and the fundamentalist basis is love my brother as thyself, and the jewish people, who believe in god and feel that they should not go out and cause problems, but they will and so -- answer sternly if they feel people are causing them problems, and the muslims, who feel they have just as much right to to islam as the israelis. host: last call of the morning. guest: i believe that is true. i was at peace conference and i saw a lot of hatred in people's eyes. i believe that with the palestinians, there needs to be a forgiveness. the semi for the jewish people. and for -- the christians the same -- the same way for the jewish people and other christians. the iranian people know the facts. if air france did not fly, if one plane did not fly from

paris, khomeini would never have been back in iran to take over the country. why did we permit that plane to fly? we give the signal for it to fly. why did we find khomeini -- fund khomeini? we should apologize to the iranian people for the things we did not do to destabilize the country, and the muslims should not be blamed for al qaeda. we had more to do with the creation of al qaeda and the muslim world ever had. we need to acknowledge that. host: do you think apologizing to the iranians would ease tensions between iran and israel? guest: telling the truth come h, period, would help a lot. you have a revolutionary theocracy right now that is trying to brutalize his people. they are darling people. we do not need to deny the

truth. we need to tell it. host: mike evans, at the author of the new book, "jimmy carter: the liberal left and world chaos," thanks for being with us. that will do it for this morning's "washington journal." have a great day. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . cuts in about an hour, a discussion on compensating kidney donors.

the american enterprise institute will post at this session to begin at 11:00 a.m. eastern here on c-span. a little bit later, the rising health-care costs and the effect on u.s. history. live right now on c-span2, the current state of the russian military and its future. that is live all day on c-span2. >> george mason university president alan mertan on the role of education and training of information technology professionals. that is tonight on the communicator 6 qana c-span2. >> now discussion ohosted by the american -- america'sñr choice

traded this is from earlier this month. >> i want to thank you very much for taking time out of your extremely busy schedule to come to what we think is a very important event. getting ready for schools to open is very important and your commitment to your -- to education is easily seen by your attendance here. we have all been placed in our seats right at the time we need to transform public education and what is the center on our plate is to make sure that happens and that we do not fail our kids because the task ahead for them in this global economy is very different from the past. america's choice and act has been holding a series of symposiums to push us forward

and make sure that we're being attentive to the right work, that we are taking a close look at what some of our high performance countries are doing and making sure that students in this fine country will be able to compete well with them. this is the third in a series and over the next day and half will be focusing in on the practical solutions that are needed to make sure that we move quickly, -- but for word on. secretary duncan likes to say, preparing to young children for success in life is not just and moral obligation, but an economic imperative. the focus of this meeting is to do just that work. i believe that he has education in his dna.

his father was professor at the university of chicago and he spent his young years working with his mother in an education to bring program for kids at risk living in inner-city chicago. he really had a front seat to look up the differences between the opportunities afforded to the haves and have-nots. i believe they had a a strong life let -- lifelong effect on his work. he went to harvard university and had an outstanding world- class education and decided it was time to spend a little time in the rest of the world. after having a little time in australia and other places, he decided it was time to come home and started this wonderful foundation to provide college funds for, again, inner-city

kids. his focus on kids being college ready goes way back for him. it is a laser beam approach for that effort. i had the pleasure spending a short time close to him when i was chief ability -- chief accountability officer in chicago. although it did not afford us enough time to -- although it was not a long time, it did afforested of judges sit and chat with each other. i regret not having spent more time with him. all over the city, even before he became ceo, you started to hear about this outstanding leader. at least half a dozen times mayor daley mentioned what an outstanding educator he was. i did not know that he would be our next ceo in chicago.

in 2001, he was elected by the mayor and had 7.5 wonderful years in chicago where all the indicators went up, up, up. but that is the right stuff. but more important to that, he was able to get into the hearts and minds of the people who live in chicago so they begin to want more for our kids. i think that is key to the kind of leadership that he brings as secretary, and i can tell you that we are in for a wonderful transformation in education under his leadership you. the other thing that i think is extremely important is that he sees education as the key reform and what we need to do is systematically take a look at what we're doing well and what we are not doingç and just scrapping what we -- what is not

working. we are already beginning to see his footprints in terms of the core elements of his administration and we are very much looking forward to supporting him as well. we clearly know that our job is this generation of -- as of this generation educational leaders is to make sure that our kids inherit the american dream that has been afforded to us. these and gentlemen, our secretary of education. -- ladies and gentlemen, our secretary of education. [applause] >> good morning to everyone, and pat, as you know, is an absolute superstar. a renewed for to the opportunities i have to work with her.

the national center on education in the economy has been at the forefront of the efforts to develop school models, realign rigorous standards and assessments. i am pleased to learn about the river and readiness program that you are now developing with the act. we're developing comprehensive test to assess college readiness. your program as to the movement now sweeping the country to develop college and career ready standards and assessments for all of our nation's students. the top superintendents from around the country gathered here today and we have also invited many innovative, forward thinkers from the non-profit and business world as well. thank you to all of you for all of your hard work because our students need it and so does our country. some of the results of our studies were disturbing. compared to peers in other countries, our students are stagnating. they have not made gains in science and reading.

in fact, in science, our eighth graders scores now lag behind their peers anna -- eight countries. in math, although scores have improved somewhat since 1995, our 15-year-old scores lag behind those of 31 other countries. four countries, korea, singapore, hong kong, and finland outperform u.s. students in every subject to evaluate. this is troubling because our kids will be competing with those around the world for all the jobs in the future. the only path to a long-term productivity and economic security is dramatically -- is to dramatically improve the depth and breadth of the education in our country. today, 30% of our students, or about 1.2 million children each year, failed to commit -- complete high school on time. only two-thirds of those who do

graduate go on to college and far too many of those who matriculate failed to earn a degree of height -- higher education. president obama was the u.s. to regain its position it held not long ago as a nation with the highest proportion of college graduates in the world. he wants every american to have at least one year of college, trade, technical or vocational training as well. the president's goals are absolutely ambitious, but so is the challenge. the hard truth is that we cannot create a seamless, cradle to cradle pipeline of college ready students by continuing to do what we are doing out if we only try to do it a little bit better. to meet the president's goals, to reach the finish line, we absolutely need transformational change. the islands of excellence that now exist in school districts have to become the norm. the promising solutions that so many of you have helped to create must be brought to scale. and our existing market base and

political barriers to far- reaching reforms have to receive. in a word, american schools need "innovation." education and innovation should not be confused with just generating more ideas or unique in vengeance. instead, we need new solutions that improve outcomes -- or unique inventions. instead, we need new solutions that improve outcomes. smart solutions are not the only way to accelerate the achievement. but without them, we will fall short of our goals and doing a disservice to our children and our country. as the president said in his inaugural address, the question we ask is not what the argument is too big or too small, but whether it works. traditionally, the k-while system has not been considered the bastion of -- the k-12 system has not been considered a bastion of education of earlier times.

the analogy might be slightly exaggerated, but it is true that for the last century we have not cultivated a culture of innovation or build district level systems and needed to sustain a cycle of improvement. starting a century ago, big, comprehensive high schools began to replace the schoolhouses of earlier eras. schools adopted the factory model that was popular purdue -- to produce the graduates of the work force of that time. a few went to college, but the overwhelming majority did not teachers and students were thought of as interchangeable with it. teachers were awarded on credentials and experience, not a classroom performance. and the structure was not tailored to the individual needs of students, but education for the masses and new immigrants. it is easy for -- to forget today that for our parents' generation, schools seemed like a moral institutions of brick

and mortar. there were no charter schools, to around schools, virtual schools, and magnet schools and early college schools were extremely rare. occasionally, a high-school the close due to an aroma. but it was rare that it would be transformed by being broken rod -- due to on enrollment. but it was rare that it would be transforming broken up. the standards and accountability movement did not yet exist. schools were judged more by inputs and outcomes. now, to be sure, a lot of innovations and options for students did not preclude schools from experimenting with a variety of reforms. schools and districts tried a slew of curricular reforms over the years, but most had little impact and staying power. some curricular reforms like the introduction of phonics and ap exams caught on and change education for the better. but more than a few reforms

failed. in fact, part of the problem with k-12 innovation has been the fads, lurching from one pedagogical favorite to the next without ever rigorously assessing what works and what does not. in the last two decades, these immoral institutions of the past have become more open -- in more told institutions of the house have become more open to innovation. in 1956 there were about 250 charter schools. today, more than 1 million students across the country attend approximately 4000 charter schools. the best will remain open and the worst should be closed. districts have not done enough to understand and apply more broadly the lessons of what does work from those top performers. in a half-dozen cities today, charter schools now account for more than 20% of all students served. good charter schools increase the number of quality

educational options available to parents who previously had no choices about where to send their children. my challenge to those cities is to take the next step and perfect the model of innovation. close those charter schools that are failing and systemically replicate and learn from those that are making a difference in the lives of our children. change in on -- and ought to burn orsha abound elsewhere in our system, but is still constrained -- change and entrepreneurship of a about of russia some, but are constrained. schools are tracking the performance of students of groups for the first time. on-line courses and online supplementation and course materials are catching on fast. we have made only limited investment in understanding both online instruction and which ones are most affected. smaller themed schools are springing up throughout districts and we have yet to distinguish between those that

boost achievement and those that perpetuate the status quo. personalized accommodations for children with disabilities are universal in a system that once virtually ignored learning and behavioral disabilities. and yet, we are just now starting to advance the project -- practices with the greatest evidence of starting our students well. we are on the cusp of a new era of innovation and entrepreneurship in education that might have been almost unmanageable -- unimaginable almost a decade ago but we still have a long way to go. the responsibility lies at our doors of the u.s. department of education. i know what some of your thinking. i was a seal of the public schools for about seven years and i would be the first to admit that i did not always welcome call when it came from the department of education. [laughter] çthat is because it has historically been an agency that monitors compliance with federal regulations. it did not open its office of

innovation and improvement until 2002, decades after its founding. even then, the department's promotion of innovation have been modest at best. i want a fundamental change in that historical relationship. i wanted to become an engine of innovation, not in compliance machine. i wanted to provide powerful incentives to states and districts to innovate, but at the same time, leave most of the creative thinking and onta for your ship for achieving our common goals in local hands. the best ideas will always come from local educators, not washington. let me give you a brief preview of some of our thinking about innovation and how we can best stimulate innovation in k-12 education. i have said recently that we are at an -- at a unique moment in the history of education reform. we have the perfect store for reform and that starts for the first time with truly having the resources to spur innovation.

as you are aware, we recently announced the $3.5 billion raced to the top fund and that by itself dwarfs the combined some of current discretionary funds to all my predecessors as education secretary. in addition, we of $650 million in the recovery act to fund an investigation -- an investment program that we will call a i-3. this fall, we will propose the i-3 fund. we will begin to make awards in two cup -- in 2010. this is a once-in-a-lifetime education opportunity and we think i-3 will support if reward for innovation for years, even

decades to come. in designing the program, we sought to avoid some shortcomings of previous initiatives and create robust incentive to expand what works, invest in promising practices, and to boldly in ave. first, we're looking for programs that will be outcome driven, not input driven. we're looking to boost achievement, matriculation and graduation rates. and we suspect successful applicants will be able to demonstrate success in closing achievement gas, moving students toward proficiency, increasing graduation rates and obtaining both high-quality teachers and principals. second, we will be looking for programs that can successfully be taken to sale -- to scale and are not just boutique reforms. and finally, sustainable innovation, what -- not one time flash and the pants. we suspect recipients will provide some -- will be provided some public dollars.

grants will be rewarded to district and not profits, including colleges and universities, turnaround specialists, charter schools, companies and other stakeholders. our basic operating premise is that grants for proven programs should be larger than those for promising, but largely untested programs. our grants will have three categories. at first, pure innovation grants of about $5 million for a promising ideas that should be tried. secondly, strategic investment grants of roughly $30 million to build a research base organizational capacity to exceed a larger scale. and finally, grow what works grants will be as high as $50 million for proven programs that are ready to grow and expand. in a few minutes, my partner that runs our office of innovation and is heading up this effort will answer some questions questionsi-3.

but first, i want to -- some questions about i-3. but first, i want to address some issues. we will be looking, but not exclusively, for proposals that advance the four reforms central to the recovery programs. there college and career ready standards, data systems that allow us to check student progress but to support and improve instruction, teacher quality, and lastly, turnaround schools. we are thrilled that 146 in -- the no. 46 in missouri recently joined is a we now have 47 states. for education on bergendorff, the cop --ç for education onta per north, the common stance is a huge leap forward. it is almost impossible to implement imagine sieve curriculum assessment at scale

when you have 50 different -- imaginative assessments at scaling up 50 different goal posts to aim for. we still have a great need for better models, to think differently about how to recruit and train and support teachers entered the drug what it'll take to get talented teachers and principals to go to the schools and communities that need them the most. that is hugely important to me. it is also difficult to design tools and resources to truly support teachers and leaders without being able to assess which teachers have the greatest impact on student learning. it is a bit like trying to treat a patient without completing a physical. in chicago, we managed to rally -- raised the number of applications for every teacher's job from 2 to 10 and many of you have similar success stories. but we still need to learn more from some of the pioneers expanding teacher recruitment by teacher america and the new

teaching fellows programs -- like teaching america and the new teaching fellows programs established in the various district. finally, we need to evaluate those programs that have been failing for years. they include about 2000 has schools that produce 50% seof or nation's of dropouts and 70% of our dropouts from the african- american and latino students. we need to revise an incremental approach to the drop of factories. districts, nonprofits and unions should have the courage to change in the face of endemic failure anincluding rewriting relationships, the curriculum, and transforming the school culture. we have some examples to draw from from charters, and the academy of school leadership. as well as green dot.

still, we need new approaches to an assortment of longstanding challenges. accelerating adolescence who are years behind, helping yellow students -- studentselo -- helping elo students. in supporting innovation, the four corners in the recovery act, in addition to that, i-3 will improve early learning and college readiness and better serving students in a rural districts. we will be encouraging not propose to expand and make better use of both the school day and the school year. and with a promise interventions without risk students. premisewe have to give collegesf

the remediation business. i know this does not come easily and if it did, we would not be here today. successful innovations are often destructive. we not only understand that, we welcome that. on-line courses often meet with skepticism and resistance despite the fact that they make it possible for isolated students in hard to stop schools to a dance to a peak losses. -- to advance to advanced placement classes. i know that innovation and inspiration often come from unexpected places. i would like to talk about the barack affect, the idea that it has made it -- he has made it cool to be smart and excel in school it was not long ago that being a teacher but -- that being a teacher is not a prestigious profession. two decades ago, the determined

a senior, wende, set out to change the perception. by her own description, wendy kopp was one of the mostly college seniors in the history -- history of princeton university, but she had booked a dream and grit. following graduation, she returned to the university after trying to raise $2 million to start her core of teachers. when she told the director of the los angeles unified district that she planned to recruit a stanford student he laughed out loud at her and get the idea that stanford students would begin to think about teaching in l.a.. i think you know the rest of the story. two decades later, diedre merkel rohrer -- teach for america as one of the biggest employers of stanford students. of course, teach for america has

not solve the problem of how in the week recruit the toughest, most committed and compassionate under gratz to -- to stay in for the long ball. but it has started a movement that has made teaching school. it has helped to gauge a -- to engage 20 somethings in the life of school. let me remind you that a quarter of a century after the 1976 oldham report, students and superintendent often heard that would happen in gaza and did not matter, but there socioeconomic background. today, the truth is much more complicated and hopefully -- thankfully, much more hopeful.

a top notch teacher can advance learning in a year-and-a-half in a year's time and students will lose ground with a week teacher who may only advance his students how figure during the course of that school year. three good teachers in a row vs. 3 about once can make or break it out educational career. teachers, for example, now use regular formative assessments to differentiate instruction and drive continuous improvement in the classroom. real time data and constant evaluation of student progress taking even our best teachers got to an entirely different level. let me tell you one last unlike the story about innovation, about the origin of charter schools. in 1988, after visiting a school

in cologne, germany, the american federation of teachers president said "any school or any group of teachers to develop a proposal for how they can better educate youngsters and how they can implement the proposal for a time frame of 5 to 10 years and after that time, the school should be invited to see the extent to which it has met its goals and it can be extended or revoked." those are powerful ideas. the following year, a citizens group in minnesota and several innovative educators picked up on the proposal. in 1991, they enacted the first charter school law. britain renovations sometimes come in and anticipated packages and they do not come -- sometimes innovations come in

and anticipated packages and they do not come from the federal government. we want to develop a culture of innovation and continual improvement. we're looking to you, the districts and nonprofits, to unleash your creativity and build the next generation of educational reform. with your help, courage, and commanded, we can transform not just our department, but many districts -- and commitment, we can transform not just our department, but many districts. this is an historic, once-in-a- lifetime opportunity. i would like to turn the discussion over to jim shelton. thank you so much. [applause] >> goodland. -- good morning.

sorry, folks. one more time, good morning. [laughter] çdon't let that shake your confidence. [laughter] the secretary has laid out agreed framework for today's conversation. we have two really important things that we have to do as a department when it comes to innovation. the first is we have to come up

with solutions, you have to come up with solutions and we have to enable it. some of the toughest challenges that we know, we face, is to implement the reforms we have as the country. the second is we need to create a very different context for innovation and put it in the context of continuous improvement to that we do not great solutions that stagnate and are no longer useful for the problems that we are meant to serve. so, let's start. the secretary said we're going to reinforce with the program the four assurances that we talked about. innovation around the standards that a vote -- is not something we are encouraging at this time, but we are thinking about how you assess the curriculum that is to follow the great standards. the second is, human capital -- three teachers, great leaders. how do we ensure that we have got the kinds of programs that are using the best combat

formation available -- information available about student achievement and putting in place effective teachers? what do the systems look like? what do the data systems like that are enabling our teachers and parents and other stakeholders to not only have accountability measures, but to know what is working, to improve instruction in the classroom, to improve their practice and to support each other's work? and then those other schools, how are we building on the opportunity to improve the stimulus dollars, the state stabilization fund, the race to the top? what we have got is a $650 million competitive program. but what -- most of you know this already. the others are nonprofits that worked effectively with our schools. we're going to create incentives

to have the applicants focus on the areas that were not piloted previously. the statute was pretty broad. we're going to give the arthur d. -- the opportunity [inaudible] the competition was meant to have two rounds following closely on the race to the top. as we continue to press forward, we need to decide to consolidate those two rounds into one closing round in order to allow the law was possible time for applicants to buy a partnership and funding of that nature. the evaluations and things like that are not funded separately, so we're looking to the applicants to think through how they produce the kind of learning that we're looking for out of these in the context of their proposals. that brings us to the five core themes and principles that have guided the design of this program. the secretary talked about the outcomes, the improvement in

student achievement and matriculation. are we keeping them in school and moving forward? and graduation, and graduation not just to finish, but to finish college-ready. we have described as three different types of grant programs. if you expect to scale, you need to have solid evidence. it needs to not only work, but work with multiple types of students. if your innovating, that is a different story. by a strong series for research to underpin europe innovation. -- to underpin the your innovation. learning, if we do not change the way we think about how we understand what the most important questions are from the field and what we invest to actually create something, then we invest in a way that allows us [unintelligible]

fourth, sustainability. it is for nothing if we create things that cannot be financially sustained for politically sustained. how will applicants demonstrate that they have thought through how this will build -- be built not only in the immediate future, but for years to come. the economic model and a support model needs to be clear. and ultimately, do you have a strategy for scale? do you have a capacity for scaled back and is it feasible --ç for scale and is it feasib? you we are talking about serious ideas, those ideas need to be designed to be used broadly. we need to serve millions of students of all kinds, or to scale within populations that we know have struggled.

they have to be designed to be easy to use, to meet the needs of students and have a chance of being picked up because they are cost-effective. a lot of these words are not yet words we have used in this department. i've heard the comment, you're going to keep all less employed. [laughter] -- all of us employed. [laughter] the framework for how this kind of work should move forward will produce some very cigna began things at the end. at a minimum, we're producing solutions that can scale regionally and nationally and we have had to do so as a result of these investments. we will have organizations that have much greater capacity. they can scale as you pursue performance in your district and we will have people there that

will respond when you call. how many superintendents are tired of asking the question, was the best? who does it? can they come? we need to be able to answer all three of those questions and we need to be able to answer them "yes." we have many anecdotes of promising practices and around the country. many of them even have some data. but we have got to get beyond that. we've got to be on the anecdotes'. we have to get to the things that work and work over and over again. recognizing that the $650 million is a unique opportunity, we need to create some platforms out of it. we need to make it possible for innovation to continue for years to come. if we do all of these things

well, then we will have some printer innovations out of this, some character models that change the way we work with our students, the kind of outcomes that we get and the kind of trajectory we should expect on an ongoing basis. we hope to do this in a way that not only produces innovations, but starts to change the way we think about the process. we need to -- we are expecting thousands of applications. how you effectively vet those, get the feedback from the best folks? allow the best to rise from the top? recognizing that in many cases you we comparing apples to oranges? we're going to try to tap in our process the power of committee. we want to let folks find each other, recognizing that they can

create the opportunity themselves. many districts have great ideas and they have no funding. did not know that nonprofits are within reach. how you crave a venue where they can find each other? -- how you create a venue where they can find each other? we're working with nonprofits to do that so that you can see it work, have ideas, see it get funded not only through the formal process, but through the informal process. i was hoping to have this process includes the way we work overtime. when my talking to you today about something that is not even launched yet? these kind of ideas are built on the great ideas of those that start them off. we will reach out to you and to many others to say, bring your

ideas to this committee, find ways to partner, find ways to get this engine of innovation started. with that, i want to end so we can take questions. the secretariat will be your for a while and i will be here for a while afterwards. thank you. [applause] >> ok, it is your turn now. as you heard, the secretary has just a few more minutes. if we can have some questions, let's have them now. >> i will take a few and that i'm gone. ç>> i'm co-director of science and math at the association of public and land universities. first, i want to thank you for your courage and good work today.

i want to make this observation that some innovations may have some unintended consequences. i'm sure you know that. the interactions of the i-3 seemed to be very important. my case study is on the question about innovations not becoming destructive, but actually constructive. i relate the experience that you are visiting with an urban university that is experiencing a downturn in the preparation necessary for physics teachers in new york city. to you, they said, through the small school model where they were not able to amount the kind of students necessary to teach -- to become the teachers to teach the physics courses. so, one innovation lead to a negative consequence. and you have some thoughts about

this. i would like to hear them. >> it is a great question. there unintended consequences both positive and negative. there is not a simple answer, but if you have, for example, three small schools and a high school building, the idea that you need three different physics teachers does not make any sense to me. those schools have to partner together. just being a little bit more creative in how you schedule, how you prepare, how you collaborate can be relatively simple fix it to some of those challenges. need to get the schools to talk to each other and get people working together in different ways. >> i am a teacher. i would like to know how we put together and refresh the existing teachers with those better the innovative teachers.

there are a lot of us that are innovators and that is one of the reasons we have been moved around. how we put those two together? >> we have spent a huge amount of time and have talked a lot about recording the next generation of teachers. it is pretty clear to me how to do that and with the challenges and opportunities are there. but how we do a better job of identifying those great, effective teachers, how we build a career ladders and make sure the other teachers are learning from them, i think as a country we are way behind in doing that. we have some extraordinary teachers like yourself that are making a huge difference every day with a leadership ability there that we are not benefiting from. we need to put them in a position to share. we have to do that. we have to break through. the answers are not here.

the answers are with great local teachers and principals. how do we shine a spotlight on them so that they do a better job of influencing people around them? not to go too far, this fund a piece of it. we spend about $3 billion per year on title two money. that is an area where we can have a huge impact, $3 billion every single year. >> [inaudible] you mentioned the density of the students in the urban areas, but also in rural. can you talk about how he might be distributing the emphasis across rural areas as well as urban? >> obviously, coming from

chicago, which is not the most rural area. i spent a lot of time in rural areas. i spent a lot of time trying to get a sense for it. teacher housing, a teacher residences is a big piece. these challenges are not unique to urban. they're not unique to rural areas. çthere are two dozen house was that we call drop out factories. 50% are in and 20% or rural. this is a national problem is not regional. we want to find the best in every single area.

we need to fund improvements across the board and not just one particular segment. >> i am the chief technology officer from the schools in lake charles, louisiana. i would like to ask you from your vantage point, what do you think the department can do to encourage innovation in programs that are already in place? i will cite to the large amount of federal dollars that come to school districts such as myself through entitled programs and i .d.e.a. programs as well.

so that all the funds are working together rather than being isolated. a release stifles innovation in a lot of ways. i think we're looking for leadership from the apartment and yourself to help break down these barriers and use the innovative strategies that are in place, but across programs rather than horizontal lee. >> i was trying to be very self creek -- a very critical in that silo that you have experience, we have ours here. you have built your silos and we have billed hours. it is easy to talk about and it is -- and we have built hours. it is easy to talk about, but hard to do. if we were to come back quickly with the teacher incentive money and money for education tautology and money for data systems. some folks have said that doing this at the same time is too much. we want to think about comprehensive strategies and

think through how we use all of these scarce resources. nobody has enough money. everybody is hurting for money. we have $100 billion out there for resources, but we know it is never enough. how do we use this money in different ways? i think the onus is on us to try to practice in a different way and can we start to think about how we support districts and states and not just title one or title two, right down the line. how do we change our business to be much more supportive, much fewer silos? we can do a better job in helping you to innovate. we are part of the problem that you -- in the work that you guys are doing internally. >> [inaudible]

we know they are suffering significantly right now. many of those assets since the government, counties, different organizations [inaudible] in house committees will be expecting to participate in thinking through the kinds of innovations that you want. ultimately, it really needs public will and community support. a threat but one of my heroes in developing his work in community schools is so important. i talk about time, lincoln in the day, length in the week, the year. money is a piece of this answer. the other piece of this answer is getting rid of the adelstein function puremovement -- battle to have to create in very different ways. our unstated but clear promise

is that we are not going to -- clear premise is that we are trying to put lots of carrots, and no sticks, but a clear implication that if districts, unions, teachers and principals, community partners, park districts, police -- we will come back and talk about promise neighborhoods. we will do very different things there. if adults do not believe in different ways, we will not get the results we want. we're trying to put resources on the table. but everyone has to step outside their comfort zone and collaborate. we simply will not invest and keep doing the same thing. race to the top,ç i-3, a teachr incentive, all of this has to be done in partnership and as you said, i cannot just be school districts with unions, with the committee, with other governmental agencies, with the business community -- that is where we are trying to invest in business here. we all have to come behind this thing. no penalty, knows dick, but

tremendous carrots for those who are going -- no stake, but tremendous carrots for those who are going to participate. we want to put lots of resources behind those folks that are behaving differently. thank you for your thoughtful questions and your hard work. thank you so much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> if we have some more questions, jim would be happy to answer them. thank you, mr. secretary. questions? >> any more questions? great. [laughter] >> right over here. you are next. >> my question is, can you talk about government asking? -- government acting in the role that philanthropies traditionally have occupied?

>> two things, one is that we expect actually that we are not filling a void that philanthropy has traditionally filled. in fact, we're trying to do a supplement and provide a mechanism for enhancing it. let me be clear about a couple of things. we're doing some fairly significant public-private pressure in all -- almost all this work. in almost want -- every one of these areas there is a private foundation that is investing and sometimes already, a consortium. and we're trying to provide them with a platform to become much more aware and in a more egalitarian way of what is happening in the field. to be clear, $650 million is ultimately a lot of money, but not much when you talk about the scale of the opportunity. we will expect thousands of

applications. if you do the math, you can do it anyway you want, 65 times -- 130 * 5. there are a lot of people that will have great ideas that will not been funded out of this. i would like to talk about the elo student spirites. in the last two years, there is special entitlement. and i know a lot of school districts did put the dollars directly to serve the elo

students. how you see this as a possibility for change? their needs are still not being met at the level they should be. and what you see coming in the next two or three years? >> to be totally honest, i am not prepared to respond to what i think is going to wind up having with the dream act right now. on the question theelo -- the question of elo students, we will have a very clear disposition and party around the students of her at low risk, low income, disability and elo will follow -- fall into that

category. most of it is specified in the statute. the important thing is going to be for the districts and states to think carefully about how to allocate their funds to have maximum impact. even with the race to the top dollars, the onus is going to be on the state's once they windows dollars and, frankly, in their plans, -- once they qualify and when those dollars. they ought to have impact by scaling the work that is being done well and my hope is that they will pursue those. çin the back. >> i would like to know -- the secretary mentioned the role and the ability for corporations -- or "companies" was the word that

he used -- to apply for these grants. can you elaborate? >> corporations are not allowed to apply for grants, but they can partner for different strategies. lea's and nonprofits are eligible and that is it. there are current eligibility performance in the statute that have limiting factors. -- eligible requirements in the statute have limiting factors. there are elements that we hope will accelerate and move through before we actually get to competition. let me touch on a couple of things that came up during questions to the secretary. formula dollars are some of the -- you know, people talk about, what is going to happen with these dollars? the reality is that this framework will carry through this administration in terms of ways of thinking about it.

people focus on the recovery act funds. there is almost $1 billion per year that comes from this office, most of which has no association dollars associated with it. they're going to teach as things that create solutions for the field. the second question on unintended consequences, one of the things that the secretary talked about was innovations that have gotten started, but we have failed to figure out how to take them to the level where they can have a real impact. the charter schools are a perfect example. they were set of to create lots of opportunity for a room to grow and expand and to try to -- to try different things. we have failed in the latter half of that. . .

biden is black market is thriving. the global black market for kidney transplants is not a

fringe activity. the world health organization estimates one in 10 of the over 60,000 transplanted kidneys worldwide each share from living donors have been bought illegally. today, the demand for organ or nation is huge, almost 80,000 americans are waiting for a kidney transplant. but only about one in four will receive one this year and a dozen people die every year in the u.s. waiting for them. the revelation of a black market for kidneys in the united states should prompt us to stop for a moment and ask some hard questions. should the compensation of organ donors be prohibited by law as it is today? with a legal market that compensates kidney donors, giving them an incentive to help them need, -- to help people in need, make a dent in the black market? how should such a market be

structured and regulated? what are the ethical and practical concerns raised by the buying and selling of human organs? to help answer these questions, we decided to convene a conversation today. we have a relevant -- eight scholar and psychologist at the yale school of medicine. she's the author of several books, including quality how political correctness is corrupted madison." also, quality when nation under therapy for " her latest book is decidedly on topic. the book was published this year by aei press. it should be noted she is not a disinterested party. her interest in transplant policy stems from her the recipient of a kidney in 2006. she will discuss her experience

at length and a walk us through some of the lessons she has learned. before it started, here are few notes on how the event will proceed. sally will talk for the next 7- 10 minutes about her experience. then i will ask some questions about that and the politics and ethics of organ donation, that we will open up for questions and answers. with that, i like to welcome sally. [applause] >> very brief background -- i am not a completely neutral party. [no audio]

[audio difficulty] [audio difficulty] >> i thought i would not have much trouble finding someone to give me an oregon.

>> you did not know much about organ donation before this? >> i did, but somehow thought i would not have trouble finding one. i did not know what i was thinking. what preoccupied me at first was [inaudible] it gradually became clear to me that there wasn't one. some people want to do it, but it is a big thing to ask and they got cold feet and some people did not match. my original thought was if i paid someone had no moral obligation, and would be sterile transaction, that more often to i'm not going to get a kidney and i will spend years on dialysis.

thank goodness, what seemed like the last minute, before us about to go on dialysis, and i realize how lucky i am because most people do end up on dialysis, and wonderful mutual friend heard from a third party that i needed a kidney. my story has a happy ending, but 80,000 people are waiting. 13 of them will be dead tomorrow at this time and it will not be a happy ending. that is how i got interested in this and where my passion to transform transplant was came from. i have fought them alone, i should say quickly. -- i am far from alone in my interest in this ever since the 1970's. people have been talking about the fact there will not be enough organs and that is true every year. the list gets longer and longer.

people have been talking about the notion of compensating donors or organ market for a long time. but it's more pressing every year as the list gets longer and as the human-rights violations grow in the black market. >> [no audio] [audio difficulty] >> it's easier for her to say this than me. giving a kidney is major surgery. i am not trivializing it. she was out of the hospital in three days and was back to work in tv zero weeks. -- and two weeks. the idea here is to let people

know that while it is a serious undertaking, no question, people get a kidney and go on and have a healthy life and the most wonderful sense of accomplishment seems likely to trivialize it, but what happened was is we show up to gather. you usually show up with your donor who is typically a family member or friend. tip sent -- sometimes a stranger will show up and say i would like to give a kidney to the next person on line. there is a special spot in heaven for people like them. virginia and i showed up, we got tested, there is a lot of physical testing. they will only transplant -- they will only remove someone skiddy if they have excellent kidney function -- will only

improve move someone's kidney if they have excellent kidney function. >> [inaudible] >> allot of people don't have this happy ending. >> you are able to get a kidney donor and since that time, you have immerse yourself in the kidney donation universe. you have become an advocate for establishing a market or compensating kidney donors. walk me through that, from the time you got your kidney from virginia to taking this on and studying the topic and throwing herself into it. >> i could see this wasn't going to be easy and one of the things

i did when i was having trouble [no audio] on a website -- matching donors.com. and if you have money, you can before, or you can sign up for free. the number of people who say they're interested in giving a kidney exceeds by one to 10 to people like me to put an ad in there. mine was very bareboned. i gave my age, my number of which is a measure of how bad my renal failure was and my blood type. some people write a very moving testimonials. usually a second party will do that, like relative, with photos

and they are very heart wrenching. i did find somebody on the web site. before virginia came along, he was set to do this, but he backed out. then virginia came along. but the point is, people go on these website and put up bulletin boards. they go overseas to the black market. people are desperate. when they're desperate to save their own lives, it's hard to fault them. one of the most wrecking things to me was when i had written an article -- one of the most striking things to me was when i had written an article about the policy implications of using matching donors, i was taken aback by the hostile reaction of some by leftists, primarily, who thought that somehow it was a violation -- it was unfair, that

i would take the initiative to save my life and other people will do the same. i cannot figure illogic because, first, it seems trying to save your life while you are not hurting anyone else trumps of lot. second, i wasn't hurting anyone else. i was not taking a kidney off the list meant for someone else. this was a donor who said i -- that invited me through my ad. i it would have gotten off the list and people behind me could have moved up. it seems like a win/win situation. i cannot figure out the opposition. i read about a transplant surgeon who is the head of an ethics committee of the head of the american society of transplant surgeons who was vehemently opposed to performing transplants of people who met

their donors this way. he turned people away from his hospital. thank goodness this was in boston and people could go to other hospitals. when he sought to have all surgeons in this country. caught these kinds of transplants -- when he sought surgeons all across the country to boycott these kinds of transplants -- i'm all for autonomy, of the efficient is not feel it is right from him -- but to remove that freedom for all surgeons is something that wanted to look into further. >> if you're feeling there should be one list? >> you put your name on the list and we'll have an equal opportunity at best. the fact that people are going overseas and are answering ads and sending faxes to everyone they have ever met since

kindergarten is more emphasis. these are not problems. these are symptoms of a dire, via -- dire, but dire organ shortage. >> obviously the black market has been in the news and it was a surprise to some that this is activity happening in the united states. could you talk a little bit about what you know about globally or in the united states, the black-market? it seems to me that it suggests there is a huge need for this and people will go take what are illegal steps to procure a life- saving organ. could you give a sense of how extensive it is and what we know and don't know about it? obviously, black markets by nature, we don't have a lot of information about them. what we know about what is actually happening there? >> there are about 60,000

transplants performed worldwide. 5000-6000 are assumed to have been conducted in the great or black market of another world of pakistan, china, eastern europe, south america, the philippines. this market has blossomed. a small part of it was the man in brooklyn you alluded to earlier who was a broker. he would fly over people from israel and match them up within the american and they would come to a transplant center and say they were friends. my first thought was -- i don't believe he has pleaded guilty

yet -- but when i first thought when i read about him was i've wished i had his number. if it got that bad, i would have called someone like that. what a position to be in. i would be involved in a transaction where he would charge $160,000. the donor gets $10,000. the nose of the donor even gets paid. that is the kind of financial asymmetry you see in the black market. he does not get his $160,000, but he does profit and you know what happens to the donor. is he well informed about what happens? it's a nauseating prospect to be involved with on either end. but these are desperate people. my reaction when that news broke, and i believe it is the first case ever the fbi is aware of of oregon brokering in this country, was why are people

surprise? people do all kinds of desperate things and this is just one more symptom of a desperate black market. my second thought was now everyone will be calling for a crackdown on the black markets. on its face, that seems like a perfectly reasonable reaction. i would call for that as well, but predictably, they will leave out the second half of the protest -- suppress the black markets, but in parallel, you have to establish a transparent, legal mechanism of making more organs available. as we know from every other traffic item, if you suppress the black market, you drive it

further underground, making it more dangerous. or, if you managed to choke off the supply, you have more dead people that need these organs. it has to be asymmetric approach and organizations like the world health organization and the international transplant society only focus on the black market and suppressing it. that is a legitimate enterprise, but it is not enough. they will actually make things worse if they pursue that strategy. >> your friend, and i'm probably naturally sympathetic to your cause, but i'm going to play devil's advocate before we talk about some of the things you like to see changed. i'm going to raise what are some potential ethical and practical objections to this. one practical objection some critics have raised is that allowing organs to be bought or

sold might reduce the total number of organs available for transplant because it could sufficiently lower the number of organs donated from a altruistic motives. people sat on a donate one because people are selling theirs. -- people will say i won't donate one because people are selling their. what is your response to that? >> i do think we have some case studies for it. in england -- in israel and hong kong, in both of those countries, less so in israel, but people who needed organs could go overseas and the national health service did plate -- did pay for transplants done in turkey. in hong kong, people would go to mainland china, which is perhaps the most egregious example of human rights abuses. some of the transplants actually

come from political prisoners. that does happen. some family members will say if you can get it somewhere else, -- there are two responses. first, if a family member -- wouldn't you want to save your own child? you probably would or to your own relatives. if there were no choice, you would because you would have bureau family looking at you asking if you're going to kill your sister. -- because you would have your whole family looking at you asking if you're going to kill your sister. there is a flip side to the lovely emerita of the gift of life. i and a poster girl for altruism. virginia did not have to do anything to me. she is the purest form of an altruist and i am enormously lucky.

but many family members, believe it or not, don't want to do it. this is the dark side of altruism -- in fact, a system that imposes an altruist narrative and policy on this practice actually is complicity in a lot of emotional coloration. you just cannot hear about it. you hear about the happy cases, and there are many, don't get me wrong. the point is that some people might not do it. what that tells you is they were emotionally coerced often into doing it in the first place and you cannot lose sight of the bottom line. this is not an exercise in altruism. this is an exercise in more or against some more people can live and needless suffering can be reduced. that is the goal. not whether people feel good about themselves. there are other kinds of wonderful things people can do to help humanity.

it is about more organs. when the net number of organs is higher, that is the goal. >> i would like to read you something -- you have been jousting with bio ephesus on this issue for some time now. there is a gentleman -- you have been jousting with bio ethicists for quite some time out. one says the people who sell are almost incredibly poor. their past the point of desperation. they're not making a calculated decision. this concern about the potential for abuse or people in dire straits to turn to this, does that give you pause or how do you wrestle with that? >> i think that is a very legitimate response to the idea of a market. a free, unfettered market. even a free-market that is regulated.

even in a black market, that is what we see in the third world. desperately poor people doing this, reluctant to do it. they're not guaranteed of the money and things are not explained well. most of these people are laborers and because of the surgical techniques are so old and they do a fairly traditional cigar that goes from here to here, it takes months to recover from that. you end up losing more money, assuming you ever got paid. you lose more money because you cannot work. it's a disaster. the response by colleagues and i have been promoting it is a regulated market. we're not talking about a situation where you pay me and we enter into a private contract or a third-party is a broker to profit off of this.

the idea is a third-party, either the federal government or state, would offer and in kind benefit, a tax credit, tuition voucher, contribution to a 401k. there would be no cash exchange. the rationale behind that is when you're talking about the people, and is -- and it is a desperate people he is talking about. not low-income people. low-income people are not necessarily desperate and can make decisions in their best effort. -- in their best interest. yet people who don't want to do this but are so poor that they have to. that is not want. you don't make this proposition attractive to people who are so desperately poor. the way to do that is not offering a desperate people what they want, which is cash, immediately, which is how the black market works.

bill then a several-month waiting time, make sure the person is well informed about every aspect of the surgery, and follow-up care, and they can back out at anytime. i might want people to become certified organ donors, maybe take a test. but the point is people are very well informed. this is a regime that would protect against this sort of desperate picture that comes to mind when we think of third- world oregon bazaars. -- third world oregon bazaars. -- third world organ bazaars.

>> there is still a lot of people who are an easy. part of it may have to do with that it involves the human body and commercial transactions involving anything having to do with the human body is uncomfortable and raises ethical concerns. others say it leads to make a modification of the human body and your this aggregating parts and putting a price tag on them which raises a host of thorny ethical questions. what do you make of those objections and do you see a potential for a slippery slope that if it is a kidney, it could be something else and on down? an erosion in the value of human life or indignity that some people talk about? -- human life or dignity. >> use a slippery slope, i will say straw man. i think that's most often the

character of these debates. you often hear, is rhetorically powerful, this dichotomy. we have this gift of life, the pure altruism, the loving kindness on one hand, the loving children who compete with each other over who is going to have a kidney as opposed to a rapacious, brittle, and human abuse of black market. -- and human, abusive black market. that's not much of a choice. it's not reality in terms of how we can approach solutions here. there's a very fertile middle ground which takes account of the most profound reality which is humane motive, financial

motives mix all the time every day. when the firemen rushed into the world trade center to save people on 9/11, nobody asked are you a salaried fireman or a volunteer fireman? they were here as a matter what. we pay rabbis, we pay teachers, we pay physicians. is that, but buying our health that we pay physicians? we pay lawyers. are we come modifying justice? this sort of crude dichotomy is almost sloppy thinking. when people talk about the modification in my view, what they're talking about is dignity and respect. the way we can sure dignity and respect is to treat people that way. when a donor comes in, whether he is someone who will be compensated in a matter we discussed before, or you come

and in to give a kidney to your cousin and you can make a decision about your own fate, protections are put in place for you. there would be more protections in this kind of arrangement we are talking about. when you leave the hospital, when virginia left hospital, she was on her round. -- she was on her own. you consider your own best interest, you -- we protect you and show gratitude toward you. that is dignity. >> dimension to middle ground. there are participants -- you mention middle ground. there are precedents in this discussion who say they're sticking out a middle ground and talk about transplant chains as a middle ground between a ban on sales and a market for organs.

can you talk about what transplant chains are and where they fit in? why they may or may not be sufficient? >> transplant chains are a fantastic thing. if you want to donate to meet, which did not match with meat or someone else, -- he did not match with me or someone else, you give me a kidney and that you give her a kidney and that would be great. now to give you zero people have -- out to people have but shane organs. -- to few people have functioning organs. this requires a lot of complications and computer algorithms which john hopkins perfected.

one man on his own started doing this and started the national transplant registry when his own daughter had trouble finding a kidney. he has been up and running a year-and-a-half. he has facilitated about 40 transplants by these dominoes were i match with you and your donor gives a kidney to that person and it goes on down this way. you can leverage that up to -- i think the biggest one is seven couples. that's all of transplants. as seven transplants it would not have occurred before. why is it not enough? i am for that, presumed consent, where i was young specified otherwise, if your organs are healthy, they can be taken. but these are just not going to produce enough. they should be done. every strategy will halt.

it is estimated that -- every strategy will help. i saw about 6000 people and have unmatched partners. luckily, virginia match, if not she could not have helped a. but we would have participated. she wrote a wonderful article in the atlantic -- about -- in " the atlantic" about these things. they're wonderful, but they're just not enough. since i brought up consider -- since i brought up presumed consent, i am for it as well. it is opt out or presumed consent. spain has held up as the most progressive. the idea is unless you have signed a card or indicated in some way you do not want your organs taken at death, they will be. spain has a very high rate of organ donation.

they still have a list, it is not perfect. one sociologists has looked carefully at this and has concluded it is impossible to tease out what is the policy and what is due to the fact that spain happens to have one of the most enlightened procurement philosophies of all countries. spain also has a soft presumed consent between families can still override it. i'm tempted to think he may be right. they're just so good at talking to families by getting them to give organs, but it sounds like a good idea and let's give it a try. we don't even need legislation. states could do it. but the best estimates -- almost 81,000 people waiting on the west. in terms of people who die by brain death criteria, which is

the typical way people become an organ donor, less than 20,000 people in your -- -- less than 20,000 people per year -- fewer than 50% of people assigned an organ donor card and [unintelligible] before institute a year regime of compensation, before we get the list down, we could stop. it's a matter of getting it down to a manageable length of time and eight years is not manageable. a few months or a year is manageable. hopefully no one would have to wait at all. >> i want to open this up for questions from the audience in a moment. i want to ask you a question about the law. correct me if i'm wrong, but the

current law is structured around a 1984 law called the national organ transplant act. there are some it -- there is some interesting history with how it came into being and a structure it took. could you talk about that and bring us up to speed on where we are today and what is permitted, what incentives are permitted, why and why not. >> in 1984, the national organ transplant act spearheaded by then rep al gore was meant to become the united network for organ sharing. when we talk about the list, that's the agency that has a contract with the government to monitor the list. they send out people to hospital and ask people to donate at their loved ones' deaths. they have an algorithm for distributing kidneys witches -- you have to match biologically, but it is basically a first

come-first serve. that is not true for livers. that is determined in terms of who is sickest. that's all it was supposed to do. but, in the fall of 1983, as hearings -- there were several hearings, in the course of deliberations, but there was an internist, i think he lost his license in northern virginia at the time. he decided he was going to establish a company called international kidney exchange where he would do, above board, because there was a lot doing it, he would fly over poor people from other countries, pay them for their kidney and fly them home. the problem was, when they invited him to talk about this during one of the hearings, he

emphasized the commercial aspect of it. he emphasized what great money- making opportunity it was, not a great public health service a good beat. -- great public health service it could be. the congressman all rattled by that. then, section 301 was entered into the bill which is the felony prohibition on selling organs, commercial exchange, and brokering for profit. if you violate that, you could go to jail and i assume this broker will be in jail for up to five years or $50,000. >> would like to turn to the audience and open up to any questions or might be. we will have a microphone making its way around. if you could wait until that comes to you. >> i would like to clarify things. how did you meet virginia?

if you have a broker? what is her race or did you give her anything in cash? >> she is a friend. i have known her since 1997. we were not that close, but that makes the story all little unusual. typically, when you get an organ from someone you know, it's someone you are fairly close with. but she is someone i know. she is a brilliant journalist. she is a few years younger than me and we had the same blood type. i didn't give her anything. except the bottomless gratitude. >> some people say if there was a market for this, it cheapens the gift. that's a frequent criticism. if virginia had been paid, you would not have this injuring gratitude because there would have $10,000 for me.

can you talk about that objection, that creating a market would undermine the merit of the nation and cheapen the gift? >> the only critics i ever say that is the national kidney foundation. others might, but they are the ones to talk about this lot. it is an enduring mystery to me within mean by that. if i were on dialysis and fading and new i only had a few more months to live, a kidney, whether it was paid for or given freely would have been torn precious to me. it certainly would not have been cheapened all. -- would have been barred precious to me. there was a great analogy -- it's almost like saying i would love to give you that kidney, i know you needed desperately, but i think someone across town is getting a tax credit, so forget it. who has ever heard of such

logic? my final reaction is that we're not talking about altruism. maybe there are people who would say if someone else is getting paid -- we're not talking about money, but getting rewarded in some way -- they may say they don't do it. altruism is about selfless concern for someone else's best interest, in respect of of what is going on around you. but i would remind these folks that if there were a distinction between people who gave altruistic way, now everyone is an altruistic donors -- but if there were a distinction between those who got something in return and those who did not, that would give them bragging rights. they can distinguish themselves as the one who's -- the ones who did it and did not get anything. charity work, social signaling

is a major psychological component. there would still be able to signal to the community that they were purchased the and gave to the community and that nothing in return. >> there were a couple of other hands. >> i want to ask you about health insurance. [no audio] did you have problems getting your transaction covered? i'm almost afraid to ask this follow-up question because i want to give any ideas, but people who oppose any kind of commercial activity here, is there any danger there trying to get this written to all the regulation people are proposing like health reform? >> as far as the first question, the recipients insurance, in my

case it was private insurance, in the case of many people, is medicare. medicare has the renal disease program which allows people who, if they have and stage renal disease, they don't have to be 65 to get medicare. they don't even have to be disabled. you can just get this. it will pay for the care of the patient and the donor's surgery. there are also federal programs that will compensate your donor. if they have to fly from other state and their family would stay at a hotel while they are recuperating, they -- it would not be illegal for me to have paid virginia for her time. i paid for a plane ticket and

any time she spent in washington d.c., away from work. the government has a program that will also compensate people for the six parent -- for the expenses. i didn't get the second question. >> in health reform, there are proposals to put all kinds of regulation on commercial health insurance. i'm just being paranoid. >> i have not heard anyone try to interfere with organ donation surgical patients. if they did, it would be crazy to because getting people off dialysis is far more cost savings and keeping people on that. it's about $72,000 a year to keep someone on dialysis and the cost of being off dialysis after you advertise the cost of the surgery, which takes about a year-and-a-half post surgical,

is the recurring cost of the amino suppressant medications. that is 12,000-$15,000 a year. it's much cheaper than being on dialysis. many people can return to work because taxpayers, after they get a transplant. >> i was struck by your comments about the tax credits people get for charitable giving. it seems to me, i know that when i give money, whether i get a credit or not, i feel good about it. if i get a credit, it's a nice added [inaudible] donations providing that kind of compensation, the people

would feel altruistic lead good and -- [inaudible] >> that's when i was saying about the silly mutually exclusive concepts. you can do something good and be rewarded at the same time. the analogy i think of is surrogate motherhood. when you hear surrogate moms talk about what they have done, they have their own children and are very good at this and they are pained by the fact that women desperately want children and cannot have them. it's almost like they're reading from the same script. they're so moved by the idea that they could allow a woman to have a baby because they know how much it means to them and if this is something they could help someone with, they would love to do it and would do it, and they do get paid for their time and effort. they shed, but they could not do it without the extra money.

i see this kind of reward as almost leveraging in natural altruism that many people have. it lowers the threshold for more people to be able to act on that altruism. we are not talking -- when i talked to less friendly audiences, i keep reminding them that we're not talking about cash. the debates i have had are maddening because the other side will keep talking about the black market as the analogy. we're talking about the mirror image of the black market. that is the only way he will cure the black market is to have a safe, legal mechanism, transparent way of doing things. but you have to fight so much against that because we're talking about in kind benefits, protection -- >> do you know of any bills in

congress that would [inaudible] >> at this point, no. my colleagues and i were working on this. there are two general approaches. it could be revived so that third-party incentives to not come under the felony provision anymore. that is very elegant. another approach, and this is one an office was looking at last year, to clarify the true meaning very briefly, the legislative history -- it is strongly suggested the felony portion was put into avoid fell

a profit. one of those incentives, speaking of leveraging altruism could be a contribution to a charity. that is what i would say to someone who thinks it will cheapen the gift. take the reward and give it away. then you'll be a 00. -- you will be a double hero. >> it seems like we did not object to someone donating their hair. we do object presumably if someone were to donate both their eyes. i will get you my hand. it seems like what is going on is there's a line of damage. we don't mind if you donate your hair because it will grow back. but maybe if you do a kidney,

it's not going to grow back in your damaging yourself prominently in some way, whether the damages they are not is debatable. -- whether the damage is big or not is debatable. so we don't let anyone engaged in a transaction where the damage themselves permanently -- with a kidney, there is a probability of having complications. it seems like what you are saying is we should not draw the line at 0, we should draw the line over it, we should not let people donate their eyes. is there anything people are allowed to do that is away from the zero? let me at an observation -- people engage in similar transactions all time. lumberjacks accept the risk of cutting off their hands or falling off a tree that is much

higher than the rescue having your job and they are compensated for that. you might think that the market sets for compensation for this, if you figure out what the risk of dying from donating a kidney is, you could apply the value of life we get from the risk choices people make in the market when they take risky jobs and say compensation needs to be that. drawing the line seems to be what we're talking about, but i have not heard people address that in that manner. >> we're not drawing a line. in a sense, i was not kidding when i say we allow people to take risks for free. whether you are getting compensated for an organ or not, there is still a risk, a mortality risk. the morbidity risk is a little bigger. i've not seen figures. but two of 10,000 people will die either from hemorrhage or a

reaction to the anesthesia. but we accept that if a person is doing it for free, but not if they work to do it for some sort of reward. virginia always says that it's so ironic that the only person in this whole enterprise who takes the risk and gives the thing of value is the only one who gets nothing for it. the transplant surgeons get paid, as they should, the hospitals, the nurses, everyone. another thing that occurred to me is that you mention hair. that's obvious. there's no analogy to kidneys except it is a product of the body. i suspect some people object to it if it is done for cash. but, we do compensate people for blood plasma. in fact, there's no shortage of blood plasma. the supply fluctuates each year,

but we are the biggest exporter of blood plasma which is different from red blood cells. when you look at trucks that come around for blood donation, that is typically the red cross and is unpaid. sometimes it will give the movie tickets or something like that. but it's a gratuity. blood plasma is paid for. we are the biggest exporter of that. we will offer families funeral payments if they allow a medical school, for example, to take the body of their loved one and use it in the anatomy lab. we have to learn to dissect somewhere. we will pay for that burial. when the state of pennsylvania in 1994 passed a law signed by the governor to do just that, to give the families agreed to

bequeath organs of their loved ones to be donated, to be operated on by anatomy students , they passed that law and i give them some much credit. but never implemented it. they were so afraid it ran afoul of the national organ transplant act. but we very cadavers' all the time that have been donated to science. this whole issue is a roiling pit of contradictions. there is a visceral dimension to it. >> we have time for one more question. >> given the fact that most americans either favor some forms of compensation or certainly don't object to them, and i know you are doing a lot of visits on the hill and talking to people about this,

where do you think the resistance is to something that is eminently sensible, saves money and lives? >> thank you for bringing up the public. in the book, one of the appendices is -- covers the literature on polling data. there have been surveys and polls done and the preponderance of these surveys have found a majority of people are very receptive to this concept. surprisingly so, even because they have often been, and these questionnaires have set up a market system. cash -- still people will say this is something we should think about. i think that you are right and it is often the case with the public being way out ahead of the experts. as i alluded to before, you

asked resistance coming from, one major obstacle is the national kidney foundation. they are cheapening the gift of logic that i find incredible. but what especially surprising is they were once very much in favor of doing pilot studies on incentives. up until the early '90s, -- wait a minute. early '90s. they change their tune in 2000. i'm not exactly sure why. i think it had to do with the change in membership of the board. there is someone who is a very outspoken opponent. so the national kidney foundation is not a help to us. unfortunately, they are considered a grass-roots organization. but they are not a grass-roots organization. they are an organization of

professionals. they have close ties with the dialysis industry, which is fine. you want dialysis industry to have the best and i would love for them to be at business, but not because they are a bad industry. i wish people dead on the dialysis. they also give research grants and educate people, but they have been obstructionists' year. unfortunately, because there is no good grass-roots group, they're few and well-meaning but small. the american association of kidney patients. there is no countervailing boys. it's actually quite frustrating. >> you can also find out about the other objections and the sally's arguments rebutting them in the book. that is all we have time for today. thank you coming to talk to sally. we appreciate you being here.

if you could get there on the applause for our guest. [applause] thank you. [applause]

>> more coverage of health care issues later with a look at the rise of health care costs and the effects on u.s. industry. that is at 1:00 eastern here on c-span. meanwhile, live right now on c- span2, the current state and future of the russian military. that is hosted by the hudson institute with military and foreign affairs analysts taking part.