for a population cared for by those organizations. i'd look for them to have a model that involves data and ongoing support to those organizations as they venture into this new world of moving from volume to value. i'd look for them to have a model that places substantial financial incentives on quality and outcomes to act as the back stop against any incentive to stint on care that a global budget constraint might impose. and lastly, i would look for them to help with the further development of better and richer outcome measures. we have good outcome measures today. measures of making sure that the important chronic diseases are under good control and avoiding complications for hospital care. those are good outcome measures. but they're not good enough. and so we need further development of good outcome measures to sustain a model that rewards outcomes. >> that's great.

if they're watching. i bet they'll ask for an extension. to modify. >> thank you, mr. chairman. i thought the point you raised, mr. chairman, about primary care was particularly important. and we have mr. burrell here. and he has gotten into this primary care area i think in a very interesting way, particularly bringing providers and patients in together around prevention. and to me that's really the ball game. i mean we understand that most of the health care bill in this country goes for chronic disease. i mean well over half of it. and we spend it picking up the damage of heart and stroke and cancer and diabetes. and you're trying to figure out a way to bring your providers and your patients together. and reward the patients. and i think that's particularly

good. since you and i talked, senator portman and i got together with the cleveland clinic and the oregon health sciences center and have actually proposed financial rewards for senior citizens under medicare for the first time, we lower their blood pressure and lower their cholesterol and stop smoking, reduce body mass and the like. and i think in the context of the chairman's question about primary care, tell us a little bit about what you're doing to bring together both your providers, your docs and others and the patients to start giving prevention and behavioral change empowering the patients to be part of your new approach. >> well, on the patient side, it starts with awareness of risk, which starts with a health risk appraisal, which we offer for free. just the discovery of the risks you have, the awareness of the risk kwous has a big effect on behavior. we ask them to share wit their

primary care doctor since we automatically share wit consent to the primary. we start with financial incentives to the member, just to participate. and then it moves for financial incentives for outcome. you see that you're overweight. you see that you have hypertension. you see the risks that you have. it's one thing to see it. it's another thing to actually act on it. we want to move to the day where stronger outcomes produce stronger financial rewards to the member. but if you're the only one that knows it as a member and your doctor doesn't, it doesn't do much good. so we give it to our small panels of primaries. it's seen by the panel. we identify the patients at high risk as evidenced by health risk appraisals. and we target interventions together with those primaries for the patients at higher risk. so it's incentive to the member to participate and to be aware and to take action. and it's incentive on the part of the primary because it's a global population-based incentive model.

if they can get a better outcome, they are a financial reward. the member does and the physician does, and they're dovetailed together. and it's the working together that actually causes we think the best result. >> senator, just the risk of being a wet blanket in this, and i completely agree with what you're discussing. >> i like we have contrary points of view. >> well, thanks. we were -- and i'm not sure if you i mentioned this -- at harvard and collaborated, and we published a piece in the "new england journal of medicine" a couple of months ago where we gave patients who had experienced heart attacks their drugs for free. so they in fact didn't have risk factors. they had already experienced the outcome. and despite getting their drugs for free, zero copays, less than 50% of them were compliant. so there is the ability for the doctor to do the right thing. they had written for all the right drugs there is the ability to convey information about risk. but the reality of human behavior is we need to grapple

with some of the complexities associated with it. it's very discourages, but we have a long way to go and we need to understand how to get into the psyche of patients. >> there is no question that there are a variety of factors involved here. i think what really swung me to this was the work of dr. roisin who is prevention officer at the cleveland clinic and the program that they have put together, which is essentially what senator portman and i modelled our approach with medicare, really does seem to be working. and i think they do try to spend the time, certainly, talking with patients, talking with families, incorporating in some of the judgments that you're talking about. but they are very clear. and toby cosgrove and others have had a long intervention. they are very clear in their view that these financial rewards, and these are of course not enormous sums of money. but the idea of a few hundred dollars in conjunction with some of these other kinds of approaches has been successful. and since chairman baucus has

given us a chance to kind of be around the kitchen table to kick these ideas around. >> that's great. >> and maybe an hour of social networking and sense of community which is something we're pursuing. >> i would like to focus a little more on patient responsibility. >> yes. >> one of the things -- >> go ahead. patient responsibility. how -- it's a big issue, huge. and your thoughts. how do we encourage it? you talk about probing the internal psychic of people. that's kind of scary. >> and we've talked about -- >> how do we get it so we encourage more responsibility? >> and part of it might be some sort of social pressure or social awareness but taking advantage of new approaches in behavioral health and behavioral psychology and behavioral economics to induce the sort of behavior that we're interested in. but the simple-minded notion that i as a doctor tell you what

to do and go farther and say you can do it for free, and we need to invoke other considerations. >> i would agree with that. and add to one thought here. it starts with incentives, but it can't end with incentives. to go back to what i said earlier, we find that the breakdowns occur at home. you don't comply partly because you're depressed, partly because of the way you live your life. and so there is a psycho social at speck to it. so we found that when incentives and awareness are combined with actual follow-up, not by the doctor who prescribes whatever the medication is, but often by a nurse following it up, the connect with the nurse has an effect on compliance. you can't do this on every patient, but we're looking at the 5 to 10% of the patients that run up two-thirds of the costs. and you can do it for them. it's the combination of all of the above -- the physician paying attention, the nurse following it up into the home where the breakdowns occur that

is so important to getting compliance. compliance is very low. >> but you can't do it in a straight fee for service based system there is no money for that. because what you're describing is absolutely essential. it's expensive to create the structure for it. so unless you have that global money to deal with up-front. >> correct. >> it's very difficult to do in a very fee for service. >> medicare does not cover it. >> yeah. >> both that global money up-front and an incentive that is based on the outcomes of care. because up until this point of creating accountability for outcomes, adherence has been the great don't ask, don't tell phenomenon in health care. doctors give a patient a prescription or advice and just assume and hope that that advice gets followed. and as mr. burrell just said, the financial barriers are only one piece of it. and starting to systematically address the barriers to adherence as part of what health care means, starting to address

did the patient understand, are there cognitive issues that are going to get in the way of adherence? are there motivational issues? are there practical issues in terms of their neighborhood and what they can do, or their work life and what they're able to manage? addressing those has to become part of what health care means. >> and that group we brought up earlier that serves the, you know, the low income and in the underserved neighborhoods, and patient response, they go out and pick up the patient and bring them in so they don't miss their appointments, so that they're always there when they need to be there. so that's been a big help for them. >> there are nine people who are working over here. it's called the supreme court. what -- how is their decision going to affect all of this? what do you do? >> you know, i've been asked that question a lot, and i don't profess to be an expert on it. but my comment has been it will

only affect pace, not direction, because we are all on a burning platform right now. we can't stay where we are. i think the affordable care act -- i mean i'm not an expert in it. i assume that it's flawed, but it's necessary. it gets us to the starting gate. and we're going to spend the rest of my career perfecting it. but we've got to start down that road. we can't stay on this platform. it's on fire. >> other thoughts? >> i would essentially agree with that. i think the changes that are under way are unstoppable, regardless of what the court decides. >> the economic imperatives will remain regardless. we've been working on this, as i mentioned in my testimony since 2005 at least it will continue. >> agree? >> yeah. we've been through a lot of changes over time. and we're just looking for some more sustainable programs. >> absolutely. we can't stop. >> well, this has been a good

session here. thank you very, very, very much. you've given us a lot of very good ideas. like most things, we just keep moving forward. thanks a lot. >> thank you. >> this meeting is adjourned. >> pleasure. >> sounds like you're doing some great work. up next, a senate appropriations committee hearing on clean energy in china and the u.s. and after that, defense secretary leon panetta and joint chiefs chairman general martin dempsey testify before a senate appropriations subcommittee on defense spending. tune in to c-span 3 friday morning for live coverage of the faith & freedom coalition conference. it's billed as the largest voter education and get out the vote effort targeting evangelicals,

tea party voters and conservatives. speakers include former house speaker newt gingrich, senate republican leader mitch mcconnell, radio host glenn beck, and many others. that's live 9:00 a.m. friday on c-span3. one of the quotes from white house staffer that i thought was really exceptionally inspiring was once you realize the magnitude of difference you can make in public life, everything else will pale in comparison. >> i think it was best put this week when brian from the white house came and said, he said a quote. those who think they're crazy enough to change the world are the ones that actually do. >> mr. brian, the same than that christopher was talking about said choose carefully and execute relentlessly. that and that meant a lot to me too many times we find ourselves taking too many things on and not really focusing on the one thing that should be your top priority. >> every year the u.s. senate youth program brings students to washington for a week of government and leadership

education. this year brian kamoie made an impact. he is a senior director on the white house national security staff. >> and so i started with the mind-set of what is it like to be them. and now that i'm in this role, what could i share with them that either i wish i had known along the way or that they will remember when they leave washington week, which as you've mentioned is a very intense, rapid-fire experience. so if you leave a few key encouraging messages, at a time where you know it's very easy to be cynical about politics, it's a good thing to encourage young people to pursue public service. >> more with brian kamoie, sunday at 8:00 eastern and pacific c-span. witnesses testifying before the senate energy committee said a comprehensive government-private sector relationship if needed if the u.s. wants a clean energy

industry. this meeting looks at clean energy in china and the u.s., comes after the chairman of the committee, jeff bingaman of new mexico returned from a trip to china. it's about 1:40. >> okay. why don't we get started. i'm told senator murkowski is on her way and said we should proceed. today we'll hear from witnesses on competitiveness and collaboration issues between the united states and china related to clean energy. the hearing follows a trip that i took to china in april to try to learn about chinese policies and incentives to deploy clean energy. my staff and i visited hong kong and shenzhen and beijing to talk about investors and business representatives and government officials.

on that trip i was impressed by the vast combination of financial investments and government partnerships with industry to deploy clean energy. china is rapidly developing and although much of its growth is dominated by coal and fossil fuels, the chinese government has combined a mix of financial incentives with government policies to promote the clean energy sector as well. that sector is not only developing domestically in china, it's also extending abroad. it's influencing the united states very directly and european markets. the situation in china is in direct contrast to the approach to clean energy that we have taken here in the united states. many of our efforts to promote clean tech in the united states

are addressed in an unpredictable fashion with funds and incentives that expire and come back to life and expire again. and they lack a clear directional policy that would allow industry to plan for the future. i believe that the inconsistent approach that we've been pursuing has put the united states at a disadvantage in competing with china for a share of the -- of clean energy markets, both at home and abroad. many here in the united states argue that we should allow the free market to determine the fate of domestic industries. there is clearly truth in that suggestion, but it fails to take into account the industrial policies and practices of competing nations as well as hidden costs in the current energy system.

the u.s. cannot compete on a level playing field with countries that have strong industrial policies when our own policies are inconsistent and erratic. in the absence of clear and coherent policies to support development of clean technology in the united states, many of our companies and industries are left to rely on trade policy to try to protect their competitive interests. trade enforcement is critical, but we also need a strong foundation of domestic policies to build upon. i want to make clear that this is not a hearing intended to focus on the trade cases that are currently before the itc and the department of commerce. the matters in these cases are not under the jurisdiction of our committee. this hearing should not be a forum to try to prejudice the outcome of any of those cases. the purpose of this hearing is to gain a greater understanding

of what china is doing on clean energy, how that impacts and relates to what the u.s. is doing. i'd like -- i hope we're able to focus on three large issues -- what is the current landscape of chinese investment in clean and renewable energy. second, what are the appropriate u.s./chinese relationships on clean energy issues, and how do we promote u.s. competitiveness with china and other countries in the clean tech sector? i believe the u.s. should continue to rig louorously cont to enforce level playing field when there are disparities, but additional measures are likely to be needed if the u.s. is to fully compete in this sector. i'm very interested in some of the testimony related to the experience we had with sematech back in the 1980s. and drawing the analogy between

what the united states did there to try to support the semiconductor industry and what might be done here with these clean tech technology areas that we're discussing today. i know alan wolff and clyde prestowitz have history with this and may be able to enlighten us as well. finally, the u.s. and china have common interests in deploying clean energy. while we may find ourselves in positions of competing with each other for these new markets, i believe that part of our conversation should also lead to answers on what the two countries can be doing together to accelerate deployment of these technologies. let me call on senator murkowski for any comments she would like to make. >> thank you, mr. chairman and to the witnesses welcome and good morning. the purpose of today's hearing is to take another, perhaps a closer look at clean tech

competitiveness issues between china and the united states. and i want to reinforce the chairman's remarks here that this hearing is not about ongoing trade disputes. it's not the role of this committee to influence those processes. focusing i think on other topics will not diminish our conversation but rather to the contrary. competitiveness challenges surfaced and emerged before goods are manufactured, factories are built because they start with the decisions made by company and individuals about where to invest the factors guiding this is limitless and there is no choice between the united states and china or any country. regulatory and tax treatments, property rights, law material availability, labor, health care costs, access to affordable energy, all of these combine investment decisions. our work to better understand these decisions can work with

china. these differences are rooted in some very important factors, including what our own constitution permits, how much taxpayer money we can afford to spend, what the american people really are willing to support. i'm one who believes we need to be mindful of these factors when we hear claims that the united states is somehow falling behind china in a clean energy race. in so many ways i would suggest that we are not falling behind. from the wages and conditions for our workers to our environmental standards and capacity for innovation that i think the united states is leading. we can and should work with china to make progress on our energy challenges but we should not necessarily copy what they do or how they do it just for the sake of copying what they do. imitating china is not the best way to compete with china. and this is particularly true for energy technology subsidies as we were to get our debt under control. i have long advocated for

funding efforts from conventional energy resources. this is a far more sustainable approach than the one taken by china. i hope that we continue to gain in traction in that direction. beyond spending i think we need to be careful about following china's more progressive energy policy. an example would be the three gorgeous dam. a source of renewable energy but it has displaced people from their homes and communities. chinese production for clean energy technologies has had negative impacts on their country's air and water quality. the solar panel factories don't necessarily run on solar power. but having said all that, i think we also recognize that our country's policies are not perfect either. even here at home where we have a proud history of improving environmental performance, biofuels have played a role in raising our food prices.

we currently have no plan for disposal of our nuclear waste and transmission lines to connect to the grid as resulting in controversy out there. i raise these issues not to throw cold water on the enthusiasm for clean energy technologies but perhaps to provide context and a reminder of the challenges that we face. it's my hope that this hearing serves as the basis for understanding how cautious we must be about accepting some of the simple narratives. in the end, it's not just about lowering the cost of financing projects that we all support or finding the money in the budget for subsidies. it's about looking at the whole picture, devoting as much attention to identifying areas where our own government can play a constructive role as we do identifying areas where it's getting in the way. it's about balancing the priorities and reaching agreement on the policies that address our immediate and

long-term needs. the discussion must account for china but i don't think that we should be overwhelmed by it. i appreciate the fact that we have the opportunity to have this hearing this morning, mr. chairman. i look forward to the statements and comments from the witnesses. >> thank you very much. we have five distinct witnessed witnesses here. let me introduce them. mr. justin wu. who is head of wind energy research and new energy finance of hong kong. we appreciate you being here very much. mr. alan wolff who is senior counsel. we appreciate you being here very much mr. clyde presowitz, president of the economic strategy institute, we appreciate you being here. mr. dan holiday, director of advanced technologies and pv

programs, thank you. dr. derek scissors, the senior research fellow at the heritage foundation, thank you for being here our approach is to have each witness take five or six minutes and summarize the main points that you think we should understand from your testimony and we will include your full testimony and if you can try to give us the main points, that way we will have some time for questions. why don't we just introduce people. mr. wu, why don't you start. >> thank you very much. good morning. it's an honor and privilege. i join you in my role as an

analyst, a division of bloomberg focused on a clean energy sector. our group provides actionable data on investment, technology, and clean energy. in addition, they do not represent any investment advice and should not be construed as such. the subject of today's hearing is china, clean energy, and the trade relationship between the united states and china. i grew up in maryland and have worked in hong kong over the last six years i offer my thoughts on the current status and what we can expect in the future. i will leave it to my fellow panelists the trade and cooperation issues. and there's no question that china is a clean energy giant. the country now manufacturers half of the wind turbines and

four of the largest wind manufacturers and eight of the top sen solar manufacturers in the world are chinese. the country overtook the united states as the largest wind market in 2010 and installed more than 10,000 wind turbines in 2011. that represents ten times the capacity of the hoover dam. in 2009 and 2010, china was the world leader in attracting new energy. though china finished second to the united states last year for reasons which i will explain in a moment. the chinese economy is expanding at about 8% per year and electricity demand growth can match. they have to invest heavily in new capacity to keep pace. second second, over 70% of

china's electricity currently comes from coal. this overreliance has become expensive. the need to diversify with something cleaner and less vulnerable is attractive and important. in 2005, the chinese government drafted its first renewable energy law which set targets for renewable energy and mandated utilities procure a certain part of electricity from these sources. this is followed by other measures which set high prices for wind or bio mass projects, a loss that required dispatch of renewables. a vision for renewables was outlined at the national level and the industry embraced these goals. local government offering land and tax incentives to clean energy companies to set up shop in their home provinces. state-owned banks went to power

companies to build wind farms and built alongside the general railings capacity, chinese state owned corporations, many previous manufacturing or construction experience began buying technology licenses, forming new adventures and hiring to build wind turbines. the ultimate result, a manufacturing boom and leading clean energy companies. it should be noted that a number of european and american clean tech companies have benefited from this boom. advanced components of wind turbines were applied by european firms and often comes from american companies. however, china's clean energy boom is not without its promise. the rapid growth of the energy bubble, there are far too many wind and solar manufacturing companies and many face intense