. >> guest: i agree with you. international law but quite honestly i was thinking that every rebellion in the last 60 years. there has been support whether it was the old communist regimes or other entities who were attacking different countries without a declaration of law on war. this is a reality. maybe we need to look at that instead of just saying we can't do it. how can we do with these groups like isis are al qaeda with

countries that the government doesn't control? >> guest: thomaston fairlawn new jersey republican line, good morning to you. >> caller: yes, thank you for taking my call. first i want to let the gentlemen know the easiest way to fix a sinus infection are almost an infection including the flu is getting enough vitamin d three. if you do this you will not get sick. we have animals that are taking more antibiotics than anybody in the country. we have antibacterial soaps. this is why we have a problem. super antibiotics are not going to fix that kind of problem. >> guest: i do take vitamin d three with a whole bunch of other things and you are right about the overmedication of our animals. we need to get a handle on that and also i hear the same thing about antibiotics so. we all use it now and that's why

we need to develop the next generation of antibiotics. the mutation of these diseases and that's why this legislation and what we did last congress is important. but you are right, there are a lot of common cures for sinus and i've tried them. >> host: we are getting all sorts of advice on twitter. wild and wonderful says lay off the antibiotics. a tweet from jody says medical breakthroughs in the past were done for the good of man. now one needs to make a million dollars. >> guest: well of course these companies to large companies but all companies, even small pharmaceuticals are in the business to make money. we don't want them to make too much money but they can't stay in business and provide those jobs in the needed antibiotics and therapies without having a

profit motive as well. this all started really with our former chairman of the committee henry waxman who is retiring this year as well as i am although he has served much longer than me. when the alternative drug act was passed in 1983 patient advocacy groups who had family members with specific diseases for which there was absolutely no treatment lobbied and worked hard and got representative chairman waxman to get behind a bill. he was chairman of the health subcommittee of the time and the result was the drug act. companies were incentivize to develop, we are not talking about antibiotics here but develop specific drugs with unique diseases in a limited population. that is the way gene and i got this idea with regards to the

game act and the adapt at specific to antibiotics. we are having the same problem 32 years later and we are solving the problem thanks to her committee. >> host: john and alexandria virginia, please go ahead. >> caller: good morning, thanks for taking my call. i have a quick comment and a question. in my understanding we have already been in syria and the middle east, we have been training soldiers that support us. during the iraq war and how has that benefited us and why are they stepping up and taking over part of the situation? my question is what is the rationale or why do you think in training moderate rebel insurgents is going to benefit anyone? can anyone who has voted yes

name of the people tell us who these people are by name and what their track record is? >> host: john thank you very much. gene green do you want to address that? >> guest: talking about iraq first, you are correct. we trained it armed and iraqi army and whole divisions disappeared. right now with her airstrikes we are blowing up things that we gave the iraqi army that they turned over to isis. i am satisfied with the dash peshmerga. they are friendly to the united states and they are in the northern part of iraq in the northeastern part. if we armed them they can take care of themselves. we still need the iraqi people to take care of themselves. we left iraq and obviously because of their political system that didn't work out. on the free syrians is going to

be difficult to know which ones are which because they change sides pretty often. but the goal still is to try to eliminate isis because of the recent beheadings that not only u.s. citizens but british citizens. i know they have one more now so it is an international coaliti coalition. the united states will provide the support. today the first french aircraft were involved in an attack on isil so it is international. >> host: do you think we should be supporting the ukrainian president from his talk with the congress yesterday supplying more than just humanitarian aid and perhaps weapons? >> guest: i definitely do. i think the prime minister the prime minister and the president did a great job yesterday in congress. ukraine is not part of nato but the countries that are the closest are the eastern european countries really know the united states will be there with them and i would be more aggressive

than art administration is right now. .. oligarchs. many of them have the money in the uk, cypress, not in the states. but i do think the sanctions can work. i think they are working to a degree. not boots on the ground for sure. the weapons that gene is talking about, that can be done through nato. very possibly. and not directly to the united states, but we heard from poroshenko yeste and we do need to support the right of the ukraines to be independent. i they want to go back to russia, that's their choice. if they want to go to the european union