nowhere to turn to. >> i'll bow honest, i don't know there is a magic public education program. we have enormous problems in federal programs and costs and difficult to educate the american public about the scale of the problem. there have been some, future initiatives, tom mentioned. the kind of things you have to look and see what successes we get from them. relatively small scale, if they turn out to be a good investment, you know do a project evaluation, they improved awareness, they don't cost much. that will be great. and, i think the more you can do through employer community, who are, are often very effective at -- reaching their -- their employees about various financial management issues. i think those are the two things to do. >> thank you. >> thank you, mr. chairman. >> thank you, senator udall. >> thank you, mr. chairman. thank you to the ranking member for holding this important hearing. i think this discussion has been

important on a mcro-cosmic level. i have questions i want to acknowledge, dr. cher nonoff yo are sitting between them. very astute staffs. thank you all for your great, spirited conversation. mr. coleman, let me turn to you and follow up on what the senator mentioned, with focus, and i will turn to dr. feder, in rural parts of the country in colorado we hatch eave, the eas part of our state is rural. we produce fuel, fiber, we hatch eastern reaches that are rural. what have you found that are unique challenges in providing long term services into the parts of the state. and then, dr. feder, i would look you to follow with how medicare itself could work with the dynamic. >> again, minnesota has -- greater minnesota also.

where the population density is, a challenge in providing services to -- to older people, old eer adults, and people with disabilities. what we found is we need flexibility. that -- again, relying upon the communities, and the community infrastructure, with which to base long term care services and supports, we need to acknowledge that drive time, the -- the differences that we need to accommodate in our policies to allow people to have some choice but they may not have as much choice. it is a challenge, but it can be done. we are also learning the value of technology. the fact that, every day there is more to be learned from how we can support people in their

own homes, with the use of technology, via the internet, via other -- lifeline-like systems and monitoring systems for people who are -- who are some miles away from -- from -- from services. >> dr. feder? >> yeah, i would reiterate that. i think reinforce the emphasis on technology to connect people to, who are -- who are dispersed to resources that can serve as supports and check, people who can check in on people who are -- impaired, and, be able to, i mean, skype is a wonderful thing. sure we got better than that. there are, i think mechanisms that can make people feel connected and supported and keep them connected to -- to care givers who are more likely to be care givers by which i mean medical technicians in urban areas. you asked about medicare.

i think that -- medicare in terms of developing, integrated delivery systems. i think medicare is in the process of doing this. we need not look to states, medicare, need not look only to states. medicare can do a great deal and is in this regard. by frying to support physicians practices, that are, small physician practices in rural areas. and using -- the personnel, who can serve several practices as care coordinators who are able to connect using -- both visits and technology. to people who are in their own homes. and enable them to -- to connect to resources for support. i think medicare can do a lot in that regard. >> you perhaps does be making house coalalls using technology without being on site? >> i am confident. it is not exactly the same. you could greatly enhance support for people in terms of

mon titoring their conditions i terms of helping them, keeping track of people, so you know when a crisis is occurring. that's what coordinators what we are looking at with social workers and nurses and -- and other professionals to help identify when people need interventions and try to connect them to the resources, the infrastructure, we are talking about, versus talking about, building, so that they can stay at home. it doesn't become a crisis. we don't have an unnecessary hospitalization. >> beoth my parents were stubborn. i won't be stubborn. my children will think i am flexible. they both wanted to live in their own homes in their later years, imagine that. they both took falls. there were not people there. both of them lay, in the bathroom and kitchen respectively for half a day or longer. and then, the result of the falls, then ended up in their, deaths ultimately. i wonder if there could be that sort of monitoring that although

you have privacy concerns and so on. >> but we can do better. i don't think there is any question about that. you think of things that cause unnecessary hospitalization, dehydration. having somebody checking in, you are eating properly, taking your medications all those things can very much improve quality of life. and quality of care for people. and prevent, of the use of ex-pensive services. >> yeah, dehydration, actually contributed to the conditions both my parents developed. let me go back to if i might. long term care insurance. i know, the doctor, you spoke to this. i know i have my pamphlet that i was sent sitting in my home office suggesting buy long term care insurance the i haven't responded. i keep thinking i will find a moment, where i will want to do that. mr. brian, i know that in the federal program. one long term care insurer, john

hancock. what are you doing to think about attracting more carriers and then a little bit of time left i might ask the doctor how we further use market forces in, market psychology to get us, aging babyboomers to participate. >> yeah, i think you have identified one of the challenges we see for the federal long term care program going forward. is that, in recent years, the number of insurers who are actively participating in this market has gone down. i am not so concerned that we have one provider of a long term care program, right now, i think that, for the way we have done it that is wait we do life insurance. not like the health insurance where people are changing yearly. what i am more concerned about is when we reupped our contract. we only had one active bidder to provide that service. so -- we are looking very carefully to -- to, at the moment. we have a provider. doing a good job. but a concerned long-term for this program is that there are

enough active participants, insurers out there to provide the service. i think the point was made earlier today, its that, the market has stayed relatively static over a number of years, and it's not growing rapidly. we are, very happy in the fact that with our most recent, when the contract opened up again that we actually increase enrollment by 20%. which we thought is positive, and a challenge on the horizon for us. >> i could help the numbers if i sign up. >> you can sign up any time. we can get you -- do it in the hearing. >> doctor, any further observation? >> very important to harness market forces literally from the ground up. and i think you have heard talk of the technologies, talk of the need for flexibility and markets are very, very good at that. there are, roles for government in this. and -- they -- they are on both

sides. good and bad. you care about privacy. you care about having -- quality personnel going into some one's home, delivering services. if you regulate too tightly what a person can and cannot do you are not going to get the benefits of bundling the different services. a thorough review, ground level, every state. ability to provide services cheaply is going to make the care cheaper. that is going to help make insurance cheaper you. can't get around that. having a very expensive, underlying care, makes insurance a lot harder. and then, you know -- you have to be able to make money or not stay in the insurance business. that's bodies. we had too little awareness and education for people to sign up. an old saying, said insurance is sold, not bought. we might need to sell more of this. and -- and -- so i think that is a bug part of ig part of it. and to the extent.

the boomers, caring for their parents, drives us. that's one thing we might see be very different in the future than in the past. >> thank you again. thanks to the chairman. i think president clinton once remarked -- this is a high-class problem we have because of the -- the extension of our life spans. nonetheless it is a real challenge. thank you all. thank you. >> thank you very much, senator udall. >> doctor, you have expressed some optimism about private long term care insurance market. individual market is not thrived as you know in recent years with premium increases as high as 90%. on the other hand, the wisconsin company i am proud of, northwestern, mutual never had a premium increase. in your opinion, how can we, or, how can we succeed with a long term care insurance market in keeping the premiums reasonable and getting people to participate in long term care insurance.

>> well, again as i mentioned to senator udall. ultimately the costs are driven by underlying costs of long term care services. step number one is work on those to the extent possible. and then, step number two is -- pool as effectively as you can. make sure you can get broader pools. this is a thin individual market at the moment. ways to enhance the poolings. by having, be able to buy through their employer. i think the key to making that more successful. >> i look forward to seeing professor feders dojt. thank all you've for testifying. and -- this is a very massive problem. i mean people are not -- thinking in advance of those kinds of things down the road. i mean people, have difficulty

seeing daily and yearly activities. the comment, doug, that you made about insurance being sold and not bought, i mean the fact is, it any just not on, we have a -- by the way, i haven't signed up either. and i may not. but -- you know, it -- it's a big problem. and the cost, associated with this. again i hate to go back to that. i really do appreciate, the doctor, your comments about customizing and, making this -- this very customer, patient-centered i agree with that. we were very aggressive, as you know in tennessee in seeking waivers and really moving to community based solutions. and by the way that was done by -- people on both sides of the aisle, through the years. and i think it worked out very well for us. but this is a -- massive, massive problem. one that -- finance committee and others here all need to be involved in, in dealing with. and -- no doubt there is a public sector role.

at the same time. i have to tell you on the private side, i think trying to -- trying to again, sounds like northwestern mutual, i do have a approximatepolicy with. has done a good job with it. the issues of being able to take in premiums now and know that is going to deal with situations down the road, is really, really tough. and -- any way i thank you all for educating us today. coming here from other places. look forward to seeing you again. >> any other comments from members of the panel? thank you so much for being here. it is clearly complicated, vast, terribly important. you have shed a lot of light. and thank you for coming. >> thank you. >> thank you, bob. >> thank you.

>> c-span congressional directory is a complete guide to the 112th congress with detailed information about every congressman, cabinet member, supreme court justice and governor. it is a available for $12.95 plus show up. -- plus shipping & handling. you can order your copy -- >> coming up on cspan 3, a panel of governors talks about tax policy at the george w. bush institute. the u.s. institute of peace looks at the future of afghanistan security after the withdrawal of american troops. and later, the group citizens against government waste, releases its annual study of congressional earmarks.

this is cspan 3 with politics and programming throughout the week. on the weekend, 48 hours of american history tv. get our schedules and seep past programs at our web sites. and you can join in the conversation on social media sites. >> at a conference on taxes and growth, hosted by the george w. bush institute. republican governors of maine, oklahoma and ten seep, talked about their efforts to cut tax rates and state government spending. ynbcs, larry kudlow hosts the discussion. just under an hour. >> i don't know if you heard the question about new york city, okay, good. i want to introduce my very good friend for more than 30 years, larry kudlow.

larry is the host of the kudlow report and -- in a distinguished career also served as -- as a budget official under president reagan. i once did a kol acolumn about , where i called him the most optimistic man in america, which i think he proves every night on cnbc. larry kudlow, you have the governor's panel. >> thank you. all hooked in, all doing good? sound on. i'm larry kudlow, it is a great pleasure to boo here. so we will talk tax reform, tax

competition and economic growth among the distinguished governors and the deputy mayor. and we have heard already, i think from the prior panel and from governor christie that low tax states grow faster than high tax states. i would regard that as so bloody obvious. but i guess in this day and age. you have to spell it out with a lot of ph.d.s. god bless them all. and leading republican governors are showing us the way and we, heard a brilliant speech from governor christie. now we will fill in the blanks. i have governor page of maine, governor of oklahoma, governor of tennessee, and my old friend, robert steel, deputy mayor of new york city. who is going to tell us what that is like also. what i would look to do if you would, just a little bit of show-and-tell. you all are doing some great things. some really important leadership things. so, i guess i will just start in

the corner. governor lepage if you would begin, describe briefly for the group and for me, your tax reform in the great state of maine. >> our tax reform goal is basically -- about a $400 million tax cut last year. we took the lowest tax rate for the poor which is basically the 2% rate. and we reduced the 8.5% rate down to 7.9%. to show, some are symbolic. really telling maine people that we were going to lower taxes. then we went in and lopered taxes on businesses. we initiated new tax credits. made some major reforms on the spending side to pay for it in our pension reform, reformed our pension. we had a $4.5 billion short fall. we cut that 45%.

the we -- did a new health care package so that we can go to free market health care. that could compete against obamacare. >> free market health care, letting consumers choose? >> letting consumers choose. >> does president obama know that? has he weighed in on that? >> not yet. >> i hope heap is nicer to you than he is to my friend, paul ryan. who will be a speaker here later on. >> basically we took some -- some taxes off, certain types of -- like aircraft. maintenance parts. repairs. off, off fuel. we took taxes off fuel for fishing industry. and this year we are trying to -- get the forest industry. we have, consolidated conservation and agriculture and frying to gi trying to give them the same tax breaks. >> governor, you were highlighted in a "wall street

journal" editorial, a few weeks ago, could you give us a brief overview of your tax reforms? >> absolutely. coming off the national recession, started in 2008, oklahoma like many states, faced budget short falls. cup years, billion dollar short fall. in our budgets annually about $6.7 billion. $1 billion. quite a bit of a short fall. when i took office we had a $500 million gap in our budget. of course i wanted to talk about reducing taxes, create jobs, create a more competitive biz n environment in our state. they said you can't do that. you have a $500 million short fall. several billion dollar short falls previous years. we did that. we prior tiitized our spending, education, public safety, corrections, transportation, health, human services. we, balanced our budget. we cut a $500 million budget gap. reduced our spending anywhere from 1% to 9%.

cult spending in the state of oklahoma. >> base line. right out of the base line? >> and decreased our income tax by .25%. this year, i said my second year unoffice. i said we will do restructuring of the tax system in our state. what we propose to dupe is let people keep more of their hard earned money. new concept. we believe in that in our state. so this year, i proposed taking our 5.25% income tax top rate done to 0% for those, couples that make 0 to $30 t they pay no income tax at all. helping the working poor. helping the poor in our state. and from, the, level of $30,000 to $70,000, 2.25% down from 5.25%. and $70,000 and above, $3.5%. pay for that. eliminating loopholes, $1 billion, exceptions, special

interest deals that people have got over the years at the state capitol. almost kufting our tax in half. 5.25 to 3.25. people said you will hurt the poor. kick the seniors out of the nursing rooms. can't fund schools, public safety all the various things they have said, said that in all states trying to cut their income tax. amazing. >> they say it every time somebody tries to lower marginal tax rates. >> isn't that the truth? >> the opponents always say that. >> every single state. >> doom and gloom. remarkable. say it at federal government also. being said right now, regarding paul ryan's tax reform bill. everything is going to get shut down and national monument. why is that? what is behind that sniff you are cutting spending, and you are cutting spending, why are you lowering the income tax rate, obviously you are preserving essential services of state guchlt wovernment. why is it liberal opponents take this line of reason snk >> here's where i come back to

them on. back many years ago when governor kefting w inkeating wa we cut our income tax. we had a growth trigger in there that if our economy grew to a certain level we would cut our income tax by .25%. we actually started out over a decade ago, 7% income tax. when i took office done to 5.5%. i come. it a quarter%. now hoping to reduce it down to 3.5%. but guess what happened over the last decade? since we come our income tax, the sky didn't fame. chicken little didn't happen. in fact we still have been experiencing in oklahoma double digit rev nenue groechlt the thd best job creation state in the nation. we are like one in manufacturing. and job growth. in oklahoma. and if you look at all of the economic indicator factors weep ear in the top ten. in fact personal income growth, this past measurable year was 6.2%. talk 4% growth factor, mr.

president. we have proven that by kufting taxes, by reducing spending, in state government and by creating a competitive business environment you can grow an economy. >> that's great. well done. awe thank you for that. governor, you have a 0% income tax. my friend moved there from california to ache advantage of it. you are, as i did home work, you are involved in an estate tax debate. maybe tell us about that. and, are there any other tax issues on the table? >> sure. we're like mary, we think the 4% growth model is too timid. averaging 8% growth the last year. i think one of the reason is no income tax. that is the biggest reason. we had vw set up their first plant, north american plant ever. the you asked them why, lots of reasons. one of the reasons they said was no income tax. we see that a lot. but we have, we are, our stories

are like oklahomas. we leadment southeast in personal income growth. and rev new growth. unemployment is falling faster than the national average. because i think capital is going to go against the best s return. one of the things we want to address is ten seep is onessee 20-something states that has an estate tax in place. that chases capital away. people have said to my face it is cheaper to die in florida. i an going to move. as they get older. and we want that capital to stay in tennessee. we are on a three year plan to eliminate the estate tax. and then we are out cutting the one tax that everybody in the state pays is sales tax on groceries. we're cutting that. here is the key challenge for states. we all cut our budgets when the recession happened. the stimulus carried states. went to states to paid for medicaid. covered up a lot of budgets. when mary and paul and our class came in. stimulus plan money was gone.

we made real cuts. we cut, 2% to 5% of the budgets. ours was 3.5%. now as revenue comes back. we have of a once in a lifetime opportunity. because we made the cuts. real growth is happening. we cannot just put that money back where it used to be spent or, as mitch daniels says, typical reaction, don't just stand there, spend something. where can we invest this to be the state we want. how can we cut taxes to create more of that. >> where can you? >> i think several things. for us, like a lot of southeastern states making certain we have higher ed focused on what are the jobs we need to be training for. that can be trades type jobs, ph.d. oriented subjects. we haven't done a good job of that. some focus, cutting taxes. shrinking government. redeploying assets. we can be more competitive in

attracting jobs. >> thank you i've will follow through. let me go to my friend. deputy mayor for economic development in the city of new york. you don't have luxury of all the lower income tax rates. let me ask you, first of all. from the standpoint of business, and investment, how tough is it for new york city, just your own view, and what has -- what have you and mayor bloomberg done to promote economic growth measures? >> well, thanks, larry. thank you for letting me be here and join the, the esteemed group of governors. it is a pleasure to be here on behalf of city. we have similar issues. you know we have a big economy, a big budget. the budget is about $65 billion. $20 billion from the state, federal government. $50 billion we fund ourselves. mostly by property tax. factor of two. most important thing. and then, when my job is to think about economic development and how to keep city

competitive. and the previous panel laid out some of the issues. that's really -- the way we think about it. you know, point one is there are two kinds of taxes. there is -- the tax that you see. called a tax. and indirect tax of basically -- the government not working well for its people. and -- i think in a funny way we think that is the way, place we can attack, and, mayor bloomberg has been, very forceful at pushing me, and my colleagues, every day, to say how can we make it so government work for you? i have ten examples. i will give you an easy one. 400 permits. licenses certificates issued by city of new york. different things. get 10% on line. 90%, show up between 10:00 and 4:00. bring a blue ballpoint pen and wait in line convenient for city not convenient for you. tripe to factor what that costs the city in terms of business, job creation and things like

that. i can give you ten more examples what i think of as indirect taxes on the economy. second thing. >> can you say, on that point, important point. can you see palpable business improvement after making the reforms? >> absolutely. there is no question. we have tried to take certain industries. a bit more detailed than i planned. new york is constantly opening new restaurants. we tried to shorten the time it takes you to open a restaurant. you have to have 24 permits. licenses. and you are up, up to you to organize them in order in the right forms.to organize that for you. shortening the time into business for several months. you are a new business. short on capital. every day you are not serving meals, collecting, revenues, it is hurtful to you. so how soon can we get you in business? lots of examples like that. i think the second theme though, larry that we talk about a lot. mayor bloomberg pushes is, it is also about expense