did. literally attacking in south korea or attacking japan, hitting them with some kind of missile system would, i think rapidly destabilize the area. and it's hard for me to believe, part of this is unknown longer involved, but it's hard for me to believe that there wouldn't be some kind of party severe response. ..

there are an array of options and that is certainly one that is there. >> we are going to turn to membership for questions. i'm told to remind you it is on the record. we ask you wait for a microphone. it will bring it to you. speak directly into the microphone, stand stand up, tell us your name, affiliation and limit yourself to one question. let's start over here with this gentleman. >> hello. my memory on this may be hazy, but i was on the defense policy board at the time of the earliest crises.

somehow or another at the time the cold war was ending they made it possible for some of their records to be made available to us. one of the things i was surprised, for those of us who saw the records, where it took about a year to persuade the russian and chinese to get into this. they were very much afraid of the american response and they didn't want to go to war with america again. that was certainly an opening. i should back up and say, it was my opinion then that we simply had to send a person of great stature over there.

you have to keep in mind, maintaining face and stature were important in the world. if you're going to send somebody , don't send the assistant secretary however able he may be. send somebody who also has the recognition and stature in the world. and happened and i knew at the time to people who had been asked by him to come over. one was the secretary general of the un, the egyptian who has now passed away, and the other was president carter. my suggestion was, knowing presidents as i did, i thought none of them would like to have that done, to to be undercut by somebody who seems to have more knowledge on the subject then you do. if anybody will do it, you will do it. well, that wasn't really going

to work and it doesn't usually work that way very often. i said, why not say, we are not inviting anybody to go but nor will we stand in the way. if there is someone of sufficient stature, step aside aside and let them come. >> so your point is, someone of a high standing needs to be -- >> well he did go and he got an agreement. >> well let's ask about that. how high does the representative of the united states need to be in these negotiations? >> i think that has to be up to the president to decide that.

any suggestion david hamburg makes on his experience and tremendous contribution to humanity, i would take seriously , and i would hope whoever the president is would take that seriously. i think that's a presidential call. >> i would just add, and we alluded to this, this regime has a pretty robust history and the report lays out the cycle that we've all been in for many years, for decades now, and there is certainly meant to present in the report a sense of of urgency and a specific statement that the next president, whoever he or she may be will be tested very early with this capability. part of the idea of this was to propose at least a framework that might be used as a new administration takes over. we are not the only ones in town doing it, by the way. >> no hands on the side of the room so i'll go to the gentleman there and come forward. >> stanley ross, unaffiliated,

but formally a humble assistant of state secretary. i asked my question from this advantage of not having read the report which i will do tonight. does it address deterrence and whether he gets it, thinking specifically of us in scenario that is very worrisome when you talk about him using his nuclear umbrella which he feels he can take conventional action with impunity. can you address that in the report? >> i would say this is the core which is the deterrence and defense. as these capabilities develop, he may believe, mistakenly, he is able to aggress at some levels and cover that with his

nuclear arms. a nuclear blackmail scenario. our recommendation are explicitly designed to dissuade him of that false impression. we propose, new abilities in some submarine warfare, the mantra of the 25000 men and women of the u.s. forces is that they need to be ready to fight tonight and that's absolutely true. that might require not only a defensive action but also proactive action. it may also require strikes into korea itself if we are aggress against with a sufficient magnitude. it's important to recognize we do not enjoy a condition of destruction with north korea and

we will not consent to that arrangement. >> we have a question from new york. please tell us your name and affiliation. >> herbert from the american china society. when the united states has been confronted with this kind of thing in the past, we negotiated our way out of it. first of all we were free to negotiate very early on when faced with it which is not been the case here because of opposition within administration and with congress. we went after serious threats in argentina and brazil and we talked them out of it. we managed to get the south africans to stop. we then had israel, india, pakistan and iran. at every stop, negotiations

achieved unless -- a lessening of the threat. when it came to north korea we have tried to do some serious negotiations. negotiations have failed most of the time because the north koreans failed to fulfill. this is a negotiating situation. a negotiating situation, what are our minimum criteria? well, it's not to come up with your hands out and agreed to get rid of your nuclear manufacturing capability. that's not a negotiating situation. you have to start with no advance criteria and then you have to look at what it is in north korea that they are after. they are paranoid, remember we in invaded north korea william

were -- when we were defending south korea. >> did you have a question. >> yes we can start by recognizing that as a country offering to send an ambassador and maybe mr. trump after the election and get started dealing with them as a serious country, not just simply a threat. >> do you want to comment on that? >> we make it clear that negotiation with north korea is one of our top goals. we've said this morning communication is enormously important. we also made it clear in the report that we recommend we have informal discussions with them. we do believe you can't sit down and negotiate with them while they are continuing to test nuclear weapons and missiles. we have to have a freeze at some point. that ought to be the aim of the

negotiation but we can sit down and start talking to them if they make it clear they will sign up in principle like all the other will have to under the 2005 framework which they agreed to once. then we then we can discuss all of these things. we make it clear in the report that we are willing to talk about forced dispositions and exercises. that's all in the report. we are willing to talk about arm control and i think we all have to remember that the north koreans had a huge threat against our ally, south korea before they even have a nuclear program. there was a severe threat on the conventional side. all of those things can be put on the table and should be put on the table but you have to get to the table first, and you have to get to the table with some hope of achieving a freeze on some of these very dangerous developments. >> we have a question over here.

>> the morning. thank you for invitation. jj greene, national security correspondent. there are those who think north korea already has achieved a militarization of a weapon. we see they continue to test delivery systems. while the concern about the possibility of a deployment of a nuclear weapon on top of a missile at some point is of great concern, i wonder what your thoughts are about the test phase which is, if they do have a weapon, when they get to the point that they start testing, because that's a huge risk. anything could go wrong as with anything they've tested and deployed later. that is a lot closer to us now than them protecting something

and launching it later. i wonder what the panel thinks about where we are now in that process and what your thoughts would be on preparing for the possibility and some idea on what to do. >> thank you. >> thanks jj, i've looked at north korea as almost not having a test phase in terms of the way they have developed their systems specifically which is basically operationally, and they are very content with putting a system out there, firing it and having it failed but learning each time. you can see, just as we've observed the progress they have made, and i would agree, although i don't know but certainly they are making progress with the submarine lunches that are indicative of progress and all of that is what greatly motivated the task force to focus on the urgency with which this is required to be addressed, and the likelihood in

the very near future that he is going to have this capability. he won't go through a test phase. from my perspective i would treat it all is operational right now and be able to address it from a threat perspective as he continues to go through these tests because they can be and they are very, very threatening. >> front row, right here. >> i'm from the naval postgraduate school. i'm an anthropologist by training. i look at this from a human standpoint. one of the changes that i have observed, i came to the pentagon 40 years ago when the admiral was a lieutenant. i met him at the naval academy. >> yes, yes, come on, asked the

question. >> what i want to mention is a change of language where both the vice president and secretary of defense, last spring, used the word relationships. i think this whole question of trying to build relationships rather than going in and saying we've got all this strike, how are you going to do with it. it's a real shift if we are going to move into recognizing how important relationships are. the question i have is how do you start putting that in military education so that you don't have the sense that if you're in the military you fight and if you're in the state department you try to work it out. >> sounds like a good question to me. >> she knew you when you were a lieutenant. >> i would say certainly from my perspective, what i have

observed, and i'm a few years removed now, but during my time as an officer there was a number number of people in the military, in the pentagon working on the relationship aspect of this. the strong preference from the military is we would rather not fight. we certainly can but our preference would be to have a peaceful outcome, to be led by astute policy and doctrine and even astute politics so that we don't get to a point where we have to use the weapons. i think the military, certainly in the last several decades has moved to an understanding of the relationships. not that it's moved away from the ability to fight but the importance of. [inaudible] we are in a much different place

than we were a few years ago and this is a great example. i believe the most important relationship in the 21st century century is the one between u.s. and china. it's driven principally by the fact that though the two biggest economies in the world. we to figure out how to make this work. if this region destabilizes, our economies go bad very, very quickly. it has four of the five largest economies in the world in this region. that is compelling motivation to try to get this right. part of this is our relationship with china which is enormously complex. you can't just pull one piece out and say do this. that's why think what they said earlier was so important. we have to understand this from the chinese perspective. what are their concerns him goals. that said, we cannot get to a point where this young leader puts a nuclear weapon on top of

a missile and puts the united states and our people under attack. that is a line in the sand that cannot be crossed. >> next question, we invite task force members to join in the discussion, comments if you'd like. let's go to the back of the room. >> could i add one thing to that other.that was just made. mike has said over and over again that the biggest challenge we face is our economy and our fiscal problems. that is a military leader saying that. bob gates said at least on two occasions that he would take money out of the budget to beef up the state department if he had the ability to do it. i don't think the type of military wanting to fight and this date department wanting to make a deal, i don't think that's correct on either count. that is common perception and i

think it's wrong. >> a question in the back the room. >> i'm a reporter with congressional quarterly. mr. mauling, when when you talk about the potential preemptive military strike, would that be envisioned as strikes on north korea's sites recognizing that it's now developing mobile missiles or would these be test that you alluded to earlier, or strikes, to destroy missiles launched in the sky. if that's the case, are you talking about developing new types of missile defense capabilities? >> we address this from the standpoint, actually, i'm not overly fond of the word preemptive, really from a self-defense perspective.

meaning, if we believe they are very close to developing this capability which can threaten us , it is important for us to develop the capability to defend ourselves which could theoretically take out launch capabilities on the launchpad or take them out once they are launched. certainly that is a part of that. the missile defense capabilities that actually will be deployed in the region on our u.s. navy ships are part of that as well as the japanese self-defense force in the maritime self-defense force. we also urge the continuing evolution of those regional self-defense capabilities to neutralize that, but it is to prevent that threat from actually being effective either before it's launched or after it's launched. we are very clear in the report that certainly could include attacks in north korea.

>> there is a handrail at the second table. yes, sir. >> gilbert from the forum. my question is, there there hasn't been a word mentioned about russia and no mention of china with its weak implementation of the march 2 un agreement. if russia and china are not involved in these actions, what besides defense and deterrence is intended to make it clear to them that the u.s. takes the situation very seriously? are there further steps expected ? >> the un resolution that we have alluded to in one of the pillars of our report in terms of forcing it strictly was voted

on and four by russia. we mention russia throughout the report. they are part of the five party talks and we recommend they are part of the six party talks if north korea joins. we made it clear that russia has to be part of this and it's clear that was the feeling of the panel. i don't think anybody has any questions about that. >> can we also say a word on u.s. sanctions policy? it's often said that the policy ought to be integrated into the broader leverage of american power. i commend to you on the contribution to the task force and it was very clear that it would be enforced strictly, which china signed on to, and we hope they sign onto with that.

if they don't, the standing regional mechanism that can enforce what we are obliged to do under un obligation is important. there are also other sanctions to this policy. this is an area where u.s. and chinese interests overlap, in shutting down north korea's network of illegal and destabilizing activities. it happens in china and southeast asia and it confronts our allies in the region. these are areas where we should devote considerable attention to try to get on the right side of this. lastly, we need to be prepared to enforce or exert, put in place new unilateral sanctions. if necessary these are steps that the united states will take

they don't faces tough restrictions as around dozen that's not acceptable. we need to increase the pressure in order to get them to come to the table. >> it may seemed like it's just simple. this is a great example of the sanctioned world which we thought we knew something about in 2006 and 2007. we are at a we are at a level now we couldn't even imagine back then. the same is true with the 2270 sanctions. these are enormously complex. there are countries in the world addressed in the report who are ignoring the sanctions but the physical aspect of sanctioning and keeping this material out work from flowing out of a country like north korea,

particularly on the chinese border where china has not been as active as we would like them to be in enforcement of these sanctions, even though they signed up for it when the un voted on. >> back against the wall, the gentleman had his hand up for a while. >> i'm jonathan from brookings. my query is more in the context, not to fault the council but this is either the fourth or fifth study group that the council has undertaken related to north korea over a number of years. obviously this is a problem that alludes easy solution. my query is this, i want you to connect the dots if you can. it's already been alluded to the fact that it's not a change of regime goal and yet when i think about what in essence the study group is urging north korea to do, the only way i can conceive of this is either the end of the regime as we know it or a transformation in the internal structure of the regime and leadership that is almost unimaginable in a dynasty that

is almost 70 years standing. is it appropriate therefore to pose the issue of whether not by design in the report but the ultimate outcome you presume the end of north korea as we know it? >> thank you for that question. i just mentioned that when i was asked to start this project, the first book that i picked up was no exit. you also mentioned there had been previous task force reports, many of which have done some serious work. i want to reemphasize that flexibility in the consideration and dedication of our task force were remarkably engaged, remarkably unified in the need for progressive and serious report. we think this is an important case study for how u.s. policy ought to be made. with respect to regime change,

the position of the report is that we do not take steps to intentionally cause the collapse of the regime which is most likely to occur for internal reasons. that having been said, if this new ultimatum, this new proposal isn't sufficient and they can tune you to defy their un obligations and don't make progress on the steps, the next presidential administration will have to take a serious look at that. we have to look at policy review and that includes questions that do undermine the viability of the regime. as mike said, it's not permissible to allow the north korean regime to exist that can threaten the continental united states with nuclear missiles. >> that would entail military force, wouldn't it? >> that is part of the toolkit,

but there is also, for example, persistent concern that new sanctions could undermine the economic viability of the regime and lead to collapse. one thing we mention is that the north korean economy is different, there is marketization propping up in different areas both licit and illicit markets that are increasing the resiliency of the regime to sanctions pressure and forcing them to have new ways to circumvent the sanctions regime. if it is important to recognize that the sanctions regime has adapted as well and that will involve new pressure and new attention in new relationships. >> question from the front row. >> getting to the point of the implication of the question of having to use military force and regime changes in that sort of thing, it's very clear in the report that's the last resort, but as mike said, were not going

to sit here and see a threat develop against the united states that puts our own people in danger and puts our allies in danger. that's the last resort. if that happens, if if we get to that point, this strategy has failed. the china strategy has failed to. it gets to what they said will not happen. it goes against south korea and that policy would of failed. it goes against the interest of japan so that would've failed and for goodness sake, a war will be devastating for north korea so that would have failed. i don't think this ought to become the front burn off option, this is the last resort. this is a devastating thing with a huge number of lives lost. the biggest risk is to north korea. >> the only thing i would add to that is maybe it's a modern phenomenon because throughout

history, certainly regimes have changed but a regime change lately hasn't been working that well so i'm a little sensitive or we are a little sensitive to advocating for that even though, it's in the report, some discussion on what could be, from a common sense standpoint, would logically get you out to a point you would have a transformation in that regime. as we are trying to figure out what this regime represents, he has executed more people, conducted more missile and weapons test in five years than his father did and 18. you don't know what's going on in his head but the actions certainly start to paint a strategy that's pretty destructive to the region and potentially to his own regime from our perspective, maybe not from his.

>> and lastly i commend to you some of the additional views in the back of the report which we do feel strengthens of the report. they do discuss that consideration in depth and i would encourage you to take a look at those. >> last question, front row. >> thank you. i work on china issues here at the nuclear security fellow. even though i'm a china expert, actually have a? talks. it seems from the discussion here there was a consensus in the discussion that increased pressure would lead them back to the negotiating table. i just spent an embarrassingly, large proportion of my adult life working on a dissertation on how to get enemies to talk to each other during conflict in the bottom line is, the united states seems to think that escalating will get the other side to the table but in the fact it undermines the other

side because they're worried about looking weak and further coercion in the future. given that there seems to be consensus, i'm curious to no, in the discussion were there any voices that talked about perhaps how the increased pressure could reduce the probability that north korea would be willing to talk to the united states? was there a general consensus that the strategy would work? think you. >> easy last question. >> i think there was a general consensus that this would work in a very difficult problem. it's enormously complex. we've had members of this task force who have negotiated this issue in several administrations. it just to the difficulty.

what is changing is the technological development, if you will, of the system which now very directly is coming into the verizon of threatening u.s. citizens and literally the dental united states and we cannot see ourselves getting to accepting that in any way shape or form. maybe that changes the view of how this should be negotiated in the future. >> with that lets think mike mullins, the task force members and observers in the panel and i want to thank you for moderating the questions from new york. thank you all. [applause] [inaudible conversation]

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[inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation] >> today wyoming senator budget committee chair on his recommendation for the reform of the budget process. the committee for responsible federal budget event begins live at 1:00 p.m. eastern on c-span2.

>> on friday defense secretary carter hosted the mia recognition day ceremony at the pentagon. speakers included the father of a prisoner of war and jerry coffee, a prisoner of war in vietnam for seven years. this is just under one hour please stand for the arrival of the party and remain standing for the playing of the national anthem ♪ ♪

♪ ♪ [inaudible] ♪ please stand as the official

party for this ceremony. john cornyn, u.s. senator for and gerald coffee, former pow of war.

♪ ♪ ♪ ♪ ♪ ♪ ♪ let's pray.

almighty god we are honored to be here today on this beautiful morning to pause and remember special heroes in our history who gave so much to their country. we pause and give thanks for more than 140,000 men and women who were held against their will in germany, the philippines, the horrors of the north korean prison camp. we pause and reflect the hundred 40000 that were held in prison camp. over 17000 never returned home to their family. this event they steal our heart to become living heroes. he allowed himself to be captured as he stayed behind to care for the wounded in the dying.

his leadership inspired thousands of prisoners to survive hellish conditions and enemy dr. nation and retain their faith in god and country. it ultimately cost him his life. maybe we feel 9 feet tall and like we could go bear hunting as he was tortured but swelled with pride when he heard his yellow prisoners encourage him with the national anthem and god bless america. our minds pause to reflect upon 83000 fellow warriors scattered around the globe who are listed as missing in action. may we continue to sift through the dirt and force of germany and never rest until william appling ten, and airmen shot over to germany is brought home and buried with his family in the land of lincoln. empower those people who work in the command with the patients, technology and funding to bring marine elwood bailey home to his family in michigan. may we never surrender through

the sacred quest until we bring joel baker home to south carolina. we asked for the divine favor in locating lester, lost in the pacific area of operation during world war ii. may we bring him home to his negative american ancestral lands in south dakota. lord we serve a great nation who cares enough to recognize those who have never come home and to honor those who have suffered by the hands of their captives. i would ask that your favor in locating the citizens of our nation so their sacred chapter in our history of our nation's history can be completed. finally, protect all our comrades in arms scattered around the globe in harm's way. may they successfully complete their missions and return home to their families and we ask all these things in your most holy name, amen. please be seated ladies and

gentlemen, secretary carter good morning senator john cornyn,

gerald coffee, distinguished guests, family, friends, thanks for joining us here today. we gather here to gather to recognize our nations former prisoners of war and those still missing. we recommit ourselves to fulfilling our solemn pledge to make every effort to bring all our men and women home to their families. we are honored to be joined today by former pows, individuals who entered captivity courageously and honorably during world war ii, the korean war and vietnam. people like captain gerald coffee who never gave up during seven long years as a pow in vietnam. thank you captain coffee. thank you to all of you here who

have served and endured captivity as you have. we are also privileged to be joined by family members of those still missing and former pows. senator john cornyn will speak in a monument. his father, tj cornyn was shot down and captured as a pow in world war ii before being liberated. senator, thank you for being here, and thank you also for your commitment to those who serve today. not only in the past, but right up until this day, including very recently when you visited our troops in iraq and afghanistan. it means a great deal to us senator. >> to the families here today and around the world, whether you are still waiting for your loved one, think you for your patriotism, and courage in the face of uncertainty and thank

you for all you have given to this country. since we came together last year on this recognition day, we we've accounted for over for 135 missing service members. missing personnel like julian jordan who served on the uss oklahoma at pearl harbor that fateful december day 75 years ago. for decades, lieut. jordan's remains were among the many, too many, listed as non- recovered. we are asked to identify unknowns in 2015 and it led to the successful identification of his remains and burial with full honors just last night. like lieutenant jordan stories, every missing person accounted

for is a promised matt and i won't stop until we achieve the first possible accounting for our all our missing. right now, far too many families have to wonder about the fates of their fathers, grandfathers, there husband and daughters, the brothers and sisters. we work hard to meet our commitment to yesterday's personnel to honor their service and families, but there is another reason we do so. we know what it means for the men and women serving today. they see everything were doing to provide the fullest possible accounting for those who served before and they know we will do the same for them. indeed we will stop at nothing to accomplish their missions, whether they're standing at their ally or standing up to russia's aggression in europe,

managing change in the vital asia-pacific, deterring north korea's provocations, countering iran's activities for helping accelerate iso lasting defeat which we will surely achieve, they know we will stop at nothing and make every effort to bring them home to their families. that is a promise we make not only to our force of the past but also our force today and of the future. that is why this commitment is so porton and that is why we are so fortunate to have help keeping it. committed family advocacy groups, veterans veterans service organizations and other nongovernmental group support our works. friend and allies around the world serve as partners helping us reach, account for and bring home our fallen. the men and women of the defense pow mia accounting agency work

day in and day out in remote field sites and high-tech lavatories alike, across the united states and around the world to keep that promise and to give hope and solace to our families. today, we can meet our sacred commitment. the force of yesterday, today and tomorrow, thank you for your partnership. thank you captain coffee, senator cornyn, thank you for sharing your stories with us and thank all of you for joining us to commemorate our pow mia recognition day. may god bless you and may god bless this great nation in the years to come. [applause] >> ladies and gentlemen, general

selva. >> thank you distinguished guest, ladies and gentlemen, captain coffee i'm going to break from the script from just a moment and behalf on all of those who wear the cloth of this station we salute you for your patriotism and your courage and bravery. thank you for being here today. it is truly an honor to be here today as we pay homage to often unsung heroes. i extend a very warm welcome to prisoners of war and your family members who join us today. you have taught us the legacy of honor and duty that we strive to carry out every single day. i would also like to welcome the families of those still missing in action. your sacrifice is humbling and we thank you for your faith and your perseverance.

you are, for us, a beacon of hope. welcome to the many of you who are committed to trying to bring every fallen american hero home from foreign shores. we are grateful for your continued determination. national prisoner of war and missing in action recognition day is especially important because it's our chance to recognize the sacrifices of our soldiers, sailors, airmen, marines and others who defend this nation. these proud men and women behind me represent that military heritage. a heritage strengthened by the courageous. of every prisoner of war and member missing in action and all the service members that they represent and we are here to honor today. today is important because we make the time to show how much our heroes, as far back as the world war, the korean war, the, the cold war, the war in vietnam and our recent conflicts mean to every single one of us. we can say thank you to those

who have faced the toughest of adversity and showcase the steel of our american character as prisoners of war. know that we still search for those who haven't made it home. they gave their lives in selfless service in missions across this world for our country. we placed that mission on there so shoulders. secretary carter shared some of those stories moments ago and you will hear more from captain coffee and senator cornyn. it is also important that today we take time to recognize the significance of the sacrifices that every family of every one of those prisoners of war and missing in action have made. to rebuilding their own lives, for for the hardship of not knowing through the difficulty of holding out hope. please know that thousands of people are resolute in their efforts to provide closure to you and your loved ones. we couldn't do any of this without the many organizations that have undertaken this task as a personal and professional

mission. their tireless effort and commitment to ensure we keep the promise echoes our pride in this nation and our pride in the men and women who have dedicated their lives to service. today i want you to know that we remain steadfast in our nations promise to bring home every prisoner of war and every member of our service missing in action military and civilian. it's a promise to the men and women of the past and those who serve today. again like those who stand right behind me. we will forever honor our sacred duty. we will never leave a fallen warrior on the battlefield. the motto that flies on the pow mia flag is one that we have internalized your very core. we will never forget. it's emblazoned on our hearts as is the memory of every member that we have lost in battle and remains missing in action.

i would like to thank every family member that is here, every individual that served in captivity, all of those who long for the knowledge of a missing loved one, and to every service organization who assist in the rebuilding of those lives and the constant kindling of the flame of hope, thank you all for being here today. [applause]

ladies and gentlemen, captain coffee. >> secretary carter, thank you so much for the honor of being part of this event this morning. my fellow pows, admiral bob

shoemaker as a great representative of all the rest of them, good to see you again, bob. pow families and mia families, thank you for allowing me to exercise this honor of recognizing our losses and our wins. i was shot down over north vietnam in february 1966. i was finally released from the communist dungeons in 1973. seven years and nine days. i want to tell you that we pows, sometimes look at our time there in the prisons of north vietnam as another form of combat. we never ever gave up.

we never ever gave in. we never lost faith in our country. as a matter of fact, faith was key to our survival. faith in ourselves to be able to do what was necessary to survive and not just survive but take this opportunity to grow and build upon the uniqueness of our experience everyday. we realized we are simply in a different kind of combat, a combat of resistance. the communist tried to keep a separate as if we would not be able to know that there were other pows in the same prison we were in. we would organize ourselves and if you can imagine, six or seven different prisons, that organization was challenging.

i want to tell you about the pow because it really does illustrate the creativity and persistence and dedication of making the most of that opportunity and taking good care of each other. it's based upon 25 letters of the alphabet and we leave out the k because there's a special name for the letter k. that alphabet was arranged in matrixes of five lines of five letters each, one row on top of the other. the top row consisted of a through e. the second row f through j. the third row, the next five, the next five with z in the lower right-hand corner. it gave me a matrix with 25 letters and from that matrix we were able to communicate with each other in ways that were

just incredible, not only by listening to the top code but by flashing it when there was a line of sight connection. it was very important in giving comfort and solace to one another. when you needed a man in the cell next to was down and hurting and his feet were locked in the ankles at the foot of a concrete slab, his handcuffs tightly behind him, he had been that way for a week or a month, you get up to your wall frequently and you tap to him gd be and he knew that meant god bless and it also meant hang in there, i'm praying for you and you can bet you were. then in the future, he would be on his wall to encourage you the same way.

for example, on the pow flag, never forget and e never forget. never forget. :

>> gda. every single night. thank you for those of you who are gathered here because of your loved ones, for our pows or maybe missing in action even this day. thank you so much for your sacrifices. thank you, mr. secretary, for hosting us this occasion. it's really significant in means a great deal for every person here. thank you. [applause]

ladies and gentlemen, senator cornyn. >> thank you, captain coffee, for sharing that story, and thank you for your service to our country and a great example that you are for all of us. i know your story has serve as a great inspiration for so many, and a beacon of hope for even more. i, too, want to thank secretary carter for the invitation to be here today. running the department of defense is a tall order. thank you for rising to the challenge time and time again. i consider it a great privilege to join you and general selva on

this special day, and i know we're all particularly grateful for the defense pow/mia accounting agency and its predecessors, and a commitment to fulfilling our nation's dramas to the families of our missing military men and women. it i is in honor of gore to be e today with all of you, and those service members who represent those families of the pows and those service members who have not yet returned to our country. today we are properly remember their tremendous sacrifice and the heavy burden put on the shoulders of their loved ones, those of you here in this audience. thank you to all of you for helping us be here to honor these brave men and women. as secretary carter mentioned, my dad served in world war ii. he was a b-17 pilot flying in the 303rd bomb group inc. the

eighth air force stationed in england. they were not as the hells angels. the 303rd was a force to be reckoned with, to be sure. they flew a record of 364 combat missions during the war, and, of course, they did it before the advent of the technology that we've come to take for granted, laser guided gps, guided munitions and the like. their success was not without great cost. they sustained more than 150 missing in action, and 764 of them were captured and were prisoners of war. my dad was one of them, and i can't help but think of them into the story today in the presence of all of you. my dad flew in 26 nations, 26 of those 300 strategic bombing missions over germany targets.

august 26 mission his plane was hit several times by enemy fire. flack at the nose of aircraft. more of it the right wing and the number three engine which erupted into flames, and the third time it hit the bombay. he and the rest of the crew bailed out at 20,000 feet, and they were captured near the french border and sent to stall what 13b, a pow camp in nuremberg. in what can only be described as a pretty awful conditions, food was scarce. i remember later my dad told me that defeat simple white bread tasted like angel food cake. they were lucky to get a daily ration of bread and dehydrated vegetables and potatoes. sanitation was pretty abysmal. the camp was infested with lice, fleas and bedbugs, and illness and disease ran rampant throughout the camp.

and, of course, he was there in the dead of the bavarian winter in an unheated barracks. and like some of our men and women, though he persevered and he survived, and after several months who is liberated by patton's army, came home to texas where he met my mother in corpus christi, and married. even with all he went through, and my dad, like so many other generation, didn't talk about it much during his lifetime, my dad's story was ultimately a happy one. it's about the power of perseverance that captain carter talked about. it's a story about the everything you have when there's nothing left in the tank, and never giving up. and for me it's about the story about hope that comes at the beginning of each new day. but the truth is there are many thousands of similar stories of sacrifice and commitment across

the country. i think, for example, in addition to captain coffee, people like john mccain and sam johnson who i served with, had the honor of serving with in congress. and there's the story of many of you here today, a father, grandfather who survived torture day after day in the japanese prisoner, prison camp during world war ii. or a brother or a husband who vanished in the midst of a fierce battle in the jungles of vietnam or in the rice paddies of correia. or a mother or daughter who was captured on a faraway middle eastern battlefield and endured great hardships at the hand of the enemy. as we remember these lives in these stories of uncommon courage, let's also remember that my father's and your loved ones sacrifice made for freedom and liberty that we enjoy today possible.

six months before the end of the civil war, president abraham lincoln famously penned a letter to a widow who was said to have lost five sons in that terrible war. a note, about 130 words, was quite brief. president lincoln, as you know, knew how to get to the heart of the matter quickly. but he began humbly. he admits to any word of consolation in offer would be weak and fruitless, given her terrible grief. that he ends the letter with a prayer, asking that god give her, the mother, the relief from the tremendous burden of grief she was sobbing and asked that god god would leave her with cherished memories of her loved ones and a solemn pride that she, quote, laid so costly a sacrifice upon the altar of freedom.

president lincoln's encouragement is timeless, and it rings as true today as it must have been. i know many of you have suffered grief and have had the burdens to bear your that's certain, but you can also take in president lincoln's word solemn pride and find enduring hope in the selfless sacrifice our loved ones made in the cause of liberty. today it's good and right that we honor those of you who have made that sacrifice. and i know each of us are experiencing mixed emotions. we can remember with fondness the countless brave men and women who remain missing, but we also remember the survivors, some of whom are with us here today, and their incredible courage and their persevered as pressures of war, fighting each a for survival. and they serve as a great reason for all of us to hope and a

reminder to each of us to never ever give up. for now we rest in confidence that their memories live on in our hearts, and we know that the many sacrifices they made were not in pain. and with each day we strive to leave no stone unturned and no person behind. to the families and friends representing hundreds of men, military men and women, thank you for letting th me honor my , and the thousands of others who were taken prisoner of war like he was calm and the families of those who have lost one's who have still not made it home. may god continue to bless you may god continue to bless our men and women in uniform, and may god continue to bless the united states of america. [applause]

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[applause] >> the department of defense is proud to present at today's observance. thank you for attending, and enjoy the remainder of your day. [inaudible conversations] [inaudible conversations]

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the budget committee chair on his recommendations or the reform of the budget process. the committee for responsible central budget if it begins live at 1 p.m. eastern on c-span2. now, veterans affairs secretary robert mcdonald testified before the senate veterans' affairs committee on recommendations for improving the va health care system. this is two-and-a-half hours. [inaudible conversations] [inaudible conversations]

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[inaudible conversations] >> i'd like to welcome the secretary, and dr. shulkin, we are glad to have you here today. we are going to change the methodology a little bit. we have two votes, one at 2:45 and one following a vote. we will run the hearing continual us. we will waive opening statements to go direct with the dr. macdonald to make his opening 70. we will go into as much to a as we can. when i had to leave, hopefully there is somebody here you can keep it rolling.

with your cooperation, we will work with those two votes to make sure we don't have to shut down. if we do it on for a couple of minutes. the ages welcome everybody to this meeting of the senate veterans' affairs committee. we had a great hearing on the innovations taking place last weekend i think today's it will be as equally as good because of the commission on care was a great project that examines the veterans administration, its delivery system for veterans and it had a lot of recommendations into. a lot of thought-provoking recommendations and i appreciate the embrace secretary mcdonald has given to ideas from others that is coming. we talked about in sino he will have a great testimony force today. let me welcome the secretary of the va robert mcdonald to make his testimony, and we will go there. and welcome, dr. shulkin as well. >> turn one. chairman isakson, ranking member of blumenthal, members of the committee, thank you for this time to talk about va's ongoing transformation of the commission

on care's final report. i wish the house had lobbied the same opportunity last week but neither i nor the veteran service or decisions were invited to testify in person. i asked my written statement be submitted for the record. >> without objection. >> first let me thank ms. schlichting for chairing the commission. i know it wasn't easy but nancy did an outstanding job in keeping things together. over all i see the commission's report as validation of the course we've been on for the past two years. there's hardly anything report we have not already thought of or are not already as part of our own test ongoing efforts. we differ on the details but we wholeheartedly agree with the intent of almost all the commission's recommendations. 15 out of 18. we certainly agree on how wrong it would be to privatize the health care. privatization would be a boon for some health care corporations, but at seven

leaders told the commission acted threaten the financial and clinical viability of some va medical programs and facilities which would fall particularly hard on the millions of veterans who rely on the a for almost all or almost all of their care. there are many things the offers that nobody else offers. we have a unique lifetime relationship with our 9 million patients. nobody else offers that. our mental health care is in or there with our primary care and specialty care. nobody else offers that. be a health care's whole veteran health care customized to meet veterans unique needs including care for many nonmedical determinants of health and well being like education, services, career transition support and housing assistance, disability compensation and many others. nobody offers about. our research and innovation has made va a leader in areas such as prosthetics, spinal cord injury, hermetic brain injury,

ptsd, polytrauma and telehealth. nobody else offers that. if we sent off and in eternity find care they would all lose the choice of integrated comprehensive care tailored for veterans by people who know veterans and are dedicated to serving them. that's what he is to veterans and that's why you don't find veterans demanding community care as the only choice if theyo demand for the only choice comes from elsewhere. it doesn't come from veterans. veterans know better. i have tested mr. mcdonough secretary. when somebody tells me that veterans should only have the choice of the choice program, i asked them are you a veteran? and by and large the answer is no. and i ask have you talked to veterans about his? i get the same answer. then i probe a little more and i found that beneath the banner of choice are always two things, interest and ideology.

let's face it. privatization would put more money into the pockets of people running health care corporations are it's in their interest so of course it makes sense to them even if it's not what veterans want or need. then there's the ideologues. they only deal with the issue in the simplest ways in theoretical terms, government bad, private sector good. that's as far as the thinking goes. thankfully most members of commission were more understanding. on one point i strongly disagree with the commission and that's the idea of independent or director for the veterans health administration. i probably don't need to say much about that since the constitution probably will not allow it but i will say that if the board doesn't make any sense to me as a business executive. would only make matters worse by complicating the bureaucracy at the top is putting the responsibility for bha so that no one knows who is ultimately responsible.

the fact is what i would have a governance board, congress is our governance board, and if congress works the way it should nobody would be talking about adding another layer of bureaucracy to be a. va is not the holdup on increasing access. we are doing that. we have been doing that for more than two years now. va is not the holdup on expanding community care. we are doing that, too. recentered a plan to streamline and consolidate our community care programs last october, almost a year ago. what's happened to it? va is not the holdup on more medical professional or getting rid of real estate that cost us much more each year than it's worth are adding more points of care where it is the. we have a major medical construction projects and 24 major medical lease is needing authorization. they are already funded but we still need a green light from congress to move forward. we are not even the holdup on holding people accountable for wrongdoing.

ask the former va employee and augustine georgia recently convicted of falsifying health care records. is facing sentencing that could include years in prison and thousands of dollars of fines. all told we have committed over 3755 employees in the past two years. we have a sustainable accountability a part of our ongoing leadership training. that veterans first act would help us hold people accountable and to look forward to seeing it brought to the senate floor for passage. the appropriations committee is also approved a budget your equal to the president's request but again we need to see some follow-through. the holdup in our very real and ongoing might be a transformation is our need for congressional action. we submit over 100 proposals for legislative changes that we put in the president's 2017 budget. no results yet. i detailed our most urgent needs, august 30 letter to the

committee. they include approving the president's 2017 budget request to keep up with rising costs and medical innovation. extending authorities to maintain services like transportation today facilities in rural areas and vocational rehabilitation. fixing provider agreements to get long-term care facilities from turning veterans out to avoid the hassle of current requirements and ending the arbitrary rule of on the a dedicated conscientious medical professionals care for veterans for more than 80 hours in any federal pay period. we also need you to act on modernizing our archaic claims appeals process. under the current law with no significant changes in resources, the number of veterans awaiting the decision will nearly triple in the next 10 years from 500,000 today to almost 1.3 million. we submitted a plan to reform the appeals process in june. we developed a plan without of the vsos, state and county

federal officials and other veterans advocates. they are all on board. we just need congress to get on board. on own after what's best for veterans. as you know i'm not running for office. i'm not angling for a promotion. i could've taken an easy job two years ago but i didn't. i answered the call of duty thinking only of giving veterans the benefit of what i learned that were dashed at west point come in the army and but what is most admired companies in the world. and i tried to do that. two years in the transmission process my only concern is to see continue. i know nancy will tell you transformation is a marathon, not a sprint. it will take several years to turn any large organization around. to turn the va around listening to our momentum of change and we can't do that without cooperation of congress and passage of some legislation we talked about. that's an absolute certainty. the commission, the vsos and va are all in agreement on this.

congress must act or veterans will suffer. that's unacceptable to me and i know that's unacceptable to you. so what do we do to break this impasse and get things moving? whatever it takes i will do it. just let me know what it is. thank you, mr. chairman. >> thank you very much, mr. secretary. we appreciate you testimony. dr. shulkin, are you going to testified or are you here for moral support and hard questions? i have one question. i want to get to the members of the committee. we are going to go continuously through the vote. i'm going to wait until the files then took over and vote and come back after i vote on vote number two totally between the votes going back and forth we will be able to keep things rolling throughout the hearing and we've got three great panels headed off by secretary mcdonald and we appreciate you being a. secretary mcdonald, if you would look at recommendation number one, which i know you've read and referred to in your testimony, have you got any idea

what you as with the cost to put implement the recommendation number one to the commission on care? >> recommendation of what is about establishing an integrated high-performing community-based health care network. in our plan in october, i get one of the exact number, i'm sure david will remember it, but we had different levels of cost depending upon what we decide to take on. we are already in the process of establishing that network. >> this editor is referring to the plan planned we submitted ae end of october 2015 where we currently spend right now about $13.5 billion a year in committee chair. that's the combination of choice and community care fund. in order to do the changes we suggest, we suggested we would need $17 million a year because

we want to fix the emergency medicine provision that so many veterans get stuck in the hole. we need the investment in infrastructure to do care coordination in an integrated fashion. we think that that's the best use of money for taxpayers, that it's actually an efficient plan. the commission on care's plan was far more expensive than that. >> and i think it contemplated putting together a network, the va being part of the total network with private sector as well, correct? >> that's correct. >> it can't avoid also do that without a contract with today from two gatekeepers which was but just issue a single seamless card? >> yes, sir. we would integrate the network and would also include department of defense and partners, health service in any other federal partners we have. >> this is not a setup, but just would like to your answer to iss it not to the end of veterans first bill that this committee

passed out of unanimously by the provisions and, therefore, provide agreement and we are expanding opportunity to make that happen and make that possible? >> yes, sir. >> that was the right answer. just want to make sure we didn't. >> i sit in my prepared remarks would like veterans first to get to the floor and we're happy to help in any way we can. >> we appreciate your support. my last question is really a comment. they have the recommendation on i.t., working on the i.t. system in the va. i'm still very interested in hearing how much progress you've made on interoperability under the program at georgia tech which i think y'all are under contract with georgia tech now. i understand there's been a recent breakthrough speak with this. >> first of all as you mentioned, mr. chairman, in april of this year we did certify interoperability with and the department of defense. but under the firm council's leadership, we have created a

concept of what's called the digital health platform. this is really taking with the industry is to a new level. it's going to increase our ability to do interoperability with community partners, which is one of the recommendations of the commission on care. and so what you're referring to is georgia tech issue a fantastic technology center. we developed a conceptual prototype for this, that i think we're looking forward to sharing with members of this committee that we think is really a path forward to take us to a new level. >> we appreciate the progress you're making. senator blumenthal. >> thanks, mr. chairman. secretary mcdonald, i think in your letter the present fashion president dated august 6 or august 2, i'm sorry, 2016 come you indicated that you had concerns about the cost estimates. that the commission put together

to reflect various options on the vha care system model, which range i think as low as 65 billion, to 106 billion in fiscal year 2019, depending on the road with, network management and other factors. i want to say i appreciate that the commission really devoted itself to seeking to improve the va health care system. i certainly appreciate its recommendations but i wonder if you could explain the va's concern with those commission estimates? >> this is the nub of the issue with in terms of the difference between the commission report and our point of view on the network, and i'm sure nancy will comment more on it later. but the question is is how much unfettered access to the private sector do you allow the individual veteran? and who takes responsibility integrating their health care?

we believe that as the va we need to take that responsibility, that when anything goes out to the private sector we still have to own the responsibly for that health care. be integrated chance to be the primary care doctor. and if we don't do that, that the results in not very good care, and also dysfunctional care because it's not integrated. it also results in higher cost care, because those doctors that they may go to, first of all, may not be qualified by us as being capable, high quality enough to be in the network. and secondly may not follow the standards of costs that are necessary to be part of that network. >> i think the secretary has said it very correctly, senator, which is we really do have differences here with the commission on to report on two counts. one is the quality of care we

believe is going to be better with va maintaining a care coordination and integration role. we believe that we understand the needs of the veterans best, and we do support and we embrace working with the private sector. that's absolutely correct, but we believe the va needs to be the care coordinator. but on the cost side, this would be in my view, the responsible just to turn people out -- irresponsible -- with no deductibles, no cost control mechanism. this would be returning us to the late 80s, early '90s when there was just one way cause. so we think the very best thing for veterans and the very best thing for the taxpayers is to do this carefully in an integrated network that the we we propose in october 2015. >> speaking of costs, the commission on care report found that 90% of all clinical

supplies were acquired using purchase cards and that 75% of what the vha spins on clinical supplies is made through this purchase mechanism. only 38% of supply orders were made through standing vendor contracts, which presumably would be more effective and efficient. and i've been told as well that this same issue may arise with respect to medical devices and perhaps other kinds of supplies. that can start contrast as you probably know to the private sector benchmark of 80-90% of supply purchases from already existing master contracts with negotiated price discounts, which they va can do unlike medicare. we are pushing for medicare to have the same options of negotiation. what is preventing the vha from using those kinds of master contracts? >> nothing. in fact, if you recall the

hearing we had on the 12 breakthrough priorities which all kind had here in the city, we did not get the same hearing in the house, one of those priorities is to set up a consolidated supply chain. right now every one of our medical centers has its own supply chain which, as you suggested, if not since ago. what we can do, -- not since ago. what we've seen from our consulted order pharmacy but we do have a consolidated supply chain is our cost advantages tremendous because of the sale that we have and also our customer service is fantastic. it's been rated number one pharmacy in the country for six consecutive years by jd power because of that scale advantage. what we are in the process of doing is building a consolidated supply chain for all of our medical centers. so far we've avoided about $35 million of cost. our commitment was to avoid

$75 billion of cost by december. i think we will beat that. >> thank you. thanks, mr. chairman. >> as a creature everybody in the audience and members of the committee we will take a bit of a different order in terms of questions and testimony. because to pay senator brown backward in a great courtesy for being here on time, given he's got a tough schedule can't go to let him do the next question obama senator boozman, followed by senator manchin and and take everybody else as they arrive when they come. we will keep the hearing moving as fast as we can. >> thank you. i will ask two brief questions. secretary mcdonald, first to you. you correctly note in your testimony that implementation of veterans of choice with is an initial going pains as we all expected. your meetings with veterans and providers and health experts and others, layout briefly the challenges and opportunities that you see for veterans of choice where we are going. >> veterans of choice, we've

made tremendous progress. when you recognize we set up a program in 90 days that affected roughly, and sent out cards to 9 million veterans, we made tremendous progress but we've also make changes along the way. since the original bill we have now changed the way we define distance, a 40-mile limit. we have changed it from geodesic distance to driving distance. that virtually doubled the number of veterans of being able to avail of veterans choice. we also have made efforts, originally the program was designed when we would simply give a phone number to a veteran and they go call your third party administrator. my belief and i know david's is you can't outsource your customer service. we are pulling that responsibly back in. the integration of coordination responsibility, and when not taking responsibly for customer service and we've taken third party administrator employees and put them into our buildings

as they test in order to make it easier for the veteran. where are we headed? about 22% of our compliments every day now or in the community. there are about 1 million veterans that rely on the choice program. there are about 5000 veterans that only used the choice program, which is really a strikingly low number but it demonstrates that most veterans would want a hybrid and even if they have a choice program they want a hybrid. >> they really want to know if they have a choice. they are generally mostly satisfied with cincinnati va or dayton va or cleveland but they want to know they have that choice. i think that's important. >> thank you. >> dr. shulkin, quickly, on their bureaucratic or legislative hurdles that prevent vha from routinely updating facilities, i.t. infrastructure, providing the a medical staff in

veterans the best care possible? >> yeah, i do think that if you ask most of our field hospital directors, he would say that there are challenges. and i think we've seen a really strong direction towards being more responsive to the hospital leaders under laverne tousled leadership. she has established executives to work with vha. we're working together to protect some of those barriers. just as the sector said, as nancy said in her hearing last week, this does take on because we are breaking down years and years of various. but i think we're headed in the right direction. >> thank you, mr. chairman. >> senator boozman. >> thank you, mr. chairman. and thank you all for being here. we really do appreciate your hard work. the choice program has over a million people participate in it, which i think is a good thing. you don't list that as a legislative priority as far as

reauthorization. is it a priority or is it not a priority, or have i misunderstood? >> we look at reauthorization as part of a program to consolidate care. so we believe we did request reauthorization in the october 2015 package that we submitted on the consolidation of care. >> that's good to know speed and we do what reauthorization. >> i which is that this is why you're asking, the program ends august 7 of 2017. without reauthorization we are going to see us actually go backwards. because we have now reached 5 million choice appointment. that's fantastic in this program should be congratulated, and we're just getting it to work. if we could get veterans first pass through is going to work even a lot better. reauthorization is also a priority. >> august 7 is an important

date, but if a woman is pregnant, you know, we really need to know nine months in advance of august 7 whether or not, how we are going to care for her. so the sooner the better. >> right. i guess that was my follow-up, and it's good to know that you cleared that up and that it is important. and truly have done a great job. this being a momentous task. do you have any contingency plans in regard to august of 2017 if the reauthorization? and then also i think you can really hope us at this hearing and in future hearings by helping members understand not on this committee but throughout congress how important it is to get the reauthorization done. >> we are in the midst right now of renewed our strategies for 2017. most of our leaders are at the national training center right now, and one of the things we

have brought up is the imports of communicating that august 7 the date and also the nine months in defense of that. i do think that's critically important. >> just to give you, to quantify this. we spend about $13 billion a year in the kennedy, as the sixers are 22% of our care goes out in the community. 4 billion of that is the choice program. we would have to reduce access to care by about a third in the committee. that would hurt veterans. our contingency plan, we are here to help veterans with the resources that you provide us. we are going to continue that mission and we would at the very best job possible but there's a substitute for what you provide in the choice program. >> thank you, mr. chairman. i do think that's something we really need to work on is to make this clear how important that reauthorization -- >> that was a terrific question at a push into. it gives us our homework to do before the august date next year. we're going to stand in recess

for a moment. we will continue to hearing and senator boozman and i will be back as quick as we go cast are to vote. we will stand in recess until senator moran its year. thank you, mr. secretary. [inaudible conversations] [inaudible conversations] [inaudible conversations]

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[inaudible conversations] >> mr. secretary, pleasure that you're with us as well. i have a specific set of circumstances that i addressed to you in a letter and want to follow-up in this setting today. and i have no doubt but what you and other officials at the va are sympathetic and concerned and want to resolve the circumstances we find ourselves in with a particular employed at a particular the hospital in our state. we have the circumstance, just

to set the background for my questions, we face one of the worst examples, in my view, of lack of accountability at the va with the case of a physician assistant who abused kansas veterans at the leavenworth va hospital, and potentially other veterans at other facilities within our state. he has been criminally charged with multiple counts of sexual assault and abuse on numerous veterans who sought his care and his council. he had a criminal record, admitted on his application for state licensure when he was hired. ..

his position at the va to help those who serve our country, instead of healing them. there are many witnesses who wish to remain anonymous. terminal proceedings have been been -- criminal proceedings have been filed. we have to army veteran brothers who were patients of this individual who felt they had no choice but to go back to this position for their care and

treatment and the quote was the fear of losing what i earned versus the fear of being sexual assaulted again, i don't know which was more important. what an amazing statement for a veteran to reach a conclusion conclusion. i don't know if i should go back because i may not get the care i need if i don't. the victim who asked to remain anonymous in an interview on july 14 when these charges were filed said this, it violates veterans trust. we are dealing with a number of issues that we have to come back to the agency task where caring for our nations veterans are now adding more wounds. i want to focus on two aspects of this. i know your staff has reached out to mine, i assume in response to the letter i wrote you a few weeks ago, but this goes to accountability, something you and i have had a conversation about for very long time.

i want to go to how does somebody get hired with this background and perhaps more importantly, it's it's troublesome to me that this individual was never fired. after the inspector general report, he voluntarily left the va. one of the conversations we have had for a long time is about the ability to fire people at the va and of all the circumstances i can think of, i can't figure out why this would be one in which a person was fired aside from voluntarily retiring. is there something different in regard to benefits and this individual's future. if we could, you had va

officials here in front of our leadership last week. i got what you would expect for me to hear from them and i'm not discounting what they want, they want a zero tolerance policy on assault. i know that the is the case, we want zero tolerance, but we have specific instances here in which the hiring process was faulty and the discharge process really didn't take place. >> any accusation of sexual assault or sexual molestation is unacceptable. as soon as i heard about this, i went to leavenworth and i was there, i dug through the data and i have different data then you have. we need to get together and compare our data because what i understand from my visit and the

documents i reviewed was when this individual, when there was an accusation of this individuals potential of having done this we immediately removed him from caring for patients and did an investigation into firing him, he resigned. we went back and looked at our hiring process and what i was told at the time, again you have different data so i have to find out why i have different data but there was nothing in his file that suggest this was a risk or this occurred. obviously you have different data than i have because this is not something we would tolerate and obviously if this showed up in a person's hiring hiring process, we would not hire them. maybe david, do you have different the data than i have?

>> no, i have the the same information you have, mr. secretary. >> secretary donald, our information comes from you and the va inspector general. a significant number of press accounts as well, criminal proceedings now proceeding in the district court of leavenworth kansas, but i have seen the application for his life insurance in the state of kansas. he voluntarily indicated he has a criminal history which unfortunately the life insurer folks didn't pick up on either but i'm sure that was reviewed when he was hired by the va. in addition to that, are you telling me when someone resigns you lose your ability to fire them? are you telling me he beat you to the punch? >> if somebody resigns they are no longer an employee.

that is true in the private sector or the public sector. if someone resigns, they resigned. obviously they have judicial issues with this individual. i think what we have described is accurate and we would continue to use this as a learning experience we can send a message to veterans about how careful we are but it also goes back to hiring practices and discharge procedure. again i would ask you to respond to my letter in writing.

>> we will respond to your organization and we are a learning organization and we want to learn from our rent mistakes going forward. we will get back to you. again, i want to be careful not to use media reports as proof of accusation so let's let the judicial process play out. we will share with you what we know and we would appreciate seeing the documents you have. >> my information, i met with the inspector general, we have had conversations extensively about this topic and i can assure you what i am reporting isn't anything but what i was told in that setting. >> i have not met with mike on this so i would ask you if you would ask the va professionals, the leadership, would you instruct them to have a dialogue with me and fully layout the

scenario as they see it to me mark. >> absolutely, that is their responsibility. we ask our medical center directors to act with members of congress. >> thank you, mr. chairman, i want to thank you for being here today. this is based on accountabilities that i know you have. i know the hair on the back of my neck raises as i know it does on yours. once we get the facts i think it's important that the driftwood goes and that's probably complementary to that person. it's important to acknowledge that there are millions of veterans on this country who rely on the va and congress needs to be held accountable to.

you smidge budgets and legislative priorities that allow you to do your job. it is our responsibility as members of this committee and the senate to carefully consider those requests and deal with them to do with what is best for the veterans of this country. before you know it, the entire va system is called into question mr. secretary, you are the front of the attack. when in fact we share more than our share of the responsibility. do you believe accountability is a two-way street? >> i certainly do. i provided today one of the most hard-hitting opening statements i could saying that we are in the process of transforming the va, we are seeing effective results but if we are continue

this, we simply have to get a budget and we have to get the legislation that we have been asking for for years. >> we passed the veterans first act out of this committee unanimously 125 days ago. we got to deal with the on the floor and it sounds like we will be leaving town next week which is crazy. i bet. [inaudible] we are we are where we are. i talked to veterans all the time, i know you you talked even more of them, some of them at the va and some of them not to much. would you agree we have some work to do to get the faith and trust back of many of our veterans out there? >> we do. in fact, we measure it, in fact i just got the measure this morning, one of the things we measure, and this is very common in hospitals where people provide customer service or veteran services, we measure the

effectiveness of the experience, the ease of getting the experience and the emotion of having it and i have a chart here that shows that we have made progress. these are obviously lower numbers than we would like but we have gone from 47% trust in december 2015 to 59% in the april through june quarter. we are measuring this every quarter. i'm not happy, nobody is happy with 59%, but that shows that at least we are making some progress and we have a lot more to make. >> in terms of greatest concerns identified by the commission, things like leadership vacancies, staff shortages, a culture of risk aversion, really, what are some of the ways that the va can improve those various issues? >> of our five transformation strategies, the second strategy

of improving the employee experience, training employees, giving them the tools they need, right now we have our top leaders off-site and we are training them in tools like human centered design and leadership, we are moving to one consolidated leadership model across the enterprise which is what great organizations do, we are training them in lean six sigma and providing the training they need. then we give them training packets that they can take back to their locations and train their subordinates and we cascade that training through the organization. that is how you change of culture and that is what we are in the midst of right now. >> okay, so as you all know we've talked about staff shortage in leadership and now montana has a temporary director or an acting director who by the way, i like very, very much.

i think she's doing a marvelous job. when i had a conversation with her two or three weeks ago and she holds people accountable very well. one of the things she talked about was that if were going to get good people, due process has to be withheld. this is a management person that understands that people look at the va and say i have no due process rights, somebody can make any accusation at me that they want and i can be gone without any argument. that doesn't help us fill those leadership positions but also those appeals. could you talk a little bit about, when we talk about accountability, you come come from the private sector. you understand that if you have deadwood on your staff it cost you twice as much money.

can you tell us about that spot. there's people who want to work for the va and yet understand that it's something that if they make a call or go against that culture of risk aversion, somebody has their back. we are. >> we are training the organization and what we called value-based leadership where we are trying to inspire them and i think were being somewhat successful giving the quality of people we have on board. i changed 14 of my 17 leaders. in two years, 14 of the 17 leaders have changed and i think we brought in better quality people. part of this, i've done a lot of the recruiting myself, as you nine know we went to the university of montana recruiting and i've been to over two dozen medical schools recruiting but our applications are down about 78% versus what they were before

the kind of environment and context you are talking about does have a real impact on the quality of the people we get. >> i think that's important to note because like i said, the issue issue that was brought up is totally unacceptable. it's just the way it is. on the same token, i do know from past life experiences, when you've got so many out there trying to make the right call and some at accuse them of something and they don't have any rights, it just just goes counter to the whole accountability issue. >> i mentioned we had terminated 375 people in the past three years. i also said 14 of my 17 direct reports are new. in my opinion the only issue we had around accountability have been the accountability in the legislation that we need but also the interactions we've had with the merit systems

protection board which frankly we all agree veterans first would fix. i think we are ready have the answer in front of us, it's how do we get veterans first on the floor in the past because we all agree that's a potential solution. >> thank you. i appreciate your leadership on this committee. i've told you that publicly that you are a class guy, but we have to get this fixed fast, we just do. >> let me just, this committee did outstanding work for over a year and a half on the veterans first bill which i think is complete in its nature. two questions have been asked. first it's about choice after august of next year. the other question is how do you deal with the production board and accountability in the va.

there are those people in the news media and some in my party and other places that have criticized our bill for not being strong enough on the merit protection board in making not making choice permanent. first of all we deal with the leadership of the va in terms of hiring and firing and taking out from the board which is the right thing to do. number two the accountability, because you have that accountability it will flow from the bottom up because the top is being held accountable. we have been able to get the buy and necessary to do that. all of us want to make sure that choice indoors, but not passing the first bill today which provides for provider agreements in the state would be a serious mistake. some people are saying they don't want to do that. we need to fix choice first and i'm happy to do it. in the meantime let's expand the

opportunity to make the contract agreements and work at the beginning of next year to fix the choice program so it is improved and perfected. i apologize for honing in but when i heard my two favorite subjects come up i had to make a comment. >> thank you for your kindness and consideration please consider me an ally in veteran's choice, particularly the legislation that we would like to see pass. i won't leave this as an open-ended question, i'm not trying to get you but as i thought for further about your response to my question, one of the things i think is true and you could look into is you indicated that he was, as soon soon as we found out about him he was taken away from patient care. as i understand the facts he continued to be an employee after that.

he was removed from patient care but continue to work at the vap the day he removed from patient care was the same day he admitted the allegations and admitted he had a problem and dealt with patients in the way that he did and my point would be that is the moment somebody could be discharged or fired but he was just removed from patient care and kept them on the payroll. to me that again highlights the difficulty in getting rid of not just bad actors but terrible actors. i need to find out what he discovered in his investigation. obviously if you have the case, you fire them. that's why we fired 3755 people. you don't tolerate that behavior >> thank you and thank you for being so cooperative.

i think we will go to our second panel. before you leave i want to thank you not just for your input today but for your leadership over the past two years. i think amazing progress has been made and we have a lot of progress to maintain. i appreciate your leadership and we are standing here ready to help you in any way we can. >> thank you. >> we call our second panel. our second panel, representatives from the commission on care.

when i got the report a few weeks ago i took it home for early reading for lots of reading but i know there is a lot of thoughtful input progress made and i want to commend the chairman and the commissioner and the other members on the work that you did. we appreciate what you've done very much. we are going to hear from both of you today first from nancy and, the chairman for the commission on care. we appreciate both of you being here today and we appreciate the work that you did your both recognized for to five minutes each. if you have any printed testimony you can submit it for the record. >> chairman isakson, blumenthal,

thank thank you for the opportunity to discuss this report and your support and the extension of time that you gave us to complete our work. it has been a put privilege and an honor to create a roadmap to improve veteran healthcare over the next 20 years. the past 35 years i have served in senior leadership rolls in large hospitals and health systems. for the past eight years i have been in michigan serving for 13 years as the president and ceo. my experience in leading henry ford which is a $5,000,000,000.27000 employee health system through a financial turnaround in navigating our organization to the years of job loss in michigan, the bankruptcies of our city in major cities will still growing substantially in

winning the 2007 national quality award have prepared me very well for the demands and complex city of the commission's work. we had 15 talented and diverse leaders. we develop several principles to guide our working including creating consensus and being data-driven and most importantly our focus on veterans receiving healthcare that they receive quality, access and choice. the report you you commissioned was invaluable as a foundation for our work. it's a detailed report that revealed significant and troubling weaknesses in the performance and capabilities. our work took place over ten months with 12 public meetings over 26 days and we sought the broadest input possible, had intense debate and dolly are but had a unified focus at all times. what is best for veterans.

i believe we have produced a very good report that is strategic, comprehensive, actionable and transformative. twelve of the 15 commissioners signed the report signaling bipartisan support. the three who didn't sign had divergent views. one thought we had done too much onto thought we had too little transformation. they require transformation which is the focus of our recommendations. there are many glaring problems including staffing, facilities, it, operational processes, supply chain and health disparities that threaten the long-term viability of the system. perhaps even even more importantly, the lack of leadership continuity, strategic focus in a culture of fear and risk aversion threaten the ability to successfully make the transformation happen over the next 20 years. transformation is not simple or easy. it requires stable leadership, expert governance and an ability to reengineer and drive performance. some of our commissioners

believed in moving va to a payer only model. some believe the government simply can't run a complex health system and that veterans should have the same choice that medicare beneficiaries have. we believe va and undercurrent leadership are making progress, aligned with most of our recommendations and believe that dha should be invested in for several reasons. one is the integrated care delivery and the quality that is comparable or better in most matrix and third the history of clinical innovation and the research in emergency capacity. fourth is the specialty programs and that is the role as a safety net provider for millions of complex and low income veterans that may not or could not be filled by the private sector in many markets. as we know even with the affordable care act, access to primary care and mental health

professionals across the country is still very challenging. our recommendations fall into several categories. dha should continue to provide care coordination and that all of the providers in the network. second the leadership and governance with continuity of leadership and creating an oversight to a board of directors. third is the operational infrastructure focused on it facilities, performance management, hr and workforce, supply chain and diversity and equity. finally eligibility for healthcare benefits and eligibility design. we clearly do not want this report to sit on a shelf and we

ask for your help to make our report come to life to enable legislation that was included that does require your action. we are mindful that some suggestions have implications and we want to work together. we do not suggest congress has not already made some dental investments in the system, rather we call for strategic investments in a much more streamlined system that alarms va care with the community. i would be very pleased to be a resource for the committee as you continue your work on this on these issues and i also look for to your questions. thank you very much it's a pleasure for me to be here with you today to address the work of the commission on care. it's a particular pleasure because for five years i sat where tom was sitting behind you as staff director of the committee.

in my first experience, the vast majority of the a staff at all levels, professional professional and highly committed to the veterans they serve. like many of us, i was was concerned to learn of the issues that came to light regarding the manipulation of wait times for appointments at the phoenix va medical center. i am happy to have been a part of the effort to better understand what had gone awry and to find solutions to those problems today and into the future. service on the commission has been an interesting experience. the commissioners brought their varied backgrounds with one characteristic in common. all of us were committed to assuring that this country's commitment to its veterans was well met. we may have differed on just how best to do that but the face of the commissioner was palpable. under our chair each commissioner had an opportunity to express his or her priorities and defend those should they be challenged.

the final report contains 18 recommendations. some of these are good ideas. others strike me as unrealistic. some are included because one or more of the commissioners felt very strongly about them. the white house made it clear to our chair that they would like a consistent consensus report. i signed off in a report with the expectation even though i had some reservations. i had had a full and fair opportunity to express my concerns in open session. among the many things i learned was that in negotiations on matters such as these, after all of the give-and-take, you have to be able to take what you can, hold your head high and declare victory one more time. that is what i would like to do here. over nearly a year, we discussed a broader array of problems at the va, many of those were long-standing. we discuss those with senior va leadership who recognize

themselves their issues that were beyond their ability to address. i would like to think that by shining the light of discussion on some of those, we may have provided the impetus to professional staff of the va to raise such issues. some quick statistics regarding veterans and the va. in 2008, there were 26 million veterans. 6 million veterans. today there are about 21 million. in 2008 the budget was $68 billion. today it is about 175 billion. in 2008, va had 240,000 employees 40000 employees and today about 368,000. the number of veterans is in decline. we lose about 5 million a decade the total number of veterans, about a third use the va for some or all of their healthcare, many just for prescriptions.

my written testimony, i highlight some of the specific issues in the report that i had problems with. i would of course be pleased to discuss those with the committee what i wish we had done, there are a number of basic commissions that i wish we had address. some of these are things that no one wants to touch such as why do we have a va healthcare system at all. this is something that a number of people asked me. we need to do something for those who are injured in training or combat but the fact is, most of those being treated in the va system are suffering the same illnesses most of us could expect to experience with the passage of time. there's nothing uniquely veteran about those injuries or diseases and in most communities there are ample surplus to treat them in the immunity hospital. some say there are some veteran specific medical injuries like ptsd and traumatic brain injury. in fact, annually, automobile and diving accidents create more

sei patients than the va treats. most of the veterans using the system are medicare eligible. if they use the community hospital, it can just bill medicare. if we are committed to having a va healthcare system, who should be eligible to use it? some people assume that once an individual puts on the uniform they are entitled to free healthcare for the rest of their lives. no need to worry about health insurance ever again. i don't think this is what we want. the system was established a few years ago which indicated that those with disabilities, treatment was the first priority of the system. priorities also included veterans a very low income. is there a better way to her ticket articulate eligibility so that the veteran, and as importantly, the american taxpayer can better understand what the healthcare system is trying to do. who is obligated to provide care for. in reviewing the materials

relating to patient scheduling, i was struck by the fact that the gate keeper for most of va care is a primary care physician. the medical education establishment is just not turning out a lot of primary care physicians. that is a bottleneck that is only going to get worse. over the past several years there has been significant changes in the way healthcare has been delivered in the united states and that too will continue over the next several years. was the commission a success? several of my colleagues believe we can only count a success if the administration and the congress adopted the entire document as we presented it. i personally am willing to declare victory with the changes that they are now making.

thank you. >> thank you mr. harvey. in light of the committee members that have been so cooperative and shuttling back and forth with folks, i will continue to deviate from our normal practice and go out of order by not recognizing myself but recognize the senator from west virginia. - thank you for being so kind as you always are and thank you for being here. do either one of you or to both of you, it's my my understanding that the commission on care's recommendation included the primary care provider to be outside the va. now i understand the access but it worries me that the veteran could receive care outside the va with little or no oversight. that's my concern. in west virginia we have quite a number of va's. i'm concerned that many doctors are not equipped and dealing with va issues.

is a non- veteran doctor trained to diagnose ptsd? do they know that they may not diagnose certain symptoms if they are uncomfortable. these are all valid concerns. i'm speaking because i go around my clinics and hospitals. i. >> guest: all the veterans. what has been done in the past is unconscionable with the wait time and all the stress. everybody recognize that. when i talk to the veterans, they still want veteran care. they demand it. i've asked them. i said if you can't get it they say no no, they take care me here. they they know what i need and how to treat me. that is my concern. in the future, how do you see them striking a balance between making sure veteran issues access to care in the community and the care received is quality how can you say that will happen in private sector? >> one of the things that's very important about our recommendations is that we are not proposing the current system

of having a separation between the private sector and the ba. what we are proposing is a more integrated model. >> who's going to coordinate that? >> va is cordoning that. >> who will be the gatekeeper. >> at the network. select the providers with very strict criteria and in the report we include several elements of that including not only their education and their experience but also their military competency and of course about 70% of physicians train in va medical centers. it's possible that we can create a very well-equipped set of primary care physicians when needed. we also suggest that every market should be carefully evaluated in terms of access needs. more primary care physicians in the facility might be needed in some markets versus others were va has adequate numbers to provide that for veterans, perhaps they would have none. the control of this va care system that were proposing is

the va. that includes vetting the networks, it includes having high criteria for participation and it could be different in different markets based on need. >> i have a question for you. >> let me just add one other thing to address a different partier question. can people be trained to be sensitive to the veteran experience? the answer is yes. i just turned around to rick and i know they have foldout cards that have a number of questions they encourage doctors to ask a person who is a veteran and this is some of that. there is training available. >> our clock is running here. the commission on care that you all characterize as a path that will move va into be more like tricare. i had spoken to a lot of my veterans and they argue that

when the predecessor started offering more low-cost insurance to military retirees, we start seeing the tricare starting to rise. they pull you in and get you on the other and making you pay. i understand many of our veterans are concerned with shifting care outside the da and less services offered and more coming out of their pockets. ten or 15 years down the road, i want us to be able to keep the promise we made our veterans, especially those with unique injuries like traumatic brain injuries, spine injuries, ptsd. my question to question to you, do you think the characterization that the commission on care wants va to be like tricare is true and what would you suggest congress to consider when thinking about the future of the va healthcare? >> actually, senator, one of our members descended from the commission report largely for

these concerns, that if we do this, it is going to be draining money away from the va facilities that are needed. i don't frankly have an answer to that. what would it be likely that copayments would increase? >> we can base the someone has happened previously. if that's the case, i would say yes, our veterans really have reason for concern. they truly should have reason for concern. >> if i could comment on that, i do think it's important to see the balance in the report. while we are suggesting primary care choice when needed within the va care network, we are also suggesting significant improvements in the operation of the veterans health system. >> my biggest problem is opiates. if you have a doctor over here suggesting one kind of opiate, how is that going to work.

who's going to coordinate that. >> the va well, we have to. >> i'm concerned about that. it's the biggest problem i've got my state and the biggest problem we have with our veterans. if you have a doctor that believes they should be treated by pain with pill versus alternate care, you have serious problems. that's what i'm afraid of, i really truly am. va needs have clinical standards for the provider as part of that va care network. those need to be consistent. >> i'm sorry i took more time than i should have. >> you are always timely and to the point. >> i'm just going to ask one question and make one observation. we need to establish an expert body for eligible care and design. tell me what that means. >> i think the feeling on the part of members on our commission was we did not have the time or the focus on eligibility but many people felt

it was time to do a comprehensive review to really evaluate it as a whole and take a look at eligibility standards today and there were members of the commission that felt for example that some of the lower priority categories were not necessary and that the focus should be on service-connected injury and lower income veterans so is felt that that would be something that a separate body could take a look at. >> when you say lower level, does that mean some of them are eligible in some of them are not? >> there's several priority categories, as you know in the question was are all those priorities as essential in today's environment. >> any discussion to expand eligibility beyond just veterans? >> there was some discussion about that as a way of helping some of the facilities more efficient. one example is with the very specialty programs that exist within the va, the volumes are

low and there's potentially a challenge of maintaining those programs and potentially they could, resource within community i think there were a number of thoughts on how to best utilize capacity within va facilities and maintain it and at the same time really look at total eligibility programming. >> lastly and very quickly, the eligibility for a non-honorably discharged veteran, with a part a part of that program? >> yes that was what we made as part of our recommendation. >> it's included in our findings and it basically outlines that for other than honorable, they would be put in a tentative category until it to be evaluated but the idea was to provide the care for veterans that often have reasons for being put in that category that have nothing to do with their service and the honorable service they provided while in the military. >> it was a case-by-case basis. >> yes,.

>> the concern is if you had a veteran who had multiple deployments and served honorably for an extended. of time comes back to the states and decide he has just had it and acts up and is given an other than honorable discharge, not not a dishonorable discharge but one of the other categories. perhaps that was caused by his multiple deployments, meet be ptsd or dramatic brain injury and it would be unfair to leave him out of the va healthcare system. >> thank you very much. >> thank you, mr. chairman, i want to thank the panel and all the great work that you have done and everybody contributed to the report. i want to begin by thanking senator mansion for his passion on this issue with regard to opiates. we are having a similar challenge in alaska and i

actually want to thank them, we had a big summit in alaska with opioid challenges in heroine challenges this summer and we had very tough and top doctors come to the va to alaska for that. i want to thank both of you. i want to focus on an area that i didn't really see in a lot of the recommendations but i know it's in there because it's a really important topic and when you talk about the delivery of care, the issue that of course i'm very focused on in alaska is the delivery of care in rural communities, extreme rural communities. mr. chairman, i apologize, i know i know there's a lot at work and i'm really sorry i missed not having the secretary, i know they're still here, but i would love the gentleman to be

able to chat at one of the breaks about the concerns that relate to this issue. i was back home in my state over the summer like all of us and in a lot of the communities, there just just seems to be a very different approach to the delivery of healthcare and some of the real far-reaching communities in alaska where we don't have roads, we have real unique challenges given the size and distance. some of it relates to how the va interacts with other health organizations, clinics, tribal organizations in the far-reaching communities but one of the things that i saw, because i asked everywhere i went, i went to a number of my communities is that there seems to be a very different standard depending on the community, even depending on veteran sitting next to each other.

i always try to talk to veterans, no matter where i go. some say i can go right down the road to the local clinic or the local native health organizations and some staff to fly to anchorage or seattle and that can cost thousands of dollars just to get to some of these different communities in alaska. some of them say, the va pays for all that and puts us up in the hospital and some say know you're on your own, literally in the same community. i'm just wondering, on this issue, how much you looked at it and what recommendations you have and more broadly, with regard to consistency, it does seem very different even in the same communities different veterans have very different experiences. >> first of all, i think what you're describing is the challenge of veterans health care system. it is so diverse and covers the entire country, to be able to

provide meaningful access in every single part of where veterans live and work. we felt that was one of the major driving forces for more integrated model so that in communities where va facilities may not be available, there is easier access to integrate with existing providers within that community. we also felt that there was a need for better integration with other federal providers which could apply in the native community across the country. the care in this country applies to the challenge that you describe which is true with veterans and nonveterans. in northern michigan we have access issues. in some area we have no obese service within several areas of women who are ready to deliver. it is a challenge and that's one of the reasons we feel it's very important to take a local look

in each market to try to provide better access. the question of why some veterans has va pay for it and others don't, that could be an eligibility determination which i can't respond to, but really looking at the diversity of markets and how to best provide the care and particularly when veterans are moving, it's not as if that veteran population is stable. the facilities available in each market are an issue as well. the need to move from more inpatient to outpatient care is something we are seeing across health care. it's a challenge but certainly something we had conversations on. >> are there relations to this in the care report? >> it really incorporate some of the questions you asked. >> doesn't focus on the extreme rural communities?

>> yes. >> are you okay on time? >> okay will go to senator blumenthal. >> thank you for all the time and energy you have devoted to this very, very important work. two both of you, mr. harvey, i think you raised in passing one of the central questions that faces us, why have a separate va healthcare system and i think you have heard some answers here which we see in our daily lives when we visit va healthcare facilities, not only do veterans want to be with fellow veterans, there are ways that veteran care

is tremendously enhanced by professionals who see them literally daily, hourly for the same kinds of wounds, injuries and so forth and i might just add, in an area that is receiving more research there was an article yesterday or the day before about that he's being done on hospitals and measures of their quality and how when consumers are better informed, not only about the metrics of outcome but also about how they are cared for, actually the outcomes are better when the emotional or social factor is part of the measurement. i think in all kinds of ways i see the va healthcare system as not, why should we have it but

it offers the immense opportunity to actually lead the nation in terms of quality because it provides that opportunity to really attract the best and the brightest as it has that certain va facilities. the challenges it faces has, i think one of you stated in your testimony, the same challenges the rest of healthcare system does. we need more primaries a doctors , psychiatrists, more equipment at affordable prices, more pharmaceutical drugs, it mirrors the rest of our healthcare system. what i haven't seen so far and maybe madam chair you can

address that, consumer protection, making sure that there are policies and procedures designed to monitor the quality of care that veterans receive outside the va healthcare system, the metrics and the evaluation can be applied but what about the healthcare outside the va walls when there are choices offered and a choice program comes into play in whatever form? >> a couple comments to that, the more unified and integrated the so called out side providers are within the va system, i think the greater the opportunity is to really evaluate performance, set standards and apply the same

approach that is within va to that care that is received in the community. that's a very important and different concept than the choice program or the traditional way the beach va is paid for care in the community. within our recommendations, we also suggest that performance metrics need to be very comparable and we should have the same metrics of performance within the community as within va and those metrics should be a requirement of participation as a vetted provider within the va system. i think the more that becomes the model i think it begins to relay some of those fears about care being provided for differently whether it's pain management in the opioid use or other elements of care that are provided. >> mr. harvey, did you want to add anything? and thank you for your service. >> the only thing i would add is that you mentioned, and we address this in part of our

report that this is a cultural competency of the healthcare provider understanding that this veteran has had a particular type of experience and being sensitive to that and as i said, perhaps when you are out, i know they have a little card that they suggest using with various questions to ask the veteran patient to elicit some of the experience so that as you are factoring this into the diagnosis in the analysis, you are giving as a doctor, you have that as cultural competency in understanding the military background is an important thing that you get through a system like the va. you're not going to get it at washington hospital center. >> exactly. >> thank you so much. >> thank you, mr. chairman. >> thank you mr. rosen rosenthal >> thank you mr. chair, thank you for being here and for your

work on the commission. before i get started i want to think senator mcdonald and his team. we had a meeting last week and a lot of people were giving me an update on the transformation and the progress on the breakthrough priorities and they think it's great progress and i thank them for their work as well. i think we are making progress and i appreciate the continued work. thank you both for being here. i'm going to jump to some of the recommendations right think the the va may have some concern or understand why,. i noted that there was a discussion on privatization so i

never miss an opportunity, when i see a word privatization ever mentioned to mention that i do not believe the va should be completely completely privatized , and of story. i don't know anyone who thinks that full privatization is a good idea. i think there's an opportunity for veterans to choose whatever pathway they think is right and necessary to provide timely care. i believe we agree with that and i say that because anytime i see privatization there somebody saying there is somebody who wants to give it to the private sector. i think there's a therapeutic value to some va presence and until i see evidence to the contrary i would never support it. on the other hand, i do think there is a lot of opportunity to use non-va providers and choice and that's what were getting at. recommendation has to do with an engineering resource center used to work at.

i think the va has concerns with this. it probably has less to do with the end result and more to do with the process. we have things that are emerging and i visited nashville where there's a new liberation campaign. they were very hospitable and i was impressed with the results. as a management consultant, i'd be less interested in creating other groups and ways to create a web of subject matter expertise and senators -- centers of excellence and that has less to do with the concept and more to do with the implementation. to have any comments on that particular recommendation? >> i think we have heard in terms of the response that perhaps the burke which was the specific component of the va

that we recommended be the center of this performance improvement work may not be the choice which is really not a big issue for me, but i think the focus clearly is on how to drive performance improvement culture throughout va, focus on clinical and business improvement processes. >> i think that's right on. i see an emerging number of best practices that we need to execute and proliferate but in an orderly way to where we are not burying and creating a hairball of good practices and best practices but, i did want to move to the board of directors one which is probably one where you don't have me. the reason for that is i feel like this committee is the closest thing to a board of directors that we have.

if we have the other layer i would be interesting to know how it is different. if we had that other layer, i think we could have monthly floggings from two different groups and i don't think that is productive. i kind of enjoy our monthly floggings and wouldn't want to share that with anyone. in all seriousness, i think it's something we should look at and i will drill down more in the recommendations. if we have that layer down, i think it could be another level of abstraction that could remove the members of this committee and the members of the whole from some of the details that are going on. i've spent a lot of time with the leadership in understanding the transformation. i think the more we learn about it the more we learn about the progress, the better off we will be. i would have to learn more and read more into the recommendation to make sure it's not putting us further away from that line of sight that i think is helpful.

i don't have any remaining time but i will follow up on recommendations 17. let me put it this way. on bad paper, i think no one has any doubt that there are veteran to should probably receive care because the nature of their separation was related to an injury or event that occurred. their behavior was actually driven by something that was a temporary injury or permanent injury that we just simply didn't know. we talked about it before, shellshocked or whatever we talked about in the past. it's more the implementation and making sure it does not disrupt the va from the things they are trying to get done with the people who are already in the system who unquestionably deserve care. i think we want to work through the same goal. it's more -- thank you.

>> thank you. i appreciate the ideas you put forth. in your testimony you talked about the ongoing leadership challenges facing the organization. that included a risk aversion distrust. separate from your recommendations regarding the board of directors and the under secretary's process, i would like to get your thoughts on how they can get after the risk aversion and the issues. that's an important problem. you might also comment about, we've heard a lot about the senior leadership conferences and workshops, do you have any thoughts if those are working or not working or if we need to change those a little bit? also, things like the diffusion of excellence, is that getting down to the shark tank

competitions, is that getting down to the local level as it should? again, what other steps should we be taking to try to improve the culture which is so very important. >> it's a very important question and something the commission has spent a lot of time on. i would just say first, i think secretary mcdonald and undersecretary shelton are making significant progress. i think the worry we have is not the development work that's going on, it's having continuity at the top for more than a couple of years. it is very hard to change culture when you don't have a consistent pattern of leadership at all levels starting at the top. our concern was how do we have more stable leadership, oversight with expertise, and that was the reason behind the governing board, the board of directors to have healthcare expertise overseeing the transformation process with stable leadership and process.

that is how stable leadership begins to happen in a positive way and people start to take a little bit more risk. there's a culture of safety around speaking up which is critical in any transformation and those are the ideas that we really tried to move forward in our recommendation. >> those things are great. i know they are working with a professor from the university of michigan who i know very well and is terrific. with the doctor has done to really engage the teams is fantastic. >> mr. harvey, we have the long-term challenges that we have had with it solutions. >> yes or. >> particularly as it relates to scheduling, can can you talk a little bit about that? you mentioned there were many years where we spent trying to get a scheduling system.

what's your sense regarding the future willingness to consider off-the-shelf solutions. again, how do we make progress on this front? >> let me start by saying we met with va's chief information officer laverne council and i personally was very impressed and others i have spoken with within the va have been impressed by her experience and she brings a lot to this. my concern is that the va, for reasons that aren't entirely clear to me seems to have just had a terrible time getting it right. what we are now saying that you should do is this very complex new system, commercial office off-the-shelf that will do

health records, payment, business practices with choice of doctors, it will do coordination with the veterans benefits administration and it will do scheduling. it will do all of these things. proof of concept is something that i would like to see because i really honestly don't think they would be able to do all of those things right now since in fact they have not been able to get just a scheduling, that one part, right. the vista system which is the electronic records is an old system. it was one of the newest when it came in. it was the best for a long time and it has been replaced by other systems in transitioning to some other system that can do these other things is going to be a huge job and you want to do it right because it is going to

cost lots and lots of money. >> thank you, mr. chairman. >> thank you to both of you for your testimony and for your months of hard work on the commission. we are going to make sure this is not a dust gatherer on the shelf. this is a thought-provoking that results in the perfection we need to bring to the va. we appreciate your service very much. >> thank you. >> we will welcome our third panel and look forward to hearing from all of them. come. [inaudible conversation] [inaudible conversation]

[inaudible conversation] as our witnesses prepared to testify, let me make an observation if i can. on on the half of all the members of the committee and on behalf of the staff of the committee, i want to tell you how valuable your help and support has been over the past two years.

we have never had a situation where the they were not ready to come forward with constructive suggestions and we appreciate your input very much. sometimes when you are third on the panel you might think you are an afterthought, but you're you're not an afterthought. many of the things we develop here come from the testimony you bring forward and many other things we learned that we should've done differently we learn when you crack desperately want to think all of you for being here we thank you for your testimony and we look forward to hearing from the following individuals. joy we were delighted to have you in atlanta georgia for your annual convention about 3x ago. we enjoyed being there. the president was there as well. it was good attendance from the governments part anyway. lorne augustine iraq and afghanistan veterans of america, commander renee compos, the military association of america, carlos from the veterans of foreign wars and we welcome all

of you to be here. we will start with mr. steele. is that right? you are recognized for up to five minutes. >> chairman isaac men, ranking member blumenthal and distant which members of the committee. on behalf of 2 million americans members of the american legion we thank you for this hearing today. generally the american legion is in agreement with many of the recommendations, however the report contains a fundamental flaw which must be recognized and addressed. the three commissioners that refused to sign the final report, the american legion is aligned with commissioner blackner. we believe that the healthcare system is designed to treat the unique needs of men and women

who have served their country. we also recognize in the best of circumstances there are situations where the system cannot keep up with the healthcare needs of the growing population requiring va services and therefore veterans must seek care in the community. thus we support the creation of fully integrated healthcare networks with the va maintaining responsibility for the care coordination, but these networks must be developed and structured in a way that preserve va's capacity. without a critical mass of patients, va cannot sustain the infrastructure that supports and makes va services world-class. providing veterans better choice as to their provider jeopardizes this critical. we also. [inaudible] we believe the commission's

analysis is faulty. the commission supports this recommendation based on a cbo estimate that was calculated using medicare rates. the commission gave no consideration how medicare rules would apply to the current quality of care provided to veterans through the primary care physician. they are not restricted to the amount of time they are able to dedicate to each patient for the number of presentations. patient. medicare on the other hand only provides payment based on ten or 15 minute consultations which would deny veterans full complement and quality they are entitled to through their earned benefits. if scored properly the cost would be triple if not more and is unsustainable. a better proposal is in the community care program design. it would set up community shared network that would allow veterans to make informed choices and access to high-quality care by identifying the best performing providers in

the community and allowing coordination of care for better outcomes. it rest on the principle of using community resources to better align resources and we believe it has the potential to improve and expand veteran access to healthcare. however, as the va begins to involve more community providers, the the issue of how medical malpractices claims are handled becomes more important. a doctor can file an 1151 claim. it will begin or increase their level of service and it would be covered by va for the veterans lifetime. no such protection exists for contracted care. it is essential to ensure that the current process treats malpractice claims the same regardless of where they receive their care. finally, we recognize that the cost for these reforms remain a significant concern. the plan was presented to

congress in late 2015 and well received on both sides of the aisle. some members of congress thought the cost ultimately we strongly believe this is the cost that must be met for va to meet the needs of our veterans. >> mr. chairman i cannot conclude without remarking on this process. modernizing the appeals process is our number one priority. senator blumenthal has just come from a press conference where he introduced his reform bill. senator rubio also has a bill. there is wide bipartisan consensus in the status quo is unacceptable and must be reformed. we will work with you personally and with the committee. what are we going to do to get this done? with that i am happy to answer any questions the committee may have. >> thankthank you, mr. chairman,

members of the committee, since the scandal on access crisis of 2014, a vigorous debate has taken place about how to best provide timely high-quality comprehensive and veteran focused healthcare to our nation's veterans. over the past two years, there has has been dozens of congressional hearings, numerous investigations, stakeholder engagement, enactment of the choice act, independent assessments and finally the report from the commission on care. all of these efforts were undertaken with the goal of getting to the root of the crisis. we need to transform the va so we can better serve our nation's veterans. we examined the ride range of ideas including privatizing the system but ultimately rejected such radical ideas and came to a consensus on a comprehensive set of recommendations for the long-term transformation of va. we support the commission, the

recommendations as detailed in my written report but i will focus on a few oral remarks that we have concerns with. we support the first recommendation calling for the establishment of community-based healthcare networks. with the va acting as the coordinator of care. va in the independent budget and the community, put forth similar plans for integrating community care into va. the commission plan however does differ in one crucial aspect specifically as mentioned previously, how it would manage the provision of care among va and non- va network providers. in order to reach consensus the commission recommended a compromise option to let veterans choose non- va doctors within the established network, even in a case where va would have timely access and conveniently located options to meet their needs.

this open choice option would increase costs, and shift resources out of va. the problem is if choices elevated as the most important principle they are likely to end up with two parallel systems and veterans will have to choose between an integrated system that is more likely to provide high-quality care and be responsive to individual needs. the open choice option and they noted there is no clear evaluation that this impact would have on the va role as a whole. its ability to deliver comprehensible care, research and education and other critical missions. this option could shift an

estimated 40% of the medical care currently provided by the va into the private sector. this reduction in work volume would undoubtably force the aide to cut services and close facilities thereby depriving many veterans. in order to ensure reliable access to high-quality coordinated care for all enrolled veterans we must have the resource to address the many decisions identified in the independent assessment including modernization of the it and infrastructure needs and the flexibility to organize and manage the networking care provided. we also have concerned about that recommendation to govern the veterans health care system. we support greater continuity of the leadership to support better long-range planning but it would

hinder the ability of the secretary to coordinate interrelated healthcare service and benefit program. instead we recommend the review process for improved long-term planning. enclosing it occurs for the commissioning care report. we appreciate the effort of the commissioners to find workable solutions to complex problems. after two years of intense discussion and debate, there is a clear path forward and it's now time to take action and start working toward health care system our veterans need. thank you, that concludes my statement.

>> chairman isaacson and members of this committee, on behalf of a rock in in afghanistan and veterans of america and more than members, thank you for the opportunity to share our concerns. we know from our member research that our members are increasingly turning to the va for healthcare. in our most recent survey, 29% of our members reported using the va exclusively, up six percentage points from the previous 20%. as more veterans return and as we face the challenges of physical and mental injuries, we need to know that the va will deliver for us. we must get this right. the commission on terror report was intended to map out a path to the va and has pointed in the right direction. we need to inform them of our analysis submitted for the record.

today's remarks will focus on general analysis of the report and three of the 18 recommendations. we have six general comments on the report. one, the report is presented as a independent recommendation. it fails to acknowledge a successive. [inaudible] it will also require extensive time and resources to execute effectively. the report fails to analyze the impact of recommended reforms on the ability to conduct research and train future clinicians. the report does not acknowledge the challenges faced by va due to the misalignment of demand, resourcing and authorities. five, the report failed to take into account reforms and programs that the current

secretary has already planned or implemented. the report recommendations are broad and can be left open to interpretation. as for the specifics of the recommendation, we broadly agree with most of them and the response to the report but we would like to focus the remainder of the remarks on recommendations one, nine and 17. specifically, we oppose external primary care proposes. we oppose the board of directors and we supports a streamlined path to eligibility for other than honorable discharges. on recommendation one, we support an integrated network of care that includes community providers led by va primary care providers managing the veterans care. recommendation one is too broad lacking critical pieces of analysis and with a critical flaw the external provider. it also assumes they could absorb the demand created by such network.

they understand the reasoning behind the board of directors and it agrees that continuity leadership is important for long-term reform. we echo the concerns raised by many including the va and do not support this recommendation in a already burdensome bureaucracy. on recommendation 17 we strongly agree with the need to provide a streamlined path to healthcare eligibility. [inaudible] due to the current process for determining eligibility, it's important to stress that with this change will be a resource burden on the va that will require congress to support with increased demand comes increased need for resources. to close remarks today, i would like to read the irate several points.

returning to the healthcare system would require coordination between the president va congress, partners in the veterans that we all serve. two, these changes will also require a significant financial investment that should not come at the expense of cutting existing benefits. three, these changes cannot be sideload within themselves but must be part of a comprehensive plan to be effectively implemented. thank you for your time and attention. >> thank you,. >> chairman isaacson, the military officers association of america appreciate this opportunity to give our views on the commission on care report. we are grateful for the open and collaborative talk that the commissioners established in order to receive information and feedback from veterans themselves as well as those representing this constituency. overall, most of the commissions findings are supported and we are pleased to see many of the recommendations incorporate the

changes that secretary mcdonald and others have been advocating for since the implementation of the choice act. in responding to the report, i would like to say right up front that we want to see the exhaustive work as a commission and the critical legislation proposed by the congress and administration be enacted this year. the panels before us have already discussed that, the budget, the veterans first act and appeals modernization, those particular ones. let me focus on three specific recommendations. first, we support establishing high-performing integrating community-based healthcare networks. while the va alone cannot meet all the healthcare needs of the veterans, the system does provide a foundational platform in which to build. that is clearly stated up front in the report. we believe new systems need to preserve well-known --

>> we will leave this to go live to philadelphia where hillary clinton is holding a camp and -- campaign rally. ♪ ♪ ♪ ♪ [applause] >> thank you, thank you. i am so delighted to be here with all of you. i saw how much fun president obama had last week, and i wanted to be here in philadelphia. before i begin with my remarks,

i do want to say how proud i am of our brave first responders working to keep us safe after the attack the last weekend in new york, new jersey and minnesota. [applause] there are now reports of a suspect in custody but we must remain vigilant. this is a fast-moving situation and a sobering reminder that we need steady leadership in a dangerous world. i am here to talk about a number of the issues that are part of this election but really much more than that. they are part of our future. a kind of country we want to have, the kind of people we want to be, and particularly, what kind of opportunity we should be providing for the young people of america. i have a proud owl on my staff, to mira early.

a philadelphia native engine native who became an activist working to and nonviolence right here in philadelphia. [applause] she loves temple and we love her i also want to thank lauren for that introduction. [applause] tamra and lauren are two examples of why i do have so much faith in our future. your generation is the most inclusive, progressive and entrepreneurial that we have ever seen. as you've seen, as we heard, when lauren was in college, she saw challenges facing students of color, but there was no naacp chapter to support them and promote diversity and inclusion in campus so she started one.

lauren remains committed and engaged, working with an organization called generation progress. she understands that active citizenship is a lifelong job. the call to service never fades. now, i know with so much negativity out there, it is really easy to get cynical. especially when it comes to politics. i remember wrestling with that challenge when i was a student during the vietnam war. it can be tempting to think that no one will tell you the truth and nothing's ever going to change. you are going to be here today because you refuse to accept cynicism. you know the next 50 days will shape the next 50 years, and you see how much needs fixing and our country from the soaring cost of college to the scourge of systemic racism to the

threats of climate change. you also know the only way we can meet those challenges is if we meet them together. you are here because you believe we can do just that. you want something to vote for, not just against. optimism not resentment, answers not anger, ideas not insult, bridges not walls. [applause]

two very different visions for america. i believe it's wrong to carry each other down. we should be lifting each other up. it's wrong to let income inequality did even worse. we have to make the economy work for everyone, not just those at the top. and it's wrong to put a loose cannon in charge who could start another war. we should work with our allies to keep us safe. it comes down to this. are we going to pit americans against each other and deepened the divide in this country, or are we going to be, as i know we can, stronger together? [cheers and applause] i know what i believe, and i'm going to close my campaign the same way i started my career,

fighting for kids and young people and families. that has been the cause of my life. [applause] and they will be the passion of my presidency, and i hope you will join me. we can't get distracted when the media were my opponent turn this election into a circus. my husband has a thing about that. he calls it majoring in the minors. getting so wrapped up in stuff that doesn't matter, you forget which really important to your future, and the future of this country. take the challenges facing young americans today. first of all, if you're willing to work hard, you should be able to find a good job that pays well, and lets you do what you love and make your mark in the world chai chair.

[cheers and applause] >> try to find her footing in the wake of the worst economic crisis since the great depression. that's why tim kaine and i had a plan, to work with both parties and make a historic investment in good, new jobs. we can create millions of jobs and make life a lot better by doing things like connecting every household to broadband by 2020, installing half a billion solar panels, building a cleaner, more resilient electric grid within the renewable energy to power every home in the country. [cheers and applause] next, getting an education should give you a boost, not hold you back. but as you know better than most, tuition keeps going through the rope, and get keeps piling up.

i understand that temple was founded to democratize, diversified and widen the reach of higher education. that is still a vital goal. so i worked with bernie sanders on a plan -- [applause] we came up with a plan that makes public college tuition free for working families in debt free for everyone. [cheers and applause] and if you already have that, we will help you refinance it, and pay it back as a percentage of their income so you're never on the hook for more than you can afford. [cheers and applause]

you can actually see how much you and your family can save under our plan by looking at the college calculator app hillaryclinton.com. and do something we don't talk about enough, a four year degree should not be the only path to a good job in america. [applause] people should be able to learn a skill, practice a trade, and making a good living because of that. so we are offering new tax credits to encourage companies to offer paid apprenticeships that lets you earn while you learn and do more across the board for welders, machines, health tech nation's -- technicians and so many other fields. [applause] another challenge i hear about all the time is from new parents

about how hard it is to balance the demands of work and family in today's economy. families look different today than they did decades ago. i think we can all agree. most need two incomes just to get by, and many people now change jobs frankly and how widely unpredictable schedules, or they have to cobble together part-time work, all without the basic support available to parents in nearly every other advanced country. that's why tim kaine and i have a plan to help working families with quality, affordable childcare, preschool and paid family leave. we fundamentally believe -- [cheers and applause] the more we can strengthen families, the stronger we will be as a nation. everywhere i go young people also share their concerns about

the divisiveness and discrimination we see in america today. you or not and you shouldn't be satisfied with the progress we've made. you should keep wanting to right wrongs and fight for justice and dignity for all. we see, as lauren said, too many young black men and women make you feel like you like your disposal. too many immigrants living in fear of deportation. too many young lgbt americans bullied. too many young women and men sexually assaulted on campus or in the military or at home. and more than previous generations, you understand that all these challenges are intersecting, and we must take them on together. [applause]

but you also see a republican nominee for president who incites hatred and violence like we've never seen before in any campaign. hate speech been normalized, the dog whistles are out in the open. and yet despite this, i remain convinced america's best days are ahead of us. in large part that's because of the inspiring young people i need every day. i'm inspired by -- i met her in las vegas last summer. she was brought to this country from mexico at the age of four with nothing but a doll, a cross and the dress she was wearing. now she's in her 20s in advocating for the rights of undocumented americans, and comprehensive immigration reform. we should all join her in this.

i'm inspired by mikey who i met in new york. mikey spent six months in prison for a low-level drug offense. after he got out, mikey discovered just how hard it is for people who have done their time to find good jobs and opportunities, but he persisted and he managed to start his own ice cream shop in new york. and i can recommend, it's delicious. we have to do more to help others get that second chance, including by banning the box and reforming our criminal justice system. [applause] i'm inspired by erica, one of the bravest young women i've ever met. her mother, dawn, was the principal of sandy hook school who died trying to protect her students.

erica was devastated, but then she made it her mission to advocate for commonsense gun safety reform. it's been painful for her. a lot of hate has come her way, and the gun lobby is so powerful. at erica will not give up. as she said, what if everyone who faced tough odds said it's hard, so going to walk away, it's not the type of world i want to live in. that's the spirit that makes this country great. we might get knocked down, but we get right back up again. [applause] and we refuse to quit no matter what. and that's the spirit we need in this election, too. now, i know that with washington paralyzed by big money and partisanship, the gap between

the change we want in the progress that politics should deliver can look like a chasm. i also know that if you're totally opposed to donald trump, you may still have some questions about me. i get that, and don't want to give my best to answer those questions. when it comes to public service, the service part have something easier for me in the public part. i will never be the showman my opponent is. and you know what? that's okay with me. [cheers and applause] and it's also true i do spend a lot of time on the details of policy, like the precise interest rate on your student loans right down to the decimal. but that's because it's not a detailed for you. it's a big deal, and it should be a big deal to your president.

so here is -- [applause] so here's what i ask any voters still undecided, give us both a fair hearing. hold us accountable for our ideas. both of us. i can't promise you'll agree with me all the time, but i can promise you this. no one will work harder to make your life better. i will never stop no matter how tough it gets. in fact, you can read about what can and i want to do the we are not keeping it a secret. we've got a book called stronger together. [applause] >> but let me take a little bit about the values that drive me and my vision for the future, because you deserve that from anyone running for president. i want to share with you the stories of three women who at

table a moment changed my life and set me on the course of social justice, activism and public service. the first one is my mother. her name was dorothy. she was abandoned by her parents as a young girl. she ended up out on her own at 14 working as a housemaid. when i learned about this, many years later, i asked how she managed to grow up into a warm, loving person, and not become bitter and broken? and here's what she said. one word, kindness. she was saved by the kindness of others. like the teacher who saw she had nothing to eat at lunch and brought extra food to share your a lesson she passed on to me was simple but powerful. no one gets through life alone. we have to look out for each other and lift each other up.

she major i learned the words of one of the treats of our method is faith, to all the good you can for all the people you can and all the ways you can, as long as ever you can. that mission guides me still today when i stumble. it helps pick me up. because there's always more good to do and more people to help if we keep our eyes open, especially kids. when i met a terrified little girl in nevada who burst into tears because she worried her parents would be -- hit me right in the gut. i knew how hard-working parents were. i knew the sacrifices they were making so that she could have a better life. when the little boy in flint, michigan, who got sick from drinking water poisoned with a lead, it just made me so angry and determined to work even harder. every one of our children deserves the chance to share in

the promise of america. the second woman i want to tell you about is marian wright edelman. she was a lawyer for the naacp in mississippi. first african-american woman to pass the mississippi bar. she was an ally of dr. king and robert community, the founder of the children's defense fund. and altogether remarkable person. one day during my first semester in law school i saw a flyer on a campus bulletin board. and she was coming to give a lecture. i make sure to be there, and what i heard was captivating. marian talk about creating a head start program in mississippi, and using her legal education to make life better for poor children and families. something just clicked in my brain. i began to see how i could translate a commitment to helping others.

i learned from my mother, my church, into real social change. i went up to her and i said, could i work for you this summer? she said sure, but i get to you. i said, well, i am paying my way glasgow side to get a. she said if you can figure it out to get paid, you can have a job. so i figured out how to get a grant to get paid and went to work for her. after graduation i could have followed my classmates to a high-powered law firm by went to work for marian at the children's defense fund instead. she sent me door to door in new bedford, massachusetts, on behalf of children with disabilities who were denied the chance to go to school back then. and i remember meeting a young girl in a wheelchair in a small back porch of her house. she told me how badly she wanted an education, but it just didn't seem possible. my heart went out to her and they wanted to help, but it became clear to me that simply carrying is not enough.

that would not -- to build more wheelchair ramps for put more resources into special education. i learned that to drive real progress you have to change both hearts and laws. so we gathered evidence we built a coalition, and i work helped convince congress to ensure access to education for all students with disabilities. and that experience turned me into a lifelong advocate for children and families. i went to south carolina to investigate the plight of 12 and 13 year old boys imprisoned alongside grown men who had committed serious felonies. in alabama i helped expose the racism of segregated academies. in arkansas i ran a legal aid clinic that provided representation to poor families, and imprisoned inmates who could not afford it. when bill was elected president a lot of people were surprised,

and even threatened, by the idea of an activist as first lady. i wasn't about to quit being either. i fought for universal health care and ended up working with republicans and democrats in congress to create the choice health insurance program which covers 8 million kids today. [cheers and applause] >> the third woman who changed my life was named sophia. the 17 year-old captain of the high school basketball team in new york city. it was a late -- it was the late 1990s and the democrats were urging me to run for senate, and i kept telling them no. after all, no first lady had ever done anything like that. i myself have not run for anything since student council. i had always been an advocate, not a politician, but they one

day i visited at school in new york for an event with young women athletes with billie jean king. hanging above our heads was a big banner that said there to compete -- dare to compete. before my speech so he introduced me. she was tall, and as we shook hands she bent over and whispered in my ear dare to compete, mrs. clinton. dare to compete. once again something just clicked your four years i have been telling young women to step up, participate, go for what you believe in. could it be i was afraid to do something i had urged so many others to do? well, it was a difficult transition, becoming a candidate for the first time back in that new york senate race. even all these years later, i confess, i don't enjoy doing some of the things that come

naturally to most politicians, like talking about myself. but i took that leap been for the same reason i am running now, to even the odds for those who have got the odds stacked against them, especially children and families. i've learned in a democracy if you want to the greatest number of people, you have to push for reform from both the outside in and the insight out. we need activists and advocates. entrepreneurs and innovators, teachers and mentors, people who change lives every day in a million quiet ways. we also need strong principled leaders who can win votes, right laws, allocate resources, and do the slow, hard business of governing. now, of course, politics can be discouraging. this election in particular can be downright depressing sometimes. not it matters, it really does. it matters for our families, our

communities and our country, in the world. our most cherished values are at stake. every election is important, from school board to state senate to president. but this time is different. we are facing a candidate with a long history of racial discrimination in his businesses. who retweets white supremacists, who led the birth of movement to delegitimize our first black president, and he is still lying about it today. he refuses to apologize to president obama, his family and the american people. we have to stand up to this hate. we cannot let it go on. [cheers and applause]

and when we do that, we send a clear message, america is better than this. america is better than donald trump. just as important, we have a chance to make real progress together in our country. [applause] i need you, i need you as partners, not just for winning this election, but for driving real change over the next four years. the fight ahead of us are bigger than one election, one president or even one generation. it's going to take all of us working side-by-side to build

the kind of future we want. that's why if i'm in the white house, young people will always have a seat at any table where any decision is being made. [cheers and applause] so if you believe diversity is america's strength, not america's burden, join us. if you believe -- [applause] -- the minimum wage should be a living wage in the woodworking full-time should have to raise their children in poverty, join us. [cheers and applause] if you believe that climate change is real and that we can save our planet while creating millions of good paying clean energy jobs, join us. [cheers and applause]

if you believe that every man, woman and child in america has the right to affordable, quality health care, join us. [cheers and applause] if you believe we could finally guarantee equal pay for women, join us. [cheers and applause] and here's how you can join us. go to iwillvote.com and register today. registered your friends, register everyone you know. this is going to be close. we need everyone off the sidelines. not voting is not an option.

that just plays into donald trump hands. it really does. [applause] text join the 47246 right now or go to hillaryclinton.com and sign up to volunteer. i understand here at temple you are already organizing campaign delegates at every football game and having a lot of fun doing it. [applause] we have 50 days, 50 days to reach everybody we possibly can. to not only win an election that's just the first step. vindicate the progress going, going even further, make it up so it clear that we are going to shape a future there represents the best of who we are. to talk to your classmates, talk to your neighbors. help us stand up for our best values and reject prejudice and

paranoia. [applause] you know, i mentioned my mother and the kindness she experienced. her life was so neglected that when she went to work as housekeeper and/babysitter at the age of 14, it was the first time she ever saw a family that loved each other, where the parents love their children, cared for them, planned for them, where she learned the lessons that enabled her to be such an extraordinary mother to me and my brothers. everything i've learned in my life convinces me that love trumps hate. [cheers and applause]

so please join us in working together. there's no doubt in my mind that young people have more at stake in this election than any other age group. and when you turn out and vote this fall, we will be sending a message much larger than even the outcome. we will say we can build a future where all our children have the opportunity to live up to their god given potential, no matter who they are, where they're from, what they look like or who they love. that's the america we believe in. that's the america we are fighting for. that's what we've got to do to stand together. we are stronger together, and let's make sure love trumps hate. thank you all. [cheers and applause]

♪ ♪ ♪ ♪ ♪ they don'

>> hillary clinton wrapping up at temple university in north philadelphia. if you missed any of our coverage of this event you can see it on our website c-span.org. live now to capitol hill where the senate committee is meeting of ways to reform the federal budget process that is hosted by mike enzi and the center for a responsible federal budget. >> convened bipartisan to the budget committee to discuss possible reforms in this book for several suggestions for reforms of the budget process, and ideas for consideration which hopefully will lead to bipartisan legislative action. this year or next year. so we are very pleased to have chairman enzi here. chairman enzi is an account.

by background, which is good training for the position. served in the wyoming legislature from 1975-96 and has served in the senate since 1997. and has been chairman of the budget committee since 2015. with that i will introduce mike enzi for his proposal. [applause] >> thank you. i understand that the announcement went out with just my name on it, and i'll let you figure it would be really short. i'm the account. that's the penalty you pay. but one of my favorite cartoons was a guy with a trenchcoat on and a half. he says just because i'm an accountant doesn't mean i'm not dangerous. [laughter] we do have a broken budget

process, and it occurred to me that congress is kind of like a binge eater. we want to diet right after the next dessert, and we all have an idea for a recipe for a dessert. be just a bit different than anybody else has ever done it will be really good and it will save money. just had to put a little investment up front. yeah, okay. that's how they got to the problem which is $20 trillion in debt, headed to $29 trillion in debt. i usually don't use the word trillion because that's a thousand billion, it's a huge problem. the budget act was passed 40 years ago and it's been followed to completion four times in 40 years. so there something wrong.

i passed a budget last year. it was the first one to balance since 2001. got to remind you in 2001 they were able to stick a whole lot of salsas three bonds in their drawers and spend the money. but this one had the balance in spite of that. the budget lasted five months and then is the accurate deal to keep government operating, and depending on which numbers you used, that cost us about $76 billion to balance, no, to be able to spend what we wanted to spend. 70% of the budget is on autopilot. we don't get to discuss that part at all. the payments are automatic and they are in law, and that forces the other 30% to use budget gimmicks. we often take a loan from the future. an example of that would be the

bill that we passed last week on water develop to have a little peace and, therefore, click michigan. earlier we were having a bit of a recession we gave some and send to automobile dealers that would do electric cars. well, the incentive didn't work out very well so there's a lot of money left in that fund, but that was an emergency fund. member, these are all supposed to be for shovel-ready projects. that money was supposed be sent right away so the economy would blossom and grow. it hasn't been used. parts of it have been used, but in the bill they were asking to use what's left in 2020 and move that forward and spend it right now. $299 million. that was the amount of overspending. there isn't any money to move forward because i was emergency

money, which means we invented it. that's one of the problems we've got. we can't invent money by causing emergency. incidentally, to emergencies never end. there's no ending date for the that's why 2020 some of this money can be used. so we take a loan from the future. and we use the emergencies. now, when i came to the senate i noticed that there were $5 billion worth of emergencies every year from forest fires to hurricanes and earthquakes and other things. 5 billion a year. and i said, if you know you're going to $5 billion worth of expenditures, why isn't a part of the budget? well, it's too hard to get them a if you don't make it an emergency. so you will notice in last year's budget we also put in, it's as good at it, it's not $7 billion. i put in $7 billion a year

through all 10 years for emergencies. some years it doesn't cover it, some years is more than enough. another little problem we have is budget formats. i discovered this is budget chairman. the president has the format for his budgets, which is the same ones we work with by the budget committee has a different format than the president's format for the same dollars. and then the appropriations committee has a different format than the president or the budget committee. and i'm pretty convinced that's intentional. it so you can't follow the money. the odds don't workmen, and even -- products don't work again. even within the administration budget, the products don't work because department of defense uses a slightly different formula for how they know take things, how to allocate things than the treasury does it was

supposed be keeping track of it. another problem we've got is we don't look at older programs. i mentioned this diet. one more dessert. we've been doing a lot of deserts over the years. i noticed we had, because i was on health, education, labor and pensions and was the chairman of the for a while, and i noticed that we had 145, 119 preschool programs. 119. i looked to see what the difference was. the main difference was that they were named for a different senator. [laughter] and i checked to see how they were working, and most of them have evolved from educational process to a babysitting service. they shouldn't pay the same amount for a babysitting service as you do for an educational program. i started eliminating. i got to talk to a lot of mothers and children, but we got them into babysitting services, if that's what they were really looking for. the education programs usually

required a mother or dad or both be at the sessions were part of the session so that they could learn as the child learned. by any rate i got that down with senator community's help to 65 programs. and since that time i've gotten it down to only five programs. one of the difficulty with reducing the program is they are in all different agencies. i didn't have jurisdiction over most of those. you can't eliminate something you don't have jurisdiction over. so two years ago when the bills us able to get an amendment passed almost unanimously that those have to be reduced down to five programs in all be put under one department, department of education. it passed but it hasn't happened yet. i've had a plan for a long time with the federal debt that's that any plan.

i figured that if we took 1 cent off of every dollar the federal government spends and did into we start balancing the budget, we could do that in seven years. now, i've been talking about this pretty place, including senior centers, because they would include social security. it would include all of the mandatory spending that we do as well as the other spending. and i'm pretty sure that if we did that come after one year people would say, that hurt but it didn't hurt that bad. if i can say this country for my grandkids, i will go 2%. now we've got it out of three years. three years is what we need to be. i've been trying to balance the budget since i got here and i've been sending back 20, 25% of my own budget each year. doesn't make much of a dent though. our budgets are passed out according to population of the state.

i have the least populous state in the nation's like it the least to budget with, but am still able to send back 20, 25%. interest rates are going to eat us alive. that's why we have to do something and we have to do something right now. we are almost $20 trillion, $20 trillion. it's pretty easy to do the math at 1%. 1% interest on that is $200 billion a year. doesn't buy you anything. but that's not the norm. and norm for us is 5% for the government. if it goes to the and if they could go to that in the next three years, multiply that 200 billion times five and to come up with 1 trillion. do you know how much we get that isn't mandatory spending?

1,070,000,000,000. that includes defense, highways, includes almost everything you can think of that's a regular expenditure of the federal government. it even includes federal employees. so i do know how we spread that $70 billion out. we are not going to be able to. we are going to have to make changes and drastic changes. i'm from a state that knows how to make changes. wyoming has had a balanced budget requirement since it became a state. and we are in a little bit of a throw right now because they have been doing in coal mines, and my county provides 40% of the nation's call. so in one week hundreds of employees got laid off. the president did say if you're not a coal miner this will not affect you. the railroad employees the next week or laid off by the thousands.

didn't believe him, and that has gone down through the economy. is what is done to the economy. if the legislature can see something coming they have to make cuts during the 20 days that they do the budget. it's a set time every year for every of yo you for doing it thy do biannual budgeting. so they cut 8% of the budget. when the next revenue reviews came in we found out that wasn't enough. when they are not in session the governor has to make those cuts. so the governor made another 8% of cats. now, he's discovered since the economy is going down even more. so he said we have to do another round of those, i think i believe that for the legislatu legislature. the legislature will be meeting in january. i'm sure they are thrilled. but that will be 24% out of the budget. can you imagine if we get 24% out of the federal budget in one

year? the whole federal budget. wow can't do that. we're going to have to have some solutions that will get things going. another problem we've got is regulation. there driving down the gross domestic product. that's the private sector productivity, and interesting statistic that i found on that was that if the economy improved by just 1%, the federal government would have 430 billion more to spend without raising taxes. warehouse the economy gone? 2.7, down half a% by. that's a thousand billion dollars we've lost. so i just got a report that the overspending for this year is now projected to be $590 billion. how significant is that?

i told you really get to make decisions on a thousand and 70 billion, so that's a pretty gross overspending. of course, it isn't all out of the discretionary funds. the other funds to up, even though their mandatory. but when they go up we have to take the money out of the discretionary money. so there's less and less to work with for defense and highways and education and all the other things we do. so i don't get invited to speak to a lot of places because i'm so depressing. [laughter] but there are solutions, and we've been working on those as the commute in a bipartisan way. we've been holding a bunch of hearings to see what other country are doing, how businesses do it, how other governments do, how states do it. there are not a lot of states we can draw on for positive

solutions but there are some. and we've gotten some. i'll start with some of the bipartisan solutions. one of them is put everything on the budget. now, of course, that would get a huge outcry, so i have phrased that a giveaway. let's put everything on the budget that doesn't have a source of revenue sufficient to cover the expenses each and every year. what i did was just put everything on budget because none of them have the dollars to sustain themselves out of the revenue that's been dedicated to them. highways is one of those examples. received money from other places now -- highways is to get gas tax, gas tax covered not only highways but all the other transportation infrastructure. but we decide we don't want to raise taxes, so we don't do that now. and while and they sent it were not going to get that federal money be better raise the gas tax. and they raised the gas tax in spite of all the threats everybody would be gone, the

surprising thing was nobody lost their job over that. because they saw the need for the highways to be better. that's the logical way to fund it. something that's directly related to the project that is being done. we don't do much of that around here. another idea we've got for solving the budget crisis is to have mandatory for time for appropriations. set aside two of three months each year that you just new appropriations. we ought to skip the cloture motion to proceed to that particular appropriation. we've got to talk about them anyway. there's still an opportunity if they want t to filibuster it and do that at the end of the process. you cover with the spending could be. so mandatory time for appropriations. i mentioned wyoming has, their budgets such as '20s and

that's all you talk about, and less you can get a two-thirds vote of the people with absolutely no debate. that's an emergency. another thing we do is wave the small budget point of order, which cost extra votes, but put a bigger trigger for the bigger expenditures. right now in the senate it takes 60 votes to pass a bill. well, it also takes 60 votes to ways a point of order if you're going to able to pass the book anyway you're not worried about the point of order. but sometimes those are huge points of order. so both sides have agreed that needs to be a bigger trigger for large violations. another thing would like to institute is a table of resources for a portfolio approach. that means they would be a connection between spending and results, and we would create

budgets of committees that would to portfolio reviews of expenditures. what am i talking about? let me give you an example. in the housing area we have 140 housing programs. kind of like preschool programs. 140 housing programs administered by 20 departments. now, you think some of the must-have seven, some some of the must attend. no. all 140 are gaveled in but all 20 agencies. nobody is in charge. nobody sets goals. nobody checks to see if the housing is actually providing housing for the people that were anticipated to give housing. we met with some folks from new zealand who went to this portfolio approach. and housing with one of their portfolio areas.

they found they had a lot of homeless people and most of them were ex-military people, and so they want to build a bunch of housing for military. and they did but they review it every year and a renewed connection they have just as many homeless veterans as they had before. maybe we are not doing the right thing. when you look into it they said, mental health. these people are living out there because they're afraid of everything or have a number of issues but they just don't want to be enclosed in anything, so they shifted the money to mental health and the reduced homelessness. so we've got to get to some kind of a process where there's a portfolio with somebody in charge, requirements, goals. we check to see if they meet the goals. if they meet the goals maybe we give them more money. and if they don't meet the goals we take a look at what those goals were and figure out why they didn't work.

another thing we do is eliminate the voter rama. i do not give witness of that but both in committee and on the floor we have this process where you don't have to turn your and in in advance. you can turn it in up to the very last minute before the final vote, and it has to be voted on. and less you personally decide not to the vote on it. people usually wear out after a couple of weeks of doing that. they are usually just political points that are being made and have really no relation to whether we're going to increase spending or decrease spending. but we've agreed to eliminate that voterama. it's in committee, it's really come and afloat, it's an ambush approach because you don't know what's coming. when i became the budget chairman i went to senator sanders and said i know that the to the quick of doing this budget is i would get the budget

together and we would meet on wednesday and yo to our opening statements, event i would like to see what the budget is. and the next day we would amendments until we are tired of amendments. i'll tell you what i'll do. i will give them to you several days or a week in advance if you will agree to provide the amendments to for hours before we do the voting. so people can look at them and see which responsible and see if there needs to be some power and minutes and that sort of thing. we didn't get agreement on that, but i think we have some agreement now to start doing that so that it becomes a more bipartisan approach to responsible amendments with limitations on the amendments. talk about some bigger reforms, i think those are pretty big but there are bigger ones that we could do, need to do but they are a little tougher to sell. we need to have a new budget commission like the bracket commission or simpson-bowles.

i was one of the cosponsors of the original budget commission and was disappointed that some the cosponsors got off and we didn't have enough votes to do the commission. but president obama said we're going to do a commissioner he appointed bowles and simpso sinn to have it up and they did it. but i think more participation by more members of the house and senate would give a little bit more agreement, and if you're able to down into pieces i think it would be more of a possibility of getting it through, and then we could vote on it in pieces as well, and it would be an up or down vote. it would not be amendable everything that could make some huge changes. another one that i'm pushing for is how the finance committee each year set the spending guardrails. the finance committee is taxes. that's the revenue.

so they can figure out what is logical that they can do during the year and what is logical that those taxes that are already in place will bring them. and i would have been that this vibrant and would be based on the revenue that is anticipated, and interest rates, a debt to gdp formula, and we would vote on it. and then we would have to stay within that as we did the budget process. i would also like to see us go to my annual budgeting. i think it's essential we go to my annual budgeting. there isn't any entity in the world that deals with as many dollars as of the federal government does, and we don't ever look at it. we are going to an omnibus this year. that means a couple of people going to sit down in a room and figure out what all the great expenditures are for this country. there is no relationship between

the committees and the appropriation subcommittees. i know that lindsey graham said that he and pat leahy sat down and worked out the foreign relations budget in the few hours. well there isn't anybody on the subcommittee from foreign relations. and they think they out to have some input on target for relations money is spent. that's why we have the of the writing process, but the authorizing process is a little out of whack. the for sure i was budget chairman i noticed there were 260 programs that were expired, that we're spending money on. and it was 293 and a half billion a year. that's a lot of money. so iheart on that a lot -- iheart -- connection we're down to 256 and 260. but we spent $310 billion. we increased the amount of

spending on the ones we still have to work authorized. we've got to look at the programs on a regular basis, but there's no incentive to do that. who gets any credit for eliminating a program? i can tell you from and limiting programs you don't get credit for it. you catch hell. but it has to be done. another thing we could do is have a regulatory budget, and i think this is absolutely essential to this idea we got from one of our hearings from canada. in canada the way it works in order for you to get a new regulation he got to eliminate an old regulation. we've got to have some incentive to go back and look at the older programs and old regulations that we've done. they didn't get into having it have to be the same amount of dollars as the new one. that would be a good goal as well, but they start out by just

wanted to get rid of some old ones so that, before they did new ones. and one of the things that they did was to make the records were budget were each agency could get credit for once they eliminated without doing any regulation. so they would have as a storehouse, possibility when it came time to do a regulation. we thought that was a pretty good idea. we are to have a capital construction budget. right now if we say we're going to go and you should over the next five years, we put the money in this year, and the president gets to allocate how much of that gets spent each of the years. and it is possible to run out of money for the five years before you get to the five years and even if there are not cost overruns, which usually confused the process of law. so capital construction budget would help a lot. so essentially what i'm saying is we need some honest accounting, more detailed accounting, so more timely accounting.

and i think we are on a path to maybe getting that done. i was hoping that it would be done before the election. that's part of the reason why we've had this bipartisan approach to it. as we been working on it nobody knew who was going to be the majority in the senate. nobody knew who the president was going to be. and we still don't. but up until we do we can be very reasonable protecting our own rights. afterwards, majority were probably want to make some drastic changes on their own. and that doesn't work very well. you have to both sides committed to these things, particularly the budget because times change. so we do know -- i've got to go back to my biannual budgeting one more time because i left out the fact that it was the route to do its budget each year, and we do the six tough ones right after an election in the '60s

you want before the next election. that would give us a little more opportunity to put some traction in it, but it would also make that two or three months that we set aside to do the budget feasible to get some detail into it, which is something we really need to do. we could do a biannual budget, and that's worthwhile anyway because then every agency would no for two years the money that they have to spend. somebody said that should save us 5% just on that pre-spending 50 right at the end of you to make sure they use their whole budget so they have an excuse meeting that amount of budget for the next time. so we only do that kind of spending once every other year. we do know what did you. got to remember, we just want one more dessert before one more election if we go on the diet. thank you for your attentiveness. [applause]

>> so thank you, chairman dempsey for that. i'm going to be moderate our panel. i'm the editor of political -- hopefully a few of you our readers. feel free to reach out and we can talk about what you like and don't like afterwards. i'm going to introduce the band of what they're going to say, then i'll let each of them speak and i'm going ask them questions after they're done and they will take questions from the audience. if you have questions please write those down on your cards and staff will pick them up before we come to question time. first we have chuck, principal of the federal budget group with three decades of experience with budget, health and tax policy, including work of the senate finance committee and the senate budget committee and the white house office of management and budget. chuck will discuss proposals regarding senate rules and procedures.

next we've got steve redbird has been 1.5 used as a senior official in the office of management and budget and department of housing and urban development. steve is a lecturer at the george washington university and directs this go study for the centers on public service at george mason university. .. there responsible for federal budget and the deficit reduction commission. he spent many years as a budget aid.

he will talk about setting and enforcing physical goals. let's start with chuck. thank you. >> it's hard to believe that i started my career here on the senate budget committee 33 years ago. time really does fly. first i would like to congratulate all the staff at the committee for responsible federal budget for turning federal budget budgeting and responsible budgeting into an important bipartisan issue. i also like to commend the chairman and his staff are taking on budget reform and doing so in a constructive bipartisan manner.

they have gone above and beyond terms of reaching out and gathering viewpoints from both sides of the aisle. we don't see enough of that right now so it's highly commendable. i entirely agree with the goals the chairman set out and we certainly need to make resolutions easier to pass and harder to ignore. we need to modernize budget concepts and address long-term debt and add predictability to appropriations. i appreciate the opportunity today to comment on the very specific proposals. first the chairman mentioned voter reform. this has occurred because there is a time limit on consideration for budget resolutions but even

after the time expires, senators can can continue to offer as many amendments as they want and they are able to force votes. it wasn't that way at the beginning, but somewhere along the way people figured out that this was an easy way to force political votes on a broad range of issues and it's so out-of-control now that they end up being dozens, sometimes more than a hundred votes which are completely nonbinding and have no impact on anything except tough political votes. ending that would be a positive step to streamline the budget resolution and make it a more impactful and sensitive document. from my view, i think the most effective way to stop it would be to have a 60-point vote of order against any amendment

unless they impact spending totals, revenue totals or adopt new budget enforcement procedures. that would stop cold all of the nonbinding votes. that is a thought to consider as the process moves forward. the proposal for budget concepts commission, that is also a very good idea. the commission last reported in 1967 and the major proposal to come out of the 67 commission was to create the unified budget were all the spending and trust funds were included in one budget, same with all the revenues. the logic behind the unified budget is that we ought to be

able to see the entire impact should be able to see the impact on the entire economy. economists like to look at the natural effects to figure out the economic effects of the budget. the unified budget has turned out to be of problematic concept or at least one that requires some rethinking. we might want to consider redoing the federal budget that operates more like state budgets, for example, which have separate operating budgets and capital budgets. this would be a very useful and impactful thing for the budget concepts commission to address and all we have to do is look at the one or $2 trillion in

infrastructure that is outstanding in our country and you begin to understand, maybe were not doing long-range investments correctly. the third point, annual budgeting, this is an idea that bounced around the entire time i been working in this area. it started back in the 80s and it's been discussed perpetually. wearing my omb hat and an agency perspective of having more certainty makes a great deal of sense. i do have a great deal of concern from a senate point of view and that is and my strong feeling after working for one of the senior appropriators for six years, one could argue the

oversight that has been done is during the appropriations process. you have very up to the hearings that go into great detail on what the programs are dealing and before switching to annual funding, some thought should be given to the effective oversight that happens during the appropriations process. we often don't think all of this is happening because the appropriation bills are never brought up individually but all the committee work has already been done. the committees do all of their work and delve into the bills very carefully in the issue of what is the appropriate oversight needs to be discussed before switching to biannual. another proposal is to have dedicated time to considering appropriation bills on the floor by reserving all floor time between may and august for

appropriation bills. i understand the motivation behind this but has been my experience that the problem with bringing appropriation bills to a vote is not adequate for time, the principal reason for not getting the boats are the filibuster and policy riders. if the objective is to bring all of the bill to about, maybe we should consider ending filibusters the same way we don't allow them on reconciliation bills and also making policy riders a violation of senate rules. a fifth item that has been discussed is a fiscal commission to bring the debt under control. this is a huge topic and i could talk at length about this but i won't because it's very limited.

i've seen commissions produce very good results. i was on the task force back in 2010 and both commissions did very fine work. i urge everybody to go back and look the reports. they have a a lot of good analysis and definition of the problem. however, we need to be extremely cautious about turning over critical fiscal policy decisions to an unelected and unaccountable commission, especially if there's going to be a requirement to vote up or down on their plan without any amendments, without any filibuster. if this kind of approach is going to be used than there definitely is some merit to it paired there needs to be at least an opportunity for members to offer amendments in there ought to be adequate time to

consider the plans they bring forth. finally, i just wanted to take one minute to mention a few other ideas that could restore public confidence and the ability, one is a joint budget resolution. that would require the president and congress to agree on a budget framework at the beginning of the fiscal year instead of waiting for the 11th hour. another is eliminating the debt ceiling. the debt ceiling itself accomplishes nothing. the debt is the result of the spending and revenue decisions are ready made by congress. going through this routine every year or two or three where we threaten global economic catastrophes, it's just irrational. we should just eliminate the debt ceiling. it doesn't accomplish anything.

automatic cr, we also should give some thought on how to prevent the constant risk of a government shutdown every october 1. if we put into place and automatic cr that would continue to allow the government function and would do a lot to restore public confidence in the government by eliminating these fiscal cliffs that happen every couple of years. restore pedigo. pay go is one of the most effective budget mechanisms that congress has adopted. at first adopted in 1990, it was reenacted in 2010 and a has been a very effective way to prevent spending and revenue legislation from making the debt problem worse. thought ought to be given to how to require congress to live according to the dictates and finally, we ought to consider

the content of the budget resolution. it's not taken seriously right now because nobody understands it. most of the budget resolution, and i know this because i had to draft some of them when i worked for the budget committee, most of it is allocating it among the budget functions. nobody has any idea what those are a nobody cares. let's get rid of the budget functions and let's instead make it a very short document that looks at budget categories, defense discretionary, nondefense discretionary, healthcare entitlements, other spending and interest on the debt. if that was the extent of the budget resolution in the debate was focused on that, i think we would have a much more robust process and people would understand it and it could help to restore some faith in the ability to govern. i hope i haven't gone too much over my time. i appreciate the opportunity to meet with you today. [applause]

>> there are many people in this room who have experience with the federal budget process. as we all no, most of the time and energy that we spend every year is focused on marginal choices, increase this program of this and increase spending for this other program and tweak this policy here and over there. it's a necessity where most of the time and attention is given. the process as we know is also stove piped. it's divided for convenience and facility in getting things done. also by subcommittees, committees whose jurisdiction and still piped on tax policy that are separated in the process from spending considerations. finally, it's focused almost entirely on the budget year and not on the multi-year implication implication decisions that are being made.

these are characteristics that are result to economize and simplify what would otherwise be in unmanageable set of decisions on the budget every year. this way of proceeding misses opportunities. we have looked at it and we think there is an opportunity to reconfigure the process to make room in it each year for considering a small number, perhaps the major policy objectives and for each of those objectives there is an associate portfolio of spending programs, often spread across multiple agencies, tax provisions, tax expenditures and they favor certain sources or uses of income that relate to a particular policy objective and regulations and other policies. that portfolio is relevant to an analysis of the government's current implicit strategy for addressing the particular policy

objective. paul and i call this policy budgeting. for higher education, for example, there is a general bipartisan bipartisan agreement that the federal government should have a role to play in expanding access to good higher education. without leaving students and their families overburdened with debt that in some cases they won't be able to repay. there's also the satisfaction in many places with a current set of policies, the current strategy for achieving progress toward that goal. the two major candidates have proposals to change policies there. this looks like an area that is ripe for a portfolio review. such a review would take the evidence on what works and doesn't work and apply it to current strategy and analyze alternatives they might be able

to generate budget savings and priority or other priorities including deficit reduction. that's the general idea of portfolio budgeting. is where the senators proposal comes into play, the proposal is to organize subcommittees within the budget committee that would focus on major policy objectives and would lead and organize these reviews. they could turn to gao, for example for recommendations for policies that are right for review based on the work that they do regularly on duplicated programs. they can also seek advice from other committees on what the set of goals are to be reviewed in a given year. then having made their selection

they could then, over a period of months asked other groups to do an in-depth review of that set of policies or that portfolio relative to each goal and make recommendations on how resources could be used more productively perhaps. then the allocations made by the budget committee and their allocation committee could be the way to implement that change in policy. that in a nutshell is the idea on how the senators proposal would be a step toward implementing portfolio budget. >> before i discuss the budget concept, i want to begin by

thinking you for holding a series of hearings and for the other senators who participated and asked good questions and made good observations. i hope that what he has started on will be some serious bipartisan negotiations on how the budget process could continue. i wonder if mr. cain will be involved in that in a different context. as you no, the budget process is badly broken. one of the good indicators of that is the problem we have is that we don't have the appropriation bills on time and there are some procedural ways to try to reduce new ways and consider new bills and i agree that some change of filibuster rules and other rules are all needed but i think more importantly, to endorse what

steve just said, that's not the most important problem we have in the budget process, congress really has a difficult time difficult time using the budget to allocate funds in a way that would improve our collective security and improve our living standards. the process is really not well designed to do that. i guess i also want to praise the senator for being brave enough to take on portfolio budgeting which is really a very base reform of what our much-needed changes in structure and process. they are actually quite threatening to many incumbents right now but if we don't consider that over the long run, or in difficulty, they have talked about some of the work that has been done in the past and i think it's well worth reading. it will not really eliminate the basic challenge we face. the parties are very polarized. it's really difficult to reach compromise.

sometimes however i'm a what that means is that the budget process can be difficult as it is. sometimes the difficulty of the process has been multiplied by disputes about how to meditate measure budgetary disputes. that's been the case for student loans, family family housing, social security, infrastructure and it looks as if parties agree on anything these days we need to spend more money on infrastructure or more money intelligently on infrastructure and i wonder how we are going to deal with the problems we have in accounting for those increases in expenditure if we do them next year. what we should really want to do is have parties not fight over petty question of how much a program cost but rather whether programs are effective and affordable. if we can reduce the estimating uncertainties about how much programs cost, we can focus on the real issues. that's why the concept is needed in my opinion.

forty-nine years ago president johnson appointed a commission full of experts and they did suggest some big changes for the 69 budget which i think was a a great advance and should not be dropped. that commission support still has some useful guidance for the very smart people and some of them in this room who make decisions about how much programs cost. just last week, in oral testimonies, the current director said those concepts need to be modernized and endorse new commission to do that. in many previous leaders have written about this and i commend to you a brookings institution policy brief on this issue that they wrote, time for new budget concept commission. in effect i want to go down there list on my list on what this commission should do and talk briefly about how it can be structured. among the issues that this

commission has to address and one of the best measures of the deficit is the national debt. another is to what extent should scoring be used for policy changes within major macroeconomic areas. should private entities be on budget or off budget? should the capital investment be made. it's a big issue. does the trust fund approach that we use measure the finances of entitlement and infrastructure programs? should it be used not only for credit programs but also major insurance programs and the disaster relief? to what extent should other contingencies and risks be included in the budget? there are some big ones out there such as global warming. what's the most accurate way of

comparing tax references to regular programs? one thing he didn't emphasize that i would like to emphasize is not just focus on spending programs but also tax expenditures. for example the housing for higher education you cannot do a comprehensive review of those programs without looking at how the tax code is used to incentivize this behavior. finally, should fees collected by the government be used as a netting or grossing issue. i think a new budget is widely agreed to be needed, at least among budget experts. it can work well but it has to be structured well also. to me there are three criteria for success. one is the staff of experts from the executive branch and the legislative branch from outside, academia and interest groups, the second is balance and composition.

in other words not stacked to deliver a particular result. third, actually being open to comments in much the same way the regulatory process is supposed to be now with notice and comment. it's having widespread discussion on some of these issues. to the extent that they can reach agreement or at least at the very least propose different alternatives than let the congress and president take the report and deliberate. have actually had very helpful negotiations over the past couple decades, starting with the act in 1990 to come up with keeper principles. some of them make no sense as far as i'm concerned and some make a lot of sense. it's time to look at them and see how we can connect them to their broader goals of the budget process. if there's a way to make that process successful, then instead of being distracted by accounting disputes which are really minor when it comes down to it, the congress can focus on the big policy choices. thank you for the opportunity to

discuss this. i would be happy to answer any questions that you have. >> one final recommendation that you put forward was to have forcible targets which i would like to talk about. having physical goals is a very good idea. we testified before the budget committee on those goals. a physical goal can be an important means of enforcing fiscal discipline and if it's taken as a credible commitment with procedures and enforcement mechanisms, it could provide a way of assurances to the public. there is no single right level of debt or deficit so there is no single right physical goal other than a reasonable physical goal should be aggressive enough to approve our condition but be realistic enough to where it's an unrealistic effective goal. setting a physical goal is an

important first step but it's not sufficient. it's of little value if her not working toward actually achieving that goal. establishing a goal without rules for compliance could actually allow congress to take credit for taking action without doing anything. to reinforce the physical goal, it is important that the accompanied by fiscal rules to enforce the goal. while the processes and a substitute for political will, putting putting in place rules and procedures to secure policy makers toward a physical goal can be acceptable and helpful. ideally, fiscally rules would be put in place and established to make sure we stay on the path. alternatively rules. [inaudible]

this could be done through the current budget process, the president's budget could be required to include reduction within the financial goals and it could be required to include to achieve that reduction. we could set up a process that will require the president to submit and the congress to vote on a plan to reduce the deficit if if it is not in compliance and is quickly accompanied by a provision allowing an upward vote on proposals by rank-and-file members that would achieve that physical goal. unfortunately congress is incapable of making some of the tough choices and compromises that are necessary. as a result, they have suggested

to meet the goal of commission which was an idea first suggested by mr. conrad. this would provide a venue to make the tough choices and trade-offs that policies have been unable to make in the regular legislative process. this is the model of the national commission on fiscal responsibility and reforms but added with a requirement for an up or down vote on the recommendations of the commissioner. the senators have regulation that would meet every four years to develop policies to put the budget on course. recently they introduced an act that established the commission to develop reform for many programs. in establishing commission at important to set rules to make sure the ar bipartisan without

setting a bar for support which is unrealistically high. i would argue there should be an upward or downward vote on the recommendations and if congress disagrees can still consider alternative recommendations through the regular slater process. they require action to be accompanied by credible enforcement recommendations to give the lawmakers ability to make tough choices necessary and stick with the plan. this can be done as carrots or sticks. the stick approach could take the form of trigger if lawmakers fail to enact legislation. a trigger should be as broad as possible applying to most if not all spending as well as revenues in order to give policymakers an ability to avoid the trigger and spread the burden. the trigger should require

savings by the physical goal but it might actually work if they could achieve more savings to give congress an incentive to enact the savings. a carrot approach could reinforce the goal specifically to provide suspension of the debt limit if the actual debt was at or below the target of gdp. this could be implemented through the so-called mcconnell rule allowing the president to suspend the limit approved by congress if the debt target was met. alternatively legislation could provide for incremental increases each year in multiple steps. the potential to avoid a politically difficult vote would give the president and congress an incentive to enact the fiscal

plan to follow through with any actions necessary to keep the budget on course to meet the goal. this approach would create an incentive to act upon fiscal responsibility policy before it occurred. [inaudible] a fiscally rule is not a substitute of choices however if properly structured, fiscal rule would ensure compliance and it can be a valuable tool to achieve it. i would also like to, that congress did reinstate into law but the problem was they learned they could add a separation into the bill saying none of the cost of this provision is used for pay go so they can avoid it. a simple rule would be to prohibit congress from including

that provision and require a separate vote in the house and senate to include that language and require congress to raise the debt limit by the amount of the violation of that time. if we did that than the pay go rule in place could be much more effective. i look forward to your questions >> thank you so much to our panelists. i have a few questions but if folks have questions they should write them down on their note card. before i get into some of the individual proposals -- the biggest proponent in this is for anyone and we cannot multiple people discuss this, the biggest proponent of process reform on capitol hill appear to be republicans. they are definitely moving

forward are trying to move forward but they are largely around alone. i'm wondering should democrats be afraid that budget process reform is simply a new way for republicans to slash spending and is there a way for process reform proponents to indicate that this is in good judgment. >> i think some budget process reforms can advance a certain policy agenda so that's definitely a concern but there are many that can make the process more transparent and accountable and don't have to be biased toward certain policy outcome. that's why i commend the chairman for having bipartisan discussion. in trying to identify areas for reform process that are here to try to advance a certain policy

outcome but are trying to advance of making the process more transparent and accountable. >> i come at this from a semi-unique perspective. i worked on the republican side at half the time i was on the hill and the other half. [inaudible] both sides have legitimate and serious concerns. on the republican side the concern is that unless realistic goals are set and enforced, there is no way the unsustainable growth in public debt is going to be addressed. on the other side, democrats have a legitimate and serious concern that if you adopt outside the context of looking at the implications of those goals on entitlement programs and income support programs, you're not really having a full conversation.

i do think there is room for both sides to come together and recognize that we do need to stabilize the growth and we do need to examine very closely the implications of reforms to the programs and i think the evidence to that is diminishing. they were both bipartisan and they both made serious substantive proposals. while both sides have serious concerns, i do think it is very reasonable to believe that a fiscal commission could be successful. >> to start i disagree of chuck's description of the sides. i think there are some that are

concerned about that as well. in both parties, there is quite a diversity of opinion about the extent to which aggregate fiscal discipline is needed and how it will be defined and how the process could be reformed. remember that goal, as as well as the other goal is that they own more important which is serving their constituents and if you will the micro level of budgeting, designing designing programs that work well. i think your point that is correct is that chairman prices out there in some sense by himself and that there is little support for his opinion and we think this is a partisan game and they have not participated in the hearing at all whereas in

the senate there have been serious participants on the democratic side and they have made very clear their desire to have certain positions be included in a bipartisan package so senator whitehouse has has emphasized for example more intense discussion of how tax expenditures in certain situations. i did not see that highlighted in the proposal for them to be truly bipartisan i think you need to see senators from both side of the aisle stand up and say they've reached a deal. much like senator kennedy and senator hatch did on some issues the real curveball that could be coming, i'm not sure which way it will curve is the developing election in terms of who wins the presidency and what's the balance of partisan control in both the house and senate so i think we will just have to wait

for that election to occur and however it shakes out, see how we restart negotiations if there are going to be any in 202017. >> on portfolio budgeting, the biggest obstacle, it seems to me at least is the turf wars that would come if this was tried across the executive branch but even on capitol hill where you have lawmakers in charge of certain policy areas and many on both sides of pennsylvania avenue would be resistant to giving up authority on that. what you see as the biggest obstacle and how do you overcome something like that? >> first of all it's easy to see this happening quickly and starting in the executive branch because the president can reorganize the process if he or she chooses. i agree that even in the

executive branch is going to be difficult because of the traditional iron grip that treasury has on revenue policy. it would have to be a white house decision to change the process there. congress would hesitate to advise reorganizing congress but it would be a much more difficult task and probably require a major realignment of forces. i think the key would be support from the leadership, perhaps in reaction to a executive process that is more focused on national goals, taking charge of the agenda and priorities in the budget process in making the budget committees their instrument. put the chairs of their preparations and the revenue committees and other major committees on the committee so it becomes a centralized decision-making process for the budget which some people thought it might be in the beginning but

the appropriators pushed back and weakened it and prevented it from happening. it could still get there. >> one quick point for my finance committee background, we do already have an example of portfolio budgeting at the finance committee because the finance committee has jurisdiction over both the healthcare entitlements as well as the tax expenditures that impact health, for example the exclusion of employer-provided health insurance. there we have an example of one committee having jurisdiction over both sides and also when there's reconciliation, when the committee is ordered to reduce the deficit by a certain amount, it can actually do that in a fungible way, moving savings from the spending side to the revenue side and vice versa. i think in looking at broadening the portfolio, the financial

committee provides an example of how that might be expected to operate. >> ed and others, obviously chime in "after words". it feels like were getting a taste of of fiscal goals and the difficulty of enforcing them with the spending caps which are still under what congress and the administration have shown they can't really live with them and it increases spending under bipartisan deals. what lessons do you take from the 2011 budget control act in particular? i give out fiscal goals and enforcing them. >> first i would say the bipartisan deals that were put east and this sequestration have some extent been a success

because they came up with offsets for sequestration. it was post to force congress the to make policy decisions to reduce the deficit and with some exceptions, it forced congress to enact policy changes. i think the biggest lesson is the need for a mechanism to be broad-based. the enforcement for the budget control act was almost entirely focused on discretionary spending. it needs to be broad-based looking at spending and revenues that is harsh enough that both sides want to avoid it. we got to a point where some were willing to let sequestration take affect.

alternatively, may be the approach of the carrot would work better in trying to avoid. [inaudible] , that could also work. >> i will disagree somewhat. i understand the frustration that led many very smart patriotic people to vote for or advocate for the budget control act and trigger mechanisms and so on, but i don't think it is possible for the congress to in effect force itself to do something it doesn't want to do. social scientists have jargon about that. they say rules are endogenous. if you're going to set a rule it will force you to do something you know you're not going to do for electoral reasons or reasons that you think is bad policy and you will eventually change the role. that's why we have the ryan murray agreement because the

discretionary caps going down to their level were not very sensible when you think about that program. i would hope that eventually we move away from that likely to fail trigger approach to empathize what ed suggests is more of a carrot approach. i think to me the real ^-caret is again, being able to adopt policy that will make the country in the world a better place to live and allocate funds more intelligently and the way to do that is to follow steve's lead and take the information you get from the executive branch and elsewhere and have congress sift through programs and really decide if it's for their own benefit and the countries benefit to fund those programs at a high level. that's the way we are going to not only reach fiscal discipline

but do what congress is supposed to be doing in the context of a budget process. >> the fundamental problem with the dca act is that it's lopsided. the caps are only on the part of the budget that's been under the greatest pressure. we have triggers and rules that contribute to the problem. we have to consider putting everything on the scorecard including all spending and spending to the tax code and having a universal scorecard with targets for savings and so on. i think that's the direction that would also lead to bipartisan support eventually for reform. >> okay, i will take a few questions from the audience. thank you for sending these up. first we have one from bloomberg

news. with mandatory spending taking up more of a total budget, is it time to address the drop in the programs in the discretionary budget. for example of research and development is going to continue to keep dropping causing economic impact. >> that's a very good question. it's kind of the issue i was raising when i discussed the budget commission. the 67 commission created a unified budget and in so doing it created a very odd situation where in order to do any long-term investment because everything is part of a unify annual budget, you have to provide most of the money upfront and that just doesn't work. you end up subjecting infrastructure and r&d and anything long-term to annual

budgeting. hopefully, if the commission is created and i think there is a critical mass to create it, we will start taking a look at budgeting the same way states to where there is an operating budget and a separate long-term investment budget. >> the budget process seems to focus on mandatory spending and it does on discretionary spending. 80% over the next decade will be on social security, medicare and medicaid. if we don't control those military program you will continue to see spending on other domestic investments declining continuing to decline. we are ready see that with sequestration. we cut into domestic spending.

there's a reconciliation process that requires committees to make changes in mandatory programs to the budget. a useful step would be requiring budget resolutions to include those who make changes. they should spend more time talking about what steps it's going to take it to control mandatory spending instead of having so much focus just on what the discretionary budget is. >> one of the general difficulties associated with budgeting related to both the previous comments is that a lot of decisions have been made now and affect us over the long run. the longer you go out, the more uncertain they become in many cases. you have a dilemma, i think chuck is absolutely right, you could be paying a stupid penalty by charging upfront the cost of

making big capital investment if in fact those capital investments turn out to be very useful to you in the future, they are valued and they laughed and they work well. on the other hand, the dilemma is sometimes we buy things that turn out to be junk or we don't like ten years later. maybe we should recognize the fact that we are obligated upfront. what they would have to do is wrestle with this dilemma and buy into mandatory programs as well. it is true that social security is underfunded but in the long run we have to figure out something to do about it. the sooner the better. that program is going to be around in the decisions we make are going to be valued or not valued by future generation, they're just be stuck with what we do regardless of what we do. >> our next question comes from sandy davis from the bipartisan policy center asking for steven

roy to take a look at this. it's focused on encouraging red using rigorous evidence as a basis of funding. >> how i see a natural fit between the two ideas, as you might expect the in-depth review he would make of current policy and alternatives to current policy would naturally draw on the deep well of evidence that in some cases exist on both sides that it is working. another productive use of resource would be to drive progress for the same goal. i see a good that to get

evidence into the decision-making process. >> i agree and i expect he will answer his own question about working at the policy center. the rhetoric right now is primarily about advanced social science methods which generate much more confidence about how programs are working and can now be done with very low cost and very quickly compared to the way they used to be done. i think the obama administration and the previous bush administration deserve a lot of credit for pushing investments in those techniques and integrating those findings and allocations to different programs. my only concern is that in a court of law evidences information that changes your mind. it's not just randomized controlled trials.

there's a lot of things that are done, they make decisions not just on controls but understanding how programs work. same goes for congress. they get evidence every day by talking to their constituents. i think it's right relevant to hear from casework experience about how well it works. in general this approach is great but we should also be open to the idea on how equitable the programs are. >> for anyone involved, most of the focus has been on reduction through the spending side of the budget. can you talk about the tax side

and whether that needs to be more of a focus, especially in terms of fiscal priorities and who's getting the benefit of tax expenditures. >> and needs to be part of of the discussion with an aging society that we are ever going to be having greater spending on those programs. they need to look at the revenue side as well as the spending side whether it's through tax expenditures or other means. any successful package is going to have to look at both the control and the growth of management programs as well as increasing revenues on both parts of the equation.

>> senator talked about the housing portfolios and includes tax expenditures for housing but didn't quite capture the magnitude of the differential between the spending for low income housing. particularly in hud there is $30 billion for low income housing for living purposes. the two largest tax expenditures that benefit home ownership benefit four or five times that number in the current year. they are heavily skewed toward wealthier, more affluent, older individuals. there's a huge description discrepancy there because they flyby below the radar.

>> the next one comes from jeff davis at the center for transportation. he says, the highway trust fund has bailouts from the general fund since 2008. they're classified as both discretionary and mandatory which means they're expecting from pay go. >> i think highway spending is one of the greatest areas that need to be treated as entirely mandatory or entirely discretionary so they are subject to spending rules. congress can authorize highway spending without it being subject but then there's no

limit on spending. it should be entirely mandatory or entirely discretionary and we should limit the amount of spending and if we were to make those reforms it would be a major impact and you would have people on both sides of the aisle that would agree that the area of highway spending is an area that is in great need of reform. >> we've had proposals along these lines in recent years for many years. the authorization could be managed by one committee and controlled by the other, it gets down to the structure of the committees. [inaudible] i don't think it makes much sense to have an obligations level and hearing, create the program and have one committee control it and maybe eventually

when we do the transportation portfolio analysis that would become clear. >> if i may, just a quick, the last time the gas tax was increased was in 1993 and it was increased by 4 cents after a huge amount of political arm-twisting. think it's a victim of the no new taxes approach to budgeting and i think it highlights the fact that in order to deal with the budget we have to do so generically, we have to look at all parts of the budget, mandatory spending, discretionary and revenues and you can't have a meaningful process where one part of that is pulled off the table before the conversation even begins. >> were going to take one more question here from jack, can members of the panel. >> guest: a solution on

reforming use it or lose it rules to curb spending surges and can they have the ability to use these resources more efficiently and carryover? >> i will take a stab at that. i think the appropriation bill is on time so the agencies have 12 months to obligate their funds. >> one last point i wanted to make which i think has come up a few times is that it seems real problem in terms of improving our fiscal policy is a lack of political will in the sense that congress already has all the authority it needs to improve our fiscal policy one way or another. you can argue how to make that decision or what is the better fiscal policy, but are you hopeful that process reform can lead to doing something about

the lack of will. it can replace the need for political will but you can improve the way the process is made and you can make it more transparent and hold members accountable for those decisions to increase the accountability. that's why making it harder to wait for budget ask would be difficult to stick to. you include the process by which you make this vision. you improve with what's available and help make the environment better to make those better decisions. you still need the political will to do it but a better budget process and i would encourage people to look at our website on our better process initiative with a range of ideas to do that. that could help lead to better results. :

[applause] >> [inaudible conversations] >> a reminder we will be back here on capitol hill at 3 p.m. eastern, when the u.s. senate gavels in. lawmakers are expected to continue working on a short-term resolution to keep the government operating after the money runs out on september 30. a procedural vote is set for 5:30 p.m. eastern. 60 votes needed to advance the bill. this was supposed to take place last week but it was moved by majority leader mitch mcconnell to allow negotiators more time for work over the weekend.

the u.s. house this back tomorrow. on the agenda, legislation to exempt u.s. olympic and paralympic athletes from paying taxes on their medals and prize money. also a bill to improve information sharing and counting cyberattacks. also struggle iran related bills including a ban on u.s. cash payments to that country. house might take of government funding legislation if it able to extend funding past the deadline and avert a government shutdown. live coverage in the house tomorrow at 2 p.m. eastern on c-span2. >> cq is writing about legislation that could be brought up this week innocent to stop the sale of military equipment to saudi arabia. it's a privilege motion meaning they cannot stop me, senator rand paul said of his plan to force a vote on disapproval of the pending arms sale to saudi arabia. senator paul said during a september 15 event that he was

not expecting his proposal to succeed but he could at least get fellow senators on record on a proxy vote for united states involvement in yemen which has been involved in a bloody civil war. you can read entire article at cq.com. >> this is the commute is on c-span. this week a discussion on the issue of the radicalization of cyberspace. let me introduce you to our two guests. alberto fernandez is a former career member of the foreign service. is now with the new -- middle east media research institute and seamus hughes is a while the national counterterrorism center is now with the george washington university, there extremism program. easy deputy director. when you hear the phrase radicalization of cyberspace, what does that mean to you? >> guest: you are seeing an explosion of a social mitch recruit particularly in america

individuals to isis. so that you social media like twitter which was a plot -- popular choice for number of years. now telegram. qcs once into individuals in the u.s. who are not like-minded people at the mosque in reaching online to find those recruiters and radicalizers. >> host: what does that term you? >> guest: a means maybe a little broader because the nature basically a space where certain image and persona and realities portrayed which is part of the tool that is used in the radicalization process. is a misnomer that exists in people think some guy watches the nicest video and automatically becomes a jihadists robot. it's more complicated. as one element of a larger intellectual psychological, emotional process that takes a person from one to be -- like anything else. love, hate, anger, fear,

complicated things. associate me aspect is an important part but i think sometimes we go from exaggerating to minimizing. we go back and forth between the two. >> host: has it made recruiting for isis easy or? >> guest: yes. no doubt about that. it allows isis to portray a very powerful image of itself which can be all things to all people. you want depth, you want religiosity. you can have it. you want revenge, you want wacko kind of of killing? you have that as well. it allows them to project a complete package in a way that bypasses television, bypasses the regular media, accessible to all people. >> guest: looking at not only the message but operationally, you see isis using it in three different ways. the first way is grooming. in the u.s. context we saw over

a six-month period we look at isis in english language twitter account. what you find is you have a number of individuals who are interested about the faith. they are naïve and if questions. there are spotters online that are grooming them in the process and answer questions in a very innocuous way. this is your answer for your question on religion. slowly to introduce the isis ideology, and narrative into the conversation. that's the first skull. the other way is logistical support. think back to a case of mohammed khan from chicago. 19 your kid goes to our airport with a 17 euros and 16 your brother and sister, go to syrias and joint isis. when they picked him up and arrested them, they found numbers of people to call when you get to turkey to cross the border. how did the kids from chicago get numbers? he reached out to context immigrants would logistical support. the last way i think is increasingly important as this

idea with fbi director called the devil on his shoulder the individuals that are taking people on to do what they can where they are. it's getting increase of hard to travel to syria the record messaging has changed in terms of joint the so-called policy. -- caliphate. it's much more do what you can wear your and your having constant essentially shaming of individuals for not acting. >> host: is there a naïveté on individuals who are being sucked into this? >> guest: the first thing you always say in this setting as always no one pattern. you get all kinds of different people. you get people who are more conservative, you get people who

are shallow, gang bangers. you get converts. but given the fact that a lot of individuality, a lot of difference, yes, but you do get a large subset of people who are shallow. this is an ideology projected through social media that can be profound but also shallow. it's basically an ideology on a bumper sticker, or 140 characters. they can become almost like a label or a sticker. they kind of empower people to do things, encourage people to undertake a path in life are a type of violence in life. it does appear to attend certain naïveté. >> guest: the old school guys about 10 years ago, they had the knuckleheads but also the big thinkers. he wanted to read the one of page treatise and understand exactly how the stuff worked. these guys for the most part, they are not interested in that type of level of regularity. that's not to say there's not exceptions and is not people.org brought into.

it's not bumper sticker idea. how do i fill my worldview to make sense what they're telling me?

to be used as a recruiting tool, and for other purposes by our enemy. we must shut down for access to this form of communication, and we must do it immediately. immediately. [applause] >> host: seamus hughes? >> guest: we look at these types of things. the redundancy in the system matters a great deal. that's not to say take down the content isn't important.

it clearly affected work went twitter essentially stepped up to the plate and is that you take down content. but it's not the be all end up to you will never get a silver bullet when it comes to social media recruitment or radicalization. it's much more so how do you take down content? how do you push counter alternative messaging? how do you do, how do you introduce the seeds of doubt seeking to in person interventions? because we will never be able to fully radicalized some online. how do you put all those things together? how do you get social media companies who by their very nature are libertarian? given the option it's a free and open society online. been essentially they been forced into this position of take down. we need to give them another alternative in terms of how do you connect i think back to my old job in government. i used to be community engagement officer on these issues. i was in sacramento about two years ago, and imam said i wanted to counter messaging. i said what you wanted to?

i'm going to tape at the i myself happen on youtube. that's great. no one is going to watch it. it's going to be 45 minutes long can you are not going to know how to tag it and join a future target audience. but as the role of government you can play an important player for convenience. i had the ability to call the guy on twitter and youtube and facebook and say i've got a guy in sacramento who he wants to do something. she's got a good message but no idea how to use a platform. can you help? again those types of things are not going to be the only solution when it comes to carrying this stuff. but you can't just pick one silver bullet. >> guest: one of the great myths in government, whether it's a bipartisan myth is there some kind of magic pixie dust or silver bullet that will make the jihadists go away. there's a button you push on social media. it doesn't work that way. however, number one, taking

stuff that even if the comeback is useful. it shrinks the footprint that makes life more difficult for them. there's a lot more we can do. one test i did recently when i testified before the senate was i picked certain terms which isis and other groups use in their propaganda, kind of terms from islam that they use frequently. and i put it in, for example, on youtube to see like surprise, what would be the first results that i would get back? in almost every case the result i got back was an extremist explaining the term. so you have a term like -- which is very important term. you didn't get some liberal or tolerant guy talking about well, -- no, you got an extremist. there are algorithms. there are ways that you can game

the system to make life a little more difficult to them, but there are no quick fixes. we love in america, politicians especially love making these broad sweeping statements as i said this is both democrats and republicans. it's not that easy to fix. it was people would have done it years ago. >> guest: there's the importance of the actual physical county. we will see efficient but it's not like it's twitter and facebook, you wouldn't have 3000 people traveling to syria and iraq. there's something drunken. there's an allegation, an important dynamic that we don't look at. we focused entirely on this idea of social media as the end all be all. there's important dynamics but there's other things that light. >> guest: people like to beat up on social media companies. these are vehicles reflecting the reality. maybe a skewed reality, they being manufactured reality. but what gave isis if i was not

that it is twitter. which isis its part is that it righteously to the second largest city in iraq and then huge part of iraq and syria seeming like that. that's what gives it power. the idea of the caliphate, the package involved in that word, the history of the. so social media is a vehicle for that stuff, but the content is not come it's not content unique to social media. it's related to the real world. >> host: is there a factor in cinching these people? we are talking about censorship, talking about taking sides down, talking about twitter decide what is appropriate and what is not. is there a hesitation about the? >> guest: there is the default position often in silicon valley and social media companies, which is a libertarian worldview. you let a thousand flowers bloom. that's the default mindset a lot of people have.

governments and societies always decide certain things are beyond the pale. whether it be child pornography or other things, or incitement to violence are not every country is the sake of your democratic countries, for example, western europe that have much to the rules and then we do. we have our first amendment, active way of looking at it. but i don't think there's any problem being kind of trying to make life more difficult for the extremists. realizing that we live in a democratic open society and there's always going to be a risk. there will always be intolerant people or unpleasant people using the media, using social media. but we can mitigate that at the same time respecting our laws and traditions. >> guest: a lot of this plays pe to it's an easier solution. meaning that it easier to take down content and ask for content to be taken down if you are a congressional official.

that's an easy solution. it's hard to do counter messaging and alternative messaging. it's hard to craft the message. it takes the right resources, the right targeting. that takes time and effort. i'm not a lot of return on investment. if you release, or if you try to do some trial and error online, some things work and some things don't. that things that don't work, you have the political cover to be able to do that. are people going to back your play? if you look at the last couple years, maybe not. this is the issue and this is what i think we default decide if they can is because the other stuff is really, really hard. >> host: finally, gentlemen, what for the effort would like to see made by the federal government or by the congress to combat this social media? >> guest: i think at least in the context is not enough done in terms of intervention space.

in many ways the online persona is essentially a reflection of the off-line life. these individuals wanted for been in a police online they are fervent i in the police off-line and just offer them, no intervention -- >> about a minute left in this conversation. we will leave it here but you can see it tonight on c-span starting at eight eastern. live in a moment to capitol hill on this money as th the u.s. see is about to gavel in. we are expecting lawmakers to continue deliberations on short-term funding to keep the government operating after the second the 30th deadline. procedural vote scheduled for 5:30 p.m. eastern. live now to the senate floor here on c-span2. the president pro tempore: the senate will come to order. the chaplain, dr. barry black, will lead the senate in prayer. the chaplain: let us pray. eternal god, help us to so live