and now i turn to my colleague, senator shelby. >> thank you -- thank you, madam chair. today as the chairperson has laid out, we will discuss the administration's $6 billion request to address the ebola outbreak, both domestically and in west africa. given the size of the request, the slow progress in detaining plans for how the money will be spent and some of the missteps made so far, careful oversight and scrutiny. as we have seen in recent week, the vast majority of american health care professionals have little to no experience with this virus. the appearance of the disease on our shores can have devastating consequences for our health care system and our society at large. consequently, it is the fundamental responsibility, i believe, of the federal government, to respond effectively to this crisis. every prudent step must be taken to protect the american people.

instead of an effective response, what we have witnessed, i believe these past few months from various agency has been confusing and at times contradictory plans. for example, the cdc's guidance to hospitals has been a moving target. this uncertainty may have exposed health care professionals to unnecessary risks. the administration also has sent mixed messages on the issue of quarantine. while the president has discouraged straight quarantine rules, defense secretary hagel has prudently put in place a 21-day mandatory quarantine for troops returning from west africa. in addition, the administration did not call for enhanced airport screenings for travelers entering the u.s. from west africa until months after the epidemic became severe. it still remains to be seen whether these cursory screenings will be effective.

not surprisingly, americans have been frustrated by the lack of clarity and coordination within their government. even though the president has named a so-called ebola czar to coordinate a response, all reports indicate that he has no actual authority to direct government agencies here. from the beginning of this outbreak, the administration has appeared to be preparing for only the best case scenario. competent crisis planning must include contingencies for the worst case scenario as well. therefore, i think we should not rule out any reasonable options to prevent the reintroduction of ebola in the u.s., including travel and visa restrictions. if the history of disease outbreaks has taught us anything, it is that things can change quickly and without warning. therefore, federal agencies must

be ready to aggressively implement a clear and organized strategy. it is my hope that today's witnesses can assure this committee and the american people that the president has a plan, that the funds he has requested are necessary to execute it, but we will wait our testimony. thank you, madam chair. some of the responses to the ebola committee we will show you that coming up here on c-span3. a live look at the capital on the first day of the lame duck session of the 113th congress. taken day got under way in senator mitch mcconnell's office as he welcomed new senators to washington and talked to reporters as well. one newly elected senator not in this group is the newly elected senator from alaska,

senator-elect stevens who has won that race in alaska. here's this morning's event. >> ready, stu? >> all right, leader go ahead. >> this is a lot happier occasion than after the 2006 election when we had president, secretary and treasurer, bob corner. we hope the new bunch will be

joined, dan sullivan and bill cassidy shortly. we are here to make the place function again. and to begin to make progress for the american people. >> you said you are ready to work with the president if he moves to the middle. does that mean you plan to move to the middle too? >> the problem is the president continues to send signals he has no intention of moving toward the middle. i was particularly distressed about a deal that apparently he reached with the chinese on his current trip, which is as i read the agreement, requires the chinese to do nothing at all for 16 years, while these carbon emission standards are ruining our environment. i hope the president can move to the middle and i hope to do some business on trade and tax reform. >> mr. leader -- how do you expect to deal with the china

issue? are you going to try to roll back -- >> we'll be discussing all that with our colleagues here in the next few days before we get ready to take over the new majority. >> thank you everybody. thank you very much! thank you! thank you! thank you, everybody! >> senator what about using a cr to block -- >> thank you, everybody! >> let's go. >> boom mic. >> how does it feel to be here? >> great. >> thanks, folks. thank you very much! let's go! thank you! mics, everybody, let's go. thank you, everybody! you did a great job. thank you.

>> some of the newly elected senators in mitch mcconnell's office earlier today on capitol hill on this the first day of the 113th congress. that group didn't include dan sullivan of alaska who was announced the winner in the alaska senate race. really just one senate race out there that is left to resolve. that is the race in louisiana between senator landrieu and bill cassidy, the republican. and on that ♪, senator landrieu has been speaking on the senate floor about the keystone xl pipeline. the house will take up a bill on the pipeline tomorrow. house rules is meeting in about ten minutes or so. look for that bill on the house floor tomorrow. follow the house on c-span and the senate on c-span2 and on c-span3 we'll show you the senate appreciation hearing today looking at the funding for the u.s. response to the ebola outbreak.

about domestic preparedness and thank everyone for the gallant and generous and dedicated work of health care workers here. but i was also really wore rained wasn't only really worried but so were the national nurses united i received a letter from them that really articulated my concerns. what they said to me, and now i quote them, is that the president needs to invoke his executive authority to maintain uniform national standards and protocols, that all hospitals must follow safety-protected patients or health care workers and the public. they then go on to talk about the personal protective equipment needed, particularly hazmat equipment, and they identified the actual osha standard number. my question to you, secretary burrell, is do you feel confident that now in the way we are responding that the doctors and the nurses who are actually

touching patients have the protective equipment that they need, that these are national standards for not only the equipment but the training so that we have a national response regardless of where someone might appear that needs help? could you share with us and did you respond or did the president respond to the national nurses united request? >> so, with regard to the issue of making sure that our health care workers are prepared i think we need to think about in the a number of different levels. the first is in that screening and monitoring and that's what state and local health care workers are doing, with then checking on the people who have come from these countries. second is that that initial front line worker, in a health care institution that needs to be able to detect and isolate, ask the right question. if you have a fever, what is your travel history? the next is the level where treatment will occur and as we describe in our submission, this will be in a more state by state basis and where the cases are in terms of treatment. the question i think the nurses were posing was on the category that had to do with that front line.

as i mentioned in both my oral and written testimony, at this point, we have trained over 250,000 people. what we need to do now, and that's part of what this request is about, is to make sure that that training continues and extends and we need to measure it, what we are hearing when we hear from the nurses, we want to make sure we respond. do they know? is the training working? do they feel confident? right now, we are working with the association of state and tribal health care organizations to make sure that we are going to put in place a measurement so we can understand they have what they need with regard to training much the second part the nurses mention is ppe, the protective equipment. >> yes. >> we have provided guidelines through the cdc in terms of what's needed in training and what to do. the second issue is access to that and through the assistance

secretary assistance and sport, barta, working with the manufacturers producing 24/7 now working with them and work with the states to make sure that those who have the greatest need and will most likely treat get that equipment. >> well, madam secretary, let follow up on this. so do you feel confident that we have -- that if ebola appears, you used -- on page four of your testimony, the maryland case example, a young lady came in, she took her temperature, she thought she might have it, she wasn't gonna go to nih, she was going to go either to maryland or hopkins. that those who would be once identified with the high temperature, et cetera, that they would have the equipment and that they would know how to use the equipment, but regardless of whether they are at a high-tech urban hospital, like a hopkins or a maryland, an academic center, but could be a community-based hospital in a rural area, that you would be ready to respond to see that they had the equipment and the training? >> that is why we are doing the

aggressive training that we are going. >> do you feel confident that we have it now or in process? >> right now what we are seeing in all the cases that you articulated and all those who have come through. we are providing at the border a kit. any individual coming through, which is where the case would originate, gets a phone number that they are supposed to call. they get a thermometer to take their own temperature. >> what i need to get is for that nurse to feel that if she has to walk into a room and provide the care that she has taken an oath to do, along with the doctors and others that are the support staff that they're going to have what they need to do the job and that they also have what they need to protect themselves. >> that is what we are working to do with all the training. at this point we've trained 250,000 and the funds that were -- >> isn't this what your money is for? >> yes. >> really? it's to continue that effort. >> isn't that part of the public health infrastructure? >> it is.

this is the basic and it's not just for ebola. >> i have to put the public's minds at east and i have to put the nurses minds at ease -- not just to put them at ease but to cover their back and their arms and legs, et cetera. a question for our constituents that go towards the military. the calls i got is we're sending our military in harm's way to protect us against terrorism. but now we're sending them to get ebola. my constituents were deeply concerned that in deploying our military to do the excellent task that you've just identified, mr. lumpkin, that they were going to be exposed to ebola and they were being put in harm's way to get ebola. do you believe in your employment and if the good general needs to respond, are our military actually going to

come in contact with people with ebola and our are military at risk of getting ebola? and are we sending them in harm's way in the same way we are doing it with a bullet, but here we're doing with the a disease? >> thank you very much for the question. i think one of the key aspects here is what i mentioned in my opening remarks is that d.o.d. personnel are not doing direct patient care of those that are infected with the ebola virus. we've taken great steps to ensure that our military and civilian personnel receive training before they go. comprehensive training. we make sure that we monitor them while they're there. and we make sure that we have a controlled monitoring situation when they return. i'll defer to my joint staff counterpart who can go into the specifics about it. thank you. >> general, welcome. >> thank you very much. the personnel who are going to

be deployed, as the assistant secretary said, will not be doing direct patient care. we've instituted four levels of predeployment training for all the personnel who are going. from the lowest levels of transient peoples, think about air crews flying in, not getting off the airplane, and flying out. graduating up to personnel who will be in country, who will have to interact with liberian nationals as they go about their day-to-day business. those personnel will receive training in how not to come in close contact with those personnel and will be issued ppe that they will carry with them in the case it's necessary. up to higher levels of training for our health care professions who will be in country at the two rural hospitals, one in monrovia and one in dakar, senegal, who will be there to treat our military personnel both for regular injuries and be able to treat them if they somehow do come in -- do contract ebola.

and, finally, to the highest level of training for our lab workers who are there now, testing blood samples as part of the support there. yes, we've got a complete protection package for those personnel. >> thank you very much. i'm now going to turn to senator shelby. i could have asked about the protection of our border people and state department people and i look forward to you perhaps submitting an answer to that. so we protect those who are trying to protect us. senator shelby? >> thank you, madame chair. on october 17th, president obama named ron clain to a white house post responsible for coordinating our response to the ebola crisis. how many times have you met with this is a question for all our witnesses. how many times have you met with mr. clain since his payment and what has he brought to the

table, to the effort, in other words, that was missing. madame secretary, start with you. >> i've been in touch with mr. clain every day since he has begun, face to face, by phone or by e-mail. in terms of what he has brought to bear it's been my experience and my experience last time when i served in government, the importance of policy coordination, i was there at the beginning of the national economic council where we did much consultation. it's a very important role in terms of when a whole of government effort is occur. and mr. clain has stepped into that role and added value to our coordination. he had been working with folks before but it is helpful to have someone in the white house day-to-day to do that function. >> what has mr. clain brought to the table? >> i can't say i've been in touch with him every single day. i've been in touch with him countless times. >> okay. >> i believe that the critical value that ron has brought to

this is coordinating the federal response between and among all the agencies, components you see represented here and having somebody who is dedicated full time in the white house to doing exactly that. >> secretary? >> my first meeting with mr. clain was within 24 hours of him assuming duties and not daily but nearly every day in contact with him and he has done an outstanding job of doing just that, coordinating and singular focus for the administration of coordinating across interagency. >> i've just been back from maternity leave for two weeks, senator. ron was appointed to his position prior to my returning. >> you'll be excused. >> since then we've had frequent interactions. it's the policy coordination that's so key to our response. >> to your knowledge, does mr. clain have the authority or power to direct your agencies to

perform any specific actions or is it mainly trying to bring you together? >> policy coordination with regard to the execution of the agency's responsibilities, those sit with me and with the heads of our operationing divisions like dr. frieden. >> secretary burrell, on october 28, president obama was -- issued more stringent rules for returning health care workers stating we don't just react based on our fears. we react based on facts. as we've all known, secretary hagel has approved mandatory quarantine for troops who have been deployed to the ebola-affected areas. forum, most military personnel, as we've learned are charged with building facilities and will have limited, we hope, patient contract. while civilian medical workers

will have direct patient contact. what facts, that was the word the president used, should we base quarantine guidelines on madame secretary? >> i will start but turn to dr. s frieden and fauci. we've determined level of risks. quarantine base system based on their level of risk. and that's based on the epidemiology which is years of experience, i think dr. fauci has been work on this for well over 30 years. in terms of the experience that we see. that's how we determine what's done with each and every group of people and different groups fall into different categories. that's how we base the decision. that's an individual basis often which is why we monitor directly and actively every day those health care workers that return. >> is the assessment -- i'll direct this to you, too, doctor,

since you'll be in on this. in the assessment of risk difficult when people are coming from various countries and perhaps don't divulge where they've been? i know you can keep up with it to some extent. who they've been exposed to, all of this? is the assessment tough to come by? >> we do several levels of assessment, first to assess the fever, to see if someone is ill. and then to assess them if they do have a fever to determine the cause. second to see what exposures they may have had working in an ebola unit or are being a health care worker otherwise or having potential exposure to someone who may have had ebola. but for every one of the individuals who returns, we ask the states to undertake an active monitoring process and we facilitate that process, as secretary burwell said so they're taking their own temperature and if they develop fever, they are rapidly

contacting the health department of their state, where they can be safely transported to a facility that is ready for them. ebola, as far as everything we've seen only spreads from someone who is ill. it doesn't spread from someone who is not ill. if you can find that illness quickly and isolate them, then you can stop them from transmitting to anyone else. that, essentially, is the way of protecting not only their health but also the community's health. >> doctor, you want to add -- >> yeah. so in some circumstances when we have a high risk, when we strat fie risk versus the movement, there is a functional equivalent of a quarantine if someone is at a high risk. it isn't as if it's all or none, but not saying there's a blanket quarantine we're being somewhat reckless of making everyone have the same sort of movement. we don't do that. to give you an example, i took care of nina pham. so i'm in the low but not zero risk. so i had direct active monitoring every day.

if i were to be quarantines i wouldn't be able to be here with you testifying. so the fact that i'm low but not zero risk -- >> maybe you would have liked that. >> if you are, we're going out the door. >> right. >> to dr. frieden, you're the head of the centers for disease control. you deal in epidemics, you're, both doctors, what can you say to the american people today about their concern -- and it's widespread -- of a possible ebola outbreak in the country? >> we certainly understand people's concerns. ebola is scary, deadly. and the images from africa are frightening. but ebola spreads by direct contact with someone who is sick with ebola. and we know that two main ways it spreads are by unsafe care giving in the home or in health care facility and unsafe burial

practices. the burial practices that are spreading ebola in west africa are not things that we do here, so not to be concerned about. but care giving is. that means for every individual who comes back from a place that may have ebola, very important to be monitored actively for 21 days. at the first sign of any symptom, even if it's not severe illness, what we're seeing now is, as appropriate. people are coming in, being tested. coming in and being isolated. as soon as that happens, we reduce the risk of spread. so from everything we've seen for the last nearly 40 years working on ebola in africa and from everything we've seen here where no household contacts became infected, ebola doesn't spread widely. it doesn't spread like flu or measles or other infectious diseases. but it's deadly. that's why the hospital infection control is so important. but from everything we've seen, we do not think a large outbreak is at all likely in this country. it's just not how ebola has

spread either here or in africa to date. >> senator harken. . >> thank you very much, madame chair. i'm pleased that the administration's request addressed not only the immediate funding need but begins to address the reasons why it reached epidemic proportions in the first place. the current spread of ebola in west africa is a major public health emergency but it should not with a cause for panic or journalistically provoked fear among our populous. it should serve as a reminder and a wake-up call. let me read you something that senator mark hatfield, former chair of this committee said when he retired in 1996. he gave us his farewell speech on the senate floor. here is what he said, and i quote. it was at the end of the cold war. this is exactly what mark hatfield said. quote, the russians are not coming.

the greatest enemy we face today externally are the viruses are coming. the viruses are coming. end quote. 1996. former chair of this committee. a decade later, a similar warning at the emergence at the avian influenza. he said and i quote, at some point in our nation's future another virus will emerge with the potential to create a global disease outbreak. history teaches us that everything we do today to prepare for that eventuality will have many lasting benefits for the future. mike levitt, end quote. both were right. the spread of the ebola virus follows on the heels of h 1 n 1, middle east respiratory

syndrome, mers. but at this time, when new viruses are emerging and new viruss are becoming drug resistant, we reduced investments in nih and cdc and acting short-sighted cut that has left us less prepared. we have to accept the fact that we don't live on an island with airline flights every day around the world, every virus is de facto and airborne virus. we must stop chasing diseases after the fact. we cannot be everywhere at once and we will never run faster than a microbe. our only chance lies in building public health systems capable of detecting and stopping diseases before they become epidemics. we have the knowledge, right here. we have the expertise and the systems to combat ebola and other infectious diseases. our challenge here is to act calmly, based on science and

facts and with resolve to redouble our resources and to build that capacity. i say that because there's some talk in this emergency funding that we should only address ebola and not look to future viral outbreaks and viruses. so i looked up the word emergency. this is emergency funding, right? >> we hope so. >> emergency funding. it comes from the root word "emerge." how about that? emerge. merriam-webster dictionary says it's an urgent need for assistance or relief. so we shouldn't confuse emergency with disaster. this is emergency funding to stop a disaster. that's what this is. now, again, that's why it's an emergency because viruses are mutating, some of them we know are becoming more drug resistant. and the zoonotic diseases that we're looking at now, ebola is

just one of those, are global in their impact. so dr. frieden, you and i have spoken many times in our trip to africa, we went a year and a half or so ago, to stop these diseases where they start. those conversations as well as the work of a group started by your predecessor, jeff copeland, inspired me to create a federal national public health institution program in last year's appreciations bill. we must invest in countries with weak public health systems so they can stop these disease before they cross the borders. we only need look at h5n1, southeast asia, to be reminded of the virus threats that are still out there. they're still out there. i've said before if h5n1 starts jumping from birds to humans and humans to humans, we better look out. it will make ebola look like a picnic.

so the need is not only to address ebola now but the emergency that's at our doorstep to keep americans safe at home by building cdcs around the world in all these countries. now i understand that approximately $600 million of your request would go to doing just that. but considering the need, that seems very low to this senator. very low. $600 million to build the cdcs, to put in the laboratories, get the equipment, train the technicians, train the open deemologists. it seems low to me. can you explain that number? what do you hope to accomplish with that investment? and could we use more to address emerging, emergency outbreaks? dr. frieden? >> thank you very much. you don't need to look any further than the difference between what happened in nigeria

with ebola and what happened in liberia with ebola to see what a difference prepared public health systems make. in nigeria, through extensive effort, because there was an emergency operation center, because there was a laboratory network, because there were trained disease detectives, because there was a public health system that could respond to the outbreak, they stopped it. it took enormous effort but they stopped it. and today, from that importation, nigeria is ebola free. the world would be a very different place today if liberia, guinea, and sierra leone had had those systems in place a year ago. they could have contained this outbreak. the global health security emergency portion of this request aims to protect not only these countries but ourselves against that type of threat whether it's the next ebola, the next sars or the next hiv, there are three fundamental areas that we work in.

they're all very specific, measurable and will leave behind as temporary assistance something that will protect us for many years to come. the first are prevention methods, how to ensure we keep our laboratories safe, that we stop the spread from animals to human whenever possible. and that we're able to immunize with whatever we can to reduce the risk of things spreading. second, and the largest component is detection. putting in place the laboratories, the disease detectives and also the surveillance systems to find problems when they first emerge so we can stop them at the source before they spread. third, of course, is the response. emergency operations systems, the ability to work with medical countermeasures and to stop outbreaks before they spread. those are the three key interventions that we would be able to implement with these emergency funds to protect ourselves against these emergencies going forward. >> thank you, doctor. i see my time is out. i'm sure i just think that's a low figure confronting what we have to confront worldwide.

and i'll ask a point of personal privilege. this is probably my last -- >> yes, i was going to note that. >> -- committee meeting after serving on it 30 years. let me thank you all for your commitment to public service and for your great leadership. if you don't mind i especially want to thank tony fauci, with whom i've had a 30-year relationship. we both came here at the same time. you came there. i came here. you have had the better of it, believe me. also, thank you for your great leadership at nih and also dr. frieden with who i have had about a decade-long association, first in new york city and later at cdc. thank you for your great leadership. and to staying calm and targeted and focused when others around you might be losing their heads. thank you very much. thank you, madame chair. [ applause ] >> i think we could say the same about you. i don't know about the calm part.

>> i don't know about that. >> senator johannes -- by the way, we're going in the order of arrival, so -- >> yeah. let me start with you, secretary burwell. in your written testimony, you mention the contribution that emery made, the university of nebraska made. i think the cdc would recognize that the guidelines you're using, significant input was provided by ose institutions. as i have looked through the request for funding here, $6 billion request, we have money to reimburse the world health organization. we have money to reimburse civil aviation organization. i could go on and on.

i don't see funding that would be available to reimburse any institution in the united states that provides care and treatment and training relative to ebola. i've talked to staff for the relevant subcommittees and talked to some of the members. and it appears to me to be an oversight. and it would seem to me to be logical, because you asked emery to take patients. we were glad to do it. but it seems at this point, some assistance in terms of reimbursement would be appropriate. treating an ebola patient is a

world different than treating mike johans who walks in with a severe case of the flu. do you know what i'm saying? go ahead, secretary. >> so, with regard to, i think there's the issue of the treatment facilities and there is funding within this request to make sure that we have treatment facilities around the country and that there will be funding. but with regard to the special institutions like the university of nebraska and dr. gold and the team there, who have had the opportunity to spend time and talk to, and the emory folks, what we have done is there is funding there that is about the creation of an education training facility. and is it our hope that both of those institutions will team with cdc. we will do financing for those institutions to be part of our training of the other institutions and hospitals around the country. with regard to the specific issue of treatment and the treatment of patients, to date, much of the conversation has been between private insurers and the hospitals themselves. if this is something that the congress -- to date it has not been an issue that has come to us. if this is something that folks

want to discuss as part of this funding, we're happy to entertain that. >> great. it's an appropriate discussion because the private insurer, when they look at the cost of care for an ebola patient, i mean, it's through the roof. they will cover a minuscule amount if there is private insurance coverage. it will come nowhere near to cover the cost. and i will tell you what you know already. and that is in the early days of this problem, couple of months ago, you folks were scrambling to figure out what to do with these patients. we were glad to be there. this was -- this was started when i was governor. we're just glad we have world-class treatment there. we want to be helpful but again i think it's a conversation we need to have. second point i wanted to make here, and this is a -- i think a

very important point. i understand the expediency of putting money in each state. each state will get a certain amount of money. it seems that the formula is based upon population. i think we're going to look back in three or four years. i'm not going to be here to question you about it. but i think we're going to look back and we're going to say, i wonder what that got us. here is the reason. treating an ebola patient is very, very challenging. and there is risk involved if it's not done properly. i don't know that every hospital out there would want to get into this business, to be honest with you. i think some hospitals around nebraska would say they seem to be doing a pretty good job over there in omaha. let's fund them and support them. i think you need a more regional concept than what is called for by this legislation, because

there are facilities out there that were way ahead in terms of what was provided here. i would like your reaction, secretary. and then i would like the reaction of the director of centers for disease control to what i've just said. >> so with regard to the question of where we do treatment in the nation and how we do that, what we have started with is certainly we were fortunate that the congress had funded and we had supported the university of nebraska, nih and emery to be biocontainment facilities. those are our anchors. >> i'm not convinced that there were federal funding. maybe a very small amount. but i think it was a state initiative. >> as those then go out from that ring of three, what we've done is we have focused our effort on the five airports that secretary johnson said that's where the cases we believed would come in. so we put in place the training and cdc did that training in

conversations with the other hospitals for new york, dulles, o'hare, atlanta and newark. and so that was the next ring in terms of treatment, to your point of the question of a strategic approach. and then beyond that, we have been doing tracking of where the including people are going. and trying to find the dispera of these three communities. that's the next point. that is how we are starting in terms of your question about a focused approach. as we have started this process, though, many states have approached us because of their desire to make sure that they have a facility within their state. as we were thinking about it, where is the concentration and where is their geographic proximity so that a patient could be within eight hours anywhere in the united states as well as what we're receiving in terms of incoming. so that's how we have started to

design and are currently working on the question of where these facilities should be, the treatment facilities. so it's both the states reaching out to us as well as the strategy we're seeing an litically and the risk. >> it's really a question of stratifying risk and which hospitals can do what. also understanding that with the active monitoring program, we'll have a head start on being able to plan for if someone has just come back, where would they go. the issue of ebola is one deadly infectious disease that's complicated to take care of in hospitals. but the more -- the broader issue is hospital infection control for ebola and other deadly infections. and what can we do to strengthen not only individual facilities but also the system that each state has to improve infection control for ebola and other threats in their hospitals? something that's valuable not just for ebola but other hospital acquired infections.

>> madame chair i won't abuse the privilege of my time but it's i will tell you with the small amount of money that's going to each state, what you're going to end up with is double-wide units that won't be adequate for the next crisis. i just think that money is going to go out there and it's just not going to be enough to do the kind of work that you're trying to describe to this committee. thank you, madame chair. >> to the gentleman from nebraska, first of all, you sent me a letter on this matter just a few days ago. when i went to acknowledge the receipt of the letter, asking for consideration and of funds for hospital workers and also for those hospitals that agree to treat and are able to treat these patients, i think the gentleman raises an important point. >> thank you. >> i'm not sure it can be

addressed literally in this urgent supplemental but it could be ebola or another infectious disease. and i think we need to look at this. i want to acknowledge the validity of the issues you've raised because for those of us who faced -- and i don't mean it in a way to say oh, my god, we faced it. but we're willing to provide care as the university of nebraska, which to be commended for their superb response, it's costly. it is costly. >> yeah. >> and in this era of stringent reimbursements both from the private and public sector, there are hospitals who are already stretched to meeting their bottom line and if the generosity of spirit and the technical capability to absorb, your point is we shouldn't add to the fizz fist call burden while they have to deal with the care burden and also the

stringent reimbursement systems that they're already under. is that kind of your issue in a nutshell? >> madame chair, it is exactly. because we want to be helpful. we never had any reservations about this. and i could not be more proud of what was happening there. but the cost in this is just huge. >> so let's talk about this, okay? >> let's keep working on it. >> okay. senator reid? >> thank you very much, madame chairwoman and thank you, ladies and gentlemen, for your testimony. doctor frieden, one of the major objectives we have is to suppress the disease in west africa. and that is many factors. one critical factor is health care workers. can you elaborate how internationally we're doing in terms of local health care workers, supporting them and also attracting international volunteers? the bottom line is do we have enough health care workers to deal with this crisis? >> stopping ebola at the source in west africa requires improving care and burial, two

key ways that it's spreading. usaid has stepped up and scaled up safe burial services. department of defense and others are helping to establish treatment units. one of the things that is encouraging is 90% or more of the health care staff caring for ebola patients in west africa are from those countries but there's still a need for international assistance. one of the things that has been very encouraging is the african union has been willing to send hundreds of health care workers in. that's in process now. we've also seen an increase in health care workers from other parts of the world. and one of the things that we try to ensure is that every step is taken to make care as safe as possible there. but there's still a gap, as my colleague, nancy lindbergh can discuss of a need for health care workers from this country and as well as around the world to help address the epidemic at

the course. not only to save lives there, but to protect us here as well. >> what are we doing to fill that gap is the obvious question. either you or your colleague can respond. >> yes, thank you. as you know, there's a significant need for health care workers and, in part, because it's a very high burnout job. we have to continue to replenish the pipeline. there's a significant effort to recruit internationally. deputy secretary can say more about that. i would just add that ensuring that they have the training and equipment that they need is an important part of the equation. and having them feel comfortable, that if they go and serve, they will be taken care of. to that end, our colleagues from dod have built a hospital, 25-bed hospital that is being staffed by u.s. public health care workers, medical personnel. and we are working with dod, with w.h.o. and others to have a continual supply of protective

gear and dod has stood up a training facility in monrovia to ensure that there is a continual surprise of the specialized training that is required. >> on that very note, if i may, to train u.s. health care workers going over, cdc began a training course in alabama in conjunction with the fema site there. all the u.s. public health service workers went through that training. it's based on years of experience that doctors without borders have. and that's the type of very intensive training that we're implementing. >> and this resources in this emerging legislation will support all these efforts that's been discussed? >> absolutely. >> and without these resources the gap will persist and the disease will be further beyond our means of suppression? >> these resources are essential to stop the outbreak in africa and protect us. >> let me just -- secretary

lumpkin, dod has set up their base in dakar. the question is, that i've gotten, is how do you get to the last mime. how do you get from dakar, supplies, personnel, trained personnel out. and the other issue coming based on our discussions is the end of the rainy season, what impact does that have? does that give us special urgency in getting this bill done? >> thank you for the question. i would like to address the issue with the end of the rainy season first. i think that's a temporal issue before us. as you're probably aware, liberia gets about 200 inches of rain a year. what has been moving during the rainy season is people by foot because many roads are closed and therefore carrying the disease. what's hard to do is to get supplies to where they needed to be. that's why it was crucial to build up these logistic networks. in the drying season, you have two different things that

happen. you have more freedom of movement for people, is one. which means an increase in spread of disease potentially, but also the temperatures go up. the time that health care workers can spend in their ppe, personal protective equipment, is reduced significantly. so that adds another burden. i will go ahead and defer to major general laravair. >> senator, thank you very much for the question. intermediate staging base is fully operational at this time with 101st brigade running that operation there. they've established a rotator flights, c-130s down to monrovia. from there we have helicopters on the deck that can take personnel and equipment out to the various locations or to do what they need to do. we've got the -- starting to get the equipment and the personnel in place, able to transfer that equipment to the last tactical mile. >> my time has expired. quickly, ma'am. >> senator, quickly, part of what this request does is enable funding to provide a transition

so that dod can depart and there is a civilian capacity in place for logistics including the last mile transport. >> thank you, madame chair. >> senator blount? >> senator blount? >> dr. frieden, there was an associated press report on november 7th that said that public health experts warned that the actual number of ebola-related cases and deaths in africa was likely much higher than the numbers being reported. do you have an opinion on that report one way or another? >> we have previously estimated that there is probably underdiagnosis and underreporting of the cases. particularly when cases are increasing rapidly. that overwhelms the treatment and surveillance systems. so, yes, we believe the number of true cases is larger than the number of reported cases. >> do you have any idea how much difference there might be? >> in september we estimated that for august onward there

could be as many as 2 1/2 times more than were diagnosed up to that point. since that point we believe that some of the monitoring systems have improved. and we don't have a more recent estimate of the difference between what's reported and what we actually think may be happening. >> i think in guinea and -- the numbers have gone up pretty dramatically lately and seem to be heading the other way in liberia and sierra leone, is there a reason for that? >> we see different trends in each of the three countries. and within each of the three countries different trends in different areas. in guinea, we've seen waves of disease increasing then decreasing emanating from a forested area deep in the country which is where the outbreak is believed to have begun. and where it has never been completely controlled. that has been the epicenter for

sources receding other parts of the forest area. not only in guinea but the other two countries. but in the parts of each of the countries which have implemented the strategy, we have proof of principle. we've seen big decreases in cases in individual areas when we get the safer care contract tracing, safe burial, infectious control and health care systems, those standard disease control methods that have worked for every ebola outbreak, and i'm told now have worked for the firestone company and near monrovia, which implemented them and individual community. so we have proof of principle but still an enormous challenge in front of it. >> on to another topic. how long should this money last that you're asking for? and what's the significance of the contingency fund and how long in the future do you think that money would be there? >> in the current context of

what we know -- and i think as director frieden just talked about, the evolution of the epidemic is something that ebbs and flows. in terms of what works we believe that the base amount of funding is the amount of money that we need across the departments. that will stave off the epidemic. the contingency fund was asked for because, to the point that was made in opening remarks about preparedness and making sure, when we have elements that aren't predictable, we want to make sure that that funding is in place. and that funding would be for different types of things. to give you some examples, if another country, another ring country has a number of cases and starts to be elevated like a guinea, sierra leone or liberia, that could change the needs. another thing that could change the needs that we would use the contingency funding for would be if we actually get a vaccine and we're still at a stage where we believe you need to do deeper and would do more distribution

of vaccines to a broader group of health care workers. those are some of the things that the contingency fund is about. it is a fund that we have submitted for. we want to make sure there's a block that the funding will not be used unless it's needed. but that we put in appropriate preparedness. >> and on vaccines you've asked for money for fda here to -- >> uh-huh. >> how would you do that process differently? would you speed it up? bring more people into the process. are there steps in an emergency situation like this where there's a way to go through them more quickly or go around them, to get to the end product quicker? >> yes, sir. we have seen that in the process right now. the congress gave us emergency use authorization that would allow us to approve diagnostics quickly. we've used that authorization six times. fda has used it six times.

we approve from start to finish in 36 hours one of those diagnostics. with regard to other emergency authorities that fda has, we have approved drugs. what happens is when a drug is not approved if a clinician asks fda for approval for that individual to receive the drug, every patient that's been treated in the united states has received a drug. can't speak to the specifics because of hipaa, but each one has received a drug. those have been approved. one was approved in one hour. right now fda is on a path. there are over 300 people working on these efforts because it cuts across therapeutics, diagnostics, vaccines. the team is working across all of those issues to make sure that we are moving as fast as we possibly can to support and across all of those categories to support and approve. we're supporting the efforts and hundreds of questions have come in from commercial entities. and that's great. because a number of commercial

entities are out there and they want to help us find the solutions to ebola. most of those questions are legitimate. it's about speeding their efforts. some of those things, as you know, there are people saying there are things that work when they don't. fda needs to watch for that, too, in this important time. the funding is about that speed and moving things through quickly. >> one last question, on that topic, for anybody who would know the answer, is there anything we need to do or we're doing in this bill to be sure that ebola is clearly defined as one of the things that you can use those accelerated processes for? >> we have not had the authorities that you all have given us, i mentioned, have been in a way that we can use them. when we've needed to, we can add to definitions. so so far we have not. i will take your question and make sure with the fda that it is answered for all categories. you know, there are a number of categories. we need to make sure. so far we've not had any be issues. thank you for the authorities you have given us.

i think you hear that we are using them and using them quickly as we can. but thank you for raising it. if we are, we will come back. >> thank you, chairman. chairman, while everybody else is making a comment, i would like to thank you for your really talented and great leadership of this committee. thank you for all you've done. >> thank you. we're now going to turn to senator kuntz. i'm going to ask senator shaheen to call the superintendent and ask that the air conditioning be turned off. i asked 45 minutes ago. >> i would be delighted to do that madam chair. i have tried to get him to turn down the air conditioning in this building before. >> now because this committee really doesn't want to waste energy, either that of the members or of the taxpayer paying for air conditioning that is unneeded, unnecessary and unwanted. so, okay? better to have heated discussion than wasted money. secretary -- senator coons?

>> thank you. chairman mikulski. i'll join senator blount in thanking you for your leadership of this committee. to the many witnesses who have testified today, i want to thank you for the vigorous discussion of the administration's emergency funding request to deal with this global public health crisis. and remind all of us that the ebola outbreak in west africa has been characterized as one of the most severe public health emergencies we've faced in modern times. emphatically agree with your characterization that our first priority is to protect american lives and that the single best way for us to protect american lives is to engage vigorously in the work and the fight against ebola on the ground in west africa. this emergency funding request provides support for every facet of what's needed to keep americans safe first by strength beening and bolstering our readiness here in the united states but principally by ensuring that we contain ebola in liberia, in sierra leone, in

guinea and preventing its spread to neighboring countries. i did want to take a moment to share that i recently had my third recent conversation with president johnson, who i visited several times in liberia in previous years, and who wanted to make a point to thank the american people for our generosity and engagement, but urged us not to let off now. because just because there is some hopeful news doesn't mean we've turned the corner on this and in the region it still remains a very dangerous and difficult time. i visited of delawareans of liberian heritage who have lost their entire family to this disease. we want to double our efforts. i want to acknowledge the remarkable sacrifice, dedication of our uniformed servicemen and women, the missionaries who are on the front line of the work against ebola. americans who go abroad should not be stigmatized when they return, should be honored and supported in their commitment and service and should have confidence that they can return

from their service and be supported when they do so. let me turn to the global health security agenda, if i might. a piece of this emergency request is for the global health security agenda, activities within a.i.d. and cdc that are designed to strengthen the whole health security systems of a ring of countries around guinea and sierra leone and liberia. i wonder, director frieden, or if you wanted to speak to how many total nations will you target with this funding request? what will you do to increase their capacity? why is this essential to ensuring that americans are safe from ebola and that this outbreak, this epidemic is effectively contained? >> our focus is the strengthen the systems that will find problems when they first emerge, respond effectively and prevent them wherever possible. and the goal there, if we think

of what could have happened in rural guinea, if there been had a monitoring system that found the initial cluster, that responded to it promptly, we would see a very different outcome today. in fact, over the past 24 to 48 hours, we've been dealing urgently with the situation in mali, which is a real illustration of this. so as part of our response to the west african outbreak, cdc had already sent teams to each of the surrounding countries to ensure that they went through a clear checklist of the things that were needed, laboratory systems, surveillance systems, isolation capacity, emergency response capacity, contact tracing, public health and a series of other things needed. the team was actually in mali when the 2-year-old child came from guinea there, sadly died in mali, but the team helped organize a response of tracing more than 100 people. over the past day or two, we've learned of a new situation of great concern where an individual died probably from

ebola, in the funeral services, family members were infected. in the care of that individual before he died and other individuals, health care workers were probably infected and we're now facing a cluster in mali. the challenge is to make sure that that cluster ends as the nigerian cluster did with making mali ebola-free again. whether or not that happens is entirely dependent on the ability to have those systems in place in advance to find problems before they get out of hand to respond effectively. that's what the global health security aspect of this emergency request is essential for. it's about understanding their vulnerability is our vulnerability. that what we do to find problems there and stop them there will protect us. >> if i hear you right, dr. frieden, what you're saying is the difference in outcomes in nigeria versus the other three countries is the difference in having a robust public health

infrastructure that made it possible to do the contact tracing and do the immediate response? part of this is a legacy of a petfar great investment in public health across the region. how well cdc and usaid coordinate to make sure that these investments are made wisely and effectively and that we strengthen the whole region's public health infrastructure? >> thank you, senator. we work hand in glove a.i.d. with cdc. cdc is essential for setting the policy for bringing the technical and medical expertise forward. and we work very closely with them, implementing these approaches, these policies. we've been jointly conducting workshops for the 12 countries in the region, for example, around the issues that dr. frieden just outlined. we're also looking forward to the fact that you have increased population pressures in areas that were previously forested. so the possibility of increased

jumps of diseases from animals to humans is something that is very much a part of looking forward to how to get ahead of these kinds of outbreaks in the future. >> i appreciate that. my last question will be this. >> senator, your time has expired. >> thank you, madam chair. >> and i don't mean to be brusque to anyone, but we've now been here an hour and a half and we have two, four, six, eight, ten more senators to go. senator coates, i'm going to be a little bit more strict now. >> madam chairman, it's good to see that you haven't lost your touch. >> well, we have a vote, so -- >> yes, i understand. i'll try to be brief here. >> sorry. >> first of all, thank you for calling the hearing. i think there's so much misinformation, disinformation and misperceptions and a lot of nervousness out there among the public.

we've all had to address that and i think this hearing gives us a better clarity in terms of where we are, where we've been and where we're going. i think all of that is helpful. i commend everyone sitting at the table there, because when i remember when secretary johnson called me a week ago saying this is going to be a government-wide effort. this is a crisis deserving of full response, all hands on deck and a lot of those hands are sitting here at the table. there has been some positive news here in terms of some steps that have been taken, despite some early struggles and a couple of bumbles that made all of us nervous. i think we've clarified that. i think all of that is positive. we do have some questions as to how we're continuing to go forward. point number one, as secretary burwell said, we have to fight this battle at the source. and i understand that. but in countries and others have said, look, if you're going to fight it at the source, you need

to have it contained at the source. and while the military has taken -- has set one set of standards in terms of anyone who has been at the source relative to what they need to do when they return, that standard stands in contrast to what our current standard is relative to people coming back and, of course, the screening is important. secretary johnson talked about that and so forth. couple of questions here relative to all of that. is canada and australia and these countries that have basically said if we're going to fight it at the source, we're going to close our borders to anybody coming from the source. that's the best way to keep our country free of that. that may or may not be the right thing to do, the necessary thing to do, but nevertheless it certainly assured their public that, yeah, okay, they're fighting it at the source. then when you add that together with what the military has done supported by the secretary of

defense relative to anybody going to the source, i was with general williams over at africa command in italy in early september and then noticed at that point they were -- they were not going to send any soldiers in there. the president made a decision. they did send people in. they're sending people in. general williams came home and immediately the team that he was with, which i think is about a dozen or so, quarantined themselves. and so what are we to tell people back at home about the military is taking these steps. the rest of the public is taking these steps. >> on thursday, dennis hastert, the longest serving republican speaker will join us on "washington journal" to discuss the 2014 election results and how republicans should govern in the 114th congress. you can see the former speaker live at 8:30 a.m. eastern on our companion network c-span.

>> the c-span cities tour takes book tv and american history tv on the road traveling to u.s. cities to learn about their history and literary life. this weekend we partnered with chartered communications for a visit to madison, wisconsin. >> for everyone, it is a glorious service. this service for the country. the call comes to every citizen. it is an unending struggle to make and keep government representative. >> bob lafalle is probably the most important political figure in wisconsin history and one of the most important in the history of the 20th century of the united states. he was a reforming governor. he defined what progressivism is. he was one of the first to use the term "progressive" to

self-identify. he was a united states senator who was recognized by his peers in the 1950s as one of the five greatest senators in american history. he was an opponent of world war i, stood his ground advocating for free speech. above all, bob lafalle was about the people. after the civil war america changed radically from a nation of small farmers and small producers and small manufacturers, and by the 1870s, 1880s, 1890s, we had concentrations of wealth, we had growing inequality, and we had concern about the influence of money in government. so he spent the later part of the 1890s giving speeches all over wisconsin. if you wanted a speaker for your club or your group, bob lafalle will give a speech. he went to county fairs. he went to every kind of event

that you could imagine and built a reputation for himself. by 1900, he was ready to run for governor advocating on behalf of the people. he had two issues, one, the direct primary. no more selecting candidates and convention, to stop the interests specifically the railroads. >> watch all of our events from madison saturday at noon eastern on c-span2's book tv and sunday afternoon at 2:00 p.m. on american history tv on c-span3. now a conversation on last week's midterm elections. we'll hear from democratic strategists and political commentator paul begala and republican strategist ana navarro. this was out at georgetown university yesterday.

>> see, they're fighting already. >> a concession name tag. >> good evening and welcome to the biennial mccourt school of public policy midterm election result. i would like to say thank you to the families and active duty members of mccourt school. i want to thank you for your service to our country. mccourt school is excited to bring you a distinguished and bipartisan panel of speakers today to discuss last week's historic midterm election. which undoubtedly will have profound implications for the country way beyond the bourbon summit. first, let me introduce tonight's moderator mccourt's

school professor brookings senior fellow e.j. dionne. to his left i'm pleased to welcome maggie haberman, senior political reporter at politico. prior to joining politico she worked at "the washington post" along with numerous state, city and congressional races. she also worked at the new york daily news where she focused extensively on the rebuilding around the world trade center in the aftermath of september 11th terror attacks. maggie's z a criticer to cnn. since you swapped seats, i have to swatch it around. next to maggie is ana. ana has served as the national hispanic co-chair for governor jon huntsman 2012 presidential campaign. she also was the national chair of john mccape's hispanic advisory counsel and was a national surrogate for mccain during the 2008 political campaign.

in addition to that she's served as governor jeb bush's -- on his transition team and served as his first director of immigration policy in the office of the governor. she's currently a contributor to cnn and cnn in espanol. and last but not least we have paul begala. paul was the chief strategist for the 1992 clinton/gore campaign. he served as counsel for the president at the white house where he coordinated politics, and communications. he's currently a cnn political commentator and adjunct professor at the mccourt school. so i want to welcome this distinguished panel and turn it over to e.j. to get the evening going. after the panel has spoken, there will be a chance for questions, there will be mikes coming down the rows. please say your name, your affiliation so that we know who we're speaking to as part of that. e.j., turn it over to you. >> thank you very much. it's good to know jeb really is ready. he hasn't even announced yet and he's already got a transition

team. but welcome, ana, welcome, maggie, and welcome, paul. i do want to join ed in saying happy veterans day. there are many great things about being involved in the mccourt school, but one is that we have an extraordinary program with members of our armed forces. i've gotten to teach so many iraq and afghanistan vets and so while i want to welcome everyone here today, i particularly want to welcome our friends from the armed forces and to thank them for their service. they are awesome students, too. i'm going to make four quick observations, then open up the discussion to the panel. i'm going to ask a few questions and we're going to try to bring the audience in as quickly as we can. we'll have a couple of mikes on either side of the audience. i may ask if we've got a lot of hands, i'll ask people to ask a few questions at a time which allows our distinguished

panelists to evade any question that they feel like evading. four quick observations. one, boy, was this a big republican win. i don't think there is any way for democrats to sugarcoat it. their hope was, well, we'll lose some of those deep red states, but my home state or original home state of massachusetts, my current home state of illinois have republican governors. no way to sugarcoat that. there were only seven or eight states left with all democratic governments, governors plus both houses of the state legislature. roughly two-thirds of state legislatures, houses of the state legislatures are now in the hands of the republicans as recently as right before the 2010 election it was the other way around. so we're talking about a very substantial republican victory. second observation, anemic

turnout. michael mcdonald, who studies these things very closely, has estimated the turnout in this election is 36.4%. that's down from 40.9% in 2010. there were a lot of turned off and demobilize ed voters. and they seemed to be disproportionately democratic. if you want to just some evidence of the democrats who stayed home, just look right near us here in d.c., maryland and virginia. the turnout in democratic counties in maryland and baltimore city and montgomery county and prince georges was way down from four years ago, not from the presidential election, and senator warner had a much closer race than he anticipated, again because of one of the key factors was a drop in democratic turnout right over the river here in fairfax and other areas like that. third is the progressives did pretty well but it didn't do them any good in the election. four red states passed minimum

wage increases, personhood amendments, laws, background checks won but no connection between the referendum victories and the election. and the last point is, in a way, bad news for each party, which is the continued huge disconnect between midterm turnouts and presidential election turnouts. this is complicated news for the republicans because it says they can't count on this victory to mean a victory in the next presidential election, but i also think it's complicated news for democrats because if they can't figure out how to turn out midterm voter, they'll be on the short end of all of those states, i think it's 37 of them that elect governors in the midterms, all these seats and congress. they both have a lot to think about. so i'm going to start and go down the panel, maggie -- and that's about all i'm going to say other than forceful interjections here and there. i'm going to invite maggie and then ana and then paul, paul is

last because he has the most explaining to do just to answer a very simple question, what the heck happened on tuesday? >> i think that -- first of all, thank you very much for having me here. i think that you covered -- you covered most of it if not all of it. look, i think that there's not a ton that is determinative toward 2016. there are a couple of things that are determinative if i'm looking at longer term impacts of what happened here. but yes, what happened is that democrats thought that they could use the ground game that they have perfected or believe they have perfected in 2012 and 2008 to bolster turnout in a midterm year. that obviously didn't prove to be true. i think that at base there was a -- there's a tremendous anger with government. and i think that obama became the main focus for us. and so one of the interesting data points for me in the

polling leading up to election day was that you had governors in states the like florida for whom health care reform was a positive. it was positive for charlie crist, yet obama care was a terrible negative. so i think what you saw in this election is that the phrase obama care has actually come to mean big government overreach, something beyond what it actually is, and that is what people are protesting against, in part anyway. there's tremendous voter frustration and anger. this was not just anti-incumbent. it was largely anti-democratic. anti-incumbent was much more 2012. and i think that is what happened. the other thing that happened, and this is going to be something that the polling community is going to have to figure out. we had a lot of soul searching among pollsters in 2012, and that's where the public polling was off. the public polling turned out in

retrospective to be right. you had a lot of states with a large number of undecideds that broke republican. but the internals on both sides, actually, were not great. as i understand it, ed gillespie's internals did not have him anywhere near as close in virginia where he ended up being. in the main governor's race, democrats seemed like they were doing much better. i know that charlie crist's internals in florida had him doing much better. it was because of things like early vote counts and absentee vote counts in florida, those are that ground game indicator. the democrats thought were going their way. but ultimately, i think that these samples were totally wrong and about two weeks ago when i talked to pollsters since, they said at that point about two weeks before election day, you could start to see everything going south. i don't quite know why the modeling was so wrong, but it was. >> thank you. so the conclusion is if they'd only called it navarro care, it

all would have worked out. ana, what's your take on this election? >> i'll give you my take on the republican side and what the republicans do differently this time from 2010. just, you know, we didn't run richard murdoch and todd akin, that really helped. i think part of -- and that comes to my first point which is that republicans, republican entity, the chamber of commerce, the national republican senatorial committee, they got involved this time in primaries which they been very hesitant to do and didn't do in 2010 and just let, you know, the organic thing happen, which led to bad candidates that could not get elected in a general. this time they fought, they put money, they ran campaigns, they were just, you know, they worked hard, they worked hard to get who they thought were the most general -- the best electable general election candidates.

second thing is, i think republicans improve their tech game. we realized that we were, you know, in the caveman era, some time around when dinosaurs ruled the earth, whereas the democrats were way out ahead. put a lot of resources into that. also, you know, republicans this time fought back against some of the narratives. in 2010 -- and even in 2012, we were like deer caught in the headlights when people brought up war on women. we really just didn't know what to do. it's hard to say anything about war on women when you've got the burden of todd akin and richard murder on on your back. turns the out when you don't have those two guys, that snippet doesn't work as well. also, opposition research. republicans got interest that game big time. there's a new organization called america rising which i think should get a lot of credit in this election.

a lot of the -- a couple of the elections, more than a couple, were decided because of opposition research that was unearthed by this organization. things like bruce braley getting caught, you know, dissing farmers or the allison grimes memo that they sat on for months until it was the right time to release it, which showed an incredible amount of discipline. i'm not sure you and i could have had that kind of discipline. it wasn't one thing, it was a lot of things. and it was also a good night because it was the national narrative, it was a repudiation of obama. so i think those are the things that republicans did right. i'll now let paul talk about the things that democrats did. >> did right? not much. here's what they did wrong. well, because of what happened. first team i agree with all of this. thank you for having me here and back where i teach and i love it and i echo what e.j. said about particularly my military students that i've had over 12 to 13 years here, extraordinary.

i didn't even finish the boy scouts. i come from a long line of cowards. people who allow me to run my mouth and use free speech, i'm particularly grateful to. it was -- well, let me go back. these waves come and i've ridden them up and i've ridden them down. and up is better. but usually it's about some overriding issue. 1994, i was there, you know -- i don't know we raised taxes, integrated gays into the military, we passed gun control and tried to pass universal health care. gee, i don't know. people thought clinton had gotten too liberal and they wanted to correct. in '06 when there was another wave, it was about the war in iraq. people were sick of bush. the next day after the election he fired donald rumsfeld. he got it. it was about iraq. in 2010 it was about obama care. this is not. this is about obama personally,

not about an issue agenda which i think is how you can reconcile all these rib liberal referenda passing. it's two sides. on my side, there's real disappointment, and i think that drove the collapse in turnout and it drove some to switch, but when you go from 53, the president was at 53 two years ago when re-elected. 53% of the country voted for him him. and election day it was 44. still one in five. who have lost faith in him. they were for him. it's all fine and i will rant and rave about the tea party and the races and the -- the truth is if he just held his own, he'd have won -- the democrats would have won. you first have to look at yourself. what are we doing wrong? how have we alienated one in five obama voters? i'm not sure what the president -- he did say something telling when he said the voters like drove us off the cliff the other day, i heard you. and those two-thirds that did

not vote, i heard you, too. i hope he did, because i think they're saying i'm disappointed in you, sir. this is -- presidentials are so different from midterm. a vote for president is a really powerful act of self-definition. it is who you are. it really defines you. i just voted for congress. my congressman now is don beyer. he sells volvo. i'm not a done beyer democrat. i wouldn't know him if it bit my ass. but i voted for barack obama. people in the middle who took a leap of faith on this guy. and you know, the second term's been just atrocious for him. and those voters paid, too, not just in the issue agenda, which i care about a lot. but they go into the break room and there's ralph from accounting, you know who listens to rush limbaugh every day. your boy obama's screwing up and it hurts you.

you get tired of defending it. you get depressed and you stay home. that's on my side. okay. on the republican side, they did a very good job of nationalizing the race and making it about obama. 57% of all advertising in senate races on the republican side was about obama. 57%. not about obama care. they started on that and they got off it. because obama care's not doing great but it's doing better than it was. it was about obama. and the sense i think that republicans have, they never have some, but the case that they're making that has i think carried the day in this midterm is not even liberal like it was with clinton in '94, but it's weak. and i don't think this has been talked about enough. but i think the beginning of the end for the second term for obama was even before it began. after newtown, newtown was right about december 10th, the president was elected november 4th, about a month later we had that horrible slaughter. the president stepped up and put

forward a gun control bill. pretty modest, much smaller than what clinton passed in the '90s, but essentially just background checks as it got whittled down. that got 92% popular support. 92%. and senator mcconnell and the senate republicans said we're going to kill it, and they did. when you can take on a newly re-elected president who just got 53% pushing an issue that got 92% support, if you can take him op and beat his ass, you need never fear him again. and that's what's happened. the thing -- ana and i sat all night in the senate seat, and the chin tuggers, the message from the voters is no more gridlock. no, actually, the message from the voters was we reward gridlock. mitch mcconnell to take the cojones and take that on and beat him. and voters did not say, oh, i hate gridlock and partisanship.

they didn't. and i think that's an important lesson for people like me to get, but also the republicans. mitch mcconnell said all the right things the after the election. now we're going to work with this president. i hope he does. for the good of the country. but for their party, it's very difficult to run around the country making the whole election about obama and then come and cooperate with obama. >> i think you're wrong on that. i hope you're wrong. because you know, i do think it was a rejection of gridlock. i think that the reason you saw such low turnout is because there is this malaise and people are just sick of government in general and, you know, the guy in charge as president obama. so he's the one, the buck stops with him, and he's the one that paid the piper. but i think people have looked at congress, have seen a republican house and a democrat senate for the last two years that has done nothing but stick their tongues out at each other. and they're getting a little tiring for adults, you know, out there in america.

so, okay, so we tried it this way, it didn't work. now let's try it this way. i also think people are weary of government overreach by the executive. i think that's a narrative that has taken hold out there in america. so i hope that the message that republicans get is that this was not a vote for gridlock, and if it had been a vote for gridlock, by the way, i think the ted cruz republicans would have gotten out of the primary. >> wait, hold on. >> the chamber of commerce won because they became -- >> no, no. >> yes, they co-opted it. >> tell mitch mcdaniel i think that was. >> the guy in mississippi? >> yeah. >> no, but he got support from democrats, that's how he won. >> let me interrupt for a second. i'm not a good chris matthews. >> there's no such thing. >> what? >> it's a joke!

it's a joke. i used to work with him. >> here's two things. one is it seemed to me the evidence is that nvgt the republican voters were there to vote against obama and the democrats were the uns with who are dissatisfied with what was happening in washington which is why they didn't vote. i think that's what the polls would suggest. but here's a question to all of you, and i'll start again with maggie because we were sitting down at this quiet end of the table together. >> exactly. >> it's interesting democrats got stuck in two ways on the question of president obama. one was they couldn't -- there was a lot to brag about, if you are talking about a drop in the unemployment rate, where the economy was when obama took over a rising stock market, we're much better off now than we were when he started. however, democrats were petrified of saying any of that because there were so many voters who were hurting and

wages weren't moving, but then they didn't offer much of a plan for those voters either. so it seemed to me democrats were tongue tied on that. and they were also tongue tied on obama. because, if everybody is attacking the president and the response is, well, i'm not him, that's the democrat talking, there isn't much of an argument going on about the president. so it seems to me that the whole dialogue of the campaign was utterly dominated by the republicans and democrats talked themselves into silence practically. >> no, i think that's exactly right. i think that one of the -- i thought that -- i agree with everything paul said, by the way. just how the voting played out. i think your diagnosis is correct. as the polling shows, democrats did not turn out. i think that one of the most telling moments in the kentucky senate race was when alison lundergan grimes wouldn't say whether she voted for obama. i think that was terrible for her. that speaks to what you are talking about.

democrats ended up distancing themselves from obama but not offering a future vision or holistic message about where they wanted to take the country. instead there was a lot of tactics and a lot of sort of individualized targeting. so you saw a lot of stuff about women's issue, women's economic issues. you saw a lot of very small bore economic discussion that because there were too many voters who don't feel like this economic recovery is benefiting them and it was hard for democrats to make that case, this is where -- not to jump ahead, but this is where i do think the launchpad for the discussion for 2016 is going to be. i think we saw a couple things on tuesday, one of which -- and i wrote about this the other day. there's a huge correlation between the amount of negative ads that you saw in every single one of these races and everybody's favorable/unfavorable going down. you really had nobody who was either at 50 and certainly above

50 in terms of incumbents, maybe warner, he almost lost. and so these races to the bottom have become kind of the norm. and people are turned off by it and don't reward gridlock. that's the one thing i disagree with paul on. but i do think for the democratic party especially and for their standardbearer who at the moment looks like it will be hillary clinton, there's going to be an inpe tus to come up with a broader economic message about what you just mentioned, wage stagnation, about how to fix it, growing out the middle class. it has to be more forward looking than what we saw in the midterms. >> i agree with that. let me ask each of you to play a role that you don't play. i'd like to ask ana to say what kind of campaign would you have run if you had been the democrats? i want to ask paul, if you had been on president obama's staff six months ago what would you have told him to do differently than he did? what kind of campaign would you have run if you were a democrat?

see we don't even have to question the republican campaign because when it comes out this way, they shouldn't have done anything differently. >> i think they should have seen because everybody saw it coming, that republicans were going to make obama the albatross around their neck. and they weren't -- they just all seemed ill prepared to deal with that attack. you know, maggie just talked about the kentucky race. but it was all over the country where they were just scrambling and doing this tap dancing that just screamed lack of leadership. so i think one of the things they should have done was figured out the obama piece and how to spin it in a positive fashion. they -- i think republicans, yes, they ran on making obama the bad guy and they got the most help from democrats who turned it into a self-fulfilling policy -- prophecy. then you had, you know, president obama who, you know,

they may not have gotten the guidelines for quarantine, the cdc may not have gotten the guidelines for quarantine out early enough, but democrats sure had him in what looked like a political quarantine for the last six or eight months. you know, where nobody wanted to be seen with the guy. so when you're shunning the guy and when rejecting the guy, what do you expect the message voters are going to get? so i think that's where they really went wrong. they should have seen this coming and they were caught unprepared. they needed to have said, you know, yes, he's our guy. we disagree on certain things, but we're not going to treat him like he's got leprosy of some sort. when you saw the secretary of explaining -- nobody else can -- bill clinton, go out to arkansas and instead of the -- >> that's an academic term, by the way. >> instead of defending barack obama, he went out there and -- this is what he said in every other state he went to and said,

look, republicans are telling you elect me for six years because we want to punish obama for the next two year. i never heard bill clinton defend obama. what he was saying is that math doesn't work. really? are you going to give somebody a six-year job because you want to punish somebody else for two years? and when he went down that road, i thought, well, okay, this is really not working for them now, is it? >> so what do you tell president obama six months ago as you look towards this campaign? >> pick up on this one. first i did agree with what maggie said and i agreed with the first half of what ana said but this piece about obama should have campaigned more is lunacy. this is nuts. i used to do this for a living. >> no, i never said he should have campaigned more. i said the campaign should are learned how to spin the obama factor. >> he should have stayed off the campaign trail which he did. except places that seemed safe like maryland and illinois. he won maryland by 26 points.

>> he did no harm in connecticut. >> there was a dead heat. >> a slight chance. >> it would have done no good and more harm. in fact, a few times that he did speak out, like when he said, i'm not on the ballot, but my poll sis are, and this is a guy as gifted with words as any president we've ever had. he ranks with kennedy, not like him, but kennedy in the modern era. and that's not what you say. you say i'm not on the ballot, but you are. it's you who can still be discriminated against in the workplace if you happen to be a woman and have no right to take on that corporation in a court of law. it's you who are struggling to make ends meet. i mean this is 101. >> do you think when he said that and everybody cringed. all the republicans didn't cringe. when he said that, was that a reflection of him being in a funk and ticked off about -- >> i don't know. i can't explain it.

>> -- warner. >> if you had been obama and he'd asked you what the heck do i do? i know we're in trouble here? >> as i say, the original sin was the failure on guns. and i know he tried his hardest. i admire him as a father, a citizen for taking that on. but having -- i've lived through it. you touch a king, you kill a king. you go after the nra, you better by god make sure you win because even winning -- that began it. but then always the best politics is the best policy. and you had obama care, the most important initiative of his presidency, which was rolled out before this midterm, right, last year, and it was a disaster. if you can't run that capably, you can't expect people to run a good campaign on it. you had this huge crisis in the v.a., shameful, shameful crisis and a really kind of mini scandal in the irs. but then on top of that was the style of leadership.

okay? voters believe that the president is too reactive and weak. seems to me he gets to the right place on ukraine, on isis, on ebola, but he seemed to get there late and he seemed to get there in a much more sort of quiet way. nr in other words, i got really angry when we had the border cries with all the unaccompanied children were flooding the texas/mexico border and he wouldn't go down there. oh, i don't do optics. i was at mile-high stadium. he had a set at the democratic convention that looked like a leftover from the movie "caligula." don't tell me barack obama don't do optics. he does it better than anyone i've seen. you go to the border. that's not bs'ing. you actually talk to the border control folks. you educate the country. you show them that these are not steve king called them drug

dealers with -- what did he say, calves like cantaloupes? >> he was talking about other immigrants. >> i can't keep straight all of steve's problems with immigrants. he should have known -- seriously, this is not a tactic. this is you have to show leadership. >> i don't know what it is then. >> no, it's actually leadership. you have to get out in front of these things. >> but frankly, paul, part of the problem is he's surrounded by a lot of people in the white house that when he says he doesn't do theater. they say, that's right, he doesn't do theater. >> too big for the gig. >> maggie, our friend tim russert ronald reagan asked him this, did it help that you were an actor. reagan said, i don't think you can do the job if you weren't an actor. a lot of it is theater. ask roosevelt. >> maggie, you wanted to say something. >> no, i think the common thread in everything paul is saying -- you tell me if you disagree -- this was ultimately the case is that the white house -- and i've never actuly been clear,

candidly, after all these years of what is the president's aids versus the president. the president remains an inscrutable figure to many of us who cover him. but there was a fundamental mystery on what the re-election meant and how much of a mandate it was and what it would mean after having a terrible relationship with congress heading into that re-election and what it would mean for the next phase. and one of the things that has been really striking, i was listening to what ana was saying how the democrats should have figured out how to deal with obama and accept the good of him and perhaps not the bad. the relationship between senate democrats and the white house just completely deteriorated in the lead-up to the election last week, and if you wanted any indicator that things were heading south, that was it. the circular firing squad started early and very often and continues. to the extent that i don't really know how things are going to go forward in the lame duck

is because things are not great between harry reid's office and president obama, they were in your paper some pretty breathtaking quotes from harry reid's main adviser. >> who still as far as i can tell still is his adviser. >> yes, exactly. >> i just want to point out to everybody is a data point. because when you hear paul talk about paul as the democratic representative here, when you hear what he is saying about president obama, it actually is quite reflective of what just happened in this campaign among democrats because there did seem to be this reluctance to go right out there and defend the president and actually to see that there are these problems. two -- >> paul has become really -- i mean, you really must have aged at some point because you have become a wise man. >> that's because he agrees with ana. >> he reflects and he learns, whereas a lot of people, their reflex, frankly, is go into denial.

the denial face lasted him -- because he was with him on tv. it probably lasted about 30 seconds. >> you have to learn from these things. defeat, believe me, i've learned way more from the many losses i've had in my career than the wins. you don't obsess about the wins. most people who are really driven, i believe, are driven much more by the fear of failure than the joy of success. it's not an equal thing. >> everyone of our past three presidents long a congressional race. i thought obama was going to win the democratic nomination because he lost a house race just like george w. did and just like bill clinton did. for the record, governor dannel malloy got elected by three percentage points which in this election for a democrat is a landslide. in connecticut. >> i agree with all of those who say we jump way too early to 2016. so let's jump right to 2016. i particularly want to ask ana is jeb going to run? i want to ask paul how, if he

sees any competition for hillary clinton coming out there? and which of you takes that she needs some it's good for her or what an ab soured thing, any primary competition is bad for you, you want a fight. but maggie's perspective on the whole thing. but start with jeb and take it from there. >> i hate this question more than the root canal i got this morning. look, jeb bush -- and i got to give you the caveat that jeb bush is my friend and jeb bush is my tenant. his office, we own the biltmore hotel in miami and that's where his office is. i see him all the time. and we talk like normal people. we don't sit around and talk just politics. i think jeb is today where he wasn't in 2008 and where he wasn't in 2012 despite many people asking him to consider running, he shut it off immediately. today he hasn't shut it off. i think he's been incredibly

transparent in saying where his head is, where his process is and even what his timeline is. he is seriously considering it. he has set a time line for himself, end of this year, beginning of next year. doesn't mean that you'll know. i may know, but it money means e will have decided, if he makes an announcement probably won't be until the first quarter, so next year is my guess. i think he -- you know, i think he and everybody is thinking running for president needs to ask themselves two questions. do i want to run? and with that comes the question of what do i offer? and what's my vision? and what's my agenda? and can i tell the american people what i stand for from a positive place? i think jeb may have answered that already. the second question is, should i run? and that means what's it going to mean for my family's life? what's it going to mean for me?

it means today in the vortex that politics have become this blender, you know, at full speed that politics have become, it means that you are guaranteeing that you're going to be in this fighting for your life blender type hunger games for -- in under national scrutiny for at least a year. if you happen to win the nomination, then you get rewarded by being in it at an even more higher level with more scrutiny for an additional year and if you happen to win the damn thing, you're in it for the rest of your life. and you come out of the white house looking like you have been in an aging room. you know, with wine and meat. so i mean, i think at the very, very weighty question for somebody that is in a good place in his life that is fulfilled. that is happy. that is making a dins fference policy.

that is making money, gets to spend time with his family, see his grandkids. i think it's a very weighty question. but the answer is, the answer is i don't know. i don't think he knows, but he's seriously considering it and i think he's very serious about it. >> i just love the idea that most panels have people who regard jeb bush as a former governor's son or a brother of a tenant. we have someone who regards him as a tenant. small "d" democratic paul on the democratic side. >> with the caveat that i don't know either if hillary is going to run. i hope she will. i'm wearing my knees out praying. and i have never -- i don't think any of us have ever in our lives seen the kind of early support for a candidate. it's not positive, but this kind of early support. i mean from the grassroots level, from people who weren't even born when her husband was running all the way up to the biggest donors and supporters the democratic party has. it's really remarkable. having said that, i am, i think

as e.j. knows, in the camp that says first she will have a primary opponent and second that's a good thing. the death march between hillary and barack was the best thing that happened to barack obama and hk hurricaillary clinton, t. they helped each other. that's the weird part of how it helped her. i went to see her the day after she got out of the race. she was really admiring of obama because she likes toughness. >> who could primary her? give me some names. >> i don't know what. abhors a vacuum. anti-war, anti-wall street, anti-washington. hillary is all three. >> rand paul? >> rand paul. someone will. keep in mind george h.w. bush had successfully prosecuted a big war and won it in a hundred hours and a cable talk show host pat buchanan got 38% against him in new hampshire and wound up with a third of all the

delegates by the time it was over. a third of the vote in my matter will go against her. but it will toughen her. one thing it will force her to work through this question of obama, which i think is a lot easier than the democrats made it look. you can't run from but like all presidents he had a six year dip. my lord, you save the auto industry, passed national healthcare, he's winding down the bush wars. he killed osama bin laden, i think he won a a latin grammy, didn't he? [ laughter ] >> noble peace prize, something. so i think you can pretty easily but she would have to work that through in the primary because it will come the left but i think it's really good for the party. it's good for her as a talent. it just -- there is no downside. seriously, it's a pain in the

neck and nobody likes to be attacked. i do but no normal person does. >> maggie? >> i think that i cover hilary more than i cover jeb -- >> thank god. >> and i would refer to that -- >> they are transferring her soon. >> exactly. i'll off on a new beat soon. i think anna is right that jeb bush is pretty straightforward about where his process is and i think his brother is, too. i think his brother had a remarkable quote, i think he wants to be president, i'm not sure he wants to run for president. >> that's true for everybody. >> that's true for everybody but not all of us will run for president. in terms of hillary clinton whose first senate race i covered, i think and there was like night and day between the first half of the race and the second half of the race that is a common trait of hillary clinton in 2007 she was pretty terrible and in 200 she was much better. her book tour this year was pretty terrible and her campaigning for other candidates

the last two months was much better, sort of a course correction. i think there will be a primary challenge. i have no idea who it will be. in my home state of new york you had andrew cuomo who has been popular over the patterson years and he still had a pretty strong primary challenge from an unknown professor with the coolest name ever who appealed very strongly to the grass roots and to this anti wall street. >> what did she get? >> 37, 38. >> that's astonishing. >> the coolest professor name we have heard, his professor he quoted. >> rottencroach. >> my mother made he go to confession after that. >> we all cheered it on.

she had no ad money and got almost 40% of the vote. hillary clinton does not sit well on a lead. she's her own worst enemy in every single one of these races that i have seen her in. she is, she tends to resort to tactics over message and that's going to be a big challenge, but she will have a primary challenge and the big question paul raised is what does she say of president obama? does she try to run away from president obama? i don't see how she can do that very easily on domestic issues. i think that she's already opened up space with him and i think it has the benefit of being true in her case. i think she believes it with him on foreign policy but foreign policy is not what most primary voters base their vote on. my big question about hillary clinton is not actually about who primaries her because i do think she's in a better position now. this is not 2008 again and president obama was a very

unique -- senator obama was a very unique candidate. elizabeth warren is not barack obama and she's not running, so in that way she's not barack obama. [ laughter ] >> i do think that hillary clinton is going to have to figure out whether she is mentally prepared for what a modern -- and jeb bush has to answer this, too. what a modern campaign looks like. it is so different than what it was seven years ago and what i've been struck watching her the last six months or so since she started doing the book tour. the book tour was not what i thought it was going to be at all. i thought it would be an opportunity to connect with voters and speak to people. she was doing essentially this, signing books and sign sitting at a table and didn't really speak to people and on the campaign trail, her stump speech was pretty good. she still wasn't connecting with

voters. when i saw her talking to voters in a diner in new hampshire, it wasn't that natural and she actually was really good at that as a senator in new york, very good. she's very good in small settings, but it's hard to go from being essentially a head of state, which is what she was in that job to going to iowa and going to the steak fry and doing it over and over and over again and i'm just not sure that she's mentally there yet and that is a big question she's going to have to deal with with. >> i want to open it up to the audience. i love the idea of a secretary of state at a steak fry. >> it was really something else. >> who -- can you guys help me if you see hands because i have these big lights in my eyes. i always say nobody likes to ask the first question so think of this as the second or tenth since i've asked so many questions. go ahead. >> is this on? can you hear me. >> yes, sir, it's on. >> so i have a question for paul

and i have a question for anna. for paul, my sense is that democrats aquillies -- achilles heal is they are analyzed by group so there was talk about how african americans didn't come out because barack obama wasn't on the ballot or hispanics didn't come out because there was disappointment in the immigration policy and the failure to develop that. do you see that with the p prospect of hillary clinton and no african american and not a lot of advancing of the immigration issues. do you see the democrats having a weakness there in term thess t energizing those who put obama over the top in 2012? and for anna, my question is, is

the republican akchilles heal, which traditionally favored far right candidates who never succeed in the end, mccain eventually overcomes huckabee and romney overcomes santorum but in the course of those primaries, those farther to the right candidates pull mccain and pull romney into positions that later hurt them in the general election, and is that the republicans problem? >> thank you, paul. you make a great point. it's fundamentally unknowable. i don't think anyone really knows. what president obama, he has really changed the way campaigns are run, but also the way the democrat democrat

democratic electrat is assembled. young people, unmarried women, people of color. all three of those groups are overwhelmingly democratic, but they are very poor performers in off years and had been poor performers in presidential years, but the president just phenomenonly, it was a combination of the man, message and mechanics. now we won't have the man the next time. i hope we have a message that energizes those and i hope we have the mechanics that are just as good but we won't know until you run it out. here is a reason i'm very excited about a potential hilary can d-- canadense. do a little better with white working class voters. you know, president obama only got 39% of the white vote, 39. that's the worst any candidate

for president has done since walter mondale. walter mondale carried one more state than my grandmother that yo year. obama carried like 28 states. still, you don't want just 39%, right? i don't. my party has a job to do better with white working class voters. i think hilary can speak to them and rally that base but fund mentally, this happened in 2014. i went through the '12 and '14 exit polling, it's astonishing. we have two completely different countries. it's astonishing. i will say to young people, young people voted at 21% turnout. it was terrible that 44 -- no 36 overall -- >> 36.4 overall. >> overall? >> 21.5 for young people 18 to 29 and i say this at every

college campus i go to, you will know because it's georgetown. how many old people get free health care in america? take a guess. what percentage? 100. what percentage of young people get free college who can't play football? [ laughter ] >> zero. >> or basketball. >> it's georgetown, sorry, i went to the university of texas so we can't do either right now. but zero. why? there's a great song called "you cannot win if you do not play." because old people vote, that's why. they asked hughie long how come he wasn't for prison reform? he said there were no votes in prison. that's why. that's the whole game. the president really, really impressively and dramatically inspired young people, unmarried women, people of color and really brought them into the game. can we pick that up, the democrats that remainn