everything wrong and is, you know, the heart of the united states and the world. let me remind you that nato was the first one to break trust by building up military equipment and around our borders. and provoking basically rules. what kind of resilience does the alliance brush it forward, like in ukraine by supplying arms there and sending instructors. and many here call for more robust measures. so is that the kind of stability that aligns? >> that was the question? >> question, do you see any -- what exactly can nato do to resolve, resolve the crisis in

ukraine and to stop building up military -- build up the eastern flank would you call it, reach the country. thank you. >> thank you for your question. two questions one on the new u.s. administration which the view of the panel vis-a-vis the overall emphasis and support for nato. and the second question is nato's role in ukraine. >> probably time for one more question. >> sir, right here. and while take the third question -- >> right here in the front. sorry. >> just building on the administration. yeah, sorry, from the nbc of canada. just building on the question from the poe tomic institution, especially perhaps a trump administration who has already talked about japan and south korea needing to better support

themselves, how does that translate potentially to allies, especially those who don't necessarily live up to the 2% defense spending commitment. and then just about resiliency and just late last week we saw moldova all but elect a very pro-russian president. nato has done a lot of work with mall doe va. how do we go forward with other countries in that area who may be leaning away from europe? thank you. >> one more question. in the back. >> thank you very much for your representations, and there would be a lot of -- for a short time. i'll be very short. one of the nato and abilities is used to decision-making, the

decision-making process. and some of the aspects are improved and eventually could be one that could be an appointment of the new assistant of secretary general for intelligence. due to the fact that the intention is one of the most important issue, there are a lot of planning who depend on that. do you see any other possibilities to increase the speed of decision-making pros in nato? even in the present situation. thank you. >> check one of the questions. >> i'm happy to touch on these quickly then unfortunately i'm going to have to run as well too. first of all, u.s. support, that i think the american public has great reservoir of support for nato. it's positive orientation towards nato and the countries that make it up. at the same time as a degree of frustration that we don't want to feel like we're doing things for european security, the

europeans don't want to do themselves. and i think that situation gives a u.s. president a lot of room to exercise leadership. to define the issues about what the u.s. interests are with nato and to lead a path forward that affirms that commitment and also tries to tackle that sense of frustration. i think there's a lot of running room for a u.s. president given the state of the public. on the question is to what nato can do to increase stability in ukraine. it's important to remember the reason there's a crisis in ukraine is because russia invaded and continues to support separatists there, has troops there, annexed part of the territory in the country. and as long as russia feels that it can continue in that path, there's not going to be stability in ukraine. so i think what's important is that nato provide additional support, political, economic, financial, military, to the government of ukraine. so that it is able to resist this more effectively and then

creates some stability. and as far as moldova goes, unfortunately there's not a whole lot that we can do in the short term about reversing this. one of the things that we do cling to is the ability of countries to have their own political systems and make their own decisions. but what we see is through means like russia influencing that and then producing an outcome such as we had, but what i think we can best do is to continue to support our own values and do that in a very visible and public way. which i think public will resinate with publics over time. and to make sure that we are communicating that effectively. and finally, when speeding up decision-making, it's an excellent question, and jorge was right to put that into a slide. to me, the logical thing always would have been to make a clear distinction between political decisions and implementation of political decisions.

and it is possible, i believe, to preserve toward consensus at the north atlantic council at a political level, decision-making on political issues. but then, once decisions at a political level are taken, even if it's well, well in advance, it ought to be able to then be implemented through the nato authorities both civilian and military without having to go back for additional political decision-making. and that is the part that always slows things down. i remember in the koes voe campaign, it was about targeting. when it comes to deployments of forces or how forces would act in a given situation saying in afghanistan, it always came back for the knack for further decisions. that's something i think we should try to separate out. we take initial political decisions, we can take future big political decisions, but in between, we need to let nato authorities get on with their

work. >> i just wanted to mention on moldova and the point that was mentioned. look, we have about europe's great zone. i mean the reality is we are facing a vast space of europe, in europe's east, not nato eu or europe, that is turbulent, it's violent, there are lingering issues, not only russian engagement, but corrupt elites, legacy issues, those trying to block it within many of these countries and the people of that region don't know where the future lies. and i would argue we haven't been all that engaged to help them find that out. so i don't -- this is my other point, dwloon nato leads on that though at the moment. frankly the european union should be having a real rethink of their eastern partnership policies, eastern partnership

has been the way the eu has engaged these countries for particularly the ones we're talking about, and i think people in the region don't understand because this is the process like many of the eu processes were a country like moldova has a stack of paper in front of it. it's got to do all of this stuff in order to really, you know, move forward. it's not going to become luxembourg tomorrow. and so it's so much procedural issues, so much elite and bureaucratic so far removed from public attention that people in moldova, people in ukraine, penal noo these countries, they don't know what the eu would mean to them. there's nothing tangible. and so i think that tailored approach to the eastern partnership would be really -- to the attune to the basic needs of those countries and how you deal with it and be a bit more willing to deal with the corruption issue. in fact, how we enabled corruption. the banking fraud in moldova.

all the money in moldova ended up in a funnel through banks. remember the eu, member nato. there are thousands of examples of this. how we don't enforce our own laws that allows this type of thing to happen. things we can do for ourselves to help moldova, we don't need to go there. we don't do it. there's a lot of stuff we have to realize that we're going to be facing this unstable east for some time to come. and we have to be realistic that this is the europe we're facing. it's not fixed. it's not a stable place. it's in fact the potential for violence continuing is actually very high. particularly in this part of europe. and if there's one lesson of history we learned, i hope,

whenever we turn away from the gray zones of europe, we always end up paying a higher price later. we need to engage up front and think about these things now. >> if i could just add, with respect to the public support in question, the pew center has done a lot of public opinion research in the united states and nato countries on this. if you look at their data from april of this year among people who lean republican and 75% of them said nato was good for the united states among people who lean democrat, it was 81% who said nato was good for the united states, independents, 78%. they even broke it down by whom you support and so for supporters of donald trump who have been the most critical. even among those, among his supporters, 64% said nato is good for the united states.

if you take one bit about the allegation. i think if you look at the numbers of forces that nato has placed in the east, they are in no way a threat to russia and was only done after, after a long and careful evaluation. thanks. >> i agree with what was said about the other answers. i'll just briefly focus on the decision making. i think it's time for nato to, for the north atlantic council, the political leadership to realize that it's not in the military implementation business that it has created these forces. it can create whether these forces can enter combat, those

are still the decisions. i think it should defer to other nato military commanders the authority to train these forces, to have snap exercises for these forces, to move them two to three times a year across the alliance. i think this will improve readiness of these forces which is the key need for the alliance. and i think it'll then prove deterrence in europe to have these forces both more readily deployable and quickly deployed by the military commanders. >> quick note on the decision-making question. first of all, let me be the first to freely admit that of course there's improvement in the nato decision-making having spent many hours in windowless rooms like this in nato meetings. having said that, it is also our experience that and of time of real crisis, nato can take important political decisions very quickly. i was at the u.s. delegation at nato on 9/11. and within 24 hours of the

subject being put on the table of the declaration of article 5, the nafta agreed to clear article 5. a couple days later when supports were requested, again within 24 hours, everything the united states requested had been granted by the allies. so when there is a crisis, sometimes the knack can move quickly. that doesn't mean we can't do better. >> the decision today, i would only add that, of course i'm an old-timer now, over the hill with when i had the privilege of commanding the nato strategic reserve forces. and the late '70s and early '80s, we invoked -- we did worse than the simple year. our whole effort really was on

the flanks of nato and we had a meritime thought process and maritime thought strategy. we had sink land and sat land. we talked about a much larger kind of a thought process and a much larger kind of an integrated and adaptable strategy. and i go back to what i said earlier, you should have -- there should be a nato strategy and it should be a free world strategy. and we don't have to worry so much about russia, i don't think, if we just put our thinking caps on and remember that it's in nobody's interest, russia's interest or anybody else's interest to get too fancy or to start too much of a problem anywhere in the world. we've got -- you know, we're in an era of globalization now, any strategy has to be an economic thought process, a political thought process, a societal thought process, technology is a part of it and of course the military. and we simply don't seem to have

that kind of not only national, but international thought process going on. so if i were asked to advise the new president and all i would think along those kind of lines, but don't worry, they're not going to ask me. thank you for being with us.

you can find this conversation online, we'll have it on the c-span video library if you missed any of it. a conversation about nato. join us later today for the live coverage as democratic presidential nominee hillary clinton campaigns in the battleground state of ohio, appearing in cincinnati. watch the campaign stop live at 6:00 p.m. eastern time. it's going to be over on c-span. and then all this week here on c-span 3 and prime time, it's american history tv. tonight, a focus on native american history. starting at 8:00 eastern with a look at the apache wars, then a discussion about the killing of native americans in california during the 1840s to '70s. and after that, native americans

and the westward expansion after the civil war. the white house also featuring a bit of history itself ahead of halloween with characters and costume, greeting tourists who walk through 1600 pennsylvania avenue last week. here's a brief look. >> i managed to save several items, including the wonderful portrait of george washington that you saw. i saved a small portraits of mr. madison. most importantly, i also saved the recordings of the constitutional convention where my husband served as secretary for president thomas, for president washington, when we ended up with the constitution as the articles of confederation had failed. but i only wish this were wednesday, wednesday, i would be having a wonderful melody. maybe some wonderful ice cream and ask you all to give me a recipe and tell me where you're from and we would share those recipes in subsequent gatherings here at the white house.

any questions? >> she held a bouquet of

flowers. she would hold a bouquet of flowers so she wouldn't have to shake hands. i shook every hand, 3,000 hands in about two and a half hours and this is the room we did that in. and then we often entertain people in the red rooms before a state dinner of some sort. and the east room well if any one person is making that into a reception room. roosevelt, she was magnificent and believe it or not, one year we entertained about 2,000 people in that room. and i don't know how they stood shoulder to shoulder, but the work got done and then afterward, we came down. and she's the one who kind of started the trend of musicals and such in that room. before then, it hadn't been used for much and kind of a stogy

place. so the magnificent of the white house is in good report the responsibility of ooedivity roosevelt. >> c-span brings you more debates this week from key u.s. senate races. tonight at 8:00 eastern, live on c-span. republicans senator rand paul and democrat jim grey debate for the kentucky senate seat and wednesday night at 8:00, live coverage on c-span of the louisiana senate debate between a field of candidates, republican congressman charles, democrat foster campbell, democrat carolyn, republican representative john fleming. republican state treasurer, john kennedy, and republican david dew. and at 9:00, republican senator kelly ayotte and democratic governor maggie hassen debate for the new hampshire senate seat. now until election day, watch key debates from house, senate, and governors races on the c-span networks. c-span.org, and listen on the

c-span radio app. c-span, where history unfolds daily. on election day, november 8th, the nation decides our next president and which party controls the house and senate. stay with c-span for congress of the presidential race including campaign stops with hillary clinton, donald trump, and their surrogates. and follow key house and senate races with our coverage of their candidate debates and speeches. c-span, where history unfolds daily. >> tonight on the communicators. scott wallstone, president and senior fellow at the technology policy institute and harold fell. senior vice president at public knowledge, talk about their opposing views on the proposed at&t time warner merger and what that merger would mean for telecommunicatio telecommunications. they're interviewed by lydia bayud. >> one of the things harold mentioned is how at&t will treat

time warner's content relative to other content. he's right, thaez the potential way that this political merger could be anti-competitive. if they treat their own content differently from others. of course that's going to be probably the biggest issue that the justice department will want to look at. >> at&t as your provider can see what you get for breakfast out of your smart refrigerator. when you go to work in the morning, when you're walking by a mcdonald's on the way to work. and can combine that with it's content that it would get from this to essentially dissect every element of your life. >> watch the communicators tonight at 8:00 eastern on c-span 2. >> health and susan services talked about the affordable care act. she was hosted by georgetown university and washington, d.c. and was asked about her work on

the health care law known as obamacare. and the fight between the obama administration and the republican-led congress over the lost future. this is about an hour and ten minutes. georgetown university is committed to standard pros moting speech and expression that foster the exchange of ie deals and opinions. while it is recognized that not everyone shares the same views, it is expected that everyone respect the right of the speaker an the organizing group. the institute of politics and public service at the mccourt

school of public policy to share their perspectives and ideas by not causing a disruption to the event's activities. at the conclusion, there'll be a question and answer session during which you may ask a question and engage in dialogue. as a reminder, the question and answer session is only open to members of the georgetown university community. please be sure to phrase your question in just that, a form of a question, and the interest of time, we ask that each person be concise and ask only one question. we hope you enjoy the event. >> ladies and gentlemen, please welcome judy, professor at mccourt school of public policy. [ applause ] >> good evening, everybody, i'm professor of public policy at mccourt and i am so pleased to welcome you to this exit interview on behalf of

georgetown's institute for politics and public service that is better known as gu politics and we ought to give a shoutout. [ applause ] the series launched this fall sex ploring the policy and political record of the obama administration with the cabinet secretaries and other senior administration officials who have built that record. our interests is in how these policy actors themselves see the challenges they faced and what they've learned in addressing them. what they'd advice their successors based on their experience. true to gu politics mission, will also be hosting a counterpoint conversation from experienced policy makers who just might have a different point of view. so, stay tuned for details on that event and please know that

the whole series will be published as an oral history of the obama administration. tonight, with health and human services secretary sylvia burwell. our focus is on health reform and health care. safe to say, one of the biggest challenges this administration has faced both politically and operationally. why is it such a challenge? when president obama came into office, we were approaching having 50 million people without health insurance at risk of not receiving health care when they needed it. and costs were rising rapidly. a terrible combination and a problem that persisted for years and was only getting worse. why was it so hard to fix? i can tell you a little bit about trying to be part of fixing it in president bill clinton's first administration. we were both there, it's because

most have health insurance through employer, medicare, medicaid, and it's really easy for opponent was active government to scare us into thinking that bringing in the 15% who've been left out, mostly, low and modest income workers who don't, and their families, who don't get coverage through their jobs will make our lives worse. now we did the obama administration a great service, not sufficiently recognized. our effort offered down a model demonstrating exactly what not to do if you wanted to pass health reform. and they used that example very well. tailoring the affordable care act not to disrupt most people who have coverage while extending coverage to those left out. to me and i do get my minute to

tell you what i think, the results are amazing. 20 million people newly insured, receiving good care with per capita costs rising more slowly than any time in history, despite what you're reading about the spike in marketplace premiums that i'm sure will come up tonight. but no question the job of getting everybody affordable meaningful insurance is not done. that spike in premiums, again, only marketplace premiums, which are heavily subsidized reflect lower enrollment than we'd like to see, insurers are unhappy, consumers who are not subsidized face premiums that are unaffordable and benefits are shrinking as out of pocket payments rise, not only in marketplace plans, but in employer-sponsored insurance as well. and then, of course, there's the medicaid coverage gap. a reflection of political opposition to the expansion of

coverage that just won't quit. so there's lots of work left to do and lots of political challenges left to face as the obama administration passes the torch. and i can't think of anybody better than the esteemed and highly respected secretary of health and human services, sylvia burwell to share her views on the challenges faced and the channels yet to come. so, i thank you for being with us tonight. i know we're going to have a fabulous discussion, and now, yet to gate proper introducing for the secretary, let me turn the podium over to ally trostz introduce her. thanks so much.

>> i'm ally ross, i'm a freshman here. like most of you watching, i came to georgetown because i love pretty much everything about politics and government in general. the institute of politics and public service here, from it's fellows program to the exit interview series has so far provided all the access to that kind of stuff that i wanted and even more than i could have possibly thought. so, whether you're a student or a member of the georgetown community, i can't recommend enough getting involved with them through different volunteer opportunities like special ops or research squad, fellows discussion groups, or other events with ge politics. that said, i'd like to introduce today's guest. our moderator is emmet j. dion, a georgetown professor in the foundations of democracy and culture. currently, he's a senior fellow at the brookings institution and syndicated columnist for the washington post. an esteemed commentator on politics, professor dion appears

on national public radio and msnbc and contributes to nbc's meet the press. previously, he's worked for the "new york times" written several acclaimed books such as why americans hate politics and won numerous awards for contributions to journalism. the current secretary of health and human services. appointed in 2014, secretary burwell has been front in center is in approving the affordable care act for the obama administration. previously, she's led many prominent organizations in both the public and private sectors. having served as a director of the office of management budget, president of the walmart foundation, president of the global development program, and chief operating officer of the bill and palestinian da gates foundation. the secretary served on the foundations and the university of washington medical center among others and held many different positions during bill clinton's administration. lastly, before we get started

with the third installment of the exit interview series. we'd like to encourage you all to join us on facebook, twitter, instagram, and snapcha snapchat @gupolitics wi with #exitinterview. now please join me in welcoming professor e.j. dion and secretary burwell to the stage. [ applause ] >> congratulations. thank you so much. good to meet you. >> good to meet you. >> thank you so much. >> thank you. >> i want to say, it's a great honor. a great and intimidating honor to be here tonight. i want to thank the institute of politics which is doing great work, and i do want to point out for the record that the institute of politics is open and fair and will be as i think judy pointed out, we're going to

have both sides of the obama record, although, after secretary burwell dose down, might receive critics of the administration to the republicans will have something different to say than we anticipate. but we are going to have all of that. and i have to say that the secretary burwell who knows so much about the policy. i was intimidated about having to do this. and i was -- my mother-in-law, i have a wonderful mother-in-law, 85 years old who's visiting us, and when i left, i said i have to interview secretary burwell in front of this serious group of people. and she said she would pray to st. francis, the patron saint of journalists that i might do a good job. whatever good comes from st. francis, he's not responsible for any of my errors. great to be with you. and i want to begin -- i want to start with you were walking into

difficulties you had to help resolve. some of the things you wish you might have been able to do and then we'll take it from there. >> thank you and thank you, e.j. in terms whf i took the job, i think as you reflected, it was a time where there were a number of challenges, and it was clear that that was something i needed to work on in terms of the work that we needed to do on the marketplace. and so, that was one thing that was very clear as i was going over. i was fortunate that i had been at the office of management and budget. and so, i had a chance to see the depth of the department of health and human services. it's over a trillion dollars in terms of the department.

if we were an economy and you measured us in terms of our budget, our annual budget and gdp, we'd be the 17th largest country in the world. it has just fda alone regulates 18% of all consumer purchases. the food and drug administration. it's very broad and diverse. the administration for community living, national institutes of health, and so i knew those pieces and parts. i think some of the things that i didn't know, i had been told and my predecessor, this is the passion that people have for their work there at hhs. and it was interesting, because i've been fortunate, you know, i worked at the gates foundation and i've worked in another administration as well. but it is really true at hhs, people consider it administration. you know, it is their life's calling for many people aej that's been a wonderful surprise. you asked what i expected. the other surprise, you know, if i'm honest about it is that

there were so many things that came at once in terms of unexpected. when i arrived at hhs, the company children were backed up at the border. in addition and ebola, in addition to the issue that, you know, the affordable care act had been working on that. so there were some surprises in that way. because the department is so diverse, certainly and part of why i went was to be a part of the transformation of the u.s. health care system. and the work we've done there and the impact that we've contributed to is one of the things i'm most proud of. there are things big and small, and whether that's our head start regulation that went out and it's the first time since i was in head start in the 1970s that we have done an overhaul. and the overhaul reduced our

regulations and what people had to do by a third. 30%. almost a third in terms what have we did. we've moved to better standards for teachers for a full day. all evidence-based. and so it really isn't one thing, it is what the department does every day for the issues that people care about around their kitchen table. so, and i would be remiss if i didn't mention all of the work in global health security and what that means is when we have things like ebola and zika to handle. so many things in terms of -- because it's an incredible work to get to work on a broad range of issues that really affect people's lives daily. >> could i ask you, you worked in government in both the white house and in the federal government in the '90s, could you talk a bit about how dealings with conditioning have changed. and i'm thinking of a couple areas and this is also how i want to back into the news of the week in terms of obamacare.

ebola was that happened to hit before an election and it became an election issue. and then in the end, you know, most of the reviews i read said that our government actually did pretty good job of dealing with it. and zoo as soon as it seized to be an election issue, everything got completely lost. that's one area. second area is on confirmations. where the whole confirmation process has gotten all fouled up over a long period of time. and that's where i'll get to obamacare, maybe we can get to that next. could you talk about your experience of congress both earlier and, you know, in recent years. >>ic it is fair to say that it is harder. it's harder and i think actually members of congress would say it's harder.

and it's harder to get things done. and i do see an experience that i also see an experience there still great people that you can work with to get things done. and we've been able to do that in a number of areas, but the way that issuings ones able to discuss and get to the core substance of an issue, obviously we have disagreements about policy in the united states. that's natural that's a healthy part of our democracy. but our ability to have the conversations and what i like to say is can we put the point on the arrow? in terms of what we disagree about? we believe this is a bigger priority than that is often the way these conversations, if you get to the substance, and that is missing, and even to do this. although i will say on some of the issues you mentioned, it's very interesting because sometimes there are actually

meetings instead of hearings. and that's where you can have those kinds of very real conversations, i think i would say, i like to say that i think the proximity to substance changed in the intervening period when i was away from washington, d.c. and that makes things harder across the board. >> why do you think that happened? >> i'm not sure. i think, you know, there have been an evolution of many things, and actually at one point when i finished my time in england, i actually wanted to get my phd and what i want to do to do, i had two different things that i actually wanted to pursue and write about. actually very different. one was the idea of the question of the state and that there would become a rise in players that weren't really state players. and that you could see this already happening. that they were going to become

these entities that would be as powerful as states, but bont states. and how would we deal. that was one whole area if i did it in ir, international relations. my undergraduate degree was in development. the second area, and it relates to this question is, i believe that at that time there was an evolution that was already happening of pushing people into single issue into reacting in their politics about single issues. and this was the beginning at that time direct mail. and now like direct mail, like with technology, it's like we've gone, you know, completely steroid tons. but because you could be targeted for the nra, and you could be targeted for choice and you could be targeted -- and so people were getting into their little lanes.

>> we could consider this a candidate for the senate some time in the future. and your thesis sounds -- your thesis sounds like judy's phd pieces. >> maybe i'll go back and get that ph.d. now. >> maybe you should come to georgetown. let's go to the problems with obamacare. i can imagine critics on the one side saying, why couldn't you foresee this, why couldn't you do anything about it? i could imagine democrats on the ballots saying couldn't you have announced this on november 15th? but we won't go there.

>> i think it is important to think about where we were and where we are now. so let's just do access. one in seven americans did not have insurance. 20 million more americans now have insurance, we have the lowest uninsured rate in the history of our nation. that's access. in terms of quality, and i think this is a very important part that gets missed about the

affordable care act. because if i actually asked, you know, everyone we're going to have a piece of paper, and i want you to write down how your benefits changed because i'm assuming you were on your parent's care many of you, and so i how your -- what changed from the affordable care act and how many people actually would go through and know that you no longer, i'm sure everybody here knows somebody with asthma, cancer, somebody has an eating disorder, somebody who has a preexisting condition. and no longer can you not be insured. so when you, for of those who are graduate students and you're 25 and 26th birthday is about to come up. first of all, you wouldn't have been covered because you couldn't be on your plans until 26. second of all, in terms of preexisting conditions, third, many of you all probably don't know there were things called annual limits or lifetime limits. let's just take lifetime limits. i've met the kid who was 15 and

had had cancer and hit her lifetime limit of insurance if we didn't have the affordable care act. i've met the mother who she's like, well, i just decided because i hit my annual limit, this was before the affordable care act that i wasn't going to get that last chemotherapy treatment. until the next year. because i'd hit it. and so, the progress that's been made on quality across the board, or most people don't know another nerdy one which is harms and hospitals. those are bed sores, falls, things that shouldn't happen. they've been reduced by 17%. that's 87,000 estimated deaths not occurs and $20 billion saved. so the quality progress, and then affordable. because that brings us back into this part of the conversation. so, this will bring us, so first on affordable, i think it's important to recognize that if we have continued on trat jekt ri that we were on in terms of medicare spending, so this is before the affordable care act, the growth that was occurring in medicare spending.

we would have spent $473 billion more. 473 billion for any of you all who are studying the budget of the united states government, any of you all have studied something called simpson bowles, look at the numbers. that is an incredible amount of savings for the federal government. and then let's talk about people and their health care. and this will bring us into the premiums. so 150 million people are in the employer-based market. for these people that we're going to talk about don't affect them, but for that 150 million people, in the last six years, we've had five of the lowest years of premium growth on record. so if you're in the employer market, that's the lowest growth that you're seen since, you know, during this period of time. so that's 150 million americans. and then there are the 55 million americans in medicare, they're not impacted.

and then there are the 70 million americans in medicaid. and they're not impacted. so let's go to the marketplace. the problem that i think people are focussed on. so in the marketplace, when we look at that group of people, 10.5 million in the marketplace, 85% of those people receive tax credits or subsidies. and the way the system was designed, it was designed so that when premiums go up, your tax credit goes up. because the whole idea at the time the tax credits are the subsidies is that you're going to pay -- we don't want you to pay more than a percentage of your income. so if your income stay stays the same, but your premium goes up, your subsidy goes up. that's the way the system was designed. and so in terms of the quote problem, i think one of the problems right now is making sure people have the right information. so they can make the right choices. and so, we know that right now

in the marketplace, for people that come back 72% of people can find a plan for $75 or less. they may to want choose a more expensive plan with different features, but they could do that if they want to make a decision on price. >> this is after the subsidy. >> yes, but not everyone receives it which is why the 72 part of why that exists. but so, in terms of the problem, what i think we need to focus on, and i think we want to fix in the marketplace, there are places in the country, you know, in states like ohio and colorado, you know lots of competition, we're not seeing a lot of the large rate increases that we're seeing in other places. but there are places in the country where we'd like to see more competition. and we'd also like to see things that settle the market. and we're going to work on those and do those. but the idea of the problem, i think one has to talk about what is the magnitude of the problem,

and that's what i was trying to articulate by putting the facts on the table. we do believe there are changes that need to occur. the president articulated those in the journal of american medicine article and rerestated them last thursday. some of those things are number one, we need probably to further subsidize the portion, the 15% if you did the math, the 85, they get the subsidies, the 15 that don't. how do we think about those people and i think we think that some of that needs to be possibly subsidized. >> number two -- >> is that property vision that keeps the group of people out because the 9 pnts 5% and stuff k37 we believe there may be

policy changes that need to occur to help them in terms of that. they're in the marketplace, but don't currently need subsidies. the president articulated that we believe that in police stations where there's not enough or adequate competition, we need a public option so that those people are able to make sure that they have a place in the plans and choices and options. the third change is working on high cost drugs. and there were a series of proposals that are part of the president's budget, but let me just highlight one to give you a sense. one in one of the biggest ones is giving the department of health and human services the ability to negotiate on high cost and specialty drugs. because that's not something we can do now. so we have to accept price instead of negotiate. so yes, there are things that we believe can be made better, i

think we view it in the world more of building on progress and there are issues. you know, some of those issues have to do with how do we encourage more competition to get lower price and those are some of the policy approaches we've proposed. >> let me stay on this for a second. that would help change these assort of risk equations. is that -- what do you make of that and in general, how do you respond to this, you know, reduce the degree of regulation or provide a broader set of

plans. some which may not meet the specifications. >> so i think one needs to think through why the premium increases were occurring. because, you know, that gets to what solution you would choose to implement. and when we look at the pricing in the marketplace so the insurers were in a new business and by that i mean, so the individual market it's a small market and it was before. since the affordable care act in dollar terms, it's doubled nearly in size. in terms of dollars. but it's a pretty small market, but it changed dramatically and it grew and what insurers were supposed to do were different. they're now ensuring everybody, not just running a business to look for healthy people. and so their ability to price in the early years, they didn't have data. that's how insurance companies do it.

because what people are focussed on is the delta. the change in rates. and i understand that. because any rate increase people, gosh, that sounds bad and you know, but we need to keep focussing on what consumers are paying and the other issue of what consumers would have paid had the pricing probably been a little more accurate in the beginning. >> two other things i want to ask and then i'll move on. mo signalled to me, the, you

know, you answered one of them which is a public option would provide an alternative. why in the world wasn't that included in the first place. another idea, i think henry aaron suggested that in some states have done this is if you put all insurance plans on the exchange and all of the exchanges, you might actually. >> it is one risk. they have to treat it as such. and that's part of the rules of the aca. those people that are in the individual market that sits right beside the marketplace, it is part of one risk pool in terms of the pricing and as people think through and work through those issues. it is a part, they have to view

everything together. are there ways to do that and more efficiencies, yes. and i think those are things that we'll think about, but the base of it is an idea that it is one risk. >> why no public option in the first place? >> with regard to that question, you know, i was not here in terms of the washington debate. and so i don't actually know the answer. not that i wasn't here -- it's that i actually apologize, but i don't know. that was a time when i was not here in d.c. and so i was not following and don't actually know the answer to the question. and i also think it's a fair thing, whenever we have had major legislation in the united states, you learn and you iterate. that's like what we do. we did it with part d, we did it with medicare many years ago. that's what you do. and there's just been no opportunity for that because of, you know, the vast divide about this issue. and so, i think it is a natural thing, you know, i don't know the specific answer to your question, but i think it is a

natural thing that you learn and you improve. and you learn, and you improve, and that's an activity that is done with both the executive branch and the legislative branch working together. and that's what i think we're hopeful will happen. and will happen after we leave, but i think it will happen. >> you actually think congress will take this up? >> what i believe is that congress -- and it's actually not even about congress, it's about the country. the kinds of things that i spoke about preexisting conditions, the on your plans to 26, the fact that actually in insurance, you and i couldn't be charged differently mean more because i'm a woman. those kinds of things, we're not going back, that's what people consider our health care system now. and so, in a world where that is true, the alternative we all have is to work together and improve the things that aren't working well. and i think that's what's going to happen in a administration.

>> i want to move to opioids because this is a problem -- i guess i have two questions. one is, was this not anticipated? to what extent was this slowly happening under the surface and then suddenly exploded to public awareness? and you know, what actions can we take? i mean there is a bill that's passed, but where did this come from and what can we do about it? >> so it was something that i think was building over a period of time, but it's recognition i think has become much more acute in terms of the recognition of the issue across the country in the last i would say two years. in terms of the problem, the administration had been workingen to over a period of time in lots of pieces and parts across different parts. and one of the things that we have done is come together around a strategic approach to the opioids issue.

certainly in the health space in terms of key areas that we're focussing on to make sure that you're actually changing trat jekt ri. and just to give people a sense, and i guess it was 2014 or so, there were 250 million prescriptions for opioids. i think most of you have a sense of the population of the united states, it's more than one for each adult in the country. and so, the idea that that just can't be right. and so, our strategy's based on three things. someone controlling the prescribing because the prescribing, that's how the drugs, many of the drugs are getting out to people. and so this isn't -- this is about helping doctors. seen the centers for disease control and prevention has put out a new set of of guidelines. the surgeon general has challenged, you know, how many providers are going to take on and take up those guidelines and working to get those guidelines out. there are guidelines about how to prescribe for pain. and so the idea of the prescribing is an issue. seen, there's what you can do to

give doctors the tool, there's also making sure that in stakes there are things called prescription drug monitoring programs. and this means if you're a physician, what happens is you need to, and i come in and ask for one of these drugs, or you think i might need one, you go on and check and make sure that i haven't been prescribed by five other doctors. same thing for the farm sis. control prescribing. the second thing is medication assisted treatment. and it's sthad in our nation that we have so many people that have substance use and misuse problems in our country that we have to have solutions like this. and this is using drugs and other means together with therapy and other things to treat people who are addicted. and this is a very important thing because it comes to the legislation that was passed. the legislation was passed, didn't address one of the in the

united states, the number of people who have h ak stoesz this treatment is extremely limited. in the need or demand. and that is a very important thing, it's funding that treatment. and that's something that the federal government is probably going to end up taking the majority of the share because states, you know, don't have the capacity at this point to do that. the third element of the strategy is something called narcan for many people, and that's what you give to people to prevent them from diagnose and making sure there's broad access about that. i'm sure you all read about the number of overdoses in cincinnati recently or in mustn'tington west virginia from a particular type of drug, but it is this drug and getting access. so the fda has approved a nasal version which, you know, might make it simpler for people like me and you to kb able to give to people if that's what needed to happen. and we're traying to hard to make sure that it's funded and the right people have access. >> couple other questions i want to ask before we turn to the

audience. we have talk ed could you talk about the frustrations with that and also what you think needs to happen. and then i'm going to ask one last question and then i'll go to the audience. >> i will be brief. with regard to those issues. i think the answer of what has happened and what should happen, it's what not happened should happen. s at this point in time. and there are two categories that this falls in. one is the funding.

and so, we do and the budget has proposed far number of years funding increases and that's important. the second thing is we believe there are reforms. and it's a bill that's a bipartisan bill. but haven't been able to move that through. i think many of the elements of that the kinds of changes we think are needed. could you talk about that a little bit before i open it up. >> i am a greek orthodox which is an interesting breed, all four of my grandparents are from

greece. i was baptisted, but in my little town in southern west virginia of 3,000 people, there wasn't a greek church. it led the greek priest baptize people there. and so -- >> only in had america. >> only in america. so we belonged -- i was raised in, you know, a community of faith. this was a very important thing for our family. my father was the lay reader and delivered many, many sermons. my mother was president of the church. my sister was the organist. i was the crewser in, because our church so was small, it was a mission. it wasn't even a church. we're a mission. i mean, there would be times, you know, when there are 15, 20 people in our church. so that's why i was both crewser in and ak lite for those of you that know those two different functions. and so, race and the faith, an important part. an important part of how i think about in my career and what i do. terms of, you know, i'm a fan of the gospel. in terms of a place to turn and

receive guidance and think about things and just i find that in my work that that's an important part of it. thinking about the role and how christ turned things on it's head.

and then i am just days in and of course there was hobby lobby versus burwell, no one told me they changed the name. that was decided against us. after 50 years, smallpox was discovered, and so at that point i was kind of thinking a little bit about that. >> we've got a microphone in the middle, and i want to invite people to line up. thank you. there you go. if you could identify yourself and try to put a question mark on your question. >> thank you secretary burwell for presenting georgetown this evening. so that people are informed when it comes to health care. >> you know, it's funny, i think this is a very important thing, and it's one of the things

around the affordable care act that a couple things, one is you -- when the people have insurance, you have to convert them to care. that has to -- it's not good enough to have insurance. you want people going, getting care and that sort of thing. and one of the interesting things about the political care, so we have a whole effort with our stake holders that help enroll people to make sure they are educating them about when to use the emergency room, how to use preventive care and those types of things. in terms of education and literacy. interestingly was with a reporter today i'm sure you can imagine, i've been with a lot of reporters over the last three day us in terms of the issues. one of them told me and it was fascinating, what she said was that in talking to consumers. the consumers in the marketplace shop. they take time. they know they are engaged in. and that is one thing that i believe the marketplace, while it is only 10.5 million is leading in people becoming

ejtsed. becoming educated about their health care and part of it is they have a tool. and so they have the ability to shop and compare also on in the marketplace, you have the ability to look up doctors. ability to look up drugs if you have certain prescriptions. and that is leading to a space where we have a more engaged consumer and that is what is going to transform the system. your question leads to something that's really, really important. and that is the fact that while erin is focussed on the marketplace as the definition of the affordable care act, five years from now, what people are going to focus on is what the affordable care act did is give us the tools to change the health care system that's about putting the consumer at the center. and what does that mean? see you're paying far test, not the outcome is your mother

healthier. and so changing our payment system, which is one of the things we're deeply focussed on and trying to do. the second is more integrated or coordinated care, and more prevention. prevention we talked about. what is sbre grated or coordinated care mean? it means that take for example a hip replacement. right now, it's paid for piece by piece. so the person who comes to your house, get rid of the carpets, bring your dishes down. the surgeon, the anesthesiologist. the physical therapist. we're bunding that payment. and that forces integrated and coordinated care because if we're being paid. and you're the anesthesiologist and i'm the physical therapist, and we need to coordinate because i want you to get that patient to me quickly so that we can have a healthy outcome because that's what we're being paid for. it causes that integration of care. lastly is data and information. and right now we have electronic

health records, but how they are used by you, the patient or consumer or by your providers isn't there yet. and these are the changes we need that are going to help us goat a place where that consumer is more knowledgeable, is engaged and empowered. they can access their health records. they'll be able to have them so that they can ask the questions that they want to ask. so, sorry for a long answer, but an important question. >> thank you. >>y, my name is zack, i'm a junior and i wanted to go back to the ownership yoids issue we talked about earlier. and last month, georgetown hosted a documentary screening with fbi director comey and dea director rosenburg. i thought one of the most interesting lines in that documentary was that the best place for substance abusers is a jail cell. and i thought that runs starkly in contrast to the approach you laid out. and so i wonder how do you reconcile the law enforcement side of the ownership yoed issue with the health care side that you talk abouted? >> that's a place where we've made real advancements when i

say in the last two years, in terms was this being a health issue and recognizing that addiction is a health issue. and certainly there are cases and places in terms of people doing things that are illegal and should be a part of our justice system. but for many of these people, this has become a health issue. they are addicted. and therefore you know, how we think about alcoholics and their addiction is very different than how we think about these types of addiction. and many law enforcement officers, when i meet with law enforcement officers, you know, you've got so many of them that look at you and say i don't want to be a health care worker, i don't want to be a social worker. give me a place for these kids to go. how many times am i going to have to deliver this? you know, save their lives, and then have no place to put them with regard to medication assisted treatment. and so i think this is a change

and i will say, it has been a change and for all that the current season has given us in terms of the conversation and i am here in my official capacity. is that in this space, there have been more m people who have come out and spoken to this issue that are in places where they were being heard that this is a health issue. and i think that helps us a lot. >> hi there, i'm a senior in the school of foreign service. and and i wanted to ask you about the prices of prescription drugs in this country. because i know hhs has taken the process to lower the prescriptions. there was a rule change when it came to making sure doctors have an incentive to try and prescribe expensive prescription drugs, but i know that you

rejected in a letter from a member or for members of congress who talked about i believe it was margin rights for drug makers who can make generic alternatives to prescription drugs. and this is personal for me. my mother has rheumatoid arthritis. she has -- when the doctor tells her i could give the drug that costs 40 to $50,000 a year, the problem is insurance doesn't cover it, she couldn't afford a plan that would cover it, and to pay that out of pocket, that's more than a year's salary for her. so i would ask you what sort of actions can we take to ensure that people like my mother that are probably thousands, if not millions of people like that can afford drugs that they would need to make their lives better? >> i think that there are a

number of steps that are important to take, and i think that particular step, that is a provision that is applied when things meet that standard. but i think there are other important tools and i spoke to one that is extremely important. the ability to negotiate on price. you all probably i think heard, i worked at walmart. you know, i did the foundation at walmart, but i will tell you there's a reason that there's every day low price there. it's called negotiation. you know, that's what you do with your supplier. and we are at hhs, we're one in three of every health dollar spent and to not have the power to negotiate to help with some of those issues, so that's a very big issue. i think another issue is continuing on the path of generics. and last year at fda, i'm proud to say, we approved more generics than we ever have in the history of fda. and we're going to continue on that path to continue doing that. and so those are some of the things that we can do. the other thing is the light of

day. and while we were criticized for putting up on our website and our medicare site, you can actually go and find out the drugs that are the highest cost drugs and the drugs that have had the highest cost increases. and there are reasons that are complex end a i'm sure you have seen this in a very recent public example about rebates and what it really costs and that sort of thing. so we were criticized because that's not really what the consumer pace. and we think that's important. so the website is clear that it's not necessarily the price, but to put the light of day. because i think we've seen very recently when the light of day is on things, that's when we get a little more help. and you specifically referred to another rule making that we have that people have opposed and called the part rule and it is a rule where we believe that you want to encourage people not to prescribe the most expensive in terms of how they're paid, but instead to prescribe the one

that is right. and so it cuts across the earlier question in that reform. those are some of the steps, cases like your mother, you know, it just breaks your heart and what you want to do is try and get those policy solutions as quickly as we can because we know there are people like that out there every day who even when they do have insurance can't receive some of the treatments and things that they need. >> great, thank you very much. >> hi, i'm henry. i'm a junior in the college studying exhibition. my question is with regards to the public option, how can a private insurer fairly compete with a government-run health care plan that gets to draw upon tax payer resources when the private insurer doesn't? >> so -- >> asked by an economics student. >> you know, i think that the question there is i think as you've seen in our proposal, it's about where there isn't

competition. so in a case where private insurers aren't willing to go in. you know, that's, you know, when you can't get folks to be in that kind of space, i think it's an important to be able to provide that kind of assurety. and i think you can design in ways that there can be competition. in terms of how you design. and so i think it's an important question. i think it's why we put the issue out there. because then the question becomes, so, i think that's an important question, and i think that's one of the key things you have to figure oultd, can you design correctly? because then the real issue is, so what's the alternative? so you can regulate really heavily in terms of regulating the insurers to make sure that think go in and they provide. that's another alternative. you could have no coverage for people. and so, these are complex issues. and one of the things about health care and working in the space incredibly complex, incredibly hard. teddy roosevelt was like one of the first presidents to talk

about health care reform and we've been working on this for 100 years. so i think your question is one of the right ones in terms of how we think about design. but i think the other thing we all have to think about is so what are the alternatives to a public auction? and really it's very heavy regulation is one of your answers. and so which, which of these things do you think is, you know, a better place to try and encourage a healthy market? because that's what we want. i mean, that's what we're working hard to create is a healthy market where issuers come in and compete with each other. and we see it working. places like california, places like ohio. and other states. >> we got time for one more question. these are great questions by the way, thank you all. >> hi secretary burwell, thank you for being here. i'm a senior here in the college here at georgetown. so, my father's insurance broker. and the affordable care act has been topic of conversation at our house far long time. as a result of that. but i was talking with him just

yesterday, knowing in advance of your visit, and talking to him about some of the concerns that he's seen in working with folks and navigating since the roll out of the law and as folks navigate the exchanges and the market and so on. and this is going to follow up on the previous question we didn't plan that, we promise, but he mentioned one of his concerns that he's seen being as you've seen carriers now recently announce they've been pulling out of certain states. and that's been a difficult it i this this the rollout. i'm curious, kind of following up on carriers pulling out of state and seeing the doctor of your choice. is that a concern of yours?

do you think that's something that can be worked on going forward? >> so in terms of the question of seeing the doctor of choice. i think rising up to the larger question of satisfaction. and so, satisfaction with marketplace plans as done by external consumer organizations that look at employer-based plans. the satisfaction rates are about the same. and so, one of the things that that i think tells a lot of us and this question of narrowing networks which gets to the issue of is your provider in the network? the trade off is price and network generally. and that's the trade off. and in the united states today. we see more and more consumers making that choice on price and therefore what you see is the issuers, the insurance companies making choices and decisions about that based on consumer demand. having said that, i think we think it is an important issue

for consumers to know and understand. it goes back to the earlier question that the gentleman asked about the consumer having information. and that's why last year, we piloted and this year we're sort of advancing the idea that you can do doctor searches so that as you're signing up for a plan. you can try and understand is your doctoren to or in the case of a pharmaceutical, if your drug is on it. and so, what we want to do is get as much competition as we can and that competition isn't just with issuers, that competition is actually with providers. you have competition speaking at the issuer level. those are some of the things and does it concern us? yes, we want to make sure the consumer can get the product that they want, but for many consumerers, this becomes a price breath of network kind of

trade off in terms of broader network is a more costly one generally speaking. and so we're going to continue to work on these issues. the consumer is generally speaking with their feet. you know, voting with their feet in terms of these issues. but always looking to understand and the other thing is, the affordable care act requires that there's network adequacy. and so, there's two different things, can you see the specialist or thing you need to see. and that has to be met by anyone that participates in the marketplace. it's a different question if it's the person you want going to like and finding a plan that matches. and so we're going to continue to try to make progress on those issues. but those are some of the core trade-offs. >> thank you very much. i want to just ask you one last question, and i'm going to set it up like one of those college applications where you can answer. this is about coming here for a phd.

>> getting it to one or the other or you could bring them together. i wanted to ask you your successor asked you what should you focus on. what should i worry about. what public issue should i really worry about or, a citizen asks you what did we need to do to make the country more just and if i could draw on the constitution and the old name of your agency to promote the general welfare. what would really make a difference. and you can go either way. or maybe you can bring them altogether. >> in terms of my successor, what i would tell my successor is that i think it's very important to continue the changes. and this gets to this delivery system reform part that we were talking about. because it gets to the affordability and the quality, some of the last few questions that these are the kinds of changes we have to get in the system. in order to get more

affordability and quality which start to get to some of the problems that people are raising and some of the concerns that we have. and so i would say number one, focus on that and making sure that that goes forward. number two, i would say focus on the importance of relationships and focussing on the customer. and sometimes the customer in our rule making are doctors and physicians. and sometimes our customer is a head start kid. and sometimes our customer is a university trying to get a drug approved by fda. but having the customer at the center of the work of hhs is extremely important. and that brings me to the citizen and the things that we need to change. i think that that is one of the things that we have tried to instill at the department, this idea that actually who are we there to work for? it's not about the policy of the program, it's about what i like to refer to in it at the gates foundation, we call it the boss. and we did that because i had

this picture of a child. and she's two years old, her name's indea, she's taking her bucket bath. you all studied development and everything. kids not particularly sad, she's sitting in the bucket taking a bath. that's what she's doing. and this picture is a picture that i gave to everyone that joined the global development team. and i wrote a note saying looking forward to the impact you're going to deliver for the boss. because the idea of focussing who is it? and this little kid on your wall, so everybody had these pictures, and i'm sure you can imagine first when i did this, bill and melinda gates were like the boss, isn't that like us? everyone adopted that this was the boss and this idea of who do you work for? and i think that ties into what we need to do to make the nation's stronger and more just. so many of our issues are about the every day issues that people live. and whether it's if you have

older for you all it's older grandparents and, you know, administration for community e living or someone in head start. and it's about the education of their child or if if you do have a parent who needs drugs and whether that's the research end or the access end. so much of our work is about that. it's across the board in terms what have we need to do every day. and so, that's trying to bring those two things together in terms of what i would recommend to a secretary and what i think we need to do and the health care issue, because it connects to people's very core of what is one of the most important things that you have every day, and the other thing is it connects to your finances so deeply. continuing to make sure we're creating a space where people can have that affordable, quality coverage. >> thank you very much. thank you so much. i want to thank the institute of politics for setting these up. i think we've had more policy in the last 90 minutes than we've gotten out of an awful lot of

the campaign that we've just gone through. and i'm also grateful to you and to the institute because i think one of the hardest things to do now because you get very little respect is to work for the government of the united states. and it bothers me that so many young people are so reluctant to join this and we make it very unattractive to them, and i think you hope to see that it can actually be quite exciting. and i thank you for your work. >> i want to encourage all of you. this is my moment for my ad to consider working government. bobby clark, one of your alumnis here who works on our team, and does incredible work for us. but i just to want encourage each of you. you can make a difference. i promise you. the kinds of decisions and choices and work that you can do every day can affect millions of lives. and so i just to want encourage each of you all as you think about what your future holds as

you think about summer work a as you think about, you know, how you think about what your career trajectory wants to be. i really do want to encourage each of you all to think about it. i've had the chance, i've worked in philanthropy, i've worked in development. i've worked across the board, and government is a unique opportunity to work on change at scale. and so, i just ask each of you to at least think about it. as you think about your futures and thank you so much, e.j., for being here and thanks for having me. >> the road to the white house getting busy in the last week

before election day. joins later for campaign rally from hillary clinton in the battleground state of ohio. appearing in cincinnati, we have it live at 6:15 p.m. eastern at c-span. all this week on c-span week prime time it's american history tv. tonight native american history. we start at 8:00 p.m. eastern with a look at the apache wars. then a discussion on the killing of native americans in california between 1846 and 1873. after that, it's lectures in history on native americans and westward expansion later nor his we with a talk about the the indians commission. today is halloween, and last week the white house featured historical characters in period dress as tourists came through. here's a brief look.

>> i managed to save several items, including a wonderful portrait of george washington that you saw. i saved small portraits of myself and mr. madison. most importantly, i also saved the reportings of the constitutional convention when my husband served as secretary for president thomas, for president washington. when we ended up with the constitution as the articles of confederation had failed. but i only wish this were wednesday because it was wednesday, i would be having a wonderful thing. i would have some wonderful ice cream. and ask you all to give me a recipe and tell me where you're from and we would share the recipes and subsequent gatherings here at the white house. any questions? >> what's your favorite ice cream? >> well, i've heard different people report it different ways, i will answer this way, when my husband had his second

inauguration, i served peppermint ice cream. i have been known to on occasion popularize strawberry ice cream and oyster ice cream which tends to be a little, not as well received as the others. >> this is also where, oh on new years, 1902, she and i stood here for about an hour greeting every american who wanted to come through the door and she held a bouquet of flowers. she didn't to want shake hands. so she would hold a bouquet of flowers so she didn't have to shake hands, but i shook every hand. 3,000 hands in about two and a half hours. and this is the room that we did that in. and then we would often entertain people in the red room

before a state dinner of some sort. and the east room, well, if any one person is responsible for making that into a splendid reception room, it's edith roosevelt, she was magnificent. believe it or not, one year we entertained about 2,000 people in that room. and i don't know how they stood shoulder to shoulder, but the work got done and then afterward, we came down. and she's the one who kind of started the trend of musicals and such in that room. before then, it hadn't been used for much, kind of a stale, stogy place. so the magnificent of the white house is in good part the responsibility of edith roosevelt. >> c-span brings you more debates this week from key u.s. senate races. tonight at 8:00 eastern, live on

c-span, republican senator rand paul and democrat jim gray debate for the kentucky senate seat. and wednesday night at 8:00, live coverage on c-span of the louisiana senate debate between a field of candidates. charles gustani, foster campbell, carolyn fayier. john fleming. john kennedy. david duke. and at 9:00, republican senator kelly ayotte and democratic governor maggie what'sen debate for the new hampshire senate seat. now until election day, watch key debates from house, senate, and governors races on the c-span networks. c-span.org and listen on the c-span radio app. c-span, where history unfolds daily. on election day, november 8, the nation decides our next president and which party controls the house and senate. stay with c-span for coverage of

the presidential race. including campaign stops with hillary clinton, donald trump, and their surrogates. and follow key house and senate races with our coverage of their candidate debates and speeches. c-span, where history unfolds daily. this week on c-span 2, we're featuring political radio programs with national talk show hosts. tuesday morning from 6:00 to 9:00 eastern, politics with a left leaning perspective on the bill press show. live from washington, d.c. on wednesday, also from washington, conservative radio talk show host, hugh hewitt is live from 6:00 to 9:00 a.m. eastern. live thursday from noon to 3:00, author and progressive radio thoes, thom hearthman and m 9:00 a.m. until noon, conservative political perspective on the mike gaal ber show live from new york city. all this week, live on c-span 2.

>> now to russian journalists explain the relationship between the russian government and russian media at the center for national interests here in washington. the two talk talked about media censorship, the impact of social media, and the kremlin's influence over news coverage. this is an 1:40. well thank you very much everyone for joining us today. can you hear me in the back? yeah. thank you very much everyone for joining us today, i'm paul saunders, i'm the executive director of the center for the national interests. we appreciate everyone being with us for this discussion of the russian state and the russian media. you know, the u.s.-russia relationship has obviously

deteriorated very sharply over the last two years and particularly actually over the last several months with a variety of causes and precipitating events. in that context, i think there has been increasing attention certainly in the united states and in other western countries to the russian media. both in the role of russian media outside russia in what i think benny and the west at this point would call russian propaganda. but also in the role of the russian media inside the countries. and it's role in shaping public opinion in mobilizing political support. and it's that latter element of this question that i hope will

focus on today. we're very pleased to have two speakers -- each of whom is a russian journalist. to my right we have maria, a columnist for the russian newspap newspaper. it is a business-oriented paper that until relatively recently was published jointly with the financial times, the "wall street journal," and some russian participation. a new media log in russia caused the wall street journal and the financial times to sell their states. however, the paper still often challenges russian official policy and perspectives on a number of issues.

and maria will speak first. to my left is anna, she is the international news chief with russia 24, which is a 24-hour news channel and is part of the complex russian state media enterprise. she is also worked in the past for ria, which many know is a russian state news agency. and anna will speak second. i hope they will each give us some very interesting perspectives on this issue of the relationship between the state and the media. i've asked them each to speak for about ten minutes. after that, we will open it up

for questions. thank you very much. >> thank you very much for the invitation. it's a big honor for me to be here in the audience. and i wanted to point out that our discussion comes at really good, bad time. because yesterday the editor in chief of my publication has been one of the best publications in russia. has actually announced that she was leaving soon. and the announcement came a year after the owner, the ownership structure has been changed. it was as we have said, the foreign owners, as holders. they sold their shares to the russian guard businessman. and since then, the tutorial

infrastructure has been changed which culminated in the recent announcement that the editor and chief is leaving. now, i wanted to start this discussion with the famous quote by president vladimir putin who very briefly cut the relationship between the media and the state. back in 2004, when asked to describe his attention towards the media coverage the tragedy, the attack, he said that the relationship between the state and the media is comparable to the one between a man and a woman. a real man always tries and a real woman always resists, right. but when you actually look at what has been going on for the last ten years. the relationship between russian state and media resembles also the bond. it's when it tried, but a real

woman cannot always resist. you were forced to surrender. now president putin has an intelligent security background as you know. you all know well. one important strategy that he learned during his service is that the media is a very powerful and is an extremely powerful instrument that can be manipulated. when it comes to the kremlin today definitely the control and manipulation of information in order to achieve the kremlin's domestic or international is extremely important. as you know, since this president vladimir putin taken power, back in 2000, the general trend when it comes to the

political freedom and civil liberties has been negative, right? freedom house has recorded almost immediate decline in the freedom. as you remember, putin assessed to power came with immediate closure of the only largest in the general at the time, ntb which was taken almost immediately under control by the program holders. and since then, the trend continued. it's important to point out that the trend doesn't -- is not leanier. it's more like it comes in waves. the waves are for persecution against the media. media russia or independent rather. usually follows some big developments. be that international or international developments. for example, as i said, putin's terms usually, correlate with

attack against media that gained too much independence, right? so back in 2000 or quite recently in 2012 when putin came back to power and replaced the president. they needed, that immediatedly was followed by a set of lows against the remaining. whatever remaining independent media on the market. most of them with some degree of foreign ownership. so once of the important passed was the one that limited the foreign ownership to 20% that as i mentioned, for example, later force midown publication and sold the shares to the russian owner. now that question -- so as i mentioned. the overall trend conveyed, theers if cushion against the media comes in waves. one would be the change of their president for example in power or a war.

also that a war coincided with another wave of attacks in the media. and every next wave is kind of, more prohibitive and the trend is negative. recently, like a couple of years ago, they didn't accept the articles. i was lag for another publication to give it. and i got five available media and sources where it could supply that article. that's because all the other ones are not really free. and if i write something very sharp and kremlin probably lo not be accepted there. now who -- when it comes to the media, who is in particular danger? which kind of media outlets are in the red zone? which are the ones who are most likely going to be prosecuted?

the criteria as it seems that i used by the kremlin when it comes to who is the media to get on deck next. but the fundamental of criteria is the access to the russian audience. the size of the russian audience. as i mentioned, the ntb was the first one to get on the attack because it's influence in 1999 and 2000 elections was obviously very strong. it was only one federal chair now which was independent from the kremlin. which was launched in late 2000 was actually gained some really strong success in 2011, 2012. the best period of tv reign, it

had ak stoesz about 12 million people in russia. which is almost 10% of russia's population. now that definitely something that the kremlin would not allow you to have with and kremlin wo allow you to have. that's why in february 2012 came cable tv broadcasting. nowadays cable -- i'm sorry. t the tv ratings survived. nowadays the audience has shrunk to five, six and sometimes in some states 1 million people. when you have a 1 million people, that seems to be all right. several media outlets with quasi

independent broadcasting have people in the audience. now, if you are okay under that criteria, the second criteria is the aggressiveness of your message against the kremlin, right? if you are extremely aggressive and very -- and the content of your message is very oppositional, very anti-kremlin, in that case you are in danger. so those large, independent large quasi independent media tend to not be too overly aggressive. even with a relatively small audience you are likely to be closed purchase that happened with such web sites as.

if you want to survive china to be overprovocative, try not to give these things. as pointed down by the former chief of rbc, that is not good publication in russia. it will become more susceptible to the content of the media that is in under favor. certain publications could be published and would not have culminated in any area. so we see the increased number of legal prosecution of the media that publishes some things that are about corruption of certain officials, for example. as it happened with the story

that was published about his new wife and his yacht. he got sued and ultimately lost in the russian court is and had to destroy all the available publications on the topic. so it mentions that over time the kremlin has become more frustrated with the same content. if anything, the prosecution tends to be kind of -- tends to increase over the time. and ultimately when it comes to specifics of taking control of the media, i wanted to point out three distinct features that characterize the kremlin, the state media relationship russia. my answer to that is there are a lot of similar trends. but in general the censorship and the control over the media

is much more knew answered than it used to be in recent years. first of all, the sensorship and taking control of the media, if it has certain trends as i have described before, does not follow any precise rule. >> two media outlets publish the same article, one can be prosecuted and not the other. it can happen. the question is, why is that? first of all, the kremlin seems to be learning from china. chinese use a similar censorship approach. that approach is much less costly. rather than prosecuting everybody, you punish one and everybody else learned.

that's self-censorship. russia is strong and reliable for self censorship. it has 10 prosecutions a year of independent media. a lot of people who stops publishing them and costing them on social networks because that can also get you into trouble. the second important characteristics is that very often rather than completely eliminating certain information that's available in the media, the kremlin creates a half fake, half true stories to complement the message which creates a noise environment in the media. and the idea is ultimately -- perceived a bunch of different description of a certain story

without knowing which one is right. that, for example, happened with the coverage of the downing of the hm-17 flight in ukraine, as you all probably remember. as would have happened in the soviet union, it didn't happen altogether. rather, the kremlin outlets broadcasted the news. but they had different and diverse explanations of who might have been behind this crash. such as the ukrainians might have been targeting the putin plane flying nearby at the time. or maybe it was the united states which supplied the special missile that targeted that flight. and what is created by this approach is that very conveniently the audience that receives these messages thinks there is no smoke without fire, right? the same approach is used in

russia's domestic audience and the same approach is used by the media. the programming ya here as well. so when russia today informs you about news, it usually gives you different information about this news and you perceive, yeah, maybe separatists had something to do with it. but there is never smoke without fire. the americans or the ukrainians definitely had something to do with that, right? and the reality is it is shifted to support the program in position rather than just saying it was a separatist. we now thinking something suspicious happened there. it can't be just that easy. it is very vent because this message provides a degree of flexibility to the kremlin. ultimately, the last thing i wanted to point out, the third

important characteristics of the kremlin censorship is the corporate, the legal dimension of taking the media under control. putin pointed out that putin has a legal education. and you can really see that in a lot of his policies. usually he doesn't just do something. whatever the kremlin does, it always has a legal document to justify his actions, no matter how meaningless the view is. the same is true of when it comes to the media control in russia. usually every prosecution of the media is provided by restrictive oath that later i use selectively particular media in the red zone.

and the corporate dimension of it is that very often the kremlin tries a certain media outlet or journalists. even if that happen, it doesn't happen for the russian journalists. it rather tries to replace the leadership or ownership. it changes the ownership structure in a more peaceful way. so here what took him about a certain media in danger in question either brought by more loyal owner. the previous owner is forced to sell it to more loyal person or in order to redirect the certain media is it is replaced with another one. right now it is happening, as i mentioned before. it forces the media to change

the ownership structure with the ownership lull that asked all the russian media to decrease the share for ownership. so there is an important aspect of the censorship that is here. it is more peaceful than violent attack against the media. but there is very few independent media outlets in russia. definitely none of them has large enough audience. even those independent media that are forced to go to certain compromises. they publish a lot of anti kremlin material but also publishes occasionally some kremlin leaks that was very notorious publication that had to do with investigation with

the flight for example. how does the russian audience react? do russians believe in this message, the content they receive from the state media? the answer is yes and no. last year the polling company in russia noticed a decline in the message and the content on of state media news. 90ers of russians receive most of the news from the russian state-owned media channels. we did see the response by the kremlin media. it actually opened the broadcast and tried to provide a little bit more to the opposition people. i myself got invited for tv broadcast, for example. i did the not go, of course

because it is not good for your reputation to participate in this broadcast. fundamentally this year, they go back to the previous levels. whether it was mistakes in the polling we don't know. but the important part is that this approach to the media this particular state media relationship in russia hs a very inflew challenge effect on the russian media. in purposeful distortion of the news creates some kind of deep distrust with the media content with the russians. unfortunately this mistrust not only influences the state media but the independent media you have russians that are quite traditionally passive.

and completely mistrustful of the news, with the state and the opposition news. and just to find the app you think by the fact that there is no truth in this worreld. everybody is trying to lie. everybody is trying to advantage of you. the best response to be not to do anything because it's likely some kind of attempt to manipulate you. so this approach is to the media. disenfranchising, demotivating the majority of the russian population. >> thank you very much, maria. now i'll turn over the floor. >> i guess i shall start from where maria stopped. so really this election day september they showed that we really have this passive public

who doesn't depend on the elections. they prefer to stay at home this sunday. so this is how the actually media has influenced the public. because we had so many fake stories in the state. so people just prefer not to go. for example, reading something on the internet. the internet is a very, very interesting factor. i will focus because actually nowadays the russian's media system