process. i don't think you would find many folks arguing with that and the fact it needs to be fixed. we are, asç i said earlier, i think as an industry, well on our way towards getting to(a point where we can moveçç information between facilities i]ys[nbçqççuçxdg çokç okçwe#ççzvñr therewlcñç i[ço move information. this isçç zt hugefá step in tt direction. vendors work on this toçóq help clients meet meaningful use[ç finding thatmç there is aç leç ity beneath the generalt( framework forymt( communicatinga for example, terminology can be veryç d9á%ujzt fromi] one organization to another.

what, for a labç( result might mean a normal range within one organization, might not be the normal range forçó another. there are many differentç challenges at the data level, while it will be really nice?; organization to another and drop it into[çñr an electronic heal record, theç challenges are veç (p'. the more standardization in terminology, nomanculature, what have you, that we can move towards and the faster to move in that w3w3dction, that;çç ç well as theç;y]t?2çtc>çç dat andw[-ñ interoperabilityfáç st will all contribute to improving ourç abilityçç forw3xdç inf flow..ñrçóç .çççç

and that level of -- the level of coding, as anñi exaópne of ti drg front, today, there are roughly 17,000ñi codes, ñiok.çó there is something coming right around the corner called icd 10, which is a new codingçó system.3 tell have over 155,000 xdcodes. soñ;the deáq&wa+xñi of complexi the coding component is about tó ñi-. so what you have is through things like icdt or icd 10 and meaningful requirements and reporting and quality requirements and joint commission and all the hoops, if you will, that the hospitals and other providers have to leap through is becoming a very, very

difficult to be as successful as you want to be in all of those, without information technology. you really need the icp's to provide the reporting, the quality data, to provide the metrics and allow you to the stay on task. host: what does icd 10 stand for? guest: that is a good question. [chuckling]. you know, i have been using it like that for years. code drg's. i forget. host: who came up with the system? guest: medicare originally. it is certainly, like much of everything else, continues to evolve and certainly get more complex with each step. of course, the folks sitting around looking at things like code have very good reasons, i know, for wanting to make the

changes they make. but it certainly presents a lot of challenges from a technical standpoint. host: medicare and medicaid comes up with a new procedure or new regulation, do they provide software technology at all or just get the procedure and you have to develop the software? guest: essentially, the regulations are developed and become available. for most of us in theñi hospita, we don't develop our own software, we rely on vendors to do that for us. so vendors, then, have the responsibility and this is included in your support fees, huge support fees, i might add, that you pay. those vendors are responsible for getting those kind of regulations, regulatory changes made to the software, make those updates available to you in a timely manner. and so if you're in a development mode as an organization, obviously, that would be an enormous challenge.

host: what is your budget a year? guest: your budget? host: your budget? guest: our budget, every year, operating budget, roughly $12 million, i believe. the capital budget in total is about 12 million. this is going to be an expensive year for us because we're bringing a lot of this stuff live this year. taking the computers to the bedside, which we think is critical. it all costsñi money. so it is expensive. we believe the payoff is in improved quality of care, creating an environment safe for patients. eliminating medication errors. and we think it is worth it. host: david crutchfield is the chief information officer for virginia hospital center. thank you very much. we will be back to talk with the head of the icu, talking with

the chief nurse and also talking with the director of the emergency room. in the emergency medicine. we'll see you then. captioned by the national captioning institute --www.ncicap.org-- .. .

eastern here on c-span. >> national book award winner jonathan kozol has critiqued the american justice system. on sunday, he will take your questions live. >> now a look at the economy of the persian gulf. steffen hertog discussed the oil market. and the future of relations between states. hosted by the middle east institute. >> thank you so much for joining us. steffen hertog is visiting us from paris.

he is currently on leave from durham university wary teaches political economy and he lectures on political violence and radicalization. he has a couple of books coming out. one is on saudi state building. it will be published soon. another book coming out is about radicalism and higher education that princeton will be putting out. today, he will be talking about the political economist of the gulf and comparing to the last time the gulf faced an economic crisis. the current economic recession has hit many western countries severely, the gulf has not been as badly hit as other countries.

we will be looking today at why that is. on thursday, september 10, we're fortunate to welcome a former leader of a group. he had a prison conversion and he is now working to combat extremist and for his foundation. he will be here talking about how to counter an extreme radicals and. then we have some scholars. paul is an executive director and the other is with lafayette university. there will be talking about is rally-arab peace. what works and what does not -- there will be talking about israeli-arab peace.

thank you. now how may welcome steffen hertog. >> thank you very much. i am grateful and i like to come back. i have fond memories of the work they did at the national archives. it is not everyone's idea of fun. but some of the most interesting hours of my life have been at the archives. i am glad to be back. i am happy with the turnout, given the have to compete with the former leaders of the hottest groups. i will talk about something rather technical and dry. i do hope it will be a more

political spin. it will be more political on things but have happened in the gulf. what i'm trying to do is briefly look at how the first world war unfolded and how it compares with a recent oil booms of 2002 and 2003 and how those booms compare in terms of the political economy and the distribution and the bargaining that happens between states and societies. what has the gulf states done up to the early 1980's for that money and how does it compare with the distributional strategies and the kind of bargaining that has happened.

the argument is going to bae tht one important player, the private sector, the big businesses in the gulf, they have shifted their role in the economy. they cater to private demand. is a real capitalist class. it is something people to not necessarily understand. everyone is being paid off or bought off. and that is the be all and end all. that is not really decays. -- that is not really the case. we have a sophisticated private sector. on the other hand, you have the population at large. they continue to be dependent on

the distribution of policies of the state. they enjoy large scale services, state employment. that part of the bargain has not changed since the 1970's. whether the state is the giver or the distributor and the population at large, the middle class depend on the state and the economic autonomy. when it comes to saudi arabia, it is a case start -- a case study. it applies to all of the gulf. we started that kind of evolution from the 19 mid 70's until now. so i talk about briefly about

what the states have been doing with the money they have been getting. they have been getting all whole lot of money. look at this graph. you will see the blue line about state revenue and expenditure, the blue line, itñi hasçó increó rapidly. ñicñrñiexpenditures have followd pretty quickly. they have spent domestically pretty rapidly. it kind of looks as if the same as happened in the recent oil boom. revenue have struck up rapidly. look more closely at the metric. the share of revenue as a share of gdp and the proportion of yheçóñfpiñiçadñi 1970's,bhçkoñwñ

expenditures shot up pretty radically and it was the dominant player, the dominant factor in the national economy. interestingly, that did not happen in the last time around. relative to the economy at large, this date has not become more important. revenue has in fact become larger as a share of the total economy. so that means other things must be going on at the same time. it is not going as a share of gdp. economic activities must be growing as fast. we have a similarñi picture in kuwait with the revenue numbers here. if you look at it relative to gdp, the state expenditure has

not increased relative to the total economy. kuwait has political reasons. you could show similar graphs of the other gulf states. this share versus one thing. the state has been more cautious at spending. look to the compound annual growth rate, the income of the saudi state. it is something like the average growth. in every year of those six years, state income has grown by almost one-third. state expenditures has only grown by 14%. more than half of the additional income growth than they have had. compare that to big 19 mid 70's oil boom.

sure enough, they spend enough. -- compare that to the 1970's oil boom. lessons have been drawn from the last oil boom. they are saving a lot more. there will be a day when oil will not be that high and it arrived in late 2008. there is a long your breath when it comes to deficit spending. in 1981, the peak of the first oil boom, when saudi arabia had those savings were responding to a total battle budget. if they're lost all revenue, if the israelis had nuked the oil

terminal, the saudis would have had enough money to spend for a whole year without any revenue from anyñiwhere. ñrthey have saved more than thre years' worth of state saving. the same ratio in qatarñi. in kuwait, it is more than four years. they cannot operateñr in the hih level of spending for a long time even if oil pricesñi are l. ñiit was not theñrñr case in th9 income like saudi arabia, they had to cut into the spending very heavily. they have been a lot more cautious. what does all of thatñr mean for the structure of the saudi ñieconomyñókóñi-9 and the relap

between the government and the business sector? ñrwith the composition of gdp become a moreçóñi importantñr pf the economy with increasing prices. not real prices. in real terms, the oil prices were at the peak of the oil boom in the 19 mid 70's and 19 mid 80's. ñixdçóçwiit has not crowdedñi oe economic activities. there was quite a lot goingñrñr. despite the vesió=ábyñi=/%úgì+ -ces. government spending of fact that?

this is a technical mcgrath. the milwaukee through it. it tells an interesting -- this is a technical graf. that's me walk you through it. it tells an interesting story. with the iran-iraq war, and then we have all of these different qì(lc@&c+ ñrsectors of the economy and the total economy. the violent bandññietçó band çóy made through real estate. you see the red band which is construction. those are classic sectors. people can make a lot of money when prices, through the fact

that as more purchasing power, trends go up. people can make a lot of money through property. there are construction booms. it is a great time to be a contractor in the gulf, particularly in the 1970's. but then when the oil price went down from 1983 on, there were hundreds of thousands of bankruptcies of small contracting companies, real- estate prices collapsed. it's the same kind of price development. but the most recent oilñr spiken comparison to the spike? if we go up herexd --çó?>ó thatt the kikoo/r]ñiñrñi typicalñi exf

rental income of the construction sector. the economicñi developments are much more stable and much more solid. on the one hand, you do not make as much money as a contractor. ñrñpibut there will be less fluctuation, west volatility in those boom sectors. it looks like the economy is on a more permanent growth trend and it does not react on a short-term basis to those kinds of fluctuation. i could walk through those other sectors. if you have specific questions on the relationship to oil prices, we can take them up in the question and answer time. the black line is the government

spending. it looks essentially the same. government spending has traced oil prices. current spending and capital spending. the physical aspects. that has really collapsedñi aftr the mid 1980's because the government did not have money anymore to pay for infrastructure. have money anymore to pay for infrastructure because they had so many salaries to pay through its current spending budget. so that was the first eye ball test showing that it seems that the structure of the saudi economy and saudi business is more resilient and les dependent on the oil prices and government spending policies of the day. now, this is something that can be confirmed through a number of

economic metric tests. changes in government spending and how that affects the size of the business sector. time series, regressions, confidence intervals and co-efish yeco- co-efficients and you have to believe me when you look at this graph here you see that the growth of government spending is tracked pretty closely by the growth and the size of the private sector. up to the mid 1980s and after that, those two lines really move together pretty neatly. after that there is a decoup decoupling. there is quite a bit of fluctuation in spending growth or in spending declines, but the growth of the private sector seems to be on a continuous line. if you do that through all kinds

of models you get that confirmed in the statistics, that saudi spending in the 1970s had a much stronger effect than the nowadays. so that is quite convincing evidence that the business classes have become more independent of state spending. that is the basic political message behind all the figures and all the technical language. so there are a number of other ways in which the private sector has become more independent of government. the first one of which has to do with the structure of spending. much of the business growth during the 1970s was driven by government capital spending. that is spending on bridges,

roads, buildings, machinery, physical infrastructure. how you spend that money you give contracts to private contractors. that gives you a lot of political discretion. you can choose who gets the contract. you can build up relationships of patronage, specific clienteles in the business sector. that is what happened. a lot of the contractors became rich because they had the right connections to the right members of the ruling elite. nowadays although the state is spending more in absolute terms, actually most of the spending and that is true of the other gulf countries is current expenditure. what does current expenditure mean? operation and maintenance expenditure, some contractors, some direct allocation of money to businesses involved, but most of it is salaries for employees in the public sector, salaries for bureaucrats.

now so many are employed in the government than in the 1970s. that current expenditure shot up with the current boom because they started employeeing people, they increased wages and welfare spending. all that kind of money at the end of the day is recycled through the private sector. businesses get to handle the money because the consumers start spending. they buy houses, they buy cars, they go to the supermarket. the important political difference is the government has no control over how that money is recycled. this is private demand. although this is still a type of rent recycling, the government has lost the political control over saying who gets that rent because it does say in the first place the rent does go to the state employees but after that who in the private sector

profits from that is not under the government's control anymore. that is very, very important political distinction between the first and the second oil and the share has grown at the same time. ñiñiñrso nowadays,çó you have sg ñilikeçó 43 civil servants accog to theçó statistics. yout( only haveñi 20 ini the md 1970' 9ì(lc@&+ the population has tripled. youñr have six times as many people drawing salaries. employedñi in the public sector. ez average t hot -- theyçó have higher salaries.tz#ñmost comes from cie employees. these are the figures that give

you a sense of the distribution ñixdofñrñi the public and priva3 sectors. i can tellñiw you, those are probably wrong. ñithe saudis employ more than private sector. many are employed in the defense sector by theñr minister interi. we do not have figures on that. the same is true -- we do not have to run through the detailed figures. there are just slightly different degrees. they are dependent on state employment. ñithis is a wrapup on theñi argt i just made based on those graphics. the government salaries, in some

ñicases, but they still constite most of the consumer demand. çóçóthey evenñiñrxd have more ol private sector salaries. that is alsoñi declined through the recentçó bust, particularlyn the real-estateñrñi3wxekñr sec. lower expenditure onçó physical infrastructure by the çó onñrñrxdñiñtl dominate the demand in those countries. ñithe politics of thoseñi has changed in the sense that the government has less control. nomies but the politics has changed in the sense that the government has much less control over how those funs. that is the basic point of salaries being recycled and the

government with projects. the private consumer decisions means real markets are created. you are in real competition. you have to run a nicer, better supermarket than the other merchant family if you want to capture that demand. you can't be schmoozing with a prince. you have to be a real business man. that is essentially what happened since the 1980s. the collapse of capital spending forced the private sector to focus on private demand and that meant they had to engage in competition and become more professional. that in a business class and that is still opaque and informal at the core but runs a much tighter ship and is more professional than most of the business class in most of the other arab countries, because

they've been operating in a competitive environment for more than 20 years now. so the take home line is that those are still raunchy economies, but those are raunchy economies where the rent cannot be used politically in the way it could be in the 1970s, and those are raunchy economies which have a real capitalist clause, which is not something that was the case 20 or 30 years ago. there are other signs that the private sector has become a much, much more serious player. it's been returning to the provisional public services. in the 1930s, a lot of schools were funded by the private sector. the few power generators that you have, the potable water was all provided by the merchant class because the states has no money or infrastructure, and the merchants were completely pushed out of those sectors by the

expansion of the raunchy estates and subsidized public services from the 1960s and '70s and on. and now they're returning to it. now you have private schools, you have public/private partnership in the provisional power in electricity. you have a triple back of the private sector of the merchant capitalists into serious areas of public service, where it's been completely mar lly margina. the government still continues publish private partnerships and this again means that business has a different bargaining position because it's not just the

recipient of rent but a provider of expertise that is needed by the government. the government has started to spend again on infrastructure, all of those countries but much less so than in the 1970s. you see that current expenditure still dominates capital expenditure, but they're now building again roads and bridges and refurbishing the infrastructure. and in fact, most of capital expenditure, most of the infrastructure being built, the machinery being bought is now being purchased or built by the private sector. so private capital information still dominates public capital information and that does include -- well, a lot of real estate speculation and it does also include real investment in infrastructure and in public services by the capitalists.

there's another way in which the local capitalists have become more powerful, that is they have accumulated so much money over the years that they keep overseas and that gives them a negotiating position vis-a-vie the government. if the government has any interest in repatriating that capital. that doesn't even require that those businessmen negotiate collectively with the government. if the government doesn't provide the kind of business and regulatory environment that would attract that capital, that capital is just never repatriated. but even without any formal political negotiations, there's a structural power to the local capitalists and governments emphasize this.

the official reports that say oh, we have neighbors where it's -- neighboring states was much easier to get commercial registration where the infrastructure works better, and all our capitalists are moving there with our money. so we have to change something about our own economic policies and that's unheard of, that would have been unthinkable 30 years ago when the name of the game was just distributing state money. business has much stronger role in economic policymaker in all of the gulf countries nowadays. it dose not have any interest in political change, so we have to disentangle economic influence and negotiating policies from the business side with larger political change or a larger political agenda of the political class. they're very happy with the basic political dispensation as it is in those countries. the businesses still remain

policy takers on most issues and they're systematically being consulted and have a veto power over policy. there are many examples of the capitalists being able to stop certain policy initiatives, taxation plans, certain regulatory reforms, and that is a fundamental change from 30 years ago when they had practically no collective political agency. but at the core, they still resemble the systems with which -- within which they operate. they're still family run, things are still informal, and in that sense it's real complementary between the governments and business sectors and both ends of that relationship are pretty

happy with the political system, which is based on informal family rules. i'll wrap up after this. there's another reason why there's no real prospect for political change in a more fundamental institutional sense emerging from the capitalist class, and that is they have no -- they would have no apartment society to team up with, to mobilize for political change, even if they wanted to, because the population at large is almost as segmented in most of the countries as it was in the '70s and '80s. so whereas businesses really developed, they've become more active, more autonomous. the majority of the population at large of the middle class, the lower middle class are still state dependent, depending on

subsidized services, state employment which in many cases consists of jobs which people really often don't have to do too much work. but that puts a strain, and that's the point on which i think i wanted to end. that really puts a strain on those systems to different degrees, because some systems have so much oil money it's not a big worry. but you have saudi arabia and bahrain. you have here a graph of oil income, and it looks like they have almost as much money to spend per person as they had in the 1970s. if you deplate those figures for the declined purchasing power, there's a lot less money available per individual, even

at times when oil prices are back to $80, $90, $100 a barrel. so that means we have lower rent per capita combined with higher spending per capita, because they have a lot more people employed relative to the total population than you had 30 years ago. public services remain subsidized. there were attempts to reverse subsidies, they always failed for various political reasons. the boom has tempted various regimes to give up more money, increase subsidies, pensions, and welfare spending. and that really means that in the long run, and i'll just jump over that, that means in the long run if you have continued demographic growth, which you're going to have even at relatively high oil prices, you'll have increasing spending needs from year to year. and if you extrapolate, and i

just jump to one graph, if you extrapolate a scenario where you have expenditure growth continuing as -- on the basis of the figures of the last few years, and you have oil income continuing on a high level, then even despite very high oil prices, you have a budget deficit within just five years and you have depleted the total reserves and i'll remind you that the total reserves right now that saudi arabia has correspond to three annual budgets. you have that depleted by 2019. this is a very mech nisic scenario. but the important message, to

prevent that from happening, they would have to eat into their current expenditure, meaning subsidies and salaries. they've cut into their project development, they've managed to bankrupt their contracting sector. they've never managed to cut subsidies substantially and cut the public payroll. once they have to do that, they face very difficult political questions and will have to negotiate with society about a new kind of bargain, potentially about taxation, certainly about curtailing of existing distributal structures in a way they never had to sense they first struck oil. it is that moment which i would venture that the private sector would play a very, very important political role as a partner of those regimes because

of its much more important role in the national political economy. i'll stop right ñrçó-- i will s(?aju here. ñi>> do weñr have any questions? >>ñiñrñixd d.c. and añi comparin the recent oil price -- d.c. a comparison with the recent oil price? other any possibleçó consequencs for the world economy? >> there is an interesting parallel. xdtheñr oil price decline in the 1980's wasçó pretty gradual aftr 1981. it didñ]ññ$rñiiñiñr not happen . ñithe writing had been on the í/ñiñiñiñiqñiñithe decline hadn they hadñr toñie1ñr slashçó the. they did not have enough savings

to cope with the situation. çóçóthe oil prices went up very quickly. it was up 75% to a low more than $40 añr barrel. tñiñr government well prepared this time around. they could use their savings and they kept their becoming stable because they did not have to eat into the budgets. çóxdñiñiñrthatñiñi is a sepir"t. ñiçóthat is )ttçó xem=9 whyçó e affected. evençó if they cut their spendig dramatically, as i have tried to show the private economy in those days is a lot less exclusivelyçó ne"9qçóñrxd. even if they had to engage in

those policies, they would not bankrupt. 1980s when almost half of saudi companies went bankrupt when government -- when the budget was slashed to little more than $100 billion. i'm not a global political economist or oil expert, so i think we can talk about private, but i don't want to put my unfounded speculation on the c-span record at this time. >> if you can state your name. >> larry marzak and i'm a banker. i had a question. you had your mech nisic scenario

of if budget deficit and the drawdown of reserves and the crunch. isn't the private sector building its future based on that not happening? and if that were to happen, what are the implications for the private sector? >> that's a good question. i think in general, most of the big merchant families are still relatively short term in their planning. there are just a few that have engaged in the kind of industries where you need long-term planning, notably petrochemicals. where you need to think 10, 20 years ahead in terms of price cycles. and those that are least dependent on state spending, the market is international and is always going to be some demand

for basic petrochemicals. as far as i have spoken to people who cater to more short-term demand, you know, people in the real estate or retail sector for example, they're not very worried. continuing private demand has to do with the fact that everyone gets their salaries and the global financial crisis hasn't really affected the local consumer market very much. and they, i think, i would dare to say would not think 10 or 20 years ahead in their planning. the traditional gulf business family is mostly in trading sense the 1970s and contracting and they operate on a pretty short-term basis.

>> i had a couple of questions. one is when you say the merchant class and the private sector, is it pretty broad based or mostly part of the extended royal family or is it broad based? >> it depends on the country. if you look at qatar, in any big business you're likely to have a -- in other places it's a lot broader based. in kuwait, there is a wide merchant class, which doesn't mean the ruling families don't have a significant presence, but they're not the dominant players. also, if you're a prince, in many cases you can't be bothered to set up and run a business, so

there are also some merchant business and serious investors among those ruling families. but those in terms of the interest, more with the rest of the merchant class more than with their other family. which doesn't mean there are not barriers to industry. those families got to where they are off true their royal connections. so it's not a completely open playing field but it's a lot more diverse than just relatives of the rulers. >> you spoke of the recycling of a lot of the cash. do you see any evidence that any of it is moving into opposition

political campaigns and there has been -- we get sporadic reports in terms of security issues. we noted there's been the arrest of several hundred fairly recently. do you see any stepup in campaigns, you know, of terrorism there? >> you would really have to distinguish one country from another. you have the kuwaiti regime where you have a lot of money going to elections. the parliament can essentially prevent anything from happening in kuwait and frequently does so. and merchants have been very, very present, notably unsuccessful as candidates, but as financers of campaigns, but it's public electoral politics. in terms of violent opposition

or islamist radicals, i mean, it's a very, very complicated debate. but most of the things that have been said about it pertain to the financing of international jihadi groups. and continues to be some money coming out of the gulf supporting international jihadists. but i'm not aware of any evidence that significant local businessmen would support the local militant insurgency. first of all, the local militants don't have a very broad base in society, whereas people might pat you on your back and you might be popular. but if you move to iraq or blow yourself up in saudi arabia, that's beyond the pale for main stream saudi society. so established players, some of them, you know, might at least

in the past have contributed to international islamist militancy. but domestically i really don't see that happens. >> i just have a question on your last slide that shows the budgets going into deficits in 2019. what is the assumption of oil prices and how can you predict them? revenue is so dependent on oil prices. >> that's a good question and the scenario is more arbitrary. that's why i have several of them. i could show you several others of them. but the basic message in all of those scenarios is as long as they stick to their ball game, that is subsidizing the local

population, then sooner or later no matter which oil price assumption you make, they will run a deficit. so sooner or later they might have to change their system. that might be in 2016 or 2025. but a perpetual increase in current spending, which is what they engage in because of that distribution of policies, it's at some point unattenable and will lead to very significant renegotiations. that specific graph i had i assume relatively high continued spending growth, but also a continued high oil price level. it's not a prediction, it's just a thought experiment. >> it's been hypothesized that

the nuclear capability development in iran could generate proliferation of nuclear endeavors all around the gulf and saudi arabia. do you think that could be so? and if so, how would that affect the economies of these countries? >> there's been a lot of speculation by international relations scholars that it might be the wise thing for saudi arabia to do to arm -- pursue nuclear arment. but based on everything i know about the elites there, the politically cultured, i think it's the very last thing they would like to do. and there's a basic misconception about the recent attempt to set up a civilian nuclear capacity in kuwait and also in saudi arabia. people think oh, those guys have so much oil and gas, it doesn't

make any sense to build a nuclear plant. this must be a security insurance policy. but in fact that is not the case, because those places are running out of gas. the industrialization has been stopped, and if you get $80 a barrel, it doesn't make sense. if the '80s it made sense to burn that kind of oil because you had huge spare capacities. but nowadays, the opportunity costs of burning the oil domestically is a lot higher in most scenarios than building a nuclear power plant for which in fact the political institution environment -- when i speak about that in france, i always like to make comparisons that french people don't like to hear very much.

it's very criminalized. there's no complicated planning process and municipalities, legal procedures they got to go through to set up a power plant, which is what makes nuclear power in many cases very expensive. if you say i want the power plant, you buy the technology off the rack, probably from the french in fact, and you have it standing there five, several, eight years later. so it makes a lot of sense for them to continue their industrializing. >> beyond the wealthiest nations you studied, what more can you say about what you've learned about all the poor nations in the region you didn't say too much about? >> that's vast.

one interesting observation to be made in the course of the most recent oil boom and the role of the regional gulf, and that is the spill overs, the developmental spillovers for poorer countries have been higher than during the last one. this time you have the capable business class that is reasonably patriotic, that has burned its fingers after 9/11 in terms of western investment, they were afraid of confiscations. so it's not the default option to park your overseas money in your stocks anymore. to a lot of that money has gone into the poorer countries. if you look at the foreign direct investment in jordan or egypt, what's come in there has been not predominantly but through to at least 30%, 40% gulf money. not all of this goes into a

perfectly productive investment, but the increased growth rates we've seen in the poorer countries did have quite a bit to do with gulf overstaes investments. because those people know how to run a business, they know how to set up a hotel or restaurant chain or build a power plant, the region is profiting more from that professionalized industry than it did a few decades ago. >> i had a question about the composition of the private sector as you call it. you talked about big merchant families, localists, capitalists. the first question is what percentage -- are there a lot of smes, is it the big-name firms? and the second one is who is really going to benefit in this? saudi basic industries corporation has a lot of

investment in asia at the moment. half a year ago i spoke to the manager of the project between yemen and djibouti. can you name who is going to profit at this point? >> i think the yemen/djibouti thing is off the table. i don't think it ever seriously was on the table. in terms of the structural of the local economies, like the local economies, like anywhere, most companies are smes. depends on how you define them, but something like 09% or 95% companies abide by run of the mill criteria, a lot of which are owned by nationals but run by the arabs or asians. but in terms of the contribution

to national development, i do think that the big business families play a predominant role, because they're a lot more willing to engage in new experiments and most of the smes are just really, really low margin copy cat type of operations. you into to saudi arabia and you have 20 shops selling the same soap. someone has to sell soap and shampoo, but the developmental effect for the national economy is rather marginal. so i think the more interesting things that are happening do come from the large business families. and the second part? [ inaudible ] >> the inside is a bit different from the outside. i can just give you examples.

it's difficult to give you a comprehensive answer. for example, the family from riyadh, they've moved into all types of manufacturing, that a lot of people predicted in the '80s would be white elephants. they've gone into petrochemicals with other partners and invested overseas in manufacturing. they've got plants in vietnam, manufacturing plants in egypt. so they are one of the examples of how far those families have moved just beyond pure rent seeking but they're not the richest. right now the people who are making a lot of money domestically until recently were the big banking families, and now increasingly with the return of capital spending, some of the big contractors are making a lot of money.

>> good afternoon. i have noticed that several of the leading recent economic indicators have shown that consumption in china seems to be rebounding and with that its demand for energy. and we have seen over the last several years in this decade that china has put serious investments into oil and gas resources in africa and central asia. i suppose my question does follow up a little bit in that the previous -- the previous question dealt with investment outside of these countries. what is the extent of chinese investment in petroleum interests in the gulf coast countries and if it's to a great extent, what impact will that have with the relations between these countries and the western

energy consumers? >> there's not much. there's somche if chinese investment in gas but the more important acts of cooperation is refining in petrochemicals. that's what has been alluded to in terms of big, off state owned conglomerates moving into china or moving into east asia and setting up plants there to push further down the value chain and get more bang for the buck out of the cubic feet of the barrel of oil. and there's a natural

complementary between asia and the gulf. asia is the manufacturing power house of the world. there's not much stuff being made in the west anymore, and the raw material for that is essentially oil and gas in most cases. so this is the relationship that's going to deepen over the decades. but it's been getting off the ground more slowly than people would have thought in terms of bilateral investment because the chinese have been very difficult and conversely a lot of the petrochemical investment happening in the gulf countries is still dominated by either local merchant families or western multinationals. so the chinese have not broken into that yet. but it will play itself out over the decades. [ inaudible ] >> there will be a great deal of

chinese interest in the vast gas reserves off qatar that may be developed? >> qatar has stopped developing it, because they got more money than they can handle and gas prices have come down quite a bit. the production itself is controlled by national oil companies in partnership with usually foreign service providers. and i don't see a good reason for why they should let foreign equity and those kinds of operations anywhere else by marginal fields. certainly not in the biggest prize and that is saudi arabia. the national oil company is a very capable player and very much equipped to maintain

their -- they don't need any foreign equity partners to do that. >> thank you very much. [ applause ] >> we take you live to a discussion just getting under way of the iranian nuclear program and the implications for stability in the region. we will hear from a former ambassador to the u.n. live coverage from the heritage foundation here on c-span. >> the international atomic energy agency is slated to release its latest report on iran's nuclear policies on september 14. according to leaks, that report will exclude incriminating evidence that has been provided

other countries on iran to attack nuclear experiments áqat indicate that iran has been exploring ways to weapon is its growing suppliesçó and enriched uranium. its own experts haveñi found ths evidence to be compelling. the politicized the leadership of thatçó u.n. agency has decidd of thatçó u.n. agency has decidd classifiedñiñi annex that will t ñibeñi publicly available. once again, the iaea, sometimes called un's nuclearñrzghñtrxd ws likely to be the dog that did not bark. the a, administrationñi -- -- te obama administration may try to pull out of thsr impasse, but it isó difficult to imagineñiñr wy country should trust regime that has liedñiñr about its nuclear

that is the world's foremost in sponsor of terrorism, and the jails, tortures, and kills its own people when they questioned the results of its presidential elections. iran to attack president has made it clear that he rejects any compromiseñr -- iran's president has made it clear that he rejects any compromise. iran is like a train which has no break-in no reverse gear. ladies and gentlemen, it looks to me like we are about to see a train wreck. if theñiñr present trends conti. çóñihe has written a timely book that analyzes past efforts to diplomatically engage )p' and why they have shruggedñi off efforts to dissuade it from ñicontinuing its nuclear progra. to this task, he brings a deep historical knowledge, analytical expertise on security

issues, and practical experience as a diplomatic troubleshooter. he is the president of the jerusalem center for public affairs and he served as ambassador to the yen through 1999. he was the foreign policy adviser to netanyahu and has advised the leaders of egypt and the palestinian authority and has been intimately involved with the arab-israeli negotiations. from 1985 until 1996 he was a senior researcher at the jaffe center at the tel aviv university. he earned his ph.d. in middle eastern studies from columbia university and has written numerous studies that have appeared in publications around the world including "the new york times." "ñithe wall street journal."

"the fight for jerusalem -- the future of the holy city." this may be a third on the best- seller list. if you will welcome ambassador gold. [applause] >> thank you. it is always wonderful to be back with the heritage foundation. we are playing a very important role in the world of ideas, part of the struggle we are facing. let me begin with an observation. one of the disturbing trends that one sees is a rise in complacency about the subject of iran. on the one hand, anyone who reads carefully the reports of theñr iaea sees that the amounts ofñr well-and french uranium tht

are in the stockpiles í steadily arewell-enrich --ñi we- ñrñiñiñiçómnu)(rq"ñi ñiuranium e stockpiles and arestqp"ily rising. according to this new report just coming out of the iaea that amount has gone from 831 kilograms up to 1,508 kilograms. the significance is that the iranians may decide at some point to take part of that stockpile and beganñiçó enrichit to the 5%ñi. ñi100 kilograms are needed to create the 20 kilograms necessary for a net -- for an atomic bomb. known sites that it has

inspected, we are seeing their ran approaching a capability of creating two atomic bomb should it make that leap toñi erupt in this-grade uranium. ñryou would think that western - that political ç6gaders across ñrthe alliance would be very alarmed by this trend and whilea subject of intenseçó discussion, that sense ofñiçó urgency does t appear to bqi on anyone's agend. ñii wouldçó identifyñrñ)áqqñiñil reasons why this complacency has said andñi -- hasçó setñrñi in,i willñi suggest anyo @rproach. first ofñr all, the current vog, administration isñi going to administhe cgrpenti going to admristration isçóñi goingñi to3

ñiçóthat could work of the polis ñiçóthatu5át(áh(rog+is the polis book is because i wantedçó toçór study howçó engagement hadñi ben tried in the past. it is wrong toxd sayçó thatñi is never been attempted byçóñi administrations andñr also by te european union. when the u.s. was busy with iraq and it approved the notion that the european union should lead the talks with iran to discuss the nuclear program to ensure that talks between the eu and the big three. the had some limited achievements at the time. they achieved a limited suspension of uranium enrichmentñr. that was part -- that was britain, france, and germany,

but thatçó effort collapsed. it is extremely instructive to read about how theñi different ñilook at the engagement over tt issue. one of the most important figures to read about when you look into the iranian nuclear program -- he had been secretary of the supreme national security council of iran for 16 years. he had been exposed to the development of the nuclear program for some time. he was also the chief nuclear negotiator during the talks with the europeans. he was fired by ahmadinejad in

iran. in 2006, he decided after departing from his job to brief his fellow iranians. it was supposed to be a closed meeting about how he looked at nuclear negotiations. some ofñr thatñr later came ozì+ ñiñiinterestingly, he confessedn iran, under his direction, was negotiatedñi -- negotiating with the european unionñi over its nuclear enrichment, engineers complete theñi conversion plan. as all of you know, uranium enrichmentñi has three essential

ferric -- essential phases. ñrthe mining of uranium and the initial production of what is called yellowcake i'zone w ñibrought in and uf6 is produce. that was done. ñrthe third phrase -- the third phase is that the uranium gas is brought to the main enrichment facility of iran andñiñi theirñ- there low-enriched uranium is produced and possibly high- enriched uranium is produced. there are undeclared nuclear facilities in iran whereñi furtr ñiconversion and the enrichment may be takingñi place and that y

material that it has and is not disclosing. nonetheless,ñrñi his statement r extremely important. idiñrñi fact, he goes into detad he says when we started the negotiations and there was no plan. it was nothing. by the time the negotiations were over, the iranians managed to convert 37 tons of yellow cake. -9ñiheñi was showing his consere opponents that z%9[pçmni was a d ñinegotiator and defended iran'i interests. lso+ shows something central aboutñr iranian diplomacy -- its the diplomacy of deception and he was proud of it.

t@y"to create a win-ñiwin situation/ one another." these are entirely different diplomatic rules. rise of nuclear iran." warning -- what that story tells us is añi warning.%"ton septemba deadline coming up for the iranian government with respect to the old, -- to the obama administration's engagement. they have to negotiate sincerely are there will have to go too far more serious sanctions. that is clearly what is at stake. what happens if the obama xd

xdñio)wadministration meets wie western allies and they say, give them another six months. it sounds prettyçó innocuous to conference making such an announcement. on the basis of my study on past negotiations with the iranians, those six months will be fully ñrçóñrçóthe thing is, iran has d several goals over many years. this nuclear program is not new. iran is a country seeking regional supremacy in the middle east. many time, israelis come here and speak about iran and you would think iran is israel's problem. the supreme leader, the president of iran mahmoud died

wid çóñr cousins in the persian gulf and and the united arab emirates. they are on the front line. iran has ambitions that are described in my book. ñrññiit was a formerñrçóñrñi iri ñiçóbahrainianñi we said that is tentacles are all over the middle eastern region, and that is part of their quest for regional hegemony. clearly, and iran that is close to nuclear weapons capability is able to realize its larger ambitions in the future. iranians are aware of their history. in the suny -- sunni-arab

middle east, among the iranians they remember the persian empire. they do not have such a long- term member mary -- long-term memory that they do not remember the ruling of afghanistan and central asia. it quotes the kingçó abdallah of saudi arabia it that you're helping them -- thisñr is in the memory of the modern middle east. that is part of the parliaments and the memory of the middle east and that is something you have to be aware of. if, indeed, even after the elections and the protests on june 12 of this yearñr for the presidency of iran there are still people who believe in

engagement or believe that perhaps this election episode was a blip and they will sit down and negotiate in earnest on the nuclear program and they will persuade nuclear -- and they will persuade iran to assist on the nuclear program, that will contribute to the complacency we feel. it will work out. there is a second issue which i callêe*q issue -- plan b issue. what if engagement does not work and i am dealing with a power that seeks to dominate the middle east? that will be a tough engagement. let's say it does not work. what is plan b? you have to read between the lines. nobody will say this in public. it is in the background music. some people say, so iran gets

nuclear weapons. pakistan has nuclear weapons. north korea has nuclear weapons. ñrthe earth didñr nld file ande sky did not fall, excuse me. guess what? i do not know -- maybe there are east asian experts -- korea has no plans to conquer japan. pakistan is preoccupied with the superior indian army to its south. iran is a different country on the move, on a roll, determined to establish its hegemony in the world. i met with the arab leaders who said to me that the crab leades say is lamas founded by the arabs and it was built up by the ottoman turks. that was the era of the persians. rñciçóthat is the thinking thate arab world hears about arab ambitions. that is not north korea and that

is not pakistan. that is a whole other situation. part of plan b is to say that during the cold war, terence -- deterrants worked. it had they tried that would hold in check the soviet ambitions. against iran, should in the minuteman and the tridents work -- shouldn't the minutemen and the tridents work? clinton had the idea of giving an umbrella, deterrance. there's a problem with the application of these principles to iran. egypt's president has said thanks but no thanks.

should they cross the nuclear threshold there will be decisions in the middle east from the gulf state, saudi arabia, egypt, turkey, to move in the direction of nuclear capability. you are not going to be dealing with the u.s. versus iran like the u.s. versus the soviet union. you are going to be dealing with a multi-polar nuclear east where miscalculation is very simple. it has no correlation to the cold war. ñinow, moving on from this motin -- this notion of the parents -- of deterrance. i have to include one other factor. when you tear -- when you deter

the soviet union, i do not remember communists suicide bombers. that did not exist. iran not fostered hezbollah and it is hezbollah that introduced suicide bombing that the arabs entertained -- that the arabs imitated. bombing attacks is the center of global terrorism. just go to state department reports. will that work with that? i do not believe that the leaders of iran want to become suicide bombers themselves and how the country blown up with them -- and have the country blown up with them. but they have been willing to sacrifice hundreds of thousands of iranian lives.

the best example? the iranian-iraq war. it recovered all the lost territories that saddam invaded by 19;éì(lc@&c+ but the senior commander of the revolutionary guards wanted to go into iraqi territory. they had ambitions. that persisted for another six years. there were children taken up by sea to war plastic keys to heaven while they went into minefields, clearing them for the army. the leadership that is going to sacrifice hundreds of thousands of people in an unnecessary war against iraq -- can that leadership be deterred? there is another issue in the rise of nuclear iran. that is taking the shiite

belief of the annointed one. under the president, this whole belief has spread and become a popular religion in iran. it is known to be a very potent belief among the revolutionary guards. revolutionary guards being one of the most important centers in iraq and they control the nuclear program. in private conversations, the president of iran has said what would bring about the arrival of the mahdi is chaos. this is another factor that makes the calculations very different than it was in the atheistic soviet union. something which frankly policymakers in the west have to

study and get their hands on -- to get a handle on. to research, you give them terms you want to analyze and they will do googol searches -- google searches. i wanted to know who believes that the arrival is going to happen in two years. i tried in the bookñi to lay out who is who. who belong to to the office -- to the secret society that of theçñ9; mahdi. ñiñii try to structure that bece iñr think that isçóçó an importt exercise to do. justñi the ayatollah orñiññiçós it spread out? does itçó include officials of e revolutionary guard?

isñr an important exercise. if xmu studied the west's relationship, thereçó isñiñi a e trendñiw3çóñiñrw3ñiçó lineñiçó  the problem. there is a cottageñixd imtámqief exaggerated. ñrñrthe ayatollah moved outsidef paris for a few months and ñrreceived commentators and academics and heçzoñi told thei have noñi inten(rx>s@ rñfy there willñi be a government tht will bring about freedom and progress for the iranian people instead of the rule of the shot of iran. the year know how many columns were written talking about him as a gondi -- ghandi who will

not take control? i make reference to that in the book. ñiduring the reagan administration, there was also a tendency to ms. reed iranñi -- misread iran, one that israel was particularly disturbed byñi including those that saidñi hezbollah is the genuine lebanese organization that just wants the israeli occupation of lebanon to end. hezbollah was not foundedñr just by frustrated lebanese shiites. the key component to founding hezbollah was ali-ñiakbar. that is in damascus.

ñr>> in 2001 he appears on pbs d front line and says, to this day, i do not know who did the attack on the marine barracks. it turns out there have bid court cases and a lot of sensitive intelligence that have come out and are now in the public domain and it turns out

that there was an iranian message from tehran to the iranian embassy in damascus which called for a strike by tthe pro -- the proto-has ala. within days that was in the hands of them. there was a follow-up message from the iranian embassy in damascus to the pro-hezbollah in the valley toñi go to attack the marine headquarters. why is this relevant today? t3ñr youñr sayókóñrño'ñrñi r frustratedççó lebanese shi'ctmo didçó not like foreign occupiers vññ;

love and on and hope for the best. -- leave lebanon and hope for the best. but if it is a direct order to the shiites, that isçó a direct attack byw3ñrxdçó iran against e and against france. xdñrzh7rñiñiandçó agaifstçóñr t just in lebanon but inñi kuwait. this goes onúaud on. part of our problem historically is underestimatingçóñiñiñr the l q regime to the west. explaining it away before -- occupation, the usual kinds of theories that one hears. it goes on today, this year.

i've heard of the heritage foundation for years, not the east-west institute. they put out a report in may. a russian-american report. it analyzed the iranian ballistic missile program. theyñi had two conclusions. çóone, iran did not have the çócapability ofñ)i strikingñr n two, iran only had liquid fuelçó rocket engines and not solid fuel which means it is primitive and do not worry. ñithe report had a huge impact. ñii saw this quoted in the "the loss angeles times." çóreport. ñrçówithinñiñiçóñr daysñiñrw3ñis

ñxiñrlaunched and itçóñi hadñr b ñiñiñorñiengines. ñiñrutheçó impact had already n done. çóñiñipeople have theirñiñi cofe morning#q said there at the firecrackers stage. i am exaggerating on purpose. that is the printer. -- the point. çóbecause i was shockedxdñrxd bg this. do you remember that on june 1 at "xdñrñrnewsweek" put out an at "xdñrñrnewsweek" put out an additionxdñi=)ñówiçóñ tñiñi1/l the cover story ws çóçóit was a big piece byçóñi ñi oneñm/ñr of the smartest mançón america.

he has his own tv show on cnn. ñcds an assertion. the supreme leader of the iran -- of irançóñi said that nuclear weapons are immoral. not only did he say this, but he entwrgd a fact, -- a fatahñi tht said they were immoral. because of this -- i will call this açó nuclear fatah --ñrñi tt does not have to worryñi n!ause iran will never do something that contradicts the foundations ofçó its regime. that contradicts the will of the supreme leader. a good reason to go intoñi the summerçó relaxed. ñrñrone problem. i asked two separate teams of

peopleñi to check into this sto. ñii had known that there had ben israeli discussions about the nuclear fatah and they could not find this. it turns out if someoneñi goes o the web se of the supreme list of fatahs, and they'rend ha icareful to update that list, i guess what? there is no nuclear fatah. now, i will tell you this. there is a rumor that there is a nuclearñr fatah. they love to tellñi that there s a nuclear fatah and zacharia bought into the argument. people read "newsweek."

they get complacent. they get relaxed. it is part of a trend line. it is disturbing. we are now moving, as i said earlier, as [jo;; -- as phillips said, president obama has said he will keep alive his policy of engagement and then revisit this stench -- revisit this if they do not begin negotiations in earnest. i already said that ifñr the administration, perhaps with european pressures, decides to extend the deadline the iranians will exploit that and move their nuclear program that much closer to the nuclear finish line. i will tell you something else

-- the iranians are carefully evaluating the will of the west. so what happensçóxdxd if this is çóextended adñrñiñiçóñr infinit? the iradi9m are experts not onlyñi in the empire but in norh ñikorea. they were underñr the iaea constraints. they were trying to make sure that theyñi expect -- that they did not have conversions to weapons-grade plutonium. but december 2002, north korea removed theñr sealsbund kicked t the iaea inspectors --útsatñi ws december 2002 -- and we have had two nuclear tests. probably not enough plutonium to

give it enough to it --ñi enough kick -- and a second test in 2009. they got away with it. nobody didñi anything. sure, sanctions. they pulled it off. theyçó became a nuclear weapons state. ñrñiñiwhat happens? we call that break up. you are under limitations and you break out. if the west has an uncertain responseçó to thet( deadline, i are very likely. notok necessarily a nuclear test but certainly efforts to move themñi closer to their treasured goal of becoming a nuclear weapon states. r(p)eful. a5xdñiñ!w÷/m%rxdçóñ  think itçóxdu/0 is too late. r(p)eful. if iran gets nuclear weapons we're not going toñiñi3w be deg

xtion but a nuclear umbrella over theñri]uyo shiiteñiñiñfwdñr other territory organizations. ñixdñion 9/11, theçóñie/+cg"ezñd ñrñigave sanctionsñi toñrxd all. ñiñiñidid afghanistan have nuclr weapons? hainaut. i h. a hard war now. çóñrñia message wasñi sent to ey country in the world that sponsors of international terrorism -- you strike america and your regime comesñi down. ñrñrthat was the message of 200. fast forward to 2009,xd 2010, 2011. it tells the operatives of hezbollahñ)÷çó you are under our

protection. you areñi under the nuclear umbrella. í/:óñiçóçócan the west retalia ñrmajor strike against a city or theçóñiñrzñxd united states? much more dicey, difficult, q#ore the freedom ofçó actionñi of international terrorism expands and the danger toñi allf ñiour security increases. ñiit is not too late to stopñi e scenario from occurring. çóthere are initiatives under wy gasoline quarantine on iran. bolton has raised skepticism aboutñi that in the wall street journal. ñilpñrit isçóñi a positive step. it has to be done effectively. it has to send añr signalñrxd tt there's political will in the west toñsurvive. to not al)ou the world order to slip into the kind of chaos to be represented by a nuclear iran.

ñrñi>> thank you, ambassador. ñiñe staff to comeñca byçó with microphones and i would ask the members of the audience to ask short questions so we have time for people. our staff is getting ready for that. let me ask the first question. i think one of the strengths of your book is that you go into depth on some of the past failures to engage iran and the past failures -- that is okay, i have a microphone. some of the past failures to dissuade iran in the talks. but the obama administration is committed to going ahead with the engagement policy. what advice would you give to çóstructure these talks so thatt is not just deja vu all over again?

xdñiççóñixdñrxdçw%ñixdñr>>ñiñi . it failedçóçó with his lead. çóñiñifáthere may be people whot çóñitblems to may be people whot ensure our ran."qñrçó after ju+ s under siegew3ñi by the iõian people. ñiqpuíavk6jñ stronglyñmomçó bes çiy+=biñri/idzrm roundingñra5 up everyoneñi whoc çxcçósome people might thinkñit iran will bee1 busyñitt:hráself. it will not getting gauged -- get engagedñrxd in foreign poli. okçówhen the islamic republic hs faced internal problems, external lyses them. ñm]m!q@e yn).ñiçó embasi ñiçóin the carterúaóministratio?

because of the internal rifts in iran. ñiñiñiñiñithis continues for a . i am not sure that the prognosis for engagement is very good. çóif you want to test this -- i put for the theory in the book -- forward the theory in the s# ñrthe -- in teh booik ñr-- in te book that they will exploit that. we are too close to the finishing line for ran -- forxd iran. we're too closeñm/çó toñi expet with foreign policy. itñi has been done. çósit with him in a closedñi ro, not in frontñi of a camera. the consequences of açó nuclear ñiiran are simplyñi underapprecd or dismissedxd. i think it is very important for

allñr membersñi of the western alliance -- i am taking this to london as well. i am planning to do some public speaking -- i think everyone misunderstands this danger. if you try to engage, keep it short. >> i would like to engage the audience and ask you toñi also keep it short and identify yourself with your affiliation ju just a private citizen if you would like. >> thank you. i am the vice chairman for the national security affairs. one thing that ambassador gold did not mention is the danger of a handoff by iran to a terrorist group of maybe not an explosive nuclearñiñiçóñi device but a di. i am told it is very difficult to find outñiçó the origin ofñkt could take even weeks, atñrñiçh

lpñd and kill 10,000,009 iranians? do you go into the subject of a handoff? >> one of the concerns are expressed and to my book is as follows. nuclear weapons were always viewed as the crown jewels of a country. you do not shareñi them withsáq. you remember the dispute back in theñi lateñrñi 1950's aboutçeaa wanting russian weapons. they do not want to give this to them. we are in a different world now. one of the observations that i make is that the quality of the conventional weaponry going from all ran to hezbollah -- fromñi iran to hezbollah is vastly improving. çóyou now have ship to shore missiles used against the

israeli missile boats. hezbollah now receives rockets with a 200 kilometerñi range so that the barriers for transferring advanced conventional equipment to hezbollah are dropping. that can set the stage for moving intocicuz nonconventional field. ñii was in london discussingñr r they tried to use a dirty bomb in moscow. ñrxdi haveñi mentioned that there was a report from the colombian intelligence which doubted the western press that they were moving in the direction of a dirty bomb. the dirty bomb is the easier option.

i thinkñr that is a possibility that one cannot rule out nuclear terrorism. i think the more likely scenario is this idea of a nuclear protective umbrella overñi the sanctuaries of terror that give terrorism far more freedom of action than we had back in 2001. >> this woman back here? >> i am from free asia. i thank you for your wonderful presentation. as youñr know, iran and north korea areñrxd cooperating on nur issues. many that i talked to say that iu(u(rr'g how the administration is handling the nuclear missile issues andñr nowadays u.s. officials reportedly seem to focusñrçó on how to engage north

korea. resuming talks with north korea. what is your best advice to the current administration in handling the north korean issue in relationship toñi the rise of nuclear iran? thank you. ñr>> it is trueñi that iran and north korea are strategic partners. iñr think irançó -- excuseçóñr h korea was thexd teacher of iran. the student has surpassed the teacher if you get the missile technology that irançó is deploying. i would not try to give advice on what it should do with north korea,ñrñiñrñrñizo7=f,7?l÷e1ñ0ge that two administrations tried to make arrangements with north u,uíñkorea. ñiñrçóñjrñi)qñizzikhrñjrçóñrñih administration. + i]ñixdçóñiñrñrñudñ&rçóñiñ '-9çc ñitestsñr and got away with it.

anything you do has toñixdñiñrñt history into account. m optimismñrñixd that it may nt be too late to deterñi iran. the europeans seem to be gained at the chinese andçó russians to not see more committed than they work before. the question is, even ifñr we gt unilateral sanctions in place a probably will not stop the iranians and the chinese seem to be in use by our efforts to stop iran. without china, is it possible to deter them? it leads us to a military response.

the question is, how much time before someone has to take military action? >>ñi i wouldçó prefer as a formr ñidiplomat not to explore the tm clancyñi scenario. [laughter] i will say this -- one of the essential questions at the u.s. government will have to ask itself is whether it has to go ñrthrough the u.n. security council. if you go through the un security council and you try to win approval, russian diplomats are brilliant at gutting açó chapter 7 resolution and making this meaningless. that is likely to happen in the futuref there is obviously talked about trading goes off for russian cooperation. i am sure the russians will brilliantly pocket these proposals. and yet, for the russians, the relationship with iran is vital. the russians are making a

terrible error. the russians think that the opposition they face in the northernçó caucasus largely coms ñifrom sunni terrorism backed by saudi arabia and theçó other guf wealthy families, but the shiites are a different story. all kited, when it was defeated initially -- alñr qaeda went to pakistan. that republic and sanctuary gavk çóñisanctuaryñiñi. çóñiçózarçóñrñrqawiñiçóxdñr hast wasçó in their interestçw%ñcuzñt him. iñfo ñrñiçóñiiñr[ñs7rñrthreshold,ñic

backfire. that is not their view right if the u.s. moves towards painful sanctions in a ñrçóvery my judgment have to form a coalition of the willing and it will have to be those countriesr who want to have anñi impactñ-n çóthe companies that are providg refined gala free products --çór refined oilfáñiñvzoñi prodcuts- products. ççóñpniñiadçóñrthey say to thou want to tradeñi in our country? youñr have noe1 business.- regardless of what theyçó do in

ñrwhen there were gasolineñr qui because ofxdñr supplyñixdñrñiñry ñiñiñiçóthatñr sameñr sensitivât demonstrations. it has to be tried, but ultimatelyçó all the states ofçe middle east has añr right of se- defense. let's hopeñi that the strenuous sanction measures can stop the iranianñi program five minutes before. ñr>> the man in the second row? looking back historically at the iran hostage crisis in the carter administration, do you

believe most iranians and israelis and you look at that experience much differently than most americans? >> well, it is hard for me to second-guessed that story. i think the u.s. was to ensure an incredibly difficult position and my heart goes out to those people that were kept for 444 days. clearly, iran read america differently than america thought it was projecting itself. there were stories into the carter administration or they were dispatched and pulled back. they made statements that they cannot defend itself. that was a term used later by an iranian demonstrators.

magnanimous gesture on theñi pai ñiç$ ñras weakness on theñrñiñ;bapt e 9%9çóxd diplomat. you areñi deal'vñiñiñer with dt cultural backgrounds, different mores. çóñiw6 ou have to haveo addressed that differently. you get the same mistakesñr as4+ americ;and british diplomats. xdñiñii alert readers to read mk to these problems. we have a doctor had not even spoken about and how that is used. i would not second-guess the hostage crisis but iranians understood americans differently than the way they thought it was projecting itself. >> thisñi woman he.móì(lc@&c+ qñrxgjñ)óm u.s. okñc0vóñjáuñ=1ñr stated that the is different than that of north

korea or pakistan because they hegemony. ñiimplyñi that theyírñ will beçe likjuruáq the bomb, and if not, in what way you see they will use that leverage differently than other countries? .

historically the iranian exports

at the evolution has been exported. there were riots right after the iranian revolution in 1979. in the mid-1990's and iranian representatives came to washington with intelligence information that iran, in particular -- and particularly the revolutionary guards, stood behind the right thing. -- the rioting. if i was trying to anticipate where problems could erupt, it might be a country like fokker rain. right off the coast of saudi arabia. should they be able to affect the regime change, i would imagine the first act of the revolutionary government would be enact the u.s. -- would be

asking the u.s. to lead. -- to leave. that is something i think you have to monetary -- monitor very carefully. >> we have time for one more question. this man right sheer. >> does the u.s. intelligence committee understand the significance of the 12th amon in the iranian policy? to get that is a very difficult challenge for any intelligence agency. they are normally not trained to study religion. the united states is largely a post-ideological society. other than israel with all the other active ideological undercurrents is also opposed-

ideological society. we could get into a whole different discussion. they do not take ideology as seriously as they necessarily should. it is also adept -- it very difficult challenge to get to an intelligence committee to try to understand it is ahmadinejad referring to the 12 ñrñrqimon ñe that enhances his position? going on that when he goes home he says this is nonsense? that is a very hard thing to analyze. you have to collect speeches. you have to see the use of the references, how it comes up.

doesn't have a programmatic element or is it just the introduction to his speech in reference? it is important to see who is a clericalñr implications are. çóñiñrñiñiñiçóñitherefore you he ñimesbeyoeh and what his policis are. it isñr hard,çó tediousñi work t someone sonld be doing it. >> i would like to think the audience and wishñiçóñrñiñi thad join me inñi thanking the ambassador. [applause] ñr[captioning performed by national captioning institute] [captions copyright national ñrñiñrñi>>ñr coming inñi octob's

original documentary on the nation's highest court. ñiçóçóhere's someñi of what youl see. çó>> may it please the court, te governmentñi concedes that the destruction of documents in a -- in anticipation of proceedings was not a crime. >> something is different going onçó here. did you needñi to appreciate how important it is to our system of government. çó>> this is the highest court n the land. ñithe framqs created it after studying the greatñr lawmakers n history in taking a look at what they thought worldwide was important for the judicial branch to do. >>çóñi i've put in as much bloo, sweat, andñi te cases as theyñr do on the big ones. ñrwe decide who wins under the w

that the people have adopted. who will be surprisedñr at a hih level of collegiality here. >> if there are four of the nine of us óizñ want to hear this case, we will hear it. >> why is it we have an elegance astonishingly beautiful structure? it is to remind us that we have an important function. and to remind the publicñrçóñi e importance and centrality ofñi e law. >> i think the danger is that çósometimesçóçóñiñi you come ina building likeñr this and think t is all about you or that you are important. that is something that içó do nt think works well with this job. >> supreme court week starting

october 4 on c-span. >> as the debate over health care continues, c-span's health care hubçó is the key resources. go online and followed the latest tweets. watch the latest events, share any town hall meetings and your comments. there is more at cspan.org/healthcare. >> to the will surgeons and a primary-care physician share personal stories. -- two surgeonsñiñiçó andiñi a - care physician share personal stories about treating patients. this is a about 45 minutes. -- this is about 45 minutes.

>> why did you getç(r'to madiso? ñi>>ñ-- medicine. >> my father was a surgeon. then the beginning it was quite fascinating to me to speak to him and get the inner workings of taking care of people. ñii was very excited to be ableo participate in that. it was a very easy process going through school, and since i grew up in puerto rico it was feasible to take care of and be with my father in office early on. it was what i needed to do and had to do. it was a calling, very simply put. from thençó on, going through school was a natural thing. unfortunately or fortunately, that is what i was exposed to in

the beginning. in my mind it was what i was called to do. it sit for myself -- fit for myself and what i wanted to do with my life. dr. , how about you? >> it is an honor to work with patients to preserve that. there have been tremendous expenses in my field in terms of breast cancer. that allows us to give patients more options and get them back on their feet sooner. >> dr. michael amedeo, how about you?

>> my first contact with madison was 9 years old. my neighbor was a neurologist. he took me through neurology rounds, and i was fascinated, which now are very rudimentary and barbaric, but i was fascinated to see what he was doing. it sparked an interest that held on through high school, college, flirting briefly with your research, but it was not for me. i was more of a people person. i went to medical school, and had a great transition in career ever since. >> explain what you do? >> as an internist? as a general internist, i am the point man for my patients. they are my responsibility. i am responsible for all aspects

of their health, coordinating their care. i am the first person they see when they have a problem. that gives me a great window into their lives, and it is an incredible honor to be so intimate with these patients and to share their problems, their choice, their kids -- i have several families where i am taking care of the third generation of the family. that is an incredible honor to be able to do that. >> explain what you do. >> i am a colorectal surgeon. the basic difference is that we are not usually the person that sees patients initially. i am a general surgeon but also specialized in colorectal surgery.

we deal with the basque gamut of diseases that involve the colon and rectum, from cancer to the nine diseases. i am a surgeon, so i am in the zero are -- the o.r. 50% and the time. the way we see it, that is what we bring to the table. çówe do smaller incisions and things that are lessñi painful,ó certainly try to cure and resolve issues withñr."çó surgl procedures. ñrxdin my particular case, it ho do with a lotçó of cancer and bowel disease,ñr and similar problems like embroiledñr diseases -- immortal -- hemorrhoidal diseases. i was in my practice with my "tçóñril

section for the hospital four years ago. >> when did you decide to become a breast specialists? i was pretty much after i finished my internal surgeons seek -- general sergisurgeon residency. so many things were not available for breast cancer patients then. minimally invasive techniques, there has been an explosion in breast emerging -- imaging, and numerous surgical techniques that are all on the horizon. that are all on the horizon. that i çóas a breast surgeon, all i dos pressçó stv thatñi is cancer and non-cancers problems for women. >> weç(pj patience it a lot of thingsñr about doctors, you reaa lot of things about doctors.

i would like you to tell us what you vmuld likeñi to say to áiáients. you? anything? çó>>ñi probably, and i do not kw mib slightly irritating, but it is also more sad for the patient because it bringsçó up so much anxiety is they have a tendency when i have a system to go to the internet and try to figure out what is wrong with them. without a medical background and grunting and the experience that we have come that there are í/always good to get it wrong. they usually think they have someçó horrible disease. if there is anything i would say is that patients should not be trying to miss their diagnoses on the internet. what i tell them is that once i tell you what is wrong with you, read all you what about your disease and learn all you can because you may be able to find

things and teach me things. you are not want to be able to make the diagnosis yourself the anxiety that then comes up when patience -- someone yesterday came in sureçó that ty had multiple sclerosis when all they had done is pensioner by crossing their legs. -- when all they had done is pinched a nerve by crossing their legs. ty provoking and it is a shame that they go through that. >> it is really a give-and-take relationship between the physician and patient. mutual respect is important, respect for both -- forñiçó tim, on time,ñrñ&r not overbooking, e patient showing up on time. it also works in terms of the internet. ñii haveçiçó seen patients comn with three or fourñi pagesçó of

breast cancer questions, which isñrç?rñi fineñi with me. they will have every question from that standpoint it is helpful. çóit goes back to it working boh ways. ñixdqñiçóas long as the patiente positiomr as anñi-9 -- have a l respect for each other, -- the patient and the doctor at the mutual respect for eachçó other, it will work out. >> the key thing for me is that this is some people coming into the office, notamjerh chip in their shoulder, but that this is goingñi to be a battle. what we have toçeti] over is tt õ.h5ñ is a team. i am on your side. it is a difficult process, and when the diagnosis is not nice, it is not a good diagnosis. that isñr something weñi cannote his doctors. if we are able toçóxd maintain m very critical>'óçó relationship between the patient and the doctor, where no one else can

get in,ñi not the insurance companies or the hospitals, no one, then things will come out no matter how serious the condition is. that is what brought us into madison, to take care of people and every person. that is what turns us on most times. if we are able to not have an adversarial contact and work on the same side, it can be very simple and very complicated. if that hurdle is passed and people mother we're trying to do the best, and yes, we make mistakes and do not know all the çóanswers, andñi yes, we are fallible andçóó human, then it always turns out toñnd be a positive experience for the patient and certainly for us. i love what i did. r+e what youñiñi do, if you have theñiiñi chance toi uu(r that for me is the most important process to get across to the p dollars we're sitting in part of

the emergency room but they virginia hospital center -- at virginia hospital center. a lot people at c-span come here. we know the hospital. dr. wilson, one of my doctors, and you are very helpful in making this happen. from your standpoint, however like to know what your day is like. how many patients do you say? how many days a week do you work? and are you on call 24 hours a day? >> as far as on call, i am on call two of the four weekdays, and my partner is on the other two at night. on weekends, we have a group said that we can cover, a group of eight internist. every eight the weekend -- every eighth weekend, i am covering eight doctors and their

patients. i come in and do initial paperwork, have patience from 9:00 to 5:00, they come to a hospital and said hospital patients, the paper work, and if you as my wife, she will tell you midnight. but i can put in up to 12 hours in a day. >> when they visit your office, how much do -- chemist time deal allocate? >> it is a follow-up on an established patient, if it -- it's 15 minutes. an annual physical is 30 minutes. a new patient is 30 minutes to an hour, depending on their age. a young person may not have much history, but an 85-year-old person, we may need that full hour and maybe even more. >> as an intern is damage you do know surgery. >> i do nose surgery. -- as an internist, you do

no surgery. >> i do no surgery. dollars my eye patients can be 15 minutes, new patients for 30 minutes, and a new diagnosis is 60 minutes because there is so much to cover. i am on calls all the time, every single day, so if you and i have a relationship and you have a problem, you can reach me at any time. when i go away, i obviously have coverage, but otherwise i am constantly on call and available. that has not really been a problem because i know my patients. luckily i do not have a lot of cross coverage. that is pretty much my day. >> is a 1.5 days in the operating room? describe what you are usually doing in the operating room. >> i do a variety of breast-

related procedures. anywhere from as simple as a breast biopsy, to try my diagnosis -- to try to make a diagnosis, to do a lumpectomy or a mastectomy for breast cancer. the pace it can have a set -- i tried to coordinate with plastic surgery so that the patient can have a mastectomy and reconstruction surgery at the same time. >> are you one time most of the time? >> barring some situation that has occurred or unplanned, but we certainly try to, as was mentioned before, respect the time of the patient. my day, i see patients to 0.5 days a week -- 2.5 days a week.

i am in the or two days a week. -- i am indeed o.r -- i am in the o.r. two days a week. it can be very easy and quick, and nine ailments, where people go on the same day. and then a lot more complicated operations or procedures, for inflammatory bowel disease where we have to intake -- take the entire large bowel out and reconstructed using the small intestine said at the present tense continued have normal functions without the: -- so that the patient can continue to have normal functions without the colon.

we have o two full we have.r. -- we have two full days of the o. r. time. it seems to my wife, but that is not usually the case. the days can go up to 12 hours or longer. i have a partner, and we are a self-contained unit. the week that we are in units, it does the whole week. we know our patients, since we are usually operating as well, we know each other's patient as well. it can be very easy are very difficult. there is a lot going on, emergency-wise, and surgery can be a very busy week.

>> health care is in the news every day, almost every hour now. the your patience talk about what is going on? >> all the time. in the past three weeks, i have had patients ask to have their imaging studies moved up. we have that timetable for patients needing a mammogram or an mri. i had patients who needed studies in january asked have been done in december because they are worried that they are going -- there will be changes precluding them from having that done. there is a lot of insight at. breast cancer patients have anxiety, i do -- anyway, baseline, but will they be able to have to care that they need to maintain their health now that they have gone through the health care and the surgery and everything else? it is really an acute, palpable feeling in the office. ñ8hey want to talk about it all the time. and i cannot blame them. >> dr.ñiñi amedevñi?

>> it comes up a lot. we often get into a more professional level of conversation with some of my patients. certainly in the last month, i am getting a lot more questions about swine flu. the anxiety of the pandemic and how it will impact and when will they have the shots? çóçówho will get it? that has been theñi foremost, bt there is a lot of curiosity and health care reform is so nebulous and up in the air and there's so much rhetoric about it, it is hard for people to get a handle on it. and like stephanie says, it causes a huge amount of anxiety. i don't think we have a clue what will come out, if anything. >> i started with you. i asked you what you thought about the health care debate. you told me that you have to start with the defining whether or not this is a moral right of

americans, to have health care. t get people besides me talking to you about this? -- do you get people besides me talking to you about this? >> before, not so much. now it is almost daily. it affects us as professionals and patients eventually. from my standpoint, when i started thinking about this, the key question in my mind, to sit back and say he is receiving adequate health care are right for every american citizen, or is it something that you purchase like a car? even though it sounds not that important, well, it is. if everybody who lives in this ñiñrñrcountry has a right to heh care, you have to define health care, a complicated equation as

it is, but that is one of the critical questions, start to address -- starting to address it, which we have not. the rhetoric starts to the maximum level where they start calling each other names, and it is not very nice. and the question is, is this the right? i am not a lawyer but it is something that obviously in my mind is a very important question. do we have a right as american citizens to receive adequate health care? or is this something that you purchase, and the more money you have, the better health care you get? that is a very tough question to answer. i am sure that theñi people on e hill are dealing with that. ñiñiçó+áñiñiñi have all but tals the mopd importantñi question,t will color the wholelebate. >>ñr if you could pick up one

thing to say to capitolçó hill about this debate, what would you say to them as the debate goes on? >> i would say, do not destroy it what works well. we are aware that certain things have to be changed and modified, but we have without doubt -- i can tell you without doubt, we have the best health care situation in note world. it some things have to be changed d the population. ñixdçóñiñiñiñiñiñrñibe8hñi gentd do not destroy somethingçó that >> what would you sayt(ñiñiñrçóe çç.-iññiñiñrçy/çóñiçó-9ñiñi>t nited st@ves. çóñrxdñiñiçóbecause of the way i

american medical system has urpáh!een ñrimen short shrift. y training. not change thatñiñi trendñrñrñre systemñi is doomed. if you look at every other developed country,xdñr which hae better healthñi statistics thane do instead a great deal less ñiñiñrtheir primary care orient. çóñiñrñrñjrñiourñiñi^stemxd is i oriented towardsñrñi procedures- specialty care.c that difference is a major cause ez-9ñr our problems. ñf'ónbñiñiñvóñiñixduntil primae óñiñiçóñiñiçóñiçóxdattractive'o

do it.lyxd xdñiñixdxdçóñi c1xdñjrñiñi surgeonxdñrñrñiñiw3i]xdñiñi. ñii had two yearñiçó swissñii] a çójfñri]--ñiñr iñrçóxdçó had5aa ñtrokstorefrontñr clinic in bal. essentially they taughtçóçó meñe allocation primary-carjçó that i did not!peally get inxd mi ñi]ñ- 'ing in medical school. çóxdxd>>ñ9iñrñi where did you gl school? ñiçito could georgetown. çóxd--ñr >> georgetown. by the end of the two years, i

haveçó learnedñi outpatient pri- 12,000 perñiñi year. [aãy and camew3 back to arlington whe i grew upçó and started the practice in 1984. >> dr. akbari, whatñiñrçó?7 abos debate? >> i echo what they have said about this. this is an incredibly complex issue. we have not defined health care. nobody knows what they're getting when they pay f)khrá. if youçó go to the store and bua box of cereal, you know what you çó for it. but when you are gettingñi a bi, with all the charges and payment isñi less than the charges, noby

çóudmrrvandsñr the pricing and t you get for what you pay. the most important thing here is toñr define does everyone have a right to health care, and then who is going to pay for it. if we all think that that is a right, we all have to contribute, and it will not come from dr. costs, or cuts the hospital -- cuts to hospitals. and as a multi-sectorial thing. it will involve the taxpayer. that is a tough not for politicians to stand up and say, and for patients to honestly say, ok, i will be willing to contribute more of the less money i am making in these difficult economic times to health care. >> when you are doing an operation or seeing a patient, you have any idea how much this

will cost them? >> i do not. i know what might charges are. i know that i am not paid what might charges are. i have a contract with the insuranceñi company, as do most doctors. i do not know what that would translate in terms of copayment, in terms of the 80/20, 90/10, and that patients do not know either. >> if you're doing a radical mastectomy, what does it cost? >> the cost in the charge are different. >> what is the difference? >> the charges anywhere from $1,800 to $2,000. é@the payment is usuallyñióñi- medicare reimbursementçó for a mastectomyñi is usually betweeni $650.700 $50. >> the money comes directly to you. >> that helps to pay for my salary, my[ñ overhead, i have e employees working in my office,

i will have two associates, another one starting next week. ñithat covers rent, malpractice insurance, supplies for the office, and one of the misnomers for physician reimbursement is that that money goes to my house into my bank. w3that is not what happens. çóñrbig businesses have overheao cover, and said its decisions. that helps to defray all those costs -- and so do decisionbh[s. that helps toñi defray all those costs. >> if i am seeing patients and i'm more participating providers, i have agreed to except what the insurance company contract payment is. ñ(gñif the patient is seeing ani am not çñii][ññrçóñr participa, i have the ability to build for the difference between what the insurance company will pay and

what my charges are, but typically we do not do that. >> ehudo you know what is goingo cost the patient? ? you have to distinguish what the hospital charges, which we have no -- i do not have any idea what the charges areñr. we have no control, nor doçó we know what happens on the hospital side. çóñrare conscious about what wee any o.r., and our limited resources. we will use what weñr needñi in trying to be as frugal, in terms ñiñixdñçxgññiñiñrñi."thq5ñ=)ññe use w%!!jz be variants --

expensive. from: that the main -- for the colonetomy, we can charge $2,000. and we get paid $300 to $900 from medicare. thatçó covers the 96-day period after surgery. if you have to intervene, you are basically getting paid $900 for that procedure, all of the post of care for the next 90 days. private insurance is takençó an idea for medicare and uí5hpì(l answer is companies that use is one-and-a-half medicare.

-- i do not know an insurance company that pays us one-and-a- half medicare. we're very much under paid for the procedures that we do any insurance companies -- and the insurance companies are using medicare and -- as their base line. we get paid out -- some get paid more, you can find out what the rates are for their visits, which is minuscule. when you call a plumber and a charge you 10 times what we can charge, it was useless orbit $100 and that is cash. there is no insurance. the dollar'>> what do i end up , whether it is medicare or insurance or out of my pocket? >> it will depend on the length

of the visit, like they said. mike charges have really relationship to what i get paid. we may charge anywhere from $50 to $250, depending on the extent of the visit, but what i paid, it usually very close to medicare fees for all of the payers, maybe 33% of that. a simple office visit, i might get paid $40, maybe $50 if we do some laboratory tests. some insurance companies said they will not even pay you for drawing the blood. you take that out of your expenses. it is significantly less than the charges. >> i am hearing that somebody somewhere anteroom decides that the medicare organizations, what you're going to get paid. tell me if that is true or not

christian or dollars that is completely true. >> who does that? >> medicare rates are established. >> an organization called medpac, a board that was formed made up of multiple people from medicine and from the federal government. they basically said something called the rbrbs rates. they about the way how much it costs to be a doctor, run an office, a pace that, to pay malpractice, and the basis of that, they said the reimbursement rate. -- they set the reimbursement rate. that is a deeply fall system -- flawed system. that formula currently being used is going to cause a 20% reduction in all physician

reimbursement. if that happens, this system is going to crash and burn. >> it will collapse because doctors that are able to take new medicare patients will not be able to. it will not be cost-effective in you will not be able to pay your rent and your employees. from our standpoint, it would get to the point where we cannot make ends meet. the amount of work that it takes to run an office and reimbursement, if you have wanted% medicare, you would not. -- if you have what had% medicare, you would not. -- if you have 100% medicare, you would not. you are not going to be able to maintain the business and most of us cannot call and ask for either rebate or aailout. that is not when happen.

some have tried. we will not be able to maintain -- and the unfortunate thing is not closing your business. my parents, myself, when we get to that age, we will not have doctors to take care of us because they cannot afford it. >> another thing about medpac, it really comes out of congress and is administered by the government accountability office. it leads me ask whether what we have right now is government-run medical treatment in this country, socialized medicine. some people get upset about that name. what you think about the medpac thing? >> in a sense you are right. everyone follows the medicare rates. it seems, however, at -- that as we move forward, there is an interest in changing that even more to make it a much more controlling system, was choice,

single payer, and that will eliminate a lot of things that we as doctors feel are necessary and important for patients. when patients come to my office, pay have an expectation as terms of care. along with beckham technology. we will not be able offer that kind of technology, all of those new things cost money. if we change the playing field so that the highs and lows are eliminated, a lot of that will go way. i think there will be tremendous disappointment in the level of care that patients receive. >> his health care in this country a moral right? [laughter] ñiñi>> i do not know if it is a

moral right. i believe that people are entitled to a basic level of [#%arw i think the morality is, is it right have somebody in other words,çó currently thee is an enormous cost shifting going on. çóif you were a medicare patient and in the hospital, york care is being subsidized by patients who run commercial insurances. that is not right. if you come in without any insurance at all, all of the costs of your care are being subsidized by commercial insurance companies. as açó hospital, it is critical, since medicare you have no to the commercial insurance companies to make up the difference because medicare will not coverñi your charges and expenses. you have to make it up from the

commercials. i think the immorality is in the equilibrium between the amount paid and the amount received. >> all right. >> i see it in my opinion that anyone who lives in this country,ñ;americans should havea right to health care. the question gets very murky when you say who is going to pay for this? the answer in a very simplistic way is we're all going to pay forçóçóñi this. will certainly not work by cutting what hospitals get paid and whatñi insurance -- what positions get paid. that will not solve the problem. having saidxhr3wñ7áyñiñiñi it y ñiçe basic question is do we have a right in the citizens -- as citizens to receive health care?

my very simple to answer is yes. ñiñrhow are we going to allocate care and restrict or limit what ithe patients ce of issues of funds and moneys ce come at the example throughout the world is that most likely cannot -- we cannot offer 100% all the time. there is no country in the world for that is possible. the second message is that every system of health care, it does e flawed. works perfectly. do we have it right as citizens of this country to receive health care? my opinion is yes. pinion, the answer is yes. >> dr. akbari? >> i would lead the moral right out. but how do we define health care? at what level does that mean? a liver transplant for everybody

or a basic level of preventive care, immunization, screening tests, and then beyond that, we allocate based on age and morbidities' whether something is appropriate. that will be the hard part, to define what you get. health care, what does that mean? you get a basic level, and once we define what everyone will get, it will be easy to see how much that will cost and distribute that across the paying parties. >> what year did you graduate from medical school? >> 1979. >> georgetown, right resort >> yes. as it turned out, yes. my practice still is as close to the markets will be kind of model -- marcus wilelby kind of

model. i think that that is changing and i think that medicine is becoming more of a profession -- there is less commitment to the long-term relationship, the extra hours, the kind of thing that the old guys did. the younger folks, and i don't necessarily fought them, but the ads would have a life, be home for dinner every night, but want to see their children grow up. -- they want to see their children grow up. so there is a loss. if i was when the work 40 hours a week, than 20 hours a week, i would be less available to my patient. someone else would be seeing them in getting to know them. i think that that is changing, but i have been able to maintain the image that i wanted by

keeping the practice small and heading tight control. it does not mean that i have not used the highest technology. i might huge proponent of information systems and have been here at this hospital and around the country for many years. you can be high tech and still be warm and friendly. >> what about in your case? did it turned out the way that you planned it? >> for the most part. i graduated in 1985, columbia, and then trained in boston. and in colorectal in the university of minnesota. my father was still around as my mentor, after medical school and residency. it is different when you have your dad. it was a great honor and i was probably the best part. it has been worth that. in terms of surgical care, there

has been an explosion that i never envisioned. all the minimally invasive processes that are still there. you could tell i am older than stephanie, but when she started as an intern, we work at the beginning of laparoscopic surgery. i had to learn how to take at gallbladder attitude. -- to take a gall bladder out of a tube. i am not sorry that i chose what i chose. if i had to do it tomorrow, i would do it again. it has been great. i love what i did. all that fancy stuff that we do is very exciting, but the most important thing, what gives me the most intense pleasure is to be able to take care but people,

to have relationships, to be friends, even though we're surgeons and do a lot of basic stuff. in case you come to work with a smile knowing that you touched people's lives. >> did you know each other before? where? >> we trained in boston together. >> as this turned out for you? =/%ñrt(tell us what you do here. >> i and the medical director of the center, the only multi- disciplinary breast cancer treatment center in northern virginia. we have amassed breasts imager is, people who specialize in breast cancer, radiation oncologist, nurse navigators, all in one location to really provide comprehensive care for the breast cancer patient. this hospital has been at the forefront of enabling that to

happen because nobody else in the area had really stepped up to the plate to have that kind of system and played. >> your use of guarantee of pennsylvania? >> in 1991 -- you are university of pennsylvania? dollars in 1991. i love being a surgeon and what i did. when i talk to dr. wiltz, i appreciate being able to work with people and feel honored to be able to becomeçó an intimate part of their family, even if it is a short period of time. but as we look forward, there are significant challenges. dr. amedeo said that the crop of doctors coming out have a different expectation level in terms of what they are going to be paid in their work hours. i think patient expectations continue to rise. at some point, something has got to get. i think that there are huge challenges ahead, but the

patient and doctors. ñi>> weñi are out of time. thank you for your time. you can go back into which you enjoy the most. [captioning performed by national c >> tonight, executives from the va hospital in arlington talk about hospital finances. we will share from the chief financial officer and chief information officer at 8:00 eastern time. examination of the]iññi american health-care sm for my hospital perspective. mar morning we will return to virginia hospital center for a conversation -- tomorrow morning we will return toçó virginia hospital uq'ter for a conversation with the chief nursing officer. ñr>> later this week, a review f the health-care debate in house andñiñi senatexdçóñrñr cod analysis from capitol hill reporters. rñif

health care systems from aroundf the world with former washington post reporter, t.r.çó reid. key resource. go on line, although the latest tweets video ads and lakes. -- and links. onxd>> chris van hollen held a n hall meeting in distressed it to discuss -- held a town hall meeting to discuss health care legislation. this was held in silver spring, md., just outside ofñi washingt, d.c. >> please be seated so we could start.

please turn off your cell phones. ñi >> my name is mary anne altman. we're very fortunate that we were able to have congressman dan hollen come up here today. i would like to introduce who is here. my vice chair is bill marks. [applause] on my left is senator teitelbaum. ñihank goldberg.

-- greenberg. of course our distinguished guests, chris van hollen. i would also like toñion# recoge çóñi=/%the officials that habeì+ here+çvñiñi today, senator mike here+çvñiñi today, senator mike ñ ñiñi. please stand up. [applause] delegate then three more. -- ben framer. jaytab sakosky. [applause] 10 richards for senator carden -- ken richards for senator carden.

[applause] congressman dan hollen was first s firstçó electedçó to congress in 2002. he serves onñrñi the health committee on ways and means and also on the committee on oversight and government reform. he has always enjoyed th i think weçóçóñr should give hia warm welcome. [applause] ñrthat is all i am going to sit because i want him to speak. think you. -- thank you. >> think you. it is wonderful to be back here. i have had the privilege of

being here on many occasions in the past, and have always found that community to be actively engaged in the public debate and closely following events and alwaysi]ñrçó taking jury responsibilities as=/% citizensn thisqññri] great democracy seri/ spíngagedxdñiññd in oneño' of tt important national debates we have had in a long time, which is on the question of health care and health insurance reform. i amñr veryçóç!eát(áq"okçó toñie delegationsok from 19 here. t(but think you all for joining. to mary anne altman, think you for joining us and organizing this. [applause] e

withñiñi my very dear friend and formerñi colleague in theñr mard stateñi senate, glenn teitelbau. thankñr youñi=/% for a disservio our state and country. senator tedçóçóñri]ñiçó kennedye he was absolutely passionate about pursuing the issues he cared about.