and the opportunities that are continuous. we have about $60 billion still to be awarded in federal contracts. . >> the vice president will send a letter about the availability in states to take loan money and take on the responsibilities of contract and, whether it be or

whether a recession or the continued high rate contracts or other energy contracts and grants that are out there or even, contracts were people who have won opportunities through the state report that -- competitive procurement will be encouraged to been -- to be minorities and small businesses. i picked up a copy of "latina magazine" on my way in. the importance of getting the information out to the state governments and local governments is that a very significant amount of the procurement, more than $70 billion, and i cannot tell you partly because some of it has passed through two states and they do not sign up for it, it differs from state to state. the game will be of the federal

level and the state and local level. if you talk to those procurement folks in your localities and you in your states, we will be doing the same thing coming down from the top. we will be encouraging them, we will watch them and gather information about how they do. we know that our record so far in the recovery act is ok, about 10% have gone to stb's, not quite 10% of the contracts, not quite $10 billion. somewhere in the mid-20's have gone to small businesses. it changes as we let large contracts that go from 27 to 24 because we are letting contracts in the $800 million range go out. we are watching the numbers. the numbers are only the tip of the iceberg. if you do not have information or access, then we have a problem. i encourage you to use the mechanisms that the commerce

department and small business administration have provided to get that information. use the people in the field. if they are eda representatives, make them do their jobs for the business community that is here today. i will be measured on several statistics when i get done. my job will be fundamentally finished in about 13 months. i have never had it term appointment before but i think this one is close to it. at that time, they will measurements of five things -- i have these things on my wall and their measurements that i signed up for. number one is get the money out quickly. as i mentioned earlier, right now, over all, in the aggregate, we have put out, in contracts and grants to states, about $200 billion by the end of this month it will be -- at the end of

september it will be to a $30 billion. we have put about $60 billion out of tax benefits. we are approaching the $300 billion mark. we're doing okay. the second thing is get the money under contract properly. broccoli means two things to make -- that we get contracts in the hands of people who can perform them and people we want to perform them as quickly as we can. we also must avoid fraud, waste, and abuse as well as we can. we manage the risks associated with that. the first part of that involves this community. if i have done a good job getting the money out and my team has done a good trijob andt has gone to people who can most effectively serve the needs of the federal government, then i will have failed in that category. in addition, i have to help build reporting infrastructure and make sure we have proper

measurements in place and finally, maintain the support of the american people. we believe that the support of the american people comes from having people like you from all over america go back and talk about the recovery thing that could work for you. i think he will start to see the blue line that comes down on my chart starting to turn. it will turn slowly and until we get back to the point -- it will take two or three years at a minimum -- we have looked at prior recessions and we find it can be as long as 38 months before you gain back all the jobs you have lost. people talk about a v-shaped recovery or other letters. that was not a reference to the prior president. [laughter]

i wish i had been that cuba. i wish i would have thought of it. that means the recovery starts and debates and starts again. it has the shape of the letter w. we have too much to look forward to to look back. we keep our eyes ahead. we want to maintain the support of the american people to understand that the fact that we might be at the end of a recessionary period is interesting information. until we put people back into jobs and we have more people in jobs than we have before this started -- the president will not think we are successful. i want to thank you for the hard work you do throughout america in growing small businesses and as a former small businessman, i know how hard it is. i stayed up late at night,

working with sales force.com and working with quick books and things like that to do all of the tasks i had to do. i want to thank you for the things you do and i want to let you know that if you need any help from our office or the vice-president's office, let david and his team now. we work through the agency's three we try not to bypass people like david and secretary locke or secretary hightower. i bring greetings from the white house today and i want to thank you very much. [applause] >> thank you, ed. i would like to next introduced the special adviser to the white house for green jobs enterprise and innovation. van jones is an advocate for human rights. he continues to shape the administration's energy and

climate initiatives. yesterday, i talked about three emerging and promising industries, green jobs, smart grid technology, and health care it. not only of these industries growing but they are the right thing to do for us in -- on our planet. today, mr. van jones will speak more about green technology which is something that all of our businesses should know a little bit about. ladies and gentleman, i would like to introduce to you mr. van jones. [applause] >> good morning. good morning! did you all eat? good. i had my back there. first of all, i want to thank david henson. personnel is policy.

when you see someone like him selected to lead an effort like this, it shows a level of seriousness that we have to make sure that we actually begin to meet some of the goals we have long had as a country to grow equal opportunity for both federal contract and all our federal activities. i want to take a moment and give david hansen a round of applause. he is doing an incredible job. [applause] we are lucky to have him. i also want to thank ed deseve. he is our general. when it comes to meeting our goals in the recovery package. he is a modest man. i want to point out a couple of things -- let's not forget that when the president signed the recovery package in mid- february, people were still talking about the great danger, not of the great recession of the great depression.

let's not forget that when the president was sworn in in january, all the economists, right left and otherwise, were fearful that we were headed into a deflationary respire of from which no one could figure out how we could recover. it would be global. nobody is talking about those kinds of catastrophic outcome is now. it has to do, essentially, with the leadership of president obama and his willingness to take bold action and his willingness to bring in people ined deseve to make sure his action is decisive. >> let's give him a round of applause. [applause] lastly, i want to thank you. it is good to come to these conferences. you meet folks and get business cards that you will forget to input in your system.

you shake some hands and maybe do a deal. at some point, you will be back in your cars and back on the job and you will be concerned. it takes courage to be in your situation. it takes courage to be in your position. you represent the forward thrust of all of the efforts of the last entry for equal opportunity and equality. we fought, in the less center, for the right for a qualified person to get a job. you now stand for the idea that qualified people should be able to get jobs and that is where we have to go together. magic johnson said," if you want to be ready, stay ready." part of staying ready, to my comments here, is not just being ready inside but knowing what is the world ready for.

as small business people, as emerging entrepreneurs, and business leaders, you could be very ready to sell eight track tapes but the world is not ready for that right now. do not try to operate the cds because they are not going anywhere either. we all live and a world of mp threes, i putz so it is not just about being ready. we want to figure out what the world is ready for. we have a president that understands what the world is ready for and what america is ready for is a revolutionary transformation in our energy system. if you look at our vulnerability is, so many of them converged on the fact that we are using a track tape-level technology to power america. our scientists tell us we are in danger of cooking the planet

with greenhouse gases because we are still using fossil fuel, the remains of dead dinosaurs coming to power ourselves in the 21st century. we have an oppornity now to diversify our energy portfolio, to use our traditional fossil fools -- fossil fuels better. and to use less energy and to have more work and better help them better well as a result. that is the fourth thrust of the president's agenda. it directly create opportunity for you. in order for us to meet our energy and security and climate goals, we are going to have to retrofit millions of buildings, upgrade them so that they waste less energy. we will have to put up millions of solar panels. that is thousands of contracts, millions of jobs.

we will have to manufacture wind turbines and put them up, thousands of contracts. we will have to grow biofuels, thousands of contracts, ultimately millions of jobs. this green jobs direction is represented in our recovery package because i don't have a lot of time, i want to focus on one aspect of our recovery package it probably it's the majority of you, in terms of immediate opportunities. then, i will let you get back to your morning. our recovery package is $787 billion. $80 billion of that is for things that are for billing or clean energy. smart batteries, wind power, biofuels, land restoration, the whole bit. in that $80 billion, about $50

billion is in one department, one agency, the department of energy. it is important for you to know that. when the president talks about building this clean energy economy, and he talks about creating these jobs and opportunities of tomorrow, he has made a bet that the department of energy will be the main motor, the main engine. we talk about smart grid, the money is there. when you talk about smaller batteries, the money is there. when you talk about whether is asian and energy efficiency, but money is there. when you down the line, a strategic focus on the department of energy, understanding it, should reward your effort. this should be a specifically for small businesses. many of you may not be started and advanced battery division

tomorrow. let me focus on energy efficiency for builders and homes. 2008, the federal government spent $200 million to retrofit and weatherize and upgrade the homes of poor people, low income people, to cut their energy bills. this is so grandma would not have to spend money trying to stay warm on the wall -- in the winter. in the recovery package, the president put $5 billion into those same activities. you're going from 200 million to $500 million. -- to $5 billion. there's an opportunity to grow jobs and workers and be a part of the supply chain. the genius of the president's commitment to energy efficiency is this -- those humble and hard

working efficiency dollars, the sexy solar dollars, the reality is that many of the judge in the near term will not be about cutting edge technology to create new energy, it will be about off-the-shelf technology deploying it to use less energy today. when i talk about? i am talking about the humble, hard working efficiency dollars called talking guns, insulation, high-performance windows and doors, replacing the inefficient boilers and furnaces with high- performance once, taking out refrigerators that use 10 times too much energy in putting in the new stuff. maybe they conspicuous -- stickum smart meters in those

homes, as well. those are jobs that small businesses can get involved and. you have to buy the insulation from somebody. you have to buy the windows from somebody. those workers have to be hired from somebody to go into those homes. the president is excited and the vice-president is also excited about this effort because those humble, hard-working energy- efficient dollars work overtime for this country. why do i say that? i will tell you story to give you an example. suppose we you have a would be worker, who either haskell wants them, you give that worker a dollar and hire them and say they are part of the addition to ever prevent worker stands up and that dollar to cut unemployment. when that worker walks across the street and she starts to retrofit a home, she blows in

that non-toxic insulation and replaces those windows and doors and does that all the work. the same dollar the cut employment, cut grandma's energy bill. with the off-the-shelf technology we have, up to 50% reduction in energy bills are possible right now. it can be captured and turned into work and wealth of opportunities in energy efficiency. the dollar just worked double time. it gets better write down the street, there might be a cold- power plant. it might have to work 30% to hard because these homes are 30% to wasteful. you cut those energy bills, you cut the pollution coming out of the power plants. you just cut greenhouse gas emissions. you just as much. -- you just cut as much.

that same dollar -- you just cut asthsma. it will pay for itself and a few years because of those energy savings. this is an area that we will see tremendous growth and focus on in this administration because there are so many good things we can do. we need to focus on energy bills and creating jobs and cleaning up the air and helping us to meet our climate goals. what i want to leave you with is a simple inside. i hope it will transform your company. i hope will transform your life. i hope it will put you on a trajectory to be with mp3 crowd over the next eight years or so it is a very simple insights. everything that is good for the environment, everything that is good for our climate policy,

everything that is good for energy independence, is a job. it is a contract. it is an entrepreneurial opportunity. if you can get that light bulb to go off in your head, every single time you hear administration officials talk about meeting our environmental and energy goals, you should be thinking," how does my company create a value to solve the problem? how do we get in there? have we become the main marketers for installing solar? how do we get in on the front end to put in the smart meters to help people manage energy in their homes?" we are in a position to do with world class.

we can go forward, as you have done so brilliantly and this stuff -- through this stuff. into the coming revival of the american economy, not just having gotten a job at some point but being a part of the next great effort to get millions of americans jobs in the clean energy economy. thank you very much. [applause] >> there is one more round of applause for van jobes -- [applause] >> this concludes our morning event. i like to invite everybody to go to the ribbon-cutting for the activity at the expo hall. you can go out the doors in the back and to the left. we will join you at the expo hall. thank you very much.

[no audio] >> host: caller[captions copyril cable satellite corp. 2009] >> mourners continue to file through in boston for summer -- senator ted kennedy. there'll be more service live at 7:00 on c-span. a funeral mass will be held tomorrow at boston's basilica at 10:30 eastern. his body will be flown back to washington. there will be brief ceremony on the steps of the u.s. capitol, followed by burial at the kennedy family plot at arlington national cemetery at 5:30. all those events are live on c- span. saturday, on booktv, an interview with the reporters

wrote the book on senator kennedy which recounts his life and family relations to his political career in congress. what's the interview saturday morning at 8:00 a.m., eastern and again at midnight. in 1959, in the heat of the cold war, soviet premier nikita khrushchev took an unprecedented two-week tour of the u.s. peter carlson recounts that trip with his son, a surrogate -- sergei. our series on medicare continues with a look at medicare part c and how it might be affected by health care legislation. this is an hour-and-a-half. >> today is the third part in our series on medicare. we have looked at medicare part aand b. today, we will look at medicare part c. we have two gentlemen who have

run the agency. host: what is medicare part c? guest: medicare part c is the part of the program that pays private insurance plans to provide benefits to medicare beneficiaries. it is mostly through hmo's but for other kinds of private insurance, as well it offers an alternative to what is referred to as traditional medicare instead of having the benefits provided directly for government contracts doors. the benefits are provided through private insurance companies. guest: it replaces conventional

part a and b. host: what is the purpose of part see? guest: a senior has the option to say if they want to do this. let's say the average medicare payment is $1,000 nationwide. instead of having all the three components, bacon called bluecross or aetna -- they can call bluecross or aetna. you basically get a medicare- basicallyhmo from a private insurance company. it is all compiled into one private option. you are covered by insurance company, privately. united healthcare is the biggest. they have to provide medicare- like benefits.

they are different but they have to be equivalent as of the same value of medicare. you by the private insurance as an option 22% of seniors do that. host: this was developed in 1997? guest: the current form goes back 2003. managed care has participated in medicare since its inception in 1966. payment on the basis of cost and formula designed to attract more private insurers into the program has occurred since the mid-1980's. there has been a number of renaming of this approach to medicare. there has been a number of changes upwards and downwards in the payment rates. the basic idea of giving people the alternative of enrolling in a private plan has been medicare really throughout its

history. guest: there has been ups and downs. the medicare payment for private plans has been high and low. there were about 8 million people in 1987 and medicare -- in medicare. the reason it was medicare plus choice was because there were two bills and the combined them. that is the way congress works. in 1997, congress passed a bill intended to improve it. it puts more money into rural areas. it backfired. it puts more money into rural areas and reduce the money in urban areas. the payments in cities went down but rural areas, people don't sign up as much for the program went from 8 million seniors down to about 5 million. when i came in, i was determined

to turn that around. we put a number of changes through congress. we made a lot of payment changes, intending to lower the premiums a little bit. it was overdone, accidentally and to make the plans more attractive. the trends have gone back the other way. you have gone from 10% of the population in medicare advantage in 2000, back up to 22%. it has become more attractive, maybe too attractive. essentially, in many areas, for low-income people, it is a great option. if you are low-income, the hmo is your cheapest option. you have to get a more limited list. you have lower co-payments and deductibles and lower out-of- pocket costs and, if you are not poor enough to have relatively

low income, you don't have to buy gap insurance. it is not for everybody but it became less attractive than it should of in the late 1990's. it is probably more attractive than it should be right now because we made some pain adjustments. host: what was the thinking behind medicare part c when it first developed and why? it has guest: evolved over time. the original notion in the early days of medicare was that a number of medicare beneficiaries were people who had been enrolled before retirement in the old fashioned hmo's.

they were not call that in the '60s and '70s like kaiser permanente. no one had the option to keep the care they had been getting before they retired. that thinking was transformed in the 1980's when large parts of the congress became totally enamored with the belief that private enterprise could always do better than the government could in the provision of health insurance or health care. they began pushing a systematic way to shift medicare out of government administration into private insurance hands. they were even talking openly been the 19 90's in the contract with america congress after the 1994 election about privatizing medicare altogether. most of the debate over the last couple of decades has been purely ideological.

this has troubled me and tom because we have 30 years of experience with private health insurance plans in the medicare program in fact, their performance, in terms of the quality of care people get and satisfaction, doesn't look dramatically different from the traditional fee-for-service system. we have had this yet you a fact. when we pay the plan's too much, they offer generous benefits. many people sign up and when we try to equalize the amount we pay the private insurers, many of the private insurers lead. -- leave. we have to make a decision whether we will make a determination about the role of private plans on ideological grounds or whether we will establish a level playing field and see the private sector can outperform the government.

so far, in the history of medicare, it has not done so. >> i think we agree. bruce and i are old friends. >> we are friends of long standing and you may be old. guest: by tend to like private plans. bruce is skeptical. he is right. you want to get to the point where you compare apples to apples. and the late 1970's, private plans were underpaid. they were underpaid in urban areas. in 2003, they are overpaid in most country. host: who is overpaid? guest: i will give you an example -- let's say you are in philadelphia. the average payment in that county for medicare beneficiary very differently but it might be $11,000 per year. if you are in medicare part a

and part b, the government will spend $11,000 per year on you and you will spend $1,100 on your premium. that is the traditional medicare program. you can buy an extra drug program on top of it. is the confusing enough? or you can get bluecross or ed not and say they want to -- say you want to buy that plan for the rate is likely to be $12,000. how did that happen? it is a complicated story. we made some mistakes and legislation in two dozen 3, the numbers of people in managed care were dropping because the payments were too low. we were trying to get people back again and make it more attractive for a couple of years. we intended to put more money into the medicare system. there were some technical errors made in the drafting.

they actually got paid more, as a result. it is not like the plants make more money. the hmo's make about 6% profit. what happens is the money goes into extra how could get to & more benefits in philadelphia? that is difficult for congress to fix because seniors are happy. they get lower premiums and more benefits. they get eyeglasses and dental care and other things. whether you were a democrat or republican, there is a debate as to how much to cut the medicare benefits. the seniors are happens about as difficult to do. you cannot call mrs. jones in philadelphia and tell her that you are fixing medicare. she had a plan to was happy with and her premium get to race. the horse is out of the barn.

i'm a fan of medicare advantage but we made some technical errors and overcompensated by making it to attractive. getting that money back is difficult because you have 10 million singers around the country who are happy with their benefits and the have low-cost. they don't want to hear that we're taking it back. host: does medicare part c say the government money? guest: it costs more money on a relative basis. host: the0! was it even developed if it cost the government more money than regular medicare? guest: originally, it did not cost more. if it was like $10,000 which was the average cost. until 1997, the government said they would pay $9,500.

they would pay the providers 95%. hmo's figured out a way to get healthier people. in the late 1990's, we artificially cut their payments. they did not want to be in the private plans. there were fewer and fewer private players that wanted to be in the program. congress, in 2003, in order to get more private players back and primed the pump to catch up. they overdid it. dollar for dollar, if you paid in the same, which is better, which program? you could debate that four days per. the average person now, their plan to subsidize to the tune of about 12%.

guest: there has always been an alice in wonderland character to this debate. when you go into the past, you can find in the congressional record members of congress saying that we need private plans in medicare to reduce medicare spending. that is why we have to pay them more. again, the date of the evidence has been clear for 20 years that you cannot save medicare any money by encouraging greater participation of private plans. yet, the ideological conviction that somehow having private plans and the system will save that congress made an explicit decision in 2003. i have never quite figured out how that is supposed to work. i can tell you that for every

dollar over and above what traditional medicare would cost, that the government pays the private plans, there are substantial additional benefits that go with that for beneficiaries. about 30 cents of every extra dollar that the government pays to private plans stays with the plans. it does not show up in extra benefits british shows up in overhead costs of the private plans in marketing and enrollment costs. also shows up in profits. the one other point here is that while 20 or 30% of medicare beneficiaries benefit from the extra payments, the other 75% bear some of the cost. those higher costs are included in the calculation of part b premiums. anyone who doesn't participate in one of the private plans a

surtax to help subsidize it. guest: i don't disagree with that. this is a philosophical debate that goes beyond liking private insurance. part of this is the concern that when you have medicare which is 18% of the population but 50% of the hospital spending6xc, medice is a single-payer program. it drives most of the behavior of the system. if you are a hospital in albuquerque, 60% of your revenue is coming from the government fixing prices. there is real competition with private insurance. part of this effort as price- fixing causes a lot of problems, volume problems.

price-fixing drives that behavior. we were trying to get as many people in medicare as we could within reason. they get better benefits. getting people back into competitive insurance companies that pay different rates to different people was another goal. the level of the system out in albuquerque pays different rates. the don't pay every doctor the same thing. they're getting some portion of the population into medicare. health care is a philosophical part of it. it concerns us to have the bulk of the consumption of health care going through a system where the government is fixing prices. medicare is a wonderful program and is helpful and no senior is uninsured. as a behavioral mechanism, i think it is horrible because the price fixing driver sped

behavior, volume-wise. there is no differentiation between cost and quality. there's the difference and the philosophical argument between republicans and democrats host: with host: which companies can participate in medicare see? guest: you have to be qualified with cms. you have to offer an actual benefit. hkthe plans filed early in the year with an offer for next year. they come back later this summer. my staff would pullout 25 that were not offering of benefit to people with medicare. cms does regulate them tightly. host: about 600 plants or s our offer? > guest: there's an average of 34 plans, private plans

available to seniors. host: when somebody turned 65 years old, you have been using $11,000 as the average cost per year for medicare a there's a $1,068 deductible. for medicare part b there is a $96.40 premium. what is the premium that a medicare part c person would have to pay? guest: you pay your premium in the system. if you turn 65, your $96 premium is automatically taken out of social security. host: how much will the premium the? guest: the $96 comes out of

yourselves security check at and then goes to pay your premium. is bundled up and sent to the private insurer. 94% of seniors that are offered a plan that has no additional premium. most of them have drug benefit. if you go and buy a drug benefit additionally, medicare part b has a part b premium and then you buy a drug benefit, part d, then you say you want them all in one. you go to a private insurer and do is sign up for the aetna or aarp health plan.

94% of the cases, you will pay no additional benefits and you will -- no additional premiums and get more be enough -- benefits. you get some of your part b premium back. that is because they can take some of that henry bigger premiums. it is very attractive to seniors. the argument is, is it overdone and unfair? what happens in most cases is that they ordered these plans and get some of their part b premium back. the supplemental medicare insurance that seniors by costs them three $0 per month. you go into the medicare hmo and you can get some of your part b premium back and you get your drug benefit for a period -- a

drug benefit free. it is easy to do when your over- subsidized. they are getting extra money that is making the private health plans do this. politically, democrats and republicans can go back in and take some of the money backjzh t that means grandma's premiums are going up. guest: i don't disagree with tom's description of the process other than his notion that the overpayment of the plans has been largely the result of an accident. he may have intended something different but i am clear that the congressional leadership was very clear about wanting to induce medicare beneficiaries in private plans by overpaying them so that sometime down the road, they could politically slashed the payments more easily than

would be the case if they tried to cut conventional medicare. guest: i was the administration negotiator for this propose. the congressional staffers were one in the house and the senate. we clearly wanted to induce more people back into the medicare advantage. premiums temporarily. we want a 6% additional subsidy and we wanted to phase it out. there are many interactions old laws. what we were trying to do got zero turbocharged. it went over the top. it was formally 10% of the population to98ñ over 22%.

i know we did not do this. the primary drafters of this, we overdid it but it was largely a technical error. host: our fault lines are divided differently today. we divided them by age and edit a health-care professional lives. if you are 64 or under -- we have one line. if you're 65 or over, there is another line. and health care professionals have their own line. we want to get your experience, particularly with medicare part c. when you turn 65, what are your options and which option will you choose when it comes to medicare? guest: my primary options or -- are purchasing an individual

supplemental policy or ma edigap policy in new york state. it might be $400 per month. i might enroll in a medicare advantage plan. says the positions i use most regularly do not participate in most medicare advantage plans, i would expect i would stay with the so-called traditional medicare. host: which is part a and b, correct? guest: and then i would probably buy the drug benefit plan, as well. host: what about a private supplemental plan? guest: i would need to buy that as well. host: tom, when you turn 65, what would you do? guest: my mom is 82 so i have 14

years to make this choice for me. she has had her ups and downs. her costs are lower and she is not paying one -- $350 per month. host: what is she playing? guest: she is in northern virginia. she pays one of the $30 per month extra because i signed for a parade gold-plated at the plant. she is happy but there are differences. she has a ppo. you have to vote call ahead and see if doctors are in the network. she had major spinal cord surgery and had to go to rehabilitation. she's paying $300 per month but she pays the rehabilitation was out of her pocket. in some cases it is better in

some cases it is worth. it is confusing as candy. seniors have to look for these options. medicare a bandage for low- income people who cannot afford other premiums, if you shop around, that is a great choice. if you have significant resources and you don't mind the cost, taking the old medicare program and going to any doctor is certainly going to be pleased-hassle option. medicare advantage will probably be less costly option. you have networks to deal with. medicare has no network. host: if somebody is a member of park city, do they have recourse with medicare? -- if somebody is a member of medicare part c, do they have recourse? guest: they have recourse with the private insurer but essentially, they can go to medicare.

host: can you drop out of medicare part c if you joined and want to go back to a and b? guest: only once a year. it was modeled after diem -- federal employees benefit plan. there are two months a year where seniors get brochures and can shop the plans. in the fall, like federal employees, they get the brochures and make their choices at the end of the year and they can change them once a year. there are exceptions to that but generally, you can also change in the spring but you cannot change of you were involved in job benefits. host: 45 people -- 45 million people in the medicare system right now? 22% of them are in medicare part

c? guest: some kind of private health plan, yes. about 50% are in hmos. -- there are 15% in hmos. \ there are a number of companies that have the retiree- employer plans change into a medicare plan. host: is mandatory to be in medicare at age 65, correct? guest: it is not mandatory. your eligibility is automatic. if you do not want to get the owñmedicare benefits for some reason, the skin of some years ago and there was a lot of rhetoric, you are not required to.

you are automatically entitled and automatically eligible for medicare part a if you have a work history and the united states. host: when you turn 65 years old, do you get a letter from medicare? guest: you get a letter of four- six months before your 65th birthday from the social security administration. that is part of the package that you get when you becomeow eligie for social security. host: everything we have talked about in the past 30 minutes, health care reform on capitol hill currently, how is affecting this conversation? guest: this is a big issue on capitol hill. you were talking about taking medicare advantage, which is medicare part c, which is overpaid, and reducing the payments. it is 12% over subsidized,

taking it back to where you have closer to payments for traditional medicare. that saves you a couple hundred billion dollars. that allows you to take money out of medicare to pay for the commercial insurance reform. is the right thing to do? it is, but for every grandmother out there who has a zero premium plan, and are happy with it, that means either their premiums will go up and coverage will go down but they don't like it when it disappears. the politics of taking away their subsidies from seniors who are over subsidize and redistributing it or not -- redistributing it to people who are not insured is the debate going on in congress. guest: i think it shows the

success of the strategy of the people in the 1990's through the middle of this decade who wanted to buy as many medicare beneficiaries into the private plans as possible to benefit the insurance industry and to promote the privatization of medicare. once you have given the extra benefits, is politically difficult to take them away. the administration and democrats in washington would argue that the reason that the benefits would be taken away is not because they are reducing the payments. they are reducing the payments to the same level the conventional medicare pays. it is because insurance companies cannot deliver greater efficiency or cannot reduce their costs and a better than the much-maligned single payer government plan. if they cannot, the notion that all the medicare beneficiary should pay higher premiums to

subsidize additional benefits, that is hard to justify. host: we went longer in the discussion because we have these two people for one hour. cathy, from toledo ohio, a health professional, you are first up. caller: thank you very much. i appreciate cspan having this discussion. i know you're talking about medicare part c. i caught your show about 4:30 in the morning yesterday. your guests were very misinformed about what is going on in the home medical industry. i have been in the business for five years. i am a baby boomer. as i understand it, if you take

a person and they are in a nursing home, it costs about $45,000 for about one year. is that correct? these were to statistics i read. if you keep someone at home. the baby boomer generation would like to keep the family at home. they're more comfortable. they do better at home. they have an opportunity to get healthier. in the home medical equipment company, we are the people that work with the families, with the care givers, we are the ones that work between the doctor. we have to almost be like social workers. we have to have respiratory care therapists. they need us to show them to how to work the equipment. cahost: what is your point?

caller: this initiative may try to eliminate thousands of our home medical equipment companies and take with the quality of it. we went through a tremendous accreditation program the cost my company about $8,000. if i don't get into the competitive program, i will be out of business. in the united states, there is between a few medical equipment companies. medicare sets the price. we don't set the price. the equipment comes from china. it is not in sturdy condition. host: do you get paid through medicare part c a or b, or part see? caller: i do not have any medicare part c customers.

we're talking about medicare part c. guest: i am all for providing beneficiaries who need it with home medical equipment and the education and service that goes with it. i still don't understand what medicare should pay three times for certain equipment what it would cost if an individual went on the internet. our argument yesterday was not whether home equipment was a good or bad thing. it was the extent to which congress, at the behest of the industry continues to insist that medicare significant overpay. .

this equipment is overpaid from a price list from 30 years ago when you can buy the stuff for a lot less. i spent years trying to fix wheelchairs and scooters. wheelchairs and scooters. i had an operation, ordeal. medicare paid $6,000 at a time no matter what it looked like or how many gizmos it had. there are some wonderful wheelchair operators and a lot of scam artists selling wheelchairs to the wrong market. every got -- everybody got paid for a 1982 fee schedule. when the taxpayer money is at risk in the trust funds and you're making decisions like this on how to pay for d.m.e., people at c.m.s. care and try but every time you try to fix it and god bless it, the demi provider in every shopping mall in america. everyone goes nuts. i understand it's a business but it's a crazy business in many cases. you're a small provider and you

sell wheelchairs and bed pans. if you give money to blue cross and aetna and sai you know what, it's your cash, they don't overpay for wheelchairs and bed pans. it changes the behavior. i know that bruce disagrees with me. to me that's the behavior. when aetna's money is at risk or blue cross' money is at risk they are not going to pay too much for a what he will chair or bed pan. when the political money is at risk, whoever shows up at the town hall meeting, that's the fundamental changes. and that's the difference for me. host: next call, under 65, please go ahead. caller: hi. thanks for c-span and thanks for taking my call. not to get off the subject here but i think part of the problem is when you have c.e.o.'s like united health care taking a $1.1 billion golden pair schute to walk away -- parachute to

walk away and $500 million in options, isn't that the problem wasting money giving these guys money? host: tom scully. guest: it's outrageous and has caused a lot of problems over the years. and certainly it's bad for the insurance industry. on the other hand, if you look back to dr. mcgwire, the long-time c.e.o. of united health care, he took over united health care, if i remember, back in the 1990's when it was metropolitan insurance company, and archaic, one of the two worst companies. he merged them when they were poor, poorly run and turned them into the biggest most efficient. he's a doctor. over 15 years he created the biggest insurance company in america, 40 shareholders. their margins is what everybody else was. and they are stock went nothing to very valuable. if you are a shareholder for united you thought he got a lot of stock options worth nothing. he turned it into an $80

billion. the point is having the company not be at risk and having some shareholders like me investing in united health care and he did a hell of a job, after 15 years they're worth a lot. on paper you can never defend anybody making $1 billion but he did create from two pretty lame insurance companies in the early 1990's a very large, very comprehensive, very profitable insurance company and the shareholders were rewarded for that. it's not like the government paid them. there are two sides to the story. the government didn't pay him $1 billion. he created a massive company. he was in it very early. again, i'm not trying to defend him. certainly the taxpayers never paid united health care $1 billion. they are the single biggest contractor for medicare. they make on average about a 3.5% profit on their part d

plan which is drugs and probably a 4% margin on their medicare advantage plan which is about the average. should mcgwire get paid $1 billion in stock options? probably no. maybe the board shouldn't have given him that much. it's not like the government paid him $1 billion. i don't think that's the problem of the insurance can we live in a capitalist company and he happened to max out on the capitalist side. if you don't like it, tax him more. host: mr. vladeck. guest: well, i'm glad that mr. scully is supporting higher taxes. if you can have expanded participation and private enterprise these sort of things are going to has. it's part of the tradeoff. i think sense the banking collapses and some of the wall street bonuses people have been a little less enthusiastic about the general desirblete of unregulated -- desirability of

unregulated firms of performing important functions. but, you know, i think bill mcgwire was overpaid too but that's what's going to happen when you encourage private -publicly held insurance companies to take over governmental functions. host: is that a fear of yours when it comes to medicare part c also? guest: not particularly. again, it's not a fear in the sense that it's a known quantity. what i would fear is that well long-term financial well-being of medicare will be damaged by the overpayment on behalf of a fraction of beneficiaries who get some of that back in additional benefits. but the rest of it sort of disappears into the private insurance industry. and as a result, the federal deficit is worse and the long-term financial prospects of medicare are bleaker.

guest: and i agree with bruce on the overpayment. i think it's a political difference. there is a lot of regulatory discussion on fixing the structure. and california had a medical loss ratio of 85%. if you collect a dollar in premiums you have to spend 85%, 85 cents on the dollar, and that's a standard state regulatory form. so every dollar in the medicare plan, private plan collects they spend 86.6 cents in benefits which is much better than the commercial sector. they're much more regulated. if you turn back the benefits to seniors higher than the commercial sector -- and, look, could you regulate medicare advantage plans more? you probably could. c.m.s. watches them pretty closely. the issue is they don't make extra profits. they have extra benefits to hand back to seniors. i agree with bruce they should be changed and they should be in a level playing field.

i personally think that, you know, we live in a capitalist country and i prefer to have a third party capitalist with their money at risk providing services than the trust funds with these giant funds that nobody -- if somebody overpays for a wheelchair nobody cares and they move on. i think capitalism, well regulated capitalism works. i would rather have that than the government fixing prices. that's the fundamental issue. host: muncie, pennsylvania, please go ahead with your answer. caller: hello. thank you for taking my call. i have humana gold choice. host: are you part c, naomi? caller: am i part b -- host: c? caller: right. yes, ma'am. this is what you're calling part c? host: yes, ma'am. caller: yeah. and i'm very well satisfied with it. and it is not a -- i can go to

any doctor that i want to. and i pay a $15 office visit co-pay and a $30 specialist co-pay. it also includes my drug program. and it's not, you know, where you got to go to this doctor that they say you go anyplace you want to. but i know the president is saying that geisinger has a very, very good plan. i use it but they no longer take medicare or the part c. and you sign a paper that you may be charge extra, you know, but the problem in there is they're taking you. but now they have this little piece they call geisinger fee.

it's like -- it's like down in tennessee, the one hospital calls it a facility fee. and it's $100 when you walk in the door. so i had changed my eye doctor to where i don't have to pay $100 to walk in the door or my insurance company doesn't and he accepts the $30 fee. i'm very, very well satisfied with that. host: naomi, could i ask you, what is your monthly premium for your medicare part c? caller: my part b? host: part c? caller: nothing. i have nothing. i pay nothing. pand i just -- and humana has gotten in touch with me and told me that with the income that i have monthly from social security, which is all that i have, that pennsylvania has a

program to cover the part b, which is the $96. and i've been approved of that. was approved july 20. and that will give me an additional $96 a month in my pocket. guest: you should have her on the program. she has all the moving pieces. she is called partial dual eligible. because she is low enough income that she just has social security, medicare, the state of pennsylvania's medicaid program will pay her part b premiums. that $96 will no longer come out of that social security check. if she has lower income, they would pay other things as well. so she's getting part of that. now she is also in a medicare part c plan, humana gold choice is a private insurance plan, i don't know, given where she's from.

it's a little unusual you go to any doctor you want. your co-payments are $30 and $15 and that's because, as bruce said, they probably have a plush plan that covers eyeglasses and other things and she's happy. if congress comes away and takes some of these subsidies down, which they could take 10%, 12% out of it, your monthly premium will be $30 plus your co-payments going to the doctor will be $25 and $40 and your costs are going to go up. it's basically two moving pieces. there are a lot of seniors out like this woman and they get a note in the mail and say, guess what, you're paying more and you are not going to be happy. whether you're a democrat or republican, it's going to be tough. this is largely me. i tell you, i don't have any cynical -- i was the primary person in the administration driving this. me and secretary thompson. this is exactly what we intended. the payments went a little farther than we intended. getting it back will be

tougher. this is the dynamics with the seniors that are the moving pieces that are causing the issues. host: bruce vladeck, any comment to naomi's comments? guest: i hope in fact if the government cuts their subsidies to humana for the caller's part c plan that humana steps up to the plate and maintains her benefits, even if me take lesser profits out of the plan. host: what was her reference to geisinger? guest: she is in a managed care plan or p.p.o. plan. it is a huge hospital complex in kind of mid eastern pennsylvania. penn state. she's in geisinger and she is probably around the herbie area. probably one of the better sfailts there. said if you are with humana we'll hit you with a splell -- supplement fee of $100. if she was in traditional

medicare, assuming she wasn't as low income, she would get part a and part b and by a united health plan supplemental coverage which would probably cost her $250 or $300 and get any doctor anytime and geisinger wouldn't do that to her. she has a few more barriers to hop over. host: fred, health care professional, hilton head, south carolina. caller: i am a firsttime caller and represented most of the insurance companies in the past seven or eight years in our area. when part c came long, the plan f, the medicare supplement, not everyone qualifies. if you don't sign up within six months at age 65 it is underwritten like a normal health plan. most don't qualify for a plan f. and typical medicare a and b is basically an 80/20 plan. so if you would have bypass

surgery at $100,000 you would have the deductibles, the government would pay 80% you would pay 20%, $20,000. they're expensive. the other problem is if you could get a plan f off the could get a plan f off the batch you are only paying $10 that is not spendable by a people living on a small pension plan. these companies, such as care improvements plus, it is a company that covered chronic illnesses. they lost $60 million in the first year. the next year, they doubled their premiums. in south carolina, we had seven insurance companies dropped out of the plan. bluecross and blue shield of south carolina has a company called in still.

a letter saying they are disenrolled. the company lost so much money. but the part i am trying to get to is, there's not a lot of profit for insurance companies, the doctors take a lower cost and the clients. now, they say the average senior from 65 years old to their demise will spend over $300,000 in medical costs. so if the government is only giving an insurance company $11,000 a year to maintain, to put the responsibility on the insurance company, i would think that would be a very insignificant amount for the government to pay for seniors. the other problem is insurance agents took a real hit. they really need to get together. i got a contract with united health care just on part b. commission was $70. without -- it dropped to $20. i now owe united health care $700. so it's not feasible. mr. scully, if you would speak to a senior and explain

medicare a, b and c megagaps you'd totally confuse them. my question is, part c is very important to seniors in this country. host: and you're a fan of part c? caller: yes, i am. marv: ok. thank you very much. -- caller: yes, i am. host: ok. thank you very much. let's start with bruce vladeck. guest: there's no payments at all to insurance agents or brokers because the government takes care of all the expenses associated with that. i'm sorry as well to learn that south carolina, unlike most other states, permits medical underwriting for medigap supplemental policies and excessive age manning. i think the underline problem is that, again, $11,000 a year is a lot of money.

it only accounts for about half the total health care costs of people 65 and older. so we have this dilemma in the medicare program that's most fundamental that we don't think we can afford its growth at the current levels when in fact the benefits have major, major holes in them. and the real long-term challenge of medicare reform, which is not being addressed at all this year i think in the health reform is that as the population gets older and as older people get less affluent, which is the result of the economic development in the last decade they are going to be, medicare does a very good job of paying for the part of health expenses they encounter which it pays for, but, again, it only covers about half or 55% of the total health care costs that people over 65 experience. guest: we mentioned $11,000 per

senior, that's an average. one of the major changes in the 2003 legislation was that every senior has a risk score now. if there's 45 million seniors, there is a process to go through and figure out if you are a 66-year-old marathoner, your plan may pay demrr 5,000 for you. if you are a 92-year-old chronic cancer patient, you may get $42,000. it vastly depends on your age and health status. if you have older, sicker, frailer seniors, they didn't want them. we flipped the incentives in 2003. so now all these insurance companies are chasing older, sicker people. you have a patient that gets a $45,000 patient and does a great job for them at $35,000 you make a profit. everybody doesn't get paid the same thing. the payment per patient varies massively by age, sex, geography and now health status. now they have 83 little things they get through your medical

records privately that tells you what your value is to the insurance company. and so now it's very attractive for insurance companies to go after older, frail seniors to get them to the private plan which is exactly reverse of what it used to be. host: under 65, good morning. caller: good morning. you discussed durable medical equipment spending a couple of times this morning. this is the slowest growing sector in medicare. it's less than 1% per year. and yesterday mr. vladeck said that congress has prevented cuts in spending. actually, that's untrue. it was cut in 1997, 2003, 2005, 2008. it's less than 50% of what it was even 10 years ago. host: is this michael rhinemer? caller: so with competitive

spending in this sector, yesterday you failed to mention that the delay in the program was paid for by the durable medical equipment sector through a 9% cut effective january this year which paid for all of the projected savings and the bidding program was expected to project. host: ok. is this michael? caller: yes. host: i was going to read your email to mr. vladeck in the program once we got done talking to part c. he's the vice president of the american association for home care. he had some issue with a couple comments mr. vladeck made yesterday and we have his email and we will read that a little later in the program after our discussion on part c. so we'll just ignore that for now but we will come back to that. loretta in for the valley, georgia, 65 and older please go

ahead with your question to tom scully and bruce vladeck. caller: yes. i am a retired teacher and i have united health care and medicare part a and b. recently they had the open enrollment, i received a letter saying i would have to take cigna medicare standard. either a premium of that. and united health care medicare standard plan or premiere plan. and my concern is this. if i don't -- if the doctor doesn't -- my doctor doesn't accept it so i have to go to another doctor but i like the doctor i'm using and i prefer having mine separate. butter in saying that it's not so if i have to get it i would have to pay $500 more out of my pocket. and i am on a fixed income. and i asked why and they said

that the government changed this. there's a legislation that did it. i'm concerned if this goes out then what will happen with my regular -- my private insurance, united health care private? host: loretta, if you stay on the line. bruce vladeck, your comment. guest: i am not sure i understand the question. there is a real problem in retiree health benefits are being cut back by school systems by governments and so forth all over the country. and it sounds to me like part of the problem here is that -- the georgia system says that her premiums will have to go up. well, those plans are in big financial trouble as well. and this is a problem retirees

all over the country are facing. but at the same time the part c plans are raising their premiums in anticipation of sort of reductions that are going to be taken in their payments for next year. so i totally sympathize with the caller. and certainly her desire to keep her current doctor. but if the school retirement plan is unable to maintain her level of benefits, you know, that's what's happening to people all over the country. guest: i think -- i believe what she was asking, she is in traditional medicare part a and part b and not in part c. she has a supplemental benefit which is separate from medicare. provided for by her school district that is like a medigap plan. the georgia school system apparently has said the cost of that, which is the private relatively unregulated nonmedicare supplemental insurance which could cost you

$200 to $400. they say their costs are going up and raising her premium. she has to pay for. what are her choices? getting subsidized by her retiree plan. she probably wants to stick with it. one alternative is to look at an medicare advantage plan. aarp and united health care has a contract with the georgia school system, she should look at the medicare advantage plan. host: which is medicare part c? guest: which will have lower costs. probably going to be a managed care plan. she probably can't go to every doctor. it will cut her costs. probably give her more benefits at a lower cost. host: loretta, do you have a follow-up question at all? caller: yes. my understanding is that the -- that the governor chose not to meet, you know, what i pay, my premium. the legislation, they decided that. so that put me out of it so i

will have to pay like i'm getting a private insurance on my own, the premium. guest: guest: well, if you live in atlanta, there's a state health insurance, it's called chips, they are a private entity that's contracted with medicare. they'll give you lots of help. they won't choose a plan for you but they can talk you through the options and give you a lot of great options on which plan to get. they help seniors make those choices. sounds like you have a choice you're not excited about. they will help you find the best alternative. host: bruce vladeck, could you talk a little bit about the power of the american medical association or the role of the american medical association in our health care system, your views on it and how if participates in the current health care debate going on? guest: well, i think the

american medical association these days is a lot less powerful than what it used to be. a lot less powerful than what people intend to think it is. the physician community has become so sort of fragmented and divided into different groups with different sets of issues. so that on issues like medicare physician payment, for example, every physician wants to get paid more rather than less and the a.m.a. can represent that very well. but there's enormous fight, for example, between the surgeons and the primary care doctors over pieces of the pie. the extent of the conflicts sort of neuters the a.m.a. in some ways in terms of mobilize physicians effectively on the political front. and these days in washington the specialty groups, whether it's the college of surgeons or even more the subspecialists,

the thoracic surgeons, the cancer surgeons, the family practitioners whatsoever are the most aggressive and effective representatives of the medical communities rather than the a.m.a. as a whole. so one of the real issues that i think dr. nielson, as head of the a.m.a., has really had undertaken a remarkable role in the last year of her efforts to re-establish a.m.a. as the voice of american medicine on health reform and i think she's made a lot of progress. but the underlying issue remains the a.m.a. now represents fewer than half of american practicing physicians. and increasingly physicians that identify themselves not just as doctors but as cardiologist, family practitioners, and that's the vehicles through which they participate in the political process. host: and what's your view on that? do they have too much power, enough power?

guest: i think -- i think on economic issues they behave exactly like every other recipient of -- professional recipient of government payment. i any over the last decade or so the government has both in the congress and in the executive branch has done a much better job of engaging physicians in decisionmaking and those areas where you most need physicians and where the process could most benefit from them in making decisions about ways to improve the quality of health care, increasing patient safety, developing new technologies, which ones ought to be paid for and which ones shouldn't and so on and so forth. i think there's an indispenseable role for physicians. again, it's not through big organizations. it's through the thoughtful,

knowledgeable skill folk and getting them the central part in the whole range of the decisionmaking processees both in the executive and legislative branches. guest: i totally agree with guest: i totally agree with bruce on everyth i think the and i m a power -- i think the ama power, the fact that they convene in the resources advisory group -- structural it had historically, they have a lot of power. politically, they are increasingly week, for a variety of reasons. return much more focused. the oncologist, the urologist, the castro oncologist -- the ama has very good staff. but it is run by members.

it is run by doctors who are rotated in every couple of years. they are run by people who are not -- who do not know anything about washington. the ama staff is good, but it is like running the u.n.. there is no there there. whether you like them or not, they have one person leading the charge for years. if you look at the other one, chipcon, who i used to run at the federation, you know, the members have one focal point. the a.m.a. to me, people say who is the a.m.a.? they are five different thousand people. most of the effective trade association town has a person who is the lead person, coordinates what they do and has a message. i like the a.m.a. but the a.m.a. has been messageless for years. the staff deal with a hundred different chiefs. host: tom scully ran the

medicare and medicaid during the bush years. and bruce vladeck ran it during the clinton years. danville, hi. caller: you've been very informative over the last three days i've listened to you. my first is just a comment is that even though it's been several years into the advantage part c program, seniors are still very confused and they still come in the office every day and say they have medicare when they have an advantage part c plan. there needs to be more education on that. really, my question is related to how you -- whether or not when you are submitting a claim to an advantage plan for a code that is noncovered by medicare but is covered by the part c

plan, are you required if it's routine to code it as if it were routine or can you code it by the diagnosis that you find? because with medicare we are not supposed to submit it, and if we do we're in violation. but if you submit it as routine to the advantage plan >> sometimes they kick it out even though they have a routine benefit and they always pay for it. so if they're cap tated, i'm assuming it's ok to put the diagnosis code correctly as what the person had, but if they're not capitated and turning it one-on-one into a claim to reverse to medicare, then that would be inappropriate, does that make sense to you? host: linda, i take it you live in a doctor's office? caller: office manager. guest: three people could answer it in the universe. probably not me. yeah, basically medicare advantage plans are effectively

private insurance plans. me frequently track medicare, their payments are totally different. whatever humana or aetna secretal relationship with the doctor or hospital is has no bearing on medicare. medicare have some basic rules. it depends -- it depends on the insurance company. my guess is there are many times when a medicare advantage plan covers something that medicare does not and if you submit it according to the insurance company's rules they'll pay it. if you submit it to medicare's rules maybe they should not. if should be covered like a private insurance company. host: this is from ray, an email question from citrus heights, california. i am a 65-year-old retired member of the armed forces and currently enrolled in medicare parts a, b and tricare for life. what are the advantages of my signing up for medicare part c? mr. vladeck?

guest: well, if he's enrolled in tricare, unless he hasome particularly expensive drug coverage issues, or it's difficult for me to see what the advantages of part c would be for someone in his particular situation. host: what is tricare? guest: tricare is the health insurance program for active members of the military which also provides some retirement benefits as well. retired members of the military like this gentleman. guest: it's pretty comprehensive. country is split up into three areas. something called triwest is the contract. they basically provide supplemental insurance. like if you buy a supplemental insurance plan for medicare, triwest does that and fills in the gaps probably at a pretty low cost.

it's going to be hard to see how you get a better benefit than you get out of tricare. because you're in california which has about 35%, 37% of the people have commared part c plan, there are a lot of medicare plans out there, it's probably worth looking. the cost is low and you could get something that's a similar cost. but if you you have tricare you probably have a pretty good deal. host: when it comes to these -- is it fair to call these private plans, that's medigap plans, how many are enrolled? guest: 11 million. host: 11 million have the private gap insurance? guest: yeah. if you look at the world of 47 million seniors and they are low income, so medicaid covers those gaps and all the deductibles and co-payments and there's another -- i forget the number, but probably -- i think seven million or eight million that have retiree health plans, or tricare. tricare is the defense

department's retiree health care program. tricare fills in the gap for this gentleman. there are probably 10 million or 11 million people that actually go without medigap at all. they pay the deductibles and co-payments and they eat the cost which is expensive. most people who are not on the retiree health care plan bice medigap. they are totally private insurance plans. they are not associated with the government. one of the reason i am a big proponent of medicare part c is they are generally not a good deal. their medical loss ratios which is how much you spend per dollar traditionally has been 60% to 0%. host: of what? guest: mutual of omaha for years or united health care, the aarp, let's say they go out and sell you a benefit for $2,000. 70% will go back out in benefits. so 30% will go to profit and overhead. we'll see it's regulated.

it's a high margin plan. agents sell it. bruce say agents don't operate in traditional medicare. it's a very profitable plan. in the medicare part c plan, 86.6% of what's collected goes back out in payments . so medigap to me is bad for seniors. tends to be very expensive. if you have traditional medicare part a, b and c, you have gaps. you need to go get medigap. it's not a great deal. medicare part d is no great -- medicare part a and b basically shoves you, unless you have a great employer, shoves you to buying private health insurance which is not always a good deal for seniors. host: do you agree with that, mr. vladeck? guest: no. it's a substantially better

deal, the medigap plans. i can't resist because tom has a couple times mentioned for part c plans run ploss ratios about 86% which is to say that of every dollar the government pays them 86% goes to pay for medical benefits. the medical loss ratio in traditional medicare part a and b is about 96%. so it's that 10% that comes off the top in the private plans that's the source of concern to many people. in terms of what bin fisharies of the program are getting for the 10%. it's clearly what the insurance companies are getting. it's much less what the government or the beneficiaries are getting for them. host: ken, 65 and older, you're on. caller: i got three little things to make. pardon? host: please go ahead. caller: i go to a specialist every three months and he charges $220 for an office

visit. medicare pays him $88.01. when i go to my primary care doctor, he charges $73, and they pay him every penny of that. i have another couple more statements and then i'm going to hung -- hang up and you can answer for me. i was forced into medicare part d because i was a salary retiree from general motors. when we started getting our statements back and how much they had paid and how much we had paid, i was so amazed what we pay our co-payment is or whatever you want to call it also goes against us on our doughnut hole thing. that to me does not make any sense at all. i got a thing here that says plan paid $774.92. and i paid $223.

and that goes still a doughnut hole. i don't understand that. you can explain it to me. i'm going to hang up but i want -- host: parts a, b and d. you don't have part c. ok. thank you very much. what's your response to him? guest: first, response on the doctor payments . he said my specialist -- bills me $220 and pays $83. medicare made a determination that that the doctor can charge him whatever he wants. you can bill 15% or more in certain circumstances. medicare says here's the rate and we are going to pay it. his commercial rate will be to $220. host: does that lead to upcoding? guest: you pay the best doc $83, they'll find ways to do

other services. if the government fixes prices, they'll find a way to have an m.r.i. machine next door and use that a lot or a c.t. scan to generate more services or check more boxes with things on the form. you can't blame the doc. the specialist knows when you come in the door, they know what the rate is, it's $83. you can argue if it's too low or not. you goes to the primary doc, he gets paid $73. the primary care, medicare decides it's $73. they pay the whole bill. the doctor can -- he's not responsible for paying the extra charges. you can debate the merits of. the senior has no responsibility to pay more than what medicare pays. host: bruce vladeck, before we run out of time, we only have a few minutes left, this is the email from michael, the vice president of the american association for home care. he takes issue with a couple of statements you made yesterday when we were talking about part b. here's the first one.

in the email he says that you said that every administer of the c.m.s. going back to the 1980's has tried to change what medicare pays for durable medical equipment. and according to him, this is patently false. they've cut numerous payments in medicare many times since vladeck left his job. it was cut in the budget act of 1997. and in 2003, 2005 and in 2008. guest: well, i guess i misspoke. congress has made largely cosmetic cuts to some categories to d.m.e. over the years, but none of them have approached the mag any tute that tom or i or our successors or predecessors proposed. and d.m.e. is still overpaid. i was interested in his comments on the call to say that the industry had

voluntarily agreed to take a 9% cut in its payments in order to delay the competitive bidding process. what does it tell you about prices in the industry that they volunteer to cut their prices 9% in order to avoid competition in pricing? i think if you think hard about that comment if explains all you need to know about the d.m.e. industry. host: and also when it comes to the oxygen issue, here is what you said yesterday. every effort for the last 20 years, for the last 20-some years to reduce medicare payments for oxygen has run into a large lobbying campaign from the supplier industry generally organized to frighten beneficiaries to say, you know, if you let this go ahead, congress is literally going to cut off your air supply. and congress has stepped in to prevent reductions in oxygen payments every single time. that's what you said yesterday. this is what mr. rhinemer said.

this statement is also patently false. in fact, congress has enacted significant reductions to medicare oxygen payment rates numerous times. numerous times. and he attached a chart. guest: again, i overstated it. the cuts have always turned out to be significantly less than independent analysts have suggested they should be to the extent that medicare, even after all of these cuts, is still paying more for oxygen at the veterans administration or the department of defense. it is not true that there have been no cuts. in fact, even with all day cuts, medicare is still overpaying for at home oxygen.

guests. both ran the agency that regulates and administers medicare. dayton, ohio, kate, under 65, go ahead. caller: i am going to listen to your archives this week so i can understand a, b and c. it's crazy. i've been dealing with my father, who is a world war ii vet teamster, had only been in the hospital twice in his life when he had a fall a couple years ago. and now we entered the merry-go-round, the insane system of our health care system. why is it so complicated for our seniors? he has now been in three nursing homes and two hospitals the last two years. i have spent a lot of time talking to health care professionals and to the residents in these places. i feel so horrible for our seniors who find themselves in this like web. and i feel like they're old rats running around trying to,

you know, trying to just survive and yet going crazy within the system wondering what's covered, what's not covered. i have talked to many of the seniors, including my father, who -- when they go into therapy from one week to the next they don't know whether they're going to be able to receive therapy or not receive therapy because of how complicated their insurance policies are. so why -- again, can't this be simplified? host: mr. vladeck? guest: i sympathize entirely with the caller's comments. sure, it can be simplified. if it is somebody would have to take responsibility for overseeing all the care some group of seniors require rather than as has been our practice people trying to do what they do well and passing the buck to everyone else.

the medicare program never anticipated the needs for all the long-term community-based care that the demographic revolution would create. it doesn't pay for much of it. and, again, everyone is so concerned about federal spending and the federal deficit that it's unlikely that it will expand to pay for most of it. the states through the medicare program ended up holding the bag for a lot of these expenses. they can't afford it. they don't want it. their principle agenda is to shift more costs to the federal government. there's no effective private health insurance for chronic care for the elder people. and they have not stepped up to the plate either. when the obama administration proposed at the beginning of this year that there be a single medicare payment not only for hospitalization for a medicare beneficiary but for all the care they needed in the 30 days thereafter, no one received those payments because we don't have an organization in the health care system that

is job sees its job of coordinating the care the senior needs. we have few small organizations. we have some pace plans. we have some experimental organizations that have tried to organize and arrange for comprehensive care for people who need it. but i would say that in general both from the insurer side, both public and private, and from the provider side, just about everyone has sort of shied away from taking responsibility for the full range of services needed by the patients with the greatest needs. and this is -- once we get everybody insured in the united states, i hope in the very near future, this is going to be the next step to reforming the health care system which no one wants to talk about. guest: yeah, it's an incredibly complicated system. i think the fact that we really

have three health care systems, not one, if you're low income you're on medicaid. if you're over 65, you're a senior on medicare. two totally different single payer type systems. and in between we have a pretty unregulated which needs to be improved commercial sector. 45 million people uninsured. at some point, and it's a long way off, you have one system that has the same structure and you pay a different amount based on income. which is the structure senator wyden from oregon -- you can't get there overnight, but simplifying the system so that you can understand. host: and you like that? guest: i've told him personally it's undoable. it breaks too many eggs. it's a very complicated system. it's been driven that way, nobody's fault, doctors and hospitals are trying to do the right thing. just became very balkanized with different economic incentives. when i was running c.m.s. during the year i was doing the medicare drug benefit, my mom

was in the hospital for 5 1/2 months in six hospitals, got so many m.r.i. and c.t. scans i couldn't count them all. was trying to do the right thing. she got out of it and said the bills that i'm getting was about $575,000 which she paid nothing. so seniors don't understand that either. she was very sick, almost died, had a total spinal chord meltdown. the system, there is no coordinate nated effort to look at people. it's very frustrating. we need to take a not excitable view of it and slowly, gradually get the system to a more manageable system. you ask me what i'd do 10 years from now, i take the ron wyden fake. trying to get the system where everybody, low income, high income, seniors, commercial sector are looking at a choice of the same basic plans and what you subsidize that depends on your income level is much

more rational than the balkanized mess we have today. host: a philosophical comment on what mr. scully just said? caller: well, i think, again, it's been very illuminating to watch -- guest: well, i think, again, it's been very illuminating to watch the health care debate. because patients suffer when there's no coordination, when there's no assumption of responsibility in the health care system. and yet the fear that americans appear to have of having anyone in charge of the health care system is very real and not entirely misplaced. and until we can really have sort of an honest, calm political discussion about how much we want to avoid making decisions or taking responsibilities for some of these issues so that everyone and every doctor can do whatever he pleases, even at the enormous cost, both human and economic that that generates, we are going to have

a hard time solving any of these problems. host: and finally, bruce vladeck, what do you do today? guest: i sort of split my time between public policy work and consulting and advocacy as an employee of nexseria consulting which is a subsidiary of the greater new york hospital association. host: and tom scully, what do you do? guest: i spend half my time in new york and spend half my time as a lawyer in washington >> "washington journal" continues the health-care debate next week. we will see the perspective of hospital administrators and directors. on monday, we will speak with

the hospital president and ceo and the chairman of the board and the chief of cardiac surgery. tuesday, the hospital chief financial officer and wednesday will have the director the intensive care unit in the hospital's chief nursing officer. >> mourners continue to pay respects as the body of senator ted kennedy lies in repose at the john f. kennedy presidential library in boston, lover now on c-span 2. later today, there will be a memorial service at the library. you can see that here live on c- span. senator ted kennedy's body will be flown back to washington. there will be a brief ceremony on the steps of the capital, followed by the burial at the kennedy family plot at arlington

national cemetery. all of that will be live on c- span. >> washington and the nation continue to focus on health care. we will talk about dealing with the h1n1 swine flu virus with dr. thomas frieeden. we will have a look inside of the u.s. hospital system with dr. john garrett. as the debate over health care continues, c-span's healthcare have is a key resource. go on line and follow the latest tweets. what's the latest events, including town hall meetings. and there is morning @ c- span.org/healthcare. >> from anchorage alaska, senator murkowski and holds a

town hall meeting. this is almost two hours. >> outside, we have a beautiful alaska evening and all of you have chosen to be here. i can only represent you well in washington d.c. -- in washington, d.c. when i know well what you are seeking as we discuss health care tonight, health care reform, health care issues, health care insurance, it is important for you to be here and much more for me to be here to listen to you. as much as i would love to stand here and spend the next two

hours telling you about everything that is in the health committee bill and not in the house bill, we can do that at another time. what i would like, tonight, is to hear your comments. so i am going to have to put a leash on myself, because i have a tendency to want to tell you everything that is in it. if i do that, i am not to be hearing as much from you. again, these are the ground rules as to how much time we would like you to spend in terms of your comments and your questions. i am going to try to exercise a little restraint, but give you the information i believe you are seeking. i want to thank you for your presence here tonight and for the comments that i have received from alaskans all over the state. i have probably received over 5000 e-mails, handwritten letters, phone calls, and so

many of you have expressed a great deal of concern with rushing health care reform through congress. at one point in time, the president said, i want to have a bill to sign by the 15th of october. he set a deadline. i have heard from many of you who are very concerned about the massive spending by our federal government. it is putting that on our children and grandchildren trade is putting future generations at risk of trillions of dollars in federal debt. many of you may not have an opinion on the government plan, but your concern about the cost of your premiums, seeing double- digit increases every year and want to know what this bill is good to do to help reduce that. how is this good to help me?

how am i going to be able to keep the insurance that i have? i have also heard from many who support the actions that have already been taken by congress and that the president is supporting. wherever you are coming from tonight, i really want to hear from you. even those of you who may say that leases coming at this from a completely different perspective, -- that lisa is coming at this from a completely different perspective, i want to hear that point of view. i hope that everyone has received a copy of the materials that were presented to you. it is a packet of information that i want to take a minute with you tonight, before we go to your questions. i think these will provide you with a little bit of a background in terms of where i am coming from and how i have informed my position on some of these issues. the first picture shows the

exponential growth that we face in health-care costs. the president has stated it. i think every member of congress has stated it. the growth curve is not sustainable when we talk about our health care costs. . part of the reason for this is many people are living longer. our technology allows for that, but also we recognize that much of this is unnecessary costs. we got duplication of tests, the practice of defensive medicine, and we have certainly here in california alaska's primary care california alaska's primary care a day results in greater utilization of specialty care. to understand why our premiums are rising so much, we need to look at how we're spending money on health care. we have gone from $250 billion in the early 1970's, to over $2

trillion in mid-2000's. i will repeat, we are on an unsustainable path and a half to be addressed in what better health care reform legislation we pursue. the second graph on the bottom of the first page is the medicare cost growth projections. includes the story macaque -- medicare costs back to 1985 that shows -- cbo is the congressional budget office, a nonpartisan budget office -- this is how much they predict medicare cost will grow without any policy changes over the next 50 years of. look at that, the increase is astronomical. but the current line indicates the net balance of the medicare trust fund. in 2018, that trust fund balance goes to $0. we have a system with medicare at that is also unsustainable.

it is broken. living to the back of that page, this is the federal spending less. the reason i have put this here is that i have travelled across the state, and as i talk to people about what is going on with healthcare, oftentimes what i am finding is that it is not i do not like what you have in the health care are right to like what you have in it, there is a great deal of emotion about where our federal government is going. what are you guys in washington, d.c. doing anyway? and when you put it in the context in terms of our federal spending and the national debt, you look at yet and it is unprecedented what we have seen in the past, basically, 19 months when we spent $3 trillion. how can you possibly spend that? when you think about the first mls in february, just in january

of the seven and $87 billion. we bailed out fannie and freddie and aig. we have that part fun at $700 billion. -- we have that tarp fund at $700 billion. we have the cash for clunkers program. and now health care proposals that could be in excess of $1 trillion. on top of everything else? tell me that you are going to do it right. tell me that you know is going to work. and by the way, we are dealing with climate change legislation. we do not know how much that is going to cost. i put these in as one of the slides to put into context what we are dealing with in terms of federal spending. our budget deficit is predicted to be close to $1.80 trillion at the end of this fiscal year.

it is substantial. it is out of control. cbo, on the bottom half of the page here, is the neutral government scorekeeper. this is who we rely on in congress to assess, to analyze the legislation that we have in front of us in terms of what it would cost. they made the comments that you have before us about health care bills before the congress. i will not read them. i want you to do it because i want to get through these slides. the next one is speaking to the needs and why we are talking so much about increasing access to health care. to better understand how we're talking about -- new we're talking about when we define the number of uninsured. we have identified 47 million

people that are uninsured in this country. if you look at the pie chart, if you will see that in fact some categories of those who earn more than $75,000, 19%, but choose not to purchase health care. you have those eligible for government programs such as s- chip and medicaid that are not enrolled, and those eligible for employer-sponsored plans but have not chosen. those that are without all affordable insurance options, that is around $13 million. that helps to put that into perspective. you then have some comments from the institute of social and economic research here in anchorage, which speaks to some of the issues that we face here in the state of alaska when it comes to access for those who are medicare beneficiaries.

we have got a situation here in anchorage, the largest city in this state, where you have only 13 out of 75 doctors who will see new medicare beneficiaries. this is an issue that -- without discussion, it comes to mean more often than anyone else. they tell me, my mother cannot get in to see a doctor. i do not know where to go. i brought my parents up from outside. i cannot get a doctor for them. at the health care meeting we had an affair banks last week, i had a woman stand up and -- in fairbanks last week, a woman stood up and said her mother as a great doctor, but this woman is talking about moving down to anchorage, and her doctor in fairbanks said, don't do it. you will not be able to get doctor to see your mother. this is a huge, huge problem for us when we talk about access. the next light on the back

there -- slide on the back there it talks about medicaid and medicaid costs. the projection from the government says that here in the state of alaska, we spend a billion dollars on the medicaid currently. under this proposal, if we pass that version, medicaid would be expanded. the cost to the state would be somewhere between $90 million every year and $130 million every year, depending on how much the federal expansion would be. this would be a cost that is passed straight onto the state. there have been discussions -- on the federal and, we would pick it up -- but ultimately it comes back to the state and is a state expense. it is something that we need to keep in context.

the last slide are some thoughts about how i believe we can advance health care reform. we must have a system that guarantees insurance coverage to those with pre-existing conditions, whether diabetes or heart disease or mental illness or very generic conditions. we must deal with this. we must keep insurance companies from denying claims or canceling coverage because of newly detected condition. those who like their health insurance must be able to keep it. we have to guarantee that help decisions that are made by you and your doctor are made by you and your doctor, and not the insurance and not the federal government. we need to make sure that we are equitably reimbursing our providers for the care they provide you and your family. we need to prohibit financing

health care reform on the backs of our small businesses. here in alaska, we have many small businesses. imposing an employer mandate, in my opinion, it is very difficult for us to impose this on our small businesses. we must keep them from pacing -- placing caps on how much they would treat. and we must focus on the prevention and wellness aspect, those that would reward and facilitate healthy behavior and lifestyle changes. we would create a program that would shift millions of americans from private to public coverage and eliminate the private insurance system as we know it. the president has stated that the status quo in health care is unsustainable, and i think if you look at the first page of your handout, you will agree with that. but we must recognize that

building health care reform on the backs of a broken medicare system is also unacceptable. we need that structural reform that moves us away from the first services -- fee-for services. we have a great will -- a great deal of work to do in washington, it is absolutely necessary and an imperative for your congress to address health care reform that gives us a system that we are proud of, but that also gives us a government that is affordable. with that, i would like to open it up for questions. i think that dennis has laid out the ground rules. we have microphones and he will be calling on you so i am not playing favorites with anybody. but thank you for your attention for right now. [applause]

>> two more comments. when we ask someone to speak and they don't get everything they want to have said said, all of you shoulhave picked up one of these cards at the front. please give us your comments on the cards. those of you that choose not to speak publicly, please give us your comments were visit the center on the internet and e- mail her. the one other housekeeping item, this particular brochure that the senator was going through is the only one sanctioned by senator murkowski. other materials were passed out which was fine but those were not her materials. those were of different groups. nike. yes, ma'am? just stand up. as soon as i sit down, your time starts.

and please tell us your name and in the time starts. >> my name is joanne. my question is, if you talk about the bureaucrats that are going to be making the decisions, how are they going to be chosen? are they going to be chosen by i s, the people? are they going to be chosen by the president? are they going to be chosen by congress? are they going to be representative of all the 50 states? are they going to part of each ethnic group? how was this going happened and at that desk? what say are we going have? >> an excellent question, one that anyone who cares about their health care for themselves or their families should be asking. i will speak to what we have laid out in the senate bill. and when i speak about the senate bill, one caveat.

there is a bill that mr. the senate health education labor and pension committee, the committee i sit down. it passed out about a month ago. there is another senate version that is being crafted or worked on within the senate finance committee by a few core individuals. there is nothing of detail yet. the house has its own version of health care reform legislation. but let me just be to the senate version, because i spent about 60 hours with members of the committee going through that proposed legislation. he would basically have, for lack of a better term, a medical board that would be composed of individuals that would be selected by the secretary of health and social services. i do not believe that the

president has any oversight over the selection, who might be on the medical panel. it is through the secretary. there is a great deal that is assigned to that secretary in terms of directives and how individuals are appointed or how decisions are made. again, it goes back to my comment that it is me and my health care that we're talking about, i want to know that it is me and my doctor who are talking about it, or if i need have other family members in on the consoles, that that is where it is. quite honestly, i don't think that having a group of nameless, faceless individuals that are

telling my doctor what he should telling my doctor what he should be doing [applause] >> the gentleman with the glasses, above the fifth row back. please introduce yourself. >> i am daryl keefer. would you support a public option if this saved the overall economy in the long run? what i mean, with the $100 billion a year of federal increase, but it would save the economy. there is now a hidden tax on insured people, and i believe that is about $1,900 for each insured worker in alaska. so both my wife and i work. so we are paying an amount for the uninsured, you know, three emergency room care and things

that rivals our income taxes, about $3,800 between the two of us. also, about 50% of our bankruptcy's and 62% of our foreclosures are costing society, and they are due to medical bills. if you look of the long run and get it with the rural economy, it would do then support the public option? [applause] >> and i have been asked many times, you know, will you support a public auction, a government-run plan? what i remind people is it is not so much the the government- run plan is in and of itself a bad thing. we have government-run health care right now with medicare and medicaid. [applause] and the va system and the ihs

system. we have it. va system and need ihs system. i am not upset -- absolutely saying we cannot have a government-run plant. but we have had a government plan that actually works. and let me tell you -- [cheers and applause] to take the model of the broken system, a system that does not work -- and in the state of alaska, medicaid does not work. if you cannot get in to see a provider, it does not work. so if we're going to move toward any kind of a goverent- run plan, that devil is clearly going to be in the details. if you cannot get in to see a provider, all we're doing with a government plan is giving you a new card. someone described it as giving someone a bus ticket, knowing

that there is no boss. -- no bus. that is wrong. i am not just say no to a government plan. >> as go back to the gentleman in the brown shirt, about halfway back on the right. >> thank you, senator. >> please introduce years -- yourself. >> my name is ray and i am one of your center -- senior citizens. not your fellow senator nor are president nor many members of congress have something that you have, our credibility -- your credibility in our trust. -- and our trust. [applause] britney when i say that high and many of our fellow senior citizens are terrified at what can happen to us if this

hurriedly and haphazardly written bill is jammed down our throats. i went down to my doctor yesterday. i got extra hour -- x-rays and an mri. it was so comforting to know that i was covered by medicare and i did not have to get to that government alpanel to telle whether i can have it or not. they know i can have it or wait like so many other countries. the bottom line, and my question to you is this, because i cannot believe the smoke and mirrors and the bait and switch signals coming from the white house. how can you add 40 million people to 50 million people to medicare, cut $500 billion from the program, without rationing and giving people like me and the elderly any of these other services that we're going to

need? it sounds like they're going to be doing a lot of rationing, denying and deferring. medicare does need to be fixed, but much of it works right now. you had mentioned what needs to be fixed. why throw the baby out with the bath water? why we fix what is wrong -- why don't we fix what is wrong? [applause] >> i appreciate the comments and what you have expressed is what i have heard from so many. why for the baby out with the bath water? well, i will tell you -- and it goes back to my comments to the last gentleman. we have got a system here and alaska that is failing our seniors if you cannot get in to see a provider. you're going to hear me say that

many times tonight. i have got to figure out a way where we can address the concerns and alaskans and people all of the country about the rising cost of health care, the rising cost of premiums, while at the same time providing new access to a doctor, somebody who can write your prescriptions and heal your body, fix you up, and our reality is right now we are not doing that. the legislation you have suggested has been rushed through. i will tell you. we have a process in the event -- a senate health committee -- in the senate help committee, it was not a good way to deal with the bill. we had at thousand page bill, presented to us for the first time on thursday night, and we were told that we would markup on tuesday morning, have your

amendments in by the week ended and the section on the government option was not even included because it had not yet been written. we spent four weeks going through all aspects of the bill, but it was a process that in fairness was not a real effort to work through the tough issues in a bipartisan way to make a bill better. the pressure on us was to get the bill at committee yesterday. when you set an arbitrary date for the accomplishment of something, and you do not set as your priority adapting good policy, what you what it is something that moves out of committee that is not good policy. i am not willing to support anything that is not good

policy. [applause] . we will be moving up to the group that is not sitting in here so we can give their forces in the room, too. they're sending me in comments. when this sort of related has to do with what your position is on the health care corporative is that have been mentioned recently and was that this. >> it is an excellent question. it is floating out there right now and has been under discussion for about a month or so. i wish that i had more details about it. in fact, i made contact with the senate finance committee just today to say, do you have any more in terms of the nuts and bolts of where you are with the specifics of the co-op? because people are looking at this as, if is this perhaps the way for us to go? what i was told today is that,

in fact, there is a great deal of discussion about the concept still and it may be something that can advance through this group of six better working and will ultimately be presenting it to us. but rain now, it is more just the theory in concept. -- but right now, it is more just a theory in concept. i wish i could share more with the. some have said that we absolutely cannot go with the co op. we need to stick with the public option. others say we cannot go with a co-op because the co-op is nothing more than a trojan horse for the public option plan. we are going to have a clashing in the meeting. right now we do not know what it is. here and alaska, we have familiarity with our rural electoral co-ops. how would that work within the health-care field? i do not know that we know yet.

is this something that is worthy of discussion? why should we not talk about it? why should we not take the time to look at all of the options and all of the issues incident saying this is the path that we must take and we must take it by the state? let us put it out on the table. [applause] >> the woman with the blond hair, blue, about half way back. this way. this side. right in front of you. right there. with that lady. predicted that lady. >> i work for a medical billing office. my concern is that we will get into the same situation we have with medicare with the reimbursement late -- rate so low and people cannot stay in business with the amount they reimbursed. if we do go for something from

the federal government, are they planning to cap fees and push doctors out of business and then we will lose all of our doctors? >> i wish that the gift is something comforting their credit -- i wish that i could give you something comforting there. the reality laid out by the director of the cbo is that in order for the health care plan that was moved to the health care committee, in order for that to cancel out, the reimbursement rates under a public auction would have to be set at medicare rates in order to work. at one point in time, we were talking about medicare plus tender. i met the group of doctors. i said, if we did have this plan and that was the reimbursement rate, what would it mean to you?

to a number, the also, i could not do it. i could not do it. you not only -- you would have doctors who are not only opting out of medicare, but would opt out of the government plan. whether it is the senate bill or the house a bill that we are looking at, the house bill put it at medicare plus 5%. doctors in alaska are saying we simply cannot do it. again, we are trying to -- the structure that has been built in the senate health committee and house side is one that is built too similar to a system that is not working for a rural states like alaska and will not work for other rural states. it might be working just fine if you are in washington, d.c. are in boston or in a big urban center. it is not working for us.

>> excuse me. this way. the woman right there. she has a gauge-ish ---- eight beigish -- >> i am here representing 16 family practice doctors, which is 20% of the family practice doctors in anchorage. we went from 180 down to 70 because of a medicare reimbursement rates. if the bill that is currently proposed, we would all be out of business by 2014. this is a very serious problem we all enjoy seeing our patients. right now for a $150 office visit, i am paid $14 by medicare. $40 by medicare. they made $3 billion lester.

what we need to do is allow our seniors to take $300 that they are paying right now to the secondary insurance, put it in savings, so they can pay us, hearing aids, other medical devices without a bunch of government bureaucracy. people should be allowed to do help savings accounts but if that is one of the things we need to change. [unintelligible] several of my colleagues have dropped of the medicare. there are other different things i would like to see. one is business offices for patients that cannot afford the health savings account to allow us as physicians to write off these losses as business losses. none of these things will cost the federal government a penny. it would pit the control back in

the hands of the patient and of the physician. we also need to reform malpractice. malpractice. that is not addressed in any of these issues. [applause] and i have already e-mailed york -- >> thank you very much for your comments. you got your two minutes. great. [applause] >> before we go, what i want to do is acknowledge you and thank you as a family practice doctor. you are, unfortunately, almost a dying breed in our state. and what is happening, as you have stated so aptly, is the government is driving those out of the practice.

and it is people like those in the room and those that are listening and watching the suffers the consequences. you have offered some good suggestions. thank you for that. >> now down to the front, third row back. yes, sir, you with the glasses. thank you. >> thank you. my name is tom mcgrath. i am small-business owner here. i provide health care for my employees with a copays so they are invested in the system. the most inefficient part of my company is that of dealing with the government. municipal, state, and federal. every part of the government that i deal with this inefficient down to the post office. [laughter] [applause] why would we want to allow the government to be in charge of health care in the united states

when they cannot do anything right as it is? thank you. [applause] >> you run a small business. do you know what it is like to making business judgment decisions for your family and business? many of us recognize that when you lose control of that, whether it is a three-year state government where federal government -- through a your state government or federal government, it may be more than what you are able to deal with. i do not believe that we in the federal government should be running health care. i do not believe that we should be building automobiles. [applause] the government is good that some things. do not ask me to tell you what they are right now. [laughter] that is a completely different issue.

healthcare, and i think this is what has driven you out here today, is personal. it is often times emotional. for us at the government level to impose more than a one size fits all standard, i do not think you get the level of decision making that you want and the ability to choose that you want for you and your family. the direction that we are taking great now, i think we need to fall back, revisit how we can make meaningful changes that do not cost this country and provide better health care for all americans. >> i have another comment from the folks out side. this is one -- how will we prevent insurance companies from placing financial limitations or caps on how much they will pay if we have not been able to do that already? >how can we actually do that?

>> i want to acknowledge the people that are in the back of the room. i do hope that most of the a able to sit. i see some standing. the good news for you is the air is probably a little bit settling on the outside. you may have had the better end of the deal. as far as how we reckon with and deal with the insurance companies, i will tell you. so many of the proposals that are out there, whether on the house side or on the senate side, and what the president is talking about, many of these issues that relate to health insurance reform our reforms of the insurance companies are willing to take on. we are talking about the requirements that the preceding conditions -- if you have lost a

job and to have lost your insurance and you have to move to another insurance plan, you have a pre-existing condition. i think there is a recognition. this is something that shelby and will be addressed. -- shelby and will be addressed. -- shall be and will be addressed. that is one of the issues. there is another area i think we will see a bipartisan result on. it is because the demands from the american public is such that we -- why would you stick with your insurance? why would you continue with a program that you do not know if they are going to -- if they will say sorry, you have now covered a new love. we are no longer a going to be covering you. these are some of the reforms that, again, are areas where

republicans and democrats are an agreement that we need to resolve. [applause] >> in the back of the room, i think it is a lady with a green shirt and hat. yes, thank you. >> thank you for having us tonight. i just wanted to give my 2 cents. i feel like this plan, the president, the house, the senate is a recent visit of socialism. -- rep of socialism. i am very afraid of that. i think they are trying to come in softly through the back door. i just wanted to say that this is not the country that i want to the then it goes to that bit of [applause] [cheers} >> your comment is one that i

have heard expressed. it is not specific to this health care bill that we have in front of us. it is a concern about a draft that we may be seeing in the nation. i think it should concern us. >> over undecided the room in the back. the gentleman with the hat in the back. >> can you wait for the microphone? but it is the gentle man with the brown hat. thank you. >> hello. i may be beating a dead horse to death. i am hard of hearing and have not heard all the answers. i do have something to say about the medicare reimbursement rate. if you are not on medicare, for

your information, if your doctor charges you a thousand dollars, medicare will probably reimburse him possibly $250 for the payment. this is one of the region's -- reasons doctors are not seeing older patients and medicare. i do not what predict i do not know what you will do about this, because the few increase the rate and the amount of spending that the government option will go up. if you go pass a law ordering them to see these patients, i have no idea what is going to happen. my other comment is that i kind of see this as we are driving along in our automobile and up the road there is a big fogbank. it is complicated by the medicare payment system, by the poor people not having enough coverage, by rich people being able to get whatever they want,

and i feel like it is as though we do not know where we are going. it is going to take a lot of working together on both sides of the aisle from the republicans and democrats to find the solution to this problem. i have not seen a lot of positive things come out from the republican side other than some negative comments, we do not want that, we do not want this. i would like to see more working together. we need it. it is going to take something like this to solve it. [applause] >> i agree wholeheartedly with you. it'll take more working together. it is going to take more time. this is complicated. this is complex. it is not going to happen

because i say that we have to have it by this date. think about what we are doing. this is 1/6 of the nation's economy that we are talking about. we are talking about health care reform. this affects you with your democrat or republican, urban or rural or live in alaska or maine. this process is everything. let's take the time to get it right and if it takes us a few extra months, it takes a few extra months. you mentioned that we need to be working together. this cannot be just a democrat solution, because it is not a democrat problem. it is not a republican problem or a republican solution. we have got to figure out how we address this issue that affects all americans. we are very divided in the

congress right now. in order to get to solutions that are workable, we have got to figure out how we come together to have a good discussion, a good debate, and work through these issues. there are a couple of good bills i think that are out there on the table that had been procured by republicans. there is a bill from oregon and utah that they have put on the table a year or so ago. that particular one has 13 co- sponsors on it, pretty much even in terms of a republican vs. democrat. there are things in it that i do not like, but is the meat of is something that we can be working off of and talking on it? yes. this is where we need to be

going, not necessarily saying it has to be this bill or it has to be this plan. we have got to be sitting down and we have to be doing the hard work. there are six men and women in the finance committee that have said i am going to hold off all the pressure i am getting from republican leadership or democratic leadership or the president and they are saying that we have to plow through and work on this. will they do it? i do not know. i am sure hoping that they have the collective will between those six to continue it. i think americans want a solution. they do not want to see the partisans disagreeing and bickering and name-calling. they want to see solutions. that is our job, to deliver solutions that work for the country. i agree. >> the lady sitting at about 6 rows back with glasses. this way.

thank you. >> thank you for being here. i have several questions. i am a 44-year-old disabled person. i am on social security disability. i am on medicare, they are for. as the gentleman stated in the back, medicare only pays between 2% and 20% of what the physicians bill. it is incredible. 1200 other bill and they will pay $47 or less. in some cases, and they pay nothing. that is the reason why our doctors are opting out of medicare. i do not blame them. as far as what you are saying you will support about health care reform, i would like to know who guarantees that i can even see a doctor? i would also like to know who

and how will it be decided whether my life style is help althy and my behavior's arm healthy i will be reworded by that by continuing to get health care? as far as our small business employers, hawaii, which i lived in for 12 years, is the only state with mandatory employer coverage. if your job is 20 hours a week or more, your employer must provide you with healthcare. what that has done is hawaii is it has for small businesses to hire twice the number of people and have them work only 19 hours a week so that the small businesses do not have to pay for their health insurance. that is why most people in hawaii work three jobs. who is going to tell the employers how many hours a week a person has to work for them to

pay for their health insurance? >> thank you for your comment. but that is a good comment. let me address the last one. @@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @ that all employers who employ over 25 employees are required to have health care coverage offered to their employees. failure to do so will result in a $750 per employee penalty. if you are the seasonal worker or a part-time worker, the penalty per employee is $350 per employee. so it goes back to -- tom, you said you were a small businessman. i do not know if you have more than 25 employees, but one of

the kerns we have is if you have this employer mandate with the penalties on it, as a small businessman, you may look at what it cost you to provide for that level of coverage. what that's $750 as a penalty per employee, even though that is a top hit may be less than what i would be providing for coverage for them as is. i think i'm just going to stop offering my employer base plan and let them go to a government option. there is discussion about a government auction ultimately resulting in a shift of 80 million americans from private insurance to a public plan. you ask an excellent question about -- had to guaranteed to

get health care. -- how to guarantee that to get health care. that is part of the problem. what is the guarantee? the guarantee as -- if you are an individual with disabilities and you have -- maybe i should not use you as an example. how do we guarantee that people get health care? what we might be able to do is guarantee that you have access to health care insurance. it goes back to what was stated by the doctor earlier. if you do not have doctors that are seeing these individuals, if they are not want to take medicare or be on the government

plan, we have given me the best ticket without the best. we have guaranteed access if you will because we said you now have insurance, but if we have to fix the other side of it, witches of getting you in the door to see a provider to help you, how have we helped you? again, to go bac to building a system of reform on a system that has failed this year in alaska with medicare, it goes back to the reimbursement issue. it is just not going to work. we will not be able to guarantee you health care. we might deal to guarantee you the card that says you can get it. but if you are living in the wrong spot, [unintelligible]

>> this the thing compared to the size of the federal government. but that is true. >> that is what is unsustainable. i do not want this to the federal government grow, i want to see it shrink. i just went to technical school for major airline. we have people from my company from all over the world. i was sitting next to a guy from england. he had an emergency operation on a hernia. they put him on a six month waiting list. six month waiting list. he had to hobble onto a plane and fly to new york and got the operation the next.

what are we even thinking? the government is not one to be able to do this. [applause] >> when i went to fairbanks for the town hall meeting last week, i talked to a man whose family lives in canada. he said, please, do not use this as a model. he said let me tell you about my uncle who had in issued with his knee. he said the made him wait for six months before -- excuse me,

four years -- it was a long time. it obviously was not as pressing as this individual you address. they made him wait for four years. it was not because there were not the doctors or the providers to care for him. he said they wanted him to wait until he hit 60, because they estimate that a knee is a good for about 20 years and it did not want to have to do two knees. that is not the kind of health care that i want. >> down in the front. the gentlemen on the second row with glass. >> first of all, something we can all agree on is mortality is not 100%. other than that, why do not we tail of the profit and bonus vaulters to run this country's healthcare now and give them an average 3 year price for their stocks and a credit for their income taxes or their capital

gains taxes, buy all their stocks, and make health care and health care delivery profitless, cooperative, and a mutually owned? i had usaaq insurance for my home and my car and i get returned on my premiums every year. i have an saa account which people in the u.s. they do not know about. the $400 that i can take with me. i could take with me. my premiums have gone up may be 1% in the past 20 years. i have the $400 in the bank. i get a return to my premium dollars every year. that is what we need in healthcare. i use to the physician, but i quit because of health reasons and because of medicare and insurance reimbursement procedures and road blocks. i could not take it anymore. i am sure there a lot of people

who are out there who would not mind a nonprofit, patient oriented health care system funded by the premium dollars of the patient. i estimate that if you charge $4 a day for people who love nothing wrong with them, $6 for 50% of the people who of wonder to problems and $8 a day for people have 34 problems, you could raise $650 billion a year. >> your time is up. >> i will just pick up on your comments about a co-op in a non- profit entity. that is something that is out there in subject for discussion is a reasonable? absolutely. will it work? who knows. i think these of the types of things that we ought not be

afraid to have out there on the table and give them due consideration. i'm sorry you left the practice. we need more of the. >> thank you. >> another question from the back. this is a number of the card questions. they want to know about tort reform and is the part of the discussion? [applause] in my opinion, tort reform has got to be part of the discussion in. it must be part of the discussion. you talk with the doctors out there. we have one that is a family practice. we will have one that left the practice. all those that i have had an opportunity to speak with admit that there is defensive medicine that is being practiced every single day in all parts of the country where you have a doctor's. it is because of the fear of

being sued, the medical malpractice and the liability. the doctors know what it is he or she should be doing, but because of the threat -- there is going to be extra careful and ordered just one more test to be sure. when in fact, these men and women and professional but have been trained, they know what they are doing, but the way our system works -- where the most litigious society in the world -- we put our providers in a box. we say, you should have done that or you should have done that it has. if they are ordering perhaps unnecessary tense that cost all of us. it must be part of the discussion. the estimates that are out there have turned from the cost to

the health care system, put it in the range of $100 billion. we have to be realistic that when -- if we are going to meaningfully address the ever rising cost of health care, we have to look at tort reform as one of the issues. it is not part of the bill that it is not part of the bill that we have coming it is not part of the house package of bills. i think it needs to be. [applause] >> ok, about two-thirds of the way back, a woman in an orange shirt, red hair, i think. >> you're pretty good at spotting them.

>> why isn't it part of the discussion? and one little thing i want to add is this mentality that you guys do not have to abide by the laws you pass. if you pass something, you better abide by it. [applause] >> and i am with you on that. we should not have our own special program. right now, as a federal employee, i am a member of the federal employees health benefits program. but my program as a united states senator is exactly the same as the 17,000 other federal employees that are here in the state of alaska. but if we were to pass a government-run plan, a government auction, i believe that we, the members of congress, and those who work for

us, should also be part of that plan. there is no reason that we should not. [applause] that is part of the senate bill. it came out of the health committee on a very narrow votes. i believed it was 12-11. it was interesting how partisan it was. it is also interesting how partisan tort reform is. we cannot seem to get our democratic colleagues to come with us in agreeing that tort reform must be part of the equation. we have got to work on that. [applause] >> ok, the gentlemen on the side with the yellow shirt. again, everyone, please introduce yourselves.

>> hello. thank you. my name is rob barrett. i have been in the insurance business for 19 years. i have a stake in this discussion i have many of the people in the audience as clients. i want to know i am here on behalf of my clients, not just myself. that being said, there was a meeting that went on with senator hollis back in january, and he had a similar discussion. 90% of the room with people affiliated with the health insurance business, doctors, nurses, and more. they made a suggestion to him, and a thing tort reform is a huge part of this, but the litigious society that we are has definitely stepped up the pace for the cost of the health insurance to the people at large as a result of their increasing

premiums. there's also research and development that we pay for as a society that does not get passed back to us. it gets passed on to us as a cost item so if we were to take the research and development that is done for the prescription medications that are necessary for everyone involved, especially our elderly now, that would be something to look at as far as the reform goes. .

an interesting point. i actually asked this this morning. what exactly are we talking about when we talking about health care reform? it is something that we need to better -- refine. are we referring health care insurance? that is one aspect of it. do we need to reform medicare so that it works in states like alaska? absolutely. do we need to the reforming the delivery system and how for instance -- how procedures are

reimbursed. i mentioned at the outset that we need to be working toward reimbursing for quality as opposed to quantity. we need to be looking to the medical home model where you have a fool on the service coordinated care. we can be looking to how we deliver our health care costs and thus reduce those costs. these are all very different. health care insurance reform is perhaps the difference then what we need to do with medicare reform. it is perhaps different than what we need to do reform and restructuring of the delete -- delivery system here. this is very complicated. it is as -- mike oginski who is

the ranking member on the senate health committee has said -- every title of his health care bill that we have gone through could be its own stand-alone legislation. it is that detailed. it is that complex. ladies and gentlemen, we need to get it right. we owe it to you to get it right. [applause] >> over on this side. the gentle man with the light blue shirt. thank you. >> my name is john. thank you for being with us today. i appreciate that. it seems to me that basically it is a foregone conclusion that there is going to be some kind of bill eventually passed. -- past regarding health care. it seems that the democrats already have the numbered to pass the bill without any republican support. my question is, if we have a

medicare system that currently allows doctors to withdraw, to not be a part of it, will the doctors still have that sort of an option we have a federal government mandated health care system, and if they are allowed to withdraw, and we have the same thing happen with this new system as we have had happened with the medicare, what is going to happen? >> that is my question. [applause] >> i the very back. a gentle man with a longer hair and glasses. in the middle. >> i hope he did not take that as a flip response. it is not. it is a very legitimate question. we do not have the answer. the fact of the matter is, those providers with opt out.

>> ibm and uninsured americans. i know you are aware that we already provided nationalized and the single payer -- [unintelligible] it is in the firm of the ihs, the indian health service. they are usually critical of this. it gives the ihs good reading, reading moderately are fully effective. the only place with the ihs still isn't tradition of services to native americans to leave tribal lands or reservations to find employment or education elsewhere. it can only be fixed by nationally covering plant. firstly, if we as americans feel that the ihs service is good enough for people to whom we owe

so much, people to whom we are making up for crimes that were committed a been spent, why is it not good enough for the rest of americans to have government help services? [cheers] secondly, if we feel that it is necessary that it is a moral duty to provide this help service to these people as the restitution for the crimes committed against them, why should we not feel as incumbent upon us to provide them to african americans or other form of the oppressed person kiddie groups who do not receive it? how is not a form of institutionalized racism? >> let us talk about theihs, because we do have here an increase particularly -- in

anchorage reticulate, it is a first-rate facility. i think that we are proud of what they have been able to do. i have been on the indian affairs committee since i got to the senate. i have had an opportunity to really spend some time understanding being i systemhs, how it is working and how it is not working. we chronically underfunded ihs which has led -- you want to talk about rationing care, you go and talk to some of those who live on reservations in the lower 48. it pretty much if you have -- if you have injured yourself after july, you are out of luck, because the money in is out in terms of what is available to be paid. it is a pretty dismal situation. i think we look at ihs and say that there are -- that it is a system that when allowed to work

with the appropriate financial backing and support, it is ok. it is not a model of government efficiency. i will speak to another form government health care we know about in this state, that is the v.a > i can tell ian that if you happen to be -- i can tell you if you happen to be a veteran who happens to live in an area where you have access to v.a. services, that is good for you. far too many of our alaskan veterans, whether they live -- they are basically is no access. they are given the promise that they earned when they signed up to serve, that of health care, but only if they happen to live in the right place. is that what we want to be doing?

i had an e-mail from a woman who said, i am on medicare, my husband is a bet. i cannot get him to see a doctor and my husband has been waiting for three months for the be 8 to sign off on a prescription drug that his doctor has ordered that he take, but the v.a. cannot decide whether or not this is something they will be paying for. we have some issues with a government run systems. again, if you are going to go down that road, you better figure out how you do it right, whether it is standing by the obligation to american indians and alaskan natives. >> the person in the middle with the green shirt. >> is nancy here?

>> no. >> my point of talking is that i had something done to me directly i had my cataracts removed. they said i needed the skin from the inside of my eyes removed because i had no side. they gave me list some doctors. i took the first one. i went over there. i saw him. he said that he could fix it. they pulled of the muscles from my eyes and removed the skin on the side and pulled them up. i went in for the operation, was unconscious while he was operating. he did 21 things wrong to me. i tried to get to the insurance to not pay him. they paid him. then i went to its 34 attorneys and they will not go against the

doctor. even out a separate did i went to lower 48 to get some doctors to pass judgment on the operation. they called the doctor up here and said, they could not help me. what we have here in alaska is that the insurance companies, the medical malpractice -- there is no help for people who have medical malpractice. as far as the v.a. is concerned, i have a printer is in the air force. he was held prisoner overseas. she was being treated for posttraumatic stress disorder. the v.a. here was treating her. then they stopped and said that she had to pay full payment because it was her choice. >> on the issue of tort reform. there are many who have concern that if we were to institute a

level of tort reform that the doctors did act negligently that they escaped free. that is not what the tort reform is about. it is not designed to let doctors fail in their practice. again, it is making sure that the protection is there for the patient. -- patient, while ensuring that at the same time we do not have a practice of defensive medicine that unnecessarily costs people across this country. >> of the gentlemen in the red shirt on the front row. >> my name is ed. i was wondering, how come -- senate and house cannot get their act together into maybe

put a levy or higher tax pay for our medicine from the imports we are getting in from communist countries? why do not we give america back to america? [cheers] >> i tell you. i am not one that what my health care shipped overseas. i am not one that once we did i want to make sure the drugs that i am taking part are safe. they are the drugs that my doctor has believe he has prescribed for me and the medication that denny. you are talking about a bigger picture, which is keeping the local and bringing it home and supporting americans. that is a tough one to argue. >> back out to the -- there are a number of questions having to do with the providers with the

shortage of physicians of practitioners and other providers. is there anything in the proposals that discusses that? >> in both the senate bill and the house a bill, there is a recognition that we do have a shortage of providers, particularly in the primary care area. some of the proposals that are out there are ways that we can in sent individuals to go into practice, whether it is payment of student loans so that they can be encouraged to come back. we need to do more to get more providers. it is not just here. there are 17 states across the country where right now there are simply not enough providers available to accept specifically those on medicare. it is states oregon, washington,

colorado, new mexico -- this is an issue that must be addressed with how we deal. @@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @ it hurts us more, perhaps more markedly, in rural places and particularly in a state like alaska. we are not growing our own. one of the things that we know, typically, at an individual will and up practicing within 8100- mile radius from where they trained. we are kind of out of luck in terms of that. we are working with the university of washington. have a training program. our reality is that we are at a disadvantage. we do have things in the legislation that does focus some incentives to encourage

more to go into the practice. one of the things that i think we need to do is recognize that it does not have to be just and senses to be a doctor. we need to have more mid-levels. we need to have the nurse practitioners. we need to have the p.a's. we know that so many communities you will never have a doctor out here. let's make sure that when be talking about reimbursement that those mid-levels are covered as well. we need to do much more to encourage those to go into the primary care as opposed to the specialists. right now the incentives are not there. when you talk to a cardiologists about what they get reimbursed for a procedure purses a family care doctor is going to get, it

is no wonder that people go into specialties. we need to turn that on its head as well. there is a lot that we can do to provide for the appropriate incentives to the we get more practitioners of providers out in the field. [applause] >> the baby in the back, second row from the back, on this side. -- the lady in the back, the second row from the back, on this side of the >> i would like to make an observation. it seems as soon as the american public becomes familiar with the definitions of healthcare, insurance reform and what it stands for is, you change it to a different name, such as health insurance. which is it? is it health care or is it health insurance or is it health care insurance reform or is a public option or is it co-op?

it is it? [applause] >> that is the process. it is. it is difficult to follow. we are all smiling and laughing, but she is right on. right now i think what you need to understand is this is still in process, a legislative process. and they describe it as sausage making. that is probably an acpt description for the you do not know what goes into, but you want to know that the allen goes good. is it a government option, is it co-op? that is why i am out here listening to you and getting your input. >> over on this side. stand up.

>> we are making these guys get their exercise. so much for the prevention and wellness. it is not working. click the button? >> palin? thank you for coming. thank you for having the courage to come here and in person rather than by teleconference? i have a couple of comments to make about what the definition i believe of health care should be. i hear a lot about money and profits and want to remind you we are talking about lives, health, our grandparents, family members, and our communities. profit and money is one thing.

we are talking about human beings. the second thing is along the lines, i think that profits and health care are morally -- a morally should not be connected. period. they are not together. you cannot have profits associated with making the right decision of the time. when you have a profit in there, you'll never make the right decision. maybe sometimes, but not always. i want to ask you how you like your healthcare. >> i am fortunate. i have health care. i am fortunate. i have health care. it is the same health care that other federal employees around the state capital of the thing that is great about my health care. -- i had a couple of dozen

plants as i can choose from. by more than a couple of dozen. i have p a i havelans that i can choose from. -- i have a lot of plans that i can choose from. i think this is what people want. when my kids were younger, i wanted to make sure that we had something in the plan that was either able to put aside something in n saa or you are dealing with the means that we planned for as a family. when my husband and i first got married, we were not making a lot of money between the two of us. we wanted to make sure we had coverage provided maternity benefits. you just figure it out. you spend money on your healthcare then you want. the point that i am making here is that i have, as a federal employee, i got choices within a

suite of options that is offered to me. i think that is what people want with bill healthcare. they want choice and they want to be able to streamline it to their needs and to their families need. as you change and grow and family grows, you change your plan. you want to have portability. how many people do you know that are stuck in a job that they do not like that they do not dare leave because of the health insurance? they are stuck there. that is wrong. when we talk about those things that we must fix -- that is one that we must fix. >> over on this side with the blue shirt next to the lady with the red shirt. there. but do you feel like you have won the lottery when he calls on you? >> i would like to see before

showing up today. i appreciate that a great deal. i think it is also a neat thing that we as alaskans can come together. we are not like the other states yelling and screaming. [applause] i -- i am a former marine. i like to be pretty keep things simple. my problem is that we have been told that our system is completely broken and destroyed and had to fix it right now. 88% of americans are satisfied with their health care plan. does it make sense that you can add that large of a number that have access to it, have it, and by these numbers are happy with

it are satisfied? doesn't it seem more logical and easy to manage if we do with those that do not and to try to take such a large step and say you cannot have what you have worked for? . . >> if i become rich or what someone says is rich, how do i become the villain? i have worked to attain what my family needs. we can't continue to try to work both sides of the fence, pulling on both ends, and having a middle-class that is torn between two sides. if we can deal with the percentage that is struggling to get it and to leave us to have what we have, i don't understand how you can say that it is completely destroyed and we need to fix it right now.

[applause] have to fix it right now. [applause] >> first of all, i think you for your service. secondly, i think you for articulating what so much of our problem is. if you look to the chart that i provided you, in terms of the breakdown of the 47 million uninsured, we have been talking collectively as a congress and saying that this is the group we need to address. we need to provide them insurance. again, i will take you around that part chart. when you get to it is 12 million or 13 million that are really those without affordable insurance options. they just do not have anywhere else to go. they cannot. they not eligible for s chip or medicaid. and they are legal citizens here in this country and they do not

have the income that would allow them to do this. we are talking about about 12 million. 12 million is still a lot of people that we need to address. [applause] but it is not something that, again, in order to address that need you throw out everything else that is working for 177 million people [applause] -- 177 million people. [applause] so here is the challenge. that is not my statement about whether or not any 9% of americans have health coverage and 88% are satisfied with their health coverage. we took a "time magazine" pau p.

there is great concern that when you're talking about health care reform and you do not have -- and you have those with valid option for affordable health care coverage. but you and your family have been working hard and a satisfied with where you are. the concern is why are you missing with what i have? this is a great tension that we are seeing around here, trying to figure out how we address those who are truly without without messing it up for those who like where they are and would like to continue with their current coverage. it is a very difficult issue. [applause] >> about 10 rows back, there is the young man with the blue shirt. >> thank you for coming today,

senator macau kit -- senator murkowski. . senator reid and the majority whip recently said that they would not be opposed to passing health care reform if they do not have the necessary votes to bypass a filibuster, that they -- i do not understand budget reconciliation. i was wondering what you think about that and whether that is a feasible solution. for the record, i do not think that is a good idea. [applause] >> the budget -- the process of a budget reconciliation is a system that is unique to the senate that would allow for a way to get around a filibuster it requires 60 votes to break it. when it moves through reconciliation, it only needs 51 votes. it is a process that is available.

it is a process, however, tt is subject to some technical rules within the senate in terms of what may be considered under reconciliation. without getting too much into the wheat, there is so much contained within the health-care bill that came out of the health committee that would not be subject to reconciliation. for example, the wellness prevention pieces. what would be subject to reconciliation would be the tax peace. here's the question to you. if you're a democrat and you are saying that we have to move this plan because our leadership has directed that we should, if all you're going to be able to move is the tax peaiece without considering the good things that are in the bill -- i think that

the wellness and prevention pieces are good and necessary -- is that where you're going to be as@@@@@@@@@ @ @ @ @ @ b@ @ @ republicans do not like it. we feel we need to be working together on a bipartisan bill and moving it back and get 70 or 80 members support. but it is an option for the democrats. they are in the majority and they have a sizable majority. they had 60. they have some options that are available to them. i don't know. i am not in these other states on this break. i am listening to what alaskans are telling me. were a representative from some of these other states where people are coming out in droves and are expressing their concern about this, is wanting to go

ahead and follow your leader. it is another thing to be listening carefully to your constituents. i think there is a dilemma out there. [applause] >> about in the same position on this side, the lady in the black and blue. [laughter] no, that one there. thank you. >> i am a junior. when we went to the iraq war, people were not that concerned with the amount of money we were spending. >> could you slowdown in little bit. >> but with health care coming up, -- when we went to war abroad, people were not so concerned with the money we were spending at a war that was hurting people. but now with a health care reform bill that will help people with their lives, money is now an issue. [applause]

>> sunland you will have to pay off this money, i would rather pay money that will help people instead of killing them. [applause] everyone keeps saying that the americans are leaving a huge debt for their kids that they will have to pay off, so why not k us? [applause] >> i appreciate you being here and i appreciate your statement. i think we'll need to be cognizant that -- i think we all need to be cognizant of the money that the government is spending, whether it is on the men and women who are serving as in iraq and afghanistan, whether it is on health care, or whether it is on cash for clunkers. the fact of the matter is that

that that is passed on to you. the choices that we make and the issues that we advance, we darn well better make sure that we are doing right and that we're doing right by all americans. i thank you for your comments. i wish we had more young people like you who are willing to stand up. [applause] >> the woman appeared, the red shirt, about the seventh row back. -- the woman up here, the red shirt, about the seventh row back. >> my speech has kind of change to. you have been very good to us all. but we are scared. we are scared of what this administration is doing to us. they are taking away a good republican and replacing it with a socialist and we are scared to death. [applause] stand firm against cap and

trade. the unions have too much control over this government already. [applause] through our apathy, some say that we deserve a are government and they might be right. but no more. the silent majority is speaking of with a roar. and we are not going to call down. we will not calmem down when you go back to d.c. we are mad. i appreciate everything you have talked to us about tonight, but i have so many concerns. there is the green movement, we're spending $10 billion in brazil for them to drill and they will not even let us drill in our own country. we are really mad. [applause] >> excuse me, we do need to stick to health care issues. [applause] >> you work for us.

you have to fight for us. tort reform is the first thing we need right now. that will be the best thing toward health care than anything you can come up with. and we need to stop illegal immigration. [applause] that will help health care, too. [applause] >> she had on too many issues and i am supposed to stick to health care. i agree with you on tort reform. that must be part of our solution as we deal with health care reform. >> the woman in the dark black that is standing there. yes. >> thank you for taking my question and welcome back home senator mikulski. -- senator murkowski. i would like to thank the young woman from dimond high, bill

linkx. i have two questions. do you have any ideas of what senator [unintelligible] ideas are on this issue? i am just asking. i am a registered nurse. i just got back from a seminar today it and i am finding out what medicare does and does not pay for and some of the things that i do as far as care for my patients. i understand there is all the stuff about insurance and who pays for this and who does that and the whole business. but my argument has and always been, for me, that patients come first. as far as the whole business on

health care is concerned, i have only one question. how long is it going to take you to figure out how long is when to take you to do this? no, i am serious. [applause] we have had president clinton who tried to introduce it. his wife got into a little something. we had the bush camp in appeare. it has been 16 years? -- we had bush, come in. it has been 16 years? i did want to know what we are going to do -- i just want to know what we're going to do. >> thank you. [applause] >> i am not going to give you an arbitrary date and tell you that we must have it by this date. what we have to do is set as a

priority -- we have got to get the best policy. if that means that we focus on insurance reform first and then delivery systems and then medicare -- i am not quite sure that we need to say that this one has to go first, chronologically, all wor we have to do them all together. it concerns me that we say it has to be done by this date. we had a conversation veered four of us were invited to the white house to talk to the -- we had a conversation. four of us were invited to the white house to talk to the president. i told him that signing on to an arbitrary date is difficult. he reminded me that congress is like kids in school and that we respond better with a deadline.

and he is right there. but you set an arbitrary date and you push it and you get something that does not work for this country. we live with that for a long time did here is one thing that somebody asked me this morning. -- we lived with that for a long time. here's one thing that somebody asked me this morning. they said, is just money. it is not just money. health care reform is very important. the last time we did a really significant reform like this was back in 1965 and we have been living with that ever since. we need to make sure that we get it right. you have to ask my colleague for his specifics. [applause] >> up here, the gentleman in the middle, about the fifth row back. the white shirt. >> i guess i should thank you

for being here mr. rakowski. my name is paul. i am not -- thank you for being here ms. mukowski. i am not scared. i want my old america back. i want my family back. [applause] and i want to be a free american dre. the problem is you and the other leaders. i have never seen such a disconnected leadership in my entire life. >> this is about health care reform. please ask a question. >> yes it is. because you are limiting 82 minutes, i have to make a broader statement. -- because you're limiting me to 2 minutes, i have to make a broader statement. will you asked baggage and young

to join you on a three-day on camera agenda where we can ask probing an interrogative questions, you are not standing before us for accountability. as long as we have the lack of accountability we are going nowhere. [applause] thank you for allowing me to make this, and picks -- thank you for allowing me to make this comment. >> we had 690 people seated in this auditorium. i do not know how many people we had in the overflow. this is my small attend in anchorage to reach out to hear from my constituents. i did the same in fairbanks. we had about 600 people there. we're going to be in the peninsula next weekend. we're going to be in the valley on the following friday.

we have to have a level of communication with their constituents. we failed to do that. we get disconnected. and we get pumped out. that is the way it works. you need to hold us accountable. i am not afraid of accountability. i am, i should not be in this job. let me stand before you and take the hard questions. i think we need to have this level of discussion and debate. i need to hear the ones that are angry and the ones that are just really sad andened. this helps me as i can best formulate on how i can best represent you in washington. you do not need to apologize for calling this out. have at it. >> ok, the lady in the front with the pink. [applause] >> thank you, senator.

i am glad you're here and welcome home. i am a supporter of health insurance reform. and i seek your support in voting for the bill. if there is no bill, there is no reform. one of the things that i am concerned about is that, if you lose your job, you lose your health insurance. he few keep your job and do get sick, you could run into a cap and not have insurance in place. if you keep your job and go for preventive care, that is not covered by some health insurance companies. and if you actually get really sick, cumin not be able to be covered at all because it costs too much money. these are issues that must be addressed. it is my opinion that it must be addressed this year. the lady that said we have been waiting for 16 years for some kind of reform is correct. the insurance companies right now must be held accountable for the changes in public policy for

providing additional health care coverage for all americans, not just the uninsured. [applause] >> you have articulated some money of the issues -- so many of the issues that alaskans are concerned about as far as health care. as far as doing something now, i do not need to tell you. i think you know that congress has a short attention span. again, i should not be flip. but our reality is that this is the moment. this is what we are working on right now. last year, which was a rebuff the focused on? energy. what was happening with the hype -- last year, what was everyone focused on? energy. what was happening with energy?

health care is now front and center. i believe that we must be working áa)d@@ @ @ @ the devil is in the details. i already had one opportunity to vote against the senate health bill. i don't think that would help alaska or the country. i am not one of those who said we should just wield this away. it is not going to go away. i take you back again to the graphs that you have been presented with. that national and federal health expenditure curve is just going to keep going up. the medicare curve in terms of where it goes is just going to keep going down. curve, in terms of where it goes, it is just going to keep going down.

america is not going to forget about this. the woman in the back made a very important point. it was two administrations ago, with the clinton administration, the last time that we really tackled it. we did not pick it up for many years. i would be afraid of that scenario, if we were to put five years beyond -- between where we are now and do nothing at all and then wait about a couple more administrations. i am one that believes that we have a really tough job to do. but that is why you elected us to do it. it is not easy. we're not going to make everybody happy. but we cannot just say, if we wait this out, the american public is going to lose interest in it.

our constituents are going to die down about this and we can move on to the next issue. i think we have a responsibility here. it is very difficult. we're not want to make everybody happy. but i believe that we have to work towards some bipartisan product on health care. >> ok, the time is upon us. [applause] there are so many questions that have yet to be asked and statements made. please fill out your cards and leave them in. there will be staffers outside. we have not stopped yet, folks. we are just close. i want to reiterate what my marine friend said out there. there are people who have been warning about what could happen tonight with rancor in i want to thank you as my fellow alaskans for voicing your

opinions. [applause] end help -- and keeping -- and helping his power volunteer on the stage to keep some control. at this point, what way would you be leaning on what is the best way to make sure we have more of the people in the united states covered with some sort of affordable health care? >> we are talking about access to care right now. i will take us back to where we started this discussion this evening. we can go ahead and promise you a card and tell you that you are covered. but if we have not giving you the care that you need, you cannot get in to see a doctor, we have not helped you.

one of the places that i have to start representing a rural states like alaska is that i have to make sure that the incentives are put in place for our providers, that they will have reimbursement that is reasonable and meaningful, absolutely. it has to be there. and that we do more to innocent individuals to enter the profession -- and that we do more to incent individuals to enter the profession. let's move toward some of the examples we see that are working in terms of access and reducing their cost. this is the medical home model. we have a good one here in anchorage. you have clinics like the mayo

clinic where it really is that whole approach. but, again, what it comes down to from my perspective, representing alaskans, is making sure that we have the providers to provide the care. if all we have done is provided you with a that insurance card, i have not helped you. that is where i think we have to start first. [applause] with that, i think you for your attention. i think you for your input. health care is so personal. and it can be so emotional. we all have their stories. if it is not with you directly, -- we all have our stories. it is not with you directly, it is with a family member or a co- worker. we see the level of interest and banks over where we are going as a nation when it comes to health care. we have a heavy lift.

that is why you elected us to go back there and do it. we cannot run from the tough issues. but the input that you have given, and there have been some good suggestions, i would ask if, as a favor to me, there are forms that you can fill out and ask me more questions. go on my website and please submit e-mails to me. give me your ideas and tell me your stories. just help me. you're helping me -- you're helping me will hopefully bring about better -- your helping me will hopefully bring about bett [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]

>> as the debate continues, c- span and's health care hub is a key resource. go on line and follow the latest. what's the latest events including town hall meetings and share your thoughts on the issues with your own set to send video. there is more online. "washington journal" continues the health care discussion next week. we examine the health care system from the perspective of hospital administrators and doctors. they will take your calls beginning on monday. tuesday, the hospital's chief financial officer and chief information officer. we conclude on wednesday.

it all begins on monday on "washington journal" here on c- span. go inside the supreme court to see the public places and those rarely seen spaces. hear directly from the justices as they provide their insights. home to america's highest court. the first sunday in october on c-span. >> the public viewing to honor senator ted kennedy has ended at the john f. kennedy library in boston. this evening, and memorial service at the library at 7:00 p.m. on c-span. on saturday, at a funeral mass beginning at 10:30. senator kennedy's body will then be flown back to washington. that is followed by a burial at the kennedy family burial plot at around 5:30 p.m. eastern.

you concede all of the events live on c-span. -- you can see of the events live on c-span. now, a discussion on the history of the national security agency. this is one hour. host: what elements of this story to you think are important for the public to know? guest: we are living in a time of national debate about where the public is focused on

torturing and domestic eavesdropping. i think it is important to note that this agency's activities go back a long time. there have been other successes and failures which helped explain where the agency is today and why it does what it does. host: a lot of people when they hear about the national security agency, they have certain ideas of what it does and what it does not do. could you explain their role? as intelligence and security? guest: it is our nation's eavesdropping agency. they collect signals intelligence, intercept radio transmissions, e-mail, faxes, you name it. they try to decode the communications and day intercept. its second mission is to protect the communications of the u.s. government, computer networks and our communications

systems. that is just as important as the intelligence gathering, which is what most people most peoplensa -- what most people know about nsa. >> hohost: how far does it go? guest: 60,000 military personnel all over the world. 60% of what goes into the president's daily brief, which is top-secret, that intelligence report read by the president every morning comes from nsa. host: this is a picture of the building. guest: it's on a 300-acre campus at fort george meade, md., which is halfway between washington and baltimore.

>> the president gets a large amount of information from the agency. it has listening posts as well? guest: at the height of the cold war it had almost 100 listening posts deployed around two dozen countries. the number today is around probably a dozen. the nature of communications has changed. we don't need all the listening posts overseas because people communicate by e-mail and cellphone now. and the internet. radovan by high-frequency radio. it has consolidated a number of its listening posts to about a dozen. host: throughout the history, there aren't three team spirit first, the amount of information that the agency takes in on a day-to-day basis. second, how it is processed or how it's consumed. for the folks will have not read your book, or the importance of

those two? guest: the agency, you have violated the two main challenges of the agency. the first is that it collects massive amounts of information. it collects the equivalent of the entire collection of the library of congress several times a day. it is a massive amount. it is beyond the capacity of any group of human beings to listen to every single message and the email and text message it collects. it depends on computers to screen through the vast amount of information looking for those few nuggets of intelligence. the problem is that the amount of communications out there, the number of teenagers text messaging, the number of people signing up for e-mail and internet service on a day-to-day basis increases exponentially every year, so it is becoming harder for nsa to stay on top of

the amount of communications flowing through the airwaves. and at the same time finding a needle in a haystack. there's a joke over there that the amount of stuff going through the airwaves is increasing so fast that now you have to find a needle in a constantly multiplying series of haystacks. that is the challenge the agency faces. it is going to get worse before it gets better. >host: there are several thousand people working there. it is a people problem? >> it's a combination of people and technology problems. they have the largest collection of supercomputers on the planet probably. even -- it does not matter if they have 50,000 or 75,000 people in the complex of buildings, the fact is it is too

much for human beings to handle. there's no other agency in the world as large as nsa in terms of its ability to collect and process the intelligence. it's the nature of the beast we are facing right now. people are talking more on their funds, sending more e-mail messages. nsa has defined a way to keep on top of that. host: our guest is talking about the national security agency. he is the author of "and untold history of the national security agency." she will take your calls this morning and he or e-mails. the numbers are on your screen. what do you currently do? what do you currently do? @@@@

the have experience at the national agency? guest: for the 25 years subsequent, i was a financial investigator, specializing in white-collar fraud, but basically trying to put people like michael milken behind bars. host: as far as the information and how is process, what has been the pay off for the nation's security? guest: intelligence provided by the national security agency has been essential. all its faults and failings aside, if you unbalanced, you have to conclude that without the intelligence provided, taken in conjunction with everything else collected by the 16 other

agencies comprising the u.s. intelligence committee, i think you would have been in worse shape during the cold war and in the periods after the cold war than we are today. and the democratic line in indiana. caller: thank you. it concerns me with the secretive government agencies and powers they have. maybe i am one of these conspirators. i believe the government does a lot of shady things. my question for your guest is with all the information the agency has, why aren't any of the agency's speaking to public radio or public television to confirm that mr. obama has eight czar that is a devout communist? why don't we see that government control is our biggest problem. they're breaking the constitution, breaking the laws of the land, we cannot secure

our own borders and they're helping out car companies. host: do you get to those kind of comments bo? guest: all the time. the one comment i get the most is that this is an uncontrolled agency. to use a phrase that was coined in 1970's to describe the head of the u.s. intelligence which was the cia, people have described it as a rogue elephant. i don't think that is a fair characterization. i think there are problems, take for example what happened during the bush administration. i think that congress failed adequately to oversee the activities of not just the national security agency but the entire intelligence community as all. the way the white house ran the

super secret activities of nsa and the rest of the community was apple aabhorrent and illegally question -- and legally questionable. we need to reassure the public and to put the rules of law back into the way the intelligence community is run. host: what types of changes? guest: what disturbs me most is the way the nsa's warrantless eavesdropping program was run was a lawyer by the name of john who wrote a series of legal opinions that said the president of the united states could order nsa to engage in domestic

surveillance activities without having to go and get a warrant from the foreign intelligence surveillance court. that's been a lot of the land since 1978. the justification was the president's wartime powers tromped the constitution. any first-year law student will tell you that has no basis in fact or american case law for that matter. this was done in secret. he wrote to the opinions and did not share them with the attorney general. it was sent to vice-president dick cheney personally. i think if any other lawyers had reviewed these legal texts, they would say we have big problems with the legality of these programs, based on this man's justification. this can no longer be done. i think running the intelligence

community in secret, without recourse to congress or the normal process that's been put in place, the checks and balances to make sure these sorts of, these acts, never happen again so we don't revisit this. host:cora on the republican line from virginia. caller: thank you for letting me be on c-span. i have one question. why do we tell so much security stuff on tv in front of the whole world? host: such as bo? caller: all the things you have been talking about this morning. today it seems like we tell too much stuff to the world. host: do we tell too much?

guest: probably. i have traveled extensively. by far, the u.s., the public knowledge of intelligence issues is far superior to any other country, including the democracy is of -- the democracies of western europe. that is a reflection of what has transpired since watergate in the early 1970's where the public's trust in government has dissipated and deteriorated over time and especially the intelligence abuses that occurred during the cold war. the public wanted to know, congress insisted the public had the right to know. frankly, the public media in this country have spent a fair amount of time talking about the activities of our intelligence

agencies, both good and bad. i think it is healthy that in a democracy we can talk about intelligence issues. we lived in england four years. there is a lovely thing called the official secrets act, which means that, if i was to have this conversation with you and england, i could be facing multiple criminal charges for violating the official secrets act. we are both democracies, but we have different standards in terms of what we can and should be discussing. i think it is healthy and the u.s. to talk about intelligence. i'm reluctant to talk about sources and methods. meaning how is it that we intercept calls and how is it we process them. but it is essential that the public know, we are putting $10 billion a year international security. are we getting our money's worth? it's a dollars and cents issue.

host: on the independent line, fred, from new orleans. >caller: good morning. it boggles the mind to look at what we are looking at right now, to see how many intelligence agencies we have and there's only one answer, from where i am looking at about 20 or more intelligence agencies. there's only one reason. you have a police state. we are a police state. we have accountability to these agencies, what they have done in operations we cannot get into. they have admitted crimes that have been exposed and no one is ever held accountable. it goes on and on. we can go to the wiretapping and all the way to murder. and torture. we are a police state. it's all there.

my question is what will happen now with the advent of internet to the infrastructure? we are looking at an operation setting behalf to secure us and that the internet and the web are two different things and the military and intelligence work off of two systems. they could strip us of all of our free speech over the internet. it will be like cable tv. there will only be a few thousand approved government decides to go into. the national security agency in this country will be a full- blown police state at this time in this country. host: we will leave it there. guest: the views of the kollar are incredibly widespread. fear is pervasive in this country. all we have to do is turn on the news at night or pick up the daily newspaper and there is a

revelation a bout the water boarding or something else that has occurred in the recent past. i think the cure for what ails us for the sense of fear or uncertainty about whether our intelligence and security agencies, the fbi and others, are they doing their job and are they not spying on us? are they opening are male and female? -- opening our mail. we have to have some sense of transparency where let's hold some public hearings and air out these issues. i know that there is reluctance on the part of the obama administration to look back on what transpired during the eight years in the bush administration.

but i honestly think that at some point we're going to have to do it, whether it takes the congressional hearings or truth commissions. there's so much pent-up concern. even within -- i speak to retirees who formerly served in the intelligence industry. they are very concerned. some of the behavior of the chiefs of the intelligence community suggest to them that these people are covering up. that they are not happy with these attitudes that basie and they are concerned that the intelligence agencies are running from things that they may have done in the name of national security during the bush administration. let's give the public some sense of what was done and why it was done, what with a cheap, and if mistakes were made and people spied upon. let's find out now.

it will get worse as time goes by, but then the public will come back when we learn new revelations and we will demand even harsher responses. i think it's incumbent on the obama administration to be proactive and tell us what happened. host: what does it mean to you that eric holder is interested in looking into some of the activities of the cia? guest: it does not matter whether you are democrat or republican, we are all americans. tortured is basically unacceptable in any shape or form. i have read legal opinions written by the justice department, justifying them. i find it obnoxious in the sense that the legal niceties were thrown to the wind and justification was found and interpreted. basically, i think that an

investigation is necessary because we are a nation of law. prior to 2001, the previous administrations would never have allowed the use of torture or enhanced interrogation. most of the people i spoke with you it was counterproductive at the least. i think that, if laws were broken, people should be held accountable. that is the way this nation is run. host: miriam on our democrats line from rochester, new york. >caller: it is pretty clear where your guest stance. i wonder what he would think about the legality of the way that people who are against our country have handled our people when they catch them.

i also have another question. apparently, the president of the united states is giving inflow united states is giving inflow -- is apparently the president of the united states is given information every morning and what the intelligence community has discovered in the previous day or whatever. i wondered if there is any kind of collective process as to what is presented to him, because it must be a lot, and secondly, it would seem to me that the orientation of the leader of the country, whether it be obama or bush or clinton or whoever, is going to influence what he decides to pay attention to or feels is important. guest: absolutely true.

gets a blue folder stamped with multiple top-secret classifications. he's the only person other than maybe the vice-president to read it. it is the best intelligence produced by the community on that particular day. it is extremely sensitive. only a few copies have ever been declassified. it's called the president's daily brief. or pdf. each president is different about how -- how much value and importance they place on intelligence. lyndon johnson was a voracious reader of intelligence. he could not get enough. the cia pact is daily brief with all sorts of juicy and titillating information, because they knew the president likes it.

jimmy carter liked precise, clean, short bredes. john kennedy liked oral briefings. he did not to read a lot of paper. george w. bush became -- it's not clear how much importance he placed on intelligence, but the caller's message that the president makes policy decisions based on what he reads every morning ohrid shapes his view on the world and affects the u.s. is absolutely true. that's what intelligence is so important in how the nation is governed and run. host: erode in the book that president george bush --

guest: absolutely true. host: do all presidents find themselves in that position as far as the tides and quality of information? guest: eisenhower came into office fully versed in intelligence matters. he was an army general, former army chief of staff. he knew about the ultra secret. he knew about breaking shermans codes. inouye about the importance of intelligence and codebreaking. then you have other presidents like jimmy carter, a former governor of georgia, and george w. bush, former governor of texas, they had no background or understanding of intelligence community stuff, so the intelligence community tries to educate them as quickly as possible about here is what you are going to be getting every morning.

tell us if you like it. tell us if it meets your needs and requirements. i have to understand that as a nation, more and more of our presidents in the future will probably know nothing about intelligence upon entering the oval office. i think the intelligence community has to get much better in terms of bringing these people up to speed as quickly as possible. and explaining what they do and how they do it. but when the days ago when the presidency used to spend decades in congress before coming into office, being briefed on intelligence matters, that may be a thing of the past. host: what about colin powell, he built a lot of the speech he would give to the u.n. on information he gained from the nsa, maybe he would have questioned the quality of it. guest: he did.

he went before the u.n. security council in march 2003 and gave a presentation basically alleging that iraq had a big weapons of mass destruction program. there were three intercept tapes that he said showed iraq was trying to hide its weapons of mass destruction. it turns out the entire presentation was wrong from beginning to end. there was no factual basis for any of the allegations made in his presentation. you could make the argument that, having been an army general, a former chairman of the joint chiefs of staff, former national security adviser, and then secretary of state, that he should have known better, he should have been able to spot that. as he was preparing the presentation, that the

intelligence did not scored a lot of the we did not support a lot of the allegations that had been publicly aired. president bush went to ohio and gave the "axis of evil" speech, alleging iraq had weapons of mass destruction and at the united states. i don't think the intelligence at was available at the times reported that allegation. there were indications and some data analysis, but, by and large, colin powell should have known better. >> bryon on the republican line. caller: a man called a minute ago to save our country was a police state. does that bother you as much as it did me? second, last night on the glenn backeeck show, there were talking about whether obama

would want a mili-- that he woud want to establish an intelligence agency as well funded at the military is. one gentleman was very concerned. could you elaborate on that as well? guest: i apologize for not having watched that show last night. i'm not sure exactly what was proposed. late senator pat moynihan proposed many years ago scrapping the intelligence community in its current form and bringing all the agencies into one house. basically creating one agency rather than the 16 major agencies and dozens of smaller intelligence organizations we have right now. as you can imagine, the senior officials of the 16 intelligence agencies we currently have resisted mightily this

suggestion that to stop the warfare that was endemic in the u.s. intelligence community, that we should basically disband those agencies and create just one. it had to be controlled by a civilian, of course. there is an undercurrent of concern on both sides of the aisle in congress that more and more you find general's controlling civilian intelligence agencies. general michael hayden was the director of the cia for much of his tenure, for much of the bush administration. it is getting harder and harder to find talented and qualified civilians. leon panetta has no prior intelligence experience before being named director of the cia. but it is getting harder to find intelligence veterans

wanting the job of being a director of national intelligence, which may be that is what beck was talking about last night. host: why don't they want the job? guest: as it is a political nightmare. you spend all day going from one meeting to another, talking intelligence politics rather than actually doing the job that intelligence professionals love to do, which is analyzing and reporting intelligence. most intelligent people i have met, that's all they want to do. they don't want to have to argue with the justice obama's about whether prosecuting or investigating former cia agents in the right thing to do. they just want to do their job. it's getting harder and harder at the top levels in the intelligence community to do that. host: you have written about

several leaders. how important is leadership to bringing about the result of trying to gather and better analyze information? with leaders stand out in your mind? how does that influence the agency? guest: we have had -- national security agency has had good directors. fair to middling as well. and the directors that fell below the acceptable definition of a good leader as well. good leadership is essential at the top. you talk to people like bobby, director of nsa in the 1970's and became the deputy director of the cia. you quickly come to the realization that the top man in these organizations -- organizations are so massive that basically, you spend your entire working day working on

policy may be seven days a week. you have to have a good executive who does all the other work. i think our intelligence community is now 700,000 people strong. it is impossible for any one man to adequately lead it, given the fact there are 16 agencies. i feel sorry for whoever is the director of national intelligence. because basically he spends much of his day holding meetings and trying to maintain integrity and ordination of effort within an ever growing intelligence community. host: one of the things is morale that you about. guest: you read in the papers that morale of intelligence agencies is being threatened by growing investigations that are being promised or are imminent.

i'm not sure how much credence to put to the question of morale. how can you sticca a thermometer into an intelligence agency that is 60,000 people strong and make a judgment of what is ugly or good? there will be some people thinking things are finance some people will think things have gone to hell and a handbaskin a. some people at the senior levels of intelligence community of or about congressional investigations and justice department investigations and trials commissions, and maybe with good reason. the morale of the agencies, these guys are professionals. they're not getting paid a lot of money. they're not in it for the money. they do it because they think it is important. all they want to do is do their

job. i feel like we should let them do their job as long as they stick by the guidelines. host: we're talking with matthew aid. he's written "the secret sentry ." tampa, fla. on the independent line with jerry. caller: that has been public knowledge since 1978. if i would greet my arab brothers in arabic, i know they would pick that up. how long would it take those agencies to find my conversations? guest: greetings to you as well. first of all, echelon is a code name that has been bandied about since at least 1998. echelon was an and as a computer

system putnto place in the 1970's to sort through intercepted communications to try to find a conversation that might have some intelligence value. that is basically all it was. it was not a global intercept network, which is how it has become to be described since the late 1990's. the caller's question about how long it would take nsa to pick up your call? an essay, for those of you who use the internet extensively and pride themselves on their expertise with google you'll know you can plug into google and alert if you want any articles appearing on for example c-span. you'll probably pick up hundreds

upon thousands of articles every day. but you can't plug in and get an alert where the computer will tell you every day every article has ever appeared on the áá nsa does exactly the same thing, except it's google alert system is much larger, encompassing tens of thousands of names, phrases, and countries. i always joke with my friends that every time i send them a copy of an article from "the new york times" that has a terrorist attack in the label, it is probably being forwarded immediately to some analyst at nsa, because that is one of the search terms they use. "the

new york times" article have buried in them somewhere the phrase "terrorist attack"? you have to feel sorry for the men and women at fort meade having to plow through all of this stuff. most of it is in name and thomas. they're looking for that one phone call in arabic maybe that the caller referred to that says a terrorist attack is starting tomorrow. that kind of thing is difficult and backbreaking. here's an example. the nsa intercepted two phone calls 48 hours before the 9/11 attacks. and as they did not get around to translating the intercept until after the 9/11 attacks. a two-day time span between intercept and translation is extraordinarily good, by nsa

standards. the problem is that it came a day late. do we hang but analysts at the nsa for not translating it quickly enough or do applaud them for moving quickly on it? host: 10 the same be said about the attack on the uss cole that maybe this information was not translated or paid attention to by the leadership at the time? guest: yes. bar harbor--you are familiar with the idea that we were breaking all the japanese naval and diplomatic codes before the japanese attack on december 7, 1941 on pearl harbor. yet to the warning signs were appearing in the intercept never managed to reach the people who needed it in a timely and up-and

with the kind of emphasis needed to say it, warning, a japanese attack is forthcoming. my book is full of examples of intelligence was available prior to many different world crises. yet it was either ignored, given short--or in many cases the cia analysts said this is garbage. we have paid in blood for a lot of these mistakes. >> quint in maryland -- were talking dicarlo democrat line. caller: i'm talking about the nsa and other agencies, information -- i am referring to vice-president cheney going on

national tv and bragging about torturing inmates at prisons and how important it was to the security of the united states. whether it was important or not, the man was bragging about breaking the law and there's a back-and-forth argument about whether to prosecute him. is the vice-president immune to prosecution? if he leaves the country, can some nation who's been offended -- this man continues to go online on national programs who invite him and listen to him brag about breaking the law and are no consequences? guest: there's only been one

vice-president in american history forced out of office. that was vice president spiro agnew tied up in the watergate scandal. the answer is, yes. whether you are the vice president or president you are still an american citizen beholden to the laws. if you violate the laws, you will, hopefully, be prosecuted. as to vice-president janedick cheney, we could devote several hours to that subject alone. if you read the newspapers and books that have been written about the former vice president, you realize that he was the main driving force behind many of the intelligence programs. not just the nsa warrantless eavesdropping program, but many of the cia human intelligence

programs and others. he really played an essential and critically important role in directing some of the super secret programs that we are now just beginning to fully appreciate and understand. yes, he has gone to great lengths to defend his leadership in those areas. i am not sure. i'm not sure i agree with the vice-president assessment on the use of water boarding, whether it was legal, necessary, essential, or useful. but this is where reasonable people can disagree. what bothers me the most is that we still do not know many of the details as we need to know to make an informed judgment about this. my gut tells me we are not going to be happy as the details began to dribble out, we won't be happy about what transpired over the last eight years and what still may be transpiring today,

for all i know. many intelligence -- i am an intelligence historian and i never cease to be amazed at how shocked i can be after so many years of study. host: rightabout house leaders use information from the nsa. you're right that when it's was prior to the september 11 attacks -- guest: the nsa said that the chatter prior to 9/11 is in mr. clark's mind and in the mind of george tenet, indicated that something big was evolving and was coming soon. as you mentioned, most of the senior national security officials of the bush

administration rejected the evidence turning up in intelligence. they said, look, we have faced many of these alerts before, it is the cry wolf syndrome taking place. al qaeda had never attacked in the nine states before. so why would they believe something would happen soon. i would love to see the material they're collecting prior to 9/11 and see if an informed judgment can be made in retrospect. to see if we could have spotted an attack. it was so ambiguous, but so we could not. host: in iraq there was a fiber- optic networks. guest: one of the bands of the

existence of nsa currently is the fact that more and more countries from the world are no longer it sending information by radio or by telephone but rather by fiber-optic cable, which basically it is a series of cables buried underground. nsa can not intercept them because there is nothing coursing through the ether. there are no radio signals or electronic emissions for an essay eavesdroppers to get ahold of. in a case of iraq, starting in late 1990 posey say's sud,'s put of their intelligence on fiber- optic cable. nsa could only year low level traffic, guys saying, how are

you and how do you hear me, i hear you ok. hundreds of thousands of hours of innocuous conversation. it is hard for nsa to do its job, to collect valuable and meaningful intelligence when that is all you can hear. that explains why nsa intelligence contributing to the weapons of mass destruction was practically nonexistent. host: thelma on our republican line from tennessee. caller: i am wondering with all of the aclu and everybody against the latest torture they heard about with shooting a gun in the next room and such, has anyone ever said anything but but obama executing the two pilots in somalia?

i guess it does not matter if you execute somebody, but just don't torture them. guest: the two pirates were somali pirates holding the american cargo ship captain hostage in a lifeboat. two navy seal snipers killed them because they were holding a gun to the head of the ship captain, so there'll able to free captain. i'm not aware anyone was executed. it is regrettable that in this day n.h. we stilpeople are dyine globe. american soldiers are killing people. it happens every day in iraq and happens every day in

afghanistan. it is just the nature of the world we live in. it was a hostage rescue situation that turned out very well, actually, in the sense that we managed to free the captives and bring them home alive and well. there have been other incidents in the past where such efforts have not turned out particularly well. so i think our congratulations ought to go out to the navy seal team members who performed the mission. it would have been wonderful if every crisis could be resolved if we sat around a table and played poker and to the winner go the spoils, but that is not how the world works. host:beth on the independent line from schenectady. caller: linda "the new york times 15 years ago had some stories about their had been --

that the government had tested on orphans and people in mental institutions and prisons. radiation in oatmeal and things like that. -- 50 years ago. that this was to protect us. are you familiar with it? guest: i am. caller: this stuff is completely unforgivable. one has to wonder what is going on today. we did not just do partnerships in america. we did them in canada with major colleges. one of the major colleges in canada worked with our government on that. guest: you are referring -- during the battle days of the cold war, the u.s. government

conducted experiments with chemical and biological warfare agents. we tested on animals and we tested -- there's a famous instance where they took a pathogen, thomas pathogen, there were trying to figure out if a biological warfare agent, how it would work on a subway system. would it to infect people if it were delivered properly? they put it into the air conditioning city -- system of the new york subway system without the knowledge of the passengers and tested them after they got off the car. they found it works perfectly fine. the passengers did not know the reason they were being asked to dust off their coats and shirts was because they had just been hit with a pathogen cloud. terrible things were done during the cold war. people forced to take lsd,

military members were volunteers were given all stork -- all sorts of nasty stuff. radiation experience mints were done -- experiments were done. it takes sometimes pitiers for these bad acts to become a matter of public -- it takes sometimes 50 years for these bad axe to become a matter of public record. there are too many secrets protecting too many -- sometimes we do not like what we see when these documents filing get declassified. these are probably some of the documents that the intelligence community does not want to get declassified at all. forced to participate in the nuclear weapons tests and to a massive doses of radiation. we only find out 40 years later

that they are all dying of various forms of cancer because of their participation in these nuclear tests. host: you spoke about iraq and the problems the nsa would have been gathering intelligence. is about the taliban in afghanistan also. host: is this traceable by the nsa? guest: yes. an essay does not operate along. their work closely with the british and australians and new zealand and canadian intelligence services. they do the same thing we do. we sometimes finance them. the taliban in afghanistan pose an interesting problem. they don't use radios. they don't use conventional --

there is no internet or fiber- optic cables, no telephones, except when they are living in pakistan. basically, 90% of what we collect about the taliban is from their use of walkie- talkies. nsa, as most people watching the show will understand -- it is set up to intercept what we use here in the west, and the developed world, lots of radios, telephones, cellphone, instant messages. in the back woods or back hills of afghanistan there are no cell phone dollars or internet links. they don't use conventional radios. they use hand-held walkie- talkies on the battlefield. nsa was completely unprepared when we invaded afghanistan in october 2001. we had no preparation of this.

an essay had no capacity against walky-talky traffic. what the military in afghanistan did, one of those ad hoc arrangements, every u.s. army and marine platoon in afghanistan has an afghan interpreter who speak the language fluently. there are three major languages spoken in afghanistan and other printed dozens of dialects. this man spends hisntire day with a radio scanner at his ear listening to taliban walky-talky translation. we pray that he is loyal and have the best interest of the american soldiers he is working with at heart. then he has to tell the american commander, there are some taliban guys watching you right now and they have in their sights. this has happened thousands of times over the last eight years. the interpreter's helping the u.s. troops in afghanistan have

no security clearance, by the way. they are not american citizens. thousands of american soldiers in afghanistan and iraq placed their lives in their hands every day. i think it is incredible how these people have done the job they have done with minimal pay knowing full well that they and their families stand a good chance of getting killed. host: technology becomes cheaper and more efficient. what does that mean for the nsa? guest: every time a new technology comes about like skype, which is a free telephone service through your computer, it's very popular. it's beginning to make some inroads in the united states. who wants to pay verizon and at&t big bills every month. if you have a computer, you can call your mom or dad or fre even if you are in botswana. every time a new technology

comes around, the nsa's job gets 100% more difficult. anything that increases the volume of communications around world and makes it harder for nsa to gain access to, make the agency's job that much more difficult. it poses a real threat to its ability to produce intelligence. host: caller, go ahead. west virginia. caller: why haven't we seen anyone held accountable for all of the false prewar intelligence? i know there wert two phases of the senate's meetings on intelligence where the investigators were there, yet we have not seen any of those individuals held accountable. seymour hersh wrote an article in "to the new yorker."

and others run about some of these incidents prior to the invasion, talking about the false intelligence and how you could not verify it. why haven't we seen anyone held accountable? guest: if i knew the answer to that, i think i would be living in las vegas right now, living s sad that no one is going to go to prison for -- if you believe that america went to warfae premises and lies, yes, you can imagine how angry you are if it seems everybody sms to skate and are not held accountable. but the fact is, will give you an example, in 2004 we invaded ir andhe insurgency was raging full force. i went to oslo to an intelligence conference.

there were some people from the cia there. including the chief historian of the cia. there were half a dozen guys sitting behind him. i stood up and made exactly the same comment that the caller did, given the fact that we now know there were no weapons of mass destruction, what george i noticed the six guys sitting behind the historian all turned uncomfortable. turns out to these were the analysts that road to the national intelligencee estimate >> "washington journal continues the health care discussion next week broadcasting from

arlington. we examine it from the perspective of hospital administrators and doctors. we will speak with the hospital's director and ceo, and also the chairman of the board. he's the chief of cardiac surgery. tuesday, the hospital's chief financial officer and chief information officer, and we conclude wednesday by talking with the medical director of the intensive care unit and the hospital's chief nursing officer. it all begins monday on "washington journal," here on c- span. the public viewing to honor senator edward kennedy has ended. this evening, a memorial service at the library. you can see that live at 7:00 eastern on c-span. saturday, a funeral mass at boston's basilica beginning at 10:30. president obama will deliver the eulogy. senator kennedy's body will then be flown back to watching it. there will be a brief ceremony on the steps of the u.s. capitol, followed by burial at the kennedy family plot at

arlington national cemetery around 5:30 eastern. you can see all the funeral events live on c-span. >> this month, the ninth circuit court of appeals heard the issue of veterans with posttraumatic stress and dramatic brain injury, and if the va can be ordered to speed up the way they handle claims and the appeals process. watch the oral argument saturday on c-span. as washington and the nation continue to focus on health care, sunday on c-span will talk about dealing with the h1n1 swine flu virus with dr. thomas frieden, director of the centers for disease control. on "q&a" a look inside the u.s. hospital system with dr. john garrett of the va hospital center. earlier today, the u.s. small business administration held a discussion on how minority small-business this can take advantage of opportunities available in the economic stimulus package. here to talk about is a special

white house adviser responsible for its implementation. this is half an hour. [applause] >> the morning. how was breakfast? very good. we are at day 2. i want to thank you for coming to our 27 annual conference. i hope over the last day that everyone was able to meet somebody new and share business ideas, and hopefully get some good input on how you will grow your business. as i said yesterday, to reach economic parity we need to grow minority businesses larger and faster. to do this, we must think globally. we must develop strategic alliances, and we must think about mergers and acquisitions. today's opening session from the

white house to main street will focus on the administration's commitment to ensuring the inclusion of minority businesses in the american recovery and reinvestment act. now there are over $60 billion of federal contracts that are still available under the act, $60 billion, so there's a tremendous opportunity on the federal side. companies need to be ready to take advantages -- take a band of these opportunities. like magic johnson said yesterday, be ready, you do not have to get ready when the economy turns around. i would like to introduce the next become a special advisor to the president and assistant to the vice president. he supports the vice-president in his leadership on the recover3 act implementation and coordinated recovery act efforts. he leaves the white house efforts to make sure the recovery act is implemented quickly and effectively through

interagency coordination. this topic is something i am sure everyone in this room will be interested in, so ladies and gentlemen here he is. [applause] >> good morning. i am delighted to be here this morning. this is one of my favorite hotels and washington, d.c to show you how old i am, the first time i was here, it was when jimmy carter was talking about och with inflation now reject talking about whipping inflation now. it was a long time ago. i learned much about the power of wall street at that time. i was sitting next to my boss and there were powerful people from all over america, mayors and governors and congressmen and senators. there was one fellow, a balding

and steve dover gentleman. about halfway -- stooped over. he scribbled something on a note and handed it back. i asked him who was the guy over there with the note. he said it was dale horowitz from solomon brothers. he had just bought $1.2 billion worth of new york city notes with one stroke of a pin. that was my introduction to the idea that commerce and finance is a powerful tool for all of us. i have been a small businessman at least three times. i have learned a lot of lessons about venture-capital. home in my garage or spaces where the three very high class porsche's that i lost learning about venture-capital.

i am not sure those spaces will ever fill up, but i have some old stock certificates i would be happy to give you, not sell you, in some companies. i have been a successful entrepreneur betimes. -- three times. the first company i found was called public financial management inc.. it is still in existence. it is the largest financial advisor to state and local governments in america, and it is no longer a small business. that is the good news. the bad news is i do not own any more -- i do not own any more. it is an exciting thing to develop and grow a company. what we know about developing and growing companies is they are the strong ones. they are the ones that will do what it takes to make things work. it is much to the advantage of the federal government in the things that we do to have the energy of not just a small

businesses, but those that are headed by women, those that are headed by minorities. those they are headed by veterans, people really want to be able to show that they can take the things they have learned, take a life lessons they have learned, and turn them into success on the job for the client. that is what we care about. y recovery act itself, and i will not bore you because i am sure you have all gone to conferences were people have given you big power plants lies and lectors you about the nature of the recovery act. the recovery act breaks down into fundamentally three pieces. . .

to rescue from the great recession. i have a slide that i sometimes use that shows previous recessions. and it shows this one to there's this blue line.

it plummets. almost 6% loss in jobs. we know the job generators are small businesses, minority businesses, the people in this room. how do we engage them in the conversation? luckily, president obama, vice president biden, they're committed not just one time, not just two times, but committed to going out 200 times over the next 60 days. we have already started the process. it used to be 90 days. the clock is still kicking. we will go all over the country. i will go to some of them. this is only my second. i will go to some of them. other members of the cabinet

will go to others. the vice-president will go to some of them. he went to one the other night. the message we want to carry, not just to the federal contracting community -- and david was correct. we have about $70 billion in federal contracts. the department of interior has 3400 projects throughout america. these are the kind of progress in rehabilitating parts of our national forests and parts of our parks system. it is spread all over the nation. and it is easily accessible locally. you can see that 2500 contracts and the opportunities that are continuous. we have about $60 billion still to be awarded in federal contracts. that is not enough. we encourage you and we will do

the top down, bottom up, here. we encourage you to talk to your state and local contract community. we will do the same pain. -- st. thing. they will send a letter -- same thing. we will speak about the availability of businesses to take on the responsibilities of contract in, whether it be for whether recession or the continued highway contracts or other contract or grants that are out there were even contracts were people who have won opportunities through the state through competitive procurements will be encouraged to be small businesses, be it women owned, and latino or latina owned.

yet to be careful about that. i picked up a copy of latina magazine the other day on my way in. the importance is that a significant amount of the procurement, and i cannot tell you perfectly, because some states do not sign up for it. there is a difference from state to state. the game will be both at the federal level and at the state and local level. if you talk to those folks, we will be doing the same thing, coming down from the top. we will be watching them and gather information on how they do. we know that our record is ok. about 10% have gone to stds.

-- sdbs. some have gone to small businesses. it changes with very large contracts. we're letting contracts in the billion dollar range and $800 million range. we're watching the numbers. at the numbers are only the tip of the iceberg. if you do not have information, if you do not have access, then we have a problem. i encourage you to use the mechanisms that the commerce department and the small business the administration have provided to get that information. use the people in the field. if they are representatives in your area, make them do their job for the business community that is here today. i am born to be measured on several statistics -- i am going to be measured on several statistics when i am done.

my job will be finished 13 months from now. i have never had a term of appointment. -- a term of appointment before. -- a turnermed appointment. as i mentioned, overall, in the aggregate, we have put out in contracts and grants to states about $200 billion and by the end of this month it will be 230 billion. we have also put out 60 billion in tax benefits. we are approaching the $300 billion mark. the second thing is to get the money under contract properly. that means two things to me. that we get contracts in the hands of people who can and want to perform them and that we

avoid elements of waste, fraud and abuse. we manage the risks associated with that. the first part of that, if my team of six have done their job getting the money out, it has not gone to people that could most effectively serve, then i will have failed in that category. in addition, i have to build reporting infrastructure and i have to make sure that we have proper measurements in place and maintain the support of the american people. we believe that support comes from people like you from all over america and going back and saying that this recovery plan might work for us. i think you'll start to see that blue line that comes down on my chart starting to turn.

until we get back to the point, and it will take two or three years at a minimum. we have looked at private -- prior recessions and it could be as much as 38 months before you came back all the jobs that you lost people tal. people talk about a v, they talk about a u and some will talk about a billw. i am not talking about bush. i wish i would have thought about that. the seriously, i really try to avoid -- we had too much to look forward to to look back. we want to maintain the support of the american people to

understand that the fact that we possibly might be at the end of the recessionary period, until we put people back in jobs and we have more people and jobs than we had before this started, i know the president will not think we will be successful. i want to thank you for the hard work that you do throughout america and in growing small businesses and as a former small businessman, i know how hard it is. i have stayed up late at night working with sales forforce.com and others to do tasks that i needed to do. i want to let you know that if you need any help from our office or the vice president's office, what david and his team know. we try not to bypass people like david and people like secretary lott.

i'd bring greetings from the white house and i want to thank you very much. -- i bring greetings from the white house and i want to thank you very much. [applause] >> thank you, ed. next, i would like to introduce to you the special advisor to the white house for green jobs, enterprise and innovation. mr. van at jones is in a war in -- an award winning author on environmental issues. he continues to shape the administration's energy and climate initiatives. yesterday, i talked about three emerging and promising industries, green jobs, smart grid technology and health-care i.t.. not only are these industries growing, they are the right thing to do for us and our planet. today, he will speak more in depth about the use of green technology, something that all

our businesses should know all will build about -- a little bit about. but sentiment, mr. van jones. -- ladies and gentleman, mr. van jones. [applause] good morning. did you eat? good. i had my back there. first of all, personnel is policy. when you see someone like him selected to lead an effort like this, it shows the level of seriousness that we have to make sure that we actually begin to meet some of the goals that we have had as a country, to grow equal opportunity through both federal contracting and other federal activities. give him a round of applause. he is doing an extraordinary

job. [applause] i also want to thank ed. he is our general one comes to meeting our goals. he is a modest man. -- he is our general when it comes to meeting our goals. when the president was doing this in february, people were talking about the great danger, not of a great recession, but of a great repressed -- depression. when the president was sworn in in january, all of the economists were fearful that we were headed into a deflationary spiral in which no one could figure out how we would recover and it would be global. and nobody is talking about those type of catastrophic

outcomes now. it has to do with the leadership of president old, and his leadership to take bold action and to make sure that the action that he takes. let's give him a round of applause. >>[applause] lastly, i want to come to you. get all those business kurds you're going to forget to input into your system. shaikh some hands. maybe do a deal. but at some point -- shake some hands. but at some point, you'll be back in your car and you will be concerned. it takes courage to be in your saturation. it takes courage to be in your position. you represent the forward thrust towards equal

opportunity. we fought for the right for a qualified person to get a job. you now stand for the idea that qualified people should be able to give jobs and that is where we need to go together. magic johnson said that if you want to be ready, stay ready. part of staying ready is not just being ready inside, but knowing what the world is ready for. as small business people and as emerging entrepreneurs and business leaders, you can be very ready to sell eight track tapes, but the world is not ready for that right now. do not try to upgrade to cds because they are not going over either. we are now living in a world of impi 3's -- mp3s.

we have a president that knows that the world is ready for a revolutionary transformation in our energy system. if you look at our vulnerabilities now, so many of them converged on the fact that we are using eight tractates level technology to power america. -- eight track tape level technology to power america. we're still using the remains of dead dinosaurs to power ourselves. we have an opportunity to diversify our portfolio. to utilize fossil fuels smarter and cleaner but to diversify into renewable energy and to use less energy and to have more

work, more wealth and better overall. it directly creates opportunity for you. in order for us to meet our energy and our security and our climate goals, we're going to have to retrofit millions of buildings and upgrade them so that they waste less energy. we were to have to put up millions of solar panels. that is thousands of contracts. we're going to have to put up thousands of contracts. we will have to grow biofuels. ultimately, millions of jobs these 21st century job and off from real opportunities are represented to iin our recovery

package. this hits the majority of you in terms of immediate opportunities and then i will let you get back your warning. our recovery package is $787 billion. 80 billion of debt is four things that are green or clean energy. -- $80 billion of that is four thinr things that are green or n energy. about 50 billion is in one department, one agency, the department of energy. it is important for you to know that. when the president talks about building is clean energy a economy, he talks about creating these opportunities of tomorrow, he has made a bet that the department of energy will be the main motor, the main engine.

when you talk about smart red, the money is there. -- smart grid, the money is there. when you go down the line, a strategic focus is understanding it. it should reward your effort. specifically for small businesses. many of you may not be starting an advanced battery division tomorrow, but let me focus on energy efficiency for buildings. in 2008, the federal government spent $200 million to retrofit of the homes of low-income people to cut their energy bills. so that gramont would not have to spend money that she could spend on food just to stay warm

in the winter. -- so that grandma would not have to spend money that she could spend on food just to stay warm in the winter. you're going from 200 million to 5 billion. there is an opportunity there to grow firms and to grow workers at. why? the genius of the commitment is simple as this. those humble, hard-working energy dollars, people want to get excited about solar panels. [applause] and the reality is that many of the jobs in the near term will not be about cutting edge technologies to create new

energy, it will be about off- the-shelf technology, deploying it to use less energy today. what am i talking about? >> i am talking about those caulking guns, insulation, a high-performance windows and doors, replacing those inefficient boilers and furnaces with high-performance ones. taking out those refrigerators that use 10 times too much energy and putting in the new stuff. it may be putting in some smart meters in those homes as well. those are jobs that small businesses can get involved in. you have to buy the insulation from somebody. those workers have to be hired by somebody to go into those homes and the president is excited and the vice-president is also excited about this effort because those humble, hard-working, energy efficiency

dollars work triple, double in overtime for this country. -- a double and overtime for this country. suppose you have it would be worker -- had a would be worker. you tell that worker that you are now part of this energy efficiency effort. the dollar just cut unemployment. when that worker walks across the street and she starts to retrofit a home, she blows and that clean, non-toxic insulation and she replaces those windows and those doors and she does all that work. now that same dollar just cut grandma's energy bill. with the of the shelf technology that we have, 30%-22% savings can be turned into work and wealth opportunities.

you cut unemployment and you cut and energy bill and then down the street there is a coal-fired power plant that is having to work as much as 50% to harde because the homes are up to 50% to wasteful. you just cut greenhouse gas emissions. you just cut asthma. you just took some asthma inhalers out of a little boy or a little girl's pocket. then it will pay for itself in just a few years because of those energy savings. this is an area where you will see a continuous growth. and there are so many good things we can do what i want to

leave you with, and i hope it will transfer your company and i hope it will transfer your -- transform your life -- i hope it will transform your company and i hope will transform your life. it is very simple. everything that is good for the environment, everything that is good for climate policy, everything that is good for independence is a job, is a contract, is an entrepreneurial opportunity. if you get those compact fluorescent light bulbs to go off in your head, every single time you hear and administrative official talk about meeting our environmental goals, and you

should be thinking, "as my company create value to solve the problem?" how do we become the main marketers for installing solar? how do we get in on the front end as we put up those smart meters that help people manage their energy in their homes for the first time, that we are in a position to do it world-class and to go forward as you have done so brilliantly in this stuff. , through this stuff. and to the common -- through this tough -- to go forward as you have done so brilliantly in this tough. period.

and you very much. -- thank you very much. [applause] >> one more round of applauds for ed and van -- applause for ed and van. i would like to invite everybody to go to the ribbon cutting. you can go out and the doors in the back into the left. we will join you at the expo hall. thank you all very much. >> later in the day, kiran mills spoke for about 15 minutes.

-- karen mills spoke for about 50 minutes. >> you've heard me say it yesterday and i will say it again today. if we have parity, the minority business community will generate 2.5 trillion dollars in revenue, creating 16 million jobs and contribute over $100 million in taxes to reduce our federal deficit. but to do this, we must continue to grow minority businesses larger and faster. today, you will hear from leaders in the small business administration, both agencies are dedicated to helping minority businesses realize their dreams and to build the community. together, they help small companies grow to medium-size companies and then to large companies.

one company who has been very instrumental in helping minority owned businesses grow it is joe jordan. he and his outstanding team, and i will emphasize outstanding tin, supports thousands of small businesses every year and helps to compete for prime contractor it i would like everyone to give joe jordan a warm round of applause [applause] -- aimed more round of applause. [applause] it is now my honor and pleasure to introduce a true champion for america's small businesses. karen mills leads partners

across the country as we were to grow the american dream. at this critical time, when so many small businesses are facing tough economic challenges, the president could not have picked a better person to be the advocate for small businesses across this nation. she had a long and distinguished track record in working with of japan or some small businesses she has spent much of her career working with small manufacturing firms, including producers of hardwood flooring and plastic injection molding. in fact, during the recession of the '90s, he helped factories increased efficiency and survive the tough economy. most recently, she has focused her energies on the potential of regional economic development clusters.