. we will see a bill by wednesday and they will have to schedule committee markup. we will get this legislation before the committee, but for the energy and commerce committee, the education and labor committee, and the ways and means committee. they will each deal with their separate portions.

energy and commerce, there could be tough but for democrats. the leadership will be in constant communication with their rank and file for a while. i think we did see some significant changes to whatever bill leadership and the three authors unveil later this week. >> patrick o'connor writes for the politico. thank you. more now on health care with house speaker nancy policy -- nancy pelosi and other democratic leaders. this news conference is 40 minutes. >> we want to bring stability to people's homes.

today we are highlighting why we are performing health care this year and why it is important to do so and do so as soon as possible. if we do nothing, but cost of health care for an average family of four will increase as $1,800 a year. this is hardship for that family and for businesses, for our economy, and it is a hardship for our budget. so we cannot afford to do nothing. over the coming weeks, congress will continue our work with president obama to make health care reform work for middle- class families in america. we will be on schedule to do as we have planned, but for this legislation before we leave for the august recess. -- but but for this legislation before we leave for the august forvote -- to vote for this

legislation before we leave for the august recess. opponents -- upon in saying that this is putting government between you and your doctor. it is just the opposite. we are removing the health insurance co. from between patients and their doctors. and in doing so, we will provide stability and peace in mind that people cannot be denied for pre- existing conditions. and people have portability when they go from one job to the next. and it will not lose their health care if they lose their jobs. this is why this is so important to middle-class families of america. today, just before we introduce the legislation, we're joined by three americans, who are with

us. they are going to talk about this. mr. hoyer will introduce his constituent, a small-business owner. i would like to turn this meeting over to the distinguished democratic leader of the house, mr. hoyer. >> thank you very much, madam speaker. thank you for your leadership on this issue and so many others. there are certain things that are a necessity for all of us. clean air, to breathe. water to drink, food to meet -- eat, and our help. those are the essentials that we're going have quality of life. the first two are needed for life, period. we are discussing all of those issues.

clean air, we passed an energy bill. we passed it in the timeframe in which we said we would pass it. it is now on the senate and hopefully that will pass it soon and we will have conference on that issue. we are now addressing health care which as i said is a necessity for all of our families. reforming health care is an economic imperative. it is a budget imperative and a moral imperative. it is an economic imperative because health insurance premiums have more than doubled since 2000, straining family budgets across america. with our company spending twice as much on health care as our foreign competitors, the cost of health care translates into less productivity for the economy and fewer jobs and less competitiveness. reform is a budget imperative. unless we can control the growth

of health care costs, our country will plunge further into debt. families will plunge further into debt. individuals will plunge further into debt. and reform is a moral imperative as well. millions of americans live without the security of health care that they can rely on, that can never get be taken away from them. the speakers talk about choice, not putting anybody in between their doctor in themselves, but making sure that they can get a doctor, making sure that they can get to a hospital. making sure, in fact, that they can have the health care that they need. i say all the time with respect to health insurance, a program that they now have, if you've got it, you will like it, you can keep it. a moral imperative to ensure that those who do not, however,

have an opportunity. they can take care of themselves and their families. those are some of the reasons why we are so dedicated to solving this problem this year. now is the time, this is our moment, as the president would say. and our resolve has been bolstered by the stories of ordinary americans, some of whom are here today, who have seen the deep loss in our health-care system firsthand. patrick o'connophil feaster is f mine, one of those americans facing challenges because of the limitations that he confronts. he is with us today from port washington and he represents the affordable health care challenges, one of the keys to

our policy, affordability. quality health care for all americans. affordability -- so many of our seniors face this issue, specifically on what we call the medicare part d doughnut hole, through which so many americans are falling. he keeps them from getting prescriptions. -- it getkeeps them from getting prescriptions. phil feaster of maryland. >> thank you. i rarely use that. all louder. my name is phil feaster, an ailing person who called me felt

was my mother. my brother -- my mother would call me fellow palin when she was upset. bridget would call me philip allen -- my mother would call me bill allen when she was upset with me. let me tell you, the doughnut hole is no treat for seniors. it is a rip-off. you pay money and you get nothing in return. can you imagine going to a restaurant where they give you an empty plate but they bore she to pay for a meal? -- but they forced you to pay for a meal? of course not. when i hit the doughnut hole, i must pay for my premium and the full price for my medicine.

these drugs cost me $700 per month when i am forced into the hole, on top of the $85 monthly premium i must pay for half of the year. i am forced to pay these premiums while receiving absolutely nothing in return. why do i keep paying the premiums? under part d rules, if i stop paying, and out of the quota for the next year. it seems like a sweetheart deal for the drug and insurance companies. and i see so many of my neighbors struggling. health care keeps costing more while insurance companies keep covering less. my mother was one of those people. she kept having tectrouble with their health. she had a stroke because she had

to cut her medicines been to make ends meet. this is america. why do we allow this to happen? i hope this is the year that we finally takes our health-care system. we have been talking about this for decades. none of us are getting any younger. we need help and we need help now. i am grateful that this legislation will start closing the doughnut hole and pilot finish it off. it will help millions like me when it becomes law. let's make this the year that we find reform health care. thank you. [applause] >> i thank you, phil. my neighbor to the north. i spent last week, saturday, in charleston, monday of last week in colombia, and i joined to

with a south carolina small business chamber of commerce, the aarp, and other organizations, holding two barry widely -- vary widely -- very widely attended town hall meetings. we heard stories from people that we're going to hear some of the today. today we're joined by diane buch and her husband. they are both from a plant that, georgia. -- from atlanta and, georgia. diane manages seher health care with medication. when her husband lost their job, it became difficult.

it can cost prohibited. they were denied individual policies. she is now forced to piece together medication and treatment. for a hard-working couple in the wealthiest country in the world, this is unacceptable and undignified. that is why we need to reform health care system now. we will lower costs for consumers in a number of ways, ending copays, and deductibles for care, putting a cap on out- of-pocket expenses each year, and ending rate increases based on pre-existing conditions, gender, or occupation. we will also restore a sense and sensibility and peace of mind,

ending the days when insurance companies effectively rationed your cares, denying coverage for pre-existing conditions. that is just part of diane's story. let me present turn now to tell you some of the rest. -- let me present her now to tell you some of the rest. >> my name is diane buch, and i am from a atlanta. this is a troubling subject for me. this is my husband. we are experiencing firsthand the failings of our dysfunctional health care system. we were here today to show our support for this legislation and encourage our elected leaders to make sure -- make the tough decisions required to ensure

that no americans will be left without quality, affordable health care. i have had epilepsy since i was 5 years old. it is really important that i have access to group health- insurance, because otherwise it becomes a pre-existing condition. i coverage for my husband's job, but when he lost his job last week, the only option had was to continue coverage through conversion policy. the price quoted was $2,400 a month. it was shocking. job found an individual policy -- joe found an individual policy but had to raise the deductible recently just to afford the rise in premiums. after being denied coverage by three coverage -- by three companies, i became uninsured. i had to postpone some of my

annual exams and try more medication and seek charity care for others just to maintain my current health status. my medication was $900 a month, another shocking fact. but this health care reform bill will help us by getting rid of exclusions based on pre-existing conditions. it will set up an exchange where we can easily shop and compare plans and set a standard benefit options to plug holes in coverage that could lead us paying -- leave us paying tens of thousands of dollars if we get sick. this gives us reliable options for coverage in the form of a public plan for health insurance. when private companies fail to meet our needs, they have so far. we are average americans and

worked hard all of our lives. we never thought that we would end up in this situation. we hope that you will do everything that you can to help people like us and all americans from the stress and trauma of losing your health care. thanks. [applause] >> average americans like diane and joe and phil and tammy, who i am going to introduce, become extraordinary americans when they speak up on behalf of their fellow americans who are enduring what all of them have had the opportunity to outline today. tammy is at ground zero. she is one of those small business owners who runs a small coffee shop. rostov's coffee.

she employs nine people, four part-time, 5 full time. she wants to do the right thing on behalf of her employees to make sure that they have health care benefits. but as a small employer, it is out of her -- even though she struggles to provide some of them with coverage that they need. some employers spending for health care premiums will more than double to $885 billion by 2019. premiums will increase 20% in the next four years, resulting in 3.5 million american workers losing their jobs. because of rising costs, one in five employers will stop offering health care benefits and the next three to five years, which means 11 million

americans will lose their employer-sponsored health insurance by 2019. you heard it here first hand. a job and health care go hand- in-hand. they are synonymous in this economy. health care reform will not only give tammy and her employees an opportunity to get quality, affordable health care insurance, it will help small businesses like hers from being dragged down by the overwhelming cost of health care. it gives them a chance to thrive and grow in a new economy. someone on the front lines for america, at ground zero, tammy rostov. >> thank you. i am tammy rostov an eye on a coffee and tea shop in richmond, va., family owned. i know that small business needs

health care reform and we need it fast. my dad, a single parent, started the business 30 years ago. i am proud to continue to run the family business. we serve our customers and provide jobs for people in the community. my father instilled in me the bayou of treating an employee like family. for me, that means making sure employees and their families had important benefits. we offer health care and retirement benefits. lately this has not been easy. on health care, our commitments to our employees is run up against -- has run up against the reality of premium costs. we had to change to a high deductible plan recently. but i continue to offer benefits. over the last four years, our premiums have gone up 80% and i cannot afford to pay those premiums. a health care business -- are

health care system is failing small businesses, it is failing our employees, it is failing our families, and it threatens our bottom lines. that is why i want to thank the leaders in congress for introducing this critical legislation. this proposal brings new hope for small business struggling with health care. it will help small business by giving us a new choices, a new bargaining power with the insurance companies, increasing transparency said that we know what we're getting, and promoting accountability so we know we can count on our health care. this bill would help my business and my employees in a number of employed and -- important ways. we would purchase insurance in the exchange in the first year it is open, and giving us more choices of better, more affordable choices, including the option of a public health insurance plan. instead of spending more than 10% of my payroll in insurance

coverage, i could save by paying 2% and allow my employees to buy the coverage that they want in the exchange. at least two of my employees would qualify for assistance for their coverage. if i continue to provide for the exchange, i would qualify for aid tax credit for half of the cost of the coverage. i would like to make one final point. the cost that we truly cannot afford in health care is the cost of doing nothing. we need health care reform, we need more choices, and we are willing to contribute our fair share. we are looking to congress for leadership on this issue. thank you. [applause]

>> thank you for your outlook and presentations -- your eloquent presentation. more persuasive than anything we can say in terms of the provisions of legislation, speaking directly to why we need health care reform and how it would affect you very directly. this is why many of us have come to congress and been involved in public service to begin with. i am proud to be standing here with steny hoyer and others and representing the democratic leadership in the house. we hear what you are saying and we promise you that we will work with the president and have health care reform, and we will have at this year. with that in mind, we will take some questions. [applause] any questions? >> now that there are allegations that vice-president cheney told the cia not to inform congress about the terrorism programs --

>> could we answer that at the end. i will. let's stick to the health care. this is so big and transformational for our country. it is about our competitiveness, about our businesses, personal security of our families, and as mr. hoyer mentioned, in terms of the budget impact -- i can come up with these and many other reasons, we hope you have some questions on the subject. >> can you talk about sessions that you have had with a blue dog democrats and others concerned about the package in draft form? how much have you met with them and could you say how confident you or did you will be able to get them on board? >> i like my colleagues to join in on this. welcome to the legislative process. in case you have not noticed,

this is how it works. we started our meetings months ago when the president had his health summit at the white house, watching the initiative, and then we had meetings all along. we have had listening sessions in the last few weeks, with our distinguished whip, mr. cliburn, and the approach that we have taken has been led by mr. hoyer and our democratic caucus, providing us the forum to listen to the concerns of members. we have made a great deal of progress. i think that we are on schedule, and conversations have been very productive. as you get toward the end, when you are ready to introduce and then go to the markup and the amendment process, that is where you get some of the differentiation be on the

consensus that we had built today. but from those conversations, i feel very confident that we will have strong health-care reform a lower-cost, improve quality, give people more peace of mind, and if you do not have you have -- if you do not have your help, like you do not have anything. >> i think i agree with everything that the speaker said but i don't think there is much in the blue dogs in particular, but to a person they believe that we need to pass and they want to support health care reform. they know their people want health care reform. as the speaker indicated, if you get down to the specifics of the house about the objectives, they are extensive and spirited discussions. those are occurring now. but i am confident that no one with whom i have talked to does

not believe that health care reform is not essential for us to do this year. >> [unintelligible] >> we're discussing the specifics. there are a number of pay-fors on the table. we will discuss those further. i want to emphasize that every democrat i have talked to in our caucus believes that doing health care reform is essential, we promised we would do so, and as i said, it is an economic and moral imperative. a healthier america is a more successful america. [unintelligible] >> if i may. we have had six listening sessions involving all of our members, and we have done so by

regions. the reason we have done it this way is because i think all of us realize there is so much about this legislation that has to do with where you live, what state you live in. exactly what to expect out of this, based upon that demographic. these listening sessions have brought all of our members to get there. i am absolutely thrilled with the excitement these members have. we all are concerned -- i come from a poor stayed relatively, and it will be challenged with a lot of this. we heard stories from other states as well. but i think that where we are -- we are in a pretty good place.

part of what we call on accept -- a massive tax increase will be mitigated somewhat by the type of savings that we put into the final product. and whether not we can get this product in such a way that the savings can be realized, can in fact be scored sufficiently to determine how much money you would need in the end product. that is what we have been doing in these listening sessions. i tell you, we are much better off today than we were thursday of last week. >> mr. cliburn, to that end, if you talk about the offsets -- doesn't make it hard when they will point to those figures and the cbo cannot even score apart? doesn't make it hard to sell in the public arena?

>> we knew that this was going to be hard. but then obama said from day one that this would be hard to do. but that does not mean that we ought not do it. that is one thing i like about this caucus. we like to go out and do the hard stuff. >> just a follow-up on this question, are definitely going to be introducing your bill tomorrow? will it be something that the blue dogs can support, because they said they could not support the draft bill that was out there? >> i don't know that they have. i saw people coming through my office all day speaking individually about their particular situation. it is our goal to have a health care reform that will lower costs. this is essential to doing this. it will lower costs for the individual, for the business, for the economy, with a government.

reduce our deficit. we will have health care reform that works. this is very important. that is why we had a listening sessions, and a record number of mr. larsen's caucus meetings on the subject. there has been a great deal of communication among members. it is our plan to introduce legislation tomorrow. it will not be the thinnest -- the finished product. in order to be on schedule, we have to roll out our legislation this week. as soon as we had a mark, then they can make their comments about something that is on the table. but it is just the beginning. then we have three different committees working their will on it in the house. and then we have to deal with the senate.

but it is pretty exciting to see the enthusiasm and knowledge that our members have in all sectors. as mr. hoyer said, in all of our meetings we have been assured over and over again that the recognition that we must have health care reform is universal in our caucus across the board. we are trying to find a way to make it met -- work in the best way for all of the regions in our country. it is pretty exciting. we will be meeting with the president, mr. hoyer and i, later today to talk about some of the issues. but i've mentioned this before, we are trying to squeeze all the savings that we can add up the system first. rightfully so -- many of our members want us to do that and we share that view. there are other provisions that we want to address that we have in common. this is not anything that is different from where we are

going. it is just more so. you have a question? >> chairman rankle roast out -- role that his proposal on friday. some democrats say they are taking a different approach. is there flexibility in paying for this bill? when you have some flexibility when you meet with the president? >> mr. randall and mr. wright larcener on that committee. -- mr. rangel and mr. larsen are on that committee. they were talking about having a surcharge at the high end said that middle income people in our country are not touched paby the pay-fors on this. lower their costs and expand coverage and give them peace of mind.

the middle income family that has a pre-existing condition, or changing job and needs portability, or loses a job and they do not lose health care, this is about them. to the extent that we can squeeze more out of the system with savings reduces the need for the pay-for, but it will be at the h aigh end. >> the speaker mentioned squeezing out. wouldn't it be great if we were met by our colleagues on the other side of the aisle in understanding what the private sector has said to us at in an item about the cost that is there. -- ad infinitum about the cost that is there. whether it is doctors or insurance insert -- industries,

there are costs in our system that we have said today that will rise by 2019 to levels that are unaffordable, 20% of our gross domestic product. but as we now those costs let us we -- let us wean how those costs. people familiar with insurance that with respect to insurance i.t., there are billions of more dollars that can be weaned out of the system. this is a moment that we have been waiting for, since harry truman, richard nixon, bill clinton, and now the moment is right. because of the citizens that we have here in front of us today, and because americans, 47 million who have no coverage, harour desire in that congress act.

as the speaker said, this is an mark, but it is a mark to fulfill the dream and promise of all americans. >> i think that was the last question but i want add something to what john said. the fact that there are 47 million americans without insurance is a critical concern to all americans, why? because all americans are paying for it. all americans are paying somewhere between $750 to $811 extra on their premium. that is extra on the premium because those faults are not paying and are not involved in the system, they're not getting prevention and wellness care said they are more expensive. -- so they are more expensive. but this is to bring health care cost down. yes, we wowant access for all

americans but we want to bring down costs down for the americas that are here today. the reason we want to do that is said that they can be healthier, so they don't have to make choices that will damage their help and will make it more expensive for the rest of us. and from a moral perspective, it is right to make sure that every american can take care of their health care concerns. yes, there are 47 million americans uninsured, bad as critically, there are 260 million americans who feel pretty good about what they now have, but are very worried about losing it because they will not be able to afford it. we have a system that is almost twice as expensive as any other in the world. that is what this legislation

attempts to do, brings costs down for the country, for all americans, for each individual, and with their families. this is a critical time to accomplish that objective and we intend to do so. >> let me just say that the president appointed and new surgeon general, dr. regina benjamin, who established our world health care clinic in alabama. we are proud of that appointment, a very necessary one. it is also about prevention and wellness and how our children are healthier. a healthier america is the goal in all of this. i congratulate dr. regina benjamin and thanked the president for this important appointment. mind you come up much of the prevention that would be part of this in the bill will not be scored as positive, because that is with the cbo scores. but those savings will be there. at the end of the day, the

revenue that we may take in may be used for deficit reduction than to cover what the industry did not want to get up as we tried to squeeze out as many savings as possible. i promised an answer to your question. >> vice president cheney was reported. >> that was information that was presented in a classified section of the congress. i did not have that briefing. the intelligence committees in did. i cannot speak to that. it behooves the committees to take whatever actions they believe is necessary to get more and permission on the subject. -- more information on the subject. as to whether they were directed by the vice-president to create a program and intentionally withheld that information from congress, and if they were asked was there anything else we

should know, but that they said yes or whether they said no. thank you all very much. and i wanted to think diane in joke and fill in tammy for being here. -- and i want to thank diane in and joe and phil and tammy for being here. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> up next on c-span, president of hamas nominee to be surgeon general. that is followed by republican senator lamar alexander on his energy plan. and later, a hearing on the use that antibiotics for animals. -- of antibiotics for animals.

tomorrow morning on "washington journal," peter rosskam and a look at the hearings on sunday at sotomayor. later, president and ceo of the national council on her organization's endorsement of judge sotomayor. date to of the confirmation hearings will continue on the c- span network tomorrow morning, beginning at 9:30 eastern. you can see the first hour hear on c-span before the house gavels in for the day. you can also see the hearing in its entirety on c-span3 and at c-span.org. also listen on c-span radio. our live coverage begins at 9:00 a.m. eastern.

>> how is c-span funded? >> taxpayer dollars. >> by donations. >> consumer funded. >> i do not know. >> contributions. >> how is c-span funded? 30 years ago, america's cable companies created c-span as a public service, a private business initiative, no government mandate, no government money. >> president obama today announced his next choice for the next surgeon general of the united states, and dr. regina benjamin makes a statement. from the rose garden, this is 15 minutes.

we are now closer to the goal of health care reform and we have ever been. over the last several weeks, key committees and house and senate have made important an unprecedented progress on a plan that will lower costs, provide better care for patients, and curb the worst practices of the insurance companies. it is a plan that will not add to our deficit over the next decade. let me repeat that -- it is a plan that will not add to our deficit over the next decade. and that eventually it will help lower our deficit by slowing the skyrocketing costs of medicare and medicaid. even though we are close, i have no illusions that it will be easy to get over the finish line. there will be more debates and disagreements before all is said and done. but health care reform must be

done. i know that there are those that believe we should wait to solve this problem were take a more incremental approach or simply do nothing. this is the criticism we heard when the country tried to pass medicare, a program now providing quality health care to generations of american citizens. it is what we heard when we tried to pass the children's health insurance program which is providing quality health care and coverage to millions of kids. it is the same washington thinking that ignores big challenges and puts off tough decades -- tough decisions for decades. it has led us into the current predicament. make no mistake, the status quo on health care is no longer an option for the united states of america. if we step back from this challenge right now, we will leave our children a legacy of debt, a pitcher of crushing costs that bankruptcy our families, our businesses, and

because we will have done nothing to bring down the cost of medicare and medicaid, and will crush our government. premiums will continue to skyrocket, placing what amounts to another tax on american families struggling to pay bills. insurance companies and special interests that have killed reform in the past will only continue to benefit even more and deny coverage to americans with pre-existing medical conditions. people will continue to lose health insurance just because they lose their job or because they change jobs. this is a future that we cannot afford. this country cannot afford have health care premiums rise three times faster than people's wages as they did of the last decade. we cannot support 14,000 americans losing their health care every single day. we cannot afford a future where our government will eventually spend more on medicare and medicaid than what we spend on everything else. during the campaign not promised

health care reform that would help control costs and expand coverage and insured choice. i promise that americans making $250,000 a year or less would not pay more in taxes. these are promises that we are keeping as reform moves for. this is no longer a policy we can fix. this is about who we are as a country. health care reform is about every family's health and about the help of the economy. i want to put everyone on notice. there was a lot of chatter during the week that i was gone. we are going to get this done. inaction is not an option. for those naysayers and senate to think that this is not going happen, do not bet against us. we're going to make this thing happened because the american people desperately need it. even those who are satisfied with their health care right now, they understand that

premiums keep on doubling, and if employers keep on shedding health insurance because it is unsustainable, and if you look at the trajectory of where medicare and medicaid are going, been in action will create -- then in actaction will be a mistake. the muscles to bring about big change in this town are after a big, but we're going to get this done. if anyone understands the urgency of meeting this challenge in a personal a powerful way, it is the woman who will become the next surgeon general, dr. regina benjamin. the list of qualifications that make dr. benjamin an outstanding candidate to be america's leading spokesperson on issues of public health are long indeed. she was in the second class at morehouse school of medicine and

went on to earn an m.d. from the university of alabama at birmingham, and an m.b.a. from tulane. she served as associate dean for rural health at the university of south alabama college of medicine, and in 1995 she became the first physician under 40 and the first african-american woman to be named to the american medical association's board of trustees. in 2002 she became president of alabama's state medical association and she has received numerous awards and recognition, including the macarthur genius award. that is very impressive. but of all of these achievements and experiences, none has been more pertinent to today's challenges were closer to regina's hard then the clinic she has built and rebuilt in bayou la batre. tell me how to say it.

bayou la batre. that is an alabama. bayou la batre is a rural town of about 2500 people. it is a shrimping town where a lot of people work for themselves, scrape by, and cannot easily afford health insurance. and dr. benjamin, she described the demographics of this town which are interesting. you have whites, blacks, and asians in this community. that our law laotians and cambodians who have moved there. it is a diverse but burvery poor rural communities. doctors and hospitals are hard to come by. even though she could have left the state to make more money as a specialist or as a doctor in the wealthier communion, regina benjamin returned to alabama and

opened a small clinic in bayou la batre. when people could not pay, she did not charge them. when the clinic was not making money, she did not take a salary. when hurricane george destroyed the clinic in 1998, she made house calls to oliver patients while it was rebuilt. tree that destroyed it again and left most of her town homeless, she mortgage treehouse and act out her credit card to rebuild -- she mortgaged her house and maxxed out her credit card to rebuild it. when the clinic was about to reopen for the third time, and a fire burned it to the ground before it could serve the first patient, you can guess what dr. benjamin did. with help from her community, she is rebuilding it again. one disabled patient brought a number elope with $20 in sight.

an elderly man said simply, maybe i can help -- i've got a hammer. for nearly two decades, dr. regina benjamin has seen in a very personal way what is broken about our health care system. she has seen an increasing number of patients who have had health insurance their entire lives suddenly lose it because they have lost their jobs or because it became too expensive. she has been a relentless promoter of prevention and wellness programs, had been treated costly diseases and complications that did not have happened. she has witnessed a shortage of primary-care physicians in rural communities where seabirds. but through all the obstacles that she is over,, she also represents what is best about health care in america, doctors and nurses to give and care and sacrifice for their patients, those americans who would do anything to heal a fellow

american. regina has refused to give up. her patients have refused to give up. when we were talking in the oval office, she said, but one thing i wanted to it that the surgeon general's office gives voices to patients. that patients have a seat at the table, someone is advocating for them and speaking for them. and now we in washington and across america who have refused to give up on affordable and accessible health care, we don't have to deal with hurricanes and floods and fires, all we have to do is pass a bill to make sure that the americans have a decent shot at getting the kind of toys and high quality health care that is affordable. i know that dr. benjamin is going to help us get there as the next surgeon general and i am truly honored to nominate her for that post. secretary sibelius is equally excited even though she is a standing there. [laughter]

let me introduce the next surgeon general of united states, dr. regina benjamin. >> thank you. >> it is kind of hot out here. >> thank you, mr. president, and thank you, secretary sibelius, for being here with me. i am honored and i am humbled to be nominated to serve as united states surgeon general. this is a posphysician's dream. but it is more than just a job for me. this is very personal to me. my father died with diabetes and hypertension. my older brother and only sibling died at age 44 of h.i.v.-related illness. my mother died of lung cancer because as a young girl, she wanted to smoke just like her twin brother. michael buddy, my mother's twin, who is one of the few surviving

world war ii prisoners of war, is home right now one auction, struggling for breath because of the years of smoking. my family is not here with me today, at least not in person, because of preventable diseases. while i cannot change my family's past, i can be a voice in the movement to improve our nation's health care in our nation's health for the future. these are trying times in the health-care field and as a nation, we have reached a sobering realization. our health-care system simply cannot continue on a path that we are on. millions of americans cannot afford health care insurance or they do not have that basic health care services available where they live. i went back, to alabama as part of my obligation to that

national health service board, a program that provides hundred served communities with qualified doctors. they paid for my medical school education and then place me in an area that desperately needed decisions. in 1990, i founded the bayou la batre rural health care clinic in alabama. my priority has always been the needs of my patients. i decided i would try to treat patients regardless of their ability to pay. it has not been an easy road. hurricanes have destroyed my office and devastated our community. and for years i worked to find resources to treat patients without health insurance or ability to pay at their pocket. it should not be this hard for health care providers to care for their patients. it should not be this expensive for americans to get health care in this country. mr. president, thank you for

putting health care reform at the top of your domestic agenda. my hope, if confirmed, is to be america's doctor, america's family physician. as we work toward a solution to this health care crisis, i promise to communicate directly with the american people to help guide them through whatever changes may come with health care reform. i want to ensure that no one, no one, falls through the cracks as we improve our health care system. i will also work to shine the light on the inspiring work of the 6200 members of the board who serve on the front line in the nation's fight against disease and poor health conditions. i like to close by thanking two of my medical school professors. first, the former surgeon general, who instilled in me a passion for community medicine.

as a medical student, he required me to go out and the small towns, spend time and participate in public health practice. those experiences no doubt lead me to open my practice in bayou la batre. i must also think former secretary of health and human services, dr. louis sullivan. he was my dean and he taught me leadership. from him, i learned that impact policy at the federal, state, and local levels to help our patience and help our community. i am indebted to both of my mentors. and finally, i like to thank my staff in bayou la batre. all the work of the past 20 years had been for patients like them today is no different. thank you, mr. president, for having the confidence in me. if confirmed, if you and the

american people my best. thank you. -- i promise to give you any american people my best. thank you. [unintelligible] >> that was a good one. we're going to get this done. >> to you agree with your attorney general into looking into the bush administration? >> live coverage of day confirmation of such as sotomayor continues on c-span3, and on the web at c-span.org. it will be played on c-span2. this fall, tour the home of the highest court, the supreme court, on c-span.

>> de two of the confirmation hearings will continue on the c- span network tomorrow morning, beginning at 9:30 a.m. eastern. you can see the first hour here at c-span before the house gavels in for the day. you can also see the hearing in its entirety on c-span3 and at c-span.org. also listen to the hearing on c- span radio. our live coverage begins at 9:30 a.m. eastern. now senator lamar alexander as an energy plan to build nuclear plants. the republican conference chairman talks about his proposal as an alternative to pending cap-and-trade legislation to it just be -- to meet the nation's energy needs. >> i am lamar alexander. i am chairman of the senate republican conference. today in washington there are other things going on.

a hearing involving a supreme court nominee. on several television channels, that will be cared for the next week. it reminded me of the watergate hearings in the early 1970's and a story that one senator told me. in the early 1970's, there are only three television networks. but several hundred as there are today. the watergate hearings involve only seven senators, four democrats and three republicans. sam ervin was the chairman. one of the democrats was daniel in ainouye. those hearings were on those networks all day, every day, for weeks. all you could watch was the watergate hearings. he told me that after two

weeks, george gallup came to him and ask for a meeting. he said that he had information for him. according to a recent survey, there is only one man in the united states better known than you are. that is richard nixon. there's only one man in the united states better known than you are and that's richard nixon. senator inaway by his distinctive appearance a being the only television networks every day for week his become a very well-known american. there are lots of choices today and i appreciate you being here today, and i appreciate those watching through television being here today. our country is at a critical point in recession in history. today's is the most severe in decades and unemployment reaches 10%. we have too much national debt. a gathering storm threatens the technological edge that has given americans.

we're only 5% of the world's people. a remarkable standard of living that comes from producing year in and year out about 25% of the world's wealth. the sting remains from last year's oil prices. we rely too much on other countries for merge. there's the unfinished job of there's the unfinished job of cleaning the air and for many, the global warming of our planet has become an urgent concern. so it's against this backdrop that for the first time ever legislation dealing broadly with energy and climate change is coming out of the house of representatives. the senate is also moving ahead on both issues and the decision congress makes will affect our well-being for years to come. the house of representatives has chosen the high cost solution to clean energy and climate change. its economy-wide cap and trade and renewable energy mandate is a job killing $100 billion a year national energy tax that will add a new utility bill to every american family's budget.

republican united states senators offer a different solution. a low-cost plan for clean energy based upon four steps. one, building 100 nuclear power plants in 20 years. two, electric cars and trucks for conservation. number three, offshore exploration for natural gas and oil and number four, doubling energy research and development to make renewable energy cost competitive. the house plan will raise prices and send jobs overseas looking for cheap energy. the senate republican plan will lower utility bills and create jobs and it should put the united states within the goals of the kyoto protocol on global warming by 2030. our plan should not add to the federal budget since rate payers will pay for building the new nuclear plants. federal loan financing for the first nuclear plants is not designed to cost taxpayers any

money. nuclear plants ensure one another, so there's no cost from there. offshore exploration for oil and gas which is part of our plan should produce enough royalty revenues to pay for programs to encourage electric cars and trucks. and doubling energy research and development should cost about $8 billion more per year which is consistent with president obama's proposals for 2009 and 2010. so in furtherance of our low-cost plan, i am today, as one senator, offering a blueprint to build 100 nuclear power plants in the next 20 years. other senators may have other blueprints in support of the same plan, but this blueprint will attract comments and support, i hope, for americans of all political persuasion in congress and outside of congress, and i welcome those comments at

www.alexander.senate.gov. this is an especially good time to step back and ask what kind of america should we hope to create during the next 20 years? first and foremost, we should want to see an america running on energy that is cheap, clean, reliable and abundant. in order to produce nearly 25% of the wealth in the world for americans, we consume about 25% of the world's energy. we should want an america in which we create hundreds of thousands of green job, but not at the expense of destroying tense of millions of red, white and blue jobs. in other words, it doesn't make any sense to employ people in the renewable energy sector, that we're throwing them out of work in manufacturing and high tech. that's what will happen if these new technologies raise the price of electricity and send manufacturing and other

intensive energies -- energy-intensive industries overseas searching for cheap energy. we want clean, new, energy-efficient cars, but we want them built in michigan and ohio and tennessee and not in japan and mexico. we should want an america capable of producing enough of our own energy so that we can't be held hostage by some other energy-producing country. we should want an america where we are the unquestioned champion in cutting-edge scientific research and lead the world in creating the job, creating new technologies of the future. we should want an america producing less carbon. i believe we shouldn't be growing 29 billion tons of carbon dioxide into the economy every year and that means less reliance on fossil fuels, and an america with cleaner air where smog and soot in los angeles and

in the great smoky mountains is a thing of the past. where children are less likely to suffer asthma attacks brought on by breathing pollutants. finally, we should want an america in which we're not creating energy sprawl by occupying vast tracks of farmlands, deserts and mountaintops with energy installations that ruin scenic landscapes. the great american outdoors is a revered part of the american character. we've spent a century preserving it. there is no need to destroy the environment in the name of saving the environment. none of these goal, the ones i just outlined are met by the waxman/markey bill. what started out as a move to reduce carbon emissions has ended up as a contraption of mandates that will impose a huge and unnecessary burden on the economy. renewable energy such as wind

and solar and biomass and geo-thermal are intriguing and promising as a supplement to america's energy requirements, yet the waxman/markey bill proves once again that one of the government's biggest mistakes can be taking a good idea and expanding it until it doesn't work anymore. trying to expand these forms of renewable energy to the point where they become our prime source of energy has huge costs and obvious flaws that may be impossible to overcome. what's worse, such an effort creates a whole new problem which some conservationists call the renewable energy sprawl where we're asked to sacrifice the american landscape and overwhelm ecosystems with thousandses of massive energy machines in an effort to take care of our energy needs. for example, one big solar power plant in the western desert where they line up mirrors to focus the sun's rays and what

spread across more than 30 square miles. that's more than five miles on each side produces the same 1,000 megawatts of electricity that you can get from a single coal or nuclear plant that sits on one square mile. to generate the same 1,000 mega watts with wind you would need 270 square miles of wind turbines, generating 20% of the nation's elect rhys frit wind would cover an area about the size of west virginia. to those of us in the southeast where the wind blows less than 20% of the time they say well, use biomass which is burning wood products. a sort of controlled bonfire. that's a good idea. it might reduce forest fires and reduce resources, but let's not expect too much. we need a forest much larger than the 550,000-acre great

smoky national park to feed a 1,000 megawatt biomass plant on a stained basis, and think of the energy used and the carbon produced by the hundreds of trucks that it would take every day to haul that stuff to that one plant. already we're beginning to see the problems. boone pickens who said that wind turbines are too ugly, quote, devote, to put on his own ranch. last week postponed what was to be america's largest wind farm because of the difficulty of building transmission lines from west texas to population centers. the sacramento, california, utility district pulled out of another project to pull out of sierra, nevada, for the same reason. the transmission lines were meeting too much opposition particularly from environmental organizations and according to "the wall street journal," california officials are worried that the state's renewable

mandates have created a, quote, high risk to the state economy, and that the state may be short of power by 2011 if the problems continue to pile up, unquote. add to that a point many forget. solar and wind energy is only available about one-third of the time because today it can't be stored. you use it or you lose it. solar's great advantage is that the sun shines during the peak usage hours while the wind often blows at night when there's plenty of unused electricity, but with either, if you want to make sure your lights will turn on and your factory will open its doors when you go to work, you still need the other power plants to back you up. so is this the picture that you want to see in 20 years? there's another option.

nuclear is already our best source for large amounts of cheap, reliable, clean energy. it provides only 20% of america's electricity, but 70% of america's carbon-free, pollution-free electricity. that's compared with approximately 6% of pollution-free, carbon-free electricity supplied by wind and solar. it is already far and away our best defense against global warming so why not build 100 new nuclear power plants during the next 20 years? we did it before. american utilities built 100 reactors between 1970 and 1990 with their own rate payer's money. why can't we do it again? other countries are forging ahead of us. france gets 80% of its electricity from 50 nuclear reactors and it has among the cheapest electricity rates and the lowest carbon emissions in the european union to show for

it. japan is building reactors from start to finish in four years. china is planning 60 new reac r reactors, more than the rest of the world put together while russia is selling its technology all over the world. india is making plans to build nuclear reactors with our help. president obama has said that even iran has the right to make nuclear power. we invented the technology. isn't it time that we got back in the game? there seem to be a couple of things holding us back. both of which are discussed at length in the blueprint that i'm presenting today. first, a failure to appreciate just how different nuclear is from other technologies, how it's tremendous energy density translates into a vanishing small -- a vanishingly small environmental foot print. a uranium fuel pellet the size

of a them bell can contain 150 pounds of coal, or 17,000 cubic feet of natural gas. france, which as i said, gets 80% of its activity from nuclear plants stores unusual radioactive waste, beneath the floor of one room beneath the facility. the second thing holds us back is an exaggerated fear of nuclear technology. nuclear power plants were the result of president eisenhowerer's ad atoms for peace program. the idea was to take the greatest invention of the last century and use it to provide low-cost energy to reduce poverty around the world. a nuclear power plant is not a bond. the material makes up only 4% of the reactor fuel. it would have to be enriched to 90% to make a bond. even then you have complicated

physics to make it explode. nuclear plants are run@@@ @ @ @ >> they have more training and aircraft pilots. you will see a test conducted by the department of energy in 1990. the ticket of four fighter jet, strapped to a railroad track and accelerated it to 500 miles per hour, faster than an airline, before crushing it into a simulated nuclear containment structure. the structure was fine after the crash. there wasn't much left of the airplane. nuclear plant was fine after the crash. there wasn't much left of the airplane. there's also the miscon vepg

that the plants are uninsurable and can't survive without a federal subsidy. there is an insurance for nuclear plants called anderson and it's never paid a dime of insurance and today the way it works that every one of the 104 nuclear plants in the united states can be assessed $100 million in damages for an accident at another reactor. that's another factor adding to safety consciousness. most reactors have revenue of about $2 million a day which pays for the $5 billion construction loans and still makes possible low rates for consumers. when the tennessee valley authority restarted its browns ferry unit one reactor two years ago, tba thought it would take ten years to pay off the 1.8 billion construction debt. it took three years. when oil prices were skyrocketing, connecticut proposed putting a windfall

profits test on the two nuclear reactors in the state because they were making so much money. >> nuclear power is the obvious first step to a policy of clean and low-cost energy. 100 new plants in 20 years would double u.s. nuclear electricity production, making it 40% of all electricity production. add 10% for sun and wind and other renewables. another 10% for hydroelectric. maybe 5% for natural gas, and we begin to have a cheap as well as a clean energy policy. step two for a cheap and clean energy policy is to electrify half our cars and trucks. according to estimates by brookings institutions scholars, there is so much unused electricity at night we can also do this for 20 years without building one new power plant if

we plugged vehicles in at night while we sleep. this is the fastest way to reduce dependence on foreign oil, one. to keep fuel prices low, two, and third, to reduce by the one-third of carbon that comes from gasoline engines. step three is to explore offshore for natural gas its low carbon and oil, using less oil, but using more of our own, and the final step is the double funding for energy research and development that launched many manhattan projects like the one we had in world war ii. this time to meet seven grand energy challenges, including batteries for plug-in vehicles and making solar power cost competitive with fuels, making carbon capture a reality for coal-burning power plants. i suggested to secretary chu that he reserve a nobel peace

prize for a scientist that figures out a way to capture carbon from existing coal plants. safely recycling used nuclear fuel. crops we don't eat, make them competitive with gasoline. making more buildings green buildings and providing energy from fusion which is recreating on the earth what happens at the center of the sun. the difficulties with nuclear power are political, not technological, social, not economic. the main obstacle is a lingering doubt and fear about the technology. any progressive administration that wishes to solve the problem of global warming without crushing the american economy should help the public resolve these doubts and fears. what is needed boils down to two words, presidential leadership. we can't wait any longer to start building our future of clean, reliable and affordable

energy. time has come for action. we can revive america's industrial and high-tech economy with the technology that we already have in hand. the only requirement that is that we open our minds to the possibility and potential of nuclear power. as we do, our policy of cheap and clean energy based on nuclear power, electric cars, off-shore exploration and doubling energy rnd will help family budgets and create jobs. it will also prove to be the fastest way to increase american energy independence, clean the air and reduce global warming. i hope you will let me know your thoughts at www.alexander.senate.gov. you will find on our website a copy of this blueprint for nuclear power plants in 20 years. i thank you, and i would be glad

to take some questions. yes, sir? >> senator, do you plan to introduce legislation to forward the blurint or will you rely primarily on the gop energy package? we will start with the gop and the republican energy package. as i said this is my blueprint. i expect there will be other republican senators offering their own blueprints to advance the republican plan. i'm going to wait and so what the reaction is. i hope to get response and feedback and suggestions and corrections to what i've said in this blueprint. i hope that several democratic senators, a number of whom support nuclear power will agree with me that the smart thing to do in this country is build 100 new nuclear power plants so i'll wait and see. i'm going ahead with senator carper on legislation to deal with sulfur, nitrogen.

we know what to do about those. carbon is more elusive and i think i'll wait to see the reaction and if i can attract democratic support. yes, sir? >> senator alexander, what, at a minim minimum, needs to be in a nuclear title in a climate change bill in this senate for you to support it? >> well, i'm not sure we need a climate change. i'm not sure we need a climate change bill. >> but assuming that the democrats in the senate decide to proceed with a democratic house bill and also tried to get some republican support most people say the fastest way to do that is to add a nuclear title. i realize it's a hypothetical, but it's a likely hypothetical. what would you like to see in this title? >> i would strenuously argue

against adding a nuclear title to the waxman/markey bill. the waxman markey bill needs to be junked. i mean, it has become a contraption of taxes and mandates that hurts the economy that may not do very much for global warming. let me give you one example of why it's unfixable. we've had testimony before our energy committees and our environment committees in the senate that an economy-wide cap and trade is an inefficient way to discourage the use of carbon-based fuels. all it would do, at least for the near-term is raise the price of gasoline, say, but not reduce the amount of carbon because it's not enough to change the behavior of americans. if you're going to put limits on fuel which is 30% of the carbon, the right way to do that is a

low-carbon fuel standard that gradually shifts carbon out of fuels and people move to something else such as electricity. so i could not support any legislation with an economy-wide cap and trade. i think the more americans look at that, the more they'll see it's unnecessary and a huge tax and they won't want to pay an additional utility bill especially when there's an alternative that would reduce their utility bills and clean the air and in my view would put us within the kyoto protocol by 2030. >> yes, bill? >> what's your sense of what secretary chu's view is and whether he might be an advocate within the administration? >> well, of course, i'm very impressed with secretary chu. ese a very impressive secretary. i believe he obviously knows nuclear power.

i think he's restrained by administration policy. i congratulate him for moving ahead with the four loan financing arrangements that were created by congress in 2005. that's more than the bush administration got done in terms of loan financing and that's very important. as soon as you get the first four nuclear plants built it will make it much easier to build the rest, but there is this strange reluctance on the part of an administration that declares that global warming is one of its great missions to the single technology that would help us deal with global warming in this generation and until this president becomes as interested in 100 new nuclear power plants as he is at building wind mills, i don't think secretary chu will be permitted to have a very aggressive nuclear policy, but that's one reason for our agenda. sometimes by our advocacy, we can change the minds of enough people that it brings democratic

support to republican ideas and we have a bipartisan idea and my goal would be that the president would eventually adopt this and say we'll have to do this if we have to deal with global warming in this generation without running all of our auto jobs overseas. yes, sir? >> senator, have you been approached by senator boxer and senator kerrie and any of the democrats that are trying to push the climate bill in trying to build bipartisan support and would you vote against a cap and trade bill even if it goes against an economy-wide cap? >> i just said yes to that. >> yes. an economy-wide cap and trade is a disaster for our country. its a job-killing $100 billion a year tax and you add to that the mandates that require the southeast and huge wind turbines. that's like requiring a state that has deserts to make elect

rhys frit hydroelectric dams and rivers that they don't have. they don't have the river s as we don't have the wind. so, yes, i would hope that the senate would start over and draft a climate change bill that would avoid an economy-wide cap and trade and that would focus on nuclear power, electric cars, off-shore exploration and many manhattan projects to make renewable energy cost competitive. yes, ma'am? >> senator, do you anticipate any of the nuclear power plants -- >> well, it might very well. the tennessee valley authority is leading the country right now in terms of restarting nuclear power plants and i just finished one and it's half way through another and it's exploring new

plants which is part of the territory. nuclear power is attributed to tennessee. we have the mountains in cities like knoxville and always struggling with dirty air. we need to produce electricity from something that doesn't put smog and soot in the air and doesn't contribute to global warming and for us nuclear power is the best option. yes, sir? >> senator, you mentioned that there were a number of democrats when it comes to nuclear energy and you are hoping some of them would come onboard and have you had a chance to discuss this with them and what is their response. >> we know the senators like senator carper of delaware and senator carbon of maryland are strong supporters of nuclear power and there are others. i have not discussed this

proposal. i'm offering this blueprint today and i'm sending it to senators and solicit their advice and hopefully gain their support. >> yes, sir? >> i'm still confused about what you want the government to do to build these nuclear plants. is anyone stopping the industry from building plants right now if they want to. >> yes. if the ideal way to start would be the president to direct the department of energy to give him a plant to build 100 nuclear power plants and to list the obstacles that stand in the way of it. >> it's not so much that the government needs to do anything. it's that the government needs to avoid stopping the plant. the one affirmative thing that the government could do is increase the number of loan financing guarantees for the first six or eight plants. secretary chu is committed to

doing it for @@@@@ @ @ r@ @ @ @d on site for years and in the next five, 10, 12 years with aggressive research we can find ways to recycle that fuel and do it in a way that the plutonium is not separated from the other fuel. so that would be a success thing the government could do.

a third thing the government could do is to make certain that it has sufficient staff at the nuclear regulatory commission, to to process the applications and it doesn't slow applications and in other words, to take a position that it is a national goal to build 100 nuclear plants in 20 years. the presidential leadership are two things we need the most on nuclear power. if we had that, it would happen, yes ma'am? oat issue of presidential heedership, you insinuated your frustration. i wanted to ask you about already the economic policies have already cost about half a million machine tool types of jobs. what do you prepare to do about the loss of capacity to actually be able to build the parts

required to have this type of program? the single west way to rebuild in america, the capacity to build nuclear plants is to start building them. there is a new french company that's come to chattanooga to build large turbines that will be necessary. westinghouse who is interested in building nuclear plants is creating a school for welders. as soon as investors are clear that the united states will build 100 plants, as soon as we get three or four up, there will be new industry here. plus there is an announcement today by babcock ask wilcox that it plans to seek approval of a small nuclear reactor that would be 125 megawatts instead of the 1240 or 1500 megawatt great, big things that we now see. that's very promising. ge has a small reactionor as others do.

if we start building small reactors, that could accelerate the building of reactors because utility companies wouldn't have to invest such large amounts of money and in the babcock and wilcox place, all of the parts are built in the united states. they're built in ohio and they're built at the factory and these megawatts and ship them by rail to a plant site and if they needed two or three they would be put together like lego blocks. >> would you be -- what do you think about contrasting something like retooling gm. giving them contracts to bell these things. would you be opposed to that? >> i don't want to see the government get in the business of -- the government is already getting into the insurance business, the banking business and the student loan business and maybe the health care business. i don't want the government to get into the business of building power plants. it's not necessary. we built the first power plants

with the rate payer's money and not government money. all we have to do is create an environment in which private enterprise can succeed. yes? >> your plan calls for a long-term -- you know, it talks about not increasing the use of electricity in the united states over the next 20 years and reducing the amount of coal by 50% and cutting coal use by h f half. how do you propose to ensure those two goals, the energy conservation coal and the coal reduction come to pass. >> i don't believe i say anywhere in there that we won't use more electricity in the united states over the next 20 years. i think we will use more electricity in the united states over the next 20 years which is why we need to build nuclear power plants. i think we are likely to use less coal over the next 20 years, and i think we should use less coal.

we have some dirty coal plants that ought to be closed and the best way to replace them is with nuclear power plants and they can't be replaced by solar or wind because they only blow or shine a third of the time. even the big, new plants in tennessee that were delighted to have that make poly silicone, the material for solar panels on roofs. each of those uses 120 megawatts of power. so if they were dependent on solar power, they wouldn't be there. they're dependent on nuclear and coal. the one exception would be that over this time, i'm very hopeful, as i said earlier, that some scientists will win the nobel prize by inventing a commercially viable way to remove carbon from existing coal plants. that would be tremendous for our country and for the world. it would permit the whole world to have low-cost, clean energy and perhaps that will be a solution. if that is the case then we'll

be using plenty of coal. >> is there an energy legislation that ensures the emissions reductions that your plan believes it could achieve? >> the answer is yes, i do. i'm not speaking for the whole republican caucus because i have different views about that. i would be in favor of's low carbon fuel standard, for example. that's 30% of all of the carbon that's produced in the united states and since we have electric cars and trucks about to be manufactured by almost every manufacturer. nissan's going to build them in tennessee, for example, we can require less carbon and fuel without raising the price of fuel. in fact, i think we could lower the price of fuel. brookings says, as i mentioned that we have so much unused electricity at night that we can

plug in cars and trucks at night and have not to build a power plant. the difference with coal is that we don't have an alternative to coal. we don't have a commercially viable way yet to take the carbon out of coal, and we haven't built a new nuclear power plant in 30 years, and while we can build natural gas plants, that's a dangerous thing for us to do because, as we know, the price can go up. it was $14 or $15 just a few years ago and we use it for so many other things. so i would -- i could support limits on carbon on coal plants after we've started -- we built and opened some nuclear power plants and shown that we're going to open more or we have invented a commercially viable way to recapture carbon from existing coal plants. yes, sir?

>> can we store nuclear waste on site or what can we do if we can't resolve the issue now to existing plants and how are we going to deal with doubling the number of plants? >> one, we can forget yucca mountain. the president's told us that. although that's sort of like saying we're not going -- we're going to close guantanamo bay without figuring out where we'll put the terrorists. that causes a problem. in the case of nuclear fuels, two thing, one, it can be stored on site safely for the next 30 to 40 years. france does it. they all believe it can be done safely. number two, we should have a mini-manhattan project on how to -- on the safest and best way to recycle used nuclear fuel.

i'm not satisfied that we've got that yet. so let's take 10 or 20 years to figure that out and at that point we can recycle the waste and have almost no residue left from the waste. so it's a two-part plan. >> yes? sir, it sounds like most of the effort is going to come from the president then in terms of pushing 100 nuclear reactors. the one thing you mentioned congress could do is up the loan guarantees. is there anything else? are you going to pursue this since you're not going to go to the cap and trade likely the way the senate's going? are you going to produce this as a stand alone bill? i'm taking it step by step and i have a blueprint for the goals. i'm inviting comment and criticism and suggestions and i'm looking for bipartisan support. i'm also meeting with people who understand nuclear power plants and asking them what are the first ten thins that the federal

government can do to make it more likely that we could build 100 plants in 20 years. i think the president should be doing that. if he really believes in global warming and that we ought to deal with it in a generation, he ought to call in his very bright administrators and distinguished scientists and say tell me exactly what we need to do at the federal level tt make sure we have 100 power plants in 20 years. i mentioned loan financing for plants. a second thing is the research on what to do with advanced -- with fuel. we may discover four or five other steps that the federal government needs to take. i mentioned a third thing. >> the senate -- >> well, each of those. congress would have to approve more financing. congress would have to approve a larger staff for the nuclear

regulatory commission if needed. congress would have to fund the research and development on a recycling of nuclear fuel, but it would make it much easier if the president would say here are the ten things we need to do. i asked congress to do this. it's part of our goal. we worked with president bush in a bipartisan way a few years ago on what we need to do to remain competitive. we had the national academy of sciences tell us the ten things we need to do. they told us 20. we tried to put it into legislation and we passed it. we could do the same thing with this goal. >> the subsidy? to an industry, and you want the loans up front and doesn't the liability end up becoming a huge -- you know? why can't you get the loans from the private sector? why can't you get the liability insurance from the private sector? why can't it come from the government? >> well, the credit's not

available, and the question would be whether the government as authorized loan financing for nuclear power plants and i give secretary chu great credit for going ahead with the first four. that's not a taxpayer subsidy if the taxpayer is not out any money and the taxpayer should not be, in the end, because the plants themselves have to put up enough money so if there's any default they'll pay for it. as far as the price anderson federal legislation about insurance, that often gets brought up, but as i say in my remarks that doesn't cost the taxpayer anything either, and it never has because today, if there is an accident at a nuclear plant, each of the 104 nuclear plants that exist today are liable up to $100 million to pay for any damages that have occurred. so there may need to be some federal action, but, and i'm looking to say what it should

be, and i haven't seen a reason for federal subsidies yet. i do encourage the use of electric cars and trucks, and i do support federal subsidies in the level of $8 billion a year about the president's proposals for energy research and development on renewable energy. >> that is the key, why didn't we get it under the previous administration. >> i don't know. it would have been better if we had. >> we can't constantly. at some point, the new administration will take credit for being president. i mean, we can't just, for example, with the debt, we can't just get in and say a that, the boat is sinking and the problem is the boat and let's dig a second hole. i've given secretary chu credit for doing something president bush wasn't able to do which is to do loan financings for nuclear power plants authorized

in 2005. what i'd like to see is president obama be aggressive about 100 new nuclear power plants. make that a part of his goal of dealing with global warming and reindustrializing america. maybe one more and then we'll stop. >> while you addressed earlier that there is a real problem with the economy, with the job losses, the fact that almost every state is bankrupt and difficult to get loans from banks, i am with the political action committee and we've been mobilizing around the country for a new, for a actual bankruptcy. in the 1920s and 30s and to actually figure out what is the means, the first thing he did was he put the wall street financial interests on public trial and showed and mobilized

the people to see what we were up against. what caused the collapse and right now we're in a situation. >> what is the question? >> the question is how are we going to create a new credit system so we can direct credit to the infrastructure projects like nuclear power and mag leff transportation and water systems,ed kind of project that would recreate our real economy. >> it's a very good question and a good one to end on. i thi we've lost sight. two-word answer is cheap energy. cheap energy. i think we've lost sight of how important cheap energy is to good jobs. across tennessee, just as one example, we have a lot of manufacturing jobs and a third of them are auto jobs. almost everyone i know down there whether they're making autos or autoparts or air conditioners. they look at every cost they have. the cost gets too high, off they

go overseas searching for a lower cost, but if electric rates are low and energy costs are low, we're much more likely to be making cars in tennessee, than in japan and mexico, and if we invent new and better ways as we did with nuclear power to provide cheap energy and think of what that does to relief poverty around the world. even in nashville, tennessee, a year ago, 10% of the people said they couldn't pay their electric bills in december. and around the world people have much less money. so i think it is wrong for the united states to embark on an expensive energy policy which is the house bill. i think it is right to take the republican senate bill which is 100 nuclear plants, electric cars and trucks, off-shore drilling and doibling energy rnd for renewable energy.

that's the plan for the next 20 years, and that would actually lower utility bills and create jobs that other plants would create a new utility bill for every american family and run jobs overseas. i thank you for your time. this is the blueprint for 100 new nuclear power plants, and i hope it promotes the same kind of discussion we had today. if you're watching thq; tomorrow morning, on washington journal, rep peter ross ckam and a look at the confirmation hurt

-- confirmation hearings for sonya sotomayor. later, janet murguia. the program begins at 7:00 a.m. eastern. and date to of the confirmation hearings will continue on the c- span network tomorrow morning beginning at 930 eastern. you can see the hearing. you can also see the hearing in its entirety on c-span3 benon c- span.org. also, listen to the hearing on c-span radio. live coverage begins at 9:30 a.m. eastern. >> how is c-span funded? >> taxpayer dollars. >> private donations. >> public support. >> consumer funded, i guess. >> your fund?

>> 30 years ago, cable companies created c-span as a public service. no government mandate, no government money. >> now, a house hearing on antibiotics for animals. this is 2.5 hours. i think all of you for coming today. i would like to introduce my panel members. i would like you to meet our congresswoman from california who has an inordinate interest in agriculture. also, a freshman from maine who

has a wonderful back ground in common cause. we were hoping for some other members who may or may not show up. we are delighted to have you here in any case. i represent the 20th congressional district of new york. i cannot stress enough the urgency that our antibiotics to not become obsolete. 2 million americans acquire bacterial infections during a hospital stay. 70% would be resistant to dry dock -- to drugs. as a result, 38 patients died of those infections every day.

salmonella causes 1.4 million illnesses every year. over one-third of all diagnoses occur in children under the age of 10. infants under the age of 1 are 10 times more likely than the general population to acquire salmonella infection. in 1995, 19 percent were found to be multi drug-resistant. that means that our children undergo all commit -- what will treatments because we have allowed treatments to become ineffective. because of these infections and is ineffective treatments is astronomical. resistant bacterial infections increased health-care costs each year.

currently, -- issues in agriculture as animal feed additives. among them are penicillin, tetracycline, and so far--- and sulfonamides. penicillin is used to treat infections from a stripper to meningitis. it also treats the ammonia. tetracycline is used against anthrax. drugs are added to animal feed has growth proponents.

in other words. these are not animals that are ill. this is the most accurate number of all. 70% of the antibiotics and related drugs produced in the united states are given to cattle big bucks and chickens to promote growth and compensate for crowded, unsanitary and stressful conditions. the noun therapeutic use of antibiotic used in poulterer skyrocketed from 2 million pounds in 1985 to 2.5 million pounds in the late 90's. in this kind of habitual non therapeutic use of antibiotics has been conclusively linked to a growing number of incidents of antimicrobial resistant infections in humans and may be -- and may be contaminated groundwater. the national academy of science

states that a decrease in antimicrobial use in human medicine alone will have full effect on the current situation. substantial efforts must be made to decrease inappropriate over use in animals and agriculture as well. resistant bacteria can be transferred from animals to humans in several ways. the most glaring is found in the meat and poultry that we purchase separate haevery day ae grocery store. 84% of those bacteria were resistant to antibiotics used in human medicine. a bacteria can also be transferred from animals to humans by workers and the livestock industry.

farmers may transfer the bacteria to their family. a third method is by the environment. nearly two trillion pounds of manure generated in the u.s. contaminates our groundwater, surface water and soil. because this maneuver contains resistant bacteria, the resistant bacteria can be passed on to humans that come in contact with that water and soil. it has been well documented. a 2002 analysis of more than 500 scientific articles published in the journal of clinical infectious diseases found at the micro world -- anti microbial resistant. the institute of medicine's 2003 report on my car bausch microbial threats clearly saw a decrease in inappropriate use is not enough.

we must decrease the overuse and animals in agriculture as well. as the impact of merce, just look it was a look at staphylococcus aureus. there is little doubt that antibiotic resistant diseases are a growing public health menace. despite increased tension -- attention, the response has been inadequate. although the fda could withdraw its approval for these antibiotics, its record of reviewing currently approved drugs indicate that it would take nearly a century to get these antibiotics out of the feed and into food producing animals.

in october, 2000, the fda began consideration of a proposal to withdraw its approval with therapeutic use of robotics and poultry. it would take five years to complete. under its current regulations, the fda must review each class of antibiotics up early career at the legislation we are here to discuss today shows just the seven class's of medically significant antibiotics that are currently approved for non therapeutic use in animal agriculture. make no mistake. this bill would in no way infringe upon the use of these drugs to treat a sick animal. it simply proscribes they're known -- of their non therapeutic use. when we go to the grocery store and pick up dinner, we should be able to buy food without worrying that eating it would expose our family to deadly

bacteria that would no longer respond to our medical treatments. unless we act now, we will unwittingly be permitting animals to serve as incubators for resistant bacteria. it is time for congress to stand with the scientists, the world health organization, the american medical association and the magic lost academy -- and the national academy of medicine. we cannot afford for our medicines to become obsolete. i think you for coming and i look forward to working with all of you -- i thank you for coming and i look forward to working with all of you. ms. matsui? >> thank you for working so diligently on an important issue. your expertise is beyond question. the congress is fortunate to have someone with your

knowledge working on a topic of antimicrobial resistance. in today's hearing, i will try to present two different perspectives. one as a member of congress and one as a daughter of a farmer. on the one hand, i am serving of the energy and commerce commission as we are working on reform. i have come face-to-face with the immense challenges that our country faces with out of control health-care costs. our economy is reeling in our budgets are out of sync because our health care costs go up and never come down. according to the national academies of science, health care is about $4 billion more expensive every year because of drug-resistant bacteria. here in the house of representatives, we have spent months to try to reform our health care delivery system so that it reduces costs. one of the easiest and most effective ways to drive down

costs is to ensure that people do not get sick in the first place. fighting antimicrobial resistance is part of this strategy. . this is a critical piece of legislation. it will take aggressive action against this resistance. once it does so, fewer people will be hospitalized with fatal illnesses like diarrhea, staph infections and food poisoning. on average, every hospital stay caused by drug-resistant bacteria cost 6000 to $2,000 extra. . .

public health risk. farmers and ranchers are this country's bedrock. they should be our strength and not our vulnerability. i'm convinced farmers and ranchers can be successful raising high quality natural livestock. they could do so in a way that does not breed what is shoping up in the hospitals and emergency rooms more frequently every day. the preservation of eakts medical treatment act would help reach goals we all share. it would encourage more ranchers to use animal husbandry practices that we know work. it would give consumers confidence that the foods they eat are safe and do not come with a price of endangering public health. and we look forward to working with the people testifying today and hearing their testimony. thank you. >> thank you. >> we're joined by congressman squear -- jerry of colorado.

>> i want to thank you for being able to participate in this hearing. and your professional training is an invaluable asset, thank you for your tireless dedication to protecting our nation's health and well-being. i'm delighted we have the opportunity to be here today and the rules committee to hear testimony on this important issue. we spend so much time here on the regular basis. working with other committee bills. i look forward to hearing more from this bill and the witnesses. this bill, the preservation of eakts medical treatment act would mark a step forward in the fight to protect our nation's food supply. americans are so disconnected with their source of food and fearful and frustrate about what is in it, they participate in growing produce and raising

livestock, instead of trusting that the food they buy is safe for their families. sadly we know all too often this is simi not the case. experts agree antibiotic resistance is a growing problem in the country as wie heard and it is aching its toll on its health and our pocketbook. we spent $8 billion a year and we have lost countless lives in the process. this is crishted in large part to the overuse and misuse of antibiotics as nontherapeutic feed supplements for animals that are not sick. we cannot undo what has been done but restricting the use of antibiotics to people and animals that are truly sick. we can make sure that we have access to a safe food supply and antibiotic therapy. this issue affects all of us. as consumers and grandparents, we have a right to know what is being put in our food. we deserve a government that invests its resources into

protecting our health. i must say it is of particular interest to me, not only as a member of congress but as myself a former organic farmer. and matsui is the daughter of a farmer, i'm a granddaughter of a farmer but i took up organic farming in the state of maine. i graduated with a degree in environmental sciences and spent years selling milk eggs and vegetables to the people in my community. i can say, i hold the blue ribbon and red ribbon in the politician's cow milking contest. if one of them because sick, i gave them an eakt. that's it. that's all we needed to be. i stopped selling the milk and made sure the cow was healthy again and got them back on track. it is a completely unnecessary situation that they're in. i complained to be involved in the organic food movement in our

state. i know the griese dairy farmers in our state are those that are selling milk. some are because consumers want to know what is in their food. we face a time of unprecedented challenges and none more important than reforming our health system. we're considering ways to cut costs and deliver effective care, we must not forget that the regulation of antibiotic use in farm animals has potential to save billions every year and protect americans from unnecessary suffering from resistance and aggressive strains of bacteria. i want to hang the chair woman for holding the hearing and the witnesses for taking time to be here today. i look forward to hearing from each of you. i yield back. thank you. i'm proud to be a cosponsor of 1549. let's put a human phrase on the

issues of eakt resistant bacteria. in my district in boulder colorado, there is dr. eric cornel that teaches at university of colorado. a couple of years, unrelated to his work, he had an infection of antibiotic resistant bacteria in his arm. they had to amputate his arm. he now has one arm because of this fast growing antibiotic resistant bacteria. and several people at the university of colorado have contracted. these unfortunate, beyond, well beyond the greater public health threat, the human toll of this has been felt by many of us right in our own second congressional district. and i hear a lot about these issues. my partner is a vliegen and in doing so, he's constantly critical of our animal husbandry practices of commercial agriculture in this country. beyond the public health

arguments, i like to add additional considerations for why in bill is important and these efforts are important. one has to do with the treatment of the animals themselves, the second emerges from that. when you look at why people are seeking the use of nontherapeutic use of antibiotics, it is so they could crowd animals closer together and raise them in condition that is otherwise would not necessarily be healthy for those animals. this leads to stress among the animals. and unhealthy conditions which can directly lead well beyond the direct public health negative outcomes, to simi poor nutritional profile and the health and nutrition and meat for human consumption. and due to the overcrowding which has been enabled by the nontherapeutic use of antibiotics. my district is home to the

holding company of verizon dairy and aurora organic dairy, the two producers of -- of antibiotic and hormone free milk. which together control i believe over 70% of the market share for those -- for those products. again, the consumers are wising up and are ahead of where we are on these issues. and people are realizing -- that -- to have residual antibiotic content in milk, particularly for children is in fact not only a public health threat but a personal health threat that can lead to antibiotic resistant bacteria, for, for for their children. so, for these reasons, i strongly support hr 1549 and i look forward to hearing the testimony today. i yield back.

>> again, the feedback. and -- the food and drug administration. i'm happy to say that -- you beefed up the budget considerably so you can do your job better. and we're delighted to have you here. >> thank you so much. i'm -- i'm very pleased to be here. i get started, madam chair woman and members of the committee. i've seen the commissioner of the f.d.a. and the department of health and human services. i'm pediatrician and until recently a couple of months ago, the health commissioner of baltimore city. i thank you for the opportunity

to discuss the important health issue of eakt use in animals. in my testimony i will provide background information on anti-antibiotic resistance and discuss the involvement of the task force and set up a framework for helping the antibiotics in animals. i'll discuss what is under legislation. >> anti-micronal agents have been used for more than 50 years for tremendous benefit to animals and human health. many diseases are treatable and preventable now. must use and overuse of the drugs contradict to a raped development of resistance. after several decades of the use, we see and continue to see

the emergence of multi-drug resistant path jens which are less responsive to therapy. oftentimes, the infections with those path jens are more search, more likely to cause hospitalizations. and they're emerging due to the combined inpact of micro drugs. we released a report trt rebound corporation and the city about mersa which found from 2000, to 2006 the number of hospitalizations which are almost mersa increased by 45 percent which was increased 1,000 hospitalizations in the city of baltimore.

these been identified for clinical use in human and veterinary medicine. some strains are resistant to multiple antibiotical agents. there has been significant increase in resistance of organize nasms and organizenisms. there's no question this is a series -- serious issue. the task force developed a national plan to combat this resistance. they cochair it along with the c.b.c. and the national institutes of health. this group teg a plan. it includes surveillance to gather information and resistance about the spread and

resins of microns. prevention and control including educational campaigns and development of new therapeutic including vaccines. the and research. and includes research and related fields to improve treatments and outcomes led by the national institute of health and product development. as the drugs lose their effective rchs. new products must be developed to treat rapid infections. the goals and action items include developing new drugs and vaccines and stimulating the development of priority products which market incentives. i'm here on behalf of the f.d.a., and margaret is out of the country, otherwise i'm sure she would be here. this is of personal interest to her. the institute of medicine report that you cited, she was one of the editors of. coming to the f.d.a. working with the staff for the center for veterinary medicine

and dr. hamburg and i support action to limit the use of antibiotics and animals to protect the public health. there are four indications for use of these. growth promotion and efficiency and control and treatment. the vast majority of classes, used in animal agricultural are important in human medicine. a few that are used in animals do not appear to impact human medicine at this time, although there are concerns if you use, a medicine, even if there's no analog, it could trigger development of resistance. protecting public health requires use of those for modern medicine. to protect and limit the spread of antibiotic-resistant pack tieria from the food supply to

humans. i want to review these principles. first i like to talk about growth promotion and feed efficiency. there's increasing evidence that use of antibiotics contributes to the high burden of resistance in bacteria. so to avoid the unnecessary development of resistance under conditions of constant exposure, such as for promotion or feed efficiency, the use of antibiotics should be limited to those situations where human and animal health are protected. purposes other than the advancement of animal or human health should not be considered judicious use. eliminating the uses would not compromise the safety of food. as a result of f.d.a. supports ending the use of antibiotics for growth promotion and feed efficiency in the united states. second, i like to talk about disease prevention and control. f.d.a. believes there are some

prevention indications that are necessary and judicious to relieve animal suffering and death. important factors in determining whether prevention use is appropriate, should include, one, evidence of effectiveness, two, evidence that such a preventive use is consistent with accepted veterinary practice. and though, that the use is linked to a specific agent for bacteria. and four, evidence that the use is appropriately targeted and five evidence that no reasonable alternative for intervention exists. to promote the judicious use and protect human patients, f.d.a. believes that the use -- all use of medically important medications for prevention and control should be under the supervision of the veterinarian. and finally, i like to mention treatment. f.d.a. supports the treatment of ill animals according to appropriate veterinary practice and science relationships.

the judicious use of antibiotics requires a strong commitment to surveillance and research. monitoring, and studdinging the cause and tracking and assessing risk in different settings and evaluating strategies to reduce resistance. i'll mention things that are going on with the f.d.a., and antibiotic drugs in animals. first f.d.a. has risk assessment methodologies during the new animal and drug evaluation to quantify the human impact in animals. we conduct research to understand our resistance and third we reach out to stake holders on all sides of the issue. we assess the relationship between antibiotic use and subsequent human health consequences, using a resistance

monitoring system. and it dictates the advantage of the expertise and resources of a large number of federal agencies and the data provide regulatory officials and the veterinarian community with information about resistance and bacteria. and finally f.d.a. participates in the international dialogue on the use of antibiotics on animals. and let me just mention several comments on h.r. 1549. the f.d.a. supports the idea of h.r. 49 to phase out the growth promotion and feed efficiency use of mike crow -- antibiotics in animals. f.d.a. recommends that any proposed legislation facilitates the timely removal of nod judicious uses of antibiotics in animals.

we would be happy to provide technical assistance on the bill. at the same time f.d.a. believes that there should be legislation allowing the prevention and control as i've previously discussed. this is an important issue for children, as it is for their pediatricians and for the public and public health director and industry and consumers and the f.d.a. we look forward to looking forward to congress on this issue. thank you for allowing me to testify. >> thank you for being here. we're delighted to have you. you worked on the hill. interesting. great henry waxman. that's a good sign. the timely removal as you say this would become, of removing a class of antibiotics from animal feed and in my statement i

mentioned that that could take a century. what would you all consider timely removal? >> i think that -- we would like to see for the for the promotion feed efficiency uses, a much shorter time period than a century but also the ability of the agency to accomplish that without you know having to expend a tremendous amount of resources in the progresses, both time and money. and so, you know, there are mechanisms to accomplish that. we don't want to be in a situation where we have bottled up, you know, many scientists writing papers for things that congress could legislate and make happen if that's what we think that is the right thing to do. >> you're a pediatrician. i'm sure you would not recommend giving our nursery class of 3-year-olds antibiotic every day to make sure they didn't get an ear infection. obviously, you were not recommended for animals.

does the f.d.a. control that or the usda? >> the f.d.a. controls the labels of drugs for how they would be used in animals. >> you can permit it. if legislation were passed. >> it would be under f.d.a. >> that's good to know. and -- one of the things obviously we're concerned about is the conditions under which these animals live. and i noted that, as part of your background that denmark which bodes the nontherapeutic use of eakts in animals, in 1998 found there was no significance. i think that's important. that after the ban corresponding improvement in animal husbandry, such as cleaner barnes and swine mortality and productivity were not affected at all. and i am sure that most of us who -- consumed, i'm sure all of

us want to think that they're raising in clean and healthy s, even though we know better. we're going to a food safety bill here. we would need to talk to you again about other things there you might want in this. thank you so much for being here. your testimony is most important. we look forward to working with you on making this a reality. thank you so much. miss matsui. >> thank you. it is good to see you here. >> prevention of disease whether animals or humans is a high priority of mine. preventing disease before they occur makes sense on many levels. i work hard to make prevention a key element of the -- congress' push on health care reform. and i support the legislation because it doesn't limit the rancher's ability to use medicines in a rational way to prevent line stock disease. prevention is just a word, if not an effective strategy, and

if we create more harmful diseases in the name of preventing minor ones. doctor, in your testimony, i found it compelling because it is really it does tread the fine line between the need to prevent diseases in our animal populations without doing ourselves more harm in the process. and in your testimony you outline how actions taken in the name of prevention can sometimes make things worse, in the case of using antibiotics to fight respiratory infections. would you elaborate on how dangerous it can be for animal producers to assume that simi blanketing their herds with antibiotics can sometimes be counterproductive, both to humans and animals? >> i think the prevention is an area that needs a lot of attention and trying to figure out how to craft a policy, whether by legislation or by

regulation. i think that the -- there clearly are situations where you can prevent illness by giving medicine for example in in baltimore, the he will commissioner, we had a case of men jites wee give medicine to all of the people who were in close contact. we had a case of a teacher that died and we had to track down the kids. they weren't sick but we were giving them medication. i think that -- in that case, there's, in preed tricks for example there's strong evidence that the use of medicine in that situation, there's evidence that people that get treated will be less likely to be sick. you understand what you're treating. you know you're using a medicine that is targeted to that bacteria. i think the concept no prevention is that -- in animals as well, there's going to be times when prevention is

important but that the decision on where that is permitted should be based on science, it should be based on understanding what you're trying to prevent, to evidence that is there, the fact there's no reasonablality a tiffs. and you know, we want to use as few antibiotics in children. we want to use as few as possible in animals, with we are going to use medicine, it should be paced on a solid foundation of evidence. so trying to set up a mechanism for that is challenging. i think as we go through, one use at a time, we have, just like we do in pediatrics, this use is appropriate, but this isn't. that's what needs to happen. >> >> you're looking at a situation, where you think it is difficult do have a working definition of this. is that right? >> i think it is one of the things that has to be worked out. i think in the bill it says routine prevention, but you know, how you define routine prevention. that's somewhere in this. that's a thing like agency like f.d.a. has done before and can

do. we can talk about the principles that would go into this determination like that or how you would assess that. but one question, i agree, with you completely, just calling something prevention doesn't make it based on evidence, doesn't make it appropriate to use. you know, it has for the to truly be based on evidence in that kind of assessment has to happen. >> that's your working definition on how we play move forward on this thing? >> these are principles we put in. i don't think it is so much a working definition. i wouldn't quite go that far but there's principles we want to look at and make sure that we're limiting what -- what is appropriate prevention to what is based on the science and supportered by the veterinary medicine. >> you believe the current practice in this country does not meet your sense of principles right now? >> there are two things. first, there's use for growth promotion and feed fish eens, which is updated as taking a position should not be used like for that period. and then, i i'm learning about

this issue just how little we understand about the farms and antibiotics and it is a high priority for dr. hamburg and myself to get a better understanding of that. it is one thing to have the rules but we need to know it is actually being followed and we need to see the use is coming down. >> that's a welcome change. on the f.d.a.'s website, there's a list of 16 judicious use principles for the use of antibiotics. one of these principles is that other therapeutic options should be considered prior to antibiotic therapy. it seems to me that the full range of other options has not yet been considered by many of our country's ranchers. do you agree more can be done within the meat producing industry to use alternative methods to achieve the same end of keeping animals safe from

harmful infections? >> that's an excellent question. i don't know if i could give you an answer. i'm not an expert in the practice of the meat producing industry but i do believe that analysis should be undertaken before their use is permitted. if it is the case that -- that there are alternatives, there's alternatives should be pursued. >> there's another judicious use principle. it is to minimize environmental contamination, with antibiotics whenever possible. would you clarify what this means? does it mean to the not to let antibiotics given into the water supply and the vegetables, is that what we're talking about here? >> that's a specific question that i can't answer. either i'm sorry -- i'm -- i

don't know exactly what the veterinarians intended with that. i nose we're concerned about the environmental impact. that's an issue that we as public health officials would want to engage in. i think we recently were written a letter by attorney general of maryland about a particular issue and of antibiotics and we look at that. if there's an environmental issue, that we could be aware of, we'll look at it and se what we can do. but i couldn't quite exactly. i think i would say, that we would look at the balance of the -- of the environmental impact and if there's environmental harm. that's something we should be aware of. >> okay. thank you so much. >> thank you. >> thank you for your testimony. which was very interesting. and appreciate your public health, and i'll certainly add to the dimensions of what we talk about today and follow up

on what, what miss matsui was talking about. in your recommendation or potential recommendation, we talked about allowing for continued therapeutic use. i want to clarify -- i think we all generally know that this is in widespread use now, that without significant changes in the way animals are wrayed, the idea of, infections and outbreaks of infections could easily continue at the rate they do now. and i'm trying to understand why you mentioned that the criteria for not allowing it would be research that showed evidence of effectiveness and has research already been done that shows that it is effective in preventing outbreaks when you -- when you distribute antibiotic to feed or is that -- that something you want to determine? >> that would be something we want to determine. i think it play be that, people play be using antibiotics not knowing what they're treating or even having an effect. but it is in the realm of -- growth promotion and feed

efficiency, we're saying it shouldn't be permitted. if it is preventing a disease, what disease? is it effective? have you looked at other ways to do it that are reasonable first? those are the things that should go into an assessment before that is permitted. so i couldn't -- in fact, you know, pediatrics, very clear what you should be treating and what you shouldn't be treating. the american academy of pediatrics has guidelines. there's a huge campaign among pediatricians. i called one of my old teachers last night. he's on the pediatric side of the issue. he, he pointed me to research that antibiotics among pediatrician hass come down by 30%. and that's partly since -- because of government efforts. and we're actually tracking what pediatricians prescribe that is truly coming down. and the patients are doing fine, probably better.

what we like to see is something like that and -- animals, there does not seem to be at this point a real clear -- to me at least, a cheer list of what are the -- are the evidence based uses of antibiotics and prevention in animals? and -- like there was -- there would be in pediatrics and the field of medicine. i think it has got to be that if, the f.d.a. is going to put a label on for -- for particular use like that, that it is very -- [unintelligible]. >> it seemed like an important criteria. i wanted to be sure if you allowed therapeutic use that we didn't stay with the status quo. the example you gave of a tragic loss of a teacher was a good example is about outbreak of disease. what we're talking about here is

routine use that creates a constant use of the medications. and i wouldn't want to see that be called therapeutic use or necessary use. that's different. >> that's one reason i talked about it separately. >> thank you. >> thank you. >> we are joined by congressman cordova from california. mr. pollack? >> thank you for your testimony. would you say that there should be or -- that there should be a different definition between therapeutic and nontherapeutic use as applied to humans and animals or do you think they're the same definition to cover both humans and animals? >> i can't think of the use of antibiotics in humans for growth promotion. other things are used for that.

sometimes. i don't know the concept of nontherapeutic use really, i don't know -- i don't know if it exists. >> that brings up a pet peeve of mine and that's overuse of antibiotics for diseases that pediatricians who come to us are using. >> i was trying to think of someone where they would come out and say, use it in a nontherapeutic way. but certainly pediatrics is taking the lead. >> that's good news. come down 30%. >> 30%. and for certain illness and find out further than that, and the very high priority. and -- in -- in -- you know, therapeutic use -- >> when you say working

definition for both, the -- the, in terms of the economic costs, would you agree when we're, effectively, if you have a -- an animal producer that is using antibiotics in a nontherapeutic way, there by, well documented of course, contributing to antibiotic resistant bacteria, that there would be a sizeable economic cost of that extra, that others would have to pay for. not the producer of the animal. somebody else would have to pay for treating people and -- secondary and tertiary antibiotics and another cost of treatment? >> i do believe it could be costly. >> maybe you could add to your own experience as a doctor and m.d., for somebody that has an antibiotic resistant infection, staff or strep or whatever it

might be, what would then be the secondary and temporary treatments for the individual and what might we look at from a cost perspective? >> depends on the infection. >> give me an example of a child who might say presents with -- strep or something and -- doesn't react to the first line of medications. >> i think it is something that would be staff, you play want to treat that with a formula that would be relatively expensive and you play wind up treating them [unintelligible] off the top of my head, it could be relatively -- [unintelligible] plus, you have the chance that if you don't catch it soon enough that you can't [unintelligible] because it spreads. and one of the things i did, is

i rounded the hospital and they presented two kids that came in with serious staff inecksfgs. and -- every month when i was a resident, we get them every month. [unintelligible] there's the consist of the medicine and then if you get hospitalized, which the evidence is you're nor likely to be hospitalized and then the cost is great. >> and i'm sure that -- doctor cornell would be hard price to put a price on the loss of his arm, an extreme health impact for the rest of their life. but i think clearly, we demonstrated that even in the best case scenarios where the health is positive the treatments can cost several times what the normal intervention would cost.

i yield back. >> thank you. >> sir, you work with u.s.a. today, correct? and i mean -- u.s. -- [unintelligible] it is my understanding that the f.d.a., i personally know that every tanker load of milk is delivered, gets tested, with an f.d.a. approved test. is that not correct? >> i'm seeing nodding. >> i think that's correct. >> and so, [unintelligible] the testimony. f.d.a. has a approved test, and

it looks for residues and -- >> yeah. >> and so is your intention that the test is inadequate or are you fearful that -- that somehow with milk, that -- [unintelligible] children to ingest it so they shouldn't have -- what -- >> the f.d.a. is an approved test on every tanker load of milk is tested. .038 of the tanker load in america have a positive and -- a tanker load is then at a cost of $12,000 per tanker load, so it is a pretty good intention -- it

is not let the residue be in the milk production. i'm trying to figure it out. >> i can help too. i think when you think about the implications of the use of antibiotics and animals, it is -- there's three that we generally talk about. one is there is bacteria that becomes resistant in the animal and the bacteria and the human eats them. that bacteria causes illness in the human. that -- the ill milk should be pasteurized. and the second mechanism is that it is for the -- not dangerous bacteria but usual bacteria but is still resistant and can pass the gene on to human bacteria in your body. that's the big concern that people have. the third is the residue, is there an amount of residue that

causes a reaction within humans? and i have not been briefed on ow or testified about whether that is an issue with milk at all? i think what i'm familiar with with milk is whether the first, an indirect route, which if you're treating dairy cows which wind up in the food supply, if they have been treated with antibiotics can develop antibiotics resistant bacter why. and that bacteria can blossom into the human food chain when the cow is lawsuitered and used for feed. i'm familiar with evidence that i believe, if i'm not mistaken, the salmonella news report, and this infection, which i believe play have implicated dairy cows. so i hope i'm wrong about that. i'll correct it. but i think there's evidence that -- cows that have been treated with antibiotics and go into the food supply play be linked to certain antibiotics, if that is not milk. somewhere.

>> as a legislative body -- [unintelligible] there's concern of overprescription of antibiotics in medication and whether they're necessary. [unintelligible] we certainably don't want to -- to jeopardize the health and safety of our citizens. i think that we focused on what is really going on. we have to know what is happening. and i'm sorry, i have not had a chance -- [unintelligible] you said you thought there play be a connection. i would like for you to tell -- >> sure. >> and that would have passed. >> i think that the -- the -- the i'm not 100% sure whether

this example applies but i'm in the uncertain about the issue of whether you, when you -- if you're to treat a cow for dairy within a a year, you would have produced resistant bacteria and whether it is in the food supply directly, is there a risk of passing that on. what i can't remember is that particular example. that's what i would say. >> and maybe i could help a bit here. are we talking about the use of antibiotics for cattle, poultry and you're sick. in fact, 70% of all of the antibiotic the produced in the united states are given to animals that are not sick. and -- rapid rise of -- antibiotic resistance in human beings. as why r you mentioned mersa, it is common in dirt.

[unintelligible] that's the purpose of the hearing. we like to save eight kinds of antibiotics which are most at use for human beings for the use of human beings. >> that's it. thank you so much for the testimony. >> thank you so much. welcome. we're delighted to have you in washington. we look forward to working closely with you on these issues. >> thank you so much. >> and the next is dr. margaret melon, p.h.d. and science and director and food and environment program for the concerned scientists, and dr. lance price ph.d, director. and center for managing economics and associate

investigator. and the research institute and another chair up here which we can pull up. and dr. robert martin, senior officer of the pugh environmental group. we welcome you here today. >> dr. melon. >> my name is margaret melon. >> you play want to pull the mic closer to you. >> my name is margaret melon. i'm here representing the union of concerned scientists. a nonprofit science organization working for a healthy environment and safer world. i'm here on behalf of key antibiotics working the coalition of environmental

agricultural and humane organizations dedicated to addressing the overuse of antibiotics and production of agriculture. i'm grateful for the opportunity to discuss an you are jent crisis, the loss of effectiveness of drugs due to antibiotic resistance. before i begin, i want to thank representative slaughter for her steadfast leadership on this issue. before i begin, and a to go on, iver prepared written testimony but my message can be summarized very briefly, the drug of the 20th and 21st century are at risk in the enormous use of antibiotics and -- in production further is partly to blame. we all know that the more we use antibiotics, the missouri the more bacteria is resistant to

them. many do not know, however, has is that we use huge quantities of antibiotics. something like 13 million pounds a year, every year in the production of poultry, beef and swine. eakts are in the same chemical class as we use in human medicine. that means when those drugs, the penicillin and other drugs are used hospitals or doctor's offices, they do not work. i want to be clear, overuse of eakts occurs in both human medicine and -- and in animal production and both studies are responsible for the problems and need to take responsibility for solving it. but while the medical community as dr. sharpstein has made clear has taken action on the issue.

we simply cannot continue, the processing of the products through animals. we need to reduce that use and we can. because both of the drugs used by food producers are not used to treat sick animals but to increase food efficiency or for wrute teen disease prevention. those things can be accomplished by other ways, including better management and it is time we get about that process. as has been said, the resistant bacteria generated in food animals have lots of ways of moving to humans. most prominently but not solely food. this is connected to many diseases, not just the food born illnesses like salmonella but

also, blood infections to urinary tract infections and recently to resistant staph. we have delayed on this issue for too long. and antibiotics working on the case for almost deak aid now with little or nothing. those are the results for our efforts. but the story is the same for most issues. public advocacy has been stymied but finally congress is poised to act on food safety and as it does, it is inherent that the resistance issue of the dimension not be ignored. mrs. slaughter's bill and the act would require the f.d.a. to review the drugs in those class that is are used both in human and animal medicine. if they cannot prove get them

off the market. the bill is supported by the american medical association, the american nurses association, the american academy of pediatrics and the fin fexuous diseases of america and other medical organizations. git getting the antibiotics off the market would preserve the efficacy of the drugs for both humans and animals. in the words of the new england journal of medicine, it is time to stop it way past its prime. >> thank you. >> and would you make sure your mic is on. >> my name is lance price. i'm a microbial gist and have 15 years of research experience and training at public health.

i am lower to present testimony to support the preservation of antibiotics for medical treatment act. antibiotics have saved countless lives. they save lives by preventing bacteria. however, it creates resistance. when they'red a stered at low doses, a practice common in animals you rapidly select for resistance. animal feeding productions, and there are thousands of animals densely packed and given routine antibiotics. and when you treat an animal with antibiotics you select for resistant bacteria to grow in their guts and the bacteria is disseminated through the entire flock or herd and is rampant in

feeding praysings. it contaminates also during the slaughter process. to underscore this point, i brought a couple of products brought in, raw poultry, and -- and raw chicken, which from my research and government research would indicate that these are potential biohazards. these are just products that i bought at the grocery store. i don't know if you've noticed but when you buy these things, there's often this leaking coming out. that's a biohazard. there's evidence for that. my own research indicates there's a good chance that these products are contaminated with antibiotic resistant bacteria because of the antibiotic use in food animal production. now the most direct way to eliminate the antibiotic resistant bacteria on products

such as these is to eliminate antibiotic use in food animal production. so this including any routine uses, whether for growth promotion, prevention, control, or even therapy. and this is whether or not, they're accepted by the american veterinary association. this is not a public health association. if they're used on a regular basis, that's a problem. that brings me to my next point. if an al malproduction system requires routine use to keep animals from becoming sick, then that system is broken. and like -- so we do not try to prevent outbreaks of human disease using mass treatment of eakts, except in extremely rare situations like the anthrax mailings of 2001 and the meningitis case that we heard about. the prevention of infectious diseases within human populations is based on public health and hygiene interventions. like sewers and vaccinations. we would never do away with these, and rely solely on

antibiotics so why do we do this with animals. the military learned long ago if bunks were placed too close together, the troops would fall ill. the military's response is not to provide antibiotics to all recruits. the military's response was to impose minimal distances between bunks. strategic placement so you don't share bacteria between the troops. the food animal industry must be forced to modify their methods in order to prevent routine infection. given the -- given the human health risks posed by overuse of antibiotics and abmalproduction and existence of viable alternatives, we should ban all nontherapeutic and nonnecessary use in order to use these drugs for treating sick people. an industry lobbyist play ask

you to not regulate this by counting one of their favorite one-liners, the science is not there. however, the science and the researchers, who do not have take in keeping antibiotics in animal food production say there is sufficient evidence that antibiotics in animal food production poses a health risk. they do not respect borders and move freely and rapidly around the world. as soon as we curb all unnecessary antibiotic use in the united states, the sooner we can begin leading the rest of the world to do the same and we can protect american citizens from antibiotic resistant bacteria in the united states and abroad. and the preservation of antibiotics for medical treatment act of 2009 is a solid first step toward becoming global leaders. and i commend the distinguished chair woman for her commitment to this issue. i thank the entire panel for the

opportunity to speak today. thank you. >> thank you. my name is bob martin, i'm senior officer at the pugh environmental group. i was the director of the industry farm animal production. i appreciate the opportunity to appear here today on this important health issue. the the silent part of our health care crisis and antibiotic resistant infections. i appreciate your introduction of the treatment act as well. and the pugh group was a 21/2 year study by the charitable trust. it was funded by, involving a cross section of -- of individuals, the commissioners had expertise in animal agriculture, and public health and medicine and veterinary medicine and ethics and state and federal policy development. we were chaired by former

governor john carlin, and one of our members was former secretary of agriculture dan glickman. we have the in the audience, who will speak hair, mr. fiddle, who was a leader among the commissioners as well. the general charge to the commission was to develop consensus recommendations to solve the public health environment and animal welfare and rural community problems, caused by industrial farm animal production. as i said, we developed consensus recommendations using a fairly exhaustive process. we conducted 11 meetings around the country. spent 2ahours deliberating on the information, we received, and we received thousands of pages of information from the animal agriculture industry and all interested parties. we had two public hearings, one in north carolina and one in arkansas where over 400 people attended the two meetings. we visited all times of industrial farm animal production. in north carolina iowa and

colorado and california and arkansas. we reviewed 170 peer reviewed reports and commissioned eight reports of our own. we had a couple of general findings. one was that the current system of food animal production in the united states is unsustainable. it represents an unacceptable level of risk to public health, unacceptable level of damage to the environment and is harmful to the animals housed in the facilities and is detrimental to the long-term economic activity of the communities where they're housed. and another general finding was that we find undue or significant influence at every turn, but industrial animal ag industry, policy on the federal or state level and enforcement and economic research at our leading land grant schools. we developed 24 consensus primary recommendations. 12 concerned public health issues. five on antibiotic use alone.