other way. this administration does not seem to have that problem. they've got different cabinet departments and bureaucracies involved in their bigger initiatives. but they are jamming is congressional committees. that never would have occurred to us. i don't think anybody spent 10 minutes thinking about welfare and health care proposals at the same time to these committees. that is exactly what this administration has done and maybe we will really learn something here. .

>> we were in an unusual situation. democrats have not been in the white house and 12 years. almost no one one worked in the white house. we had very little idea. they told us a little bit about how this works.

they do not know how i white house works. he can see a dramatic difference on how the obama administration hit the ground running. they have done it before. i imagine that most campaign workers feel the same anxiety the moment that their candidate wins and realize that now you have to share this thing with everybody else. yet to do with a party that was on helpful or oppose what you are trying to do. now they were in as good of a position to get an influential role in the administration as

you waere. you actually believe in the guy you just elected. it is difficult and important for a white house to figure out how to integrate the rest of the world and make sure that people from the campaign are in a position to fight for the promises. one of the roles that i played in the first clinton term we were the creepers -- keepers of the flame. we reminded that the senior people -- that the american people signed off on this. this is really what the president believes and want to do. the bill clinton completely

empowered us to do that. he wanted to make good on those promises. he did not want to have to sacrifice them. i think it is just part of the moving to washington aspect of governing. everybody in -- people on the hill thought that because they have been doing domestic policy for the last 10 or 15 years that they were naturally candidates as we were. >> we have not it is similar experience with respect to the eight year period i think republicans are united because we have been in the wilderness. " another president wanted a combination of the people. people that he had worked with

the known and could trust. he knew us. i drove around the state legislature. -- i grew up around the state legislature. there is a lot of the domestic agenda. i'll never forget one in the call me. he said the president wants to talk to robin the domestic policy advisor. i went, are you kidding me? i thought, could i do that? karen hughes and i talked about this and how we are going to manage. i was told i never see your children, i resisted a mother. it is hell. the people are evil and a name.

he made it sound as bad as possible. i cannot go under those circumstances. the next thing i knew, the president was calling up indian as the future running off the mothers. -- calling up andy and asks if he was running off the mothers. >> i went down to atlanta for the campaign where i worked on speechwriting and trying to make sure the policies of was all chordata. -- policies were all coordinated. [unintelligible]

he picked up the phone. >> we have had a chance to to all quite a few things. i then we should open it up to the other participants. >> there is a pulled wisdom about whether it makes sense to develop policies during a campaign and identify with what did voters are voting for. or is a bad idea because there is a competitive environment. they may not understand the trade-offs or decide not to give them the current administration. is the campaign a good place to develop policy? does it make sense to look to the campaign to inform policy during a government time? >> i feel pretty strongly that

anybody who runs the president needs to know why they are doing it and why they want to be president. as a practical matter, once the campaign gets going, you can still make policy. you should. you can still search for new ideas. if you do not know why you are doing it and what is the most important thing you want to accomplish before you seek the job, you probably will not get it. you will also be completely at the whim of your political operation. i almost divide the world into the two parties. we are the whoms and the hacks. both of those personality types

are necessary in the campaign, but the country will get a much better results if the presidential candidates has a n agenda that has been thought through in all the different aspects so that it makes intellectual sense. for that matter, i think that the best candidates are ones who actually run on company as opposed to running on a a mood. i think our system was designed to be a job interview to negotiate the terms of the job contract and what you are going to do for the country. >> i completely agree with that.

i would add only one thing. all that string of reasons, i would add a track record experience that substantiates that philosophy and that agenda. >> one of the things president's discover when they get in office is reality. they are very viable and setting a path and charting a course. you have to fill your situation. -- you have to feel your situation. their party is in control of both houses. i ended up working for three

presidents. none of whom had the majority in both houses. given that, you have to figure out what your strategy is going to be to deal with the context in which you face. it is one thing if you have your own part to work with. it is another thing if you are gerald ford were george h. w. bush was larger opposition. the first thing you have to take into consideration is how you -- is what is the composition of congress. the second thing is what is the reality that i case in terms of

the real world? raking came in and we had two years of back-to-back in flation. the industry was 21 for pfizer. -- the interest rate was 21%. we had rising unemployment. every taxpayer had been pushed into a higher tax bracket. we had bracket creep. when he came in, he had no alternative but to focus his attention on the economy. this was a source of intense irritation.

supporters were very interested in social issues that they thought were important, and they had intimated their support toward him during the campaign i can remember being in a number of meetings were they were extorting him for ignoring their issues. he discovered what opera designs discover. i cannot focus on multiple things. i have to decide what the priorities are now. those parties are in part driven by what you have said. they are also driven by what is the context the base with respect to the congress and the reality of what is happening in the country. we win three campaign recently in which the number one issue is going to be iraq. if you voted the primaries, --

if you looked at the primaries, that is what was with the abiding candidates for did reality is we have a president to is facing a challenging economic environment it did not receive a lot of attention during the campaign. and now consumes an enormous amount of thihis time. you cannot ignore the economic realities of what we face now. i am interested in what other people's experiences are with respect to the extent to which campaign promises can assist you. i think reagan's campaign promises on the economy did in system pushing through the tax initiatives that he did. they improved to be an albatross around your neck, because you

have made the promise in good faith, partially because you believe in it and partially because it will get support from groups that are important to you. reality changes into now have to decide what you are going to do. george h. of the bishop -- george h. w. bush faced this with respect to taxes and how he was going to be able to produce a balanced budget. when that network because congress would not go along with it, he was not based with a campaign promise that proved to be very difficult to keep. likewise, most presidents have

come into office with one or more commitment to the steel industry. it tends to be enormously successful in using in201 of the trade act to present presidents with an escape clause case in the first six months in office. and of this cost an enormous not of consternation with the most recent president bush's is ministration. how are we going to do with this campaign promise? many thought this is not the direction that we really want to take policy. i would be interested in your experience. >> why do i have to start?

come back to me. >> in the albatross department, we had do not as to not tell right out of the box. i traveled with bill clinton for the better part of two years. i do not even think i ever heard the promise made. he had made it, but it was not one that had been thought through. that was one where there was not any way to get it done. it was an example of you having to be careful in making your campaign promise and they do not promise things you have no possibility of delivering. if you make those promises, you have to level with people that it will be difficult to do it.

the hardest thing for a candid to decide recanted it to decide is whether they will -- for a candid to decide is where they will accept reality and where they will transform it. clinton made such an ambitious stance on welfare reform. our own side would have watered it down to nothing if they could have. because he promised so much, we had to make good on it. if clinton had not made a big promise as he had, it would not have come out of congress on its own. the luxury of the campaign would be the possibility that it is not entirely bound by existing reality in washington, cbo scoring. it is important for campaigns not to promise what is

mathematically impossible. or to pander in ways that are fundamentally dishonest. it is important to try to raise the sights of american politics to do the presidential campaign is the one chance to have to do that. >> it is so important that he is doing what he is doing. the presidential campaigns will be what they are going to be. the speech writers will credit the speedstches. our parties go through various cycles in terms of how intellectually prepared we are. >> the cycles you think would correspond with to get elected. they do not. >> acting -- i think having a

really vibrant intellectual situation is critically important. there are times when they have gotten in trouble because the part is the quite a to the speeches. bu>> my observation was is they were all things said were very important to a subset of folks. to the extent that you in the maneuvering were disappointing or whatever on some of those issues, they are not so macro -- immigration is my biggest disappointment -- that it overtakes everything.

you make a lot of people mad. people are still writing about how we can capitulates so early. >> why did you? >> why did we? we cannot pass it. >> there are probably no generalizations about american politics that hold true of all cases to the same degree without exception. there are some tendencies. i think this question of campaigning vs governing does bring to the surface a real structural difference between campaign and governing. to the first approximation, campaigning is about edition in governing is about solution. it is no accident that people

often say that to govern is to choose. it is much less frequently said that to campaign is to choose. there is a reason for that. what that means is that in the transition, you are going from something -- to something that is going to be [unintelligible] that carries with it to the imperatives -- two0 imperative compared his. one is the struggle. for the control of the secrets. denise and i both remember the first 12 months when we had healthcare, welfare reform, a major change of direction on economic policy.

there is a controversial decision to proceed with a couple of votes on trade issues that were divisive. the question of what comes before what, because you cannot do everything at once. it is very important. circumstances can highlight contradictions between or among equally serious presidential campaign promises. it is no accident that during the transition the first month of the presidency, there is the battle of the bobs. bob rubin represented an important promise that bill clinton and demented. -- admitted. the president decided he had to

pick a side. he made a clean decision. it was a brief, predicted decision that people the way for a subsequent partial redemption of the original promise of putting people first. it certainly was the manifest during the campaign that there would be some tension between these two pieces of putting people first. circumstances forced the president's hand. i think that virtually every administration can probably record instances in which there is a tension between two equally important promises that has to be resolved with a choice. >> campaigning is something like

falling in love. governing is something like marriage. in campaigning, it is all wooing. in marriage, it is a lot of arguments -- in governing, it is a lot of arguments, purposeful, and ultimately more satisfying, but more difficult. the interesting thing about the early days of the administration as bill suggested there is a lot of disbelief that goes on in campaigns. a new president see in him in her -- supporters see what they want. there were plenty of battles that went on for people who

fundamentally disagreed with some major promise that bill clinton had made had just selectively ignore it and thought he is for this. for the president himself, keeping all these people have been who -- happy had been a challenge. >> richard >> nixon ran on the law and order platform. one of his main point is that he will cut the crime. during the transition, we were trying to figure out what that meant. in my first meeting with the president, he said the crime has gone up very high in the district.

we have got to cut the crime. so i said, cut the crime. i called mayoral of washington and said i'd scheme for the president and you like to cut the crime. would you go ahead and cut it. there is a long pause. çóñ)oj"r days. çóñ)oj"r i said that aside. crime is going to go down. three months later it was up to 202 a day. we had to figure out what we really do to cut the crime. that was a campaign promise that a president had repeated several times. the men had a brilliant man, robert dupont, he did a study

that showed a correlation between heroin addiction and crime that we were addressing, arm robbery, beverly . a call the mayor and if we have this data. i said maybe we need to support you drug treatment programs. we looked around to see who did drug treatment. there were no republicans that did. we then have to look around the country. who can address this problem? we found a person in chicago. we brought him to washington. we said the drug treatment problems all over the district of columbia. can we possibly support making an opiate available to addicts? these are very tough policy questions for us driven by a campaign promise to cut the crime in the district.

that is our scorecard all the way. we got to the point were we able to reduce the rates of increase. that led to a metaphysical discussion -- if you reduce the rate increase, are you actually reducing the crime? it is difficult to come up with an answer. after four years, we would've done hired peter bourne who is president of the drug treatment program. we do not care what party people came from. that campaign commitment that he made in 1968 was a very important part . we were checking to see how we are doing in cities all over the country. >> there is an aspect between connections of campaigning governing that have not come up.

that is the idea of the permanent campaign, which is the idea that campaign does not stop when it ought to. the attitude in the activities of the campaign have too much influence on what goes on in government. it to be interesting what people think about whether there is too much campaigning in the white house. >> [inaudible] >> the person with the biggest microphone in the country need to take it in use it to advance legislative and other policy incentives. if that is a permanent campaign, we are all guilty. how the president uses his time is the most viable commodity to have.

it is a permanent campaign. this warrant issues like the last one and the one before and the one before. it the next election is what is driving everything and it is just the politics, then that will be destructive. she is exactly right the president got elected on ideas. he should spend all the time fighting for him. >> i think it is a to edged -- it is a two-edged sword. you cannot deal with congress and as you demonstrate an ability to go over their head to some degree. there is nothing worse in going over their head. they all know it.

they all hold a town hall meetings. i think the president of the most affected are the ones who have managed that. they have not gone out there to many times been proven they could not deliver. as soon as that happens, you are not having a good time. >> i just wanted to pursue more on something roger brought up. [unintelligible]

we have moved from a situation in the country where party politics was fairly flexible and pragmatic to a situation where it is much less so and more polarized. i wondered how each of you had different experiences with party politics. i would like to hear how that has operated in congress and how it affected you. >> i think this is a fairly simple phenomenon. when i first came to washington, the celts had still not gotten urged the south had not gone over lincoln. -- when i first came to washingyon,ton, the

south had not gotten over lincoln. in order to legislate, you have to go find [unintelligible] it is no wonder everybody was nice to everybody. your legislating with one set of people. we had a golden age of stability. the south did it lincoln. -- get lincoln. [unintelligible] i believe this is the new reality. i do not believe there is any -- were not going to have real liberal people in the republican

party. >> i think the party perce -- per say has a influence over who the national chairman is pete. it is all the subsets identity groups that are more problematic and less affiliated with you or anybody they you are connected to. i do not fundamentally disagree with you. we are where we are. it will have an effect on our country. it to be the same thing for president obama as it was for bush. >> i do not think it is insurmountable. i think that in spite of the efforts of all our respective

efforts, it has gotten progressively worse. it is possible to make progress for there are areas of common interest. we found that where there were general goals that both parties were interested in working on, even if they did not start from the same spot, it was possible to find common ground we actually had a pretty productive time of a few years. we were done balancing the budget and reforming welfare and areas where there were things they wanted to do and we wanted to do. it was a question of working out

details we could agree on. where we ran into trouble was will make up to the end of the list of common things on our to do this. there really was not -- will make the drug to promoting the extension of child care -- when we got around to promoting the extension of child care, they said we did not need that. when not one to negotiate forever. -- we are not going to negotiate for ever. the challenge is not that the partisanship in itself. it is where their people in either party who were willing to go out on a limb and reach -- and break or cut the boxing -- break orthodoxy in their own branch.

there are all kinds of interests that raise a red flag any time you move toward progress. i think that members of congress run in districts that are very narrow. they are accurately reflecting by being more ideological. >> the thing that is really critical here is that there is nobody in congress that feels accountable for passing legislation. they are not going to go home and saw for the -- suffered the consequences if the health care bill is not passed.

[unintelligible] nobody on the hill feels really accountable to execute a play. >> the three presidents represented also had three vice presidents to giv. during the campaign and the transition, to what extent was the vice presidential candidates staring you toward certain promises and may be holding their feet to the fire to try to achieve those promises? >> he said he wanted to meet the guy who we had hired. he wanted to cut every single program.

>> i think my case is famously known. the vice president was not in the domestic agenda. while his deatstaff would weigh, he had other interests. >> there is a frustration that carter -- we could only get the vice president to engage a lot less than we wanted to, because he was the most effective staff lobbyist. he did not like people knowing what he was doing or listing to his conversations with the president.

sometimes this is on things that we thought were quite important. there were other issues where he was facing [unintelligible] cue is a protege of hubert humphrey. -- he was a protege of hubert humphrey. he brought a lot of thought to it. as far as vice presidents, he was the heartehardest to pin do. al gore was a very passionate advocate for the promises that he worked on.

even before clinton picked him, he had consulted on environmental policy. luckily for them, clinton and gore had different interests that they were passionate about . clinton had not spent that much time on environmental policy. he was happy to give up vice- president gore some running room on that issue. i think it might have been more difficult if he had two guys who were done on the same issues -- who had worked on all the same issues and had a different promises. it worked out quite well for us. >> [inaudible]

one thing that we have not mentioned that i think is worth noting since we all came out of the white house, is the when the present first comes into office, he has a large number of people positioned that require confirmation. people cannot active in those positions until the are confirmed. the initiative inevitably swings to the white house and the

office of management and budget because the director has to be confirmed. you always the confirmed. the associate directors not have to go through senate confirmation. when you are putting together the first program that the president is going to deliver at a joint session of congress, it is very short. that is the first opportunity that a president really has to address the congress about what my priorities are going to be now and what specific proposals they are going to advance. there is a huge advantage to the white house staff, because they are the ones who are there heavy

laden with people who have been on the campaign. that is a very powerful arguments. we want to be known as a administration to keep his promises. the they then are in a position to a little more effective. the initiative and drive always comes from out of the white house. >> time is a great foe. i have to call an end to this interesting and particulate discussion -- particular discussion. this is one of four sessions in

this miller center of public affairs center suppose him. you can go to the website. google miller center of virginia. you can find out when the others will be aired. thank you for weighing in on this discussion. >> and tristan the want to get a picture of the group. the hot -- how i understand they want to get a picture of the group. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]

>> up next, a look at government computer security -- security and dealing again cyber attacks. there is a discussion about the effect of immigrants on the health care system. the center for national policy talks of a security situation in afghanistan. a health care hub is a resource. go on line and follow the latest tweets. he but today to healthcare evince like town hall meetings, held incentive debate and update your opinion on health care. this is at c- span.org/healthcare. >> a look at health care town

hall meetings with usa today reporter kathy kiely. bing west previews the presidential elections in afghanistan. birch solomon -- also come burt solomon. >> and now a discussion on how the government is preparing for the possibility of a large- scale attack on the computer networks. this is about an hour and a half. >> this morning. thank you for coming out to this morning.

this'll be an interesting discussion on cyber events. i have just a few brief announcement . alibi to recognize the sponsors of today's practice. -- breakfast. we have three companies with us today. first we have jeloit. the offer technological specialties, and inter agency processes. next to have guidance software. the offer cyber security solutions. [unintelligible]

ibm includes services, hardware, resource, and financing. cyber security issues are at the top of their agenda. the juniper networks offers the federal government a security solutions portfolio, enabling a trusted environment to support programs. [unintelligible] their real time adapted security solutions equips customers with insufficient security defense purda. [unintelligible] next of like to remind everyone that it yet not done so, please

turn off your cell phones and put them on by a break. you'll find several items at your chair including a subscriber form and an evaluation form for feedback on the event. if you can drop them off at the registration table on your way off. if you know anyone who is on able to make it today, this event will be broadcast later today. out like this to be turned over to our moderator. >> thank you for joining us i'm going to start off by saying the best way for this to go is questions from all of you. even during the program if i am speaking, still free to raise your hands. i have plenty of my own as well. i'm good jedi panelists introduce themselves and give a brief synopsis of your

experience and may be a free comments. >> i want to thank you for the opportunity to speak today. i am from the department of defense, specifically i am in the office of the assistant secretary of defense for networks and information integration heade. my focus in that office is a program that has been ongoing now in a pilot program for a year and half or two years. it deals with the defense of cyber security efforts. you can see by the name that it is an outreach by d.o.d. to those companies that they deal with in the private sector and

the effort is to collaborate with the companies on improving network security on the defense industrial base on classified networks. this effort is in a pilot stage. when you read about collaboration between government and industry, here is a case in point where the department has taken that seriously and is working with those companies in the private sector. we understand there is the need and the coloration -- collaboration has been done to this program. >> you will need to describe how i got into this? >> yes. >> i was a foreign service officer. i came back from central america. i have worked for the car.

i was walking down the hall. he said, you know how to program computers? i said yes. he said, good, i want you to go to a meeting on des. that was 1992. >> tell them about the commission. >> since then i have done a little bit more. it got a lot of attention. >> this is supposed to be a little about response about recovery. at that assured the story that i didn't because been told to do it is another dick clark story. he gathered a group of people that he called the duty mind project.

-- dirty minds project. its purpose was to figure out if you are going to do a lot of damage to the united states and exactly how you would do that. the theory was the whole mantra is the to understand how the offense could do it, you do not know how to defend. they had really bright people. he brought me along to observe because it sure was not in their league. these are people who really understood how the network worked and where the vulnerability points to work. i was sitting there expecting to hear a problem with the routers. it turned out that was on the problem. the way the united states -- the reason, the vulnerability point -- was not the technology.

it was the idea that if the attackers did it in waves rather than an attack, the defensive and veneer of the entire united states is one person than they make them work with 28 hours straight, and about 18 hours, you hit them again, and then hit them again, and then sevener eight hours, there is that any defense left in the we talk about automation. in the end, it has ceased being an automation brita it has become a human capital issue. we have missed the human capital part.

you are chairman of the commission said it is time to focus on the human capital side of this. >> i am was born in texas. i have an opinion on everything. i am happy to be here to join you. let me start first. we are in your dead for joining us. you are the ones on the front line for this important challenge. it is critical that we support you as best as you can. thank you for joining us. i retired from the air force. i spent 33 years there. i ended up at the security agency. i enter this in the late 1980's. i have been thinking about that for some time.

we devised the information assurance strategy which emerged. i taught dick clark everything he knows. the need for that to get back to him -- i need for that to get back to him. >> thank you you all. i'm going to start off with a general question. we have all seen all sorts of headlines about cyber attacks on the grid, government websites, it is all of the news. is it the threat increasing or is awarawareness increasing or is it both? >> the framework for me is, yes, yes, and in a. the threat is increasing. for the most part, it is confident he goes back 20 years. the idea that it has not been

that confident -- competition is not the way to think about it. it is more developed. we have come to understand that threat in a way which is much more effective for all of the technologies that industry and government have developed. there is a better understanding. the downside of all that is that it is only the tip of the iceberg. we still have a total misunderstanding of the strategic context of the threat. yes the competency has increased, but it has been for some time. yes, we understand it, but no, we are not coming anywhere near coming near the threat. >> it is not just about defense.

what would he say? >> there are two aspects of it. what he said is exactly on target. mike mcconnell in an interview said something that was moving. he said we are at an strategic of such a point in warfare, not like -- unlike the one in the '40's. th

>> this morning. i am the executive of critiquing the impact of immigration. we do not have the views on things other than immigration. there is no stand supporting or opposing any kind of reform on health care. our staff and board certainly have a pretty wide variety of views on health care as well as other issues. healthcare being such a big part of the economy is an important thing. we do have a contribution to

make. there has been some discussion already of the immigration aspects of the health-care issue. from our perspective, and that has been limited because it has been mainly about the issue of legal status. will illegal immigrants be subsidized by some taxpayer funded health care program? that is an important aspect of the issue. our speakers will touch on it to some degree or another. the important thing i think is to understand that the problem of emigration as relates to health care is not strictly one of legal status. it is not limited to illegal immigration, as important as that is. it is a question of immigration overall and the impact it has on health care.

illegal immigrants are not a different species. their people. they come from the same countries and families of legal immigrants. to understand comprehensively the impact of immigration on health care, you need to look at all immigration not just illegal immigration. that is what we aim to do here today. for many years he has worked in both immigration policy fields and in the health policy field.

he has a lot to bring to this discussion. last is robert from the heritage foundation, a private the nation's leading scholar on the issue of welfare reform. over the last several years he has been doing significant research on the issue of immigration and its effects on public services and costs. the three speakers will say their peace and then we will take questions and answers. >> i am director of research at the center for immigration studies here in washington as congress debates health care reform, the impact of emigration is or should be an important component of that debate. whether illegal immigrants get the access to some new government program for public auction has been discussed to some extent, but the overall impact of emigration has not

really been discussed. we at the center do not have a position on what form healthcare should take. i am sympathetic to some of the president's proposals, but that is not the focus of my discussion. i am instead going to discuss with the data tells us about the impact of immigration on the nation's health-care system. i am going to primarily rely on data collected by the government. what i think that will show is that it is very difficult to imagine getting our health care house in order without getting the immigration house in order. i'm going to rely primarily on government data and a population survey from 2008. that is the most recent data available. it asks about health insurance

coverage in the previous calendar year. that would be how much you had in 2007. the survey is collected by the u.s. census bureau. it is our primary source of information on health insurance coverage in the united states or any population. most of the information i will cover is available at our website www.cis.org. in 2007, 33% of immigrants did not have health insurance compared to about 13% of native- born americans. immigrants account for 27.1% of all u.s. residents without health insurance. we can see this in figure one wishes to my right. -- which is to my right.

it shows that immigrants are 12.5% of the nation's total population, but they are 27.1% of the uninsured. this is just the immigrants themselves. we can keep the camera on figure one a little longer. the impact of immigration is not just to find to the immigrants themselves. the democrats also have children whom they are often able to provide health insurance for. it the children who are born here under the age 18 are included with their immigrant parents, then together they comprise 31.9% of all those without health insurance to place this figure in context, the year 1 shows that immigrants and their children are about 16.80% of the total population.

@@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @r acknowledged. there is another way of thinking about the impact of immigration. we can look at how much

increases from immigration. the government report, the number of uninsured is of about 64 4 million. in 2007, there were 5 million immigrants who had arrived in united states since 1999 who did not have health insurance if we just take the 5 million and/6.4 million. we find that 78% of the growth is issuable to these newly arrived immigrants. if we add in the u.s.-born children, that figure gets to be over 85%. in other words, if we had no emigration after 1999, most of the growth would not have occurred. immigration is not only impact the side of the uninsured population.

it also plays a role in the medicaid system. medicaid is the primary government program that provides health insurance to people with low incomes. it goes by different names. in california, it is called medical,. there is also a special program for children. it is on medicaid. when we talk about medicaid, we are talking but the big program. in 2007, 19% of immigrants and their u.s.-born children were on medicaid weekd. we can combine that with the share that are uninsured and figure two in does that. what it shows is that 47.6% of immigrants and their u.s.-born children were either uninsured or on medicaid.

that means that almost half of the immigrants and their children have no health insurance or have it provided to them by the government. they bought him shows that about 25% to about 1/4%. why are so many lacking? the large share without health insurance is partly explained by the large share to have a very the levels of education. about 1/3 of all immigrants did not complete high school in their home country. that means of a typically work at jobs that do not provide insurance and it often cannot

afford on their own. among illegal immigrants, we estimate that about 55% to the graduate from high school. we can see the importance of emigration to this question by looking at statistics. if we look at college educated immigrants, 15% are uninsured. immigrants to do not graduate high school, half are uninsured. a big part of this is education. it is not just education. cultural factors also seem to play a role. if we look of a fluid emigrant to have a college degree and compare them to affluent natives, and the natives are two. -- the emigrants are 245 times more likely not to have health insurance. i was looking at households less

than $5,000 or more a year. -- $75,0 or more a year. the immigrants in that position are much less likely to have insurance than a native. there are other reasons. immigrants often come from countries where health insurance is not that common. they often come from countries where it is provided by the government automatically. these two factors also play some significant role in why immigrants still often choose not to. one thing wcan say is lack of health insurance among immigrants is not caused by immigrants' willingness to work. in 2007, 3/4 of all immigrants on the job. there is no fundamental

difference between the work. this is not being caused by immigrants sitting at home and not doing work. the reason so many do not have health insurance is their low educational attainment. there is no single better predictor of how an immigrant is going to do in the modern american economy and then there education level. this is true whether we were to look at welfare, income, homeownership, or health insurance coverage. we have only talked about all immigrants and their kids. what about legal status? we have estimated that 64% of illegal immigrants are uninsured. they account for about one out the seven people in the united states without health insurance. if we were to count their u.s.- born children, it is more like one out of every six people without health insurance in the

united states. this is not the whole story. about 7 million uninsured illegal immigrants. that is about a million we count the u.s. children. a lot of folks are concerned about costs. we are in the process of trying to develop more precise estimates. our best estimate is that we are spending about $4 billion a year providing health care to illegal immigrants. that is just public spending. $4 billion. it is more to count their u.s.- born children. uninsured illegal immigrants use significantly less in healthcare than uninsured native-born americans. they tend to be younger than native-born americans. health-care costs generally rise

with age. illegals are relatively young and so they tend to cost less than a uninsured natives. although the stereotype is that illegal immigrants go to emergency rooms all the time, this is not really correct. the problem is not so much that they go more often than the rest of the population read there it is that when they go there much more likely not to pay. that is why it is a problem. 13% of native-born americans are uninsured. they pay the vast majority of the time. more than 60% of illegal immigrants are uninsured. they often do not pay. when illegal immigrants use emergency health care, there is often no corresponding stream of revenue going to the emergency room to offset all the costs

they create. this is the reason why emergency rooms to get so overcrowded and areas with but illegal immigrants. illegal immigrants are using the system without paying for the system. we can also calculate the cost of taxpayers of the whole thing of what legal and illegal immigrants cost. charity pay on top of the cost to taxpayers from all immigrants who are uninsured, we are estimating that about $11 billion a year. what if we try to provide medicaid to the uninsured immigrants? the cost of the very high. if we decided to cover just the

uninsured illegal immigrants with medicaid, even taking into account of their much your age, it still cost about 15 billion to $30 billion a year. providing medicaid to all uninsured immigrants and their children would be enormously expensive. that to be $60 billion a year. what about an amnesty or legalization of illegal immigrants? would that solve our problems a? the president has made statements that he thinks an amnesty would solve our problem. the answer is, nmo, would not. lack of health insurance is very common among illegal immigrants. in 2007, 1/4 of those of the green card did not have health

insurance. that is more than twice the rate for a native-born americans. if we look a green card holders who do not have a lot of education, 35% are uninsured. in that sense, we think that more illegal immigrants would have health insurance. there is a cat. if we look at those less educated green card holders, another 28% on medicaid. that means that we have not result the cost problem because we did not solve the underlying problem which was that illegal immigrants are unskilled. we think that 80% have no

indication beyond college. a majority have not -- no education beyond high school. a majority have not even graduated. 80% are either high school dropouts or have early high school education. we have to ask the question if you can have health care reform about immigration? can you let illegal immigrants stay in the for the large cost? the answer is in no. if the illegals stay, the costs will stay as well. we either enforce the law and reduce the illegal population overtime or we just accept the cost. if one still favors an amnesty, the have to be honest and make it clear that in areas like health care, the costs are significant for letting the

illegals stay and may actually get quite a bit bigger if we legalize them. legal immigrants are free to stay, of course. in the future, we have to decide whether it makes sense to continue to allow in so many legal immigrants to do not have a lot of education. some research shows 1/4 of legal immigrants have not graduated high school and some research shows that 1/3 have not graduated. a very large fraction of the illegal flow is quite unskilled. most legal immigrants are allowed into this country because they have a relative here. this means that most legal immigrants are selected without regard to their education or impact on taxpayers for the health-care system. if we want to avoid large costs,

we would need to significantly reduce the number of legal immigrants who are allowed in the future. there is still one final point that bears mention. the large share of an illegal immigrant on medicaid should not be seen as some kind of moral defect on the part of immigrants. the vast majority of emigrants do not come to the united states to get free health care or to sign up for welfare programs, though that often does happen. the vast majority of immigrants, including those here without insurance, hold a job and work. the problems i have discussed our an unavoidable consequence of allowing a large number of immigrants to work but have very little education. as a result, they or their

children are uninsured or use a welfare programs like medicaid. @@@@)#@ @ @ @ @ @ @ @ @ @ @ @ ' be affected by the health reform legislation that is being crafted by the house and senate.

there are 12-50 million immigrants their mere presence means that every provision of the legislation that is designed to extend health coverage to those without insurance will potentially expand the taxpayers cost by billions, if not by tens of billions or more. many immigrant households have children. they are automatically eligible for a government health care of various sorts, even if their parents are here illegally. government agencies and nonprofit often only look at things like income levels and other similar qualifiers when they are enrolling new beneficiaries in public programs like medicaid. the often overlooked once immigrant status even though

that could disqualify someone from program precipitation. today, i will focus my remarks on the main immigration implications of the house and senate bills. i will make a couple of observations about the senate finance committee's legislation, although there is no legislation from the committee yet. it is of being negotiated. -- it is all being negotiated. health reform legislation contains a number of provisions that opened the door to taxpayer funding of immigrants' health care. that is for illegal aliens, illegal aliens who are supposed to rely on the sponsor for financial assistance during the

first five years in the country and for certain immigrants who sponsor other immigrants. we will look at the taxpayer funded premium subsidy. h. r. 3200 title 2 relates to coverage. this section or title create a government agency to regulate health insurance. individuals and employers will have to go there for government approved health insurance. it will run the public auction. it will operate a graduated subsidy program. section242a defined to is available and how many credits that they can receive to determine the amount of the premium subsidies reviewed the bill qualifies all lawful permanent residents regardless

of their sponsors pledged responsibility for the requirement five-year bar for most programs. section 242d exclude receipt of these premium subsidy premiums from counting as welfare. taxpayers will subsidies -- subsidize households up to 400% of the poverty level. section 242 generously subsidizes many people, including foreign born well into the middle class. on the house bill, that would be up to $80,000 income a year for a family of four. the money does not count as welfare payment. that might potentially risk deportation as a public charge or jeopardize their ability to sponsor other immigrants.

the credits are available to sponsor illegal immigrants and foreign born immigrants sponsors themselves. the senate finance outline indicates that the bill will subsidize insurance costs up to three times the poverty level. let me talk briefly about public charge doctrines. public charge doctrine is a longstanding u.s. policy dating to colonial times and has been vigorously a part of our immigration policy throughout our history. it is supposed to protect the country from importing people who become a burden on society. would-be immigrants are denied in pieces on public charge grounds. they have to low-income whatever other factors would cause them to not give them a visa.

this goes on continually. very few immigrants in a more are deported for the reason of being public charges. it pretty much that once you are here you are safe. the 1996 welfare and immigration reforms strengthened a public charge doctrines somewhat. immigrant sponsors now must sign a legally enforceable affidavits to support. in the must have earnings of at least 125 it% of the federal poverty level. their household income is deemed available to the immigrants who is applying for programs. because the provisions to suspend some welfare reforms requirements, it tends to weaken public charge doctor. the bill creates a situation

where sponsors of immigrants and the immigrants themselves can collect taxpayer dollars for health coverage when immigration policy would require that they be more self-reliant. section 242 of the bill states illegal aliens are excluded from receiving federal payments under the affordable credits premium subsidies. but there is nothing in the bill requiring a screening of affordable credit recipients, such as screening them through the save system. one congressman offered an amendment in the ways and means committee to correct that but it was defeated along party lines. senate legislation amid the same eligibility verification requirements that would insure that only lawful immigrants and u.s. citizens benefit under these programs .

now let's turn to medicaid. title 7 under division b of the house bill 33200 expands medicaid eligibility to those earning 1/3 of but the official poverty level. the minimum income required of immigrants sponsors falls below the sponsors eligibility for tax payer funded health care for the poor. it is at one 1/3%. the health bill expand medicaid eligibility to 50% above the official poverty rate. that leaves an even larger gap for immigrant sponsors who are poor enough to be on medicaid to still sponsor and bring in additional be some holders.

this aspect of the legislation has an undermining of fact on the public charge doctrine. section 1702 of hr 3200 expense of the prohibits saves, which administer medicaid about making further determinations about new enrollees' eligibility. one such provision requires states to presume someones eligibility. in other words, these provisions set up a system that amount to be kind of in role first and do not ask questions later -- enroll first and do not ask questions later.

it to apply the same verification standards and existing verification system that is in the medicaid statute. this taxpayer protection amendment was lost by a single vote. senate legislation omits any verification requirement of once eligibility. -- one's eligibility. finally, let's look at the mandate exemption. the finance committee outlined like the help and house bills mandates that individuals must carry health insurance or else they face a fine. the finance outlined says that illegal aliens will be exempt from the individual mandate. that is interesting, but it sets up a system where you have

americans and illegal immigrants you have to have coverage or else pay a fine. illegal aliens with the escape both the mandate and any fine for being uninsured. it appears that this sets up for illegal aliens to be free riders. they would still received taxpayer paid medical services. legal aliens will be free from any responsibility or sanction that other people would bear. to conclude, these bills expand government health coverage and a taxpayer funded subsidies for government controlled private insurance and the public option. they make it easy to enroll new people in government run health programs with what amounts to a build in willful ignorance about

characteristics which would be disqualifying, such as being here on a temporary visa or being is still under one sponsorship requirements were being here illegally. the bill makes no provision for ensuring that only lawful u.s. residents benefit from these programs. the health reform plans that are on the table will create new incentives for illegal immigration. they will preboard illegal aliens by giving them help care at no expense to themself further weaken the public charge doctor and that long served a national immigration policy so well. thank you. >> thank you very much. as we have noted in the previous comments, immigration is

primarily disproportionately lower. 1/3 of all immigrants are lacking in high school degree. the pfizer are lacking a high school degree. eight you agree a person who lacks a high school degree pays more in taxes than they receive in government benefits, you would believe that this system is good for the u.s. taxpayer. if you believe that someone who lacks a high-school degree possibly receives a smidgen more in government benefits than they might pay in taxes, and then you would recognize that this system both legal and illegal is very costly to the u.s. tax pay er. since immigrants are disappear fortunately less educated, they are reducing the average education level of the u.s. work force. if you believe that reducing the average education level of the national work force is good for

an economy, and then you would believe that the current legal and illegal immigration systems are good for the u.s. economy. if you have an antiquated belief that having a higher education that having a higher education work force is have to conclude the both legal and illegal immigration is currently unfortunate in terms of quality economic growth. in the united states, our country spends over $700 billion on welfare assistance. that is cash, food, housing, medical care for low-income people. these are programs like medicaid and public housing. of that, roughly $100 billion more goes to lower skilled immigrants they are a substantial and significant portion of the u.s. welfare system. the way that i would

characterize our current characterize our current immigration system@@@@@@@@@ @ @) the united states has a very generous system of support for less advantaged individuals, and this would be very difficult to provide that level of support to essentially an unlimited inflow of low-skilled individuals from the third world. that is what the immigration system currently does. if we were to look at the current health care reform legislation, this takes an unprecedented step in opening up the u.s. welfare system to illegal immigrants.

law, we have had a system of i did it -- identity checks that prevents adult illegal immigrants from getting on to these welfare programs. you have to be able to substantiate your in the country legally. you have to be able to substantiate that you have been here over the time limits for eligibility. the health care reform legislation turned up on its back and tramples it to the dust. it says that we will not verify. we will not check. we have a complete open door for every illegal immigrant current and in the future to simply enroll and receiving benefits under this program. when the only will not check them, we will not check them once they begin to receive the benefits. if you are going to do that with respect to health care, why would do not also establish the same precedents with respect to food stamps and public housing

and earned income tax credit? i believe that is the direction that the congress want to go to allow all welfare benefits to be fully available to all illegal immigrants. this seems to me that not only set up a substantial cost -- i believe it is on the tune of close to $200 billion over the next decade. . .

what could happen is that somebody to enter the united states against -- illegally in the future with a significant medical condition involving health care, and they can declare themselves eligible for these health careñi programs and engage in these public auctions, and receive medical care without being checked to see if they are lawfully eligible for these programs. i believe that we will continue to draw the seriously ill from all over the world to come here to receive medical treatment. and once you connect them to the dialysis machine or what ever the says, we are unlikely to pull the plug and say that they went out of here. that is mind-boggling. that is the establishment here. established here there -- and the precedent that is being established youhere.

a that is targeted to low-income people, medicaid, public housing, food stamps, so forth. over the next decade, the u.s. will spend $1.50 trillion on means tested welfare for lower skilled immigrants. those are the high school degree or less. half of that, around $750 billion over the next decade will be for medical care for lower skilled immigrants. this is primarily through the medicaid program. it is a massive expenditure in a time which the united states is already going bankrupt as a nation. the health care reform that is pending in the congress would add additional costs on to that, not only by making the illegals eligible for free medical care, but also by extending medical

care to all of the legal immigrants who currently do not have it. steve's numbers here are very good, about a third of the uninsured are immigrants. if you look at the lower income uninsured, where the core of the expenditure will be, that number is probably significantly higher, as much as 50% of the lower income uninsured. we are about to, i believe, going to a system of nationalizing u.s. healthcare, creating a government monopoly, -- in order to provide health coverage to immigrants. in addition to the health care reform, we have the fantastic cost associated with pending amnesty. one of the things that we know about illegal immigrants is that very few of them are eligible.

if you are an illegal immigrant, you come here during -- you're going to find some way of becoming legal or you're going to come back home when you are of retirement age. one of the clear things that any amnesty bill or earned citizenship bill does, at the point of passage, it immediately takes all of the current illegal immigrants and makes them potentially eligible for social security and medicare. an astonishing out your costs. all of which is hidden in the normal budgetary calculations which only calculate the cost of amnesty over a 10-year period. you're going to put as many as 12 million individuals into the social security and medicare systems. the cost of that once they hit

retirement age would be around $2.50 trillion. of that, $1 trillion will be for medicare alone. this is just another aspect of, not only are we spending enormous sums on the current system, the enormous sums on the current low skilled immigrants, but with health care reform, we will pile much more money on top of that. if we add amnesty on top of that, we will be adding another trillion -- another $1 trillion, $2.50 trillion if you count social security as well. we're beginning to look like argentina in terms of the level of public debt that we are racking up here at an unprecedented rate. a substantial portion of this debt is due to the fact that we are bringing in very low skill

individuals through both legal and illegal immigration, providing them with a vast array of government services that they do not pay for, and basically piling up the debt on our children in order to pay for those services. thank you very much. >> thank you, robert. steve, did you have a question? >> i have a point of clarification. what you're saying is, if they have a public option or some new government program, they could have created a situation to verify whether the person is eligible. some legal immigrants are not eligible because they have not been here long enough, but illegal immigrants are not. the issues explicitly to make them eligible in the sense that they took out the enforcement. they also said that they were not supposed to get it, so would it be a speed limit on a

highway, that a pronouncement that police will never patrolled highway. it is that kind of what we have done? >> it is difficult to know the motivation for omitting the verification provisions. i think the one provision that is in their that i mentioned that excludes availability but does not require a way of checking ait, it is like the highway sign, the highway marker you mentioned. but is also similar to -- have you ever seen in no trespassing sign in the middle of the woods , and there is no fence, no former with a shotgun or whatever? it is just there, no enforcement

whatsoever. >> i would say the motivation is clear. it could not help but be clear. it is an unprecedented step in the u.s. welfare system to basically say, you are not eligible, but we will not check. we have never done that. i wonder why that provision is in there. on multiple occasions, they deliberately voted down amendments that said, why don't you apply the traditional checks? by the way, these are over 71 different federal welfare programs. you use this type of check to make sure a person is eligible. that is what you do. it is not only just to check for illegals, it is a check for employment verification. if you come in and have eight specific and come, the

government determines whether york and come is, in fact, that low. -- whether your income is, in fact that low. if you proclaim your eligible for this, we will let you win. if you proclaim that you are a u.s. citizen, you are in and we will never checked you. there is only one reason for doing that. it is because the deliberately intend for all illegal immigrants, both current and future to received free medical care at the expense of the u.s. taxpayer. >> when you referred to the $1.50 trillion in the next decade, are you talking about illegal and legal immigrants? >> it would be much higher if

you granted amnesty to the illegals. under the current system, recognizing that lower skilled immigrants take about 15% of total means tested, cash, food, housing, medical care, that would be at least $1.50 trillion. over the next decade. it is those with a high school degree or less. probably a majority of that is for those who are currently legal. >> speak up and identify yourself. >> to questions. did you find any difference between illegal immigrants and illegal immigrants in terms of their paying back? the use of emergency services? you mentioned they tend not to pay for that.

might that potentially change or they legalize? the second question is for mr. edwards. have you looked into the agricultural workers and the provisions, how health-care reform might affect that segment of the population? >> the statistics i gave for what taxpayers pay, remember, uninsured people pay billions of dollars for their care. they just don't pay for most of it. the total sum of what taxpayers pay is right around $43 billion. at $4 billion of that is going to illegals. some more money might be going to legal immigrants. we don't have a body of research showing that legal immigrants are more likely to pay for services. i don't know of any that says that when they are uninsured.

legal immigrants tend to have health insurance than it illegals. the big difference seems to be medicaid. they get insurance, but entirely at the taxpayer expense. if your concern was that they did not have insurance and now they do -- that is positive. it might improve their health care outcomes. if your concern is the taxpayer, that is bad. being on medicaid is much more expensive than being uninsured. >> one of the bills -- i believe it is the senate bill, but i may be mistaken. states that offer a permanent residence for u.s. citizens, it may be the house bill -- i may have been reversed. it is a permanent immigrant visa holder.

the other says that -- it the other says that -- it includes anybody who@@@@@@@ anyone here with the protective status and the non immigrants visa , and part of the bill has separating and not extending the coverage, without checking or verifying that the people without the visa holder, non- immigrant visa holders, and the other one says that anyone here who is here legally, -- >> this would include foreign students and illegal aliens, and there is actually -- there are millions of immigrants who we have described as immigrants but they do not have a green card. they are legally here,

temporarily. >> in reading the memorandum, the second bullet points says that immigrants account for 27% of those in health insurance. obama says that legal immigrants account for 27%. the one before says 64 percent of illegal immigrants -- can you explain it? >> what fraction of immigrants do not have health insurance? the other is trying to measure the impact on the system. if they're only 10 immigrants and half don't have insurance, it would be a trivial fraction of the uninsured. one statistic is how many people, of immigrants are uninsured? one is what fraction total they comprise? in the case of immigrants and their children, the two statistics are somewhat close.

about 33% of all immigrants, not their kids, did not have health insurance. they comprise 27% of all people without health insurance. a third don't have it, and they make up a fourth of the total. you can't just no one without thinking about the other. that is why this to statistics -- they should be a little clearer. making clear the total verses what fraction, but that is how it is. >> a comment for the director as well as a question. i enjoyed your book of charts, the impact of immigration. second of all, when you talked about the impact that happens to be mentioned, $2.50 trillion

roughly. in your analysis of the martinas bill in 2006, you estimated that in addition to legalization, there be at least over 60 million people who come into this country through chain sponsorship. is that included in the out years? >> no, the $2.50 trillion would be the cost of providing to the current illegal population. the bill three years ago did have it. it would impose even greater costs. the bottom line to understand this is to recognize that the u.s. has a very large and robust welfare system.

we don't recognize it because it is over 71 different programs. in order to calculate the cost of these programs. social security and medicare appear on two lines -- you have to really dig. when you add all those things together, the cost of aiding the two were -- the tour, is three- quarters the cost of social security and medicare. it has grown as rapidly as social security and medicare over the last three decades. the pieces are never put together. the bottom line in terms of medicare -- immigration is that the system along with other government systems, it constitutes a massive transfer of resources each and every year

from the middle class down to the less advantaged. we can barely afford to do that for disadvantaged lower income americans. huge numbers, both legally and illegally who fall into the criteria of these programs would not work all the more legal -- the more illegal immigrants that we have, the greater the cost to the u.s. taxpayer. he wrote -- it receives $20,000 more in government benefits and then they pay in taxes each and every year that gap . at that moment, we're borrowing

it. in the next decade, we will be putting a debt on the future in order to pay for it. >> next question? >> [inaudible] there is a problem with education people -- with education level, the people coming into the country. have you done any cost-benefit analysis on what benefits the economy, and what the cost would be if he did not have the means to do it? >> yes. as the level of immigration has gone up, one of the most troubling trends in the u.s. labor market is that less educated americans are worth less and less. there are about seven or 8 million of them not in the labour force who are 18-65.

if we look at people who only have a high-school degree, especially the young, 18-29- year-old. it has declined by 7 million as well. all told, america has 25 million. these are people with no education beyond high school, not working. the total work force is 7 million to 8 million. it looks like we have this enormous supply, but the situation has deteriorated dramatically. teenagers used to work at very high rates, 16 and 17-year olds. the last year has seen a massive decline. roughly speaking, if only 1/4 of the less educated not working or native-born, would it work?

throw in a few teenagers, you could throw -- he could replace the whole work force. the other thing that is going on in the u.s. labor market that most people think is equally as troubling, wages and benefits at people on the bottom has deteriorated dramatically. not only are less educated americans working less, they're making less. there are astonishing statistics. let me give you one of my favorites which is very well documented. meat packers, generally done by people without a lot of education. their wages are 45% less today than they were in 1980. for high-school dropouts, wages are about 22%-25% less than they were in 1980. if we have less unskilled immigration and paid workers more, it appears we have a huge -- from an equity point of view,

that would make a lot of sense. we have adopted this other policy where we flood the unskilled labor market, keep wages low, and allow non work to become very common among less educated natives. there are other issues going on there. other factors are affecting less educated people in this country. it is not just immigration. but i think immigration is a part of it and something we can do something about. we can change our immigration policy. the japanese setting up factories in malaysia and displacing u.s. workers is tougher, were as reducing the immigration level or reducing your unskilled immigration level is something that is tangible and we can do something about. >> i happened to work on both the issues of welfare and poverty and immigration. so i get this very paradoxical message that i can go to one group and be told in the morning

that there are absolutely no jobs for lower skilled americans in minneapolis or milwaukee. and i can go to another group in the afternoon and be told that we have to have massive low skilled immigration because americans won't take those jobs. we have to reconcile these things. if you were to go for any discussion on black poverty and a black family structure in the united states, the overwhelming consensus, particularly on the left, is low wages for black male workers and a lack of jobs for black male workers. for 20 years, that is the prevailing factor. that is why we have poverty, welfare, and so forth. at the same time -- that we do not have enough workers to fill

these lower skilled jobs -- that have almost been flat for several decades. somehow, we need to have more of these workers. it is a misnomer to suggest that it makes the economy larger. that somehow the average citizen benefits from it. it is true that makes a larger pie, but the immigrant eats about 90% of that share of a larger pie through his own wages and it does not confer benefits on the rest of us. it does confer cost on the rest of us. >> let's take a couple more questions. >> you mentioned that residents

in your own countries do not have knowledge of the systems -- what is the risk of medical tourism to get medical coverage in the u.s.? >> that is a reasonable question. it can be a lot of people numerically. it can be millions or billions of dollars, whether it be a large fraction of the health care pie. remember that people that engage in health care tourism will be the most affluent to find they can't get insurance in their home country. they are aware of and they can afford the plane ticket. they can navigate the process which millions and millions of people do every year. what you would not expect is a person who is not literate coming from india and trying to do medical, but you expect

someone to a college in india that they can't afford to treat and being able to buy a ticket. that would be more of a phenomenon against the most educated -- i amongst the most educated. that would be another example. there are about 400,000 births comprising about one out of every 10 births in the u.s.. what percentage of people who are women, who arrived pregnant? -- what percentage of people or women who arrived pregnant? it is hard to get a handle on how big that is potentially. as robert pointed out, if you do not verify, which is what this new bill considers, that could grow much larger. >> i would consider the precedents for medical tourism to be quite strong indeed.

in the 1980's and 1990's, we allowed elderly immigrants to come and then get on your program called supplemental security income. in fact, elderly immigrants coming to the u.s. to retire on this welfare program, it was the fastest growing element in u.s. welfare. it was absolutely unprecedented. what we found, and we had testimony on this as part of welfare reform in 1996, across southeast asia, there were publications in the native languages on how come the united states and retire. in chinese. we have testimony to that effect. one of the things that happened

in welfare reform was that welfare reform said you had to be a u.s. citizen to get ssi. that sort of checked that massive inflow. the people that are not attracted to these benefits -- not only are people aware of not only are people aware of this, but you you have agencies and organizations set up to draw them in. another aspect of this is that any illegal immigrant who is here would have the absolute option of bringing in their grandparents, and declaring them eligible, receiving free and medical treatment under the system. the record of achieving that is absolutely terrible. what you are going to do here is create a mess that will be

exploited, and that will ultimately have to be cleaned up in the future after you have already spent a lot of money. >> let's take one final question. >> this is a very interesting study. would you continue the cost of not getting insurance to these people, in light of the h1-n1 virus? o actually cover these people and not expose the citizenry to even more health costs? >> i do have an estimate for illegal immigrants. right now, we're spending about $4 billion on their health care. let's say we give the medicaid. there are about 7 million, but they're relatively young.

you're still looking at about $15 billion. it would be more expensive to cut -- to cover them on medicaid. the health care outcomes might improve. when you're talking of communicable diseases, that would be an advantage. the bottom line is, people who are uninsured to cost taxpayers money, but government insurance costs a lot more. their health care outcomes improve, but there is a balance. we're not going to save any money if we ensure folks. people who do not have insurance put off care, they pay some on their own, and taxpayers spend billions on them as well, but it is not anywhere near like with actual insurance. >> when lyndon johnson launched the war on poverty, welfare spending in 1964 was about $70 billion a year. it is now 10 times higher.

it went from 1% to 5% of gross domestic product. the next decade, it will be 6% of gross domestic product. where spending the additional money in order to save money. boy, is a good thing we saved all that money. the bottom line is, as long as you have to this type of low were skilled immigrant in massive numbers in the united states either legally or illegally, they're going to cost u.s. taxpayers a lot of money in one way or another. it to the extent that youthful inc. -- those costs go up. >> i will make one observation. the congressional joint economic committee just recently came out with a report, and it looked at how well cost estimates had done on several of the programs

in the past. the estimates on the front end of medicare and various other programs -- i believe the joint economic committee's identification of the cost was that it underestimated in most every instance by anywhere from 1.6 all the way to -- all the way from 1 to 16. between that and 16 times underestimating, that is a huge risk of liabilities you are potentially going to take on. that is one element of adding that. >> thanks to all the panelists.

all your publications as well as video on this event would be on our site at some point relatively soon, cis.org. thanks to everyone for coming. [applause] calle[captions copyright nationl cable satellite corp. 2009] >> on c-span this morning, they

look over the security situation in afghanistan, we are live with your phone calls. >> this morning, health affairs host a conference on the government role in health care. you can watch live coverage on the c-span2 with c. everett koop. >> this fall, answer the highest court, from the public places to the area's only accessible by the justices. the supreme court, coming in october on c-span. >> afghanistan will be hosting its elections, and the taliban

has been executing a large number of suicide bombings. the center for national policy hosted this, and this is nearly one hour and a half. >> this afternoon, welcome. >> i will be the moderator for today's discussion. building a secure state can be done. the center for national policy has been a mainstay here since the -- on the national security issues. he assumed his responsibility in this role a few weeks ago. this is the culmination of a series of programs examining the challenges and opportunities in afghanistan. we have the limited economic

resources and the tribal and political division, and widespread insecurity. the people of afghanistan will go to the polls to select a new leader. will the people face violence or intimidation? will karzai returned to office? well abdullah abdullah force them into -- will abdullah abdullah force them out of office? as his campaign strategy reflected a cynical at reach, or has this been an admirable attempt to get the tribes into the identity of the modern nation state. is the national army of

afghanistan guilty of leading the fight against the taliban. can they be reformed and ernest that -- earned the respect of the afghan people. this political reconciliation achievable. but can they survive the negotiated return of the taliban. we are joined by two very distinguished panelists. >> general barham and a man from the center for peace. he holds a master of laws degree, he is a graduate of the national army war college.

this was in the united states at all levels, from litton had to lieutenant-general. he deployed in october 2003 to afghanistan, commanding 20,000 u.s. forces and combined forces command in afghanistan, as part of operation enduring freedom. he was responsible for the u.s. central command, for pakistan and most of the southern part of the is pakistan. the nato force and many members of the surrounding nations. he is the director of the center for strategic studies at the defense universities, and his comments today are not a

reflection of the u.s. government policy. j. alexander their. he joined -- thayer. he joined in 2005 and is the director of the process, for national reconciliation. he was a leader of the genocide prevention task force and the genocide project, and is the director of the rule of law programs, and the programming relations between afghanistan with the informal justice system. before joining usip he was the director of the project on failed states, with the development and the rule of law. in 2004 he was the legal adviser to the constitutional reform commission in kabul where he was

part of a new judicial system. he appeared as a expert commentator -- an expert commentator, and he has written in the new york times and the washington post among others. he has a bachelor's from brown, and a diplomacy from the -- from the fletcher institute. the program will try to maintain as much flexibility as possible. we will begin with opening comments, and this will run 10- 15 minutes. we want to preserve a maximum amount of time for as many questions as we can fit in. i hope that we will be able to accommodate a few questions with the opening remarks. if you would began. >> i should highlight that the moderator -- congressman mchale

took six months out to serve at -- in the marine corps in afghanistan, as the senior mentor, about two years ago. he is not only a moderator, he has tremendous on the ground experience. >> i had a much shorter hair cut. >> i will be watching my comments carefully, and -- this is low pressure. thank you very much and i look forward to a great discussion. we have more of the questions for the comprehensive list, and i know that he is wanting to drill deeply into the election contest, so i will take a broader part of this and use this as a setting in which the elections will be of ululated a bit.

since the arrival of the administration -- i pointed out -- there is a little bit of a math equations. this is a combination of leadership with the strategy and the resources. we had to do this for afghanistan, and since january this year, with the president's speech in march, we have seen significant changes being rolled out in all three of those areas. this was in the resource to mention. it is important to say that we are on a course of change right now, and this has not yet been determined. this is particularly important to recognize how the election is

fitting into the context. this is the timeline for the enterprise, with the administration and the new policy, and the military effort that i will talk to you about, they are only just beginning the enterprise. this is a bit normal from the approach. we do not deal with the success or failure based on today's headlines. this is over two or three years as a minimum. we have had a major change in personalities from the united states and nato standpoint, and organizational structure. we have a three-star general,

david rodriguez. and we are going through a change in the organizational structure. we are connecting more closely with the military headquarters, and to change the military command structure to make this respond at the appropriate level. we are looking at the theater strategic requirement, with the non military dimension. and we have the three-star operation, this is the important change that is underway right now. the strategy that has been laid out, this policy to go to afghanistan is quite clear about what the strategic goal is right there. we have the safety and the policy overview, and this has now been made into reality on the ground. we have to see how this will play out over time. our friends and allies in the afghan government are going to be building a joint campaign plan that will allow us to see

the road ahead very clearly to lay out a road map that we will measure the progress against over the next several years. this will not be in 30 days or 35 days, this is going to take some time for the effect of these changes to gain traction and move forward. and the resources, we have committed a substantial amount of the combat troops, the boots on the ground and the soldiers and the marines that were going inbound. they are there to support the addition. we have several hundred u.s. civilians that are there to reinforce the capability, around the country. this is going to be felt over the next six months. we have to be careful about looking at the speed with which we evaluate the speed that is

ahead. i was in a couple -- kabul and we had 21,000 forces there -- and we had spent the previous nine months focused on the elections, and we were on the edge of the chairs in 2004 as to whether or not this would play out as hoped. the interested -- interesting markers that we have, were for the united nations who generally in the election effort, expecting five and half million people in afghanistan would come out to vote. 10.5 million afghanistan people would come out to the election. on election day, 8.5 million people in afghanistan came out

to vote. this was an astonishing number by all estimations that we were looking at at that time. we have registration numbers for potential voters to -- somewhere from 50 million to 7 million. there will be a great debate about the number for the turnout for the actual voters, and the numbers -- if these will be adequate to be representative of the overall population of afghanistan. will this be heavily tainted and more secure in the north? i know that they will talk about this as well. we are not certain about this, about what success will look like, in terms of what we can expect with the election itself. president karzai was in a field of 18, he was honoring this with

the ballot. if the over 50% level was required for the victory, will this happen tomorrow? we do not know at this time. we have 40 candidates in this election, and many of them have substantial numbers, with abdullah abdullah having 25%. what does this mean for regard to the security, and what will this look like? i suspect that this will be a violent day in afghanistan. this peaked and that this was over the level of violence that we have seen in afghanistan. the marines and sailors in afghanistan, the number here was 52. halfway through the year we have had 160 americans killed in

afghanistan. the coalition casualties were 59 for the year. coalition casualties were 279, and the numbers -- the tragic number of soldiers that were killed, on the coalition side is dramatically higher than it was several years ago. we are going to face significant violence tomorrow and this will be well supported by the people of afghanistan. the aftermath of the election will not be known tomorrow, and it will take some time to count the votes. the potential for instability during that time is very substantial. this should be of particular concern for us once we find out what the polling numbers are going to be. if no candidate gets over 50% of the vote, we go to the prospect for the runoff election.

the intervening time is a time of substantial risk. as will look at at the election window itself, this is going to be a major effort and this will create a result, and we have to live with the results and the international community. this is collectively with the people of afghanistan. this will be their government for the next five years. i think that the ineffectiveness and the potential effectiveness of the government is an issue that will raise the highest level of concern here in the united states and the leadership. we clearly worked very hard to help the new afghan government be effective. we will be able to improve security in afghanistan. i believe that he will come in with whatever his requirements are, and the resources that he

have are going to improve security in afghanistan. can we keep pace with that improvement, by improving justice and improving the rule of law, with the economic development in afghanistan. we are working with the new afghan government, and the institutions that were in place. many pundits are basically asserting that we only have a year or t w o patmos to have progress in afghanistan. we have to be careful of the markers in afghanistan. one thing that we do not understand is the degree with which the taliban elements are really looking at this as a game of running out the clock. the fundamental tragedy is too -- strategy is to win by running out the clock on the americans.

one thing that i heard after visiting the village was, the americans have all of their wristwatches, but we have all of the time. we in the international community, even the afghan people want to look at this as beyond that immediate sound bite, as to how this goes. with the talk of the exit strategy, we have to look about whether this is us leading -- leaving the region once again, with the taliban strategy and whether this is the right solution. we have a history of leaving the region, and the result has not been positive. many of the friends and adversaries believe that we are on track with this and this is the outlook as we look at what we are trying to achieve.

we are trying to show resolve and partner with the friends and stay the course, until we succeed here and began the turnaround, this will be one of the most difficult decisions that the administration and the international partners are going to have to make over the next one and a half war two years, and the ability is to stay the course, with the players in the international community. and with the neighbors who are watching this closely. let me turn this back over to the moderator. i look forward to your questions and the other issues that were raised at the beginning. >> before we came into the room, he said that these views will be his own. he said he would be speaking for millions.

>> i just got back two weeks ago weekskabu two weeks ago -- two weeks ago from kabul. election fever is in afghanistan. i remember this from 2004 and 2005, they look at the potential for the elections and this is important to remember that even if these elections are problematic and i will go into this, if the institutions are not strong enough to support democratic process, which is also true, it is not to say that the people of afghanistan are not democratic and do not want to choose their leaders, people love elections. they proved this in 2009, that

they are understanding the political process, they are willing to take grave risks for the political process. there is also a provincial. they were frustrated by their position, this is what they mentioned last time. the people afghanistan say that they were dealing with this process. this is an odd, existential question.

what we are thinking about is people are coming out and voting for the candidates, and that person goes on to lead. and if -- i am it unfortunately i'm happy to report, they said that there will be an election tomorrow. what i mean by that is that, afghanistan believes that the outcome of the election is going to be determined in part, for the united states. they will fly this rationale retroactively, and you have to take this as a conspiracy theory, and you have to take this as this is borne out by 30 years of experience.

this is the salary for most of the people who surround the president. this maintains a lot of the sovereign capacity. people are not likely to believe that he will be someone who has chosen to -- i am not suggesting that that is the case but that is a widespread perception. the other perception is that everything is done in the back room deals. looking at the process and believing that the leaders of afghanistan were not selected by the popular vote. and certainly, the role that he has taken has not been -- he has not been a popular campaigner but he is bringing inve