the time it takes to have these difficult conversations. there are now proposals to compensate a patient's personal physician for doing this hard essential work. proposals that have been misconstrued and misrepresented. on february 24th, 2006. my family celebrated my parents 60 its 20 anniversary. the last one, as it turns out. -- my family celebrated my parents' 60th 20th anniversary. -- wedding anniversary. the cost, though significant to , were much less if my father had been held in a custodial unit. -- were much less if my father had been held in makinin a

custodial unit. and we had come to deal with his recurrent falls. i always thought that he would break a hip. i knew he could never survive the surgery and rehabilitation. agitated and confused father when the time came and he was in pain and there was nothing more to be done. .. i could never do this to anyone. i have been steeped in the healing traditions of my profession. i can never by law, order, egypt, cause harm to anyone in my charge. i know that excellent relative care. -- i can never by law, order, or he dedict.

soon, 20% of america's populace will be over 65. by 2015, there will be 18 million people over 85. one half of them will have some kind of dementia. on the 20% will be fully mobile. at the same time they're growing, the numbers of physicians and train nurses caring is shrinking. the number of primary care doctors being trained is half of what it was a few years ago. the american college of physicians calls our current circumstance a collapse in primary care. only 300 verso geriatricians are trained each year. there is only one for every 8000 people over age 65 and america. why did this happen? how has this happened? policy created this problem. perverse payment incentives have undermined primary-care

medicine, have promoted specialization and technology over face-to-face interactions between doctors and patients and families. all insurance systems for medicaid to manage your have undervalued doctors like me for decades now, devalued our time, our cognitive conferencing and consensus building skills, rewarded us only for the wrong things. another trip to the er. another round of antibiotics. another course of chemotherapy. we need to take the time to restore a system where the primary care doctor patient relationship has meaning and value again. peoples family want and need someone to trust, someone to advocate for them, who will go to bat for them, who will tell them the truth. who will talk to them in the most difficult times, educate them and offer options. and study after study has shown that the health care provided by primary care doctors, restoring them to the center of the paradigm, will be less expensive care and more satisfactory care.

and it also involves educating the public about the importance of advance directives. this is a wonderful website would together by the center for medical humanities and ethics. where i teach by our bioethicists in texas living wills.org. we need to educate. we need to educate the public. what procedures, under what circumstances are helpful and which are not, we'll let our health care proxies, what are the role, what can they do and not do? what is the role of the family, for doctor? let me make this clear, nothing in anything i have seen is proposing that doctors substitute advanced care planning for medical care. no one is proposing death penalty were outside experts to decide who lives and dies. i would not be a part of such a system nor would any physician i know. but any system that refuses to reward the work of health care

professionals for doing advanced care planning and conferencing with families during difficult times is preordained to be cold and bureaucratic, sterile and uninhabitable. and will subject our failed elderly who finds him or herself with an end-stage disease at the end of their lives to inappropriate, unnecessarily expensive and possibly futile care. end-of-life discussions are complicated. decisions are often arrived at incrementally your family members often at odds over many things must all be on the same page. and electronic medical record is not much help here here most of the time there is no need to rush the process. it's a lot like health reform ought to be. well thought out and implemented with caution and concern. at the end of his life, my father no longer knew that i was his son. but after each visit with my father, if he was still awake, i said to him, i love you, dad. and it was always a surprise

when he answered, i love you to. because this was something my father could never bring himself to say to me when i was his 12 year-old son, or his 50 year old son. from the depths of his dementia my father gave me a great gift or he would be honored by my your presence here today. thank you. [applause] >> thank you so much, all three of you, for giving us a sense of what it really is all about in the areas you operate in everyday. i want to start, we're going to open this up once again to questions from the audience, but i wanted to ask you. we have heard now in the weeks since congress adjourned that

many lawmakers want to back away from section 1233, that is basically been thrown overboard as far as some of the members of the senate finance committee are concerned. it is too hard to explain. people are too confused. it is just not worth it. how does all of this make you feel, given what you talked about? >> i have very mixed feelings about it. i think in the end, this national dialogue about and of care like there will turn out just as the kerry shopper debacle turned out to be positive. although there was a lot of heat and smoke in the end, there was actually a lie because people basically said throw them out. throw government out. these decisions belong within families. this is not, you know, this belongs to us. and i'm hoping that in the end, that will be the same conclusion

as a recognition that advance care planning is about restoring power and control to the objects of all of this discussion and expense, the patient and the family. and that we have begun, as i and all my colleagues have increasingly been doing, talking to the press about what advanced care planning really is. that we have begun to turn the tide on these lies about death penalty and that's all they are, in his life. and we just need to keep saying that. i also think that the most salient health reform changes to improve access to primary care, geriatricians, like me and jerry, to improve access to palliative medicine are things having to do with workforce. those are much more important than, you know, a $75 payment for a discussion about advanced care planning which is not going to be sufficient to turn the tide on the physician incentives

to keep doing things. all the incentives need to change, so this is just kind of a strongman for assault, but not that critically important in and of itself. if we could do something about loan forgiveness, to get people to go into geriatric nursing or geriatric medicine, or if we could do something to get medicare dollars to support palliative medicine fellowship training which not all the attendant medicine fellowships are is an entirely supported by philanthropy, which is a pretty failed me for public policy. i might add. those policy changes which are unlikely to be controversial would actually have a huge impact on access to quality care. so i am hoping that some of those measures and there in some of the bills that senate finance is considering, survive. and they don't survive this time, we will keep on getting them in next time. >> chris? >> it's a very interesting question, susan, and i think my

concern is that so much of the heat, not only about the death penalty issue, but the others, has not been in any way related to what's in actual legislation, as you know, and as we've talked about all morning. so the lasting in the world that i would want strategically for the nation is to hold onto something that gets misinterpreted and gets used for political or other kinds of reasons, and not get to what we have been talking about all morning today, which is expanded coverage for americans, reduced cost burden for the families, and improving quality of care. that's what we really need to accomplish. and within that, what we are talking about, the end of this morning about palliative care, is part of the picture but it isn't the whole picture. so i would not want -- i would want that to undermine the

chances of a reform package getting through. i do think that diane's point is very well taken, that there are a lot of things we need to do in changing the payment incentives. the previous panel talked about bundled payments, accountable care organizations, medical homes. you could build in expectations about palliative care and about palliative care expertise into every single one of those. that would have much more impact overall than as diane said pang a primary care physician $75 once every five years to have a conversation. that is not going to transform our system. >> and, jerry? >> well, you know, i think a lot of people when they hear about some of the proposed legislati legislation, get frightened. first of all, as i said, they are frightened about the subject of death anyway. they don't like to talk about it and they certainly don't want any kind of top down system imposed on them.

so obviously, you know, as a practicing doctor, i am in favor of education. you are right. every five years of communal, in a conference in the exam room is probably not going to do it. but we have taken great education campaigns in this country to do with other health issues. think about smoking. now we are engaged in one with obesity. i mean, this is, to change attitudes, to get people thinking about these issues and comfortable talking about these issues needs to be an educational campaign. and i don't really know how to do that, but i do know there are people that do know how to do that. and i think that's what we ought to really be focusing a lot of effort. >> i think you all do a pretty darn good job of it and have done so here this morning. let's open this up to questions and discussion from the audience. once again, i would ask you to identify yourself by name and affiliation. if you would like to address it,

to a particular analyst, please do that. if it is one for everybody, please indicate that as well. while we are waiting again for any more to come forward, if we build this kind of system, chris, that you just mentioned, and that the other panelists also discussed, accountable care organizations, where payment goes to an organization and it is not on a fee-for-service basis. it is not stimulating this ct scan that particular intervention, but really did, in fact, engage people as diane said, and when finally there is a recognition that maybe things are not going according to hope and that the time is near. what would these look like? these are also kind of scary concepts for americans because there are not a lot of these entities out there to go to and say see, this is something you might actually like. >> there are, i mean, there are a lot of them but there are some

of them. and they are not small. i mean, we heard this morning about geisinger and mayor and kaiser which is eight and a half million people. and intermountain. and a number of other integrated groups. what could happen with something like an accountable care organization is that you could force the hospitals and all the different physicians specialists to come together and say what do we need to take good care of this population of patients. and then they would figure out they needed a palliative care expert and they would figure out a way to pay for it. and it wouldn't require any specific sort of overengineering if we're going to pay this much for this and that much for that, because these systems would figure out. that is what you have seen happen at tranninety at most of these physicians are on salary.b

this seems a good thing to care about. ultimately, it does end up costing less and there is very poor data about that without anyone having to ration anything or any care that makes a difference. we will really coordinate care and get rid of things like that frightening story that diane told about the first patient where huge amounts of that expense were not only unnecessary but were terribly painful and for the family. a comment darrell made any earlier panel that there are lots and lots of physicians out there who want to participate in this change? >> absolutely. one thing i didn't mention was a conversation i had with judy's oncologist when he offered her

chemotherapy directly into the brain. towards the last four weeks of her life, and she called me and said my doctor offered me chemotherapy into the brain. what do you think? you know, should i say yes to the. he had been hitting them out of the park all for the prior six years, so we wanted very much to take his recommendations. so i called them. eni had been in regular contact for about 14 months about judy. and i said, you know, what are you hoping that this treatment might accomplish for her? and there was a pause and he said, i actually don't think it will help her. so then there was another pause while i took a deep breath, and i said well, do you think we should be recommending that she do this, given that it is pretty high risk? because if you put a foreign object in the brain, the risk of infection. and toxicity is quite high. in his response was very

instructive. his response was i don't want you to think i have abandoned her. so this wasn't about money. this wasn't about that's what he gets paid for. this was about he did not know any other way to signal his commitment to her. to signal how much he cared about her. my job with him was to help them show how much he cared about her by going to visit her at home, which is what i did. i said she really wants to see you. she wants to say goodbye to you. can't you make a home visit? he had never made a home visit in his entire career. he was in his middle '50s. takes care of cancer patients. it was incredible meaning for to her and him. and he spoke at her funeral. hopefully it will make it easier for him next time. but he had never knew how to have that conversation. he never knew how to understand that his presence, his commitment to her is what she needed. not another procedure. but the motivation was to show her how much he cared about her.

so doctors do desperately want to do the right thing for their patients. there are no evildoers here. the system is structured to get the results that we see. >> jerry, i have seen you notting. >> i want to pick up on a point. teaching young doctors, medical school and residency, teaching them the kinds of behaviors that you mentioned, getting them to understand the importance of doing things to patients at architect and logical, but our humanistic is very important. and i have to say that in very -- and not very many places as it ought to occur, is this occurring in america today. i have really had the privilege. it has been a privilege, my wife and i., my wife is an attorney, and we both volunteer our time to teach a basic ethics module

at the university of texas health science center in san antonio, both in the first year and the fourth year. and, you know, what do we do? we have conversations like we're having today. we read essays. we read short stories. we read poems. we talk about these very difficult conversations that we must have with patients, and how important it is for us to be attentive to these needs. i mentioned in the beginning of my talk that i deal a lot in nuance. you know, patients very often are afraid to ask these questions of us. how long do i have? what is therapy going to be like? what can i expect? but if you are taught to read the nuance in your patient, in a face-to-face conversation, it can make a tremendous difference. you can really have a breakthrough with someone. and this needs to be a standard part of medical education.

and just like everything else, very often the dollars aren't there for those in medical schools. i mean, we don't treat patients at the center. we don't get research grants. we read poems with medical students. you know, why should that be paid for? in our system. well, let me tell you, i believe that this can make a big difference. it has made a big difference, and so aside from educating patients at end-of-life issues and advance directives we need to educate health professionals in being able to engage their patients during difficult times. >> can i just add to that? i mean, think about mrs. g.'s pain, untreated pain. really come her doctor did not know how to manage pain. i hate to break it to. most of her doctors had ever been taught to manage pain. you should be scared.

they don't know what they are doing. it wasn't in the curriculum. most medical schools have no mandatory training on this, what they are very good at integrating somewhat and putting them in the icu. or you know, ordering a cat scan, we are really good at the doing that. but the most fundamental human needs have been lost from the curriculum, and most medical american schools and we have no national control over the curriculum. medical school by medical school determines this. it is a huge problem and there is no health reform without medical education reform. >> let's take a question here in the front from gail. >> i agree with the concept that has been raised several times about the need to change the reimbursement system, reward the kind of behavior we would like to see. i am very supportive of selective loan forgiveness. i think it'd be much more effective in an era when medical

schools missions are very high and physician income growth has been very low, or negative and were not giving it enough attention. but aside from changing the monetary incentives, important as that is, i am going to implore you to use your influence, to indicate that this is more than just about getting the money redistributed. it is going to be, how do we try to make sure we have the full spectrum of people who could be working on these issues, how can we make more and better use of advanced nurse practitioners to help us with our shortage of primary care physicians. you talked about training new positions in these issues, which i applaud. i am going to plea with you, we need to figure out how we're going to reach this stack of physicians, 600,000 strong or whatever we are, that are out

there. we can't rely only on helping to retrain the new ones coming through. i have to say, when i have spoken to physicians that are in residency, or while they are still in medical school, i am not overwhelmed that they are treating, seems that much different from the training that other positions, including my husband, who was trained in the 1960s, somebody not fundamentally different. so i'm going to urge you, because you spend your life on these issues of trying to think about in addition to arguing for more money and for better recognition for primary care and geriatrics, and in particular, to think about strategies that we can use to reach out to existing physicians. i was, diane, when you talk about the lack of knowledge about pain management, but i don't know is, do you think that most physicians know they don't

know about pain management? i mean, is that sort of the first thing that we need to do? you don't know what you're doing, but actually there are ways to fix that, just like you can call on other people to help you and hear our modules that you can take in your next cme about pain management and other issues ask i think that it's just not enough to talk only about more money and not enough to talk about only reaching out to the medical students. i mean, that is just not going to get it done. >> gail, you couldn't be more right, and i would point out we do talk a lot about the pipeline, but every physician is expected to learn new stuff throughout the course of our careers. we all do that. and actually now all 24 specialties within the abm as boards require periodic recertification to show that you have been keeping up with your knowledge. so ashley have a tool now where

we could begin to both offer that kind of education and also measure it and told physicians accountable. and actually recognize them when they achieve it. so i think that your point is very well taken. you should be aware that some good news on the horizon, we've been talking about all the problems out there, is that 10 different specialties got together to create a subspecialty certificate. diane was very involved in this, in hospice and palliative medicine. medicine. so there now are board-certified specialist in this area, and notches in the primary care arena but in several different surgical specialties, in psychiatry, in neurology, in pediatrics as well. so the fact that there is no kind of a recognized way of saying this person actually has these skills should allow us going forward to be able, and maybe even have, you know,

educate consumers, especially family members, ask these kind of questions. you know, do you have a specialist in this area, or do you have expertise in palliative medicine. learn that term, and ask people about it. that will begin to make a difference to. >> well, i appreciate your comment, gail, but i have to say this. someone who is work and the fee-for-service medical sector for over 30 years who has been basically at the mercy of whatever medicare, cms, decides every year what my services are worth, i have to tell you this when you talk about, let's not talk about more money in the system. and i'm not talking about that either. i would like to see them shift some money in a system that when an air nose and throat doctor gets more money for cleaning blocks out of my patience here because that is a surgical procedure, then i get from a 90 year-old woman comes into me and tells me she has had a little spell and i have to use my time,

my diagnostic skills to try and figure out is a serious, does she need to go to the hospital, do i need to do some tests in the office, what can i get away with with this woman and it might take me an hour. and somebody cleans wives out of an ear and gets more money. i would say there is a problem with the system. and in my estimation, and i talked about medicare being flawed system. it is very flawed, but it is fixable. it is fixable. if someone will sit down with doctors who have been doing this for a while and say, you know, how would you fix this? is it right that an mri scan is reimbursed at $1200, but you get, but dr. winakur, you get a $60 when a patient comes in with a little spell? well, i say yes, we don't need more money in the system, but we need to reallocate what is in the system. >> all right. as we wind our way to a close, i want to do a slightly different

version of what i did with the earlier panel where i asked the earlier panel to speak to their elderly parents. i'm going to turn things around and ask you to speak to your children or grandchildren. and i know chris in particular has a very smart 13 are sold year-old grandchildren i want you you to imagine infinite you a couple really sharp 12 and 13-year-olds who are your grandchildren or your children, and i want you to tell them what your hopes are for the health care reform debate that we are having in this country. and in particular, with respect to these issues. now these of course are going to be 12 and 13 euros. they are not prepared to think about death or dying, but they perhaps are smart enough to know that they too will get there someday, or they certainly sensed that their parents or their grandparents will. so you have 30 seconds of their attention because they are about to go play on the wii or

something else like that. >> what a great question, susan. well, what i would say is if you are right, not to talk about death, but most importantly, this gets to the topic of the whole session today, is that my hope for her would be to live in a country where she didn't have to worry about going broke because of health care expenses herself personally. that she could live her life and be confident that there would be some reasonable approach to providing medical care for her parents, for me, and for her, should she need it that would be affordable. and that she could be confident that'sthat is qualy

care. i have been enticing carrot into going to medicine, of course. -- i have been enticing her to go into medicine. this would be a personally rewarding career as a physician knowing that you can help people in the ways that made sense. >> well, i have a 23-year-old and a 20-year-old. what i say to them is that i'm working for a time so that when they are my age, there will be no debates about health reform. everyone who is born an american citizen will know that they have access to high-quality medical care just as they know that if they put a letter in a mailbox, it will arrive. that is not true in many parts of the world.

we take this for granted. we want a system that people take for granted, that it takes quite -- that it is consistent, people can benefit from it, they can get the care they need, no matter who they are, no matter what their income is, that is what i'm working for so that my kids and their kids will inherit that kind of system. >> jerry, the last word to you. . . who we call doctors. one has a degree in redish romantic poetry. [laughter] >> and the other is about to earn her doctorate in counseling psychology. why they did not choose to go into medicine, i think, well, we touched on some of those issues today. today. but what i want to tell betsy and emily is that your father has written down and you know

where it is what he wants when it is his time. and i encourage you to, at some point in your lives, have this conversation among your own family and write it down. >> and on that note, we will bring this to a close. i want to once again say that health affairs really is so grateful to the organizations that made his forum possible today. the robert johnson foundation, the association of american medical colleges, the american board of internal medicine, and the american hospitals association. we pledged to bring you a serious discussion that was at the level that the topic demands, a serious health reform as we said demands a serious discussion. i hope in the process we have also brought you one that you have found provocative, stimulating, informative, and as

we heard from the last panel, even emotional. thank you very much for coming today. please take a look at our website, [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> as a healthf care conversation continues, c-span's healthcare hub is a key resource. go on line and follow the latest tweets, video that, and links. you can also give information on

the senate debate in your opinion about healthcare with a citizen videos. the c-span healthcare hall at c- span.org/healthcare. >> members of congress are holding town hall meetings brown the country as their on their brink. -- break. dan lungren talked about health care legislation. see his comments and their responses tonight at 8:00 on on c-span. tonight at 3 our conversation with alice walker, winner of the pulitzer prize for her book "the color purple ball we." see their comments tonight at 9:30 p.m. eastern. open time washington times close

he is interviewed by the founder of a normal and national organization for the reform of marijuana laws. on afterwards, saturday at 10:00 p.m. on c-span2 's tv. this fall into the home to america's highest court, from the gramm public places to those only accessible by the justices. the supreme court come in the first sunday in october on c- span. >> now today's white house briefing. [unintelligible]

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[no audio] [no audio] >> we are having some technical problems with their ideal here. we will try to fix the problem and bring it back to you in a few minutes.

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>> we are having some audio difficulties. here it ends at a different point in the program. -- here it is at a different point in the program. >> there are some differences i do not want to get tremendously involved in. i would reiterate what we have said before. the economy that the president has inherited upon taking office was at the brink as many said was sliding into farther recession or possible depression. actions taken working to make the housing market work war for america. to deal and address foreclosures.

you see some good news and some not so good news. the president is pleased with the fact that it appears we are making some progress in stabilizing the economy. we will not be satisfied until we get the economy fully back on track. >> tell us how you see things playing out after the president returns in september? yesterday's nancy pelosi said to cannot pass a bill in the house without the public option. the last thing you can knock

td.:çiwsbd public auction. have you things unfolding in september? the sitcom down to -- does it come down to a committee in resolving differences? >> obviously, you got a myriad of opinions on either side last night the senate finance committee members spend about 90 minutes on the phone working through and making progress on their ideas. at the white house has gotten that on the phone call. the reports on the phone call for that they were making progress. i think they believe that the president strongly believes that they should continue to work on a bipartisan basis to

try to get agreements on what is outstanding in order to get a bill to their committee and hopefully out of their committee in a timely fashion. it is hard to know exactly what is going to happen then. we hope that the senate finance committee will continue to work to make progress on that side. we will see what happened in the house. it is hard for me to appear too far in the future. >> what about splitting the bill and having reconciliation? >> i was certainly reading the reports on the. i have not heard a lot about it. we are working with republicans

in democrats. >> it has been a long month since the health-care debate >> it has been a long day. >> what has the president learned this month in terms of the health care debate? >> i hesitate to call august the make or break it month. i know you geysers spending a lot of money on branding. -- guys are spending a lot of money on printing. i do not know which bigger network will make it. if this thing makes to october, it'll be a more important month. not to " the president, but even know, i think that much is always made of where things are

at a certain time in the process. the president the point is not to worry about the 24 hour cycle and worry about the overall process and policy. they do not know that i would read a tremendous amount into any specific time frame like august. if you look at the nbc poll, there is a lot of heat around town hall meetings. it showed that an equal number of people were more favorable by healthcare than they were less favorable. if i do think the president has used august and the town hall meetings that we have had and

will do again into timber to continue to tell people about why health care reform is important, what we can afford to do nothing. the stakes that are involved and try to push back on the misrepresentations of on your still out there about healthcare. >> you are not saying the president has learned anything over some predetermined amount to time? you see it as he needs to be more of a vocal face out there? >> i am bouncing rebalancing that was how the president is overexpose. i think he will continue to be out front in september and october in trying to get something done. i think he understands. i think we have made progress. if you look at what the poll showed, the president has made some discernible progress about

the government making and applied health care for seniors which is not want to happen. it is not in the bill. him being out there pushing forward on the rumor is why the american people and seniors do not believe that it exists. >> just a side note. the polling numbers makes it look much better than it actually is. it shows is again drop-in support. -- shows a significant drop in support. the release of the lockerbie bombing. the president said he hopes they will place him under house

arrest. people are outraged. >> rightly so. the images that we saw in libya yesterday were outrageous and disgusting. we continue to express our condolences to the families that lost their loved ones as a result of this terrorist murder. we communicated with the libyan government. we continue to watch what they do in the days going forward about this individual and understand that the video that you saw yesterday's is tremendously offensive to the survivors that lost a loved one. >> the guy who shook the

president's hand runs libya is thumbing his nose at the president. let's we are watching the government to see how they respond. >> [unintelligible] >> do you mean blackwater? i asked for an update which i have not yet gotten on where we are in different contracts. as a relate to the cia contracting, i would direct to specifically to them for responses on that. if you use the sweet voice on the phone never know you could get. >> i want them to stop killing. >> you should let them know. >> you should, too.

>> did to say whether the administration will sport on whether to split the bills? >> almost all of legislative affairs is happily on vacation. >> you cannot get an answer. >> he described it as a beautiful place in the mountains of new mexico. if my number comes up on his caller id, he will ignore it. it goes to voicemail. >> you have no idea? >> i've not received any further information. our focus is on continuing the process that is going on now and the focus that democrats and republicans or together on a bill. >> one of the readout from the

call last night suggested that they are looking at scaling back its ambitions in terms of how to cover reform. is bipartisanship so important to the president that he is willing to scale back some of his plans to accomplish that by partisanship? >> we have to look that old and a new -- he is going to evaluate old simile any piece of legislation as to whether his goals and principles for health care reform. i have seen -- i'm told it is part of the 90 minute call and that there was not a large amount of time spent on this topic, that the focus was on continuing their negotiations about comprehensive reform. the president's goal is not to print a banner in sign a bill just so somebody can say we have reformed health care.

there are specific goals and principles, cutting costs, increasing coverage, ensuring that we have the type of insurance reform that protect consumers against the type practices that we have seen in the past. those a part of the goals and principles. >> members have talked about a change of heart or that they learn something about -- by attending these town halls and a change how they feel. has the president learned a thing or taking anything away from town hall meetings? he seemed -- he seems to be in the same place he was on health care reform. >> i think the president't has taken away that we can have a discussion about a very

important issue. as he said, not above each other but with each other. that is the case yesterday on the phone calls to govern the radio show. the questions that he got in, new hampshire are manceror montk he continues to be very resolved to getting something done on this issue. the president continues to believe that's the worst possible outcome is doing nothing. we know what happens when we do nothing. we no premiums are going to continue to skyrocket. we know small businesses are one to be an able to afford coverage. they are either going to drop the idea of covering employees or drop the number of employees that they have employed by the small business. we know that insurance companies will continue to discriminate based on whether not they believe somebody has a pre-

existing condition. that is what it is doing nothing would do. the president is determined that we will do something to move this process along. >> you are aware that conservative group took a shot of the president what he is vacationing in martha's vineyard. i wanted to get your response. there is a larger issue of him going somewhere instead. >> this is the same individual the we talked about who is the recipient of the largest health- care penalty ever issued by a federal government for fraud for a company he was the ceo of. leaving that aside, i do not

think the american people begrudge the president taking some time with his family that is well earned in will desert. -- and well deserved for a few days. >> can you shed any more light that there might be some event during a scheduled vacation conference calls or appearances. what is we-weed up? >> i do not know i should do that from the podium. it is a phrase i use. i will do that. must do this in a way that this family friendly. that is when people get nervous for no particular reason, when they -- look, i think the way

the president used it was -- i talked with you about this. in august of 2007, the rap on the president was -- they are doing -- it can possibly win the nomination let alone the presidency. august of 2008, everybody was nervous about whether the entire presidential campaign was slipping out from underneath the hands of the president to the previously did not think could be the nominee. this is an aug. punt and pattern between riddick pandit pattern between you getting overly nervous for something that has a long way to go. bedwetting would be the more consumer friendly term.

in terms of the first thing, i think we will have some sarah gets out doing so. i do not think the president will break his vacation. i do anticipate as we talked about that he will continue to touch base with members of congress in the house and the senate on the finance committee to check in with them about progress that is being made. >> getting back to libya. what is the show that went out on the tarmac going to have on prospects for any improvement in relations? >> again, we have registered our outrage. we have discussed with the libyans what we think is

appropriate as we did with uk and scottish officials. -- and our opposition to the release to begin with. we will continue to watch the actions of this individual. >> would you acknowledge the show they put on has set back prospects for improved relations? >> i felt comfortable saying that the administration believes that the images that were broadcast throughout the world were outrageous and incredibly offensive to americans and particularly to those who lost their loved ones on that flight many years ago. >> what was the president's specific reaction to what he saw? >> i think i'm conveying his sense of what those images

encapsulate. >> the president said the cash for clunkers program was successful. if that is the case, why are you sending it? >> this is a temporary program to assist consumers, manufacturers, car dealers in replacing old and outdated cars with far less efficient -- that got far less of fishing miles per gallon to trade it in for one that fits far better miles per gallon. it was designed to be temporary. it has been enormously successful. it is so much so that we are winding it down to ensure all the applications will be funded with the $3 billion that congress approved in two steps. >> the money has run out. >> right. the program has reached its

limit. this is not a program that was originally designed based on the time frame. there was not an ending amount of funding. there was first $1 billion appropriated. congress then was concerned that the program needed more funding and was doing well. they approved an additional $2 billion. i will say that thus far, the government has approved and processed 170,000 applications in roughly a three week time span. it was originally produced to process 250,000 applications in a three month period. to address any concern about the backlog and the number of applications that we have received, the president suggested to triple the number

of people that are processing those applications. there has been a lot of discussions about this. the states that a dealership received reimbursement, within 10 days of a completed and approved application for reimbursement. what we are experiencing is you get these applications based on a sale. some of them are not completed. some of them black information or have been filled out incorrectly. -- some of them lack information or have been filled out incorrectly. once they are approved, we are meeting the 10 day time frame of reimbursement.

all major automobile makers are now supporting any liquidity problems that dealers might have in that 10 day period of time. i think the president was pripet -- correct. the program has been successful. >> just picking up on that. didn't congress originally authorized this as $4 billion? >> we originally requested $4 billion. congress is part of the supplemental appropriations and approved $1 billion. when that was nearing its finality, an additional $2 billion. since the match -- >> and to imagine $4 billion, while $3 billion? >> it does clearly been successful.

>> it is designed to be a temporary program. there is no way now to get an additional money with congress out of town. >> i'm curious once they do come back. >when they think of taking more money to go up to the $4 billion? ? >> they have until 8:00 p.m. eastern on monday. based on the flow of applications, the administration is confident that is inappropriate amount of time to end the program and be able to process and fund all the applications that have been fembot. >> tom-will it with a bipartisan

group -- tom-shal daschle is wia bipartisan group. [unintelligible] we suggest allowing states the option to establish plans of their own. even then, in mid june, the town hall had not become a topic of conversation across the country. then he would say the public plan is an impediment to a final product. is the meeting today about talking present into believing that are talking, sachle into believing that it? more importantly, i think the

city s today and saturday. -- more importantly, i think he said the issue in today that we have to insure quality to drive down costs. to achieve that, the preference is a public auction. we are open to other ideas like the one senator daschle. >> do you agree with that assessment? >> i think he will use the opportunity to talk about where we are in health care and ideas for continuing to make progress. i'm sure that is a topic that will come up. >> the poll this morning has 49% of the country believes the president will make the right decision. 55% pretty seriously believe the country's on the wrong track. >> what was the number in november? >> i cannot tell you.

>> i think it was in the 70's. >> it was different in january or february. i am wondering if you have any anxiety that the broader health care debate is not changing the numbers on health care but having an effect on the way the entire presidency is being viewed? >> the short answer would be no, based on the fact that the president's overall approval rating is 57%. that is a healthy number for a president's approval rating. i appreciate you giving me the opportunity to fill in those blanks and. i think the president will be the first to tell you this is a complex issue. health care reform has never been easy. this process is one that is

messy. i do not doubt that -- look, if you ask people if you are seeing information and as a result of this bill, a 55% of the american people believe illegal immigrants are going to get health care as a result of this bill despite the fact that the bill prohibits that, i do now doubt that weighs down on people's perception of the bill. it is knowingly untrue but he will continue to hear that. >> out with some of numbers of health care itself. -- i wasn't just talking about numbers of health care itself. i was talking up the overall view. there is some indications that

the number have disappeared during the intensity of this health care debate. >> we will continue to of body weight that. -- to evaluate that. i think you can look at any poll before the president made a decision about extending money to the automobile companies said they did not go out of business, not necessarily the most popular thing. increasing our troop strength in afghanistan was not the most popular thing. those are decisions the president believes is in the best interest of the automobile industry. we will certainly continue to look at them. the president will continue to make decisions on what he believes is important in the

steps of have to be taken on health care based on what's as in the country's best interest. this is our job to fix. >> in addition to being the president's friends and democratic leader, does that hinder his ability to give the president unsolicited advice? is there a vetting process to know hugh he is representing when he goes into the oval office? >> the president has had a relationship with senator daschle that dates back to 2003 and 2004. the president knows and expects that when he asks him a question that he is getting the opinion of senator daschle and not

anybody else. >> [unintelligible] [cell phone ringing] >> leave it to me to take a cell phone predicted a bone before vacation -- leave it to me to take a home before vacation. >> he was willing to be a one- term president if it and many health care reform through. is that a message that you have heard him say? is that his view? >> i do not know that i had specifically heard it on health care, but i have heard the president say that if making tough decisions in getting important things done that washington has failed to deal

with for decades means that he only lives in this house and make those decisions for four years, he is quite comfortable with that. the way he approaches this issue of the economy, afghanistan, and yet these issues, is not a motive self preservation or how best given all the information out there. it is not what is in the best interest of his personal pulling options. >> does the president's plan and a policy announcement next month regarding the closing of the detention facility in guantanamo bay? >> obviously, we've got several task forces that are evaluating the detainees that are there and making determinations about what

comes next in order to comply with the president's executive order of january 21. i do not know of any specific time lines formed out. obviously, we have had it ministration had -- the administration had eight jurisdiction to suspend this mission. they continue to meet with the president. i do not have in front of me any notion of a time line for the decision. >> it is my understanding that the president need to submit some sort of plan to congress before the start of the next fiscal year, october 1. is that your understanding? >> i would have to double check. i know there are some requirements on task force

requirements that relate to information that was passed as part of the supplemental. i would have to tackle more that is. -- check on a where that is. legislation requires the commerce been notified about any potential detainee transfers. i mentioned on august 7, congress was notified that up to six potential did teams could be transferred within the next few weeks. -- detainee's could be transferred within the next few weeks. there is some sort of -- i cannot bring it out it is a classified document. i will check on that. i know there is a deadline. it may be next monday when it is released. >> sunday or monday.

>> do you rule out the possibility of president obama traveling to guantanamo bay, cuba? >> i do not see why he would. i do not necessarily see why it is necessary for him to go. >> the ranking republican in the house and house committee says that [unintelligible] that if that place was picked for detainees, that it will be an act of terrorism. what is the administration's position on this? >> i will check on the disk -- on the declassification. we are working with local

communities. the multi jurisdictional groups met with local officials to discuss the possibilities. no final decisions have been made. i think it bears repeating. i forget the number. i used to have it in my head. there are a number of individuals that have been convicted of war held because of their involvement in terrorism in prisons throughout this country very safely. there is a super max facility in colorado that holds some particularly gruesome individuals that have yet to --

the conditions around that town have yet to devolve into what congressman hoax seems to think might happen in a different part of the country. >> to the president tell rabbis and we are all god's partners in matters of life and death? if so, what did he mean by that? are his religious convictions influencing his views about what should and should not be in the health care? >> i think the president has talked. i think the rabbis are a group that invited him to be part of a call because of their moral and ethical beliefs and how they relate to health care. i think the president has talked about it. he has a healthy and long standing of separation of church and state.

>> can we look at the transcripts to see? >> i will certainly see it that is a possibility. >i can hardly hear you. >> [inaudible] some people have been terminated. what is the u.s. government going to do about this company? hiding these people. >> out have to look at some of the instances you are talking about to have a sense of what involvement the government would have been that. >> have you spoken to the president about these two bills? >> only that the focus is on

seeking a bipartisan solution. >> you seem to open the door to reconciliation one way or another. >> he said -- he has said that for months bill he is focused on getting something done. we know is what happened -- we know what happens if nothing gets done. no, it was reality. >> why did the white house not without a statement on tom novak? >> i'll talk to the press secretary about that. look, i would say that i did not know that. mr. novak was somebody who wrote for when the local chicago

papers -- one of the local chicago papers. no matter how you felt about his personal political leanings, think the president would agree with many that have said they had respect for his reporting and for his ability and opinions even if they did not agree with them. that is probably a good lesson for all of us either in august for town hall meetings or as we move forward on issues like health care. >> in afghanistan, there are reports of voting irregularities -- irregularities. in reaction? >> i reiterate what i said

yesterday. the preston has tremendous respect for the courage of millions of afghans that went to the polls in the face of threats of violence and to choose their leaders. we will -- i think it will be quite some time before we get preliminary results. we will watch that as we move forward. >> did you get a sense of a president's vacation? we heard you make off with the president. what is he going to do with his time off? >> i have no idea fees went to gulf -- if he is going golf. i think he will spend 80s imparted this time relaxing with his family. there are no official events scheduled in the week ahead. i anticipate that he will play golf in number of times.

i do not have anything that says that he will play with tiger woods in the next few days. >> did the white house make the decision [unintelligible] >> i think there is to read these going out -- a release going out announcing a delegation that will be sent out shortly. i do not have the list in front of me. >> after the federal reports about blackwater and the cia targeting programs -- where does the new obama administration draw the line between the government monopoly to release the report and the legitimate outsourcing of parts of the business to private contractors?

many democracies are very skeptical about outsourcing. >> the president talked about and has instituted and an openness for contracts as part of the new administration was something that you were done as a member of the senate with tom coburn. i have asked for some guidance on what contracts we have and where we are with those in relation to the company formerly known as black water. i would encourage you to contact individual governmental departments for specific comments on contracts that obviously have been left during prior and ministrations as part of that department.

>> there is a hurricane bill headed toward newfoundland. are we prepared now better? >> the president has received regular updates from john brennan throughout the week on the progress of the hurricane across the caribbean. he has great confidence in the personnel that he has put in positions, whether it is in charge of the department of homeland security or in fema to deal with, whether it is a hurricane like a train that could come ashore or any other natural disaster that the government and the american people could face.

it is our hope that the storm will avoid reaching the united states and turn back out into the atlantic. there will be a busy hurricane season. we will continue to monitor it throughout that time. that is all the time may have. have a good week. >> as the healthcare conversation continues, c-span's healthcare hub is a key resource. go on line and follow the latest tweets, video ads, and links. keep up-to-date with healthcare events like senate debates and even upload your opinion on health care with a citizen

video. the c-span healthcare hub at c- span.org/healthcare. >> members of congress are holding town hall meetings across the country while they are on this summer break. dan lungren talk to constituents in california this week about health care legislation. hear their comments and his responses. that is on c-span2 at 8:00 p.m. eastern. tonight we will have a 3 hour conversation with alice walker, the pulitzer prize winner for "the color purple." si netroots conference comments tonight and 9:30 p.m. eastern on c-span. >> q and a sunday night on c-

span. >> how c-span funded? >> private donations. >> grant and stuff like that. >> donations. >> i do not know where the money comes from. >> how is c-span funded? america's cable companies created c-span as a public service, a private business and it. no garment mandate, no government money. >> before they for camp david, president obama talked but yesterday's presidential elections in afghanistan. the election commission is expected to release preliminary results on december 3 and final results about two weeks later.

ellen is a few words about the elections in afghanistan. this was a huge step forward, even as violent extremists were trying to stand in the way. the election was run by the afghan people. it was the first democratic election run by afghans in over three decades. more than 30 presidential candidates and more than 3000 council candidates ran for office, including a record number of women. from 6000 polling stations and forces to believe in providing security. over the last few days, we have seen acts of violence and intimidation by the taliban and there may be more in the days to come. we knew that the taliban would try to derail this election. even in the face of this brutality, millions of afghans exercise the right to choose their leaders and determine their own and destiny.

as i watched the election, i was struck by their courage and the dignity in the face of this order. there is a clear conference between those who seek to control the future at the ballot box and those who killed to prevent that from happening. extremists have shown them willing to murder innocent muslims, men, women, and children, to advance their aims. the future belongs to those who want to build and not those who want to destroy it. that is the future that was sought by the afghan to want to the polls. the united states and not support any candidate in this election. our only interest was reflecting the will of the afghan people. that is what we will continue to support. we wait for the official results and the electoral complaints commission.

we will continue to work with our afghan partners to strengthen afghan security, governments, and opportunity. our goal is clear, to disrupt and destroy al qaeda. that will be achieved in our troops will be able to come home. our men and women in uniform are doing an extraordinary job in afghanistan but a so are the civilians who served by their side. all of them are in our thoughts and prayers as are their families back home. this is not a challenge that we asked for. it came to our shores when al qaeda launched the 911 attacks from afghanistan ameri. american shares a common interest in securing security opportunities and justice. we've afford to renewing a partnership with the afghan people as they move ahead under a new government.

i want to congratulate the afghan people on carrying out this historic election. i wish them a blessed month as they come together to welcome this. thank you, everybody. >> shortly after his comments, president obama and his family left for a weekend at camp david. from there they had to martha's vineyard for a weeklong vacation beginning sunday. >> this fall, into the homes to america's highest court from the grand public places to those only accessible by the nine justices but to the supreme court coming the first sunday in october. >> he is interviewed by the

elder of nor wall, the national organization for the reform of marijuana laws. that saturday at 10:00 p.m. eastern. fembo>> in a few moments, represented lundgren hosting a town hall meeting on health care. after that, president obama comment on the afghan elections. from today's "washington journal" president obama is policies. -- obama's policies. . .

>> thank you for being here. this is tremendous. we often times worry about whether anyone will come to our meetings. we do not have to worry, now. that is why we send out notices and so forth. i appreciate the fact that so many of you have come out and it seems to me that this is a great demonstration of democracy in action in our third congressional district. i think you for being here. -- i thank you for being here. [applause] normally, i would spend closer to you, but we brought in more

shares. unfortunately, a lot of people could not get in and they are outside. we have some speakers so that they can hear. we can see if we might be able to have people come in with questions from outside especially those of you here that i can see. let me introduce a number of members of my staff so that you know who they are, you can contact. if we cannot answer your question tonight, give your question to one of our staff members and will do our best to get back in touch with you. peter is my deputy of staff. he comes to me after two weeks of vacation spot with his wife who is a captain in the united states army that just return to afghanistan.

marilyn is the administrative director of the office. she oversees operations of the office and handles affairs in the district and does average for the office. betty jones, who is out here as well. liz donnelly joined our staff in the last month and bob ellis is the senior field representative over here on this side. i got bob from the sacramento bee. he was a career person in the press. oliver is the one you would contact if you have issues with the citizenship. michelle is here.

michelle is the constituent services rep. for those of you who have not been to one of these meetings before, you would wonder why we have to talk to the department of state. of the issue passports and we hear people -- hear from people the day before they have to go to europe and south america. we can generally work magic, but it helps to give us more than 24 hours' notice. crist o'connor is a great young man who has been working with our office. i was privileged to have some discussions with his dad. his dad is a pow in vietnam. his dad is a great guy and we are happy that we have chris working for us. the center weisman work for me

for many years when she was a child. she left before forces she also -- she left me for horses. she has worked on the senate side and has worked tand done a great job for us. she has done an outstanding job. our communications director is also from washington d.c.. let me just see, even though the manner in which we manage these town halls, this has been suggested to be a health care or leased primarily as a health care issue forum. this would be the second one i had.

i have one a month ago and folsom -- in folsom. i have done three telephone town halls where the primary subject was held care. let me just say this. i think that the outpouring and passionate views of the public have made a huge difference in washington d.c.. [applause] after i had my town hall meeting in folsom, a month ago, i went back and told my colleagues what i had heard and what i had seen. the passion, the interest, the knowledge that people had about this issue. i said that this is something i have not seen on a domestic issue in attend, 20, 30 years. this is something that is important to people and they

want us to get it right. there should not be a rush to judgment. we should figure out what they want us to do and how we do not destroy a system that is defective. that we do not get rid of the best parts of our system and we should attack the problems that exist in the overall health care system. [applause] in there were some that were surprised that we could not take the time and now we have to pass this before we leave in august. three committees are going to work on it. we will have a 1000 page bill. people that are saying that actually believed it. i've disagreed with them. the president had given us a deadline. i thought it was wrong.

nonetheless, that was the debate. had it not been for the response of average, everyday americans at town halls and in meetings on the street, people stopping me at the airport, if that had not happened to basically all members in the house and senate, we would not have had any breathing room to allow this to happen. i want you to know -- [applause] here is what we will try to do. do we still have cards? we have comment cards for people to write out their questions so i can get more than just the questions i can get to today. secondly, i will try and get the first question on the inside, the second question from the patio and the third question from the outside so that we can

give people a fair chance as possible. you may have noticed that we have some tv cameras here. c-span is televising this. they are filming it and they will show it at some point in time. in order that they can have the questions properly heard, we ask you to either ask the question from this microphone up here or brian has a wireless microphone that he will utilize. if you do not get to the microphone, it will not be heard by the people that are using c- span so i would ask you to please do that. -- that are dealing c-span so i would ask you to please do that. i am the son of a doctor. my dad was my hero. i wanted to be like my dad. as a little kid, i would go on house calls with him and do

rounds at the hospital with him. some of you may have heard that i wanted to be a doctor like my dad. i want to know redan -- i went to college to do that. i did not flunk, but the rigor and the outcome was such that i knew that i should do something else. i never lost my sense of service. when i looked at health care, i looked at through the eyes of someone who grew up with a father -- i looked at it to the eyes of someone who grew up with a father who was a doctor. he took care of people who couldn't pay. he also took care of famous people. he was richard nixon's personal physician. he was an infantry physician in normandy.

his medical field station was close enough to the front lines that he received a purple heart after being injured in an artillery barrage. he was the greatest advocate for his patience than any other person. i saw him get angry at nurses if they did not do their right job and fellow doctors. he was the greatest supporter of nurses and doctors. i heard him on the phone many times. he would say, "oh, you want me to release my position from a hospital. she is 85 years old. i am afraid if she goes home that she will not be able to take care of herself and if she slips and falls and it's a broken hip, she will be back in the hospital and subject to certain potential illnesses including ammonia.

by the way, what is your medical degree and where is it from? oh, you are not a doctor. you just work for the insurance company? i want your name and i want to know where i can reach you because i am putting it in my medical chart so that if something happens to my patient, you will be held personally responsible." the only reason i mention that is because there will always be the need for the doctor to be your advocate for the care that he and you believe you should receive. [applause] in all of the discussions that we have for health-care reform, it seems to be extremely important that we never lose sight of that. when i get sick or one of my children get sick, i do not say that i have to call the insurance company or the government. i say to let me get a hold of my

doctor. let me find out what is best for my child and what is best for me or my grandchild. i think we have lost some of that. if you analyze medical care in the united states, we have the greatest innovation. we have the greatest new technologies and the greatest advances of any place in the world. if you look across the board, whether it is a new pharmaceutical products, new instruments or new techniques, i would not want to go anywhere but the united states. having said that, we have to recognize that we have some problems. there is a significant problem of people who are uninsured. of the president talks about 43 or 49 million people. when you break it down, and you take out 10 million people that are not citizens, when you take out people that our young people

and have sufficient salaries to be able to buy insurance but decide not to buy insurance because they are in the healthiest years of their lives and do not want to do it, when you take those people that are uninsured for a period of time but were injured before and insured afterwards, for those hard-core uninsured, and it is about 9.3 million people. that is not insignificant. we have to deal with that. that is 3% of people that are having difficulty getting care. should we turn over the entire system that generally works for the greatest number of us in order to try and take care of 3% or should we try and figure out how we specifically come up with a solution.

there is no doubt that there are some problems with insurance. i would like to see us come up with portability, meaning that if you move from one job to another, it doesn't necessarily mean that you have to change your assurance. shouldn't you decide when you want to change your doctor as a result of your relationship with your doctor and what your looking for? secondly, it seems to me -- and what you're looking for? secondly, it seems to me that we are always want to have arguments about medical care costs that have skyrocketed. at the same time, we do not want to stop the high quality that we have. how do you do it? there are those that believe that the best way to change what

we do now is to have government funded health care. i do not think that we need to do that. ultimately -- [applause] [applause] as i say, there are others that disagree. the way that i analyze this is that if you were trying to have some way to keep cost down, there are only two ways to do it. you have a government run system and you do it by rationing and i will give you examples of that, or you can try and have greater

-- all of us have he should know what the success rates are. that information should be available right away. you ought to know how much they're charging. some hospitals may charge differently than others. that arms us as individuals to make decisions. we are talking about cooperatives and that might be the case. expanded opportunities and choices that you would have. one thing that i believe might help us in that direction is to say that you should be able to choose a plan that is legal in any state in the union rather than just currently in california. it will be enforced under

california law so that you have many more options. it seems to me that that will help us. some are talking about this. they talked about cooperatives. they have a different view. but here is the idea, as i see it. knights of columbus, kiwanis club, alumni from a particular in a nurseuniversity, you wouldw them to establish health associations and thereby have pools that were large enough to bring costs down. you would be going beyond the polols are available right now such as a you work for.

-- as who you work for. once again, please use the microphone. we have the moving microphones somewhere. there he is. i am going to try to take one question from inside them one from the patio and then one from the outside. from the inside, right here. go ahead. >> i want to make it clear that i have read through the bill. my question has several components so i will try to be quick. the first part of it is that in a stimulus bill, this grants the government the digitizing and collection of our medical records end in one section it

gives the government real-time access to our financial records and if those two things are not disturbing enough for you, if you continue on throughout the rest of the document, there are four sections that exempts the government from protecting our privacy from documents that are in their possession. you can find this on page 304. section 1221 is on page 4 04, section 1301 is found on page 455, section 1866e which is on page 476. my question is, why would i ever agree with a bill that invades the privacy and exempts the government from their current obligation to protect us? >> >> thank you for that

question. you spoke of the stimulus bill going into computerized records. as a general rule, as a general idea, the computerizing of medical records and is a good idea so long as we have strong privacy protections. what i mean by that is this. if you go to a lot of hospitals, you find that they are computerizing their records and they find that to be helpful for a couple of reasons. one simple reason is what i tell you about my dad's and rising. when i went to summer camp, my dad would ride as notes and his secretary would have to type them for us because we could not read dad's writing. there are mistakes that are made because people misinterpret

handwriting. a lot of hospitals are setting up systems whereby the dr enters his record by computer and records are kept. the question is, can we do that with your medical records that are developed and doctors -- and doctors hospitals. if in fact you were traveling and became ill, and you wanted to seek treatment, it would be very good if that new medical provider had the opportunity to review your records that your permission -- at your permission. it would probably eliminate some duplicative tests that they would not have to do. it would allow them to compare them with your previous test to

show a few have had a change as a result of an accident or an illness. secondly, when they are prescribing something for you, it would minimize the potential of them prescribing something for you that as contraindicate if. that is that you may have taken something and they could check your records and know that. in those ways, it would be affected. the thing that i have said is that the devil is in the details. we have had someone who is being prosecuted for hacking into more than 1 million credit histories. >> 140 million. >> in washington d.c., we talked in trillions. -- talk in trillions. if that can happen, think of

what could happen if they got into your medical records. while the principle is a good one, we have to be careful how we do it. there are some sections in the bill that deal with financial records that are supposed to go towards your eligibility for various programs, here. there are any number of programs for which people are eligible depending on their income levels. i am always wary of the government getting too much of my financial records. here is what i would say to you. i do not think that we have done the proper investigation. even though i strongly agree with an it solution, i do not think the protections are in here that need to be here. am i saying that i have the solution? no, i do not.

we have to do a better job of it. that is the problem with a 1017 page bill. frankly, i think we could get an agreement across the aisle on a number of different things that are not complete overhauls of the system, but are changes to the system that most of us would think would be common sense. that is what i think we should do rather than the other way. [applause] >> we are bringing somebody in from the patio. >> thank you for being here this evening. i recently returned from canada and i am a naturalized american said its citizen. one of my friends of fell from may ladder and broke her knee and they did some minor surgery and she will go to toggery in october of this year to get the final treatment after a wait of

17 months. i am not happy of the idea of following canada. [applause] secondly, i have a friend who retired from the house of representatives. i would recommend that we quit all this talk about health plan. could you work it so that all the american citizens can have the same health plan that those that have it on the hill? i am sure your father, the doctor, would think that would be a good health plan for assault. -- for us all. thank you. >> in consideration of the bill before the various committees,

we tried to deal with that question by saying that if the public option were part of the program, all members of congress would be required to be in the public auoption. in one committee, it was adopted in another committee it was shot down. it seems to me that that mechanism that this is one that american people should have. i would expand it beyond the four options. i would allow americans to have access to the different options that are available in all states so that people could make their decision there rather than for me to decide which two, three or four should be there. i was in canada last month.

>> the best i have it is a 2001 survey asking americans and canadian professionals about health care in their countries and found that 51% of canadian doctors rated their emergency room care as acceptable. 80% of american intensive care units were considered excellent and considered to those in canada. 84% of american administrators of the diagnostic and imaging technology was of the grade that they needed compared to only 49% in canada. you may have noticed that the incoming president of the america -- of the canadian

medical society announced this week that they have a serious problem in canada. actually, it is a woman. she described as a canadian health system in a crisis. she said that canadians have to understand that if it keeps go ing on without change, it is in sustainable. she said we all agree on this. i am not saying this to degrade the canadian system, i'd think our system works for american spirit it has problems that we need to deal with those problems, -- i think our system

works for americans. it has problems that we need to deal with these problems. >> i feel like we are now being heard at all in washington and we are being completely dismissed. i've never been involved in politics before, but this is something that is very important to me. my mom is in florida. she doesn't really understand what is going on and so she does not understand it. i am a regular citizen, a soccer mom, and i just came to say that i had been unemployed -- have been unemployed and it is taken me six weeks to even get a phone call from unemployment to get a check. i was wondering how a government run health care would work where it is bureaucratic and i am concerned.

the other thing is, as a conservative and somebody who is for this bill, what are republicans doing and what are you going to do to make sure that this bill gets stopped? thank you. >> thank you. i understand bureaucracies. the other thing i noticed is that when i say that i don't want someone coming between me and my doctor, what i am saying is i think that the choices ought to be made by people who have my confidence. as you make that further and further away from you, the ability of that person to be able to understand yourself chelation and be able to make

that judgment is impaired. in terms of government, there is nothing further from the than the federal government and the system. the point that you make is a very, very good one. will we have a magic change in insurance companies? no, that is not going to be the case. if you have competition, so that you say to your insurance carrier, "look, this isn't working. i'm going to go somewhere else." you can sue the insurance company if they make the wrong decision. you cannot sue the federal government. if you just are looking at those things, no public program is one to be perfect, but i think we stay better chance of having a good system if we increase competition, increase information and knowledge, have important legislation.

there has to be legislation. madison said that if men were sense, we would not need government. then he suggested that we needed government because we are not saints. you have to make sure you watch those that are watching you. you have to be careful of government. [applause] on my side of the aisle, even though we're a distinct minority, the majority party to pass a bill without a single republican vote. they could lose 40 of their members and still win. we do not set the agenda. we tried to present views and alternatives as we think they should be presented an attempt to build a consensus by talking to members of congress to do the

right thing. we have raised issues over this debate, but we have been frozen from our ideas being in the bill. if it had not been for americans, on their own, organizing and coming to meetings, we would say that we would not be where we are now. our obligation is not only to be against something, it is to present alternatives. there are at least four major republicaalternatives. my hope is that the president will now say that we may have overreached. maybe we'd misread the american people. maybe they do not won a total overhaul of the system and maybe what we need to do -- [applause]

maybe what we need to do is try to reach consensus as best we can and start with those things that we can agree on in the very beginning. that would make more sense to me. that is my hope of what will be done as we move forward. thank you very much. we have a question from inside. this lady right here. >> thank you for having this meeting for everybody. i will keep this really sure. >> what you try that other one. -- why don't you try that other one? >> i know that the house can pass this without any help from

the republicans. if the democrats choose to use that option, or to use the reconstruction option, is it possible to reverse this action? he said reconstruction, and i think you mean right reconciliation. they can avoid the 16 boats that they need to overcome a filibuster. the complicating factor is they are limited in what they can do. they can do some legislating on the bill and so it would be a piecemeal bill. thank you for that observation. my concern is this. if we get this wrong, now, it sets in place a structure that would be very hard to undo. that is why i called a profound decision to be made. it is not just going to affect

you and me, it will affect our children and grandchildren. . that is why i am concerned about it. the president has cited the mayo clinic as one of the standing systems of medical care in this country. my dad trained at the mayo clinic one summer before i was born and i visited the mayo clinic when i was a lawyer on a matter. i know people there. they have come out signing a letter with 12 other systems they consider to be similar to theirs although they would not say what they were the best. they said that as they understand it, the plan that has been adopted by these three committees in the house, it would put them out of business. i cannot give you chapter and verse as to how they can prove that, but i can only say that

the system that the president holds up as the best in the country, they believe that if we pass this bill because of various aspects of it, it would end up to be their demise. i have to pay attention to what they say because of their one of the leaders in the world, were you think the saudi princes come? they come to the mayo clinic. they are a plu +. i do not know if that is what the president intends to do, but if that is what they say is one to happen, i think we need to stop and listen. [applause] >> we have another patio person. >> i am a patio person and i had to fight my way in. thank you for taking my question.

just a incidently, there was a customs office to help those saudi princes. in 32 years of selling insurance to people in the sacramento area, i have done a great deal of work with medical care. in the last few years, i have been very successful and my clients have been very grateful to be introduced to a high deductible plans that are held savings account compatible. in the dialogue and in the bill, i believe an hsa would be illegal. they had a $25 co paid for drugs they now know or $150. i have patients that want to have choices in order not to have to pay hundred $25 for a drug. sometimes there are things you

cannot avoid taking, but sometimes people can make choices. what i would like to know, where is the dialogue? is there a place in all of this for the consumer to take responsibility in how their dollars are spent? we buy a flat screen televisions for the nets. that is my question. -- we by flat screen televisions for peanuts. >> that is my question. >> under the bill, after five years, many private programs have got to meet what is said by the public option or by the federal czar that would require them to be with the public

option. by definition, theh hsas would be illegal. what can you do to get people more involved in the process so that they're making decisions and are awaiting decisions with information and with skin in the game. if you look at safeway stores, the ceo of safeway stores has taken it upon himself to become fully invested in the health care of his employees. they have come up with a system in which and there is again in the game. there is a certain amount of money they make available to their employees. that goes towards deductibles. but if you spend more than that

in a particular year, you have to be paying for that out of your own pocket. above that what it does is get you involved in the earliest stages. the other thing that they do is they help their employees with information about comparative costs. an article by red david example -- an article that i read, it gave an example of a colostomy. they went and surveyed practitioners and hospitals within an hour's drive of their headquarters. from what i recall, it was something on the order of seven different options you could have and the prices ranged from $700 to a couple of thousand dollars.

they made that available to their employees, not telling them that they have to go here or go there, but their employees could make a judgment where they took into account quality and cost. the other thing that they did, and this goes to the point that my patio person just made, they tried to create rewards and their health care plan that rewarded -- rewards in their health care plan that rewarded fitness programs and getting your way to a certain level. they were allowed under their system to give you a benefit for doing that. as a result, in the first year, the company's total health-care costs went down 11% and a shared that cost savings -- and they shared that with their

employees. how did they get that done? they provided incentives. that is one of the things that i am not sure is allowed under the bill that is before us in the house. they say it is unfair for you to give discounts for people doing this sort of thing. i do not want the federal government, whether it is the president or the secretary of hhs telling me that i can't eat ice cream or them telling me how much i should wait. i think it is reasonable for an insurance company to say what you're going to pay, but if you do the sorts of things, we believe it will give a healthier lifestyle. we are allowed to give you a benefit for that. i happen to think that that is

the kind of incentive system that americans respond to. nobody takes away your freedom. you are allowed to make a rational judgment, but your actions have consequences as opposed to the government somehow mandating so that we become a nanny state. i think that there are things that can be done. there are other companies that have done the same sort of thing. i think that these are the kinds of ideas that we should be taking into consideration as we try to do something on that level. >> we have somebody from the outside. [applause] >> you're doing such a good job being polite and c-span might be disappointed. but let's disappoint them. >> i may senior citizen, a very senior citizen. i am absolutely against what is going on in the health care thing.

i do not want it. that is a statement and not a question and understand the dynamic for a question. my question is, to you, there are hundreds if not thousands of people out here. i have been told that pre planning did not think that there would be this much interest and this is the biggest room that you could get. i would like to nknow what you would do to listen to the rest of the thousands of people that are outside during your vacation from the senate. >> some people would think that you of elevated me to the senate. >> here is what happened. this is the largest in you i could get. but i can find a bigger one if you need help getting a bigger room. >> we are going to have to more down-home meetings.

we have one in rancho cordova? >> what are you going to do to come back to citrus heights and listen to the thousands? >> i will be happy to come back. >> good. " usually our problem is whether anybody will show up. i am happy to do this if we could arrange it again. of course, we would have to say that anybody that came in this time could not come in next time. bucs you have been here. you have no idea how many people are outside. the parking lot was full of people were still coming in from across the street to listen to you. i think that somehow, during a recess, you need to provide a way that you can hear the rest of us. >> i will be happy to see if we can arrange that. thank you very much. >> thank you. >> guess? >>-- yes?

>> i had a quick question about health rationing. there has been a lot of talk about a public auction. you can see that i have got a very handicapped son. if it becomes and obamacare rationing, i am curious -- there has been a lot of speculation. >> whwe can argue about the specifics or the details, but if you analyze the government run plans, and let me say why i'm speak about government-run plans. there was a suggestion that the public option is off the table. the president's spokesman just this afternoon said that it is not off the table.

that has been misunderstood. [applause] here is the reason why i have a concern about the public auctiooption. if you look at the student loan program, we had a private option and a public auctioption. they said that the federal government should take over. they said the federal government could do it more cheaply. i am just telling you what we just passed. we have one of the best companies in the entire country that has done an outstanding job of processing these loans and keeping young people current with those loans and added up the federal government can do the same.

secondly, if you look at the medicare advantage program, that is a program that was put in in the last administration and it was to offer a private sector alternative to regular medicare. my district has one of the highest percentages of senior citizens. under this bill, it will emasculate the medicare advantage program in areas like my district. thousands of people will no longer be on medicare advantage. [in distinct yelling] >> it becomes a public monopoly. it is difficult to have competition to drive down costs.

the ultimate way you do it is by rationing. in the united kingdom, they'd just announced that there panel that besides the effectiveness -- that the sides of the effectiveness of treatment will decide that they will no longer allow painkilling stairwell injections for people with low back pain. they said they have 60,000- 90,000 people that take it. that resonates with me because about eight years ago, i had what appeared to be low back pain and the only way i was able to recover from it was that i went to a pain specialist and i got the deed to their rural and killing injections. i was trying to think, if i had that pain and i was in great britain and i am told that some

panel who was never seen me as a patient has decided that for purposes of bringing costs down, they're going to stop that, i would be going out of my mind. that is why i have a great concern about it. are we ever going to have all the money we need? no. how do we handle it the best way we can? >> i think you have competition and transparency and in special cases, where government needs to assist with funding and the children who are handicapped and those sorts of things, i think all of us would understand that as an obligation that we have. to immediately turn it over to government, and predicted private sector, -- and forget the private sector, i think we can. >> i would like to thank you for the opportunity to ask a question.

i am a recently returned peace corps volunteer. i am currently unemployed. i am unable to find a job. i'm ineligible for unemployment insurance as per rules of the peace corps. i will have to cancel my health insurance next month because i do not have a job and i cannot afford it. i have a pre-existing condition. more people voted for the president than the republican candidate. the promise me and everyone else, the majority of the third district, to not only represent the views of the vocal minority but also the views of the majority of the third district that desperately want and need health care reform? thank you. >> as i said, i believe we need

reform. the question is, what type of reform should we have. [applause] >> i do not support a whole cell overturning of the system that we have. [applause] >> i do say that there are things that we must do with respect to pre-existing conditions. the republican alternative had amendments to try and do that in a way that was different than what the bill had, but nonetheless, to provide for that. secondly, with respect to those that have an inability to get insurance, for various reasons, there is a group of people, we should be able to establish a program to assist that. some proposals would include --

[inaudible]

first of all, i would like to thank your staff, there were thousands of people that have come out tonight. there are so much -- and there is so much energy out there. i am happy that still could be let in. following up on the last person question, in looking at the

health care reform, the needs are many in the resources are relatively few. my concern is, there are illegal aliens in the united states. that number is between 25,000,030 million is more accurate. in southern california, there are between six-6.5 million. i think the 30 million is much more specific. my question is, in trying to do research in the health care reform bill, i could not find anywhere were specifically denied health care benefits to illegal aliens, nor could i find anything that specifically granted them rrights.

my question is, can you unequivocably say that we will not be funding illegal aliens healthcare out of medicare and medicaid, currently, in california, and i work for the department of health services, we are spending millions to provide emergency care for indigent and illegal aliens. the other reason that i am asking is because right behind that, i have seen a preliminary bill for illegal immigration that the administration is proposing. they're talking about opening up the doors for 24-hour amnesty approval with no background checks. we have a problem. we have people that start fires

because of drugs. we have people who are here illegally. we do not know who is here and who is not here. getting back to my original question, will this reform, the way it is written, fund the little alien health care. >> that has been brought up. that he had no specific provision for it. when they were going through this bill, a congressman from georgia, congressman nathan deal offered an amendment that specifically said that you would have to show some evidence of citizenship in order to qualify for medicaid as it exists or under this new program and that was defeated 29-28. there was an amendment that was brought forward in the next day

and by a democratic member, zak space of ohio but it did not have any requirement to show any identification. my sense is that we should bring an amendment on the floor would require proof of citizenship in order to be eligible for one of these programs. [applause] >> i think you very much for your time for your frank answer and i hope you will be as diligent when the illegal immigration reform bill comes up because from what i saw on lou dobbs, cnn is supposed to be impartial, and it sounds like it is not very good for the american people. . .

>> she is the speaker of the house. i did not vote for, but she is the speaker. she did say that she is going to wait and have the senate act first. the action, if there is action on immigration will be on the senate side first. what you described, it will not go anywhere. >> why is it so difficult to close the borders and develop an immigration plan that is

rational? i'm sorry -- >> i will be happy to deal with that issue for another town hall. are they going to allow me to go outside? >> i would like to share. i live in carmichael. i definitely am appreciative that you do these. i think it is vital to the health of our country to have this kind of a forum where we can tell you what we think. it is kind of a lost art form in our country today. that is one of my concerns. the question that i have for you is, i have been a registered republican for 40 years. recently, after the last federal election in november of this last year, i redid my

application as to which party affiliation i am going with. i said i am declaring nine. i am so distraught on both sides of the aisle. [applause] and i am leading to a question. the concern about both sides of the aisle is that it appears to me that because of party politics, there are an awful lot of issues that cannot be resolved because of partisanship. if we would be able to put away the partisanship of republican or democrat, and understand that our congress is there represent the people of the country, they would go a lot further in terms of solving some any problems -- solving so many problems.

as a person in your district, are you going represent everybody from this district when you go back to congress? or are you going to represent the public in -- the republican perspective, which concerns me deeply? >> i try represent the perspectives that i will share with the people that i represent. more often than not, that is the republican perspective, but not always. i try to work with people on the other side of the aisle. i am the main author of the safe ports act, the security for the ports of the united states. i went out and sought a democrat from southern california to be my co-sponsor. while i was running for re- election and while i supported john mccain and his ticket, and opposed senator obama and senator biden, -- i worked with

senator biden on a crucial piece of legislation to protect our shores from illegal drugs and the potential of terrorists explosive materials and outline what is note -- what is known as semisubmersible vehicles. i was working with him to make sure we could pass, on a bipartisan basis, legislation that i felt was good for this nation. i believe we passed that on the last or second to last day of the last session. i have tried where i can to do that. i am working with jim mcgovern, a democrat from massachusetts on a bill. it is about reducing our overall nuclear arsenal to levels that i think are sufficient to protect this country. we dedicated some of the funds

said -- some of the funds to the program directed at identifying and securing nuclear weapons from the old soviet union as well as nonproliferation and the rest of the world. a portion of the savings will go to assisting poverty and education in the underdeveloped world. a significant portion goes to reducing our national debt. i cannot reach much further than jim mcgovern to work with. when i was in congress the first time around, the soviet union was still in existence. the wife of a famous dissident in the soviet union had been seeking our treatment. she had to go back, so she went to the congressman from the area in which she was staying. it was barney frank.

she said, were you accompanied back to the soviet union so the kgb does not do something terrible to me? barney went to the speaker of the house and asked permission and funding for it. he said only if you get a republican so it is bipartisan. he came to me and asked if i would accompany them back to the soviet union initialing of the bipartisan nature of our belief that the dissidents in the soviet union ought to be protected? and when we were there, we would meet with people with whom we had identified as democrat and republican members. i have always tried where i can to reach agreement. but where, on principle, we cannot reach agreement, i will fight for it. [applause] there are times when you can do that. if you truly believe that something is the wrong approach,

i don't think it helps the people you represent or this nation to say, and the spirit of bipartisanship, i'm going to forget what i think is right and agree with that. i hope that is the answer -- [applause] >> thank you for being with us. this bill, you want to address cost effectiveness. in listening to certain radio stations and certain members of my colleagues, we are interested in the moneys that have been set aside in the bills. i know there is more than one bill. i am referring to the bill that is over a thousand pages. there are quite a bit of moneys for an increase in abortion.

i would like that addressed. it is supposed to be cost- effective. the word "abortion" is not in that bill. it is addressed and their reproductive health care. what are your feelings on it? and the politicians who claim that they are pro-life, what are they doing in regards to these moneys that are being appropriated or that may be appropriated? >> i happen to be pro-life and have voted that way. [applause] but even with those that disagree with me on that, there has been general agreement that we would support something that restricts federal funding for abortion. it says, you may believe in abortion or believe in right to choice, but it does not mean you

obligate taxpayer dollars to be used for it. [applause] and that has been generally accepted with democratic and republican presidents. if you have a public auctioptio they have made it very clear that the public auction will include abortion coverage. at the end of five years, all private insurance programs that still exist must meet the standards established by the new czar in this bill to provide the same coverage at least allowed in the public option. that means federal funds would be allowed across the board that were not allowed before.

while it does not specifically overturn the amendment, in a different way, it causes federal funds to be used for abortion and obligates every single policy out there to provide abortion coverage. it does not talk about it. but because of the way it works, enforcing those standards -- by the way, if your employer at that point in time, and a policy that you have for your employees does not meet those standards, you get fined. not only is the option not available, but you will be fined if you do not provide it. i think that is a very troublesome development. [applause] >> i have been outside for an

hour, and there are a lot of people out there. >> i will be out there at 8:30. >> i know there is a lot of details -- and the drug companies, all the different entities involved. my concern is, these policies that are going to be determined , are you willing to put your own family on those policies and entrances -- and in assurances? well nancy pelosi allow her children to be covered by those insurances? >> as i mentioned before, there was a specific amendment offered before the education and labor committee to require the president, the vice president,

the members of congress to join the public program. the amendment was offered by congresswoman -- a congresswoman in north carolina -- she supported the one offered by congressman blunt in misery. -- missouri. it was defeated saying it was procedurally out of order. in another committee, it may have been adopted. into committees, it was not adopted, and one committee, it may have been adopted. i would say that what we ought to do is increase the opportunity for competition, increase the number of options that people have, and have that as the answer.

do not have a specific public option, and some people disagree, but i believe it will inevitably lead -- inevitably lead to a public monopoly. [applause] >> i would still like to say, if it is good enough for americans, it is good enough for our legislature. make it good. >> the first time i served, i was elected in 1978. the members of congress were not under social security. my thought was, if you think is good for everybody else, you ought to be under it. the bill was passed in 1982 that put members of congress under social security, forced them to pay into it like everybody else. >> it would get a lot of

promotion if the legislators would say yes, i like this. >> you notice a lot of them don't want to be in it. that ought to tell you what is wrong. >> thank you for coming in allowing us to voice our questions and concerns. my question is somewhat related to health care. i know there is a health czar, and 40 or so others. my question to you is what you think about them, and the shadow government being created? [applause] in addition, i want to know who is paying their salaries and what they are. >> let me try to break it down into two parts. the chart i brought here shows

the 53 agencies, departments, and programs that would be created or would have increased programs or policies in them. the colored boxes are new agencies and departments. i use this to provide -- this is the health-care provider on that side. this is you, they call the consumer, i say the patient. the other question you had it is about members in the administration. one thing they looked at was cabinet officers. cabinet officers are supposed to be top advisers to the president. they thought was important

enough for the president to select whom he wished, but to require them to have the consent of the senate. what has happened with the development of czars. even though every administration has had people like that, we seem to have many more this time around. is it a legitimate way for the president of the united states to say, look, i want advisers close to me. i do not need the congress approving by advisers. every president has had that. or is it an attempt to try to get around the constitutional requirement for consideration by the senate and confirmation by the senate. i am worried because it appears -- [no audio] i find it to be troubling.

i find it to be a difficult proposition if, in fact, any administration wants to work with the congress. it ought to upset the senate more than the members of the house, because we do not have the opportunity to have these people come before us. i will admit, on the senate side, for both democrat and republican nominees, the senate has gone kind of crazy on the way they deal with confirmations. there is such a lag time when a president comes then, before he has his cabinet or his people that have to be confirmed by the senate, you put a present -- the president can't have as people there for the first six months or so. we ought to streamline that, and the senate ought to get a grip on itself. i am still bothered by an administration that seems to be proliferating czars.

i do not like the name czar. [applause] old-fashioned historical concern of mine. >> [inaudible] >> i do not know about communists, but i worry about them as they are. >> i agree there accesses and abuses in our health care system today. i disagree with the complete destruction and overhaul of the system. the term throwing out the baby with the bath water comes to mind. [applause] several things come to mind that would lend themselves to constructive legislation. health insurers denial of payment and limiting payments for unnecessary procedures, medications, and devices which lead to over billing by doctors and hospitals to recoup lost

income from health insurers brings about lower payments from insurers and brings about greater inflated billing. on and on, with a ramping up in pricing. it is completely out of the realm of reality. bringing both camps down to realistic starting point based on real world costs will greatly reduce the overall cost of medical service. tied with that, we have the fda. the people of this nation are being poorly served by the fda, an organization that approves drugs with little independent testing. it relies on tests paid for by the manufacturers themselves. it is not looking out for the best interest of all of us. the fda limits and seeks further control over natural remedies

and substances which, in many instances, creates artificial drugs. it allows and encourages over inflated drug companies, and over inflated pricing of medicines. the fda needs to be reached in may -- recreated as a servant of this country. >> most of the complaints i hear, the fda does not improve drugs more quickly or quickly enough. i believe we have tried to respond to that issue by accelerating approvals were appropriate. secondly, drugs that are made for the flu, swine flu, that sort of thing.

it may not be utilized if you happen to be -- happened to make the wrong choice. the government in some places subsidizes its. you also have some drugs that are necessary for immunization on a large scale. we know that a minute number of people or percentage of people are going to have adverse reactions. the lawsuits can be enormous. it could create a disincentive. we have certain immunities that are allowed. fourth, when you talk about natural substances, the congress dealt with that about a decade ago. it was under a bill that was sponsored by senator hatch from utah. one of the questions we have now is, did they go too far? some people are seeing that they take supplements. supplements are not enforced by

the fda. there are those who question quality levels of supplements and whether or not some of the ingredients in supplements are actually harmful for people. we have not recognized that. it is usually athletes, what was in it, what did they take, and so forth. i am not an absolute defender of the fda, but i have to tell you that under all circumstances, with the contending force that combat them, they generally do a pretty good job. i think there are some real scientists there. one of the issues they usually comes up is, what about generics? why can't we have generics earlier? it goes back to our constitution, the promotion of science. i forget the exact term.

it is why we protect artists rights when they write a song or when they perform, we protect new patents for a number of things including drugs. the ada is, we want people to use their ability at coming up with new ideas, and it requires some risk in terms of their intellectual capital and money. in order to have people continue to take that risk, we want to make sure they have a benefit that is financial. the way we do that is to allow a number of years in which they have the exclusive right to that which they came up with. we had a problem 27 years ago when the fda took so long, the effect of life of the patent was very limited. we had an extension on that. generics come along after the

life of the patent is over. they have to prove to the fda that they can produce the very same thing. the patent is available for everybody to copy. so long as they can prove that they can produce the very same product, chemically speaking, in a safe manner, they are allowed to put it on the market and don't have to go through the same sort of approval process as if it were a new drug. so we have these things. there are also other things that are new kinds of pharmaceuticals that are biologic in nature rather than chemical. that as a whole other thing we can go into. i see is after the hour. i promised everybody that i would go up there for a while. >> congressman, we have time for one more question right here in the front. >> i thought i was in charge, but go ahead. >> these guys from washington

and they are in charge of everything. >> since we have such a large crowd outside, everybody in the audience, could you please exit that your right over here to the side. i can't let you go out this way. the police department wants everyone the exit right there. >> yes, ma'am? >> i am a retired registered nurse. i also was a small business owner. i would like to know, maybe someone has asked, private insurance carriers have been demonized by the president and by the congress that allows -- has anybody addressed the fact that medicare sets -- the insurance carriers follow suit. if medicare says they're not going to cover it, the insurance carriers also did not follow

suit. this is a really big deal with the mismanagement of the system of medicare at this particular point in time. had you feel about the fact that we're trying to expand the role of government and we can't even manage our medicare system as it is? we're losing money, there is fraud and abuse. you do not have enough officers to track down that fraud and abuse. the demonizing of the insurance carriers should go back to medicare, i would think. that is a government-run program. that would be a concern for me if we are going to do public intervention. i believe we need health care for all, but we need to do it in a more appropriate way. >> it underscores what i have been trying to say. government does some things very well, but i cannot do a lot of other things. in this case, it comes down to the question of, as you say, when medicare says they're not

going to cover something, that is what the insurance companies do. it gives them only as to what they decide. what happens is, on the government side, if they're going to try to save costs, it is by way of rationing. they do not have an alternative because they are a monopoly. do we want to try to keep costs down as much as we can? there is a way of doing that, it is called competition. we need more information so we can be informed consumers. so that we, as individuals, are empowered to make those decisions, not big brother making them for me. thank you very, very much. i am going to go outside. we have a town hall on health care in jackson on saturday at 10:30 a.m.

and another a week from wednesday over at the city hall at 7:00. thank you for being here and being so courteous. [captions copyright national cable satellite corp. 2009] >> he said to go this way. he city can't get through here. >> planning on attending a local town hall meeting? you have a video camera? you can submit your video to air on c-span. visit c-span.org/citizenvideo for details. coming up on c-span, new jersey gov. john four resigned and the

economy -- corzine and the economy. and rep lungren hosting a town hall on health care. >> this fall, and to the home of america's highest court to those places only accessible by the nine justices. the supreme court, coming the first sunday and -- in october. >> in new jersey gov. john corzine was on a panel of online bloggers and activists. it is an hour and 10 minutes.

>> a good morning, everybody. thank you for attending. i am a blogger for "mother jones" magazine. the topic of today's session is the economy and the twenty first century. what i want to start out with is a couple of minutes, sort of setting the stage about the economy in the first decade of the twentieth -- twenty first century, and how we get to fix this mess. we have all got a pretty good idea of how we got here. we have had the biggest housing bubble in american history. when that bubble burst, homeowners lost trillions and trillions of dollars. there were a customs -- they were accustomed to using their homes as atm machines.

their wages have been stagnating for the past 30 years. it peaked during the bush administration when not only wages were stagnating, they were stagnating during an economic boom. that had never happened before. no regulation in the financial regis -- industry have levels skyrocketing, and the collapse of the housing bobble led to the collapse of wall street. in addition, the stock market crash at the same time was a few trillion dollars more of lost wealth. we have lost $10 trillion to $15 trillion in the last couple of years. what all this happened, the global financial system turned out to be a lot more fragile than a lot of us thought it was. and we were only able to avoid a replay of the great depression

through massive intervention, both monetary and fiscal intervention from the federal government. it looks like our economy might be turning around. we are not out of the woods yet. here is something to think about. it in the 1981 recession, it took about seven months from the bottom of that recession until we had as many jobs as we did before the recession. those were the good old days. in the 1991 recession, it took 29 months before we recovered from that, before employment recovered. in the 2001 recession, it took 55 months, over four years before jobs recovered. today, it looks like we are maybe getting out of our slump.

we are facing in our third jobless recovery in the past two decades. those jobless recoveries are getting longer and more jobless every time. medium wages are still stagnating. the american dream is used to be a house in the suburb. it turns out that picket fence needs a paint job and is looking pretty rickety right now. that is our subject for today, how to fix that fence. that is what our panelists are going to be talking about today. let me introduce our three panelists today. and a burger -- anna burger is the chair of change to win, a coalition of unions representing 6 million workers. and she is a member of the president's economic recovery advisory board. [applause]

dean baker is an economist. if he is the co-director of the center for economic and policy research. he blogs at the american prospect. he was probably on top of the housing bubble before any other economist in america. he is one of the guys that got it right. he is also the author of a founder and plunder, the rise and fall of the american economy. [applause] and finally, john corzine to spend his time in the 90's as the ceo of goldman sacks. he is currently the governor of new jersey. gov. john corzine. [applause]

let me start off with a quick question. maybe you can give us a little bit of an overview at things. given where we have been for the past 10 years and where we are now, what are the two or three biggest risks, challenges that we face going for the next couple of decades? >> let me start with the immediate future. you were saying this in the introduction, we're going to have a long period of very high unemployment. i used to be a big pessimist. i was on a panel the other day with mccain's chief economist. we were all agreeing that we were looking at 10% unemployment next year, continuing the high

end of 2011, and backing down in 2013 or 2014. it is an unusually high. of unemployment. beyond that, are we going to be back in this pattern of bubble and burst growth? a lot of people talk about this period of healthy growth for the economy was growing very rapidly. wages grew at the rate of 1.5% or 2% a year. profitability was very high, and everybody was gaining. then we had this period in the 80's where most of the gains went to those at the top end of the income distribution, which led to this institution -- there is a gap. the biggest risk to me is

whether we get back into that story, where once we get the economy back on track, as it of having this pattern of healthy growth, we get another sort of unsustainable trouble -- unsustainable bubble driven growth. then we're facing another horrible situation. >> what might keep us from getting there? >> the unions are a big part of the picture, and if you look to the post war period, unions were a big factor to make sure that wage gains were broadly spread. over 30% of the private sector was unionized. that makes a very big difference. our trade policy has also made a very big difference. it has been deliberately tilted towards hurting working people.

we can have open trade that leads 3 distributing, -- that leads to redistributing, and those are really big parts. we have to fix health care. president obama is exactly on the mark. it is not just providing health care, but it is an economic meter. if we had the same per person health care costs as canada, gm would of had more than $20 billion of additional profits in the last decade. consider that as a start. >> what keeps you up at night, anna? >> we know how to grow the economy, but you cannot grow our economy on low-wage jobs with no benefits and having people being

buried in debt. [applause] we have to grow our way out of the economy. let me say i am so glad to be here, i am glad to be part of an organization where we can sponsor a nation and the advertisers with you. we work together in the future -- is even more important. making change that works happen does not happen before elections, it happens afterwards. we can make things happen. we need to figure outow to clean up the financial industry we also have to shake the country on its head because everything has been going up to the top. we need financial regulatory reform and consumer protection.

we have to turn those jobs in to good jobs. we can do it by investing in low carbon economies, we can do it by creating all kinds of jobs and the health-care crisis. we have to make sure they're not just low-wage jobs, but good jobs. we need to make sure that when workers want a voice, they can have it and share in the prosperity. what keeps me up at night is that every single day in america, workers want to have a voice and there is an employer that is threatening them, intimidating them, and violating the law so they do not have a voice. i want to see a day when workers can share the prosperity, and we can go back to a time where we shared prosperity across all levels, not just give it to the top 1%. >> what might keep us from recovering?

>> i am not going to repeat everything said, but the distribution of income is completely skewed in the country. it is shrinking our middleclass. when that happens, we do not have an economy that functions well. we have seen huge disparities brought on by a lot of the things that have already been talked about. tax policy is completely biased towards capital as opposed to labor. we need to have a change in our fundamental structure and our tax folks. the idea that you are paying 15% on dividends and capital gains verses marginal rates for middle-class tax people is 25 or 30%. it is unacceptable. there is a lot of work to do there. i believe we have to change our educational policy so that we have skills that are actually

matching the world that we live in. we're giving up our competitive edge. we don't have the skill sets actually compete in the world today. i think that is a huge mistake. it does not mean you have the good of vouchers, it means he had to change your curriculum's and have things to make you competitive. we do not put any money on the making sure that we are leading the world and a lot of these efforts. i believe there are a lot of structural issues. the trade policy is completely screwed up. we do not have free trade in regard currency trading, but we do in regard to production. i believed that there are a lot of fundamental, pivotal changes , all the things that come in on

the collective bargaining. there are a lot of things we ought to do if we want to make sure that america's middle- class succeeds. >> i know you have some opinions, how do those things work together? what are we doing wrong? what should we be doing right? >> starting on the trade side, there have been wont -- there has been one side of protectionism that those on the top and, workers like me, doctors, skilled professionals -- it is difficult for foreign professional to come and work in the united states. economists always look in a kind of blank-faced. it is really silly. it is very explicit.

if the university wants to hire a foreign economist, a foreign born economist, had to say that the first tried to hire a u.s. citizen or green-card holder. walmart does not have to do that when you get shoes -- when they get shoes. it is an exclusion is policy. economists look you like, what are you talking about? intellectual property is an incredibly backward method. it has the biggest downside -- by 2012 is expected to be over $300 billion. a competitive market would be about one-tenth as much. it is almost 2% of gdp, an enormous amount of money. it is a really backward way of doing it. the vast majority of drugs brought on the market are

copycats. they did not offer new cures. they are simply trying to get a chunk of the patent grants. it gives enormous incentives for drug companies to withhold that. it is quite a contrast. if i do a study, somebody calls me up, i ate in expected to share it. -- i am expected to share it. in medical research, it is never shared. it really indeed researched the way we have this. we should have much better ways to finance it. it leaves a very high prices for drugs because we impose this on other countries. i say we have this very backward in terms of our trade policy and intellectual property. i would say just a word about copyrights. a around the world, countries have to have u.s. copyright

standards for disney. we can push that on them, but if they have to have labor standards, i would be an interference with domestic policy. i do not quite understand that. i think is very backwards. >> i think i would just add to that. we have selectivity in regard how we deal with currency. and we leave ourselves in a position that undermines working people in this country because we allow a fixed exchange rates to work against our manufacturing sector and our middle-class families. all of these issues are totally disconnected from the rubric of so-called free trade. we do not have free trade on anything other than things that

are accentuating the bottom line of corporations in america. it is one of the areas that structurally has to be seriously reformed if we're going to see an opening up in a resurgence of investment activities in the investment sector. >> and we do not have a long- term economic plan for our country. we actually need to do that. we really need to move to a low carbon plan, job creation, and we need to figure out the transition. a around the world, some countries are thinking about what it would mean to do a transition to a low carbon economy. they understand there could be new jobs, different jobs, and loss of jobs. had you -- and how do you make a plan that can deal with all of

that at the same time. you can take care of people losing jobs and to be thinking about how to do it in a way that creates the best job possible. the united states lost a tremendous amount of our manufacturing base, moving into a service economy. where do we go from here? can america exist as a largely service economy oriented country? do we move on to a grain economy? is that more hype than reality? >> just because it is a service economy does not mean it has to be a low-wage economy. [applause] it is why unions came together, because we represent service workers. there are a lot of workers. we can get there because we thought we could raise our voice

and have a decent standard of living. on the assembly line at 50 years ago, they did not have an inherently valuable job. their job was valued because we had a union that had at good wages, health care, retirement. we can do that for the service economy. we have good wages for service workers or they can support a family, raised their kids, give them a better opportunity, and do it by organizing. at the same time, we need to be able to make things. go back to a manufacturing base in this country. a low carbon economy, a green economy gives us the potential to do that. we can create jobs, build things here, and to transform our country. we don't just leave for homes,

but for public buildings, private buildings. it is a huge amount of work that needs to be done. >> as a ground level politician running a state, green jobs in new jersey, is it reality? is it happening? >> first of all, it is a reality. we're on track to produce, over the next five years, 20,000 incremental new jobs in the green economy. there is a huge effort going on to prepare and train people for restructuring those buildings, bringing with authorization to public buildings, and to do it in our neighborhoods across the state. there is a second sector in installing a lot of the alternative energy efforts that are going forward. we used to have more solar panels in new jersey than in any other state.

we are moving forward with offshore wind. we do not have onshore wind, but we can produce 3,000 megawatts of offshore wind. the installation will produce jobs. what we need to do is make sure we are producing the turbines and the equipment associated with it. when we do this, we are creating a whole new industry. it is not going to solve the problems in a total holistic way, but it is a major step forward. we have to make sure that we give the kind of financial support so the people who want to make those investments can do it. and we need to train workers that we're doing fully in new jersey, setting up separate unions that are actually

focused on the green job economy. i think we can make real progress in creating -- in creating jobs in using the change we're working and as we go forward. >> it has become fashionable in some circles to say the united states will no longer be a manufacturing company. the people are saying that. the arithmetic does not hold up. if you say that we're not going to have a deficit equal to 6% of gdp, but maybe 10% of gdp, how are we going to pay for that? one of our main service exports is actually the fees that are charged in the courts where people offload ships. we're not going to pay for manufacturing imports on those fees. another is tourism. the idea that somehow we are sophisticated people and we do

not manufacture goods, it does not sound to me like more high skilled work and working in a factory. at the end of the day, unless there is someone in the rest of the world prepared to give us huge amounts of money, we're going to have the manufactured goods. we have a future in manufacturing, there is no way around that. >> to emphasize anna's point, we have a lot of immigrant workers in meat packing and construction. those are sectors i often see referred to as low paying jobs that are unpleasant. they did not used to be low- paying jobs. if you go back 30 years ago, a meatpacking plant had a good paying jobs. it has only been because it was deteriorated and unions broken. whether a job as good or bad

really depends on the situation, whether it is an organized job, what the social situation is. we can make any job a good job. >> one of the main reasons for this, in the last third of the 20 a century, union densities collapsed. private sector densities are down 10%. how does that change? how do we get unions back? word is the employee free choice act come in? -- where does the employee free choice act come in? and the regulatory bodies making the economy more and more manageable -- how does it all come together? >> if you think about history that started out -- from 1935 to 1947, workers wanted to have a union, and they could. it led to the greatest economic growth in our country.

in the late 1970's, there is a supreme court decision that unions had to go through a terrible election process, they could not just sign a card and have a union. employers began to harass and intimidate workers. it was just so painful to win a union. 70% of workers would have a union if they did not have to risk their job to get it. campaigns would have a worker fired. 90% of employers were hiring union busting firms to teach the managers have to intimidate workers. workers would be threatened that their places would be close, pay cuts, all things that happen every single day. that approach has led to making it harder and harder for workers to have a union. as union density has gotten smaller, the standards for other

people -- it is not just about standards in the workplace, it is everything else as well. right now, if you double the private sector rate to 15% density, instead of having blue dog democrats, we would have true blue democrats. union voters vote for them -- would vote for progressive candidates. it is about what is good for our country as a whole. we can be out there supporting candidates that support working families. passing the free choice act is important. if workers want to have a union, they can have one. it says when employers violate the law by intimidation, they get really strong penalties as they do not do it. the third thing is, if they want to have a union, they can.

there are two wars in the workplace. what about keeping people from having a union and the other one to keep them from ever getting a contract. we can do it when we pass the employee free choice act. wheat and level the playing field. workers can board and ensure the prosperity of the country. that is what will happen with all of our support. we can make this happen this fall. we will have 60 votes in the senate, and we can give workers a chance to have a decent life, sharing the american dream. [applause] >> macro economically, what does higher density unions mean? >> following world war two, you had broadly shared prosperity. you have rapid activity growth, and it was widely shared throughout the economy. i am not going to say it is the

only factor, but it is a big factor. picking up on her point, it is not just the direct effect that unions said they wanted to share the gains and profits, but it is also the indirect effect that you have that every important piece of legislation in the last 60 years would not have gone through without the backing of the unions. recently, think of minimum-wage legislation. there is something to make sure that people get a decent wage when they get -- when they work. if you get a stronger union movement, we don't only get the direct effect, it will have workers in the position to stand up for their rights to make sure they get their share. we also get a much more friendly political structure. >> new jersey has the highest density of unions in the country per-capita.

we have the second-highest in come in the country. we probably have the widest share of benefit programs. i hear my point in my current election telling me that is all bad. that is why people are leaving new jersey. in fact, it is why people come to new jersey. we actually have a social contract to make sure that we educate our kids, tried to provide broad based health care, make sure the work place and work conditions are enforced. without the union movement, that would not happen. without union participation in the political process, those kinds of commitments would not be made, not just in my administration, but throughout the years. it is the same reason why we have quality retirement benefits, quality health benefits in our public sector. and we have brought dissemination of prevailing wages and maintaining quality

earnings for our folks in the building trades. . the world was global. with the economy was global. we were not we were focusing on their members. a lot has changed.

people believe that we needed to do all grow. we had to do globally as well. we need to figure out how to partner around the globe to be able to pressure on them so that we could actually win. i think it is an example of partnering -- where the employee was headquartered. we could actually win organizing rights for workers here. i think it has organize welfare and all part of the world. i think the labor movement to understand the need to take on all sectors and think about to support each other.

how to have clean tropics that are better for the -- cleaned truck that as better for the environment and community. it is a huge step forward. the word of the laborers are doing with the comanche about concluding them to see what they -- [unintelligible] it is another the partnership with been able to develop. there are hundreds of thousands of warehouse workers who are taking this step off the ships and putting them onto trucks and moving the. -- it. will need to do with the employers who are actually have the power. you have seen as began to change already. if we do not prime a globally, we will not be able to do with the issues here at home.

>> unions are stronger in europe than they are in the u.s.. europe is more progressive. it they have less income quality. they seem to be recovering from the recession better than we are. what is the economic research? is that a coincidence? is it related? >> the first part, they have more quality. that is clear. unions are of more quality. there is good research supporting that. they have much more quality than the united states. i'll give the bad side to unions. most european countries did not have as much stimulus as the

u.s.. one of the stories it was not the same crisis and it was in germany and france and then the mark. you are worried how you are going to pay the market next month. it is really a desperate situation. unemployment benefits help. being unemployed in the u.s. coming you are in desperate straits. what that means is if you are sitting there in germany with 9.4% unemployment is close to the u.s., germany could probably have that and it would not be a disaster. that was the unfortunate side pitta i know a lot of people in europe. why are you all pushing for stimulus? they think it is not so bad. as it what you mean, it is 9.4%.

they said they could live with that. >> because they had -- if a worker is going to be laid off -- i was at a forum and they were saying that in places where they had strong protection, they did not have layoffs. were they had global banks but relying people off, they did not have protection. in the u.k. there is a lot of job loss. at times, where action going to stabilize the economy. -- we are actually going to stabilize the economy they have stronger union said. they have laws that protect them. it is a greater partnership. there is such a thing as a social contract.

even to them up and spit them out. what we need to do is be able to organize workers of the we can bargain to put a value back on work. what you do on the job is going to determine whether your community is living the american dream. we can recreate the american dream by giving workers a chance to share in the prosperity and create more jobs. and make bad jobs better paying jobs. >> how does healthcare fit into all of this? one of the things that i think you are kept them from feeling quite as bad, they have better automatic stabilizers. there is spending in europe that happens automatically counted more than we have in the u.s.. one of those things is health care. everyone has health care. everyone is still going.

that is not the case here. how does healthcare fit into the economy going forward. >> it gives people more security in their jobs. in terms of any quality job, any would be more secure if the know if you lose the use of health care for your family. it to be very different universe. realistically, what will this look like at the end of the day? even the most minimal state change out of this, reforming health insurance to begin no longer discriminate based on pre-existing conditions, that to be a huge thing. with the people in their 40's and 50's -- they are scared they lose their jobs bill never be able to get insurance. i know people that have a heart condition that cannot get insurance. they will pay 50,000 year to look for that. that alone makes a huge

difference. we pay more than twice as much as the average of other countries. it is the same thing if a government to a tax and economy in third in the garbage. -- and threw it in the guard. -- in the garbage. it has the same effect. it is an enormous threat on the economy. if you get their health care system under control, it opens up enormous amounts of resources are having a more vital economy. >> 20% of our budget is held in health-related efforts in the state of new jersey. if we were where you were in european countries, at 9% or 10%, think what we did do on a

$2 billion $3 billion -- $2 billion or $3 billion pay down. the state's are choking on their inability to be able to stay up with these growing health-care costs, whether it is for our retirees or providing the help to people where we are providing universal health insurance. the craziest damn place to be providing health care in a point of crisis as opposed to action preventive care and all of the other things that come with an organized system. we need a public auction -- option. actually, i think we need the most progressive public option capture those kind of dollars

and three direct them to the things that will help our overall economy. i go back to education and basic research. we could do so much more it will not actually paying these it mistreated fees and multiple -- paying these administration fees that are absolutely choking in inefficiency of what is going on. yet to negotiate working conditions. how big of a deal is it to move healthcare out of the picture? >> right near, they are bargaining about health care costs. people who have health care, some premiums will cover those who do not have health care bri. the share of what they can win

is bargaining. make sure we cover every man and woman in the country. there are other kind of benefits. it would be incredibly important. a lot of the workers say they have no health care. the rest of the time we are fighting to hold on to healthcare. >> i'm going to be taking questions for the audience in a few minutes. if you have questions, we will have some guys with microphones going around. keep that in mind. i want to go back to the beginning of the crisis. that was wall street. you have a unique perspective. >> i only talk about being in the marine corps now. i stay away from the wall street stuff. >> you spend a career on wall street. you are the ceo of goldman sachs. you have also been on the other side as a senator and now governor.

two questions. to what extent you think wall street was responsible for what happened over the last decade? as somebody who ran a big investment bank and now is on the other side, what needs to be done to rein in wall street? what kind of regulatory framework to do we need to have going forward? >> when there is nobody watching the hen house, people who are charged with generating rate of return on capital and making money will go to extremes. that is exactly what happened over a very long time frame. there was a stepping away from the regulatory supervisory responsibility. people who were regulators and not believe in regulation. they did not believe in washington and what was going on. as opposed to tightening or

expanding supervision, and they actually lose and all of the rules nonstop for about 25 years. if there were innovations in the area, it was excluded from the regulations. directives of being the most visible example. that allowed a build up in leverage that people who said the risk reward is let's take the risk and we will get rewarded and if we fail somebody else will back us up. the loss would not be to the individual or to the institution. i love the people that worked at failed institutions got job someplace else. -- a lot of the people that work at failed institutions got jobs someplace else. institutions and not have to go to the cleansing process of failing. i put most of the problem from

the standpoint of not properly structuring regulatory sense institutions. more importantly, the people in charge and not believe in regulations. there was no checks and balances. the risk reward equation at an institution got way out of balance. senior management had a lot -- at a lot of the places the not put it on the institutions themselves. that is a potion for what has happened and what you describe in your opening remarks. you have to have people in charge of the institutions you do have that believe that they have a responsibility to protect the public. if you are reading ayn rand as your philosophical format for how you go after looking at the

regulatory structure, you are going to get a different olive for those that agree that there is a responsibility. those people need to be divorced from the industry that they regulate. we need new element of regulation that take into account the it fans them. the idea that we are now 20 years into the development of derivatives and there is no effective regulation of those is impossible to understand. when i was a ceo of goldman sachs, i was scared because i saw other people utilizing these things that were actually going to back of long-term capital. it could destroyed a firm because we had to deal with people that were leveraged to the hilt. there is no consumer protection

and how these instruments were used. this initiative that is being talked about in washington, to have some sort of oversight of how financial institutions interact with the consumer market, is absolutely essential. if we do not do, we will have not learned one damn thing. >> i do not want to pick on wall street. i want to bid on the whole financial industry. lack of regulation as part of the problem. it was all about greed. i'm trying to figure how they can -- they weren't taking incredible risks that would risk people's jobs, communities, and economy. we do need to regulation.

when it is too big to fail, it is too big. we need to figure out how to have banks that our banks. we need to figure out how to separate products to make sure that the ones that to guarantee for real people are what they say they are going to be. we need to figure out real reviews of hedge funds. we saw what was happening in private equity and hedge funds when they were leveraging private companies and taking out all the wealth for a few people and selling them with huge debt. workers loss of benefits and pay and patience loss capita a few people could go off with a lot of money. we saw what is happening to our members of consumers.

they were being sold bad and dangerous products that they cannot afford and did not need. then there are losing everything. we approach it from both perspectives. how you deal with private equities that are bad for our economy and workers? i do think we need to have for a transplanted. when have to have good systems. we should not have a conversation that is tied to a rational risk. we need to figure how to take risks out of this financial system sorry not saddled with a. we have ceos who made a lot of money by making bad decisions. [unintelligible]

need a system that will look at the whole picture so we can take some of that stuff out. i totally agree. we need a consumer protection plan that will do better than congress in september. guess who's against all the financial regulatory reviews -- reforms? the financial industry. wall street and the banks have all come out heavy-handed thinking they can own our country and get away with it. we are going to have to push them back so we can turn our economy around again. [applause] >> the problem with regulation is not a past tense. it is the present tense.

there is a lot of good stuff there. goldman sachs is now a big holding company. it changes that is at the peak of the crisis in october. -- it changed its status backed at the peak of the crisis in october. it is supposed to be much more tightly regulated. they have said they have not change the way they are behaving at all. they have made very good profit. their trading turned out for them. they made good profits. but for them. had they lost, that is our money. they were betting with our money. they got a $20 million loan guarantee from the insurance operation. this is what glass eagle was. -- invented to prevent. they did right in front of our eyes. now they are handing of billions

of dollars in bonuses. it is like robbing the bank and friend the police officers. it is incredible. we have really big problems here. i think the financial systems are hugely bloated. we need mortgages. we need all these things. if you go back 30 years, people got mortgages. the financial sector defines a quarter of what it is today. you are hard pressed to see what we have done with the huge floating and expansion. are we more secure? can businesses give better access to capital? i would be hard-pressed to make that case. i would like to see that rain then some. -- reined in some.

>> i come at it from a slightly different way but not with the end result. there is too much concentration. we have created institutions that are too big to fail. we need to be using antitrust policy. you need to make sure you have more security and everyone that has implications for the system should be in the regulatory system, including the head funds. they ought to be a change -- there ought to be a change any structure. capital should be treated the same as labor in terms of tax policy. that is how i look at the issue about transactions. i think we have undermined the flow of resources to society

because we have differentiated under this claim that people are not going to work at a marginal rate of 30% of capital. that is a ridiculous argument. it is not consistent with history. i think it is a major flop and part of the fix for the current going forward structure. >> with that, i will open it up to the floor for questions. >> this question is for in the governor. to what extent you hold hank paulson responsible for the financial meltdown? specifically with reference to the demise of lehman brothers? >> as you probably know, that is an awkward question for me now because i am in love with hank paulson.

the real problem with the paulson tenure was not the financial crisis. it is the failure to do a damn thing about supervising the system before hand. the fact is that these kinds of problems that we have been talking about here but so far out of control and there was only talk about deregulating the system right up to july of 2008. there was actually a study going on how we were going to may our financial system more competitive in the 21st century and a more deregulation incident enforcing the rules of the road. the decision to the lehman brothers bill was an alterable mistake in created a hellacious

firestorm. the real issue was the inconsistency. figuring out how to do aig, lehman brothers. if there had been a consistency that there is a crisis then i will give them better marks. the real problem was what happened before the crisis struck. >> ben bernanke? should he be reappointed? >> yes. >> i've been laboring over this. in my mind, he is most responsible for the crisis. i'm also not happy about his failure to regulate the investment of goldman sachs. i think he acted outrageously in pushing the tarp. he said the commercial paper market was shutting down. he did not tell congress that i could directly by commercial paper as the chair of the fed. it does not have to shut down. it is inserted to envision him

being reappointed. then i think for a moment that it does not get the job, larry summers will be more fearless. and i think, let's reappoint ben bernanke. [laughter] >> in his defense, he said a few years ago the part of the problem of the economic situation -- [unintelligible] i am not voting yet. >> ok. >> you said that 20% of the spending in the state is through insurance and medical benefits. why are you feeding the insurance companies that are wrecking this country? why are you not going the nonprofit insurance sector through the power of your checkbook? >> i am not sure exactly where we would go to the non-profit sector. we have a state health benefits

program which is state managed, but we have the outsourcing so we get -- so unless we are going to build thenfctur, the fact is that when you get to outsourcing underlying guts of your insurance program, you still end up paying the fees that the insurance company has charged for administrating the program. i am a big believer in a publicly nonprofit health-care system o, care systemption -- health-care system. a public option. if i am not mistaken, medicare works. if we could afford to build the right away, we would just have a

hard time getting there immediately. >> my name is michael wilson. how do we make sure that it is not a jobless recovery? >> some of the things before our very important. i appreciate the question. we need to reinvest. there are opportunities that we have in terms of a low carbon economy, investing in green technology. i think transforming our tax and trade policies to encourage job development here will do that. we probably need a second stimulus and recovery package. the first kept some of the jobs. even though we had some job

loss, we did not have as much as they would have had otherwise. [unintelligible] we have to invest in our safety net which is desperately afraid. if you look across our state, there are local revenues and home foreclosures, then been cutting off from the basic services that people need to survive, health care, child care, all kinds of care that people need. a program to put people back to work and create those kind of jobs. >> a second stimulus package? >> absolutely. we need one desperately, bigger than the first. over $1 trillion. i know that scares people. that is realistic.

talking to people, we have this enormous gap in demand. you cannot spend too much. i mean that literally -- i do not mean that literally, obviously you can. we do not have to worry about this. we need a second stimulus. we would extend unemployment benefits -- will have a lot of people that point to the unemployed. what did they going to do? they do not have welfare anymore. we have a work based system of support that is good and a lot of ways. if people cannot get work, that is a bad story. at the end of the day, it means getting the dollar down. we have to get our exchange rate down. >> on the second recovery package, we will not have a jobless recovery if we do not

have a second stimulus package. we will have a real visitation growth and unemployment. it will shock you. local government will not have the ability to deal with their budget shortfalls without massive layoffs. we need one and we need to get planning on it right now. every state that does a realistic projection of where they are going to be if revenues do not grow and there is not a substitution for what was provided for medicaid and education and stabilization, it is going to have a shockingly large shortfall in the coming year. that is going to mean job losses and an enormous shrinkage of the public sector. >> that is absolutely true. if you think about how painful the state budgets were in 2009,

2010 will be even worse. it will have a rippling effect. we should do this. >> the administration has not done a good job of pushing stimulus. we really sure. the economy would be in much worse shape today. you do not want to brag about the economy shrinking 1%. that is a helluva lot better than a shrinking 4% or 5%. >> how can we utilize the wisdom and the direct experiences of union workers who are now 70, 80, and 90 years old? how come we utilize their direct experience to encourage an influence the direction of union

is now? >> we have retirees who are all over our country who need to be involved. i was just out at a health care meeting this morning. one of the members was there and retired. he is going door to door and saying why healthcare was important. we need to stay up with them. when they moved to other states like florida, we need to plug into the community. part of the 21st century union is being able to communicate to people and a lot of different ways. we can do by phone or e-mail or a lot different ways. >> we were talking here iabout the financial bubble.

i must say i think we have a much more serious bubble, and environmental bubble one. i do not see how we can recreate the financial system. i didn't think mother nature does a bailout package. how do you see the financial industry against the threat of global warming? >> we have not made any where near as much progress. there is not a lot on the horizon. a bill going to the house to be something and not very much. given the threat we are facing in global warming, we are going to have to do an awful lot more. one of the things i would say is that i wish environmentalists would think about the issue more broadly. when you look at your obverses the united states, there are

comparable living standards but greenhouse emissions in europe are about 16% of what is in the united states. one of the big factors is that europe, they had taking a bunch of benefits in growth in shorter work time. it is seen for people to get six weeks a year vacation. everyone has paid parental leave and sick days. that issue and not on the environmentalists' list of how we are going to improve the environment. that could be a good way to go. it could do a lot of good things. that is not the whole store. there will not be a single thing. they are going to be a lot of things. we will have to do a lot more than what is currently on the agenda. >> does it make sense to make new regulation agencies like the

cpa rather than preparing and auditing the securities and exchange commission and the fed who were already supposed to be doing that? >> i do not think it is an either or situation. there are elements of our financial system that it did not have authorization for the did not have the tenacity to be supervised. the derivatives market is the most visible situation that turned into almost a -- to what was regulated. the idea that we do not -- to where we have investor protection but we do not have consumer protection is bizarre. that is 2/3 of our economy. people are exposed to all kinds of projects, all kinds of

pricing mechanisms that make no sense and there is no one really bringing checks and balances to us. a consumer protection agency is absolutely essential. it ought to be driving consumer education in a way that we do not do in this country in a responsible manner. it believes the -- those that understand the value the ability to rip off people that do not understand the general concepts that are involved in finance. i think it is not in either or. if you put people in charge of agencies that do not believe in regulation, you are going to get the result bets are obvious, regulation is not going to anchor -- results such are obvious. regulation is not going to fix

the process. >> we have to look at the government structure of the fed and figure out if there is a way we can take it out of the banks. the whole democracy is that we need to look at transparency. >> it is outrageous. you expect that the bane's art appointing your own regulators are like the pharmaceutical appointing people to the fda. we need a consumer protection agency. auditing the fed, the fed is in and out to dollar trillion alum. we do not know what they did. -- the fed was in and out $2 trillion along. we do not know what they did. and nobody knows where the money went. >> i am afraid our time is up. i want to thank all of you for coming.

enjoy the rest of your day. thank you. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> coming up, president obama comment on the afghan elections. then from today's "washington journal" paul light takes calls on president obama's policies. after that, new jersey gov. jon course sign on the economy. -- course signed -- corzine on

the economy. >> tomorrow we will talk about the rise in unemployment filing for the obama insurance -- unemployment filings and struggles for the obama administration. we will talk above the disclosure of american client to use offshore accounts. also, a discussion with ronald kessler about his latest book. that is live at 7:00 a.m. eastern on c-span. >> he is interviewed by the founder of normal, the national organization for the reform of marijuana laws. afterwards, saturday at 10:00 p.m. eastern on c-span2 new >> president obama left for camp david earlier today before heading off to martha's vineyard

for a weeklong vacation. before departing the white house, he talked by yesterday's presidential election in afghanistan. the election commission is expected to reach preliminary results on september 3 and final certified results about two weeks later. >> this was an important step forward in the effort to take control of their future even as violent extremists were trying to stand in the way. this election must run by the afghan people. it was the first democrat to election run by afghans in over three decades. more than 30 presidential candidates in more than 3000 provincial council candidates ran for office.

that included a record number of women. from 6000 polling stations around the country, security forces took the lead in providing security. over the last few days, we have seen acts of violence and intimidation by the taliban and there may be more in the days to come. we knew that the taliban would try to derail this election. even in the face of this brutality, millions of afghans exercise the right to choose their leaders and determine their own destiny. as i watched the election, i'll show by the courage in the face of intimidation and the dignity in the face of this order. there is a clear contact between those who seek to control the future of the ballot box and those who killed to prevent that from happening extremists have shown themselves willing to murder innocent muslims, men, women, and children that get in their way. i believe the future belongs to

those who want to build, not those who want to destroy. that was sought by the afghans who went to the polls and those to protected them. the night distaste not support any candidate in this election. our only interest was the result of full -- reflecting the afghan people. that is what we will continue to support as we await the official results. we will continue to work with their afghan partners to strengthen afghan security, governance, and opportunity. our goal is clear, to disrupt, dismantle, and defeat al qaeda and their allies. that'll will be achieved in our trip to be able to go home. -- that will be achieved in our troops will be able to come home. our men and women in uniform are

doing an extraordinary job. so are the civilians who served by their side. all of them are in our thoughts and prayers as are their families back home. this is not a challenge that we asked for. it started when they launched an attack on our soul of -- soil on 9/11. we are pursuing security, opportunity, and justice. with four to renewing our printer with the afghan people as they move ahead. i want to congratulate the afghan people on carrying out this historical collection and wish them a blessed month as they come together to welcome this. thank you very much.

>> paul light was our guest. this is 30 minutes. continues. >> host: our guest is paul lite, professor at new york university. good morning. >> good morning. >> host: thank you for being with us. you have tracked the obama administration, their changeover in power and how things are going, give us a sense of how the public is feeling about president obama right now. >> well, it has been a bad 100 days for the obama administration. pretty upbeat and lots of things happening the first 100 days. really rolling forward with the stimulus package and so forth, but the second 100 days have been tough. his approval ratings are down. there's bitter, emerging fight over healthcare, obviously. i think that in many ways he's given too much power to the

house and the senate. too much hour to nancy pelosi, speaker of of the house, and harry reid, the senate majority leader, to push legislation forward. he hasn't exerted the powers of the presidency really to push this debate forward on a plan that he favors. he's quite equivocal on healthcare from week to week. do we require a government option? do we not? he's flip-flopped on that issue. this is a pretty tough time for him and unless he comes out of the august recess focused again, i think it's going to be a very difficult september through the end of the year. >> recently quoted in a piece in "the hill," written by sam youngman, analysis has been disaster for obama. you say that capitol has spent a bit at a time on a piece of

legislation. light said, eventually it runs out. >> well, you know, lyndon johnson came into office huge congressional majority, just great political capital after lumping barry goldwater in the 1954 election. he had a large number of bills that had already been drafted that he had embraced as his own and he phed and pushed for that first six months. he was saying all along that everyday you spend your political capital you got to move it or lose it and get it done. and the longer you sit out there without firm legislation for congress to consider, the more you skwaquander your capital. nancy pelosi and harry reid are

great individuals, they are not great legislative movers. we're ready stuck on capitol hill with the obama agenda and president obama has a very limited stock of political capital. he's using it up at high rates. pelosi and reid are using up his political capital. it is giving your checkbook to your neighbor and basically saying, go ahead and get me some home improvements and it is hurting obama right now and it is looking like a pretty tough fall. >> host: in that piece in "the hill" you mentioned one reason obama spent so much political capital is aside from the ambitious agenda, he allowed congress to set the tone of for example, healthcare reform. >> well, you know, you come in and the senate was the great incubator of policy ideas, they were chunking bills out regularly and the president

could come in and like shopping at a department store, could pick and choose a handful of priorities and really press forward. that is what obama did with the "serve america" act, a significant piece of legislation that has been forgotten in this kind of early history of his admin stragsz. he picked it up and it it had been co-sponsored by kennedy and hatch. it was ready to go and he jammed it through. perfect example of how past presidents have extended their political capital. but then he let the house design stimulus package laden with pork. a lot of vulnerability to fraud and abuse. the stories are already starting to come out and he's let the house and the senate develop the energy package and now healthcare and it's recipe for disaster. the president has to use that bully pulpit for more than

exhorting the president to act. the president needs a substantial proposal to submit to congress and cannot waffle back and forth publicly. there is a time for negotiation, private negotiation with congress and there is a time for public conversation with the american public. and we've got those confused right now and i think the american public is quite confused and that is why many attacks are ringing true to the american public because they don't know what president obama really stands for here. >> host: what is your impression of what we've been seeing at healthcare town halls throughout the country? >> oh, they are really not useful conversations. i don't know how much is scripted. people are terrified. even president obama is talking about not getting insurance and government bureaucrats in the middle of the decision about

healthcare. americans don't have a lot of confidence in the federal government to deliver services, to deliver goods. president obama has yet to rollout an agenda that would reassure the public that the federal government could actually run a healthcare program, let alone the details of the healthcare program. americans are looking at this and saying, i don't want the federal government involved in it my healthcare. it is the devil they know, which is their own insurance company. most americans say they are satisfied with their insurance companies, but when you get down to nitty-gritty they are telling us it is a hassle to deal with their health insurance companies. we have done nothing to reassure them the federal government will get better at delivering service, so practically any attack will stick. the death panels and so forth and so on, there's a lot of of muddiness in this it debate and it's a bitter debate, much more

bitter than you would have is thought and it is not all scripted. a lot of it is is i think genuine and you have the counter attacks and so forth. americans are really quite confused about what is going on and this is becoming a sink hole for attitude on all sorts of issues from immigration to the iraq, afghanistan wars. >> host: mary is calling on the democrat line from washington. good morning, mary. >> hello. >> host: welcome, you are on the air. >> hi. i'd like to say i think obama, you know, is a lot more popular than what is getting out. i think the reason he was put into office was because he supported healthcare. i think it it is our biggest civil liberty we'll ever have because healthcare, if you don't have healthy workers, you don't have a good economy. if you have people that are putting everything they earn into paying healthcare and the policies being offered in the private sector really are lousy policies that people do not know

until they are sick what they really have and at that point it's too late. the gentleman that called in about his wife and the liver transplant, there is a prime example. 500,000 dollars for something that cost $250. the reason it is that skewed is because the healthcare insurance industry has pushed these prices up really high to force people to have healthcare and that's not a fair system. the united states government is paying for a whole sector of of people to have healthcare, so the private health insurance companies don't really want the small business people and i'm somebody who was self-employed person, paid in taxes my whole life, thought i was upper middle class until i got stage four breast cancer. within eight weeks of that my healthcare went from $369 to $479, a year later $569 and as soon as i went on disability, i was cancelled. now this is unfair to someone

who has paid for healthcare for their whole life and stuff when they need it the most there is laws and rules that allow them to be put in this position. fortunately i am in the state of washington where they offer good healthcare for people like myself, you know, when the situation happens. i was able to go on to a basic health program, state run. i tell you, i felt as though i've had a lot less stress in my life because i know it's going to get covered. my billset covered and stuff. a middle-class person shouldn't be wiped out because of one illness. >> guest: i agree with you. i'm not an expert on healthcare. you want to talk about death panels, every insurance company has one. they decide what the percentage of possibility from treatment

is. they decide whether treatments are coverable. we've got that problem across the healthcare system. we've got high expenses across the healthcare system. i think the problem here is that the debate has shifted entirely to the obama proposal and the obama proposal is not clear to most americans. it is fuzzy. and i think that's because we're dealing with five or six packages that are moving forward on capitol hill and the president hasn't made clear what it is he actually wants so that he can beat nothing with something. i mean, what we basically have is debate between no action, nothing, continuing with our current system and we don't have a something to really talk about. so what we have are people who are against healthcare constructing a reality around an obama plan that may or may not be true, we just don't know.

the president has not seized the initiative. he's working the issue of whether or not we need to act or stay in the current tense. what he needs to do is focus on what he wants and then harness that gigantic engine of support that we saw in the campaign. young americans, middle-aged americans are on the sidelines on this issue. they don't know what they're supposed to do and we need to get the obama admin stragsz, if they want to, from a political standpoint, just from sausage making that congressional phrase for how you put together a legislation. if obama wants to win on the issue, he's got to mobilize supporters behind a specific plan. that is what johnson did on medicare in 1965. >> host: a recent gallup poll shows that americans disapprove the handling of healthcare.

43% do approve and that number has shifted only slightly from a month ago. and gallup says of four issues tested in the august 6-9 poll, the president fares worse on healthcare. his ratings on the economy are slightly better with americans divided in how he is handling that issue and president gets better ratings for handling foreign affair and reducation. >> guest: presidents astart ou high in the polls and tend to drift away a few percentage points at a time until their approval starts down into the low 40s into the upper 30s. and 30% range. and what we are seeing right now is a classic pattern. the president is running out of steam. he has a very brief amount of time left to really harness what approval he has and stick it to

a bill. the real skill of being president in the legislative process is what i call the focusing skill, the ability to tie your approval. the seats you have in congress to a specific piece of legislation. what we're missing here is you cannot one week say that he favors the government auction before the medical american medical association said that has be a solution and then later say that is not a priority. the american public gets confused. the opponents are able to pace a bit with any charge they want. they are doing focus groups right now. they are figure out where the president is weakest. that