>> joshua booth and it's #seniorschoice. the question i think you'll find this interesting, joshua thinks that your plan sounds like the affordable care act, exchange of subsidies, market forces, is this just extending the individual market rules of the affordable care act to medicare? >> i don't know hardly any market forces that are working in the affordable care act. that's number one. there's no true exchange. what we're doing is there's a lot of real market out there. all we're saying we're going to make sure whoever is participating in that market isn't cheating seniors in terms of quality or actuarily equivalent programs. that's all we're doing. i feel greatly insulted that's compared similar to the affordable care act. >> my name is blair furlough, i'm an economic development consultant here in washington and also a member of the no label citizens movement.

really appreciate your remarks, senator, and your emphasis on the importance of the budget, informed decision-making choice, accountability and the importance of a robust representative government. i think those of us in no labels, feel particularly that not only are some of our systems brok broken, as you've alluded with some of the problems with medicare, but congress is broken now too. and we wish that members of congress were all about the importance of the budget, informed decision making, accountability and representative government. and i wonder if you could share with us your thoughts. you've seen how sausage is made on capitol hill, and we the taxpayers certainly have some skin in the game not only with what happens to medicare but many other important issues. what can we do that could help fix congress so that some of

these same principles you've talked about today could be part of the decision-making process under way so that thoughtful proposals such as the one you've described can be honestly considered and debated? >> that's a good and tough question and it's going to get me in trouble, and i don't mind being in trouble with my peers. i think the first thing you can do is quit sending career we have the government we have, because the american people have sent the people that are here, here. they are wonderful people, they have great hearts. the fact is, most of them lack a frame of reference about what the real world is like. when you take somebody that has never had real exposure in the real world on real issues that require blood, sweat and tears, and hard knocks, and you have people without that who have

been in a political position the whole time, they're working at a deficit, and the deficit is the real world and common sense, and so if you look at the senate, 65% to 70% of the senate is filled with people who are the exact opposite of a guy by the name ron johnson. he had no political experience whatsoever, and what's his number one thing? fixing our problems. he doesn't care about the politics. as a matter of fact there's more conflict on our side of the aisle with guys who want to fix the problem rather than politics. the second point is that it hurts decision-making in washington is everybody is think being the next election which means they really like the job, and what we need is people who hate the job, like i do, but want to fix the problem, and so what i would say is, if you want to fix washington, you can do process reforms, and it will make some impact but it's not going to change until you change

the motivation of the people that are here, and it's always the next, the horizon is the next election. we will fix it after the next election. when we're more secure, and that just goes back to human nature. kind of like senior buying medicare. everyone wants to get stroked. politician's stroke is getting reelected. i think what we should do is fix -- you know, we have the capability to fix every problem in front of this nation right now. that capability is there. the problem is if we fix it, we'll all get fired. great! let's fix it and all go home. the point is, is most people don't want to go home. i can't wait to get home. i would tell you is you have the congress you've sent here because you have, as americans, have decided you're going to put your vote and your vote with career politicians who tell a big story but the action --

they're great salesmen but their action is far different to what you've been sold. ask yourself the question, there's a bipartisan bill, i think 37 co sponsors, called the fast act, which will address tons of the fraud that's occurring today in medicare. it's bipartisan support in the house and senate, that we worked with cms to develop this bill, why isn't it on the floor and passed and sent to the president? it has nothing to do with medicare and everything to do with the next election. there's hundreds of things like that. there's 27 different jobs bills waiting that have passed the house that aren't going to come to the senate floor, not because the country doesn't need them but because it doesn't fit with the scenario of the next election, so what is the motivation is, we ought to be americans first and republicans and democrats and independents second, and you see exactly the

opposite of that. we can change the process we want until you change who is coming up here and what their motivation is, in terms of being here and getting the stroke, you're not going to change it. next question? >> dr. coburn, i very much appreciate the idea that market forces and consumer choice can really control our health care costs and improve the system but i worry it doesn't operate like a true market not just because of government involvement but because of the imbalance in information between consumers and insurance companies primarily but also consumers and their actual care. i'm wondering if you've considered the patient's senior choice act supports tools to help seniors understand what they're choosing when they choose their health plan, not just the monthly premium which

is probably the clearest thing on your paperwork but also the kind of benefits you're receiving, the care, coordination and other supports you're receiving and out-of-pocket costs you're exposing yourself to. >> i think that's a great statement and a question. we have looked at that. that's part of what this organization is going to be that's going to control this system. we have it right now we have 15 supplemental plans in medicare. we tell them what you can put out, what you have to put out. it's not any different than that, the same thing. the question is, is can seniors navigate that, and up to a point, yes. but i would tell you that my mother died a year and a half ago, and my brother and i helped her navigate what the choices were, when she no longer could do that. so we're talking about a very small group of people that are not going to have family involved, in helping them make those choices. the question is, is how do you keep the bad actors out and how do you keep those that want to cheat in the system and how do you have enough transparency so you know when that's going on so

seniors aren't being taken advantage of? that's the key. i'd go back to the other point is one of the reasons our health care is out of control is everybody thinks somebody else is paying the bill. and you know, i'm the first to admit that market forces won't solve everything, but i'll guarantee you they'll solve it a whole lot better than what we're doing today, and there will be people that fall through the cracks. it won't be perfect. but the allocation of that resource to actually apply dollars to make sure somebody has a good health outcome, is going to be much better than what we're doing today. because there will be a consequence for a doctor overutilizing something because they'll be being watched by the very people they're contracted with if a private insurance that's competing with medicare, that they're not going to do it inappropriately. there's no controls, there's no

brakes on in system now for bad behavior, in terms of the market. and what we have to have is -- the question is, can we have great health care for seniors and have it in a way that's much more affordable than what it's going to be inned future? and i think the answer to that is yes, and that doesn't mean we trust markets 100%. that means we let markets work but we make sure we have the controls so when market starts, if we have a bad actor in that, it's identified and they're gone. >> senator we have time for one last question from the audience and one last twitter question. >> okay, right up here. >> you said many times that a big factor is control, you know, finding the physicians that overutilize as a criteria. what are you going to do to protect against the ones who are going to underutilize testing and that sort of thing so they

appear good and score high? >> well, first of all, i think that there are two different aspects to your question. one is laziness. the other is whether or not you have a physician that's committed to your health care, and i'll tell you if you have a physician that's not committed to your health care, it doesn't matter what system we have. you're going to lose on that. i can't see a guy, if you come to me as a physician, if i'm really a physician, and i'm not talking about being a doctor, i'm talking about being a physician, which is what we should want, and i'm going to cut a corner on your health care so i look good? i've already violated my hippocratic oath. the difference is, i can look good and somebody else pay the bill when i overutilize, but you're talking -- and that's the whole point of where we're going right now. guaranteed medicare is not guaranteed quality care, and is not guaranteed access, and the

choice is, are you going to have access to a doctor in the future? that's the first thing. we're going to have 150,000 shortage of doctors in the next ten years in this country. the doctors my age are all saying see you. i'm not messing with this anymore. i've had it. so i would say the motivations on both sides of that question are different. could that happen? absolutely. that happens today. that happens because when you go to see a doctor on average, they don't spend the time they should be spending with you to actually listen to you about what's going on with your health care. that's happening today, because medicare underpays primary care doctors, and so what do they do? rather than set down and spend 45 minutes with you to hear paid for that, which medicare won't pay them for, they spend, you know, you go in, the average right now is less than 30 seconds before they interrupt

you, with you telling them, because they got to get busy to see the next patient, so what do they do? they hear part of what you say, they order a whole bunch of tests to cover themselves, and walk to the next room, because they're on the treadmill because medicare set up a payment system that says you can't make it if you actually spend the time with the patient. we won't reimburse you for doing that and there's good studies coming. we have a new group of doctors out there that have said i quit it all. i'm going to go into concierge medicine. you pay me a flat fee. i'm yours 24/7, 365 days, you get a comprehensive exam, see you, talk to you any time you want. these doctors are telling us this. i'm finally getting to practice medicine the way i was trained, i get to sit down and listen to my patients. on average they're ordering 40% less tests because they're actually listening to the patient. the insurance companies that are actually covering some of these are actually spending less and getting better outcomes, reduced hospitalizations, because we

were all trained, no matter what you do, listen to the patient, they will tell you what is wrong with them. and nobody's listening because we have a system that says get on the treadmill, here's all we're paying you, and i can't pay my nurses if i practice medicine the way i want and get reimbursed for medicare. that's why you're seeing people not wanting to take new medicare. so what good is a medicare program if you can't get a physician? and if you can get one, what good is it if they won't listen to you? so i would tell you the downside is continuing the status quo, because it's going to get worse, and we know that. we're seeing it. >> senator, i'm afraid that's all the time we have for questions today. on behalf of the hudson institute i thank you for coming here and for your leadership on these important you a happy birthday yesterday.

>> thank you. see you all. [ applause ] david ignatius has the latest on afghanistan, the uprising in syria and the tenure of iran's current president. then american patretroleum institute ceo jack gerard discusses the alternative energy experts and hubert hamer and jerry hagstrom look at how farming and agriculture have changed over the last few decades. washington journal live at 7:00 a.m. eastern on c-span. coming up at 10:00 a.m. eastern, a forum on religion from georgetown university's berkeley centers on religion,

peace and world affairs. scholars will discuss the arab spring, religious extremism and the obama policy for dealing with religious issues. you can see it live starting at 10:15 a.m. eastern here on c-span 3. they would wear garments made of home spun cloth. and this home spun cloth would be much more rough textured. it would be much less fine than the kinds of goods they could import from great britain. but by wearing this home spun cloth, women were visibly and vividly and physically displaying their political sentiments. >> sunday night at 9:00, george mason university professor on the role of women during the pr american history tv this weekend on c-span3. former natial advisers zbigniew brzezinski and

discsed how policy has changed since they served in the white house. they also discuss the political democratic transition in egypt and iran's nuclear ambitions. from the university of marriage in college park, this is an hour and a half. >> good afternoon, my name is john towson, and it's my great pleasure to welcome you to another forum with these two giants o former national security adviser to jimmy carter. and former national security adviser to president george w. bush. thank you, gentlemen, very much for joining us today. we really do appreciate it.

[ applause ] >> this forum could not be more timely. unfortunately could not be more timely. the united states is facing enormous challenges in the united states as the arab awakening continues to change politics in the region. the violence in syria, can i say the bushery in syria, has left many wondering what america and the international community should do to end the bloodshed, and the challenges posed by iran's nuclear program have many talking about the prospects of war. let's all hope that does not happen. our guests today are especially suited for shedding light on america's policy choices on the rapidly changing environment in the middle east. the forum was sponsored by the college of behavioral and social sciences is organized by chair

for peace and development and supplementing these events is deep and cutting edge diplomatic research that includes years of polls in the arab world and united states. today the program is releasing results of a new public opinion poll about american public attitudes on a possible war with iran. the results of which are available for you outside this hall. to introduce our esteemed guests i'd like to present dr. sadat. [ applause ] >> he's been a supporter of rights for human life. she's been a member of the university of maryland community for two decades and has helped

the university too establish the anwar sadat chair for peace development. hers has been a steady and insightful voice we've continued to hear including here at the university last spring. the university of maryland brought in the behavioral sciences have been honored to count mrs. sadat as one of us. it is my pleasure to present mrs. sadat to you. [ applause ] >> thank you very much.

thank you for your kind words and for your support of the sadat dhar and international studies group. ladies and gentlemen, it is my pleasure to introduce our honorable panelists of this event forum. but before i do so, i'd like to say a few words about the arab awakening that has been sweeping much of the arab world. especially my greek country egypt. in this regard i want to welcome our ambassador who is here today. egypt is, of course, going through challenges. both economically and politically as it transitions to democracy. i know that our panelists will discuss some these challenges, but i want to make a few comments. despite the enormous

difficulties, i remain optimistic about the future of egypt. and in the greatness of our people. as i witnessed the remarkable changes that have already taken place in just over one year i think much has been accomplished. though muchp more needs to be done. from the outside the inevitable transition seems frustrating. but what egypt needs is patience, understanding and space to go through its inevitable transformation. our people and leaders will, of course need to do their part. one of the most difficult challenges of revolutionary changes is how to assess and come to terms with the past. for sure there must be an

accounting of previous injustices of the suffering of the many of what happened to innocent people. healing starts only with such accounting. but to move forward. to build a better future, to come together as a greek nation, we need to find it in our hearts to forgive, to invite all egyptians to be part of our brighter future. my late husband president sadat found it in his hard to overcome the of war and destruction. and forgiveness and reconciliation is what made our friend nelson mandela great. egypt has many great men and women who would find versus to

help move our nation forward. allow me, ladies and gentlemen, to introduce our outstanding panelists. i will not review their extraordinary biographies as that would take all afternoon. and i know that they to all of. i will just say a few words. i met him as he visited egypt. he was central architect of the camp david accords between egypt and israel. and i know that president sadat admired his brill yens and dedication. since the days dr. brzinski served as a professor at harvard and columbia universities, he

has served his country in multiple capacities. he is currently a counselor and trustee of the center for strategic and international studies. foreign policy at johns hopkins university. he has thankfully never stopped writing or commenting on international and national affairs. and his newest book strategic vision just released in the past few weeks and available for purchase outside this hall has been deservedly a bestseller. he is without a doubt one of the greatest strategic thinkers on global affairs our time. it's an honor to have you here.

the honorable stephen hadley has never stopped serving the united states. it is hard to find anyone in washington, republican or democrat who does not respect mr. hadley. he's known for his thoughtfulness, his openness to differing views. his consensus building style. and his deep knowledge. that's why american leaders trusted him with some of the highest positions of the land including as national security adviser to president george w. bush. he has served in multiple administrations, both republican

and democrat, including briefly with dr. brzezinski in carter white house. currently mr. hadley is a founding partner of the rice hadley group. he continues to serve his country and co chairs a bipartisan senior working group of the united states institute of peace addressing american policy in the middle east. he's an extraordinary american. steve, thank you for taking the time to join us today. finally, the panel will be moderated by our own professor. ladies and gentlemen, i think you are in for an intellectual treat.

thank you for attending. [ applause ] >> well, thank you very much mrs. sadat, and thank you dean toshend for your support. i know i usually see you in washington and all these other places. i know for some of you this may be the first time to come to maryland, so welcome and we really appreciate you taking the time to join us. i'm going to go ahead and start asking questions, but before i wanted to explain why you're surrounded by such beautiful art. if you notice, and dr. brzezinski, being married to a wonderful artist yourself, you appreciate that a bit. we have a sculpture and a

painting. these are products of an annual competition we have, which is called the sadat art for peace program. it's in conjunction with our outstanding art department. and usually the best painting and the best sculpture. these are the winners from 2011. let me tell you, the best winner for sculpture is jesse barrows which is intended to represent hearing the voices of the people in the arab awakening. the painting is by phonat chow for a piece called one and two. i don't know if they're with us, i want to congratulate them. i'm going to go right to a substitute questions. not surprisingly i'll start with

each of you. the sadat forum, mrs. sadat is here, but egypt is not only an important country in the middle east, but there are p essential choices regarding egypt. before i ask you now what we should be doing, the crisis that came out of the ngo. i want to look a little bit before the revolution, i know that you have been a key player in mediating the camp david accords between egypt and israel at camp david maryland. and when you look at american farm policy over the last several decades, it's been anchored around a particular relationship with egypt and