these strategies. we don't have these buses of principles waiting around. .

quacks' the timing of accountability judgments, when students are taking tests and how it affects our ability to track the student outcomes to teacher outcomes. we need to think about what those assessments look-alike. i keep hearing on the selection around dispositions and how you assess teachers abilities and believes that all kids can learn. they can fit with the school context. i want to raise those two issues. >> i am the director of the center you are in that howard and i welcome all of you here. i am also a three term pta president in prince george's county. my concern is that students are being taught to pass a test to evaluate the school. when you start talking about broad based learning and teachers who are traditionally teachers that teach by

tradition, they are not in a position to do that because they are teaching to the -- teaching to pass the test to evaluate the school. these are things i often pondered and i wish that you would consider this. onyx should be put it back into the schools. johnny -- phonics should be put back into the schools. that is an assessment from a mother and a pta president. >> i and the co-director for the center of law and education. i have a question. this has to do with the frame that i have heard here and elsewhere about increased accountability and increased autonomy and authority and the implications of that and whether, for those of you who say that, what that means in terms of the role of any

standards of practice or requirements, policy requirements for what schools need to do. 1 reading is that we should pretty much minimize or get rid of them all together and give autonomy and expect results. do you believe that or if not, what kinds of standards of practice, what kinds of requirements are helpful and in what way should they be used in relation to outcome measures? i think that question has implications about district and state capacity in terms of what they do. whether or not we do or don't have in place as a focus some standards and expectations as to what the schools need to do so we can help them.

>> we will accept that as a rhetorical question. >> it is not really. >> i am not sure we will be able to answer that today. since you said you had strong views, we welcome you sharing with us, either through some other mechanism and giving us your point of view on that question. thank you. >> i am with the foundation for excellence in education. i am the caboose. thank you for sticking around. thank you for letting a share a few remarks. i think we need a student center system. the students need to come first. their academic achievement needs to come first. i would like for you guys, if you get a chance, governor bush is hosting the action summit on october 8 and 9. i have pliers to any -- for anyone who is interested. we will talk about

accountability, data, charter schools. the florida an example might be helpful to you. the current nclb system has a pass-fail system. it has created confusion as to which schools may be failing and which schools many smaller interventions. florida is the only state in the nation the grade schools a-f. new york city provides a clear delineation of where the different public schools are doing in the state and florida provided considerable resources to the d and f by schools. we also had about her program that provided students to select a better-performing schools. we think that is a critical component. if the child is in a killing school, why make him stay there until the school district can figure out. -- if a child is failing in school, why make him stay there until the school district can figure it out? when it comes to determining

school grades, fla. focuses on the bottom 25% of students as the component of their school great. no child left behind focuses on different ethnic groups and gender. sometimes kids are lost in the shuttle because of the size of the particular state. if you focus on the bottom 25%, you'll capture the lowest performers. we will -- we would like to consider that as an option. we think the most logical measure for effective teachers is to look at the student achievement data of the students coming for their classroom. thank you very much. >> this concludes our public comment. i would like to acknowledge that another commissioner has joined us. mike johnston is the colorado state center and senior policy adviser at new leaders for the new schools. thank you for joining us. ladies and gentlemen, this concludes the program. let me make a few concluding remarks. the aspen institute commission

on no child left behind will continue. this series of public hearings will be around the country for the next few months. you will hear testimony from many people to gather information for our forthcoming report with updated recommendations for improving the lot. the topics will include a teacher and principal effective mass, accountability, data, and standards, improving our nation's high-school. you will receive information on the dates and locations of these events in the coming weeks. we look forward to continuing to work with leaders all over the nation to advance effective education reform to assure that all of our children, regardless of race, in come, of the zip code, have access to a first- rate education that can prepare them for responsible citizenship, higher education, and rewarding work. thank you all for being with us

today. this concludes our hearing. [applause] host: calle [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] [no audio] >> mid week in washington with congress due back from their august recess next tuesday, september 8. it was reported that house speaker nancy pelosi will let representative charlie rangel not report federal assets. democratic aides said its baker policy will not pressure mr.

riegle to resign his post or publicly censured him on less the house ethics committee sounds tip -- finds him guilty on ethics charges. later today on the c-span network, last sunday, japanese voters replaced the party that has been in power there since 1955. at a forum today, we will consider what the new majority government will mean for asia and the u.s.. it is a discussion moderated by cbs chief washington correspondent and "face the nation" kirk bob schieffer. a review of the health-care debate in congress later this week with highlights of house and senate committees and analysis from capitol hill reporters. on sunday, a comparison of health care systems from around the world with former washington post reporter tr reid. >> as the debate over health care continues, cspan's healthcare hub is a key

resource. you can go online and what's the latest events including town hall meetings and share your thoughts on the issue with your own citizen video, including video from any town hall meetings you have gone too. healthcare. >> pfizer will pay $2.3 billion to settle charges of promoting its drugs for uses not approved by the food and drug administration. here is more with justice department officials and health secretary kathleen sebelius. it is about 40 minutes. i oversee the litigation for the

u.s. across the country. i am honored to stand here today with dedicated colleagues from within the department of justice as well as beyonce to announce an historic settlement with pfizer inc.. it arises out of civil criminal allegations relate to pfizer's illegal promotion of the various drugs. in a combination, civil and criminal settlement, pfizer has agreed to pay $2.3 billion, the largest health-care fraud settlement in the history of the department of justice. within that $2.3 billion, is a criminal fine of $1.19 billion which makes it the largest criminal fine history. today's settlement is an example of the department's ongoing and intensive efforts to protect the public and recover funds for the federal treasury from those who seek to profit from property it shows one of the many ways that

the federal government can help the american public at a time when budgets are tight and health-care costs are increasing. before i turn this over to my colleagues, i want to highlight three things about what we are announcing today. first, combating health-care fraud is one of this administration's pop -- top law- enforcement priorities. every year, we lose billions of dollars to medicare and medicaid from abroad. those billions represent health care dollars that could be spent on madison, elder care, emergency room visits, or lowering the cost of care. instead, they are spent on medicines and devices that are simply not effective for the patients to whom they are prescribed or the result of a result of illegal kickbacks. when a drug is marketed or promoted for non-authorized

uses, and the use not approved by the fda, as was the case here, public health may be at risk and there is a real danger for patience that the medical providers who prescribe the medicine or the device are not provided or do not have full information about the drug risks and benefits. because health care fraud is such a significant problem that affects safety as well as the federal treasury, the department justice and the department of health and human services recently reinvigorated our long- term partnership by launching the health care enforcement action team heat > this task force is led by people at the topmost level of both departments. we have already worked to increase coordination, intelligence data sharing, as well as to secure indictments against dozens of defendants which we have announced on a regular basis. second, today's announcement reflects the department of justice working hard to protect

the federal treasury and protect american taxpayers. while most medical and pharmaceutical providers want to do the right things, when they cause claims to be submitted to medicare and medicaid, that is real doubt dollars out of the taxpayers' pockets because it affects the federal treasury. enforcement for the false claims act as the primary means with which we address this. in this fiscal year, 2009, before the settlement today, the department had recovered $1.57 billion in settlement judgments under the false claims act. as a direct result of that, we recovered and additional $473 billion to state medicaid programs for a total impact, before today, of $2 billion. the settlement today which matches the $1 billion civil settlement increases with the $1.19 billion criminal fine as well as $105 million criminal forfeiture, brings us to $3

billion this year. the third thing i want to highlight is that this settlement is a testament to this department of justice's approach to law enforcement which is all about a broad, court made effort among federal agencies and with our state and local partners. the efforts here and with the people who work part in this case who are in the room today is reflects coordination, cooperation between the civil division, the u.s. attorney's office, the district of massachusetts, the eastern district of kentucky and others. all of them played incredible important roles. it also includes the investigative efforts of investigative agencies across the federal government, including the office of the inspector general, the fbi, the defense office and others.

that list demonstrates broad reach of health-care fraud as a cut across many federal programs as well as state programs and the importance of strong enforcement. from the attorney general on down, we know that we can do amazing things like recovery $2.3 billion in federal and state treasuries we partner side by side with our sister federal agencies, attorney general offices, and the public. we are deeply committed to working together with federal, state, local, and travel partners on numerous issues with health care fraud at the top of the list. the press release will talk in more detail about many of the people who have been involved in the settlement in particular, i want to know the critical

commitment of secretary kathleen sebelius and her team at hhs and their focus on stopping health care fraud in its tracks. with that, i want to introduce the secretary for the department of health and human services, kathleen sebelius. >> thank you. you are going to only hear from five of us this morning because if you heard from everyone who helped with this investigation, many of whom were in the room, this may take all that. we want to represent the good work that was done by agencies across the government. this was a team effort. the to part of justice, the fbi, and other groups were involved with this extraordinary work. at the part of health and human services, we are charged with keeping americans held the and

making sure they get the best care possible. that means part of the responsibility is spending health care dollars wisely. it also means stop the danger is, off-label use of some prescription drugs. a critical part of the mission is fighting fraud. that is a job our entire department takes seriously which you saw in this case. the office of inspector general in this department and dan levinson is here on the stage with me this morning. he spent four years in the conduct of this investigation. they did not just implicate pfizer. it actually identified and charged the senior managers who were responsible for the fraud. some of those agents are here today. i would like to acknowledge them along with damp levenson who has been a tremendous leader of this office. with the leaders -- come on, i can see you. congratulations.

the investigators from the food and drug administration also helped put this case together. americans have tremendous confidence in the medicines they take. that is a tribute to the great work the fda does each and every day. thanks to the attorneys from the fda, the centers for medicare and medicaid services, and the ig office, we now have a safer drug supply available to the american public. this event marks the conclusion of just one investigation. it is another step in the administration's ongoing campaign to prosecute any individual or organization who tries to ruboff health-care consumers and the federal government. you've already heard the associate attorney general perrelli in may and attorney general are colder and myself were here for the health care

initiative, heat. our investigation in houston led to the arrest of 32 doctors and health care executives in four cities for treating medicare of $60 million. the ongoing work of the heat task force can be monitored at the website which is www stop medicare fraud.gov. as you hear from other speakers this morning, you will see that this settlement is historic, not only because it is the most money taxpayers have ever recover from a drug company but also because it includes the most comprehensive corporate integrity agreement that a drug company has ever signed in the united states. the agreement requires that pfizer's audit committee conducts annual reviews of the company's compliance program. the senior executives have to annually certified that pfizer

insists that doctor's complete paperwork to assure that pfizer is doing the right thing. this is the first time ever that a drug company has agreed to look at the risks associated with marketing on its own and develop a plan to deal with those risks. we are going to continue to closely monitor pfizer's performance. these steps reflect the obama administration's dual focus on prosecuting and preventing health care fraud but we don't want to just catch crooks, we want to stop them before they strike. whether it is by coming up with new ways to track medicare claims or prosecutions like this one that make companies think twice before bending the rules. to just give you one additional example, on monday, the centers for medicare and medicaid services announced for the first time they are creating a national database to track our efforts to crack down on medicare fraud. the data base will help us

identify where we are doing well and where we could do better. also where to find the best practices to improve our results. we know the stakes are extremely high. when companies or individuals defraud medicare, medicaid, they are not just dealing from taxpayers, they are also jeopardize in long-term finances of some of our most important government programs. in some cases, america's health stuffers also. on necessary or dangerous procedures to not just cost dollars, they can cost lives. we are working aggressively in this agency to make sure that americans get the care they need and that the dollars are well-spent. like the rest of our partners here today, the department of health and human services are committed to doing everything we can to keep the americans and their health care say and i look forward to continuing to work with this extraordinary team in the months ahead to do just that. of like to turn things over to tony west, the assistant

attorney general for the civil division. >> thank you, secretary sibelius. thank you for your leadership on this issue. my name is tony west and i am the assistant attorney general for the civil division at the department justice. today's announcement represents the largest criminal and civil settlement of a health care fraud case in u.s. history. this landmark, $2.3 billion settlement with pfizer and its subsidiary farmacia, is important not only because it includes a record amount of money in criminal fines and forfeiture and not just because pfizer has agreed to pay $1 billion to resolve serious fraud allegations, including over $300 million paid to the states, this case is important because of what it says about the u.s. government's coordinated efforts to combat health care fraud and

what those efforts mean to millions of americans who rely on the integrity of programs like medicare and medicaid for the health care they need. today's settlement to demonstrates that health care fraud is a priority, a top priority for the civil division and this department of justice. when it comes to marketing drugs that so many of us rely on, we will expect companies to be honest about the claims they make about the drugs they sell. this civil settlement and plea agreement represents another example of what penalties will be faced when pharmaceutical company put profits ahead of patients' health. illegal conduct and froglike the allegations in this case, puts the public health at risk, perhaps medical decisions by health-care providers, and costs the government billions of dollars. it is not just the government who pays more.

when health care fraud occurs, that drives the cost of health care up for all of us. consumers pay higher premiums. companies pay more to cover their employees. every medicare and medicaid dollar lost to fraud means that your children will see doctors for preventable childhood diseases. more seniors will be faced with the stark choice between food or medicine. fewer people will get the health care they need to dramatically improve the quality of their lives. that is why settlements like today's are so important. not only do they protect consumers, they also bring money lost to fraud back to public health programs, especially medicare and medicaid. today's settlement was made possible by two things -- tough enforcement tools and terrific teamwork. first the tools -- the department justice has strong enforcement tools that help us

work every day to ensure that taxpayers are protected from fraud. on the civil side, we used the false claims act which has allowed the civil division to recover over $14 billion from fraud against health care programs since 1986. pfizer has agreed to pay over the $650 million to resolve allegations of the false claims act that the company illegally promoted four drugs using false and unsubstantiated claims regarding their safety and effectiveness. it caused federal health-care programs to pay millions of dollars for prescriptions that were not for medically accepted uses. in addition, the investigation of pfizer began in 2003 with a whistle-blower who filed a key action in the false claims act demonstrated the importance of the key tempered visions and

exposing fraud in government programs. we also use the anti-kickback program to put an end to the practice of paying kickbacks to health-care providers to induce them to prescribe many of the pfizer's own drugs. patients must have confidence that their doctors are giving them the best medicines for the right reasons. on the criminal side, the civil division's office of consumer litigation use the food, drug, and cosmetic act, which requires the company specify the intended uses of the product in its new drug application to the fda. once a drug is approved for an intended use, it may not be marketed were promoted for off- label uses. that is, a use that is not specified in the application approved by the fda. in this case, pfizer asked the fda if it could promote the sale of bextra, an anti-inflammatory

drug for other uses in doses higher than the maximum for the fda said no. pfizer marketed the drug for those unapproved uses anyway. when off-label marketing like this occurs, patients' health and lives are put at risk and those who cause that risk must be held accountable. second, the teamwork -- without working together across agencies and state lines, this settlement would not have been possible for the partnership that has developed among the various agencies, the u.s. attorneys and the numerous law enforcement officials as recently led to several substantial health care fraud enforcement actions, prosecution, and recovery. i want to thank our law enforcement partners for their continued commitment to ensuring the integrity of our public health care programs and i am proud to stand with them here today. it is my pleasure to introduce to you the acting united states

attorney for the district of massachusetts, michael louts. >> i want to thank you for the opportunity for commenting on the settlement today's resolution addresses criminal activity within pfizer's farmacia division. like every drug, before they could block -- legally sell the drug, approval had the uptake. there's no such big as a general approval for a drug-free fda approval is indication-specific produce cannot secure approval for a drug for treatment one problem, such as a cure for the measles, and then market and sell the drug for another problem. any indication not on the label is not approved for the drug. it is a violation of the law. the fda approved bextra in 2001

in specific doses for treatment of symptoms of osteoarthritis and adult rheumatoid arthritis and for the treatment of primary dysmenaria. the fda did not approve all the dosages and uses. why not? as the fda told pfizer, it was concerned about the safety of the drug. the fda had noted that the drug caused an access of serious cardio problems. despite the fda decision, but pfizer marketing the same position the drug for all manner of acute pain as a complement to be c pfizer toelebrex. the pfizer marketing machine push this combination from 2002 through 2005. the marketing machine also pushed the drug for other uses. among other things, pfizer invited doctors to consult, many

in resort locations. their attendance -- their expenses were paid and there were entertained with golf, massages and other activities. their job was to help pfizer the crowd how best to promote the drug for the off-label indications. the pfizer sales force claimed that the drug was a period when pfizer had not conducted any head-to-head studies between the two drugs. they had no clinical evidence that the drug was superior. claims of superiority was not supported by the label. pfizer utilize continuing medical education events to propose -- promotes off-label prescriptions. the use the publication strategy to initiate funds and draft articles touting the drugs for unapproved uses. it is for this conduct that pfizer will pay the largest rebel punishment ever in health care fraud case history.

among the factors we considered in calibrating the severe punishment was sponsored's recidivism. this was the fourth settlement this decade for five separate in 2002, pfizer paid $49 million to resolve allegations that have failed to report drug prices for its drug lipitor. in may, 2004, they paid $340 million for the off-label promotion of another drug. in april, 2007, pfizer's division pled guilty and entered into a deferred prosecution agreement for payment of kickbacks for off-label promotion spread pfizer paid $30.7 million. my office handled by last two cases and during the 2003-2004 negotiations, pfizer management

asserted that the company understood the rules and had taken steps to ensure corporate compliance with all law. many of us involved with today's resolution were involved in those negotiations and we remember these promises. little did we know, when we struck our border with pfizer in 2004, that other parts of basra were violating those very same laws for other drugs and continue to do so. unfortunately, they're not the only drug company that has participated in health care fraud. a dozen years ago, prosecutors in boston, philadelphia and elsewhere began criminal investigations of major companies in the drug industry. the first major settlement of these investigations was in 2001. there have since then been 42 other major criminal and civil resolutions against the nation's drug companies. the settlement today of $2.3 billion means that in this

decade, the drug industry has paid to the federal government $11.7 billion, $2.98 billion for criminal fines. i like to commend the amazing work by the government team. these cases require enormous commitment above and beyond the call of duty. they worked incredibly hard. they take many years of effort. at times, you think you'll never see the light at the end of the tunnel. moreover, the folks on the other side have more of everything, more money, more resources, more lawyers, more paralegals. we cannot praise and thank everyone. if you are here, look behind you, much of the team is here. that will give you a sense of the scope of the people involved. today's result is a testament to the hard work and dedication of the two lead prosecutors in my office. they picked up the case in 2004

after the work on the previous matter had ended. if there are two extraordinarily excellent supervisors, we have them. this case cannot be done without effective collaboration. this includes the commercial litigation branch and the office of consumer litigation and all the various law enforcement agencies. the extensive federal team was ably assisted by an energetic team of state prosecutors, spearheaded by a team of assistant attorneys general in massachusetts, oregon, and ohio. we work seamlessly with the united states attorney's office and the eastern district of pennsylvania and eastern district of kentucky. their assistance was crucial. we have collaborate closely in the past with those offices. we did so here. we share a common goal, a goleta share with everyone work on this, and that is to ensure that the rules are followed and the public money is protected from

fraud. those who would cheat on a broad scale across the united states would do well to take notice of our close collaboration. while this case represents an extraordinary accomplishment, our work to protect citizens continues. thank you. >> thank you, mike. good morning, everyone. i am kevin perkins, as you have heard from our partners in this investigation, the settlement today is monumental. is much more than a large health-care fraud settlement in history. hopefully, it sends a clear message that the fbi and our partners will not stand by and let any manufacturer peddle their prescriptions or products for uses beyond their intended federal government approved purpose. under the provisions of the food drug and cosmetic act, the company must specify intended

uses of its product to the fda. once approved, the drug may not be marketed or promoted for any so-called off-label uses. any use of specified in the application which was approved by the fda. pfizer and its subsidiary intended to circumvent specific fda directives concerning their drugs by using itself forced to aggressively promote off-label uses. to date, we have interviewed numerous positions, sales reps on this, and managers who have cooperated these assertions. we would not be here in this investigation and so on if it weren't for the ethics, professionalism, and courage of a few company employees. these employees were willing to step up and speak out against a corporate giant that was blatantly violating a law and misleading the public to false marketing plans and providing incentives to health-care providers to help them prescribe certain drugs.

i also want to thank the hard work and dedication of the fbi investigators and analysts who worked as tirelessly. in addition to our federal state and law enforcement partners to cooperate in this investigation. these types investigations are often long and complicated and require many resources to achieve positive results, the fbi will not be deterred from protecting the american public to continue to insure that pharmaceutical companies conduct business i lawful manner. thank you very much. >> thanks very much to everybody. we will take a few questions. >> you make very clear how pfizer violative pilaf. -- pfizer violated the law. did their conduct actually are many patients? >> whether or not a patient was armed was not the focus of the investigation.

>> why is spicer -- is there a concern that pfizer could be affected of selling the medication? why is and pfizer pleading guilty? >> the pharmacy a division is the one that had the nda for the drug. they struck a marketing arrangement with pfizer before the division was acquired. in many respects, while the marketing chief for pfizer was the one who took over and pushed this, in many respects, the pharmacy decision -- division was logical division of choice. we look at it this way -- if we exclude an entity, the entity is done. it has to sell it can to other

companies for those assets include the assets like the drugs and employees who marketed and sold them. there is no opportunity in that of fans for -- in that event of a continuing corporate continuity. we think that the better choice here is to have a plea that allows us to have a strong, infected corporate integrity with the surviving entity. >> you talk about -- the talk about being a recidivist company. you identified senior managers. why are there no charges against them? >> there were two convictions arising out of desperate that it has actually occurred. >> can you talk a little more about the marketing machine and

how they interacted with doctors? did they create phony prescriptions? they are playing doctor at the same time as marketing? >> we have the inspector general of the department of health and human services who can answer some of these questions. >> i would not say that they played doctor. i would say that the sales force that pfizer was effective at getting doctors to adopt things that were beneficial to the drug bextra. >> is there any other executives that you will be talking to about past criminal charges or is this investigation

done? >> discloses this investigation. -- this investigation is closed. >> what about the ceo of pfizer? did he know? >> this brings this investigation to a close. >> was there must discussion about the subsidiary of pfizer or pfizer being disbarred? >> i am damned levenson, the inspector general for the department. i would like to thank the secretary for her tremendous support and her leadership over these last few months as we have successfully concluded what is a more than four-year investigation done by many of our great government partners. i want to single out our boston regional office, our special license did on extraordinary job over the course of more than four years in bringing this case to a successful conclusion the

corporate integrity agreement that is part of the settlement that goes forward five years, is an unprecedented cia in terms of its provisions and its reach. the secretary outlined some of the broad features of the cia. i want to underscore that for the first time and we have been doing these agreements at the department for a number of years, this is really reaching into new territory. pfizer will be under obligation to proactively identify potential risks associated with the promotion of individual products. they have to implement plans to mitigate risks. we have internal and an external compliance requirements as well as a very robust plan going forward to avoid this kind of conduct from happening again. >> could that will be employed

if they violate the cia? >> it could be employed. it is important to understand that this settlement is for the benefit of american tax payers to return significant dollars that were spent on the programs. it is also for the protection of our beneficiaries who count on drug pipelines from a variety of manufacturers including this one for it is important to understand both cost and benefit as we proceed in putting together a court integrity agreement that is strong, that will avoid the kind of bad behavior that we have seen in the past, and that serves the benefit of taxpayers and beneficiaries. >> is compliance included in the cia itself? >> yes they are. there appear range from fines to

potential debarment. >> can you comment on the $102 million that will be paid? >> there is $102 million to be paid to whistle-blowers. for more information on how it is divided -- if you want to talk about key tamper cases -- be quacks like many of the health- care fraud cases that we do, this began with a key tam action. there are several real lawyers who will be getting some of the share of the settlement. depending upon, i think there were 11 key tam actions that were implicated by the settlement in various parts of the country.

>> there has been complaints that the key tam relators were not hearing from justice without hearing whether you would intervene. they say -- are you bring more resources to these key tam cases? >> the majority of health care fraud cases that we do at the department of justice begin with key tam actions. that is an important provision of the false claims act. is an important resource -- it is an important resource and something we will continue to do. >> all these are employees? >> i don't know the answer to that. >> were they all company employees? >> we will try to get that answer for you?

>> how are americans supposed to trust this company moving forward? >> as the inspector general disgust, we have a path- breaking corporate integrity agreement which will be the foundation for ensuring that we can have confidence in the future. it will require an enormous amount of monitoring by the government and the inspector general's office. they will be spending a lot of time working with pfizer to make sure they comply. we will continue to rely on the tools we have. there is a question about focus on enforcement. from attorney general holder on down, health care fraud is a very significant priority. we're putting a very significant resources on it to ensure that we can recover funds in the health-care area as well as the

broader health areas wherever we can. >> can you name any other drug companies that are being investigated? >> we cannot comment on any ongoing investigations. >> are there and a doctor is being indicted as part of this investigation? >> the focus of the investigation has been on pfizer and particular individuals within the company. >> the settlement was done during the bush administration? explain why you're having such a high-level announcement which never happened in the bush administration. does this signify your commitment to this area? >> there is no question that there is a significant department commitment. it is not surprising that the department of health and human services would have -- would use this opportunity to promote the largest settlement in history.

this is a very significant day in our efforts. it is part of a longer effort where we have tried to reinvigorate our efforts. they have -- there has been worked on over the last four years. this is part of our broader commitment. >> you have all talked about how difficult this case was to build. can you give us an idea of how you build it? mr. perkins, you said your agents interviewed some of the positions that went to these meetings. what other kind of work did you do? >> it was basic investigative work. significant record review, significant interviews, and piecing it together. we traced the flow of funds and looked at the statues. it did not differ from an the other kind of health care fraud investigation other than the size and scope. we also work very closely with

the folks at health and human services in investigative teams. we interviewed physicians, we interviewed health care providers, we interviewed people who corroborated on the allegations. we gather the evidence needed and gathered the financial records and gather the corporate documents and it was a slow trudge through the process. we are willing to continue with the resource commitment because of the outcomes we received and achieve here, not only in the ponds and the convictions but also in the protection of the american public. >> some of the behavior that you described in this case such as paying doctors to appear at training seminars happen all the time. the inspector general had laid out maybe three years ago behavior is that they thought might cross the line. are you setting a new standard of behavior is that you think

are crossing the line? >> i don't think we're setting a new standard on that. i defer to the inspector general or the u.s. attorney. i think what we are doing is we look at each and every one of these and we know when they cross line and when they don't. those to be specific individual matters we would deal with. as far as setting a new standard, no, that is not what is happening. >> one reason why this is a very significant recovery is you have a combination of several things coming together including whether it is the payment of doctors to actually work together to prescribe things off-label for a use that was identified at the time.

the drug has been off the market since 2005. thank you, everybody. thanks to the entire team, many of whom are in the room, for your tremendous work. thank you. host[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> this past sunday, japanese voters replaced the party that has held nearly continuous power since 1955. a form today considers what the new majority government will mean for asia and the u.s. it is moderated by bob schieffer, we will have live coverage at 5:30, eastern here on c-span. later this week, a review of the health-care debate in congress with highlights from house and

senate committees and analysis from capitol hill reporters. on sunday, a comparison of health care systems from around the world with former washington post reporter t r reaed. >> go online and fall latest information on the health-care debate. what's the latest events, including town hall meetings and share your thoughts on the issue with your own citizen video, including video from any town hall meetings you have gone too. c-span.org/healthcare. >> from a conference on historic black colleges and universities, opportunities in employment with cia director leon pieta -- leon panetta. >>

it's always alcorn. i am pleased to be joined on this panel today by two very distinguished senior officials of the federal government, the chief of naval research and a director at the central intelligence agency, the cia. i will introduce them momentarily. we also have the pleasure of two other distinguished gentleman on the panel with us today, our executive director of the white

house initiatives, dr. john wilson jr.. [applause] and dr. johnny houston, the senior researcher at elizabeth state university. [applause] black colleges and universities have worked to link their students and programs to the intelligence field, science, technology, and academic research. from concepts as seemingly esoteric as insurgency modeling to applications as seemingly mundane as cleaning products, technology transfers among the u.s. governmental agencies, corporations, hbcus and other academic institutions are

impacting our national security and affecting our daily lives. there is a great deal of talent on the campuses of our 105 institutions. programs at the office of naval research and the central intelligence agency will allow these two government agencies to tap into that talent. by tapping into the innovative ideas and research that is being carried out at hbcus across the country. today, we will explore how hbcuis can build capacity and partnerships by jointly collaborating with the office of naval research and the central intelligence agency. as we see is the capacity to ride in the areas of intelligence, science, and technology, perhaps, and even more importantly, we explore a way forward that helps our students and graduates

understand how science and technology will affect their success in their personal and professional lives. between 1946 and the founding of the national science foundation in 1950, the office of naval research was the federal government boss only agency whose principal mission was to support basic research. over the past 63 years, the office of naval research has evolved into a more diversified agency. today, they are responsible for basic and applied research and technology development as a court mates, executes, and promotes the science and technology programs of the united states navy and marine corps. these programs produce research and technology portfolios to serve several constituencies, the united states congress, the

fleet, the force, industry, and universities. today, we are privileged to have, as are for speaker, the director of naval research. he is rear admiral nevin carr. admiral car is a career navy veteran. he started when he was 17 years old and i did not ask how old he is now. [laughter] but admiral karl spent his naval career at city in cruisers and destroyers deploying to the mediterranean sea, the black sea, the indian ocean, the persian gulf, north and south atlantic, the south pacific, the baltic, caribbean, and red seas. he served on the u.s.s. king, the u.s.s. mccandless, the u.s.s. dwight d. eisenhower's among others. he commanded the uss ealry bird,

winning in two tours. while in command of cape st. george, the ship52q participatig combat operations in support of combat -- iraqi freedom. apple cart has served in the office of secretary of defense where he worked on the various ships. he worked on several ballistic missile defense programs. he later served in the office of the chief of naval operations as requirements officer. he was executive assistant to the commander u.s. fleet forces command. following promotion to flag rank in 2006, he was assigned as deputy director of surface warfare for combat systems and weapons and later, as deputy assistant secretary of the navy, and director of

international programs office. he completed his education by earning a b.a. from the united states naval academy. he and i gave each other a high five talking about maybe an army football. i was at an institution and rooted for army and we have no bonded. [laughter] he received his master of science degree in operations research from the naval postgraduate school and completed the advanced management program at harvard business school. .

>> to say a few words about the critical role of science and technology in our future, and the key role played by the historic the black colleges and universities in the success of that future. the 105 voices of history many of you heard on sunday are also the voices of america's future. [applause] that future depends on our ability to compete in the global marketplace, especially in science and technology. i would like to touch on who we are and what we do at the office of naval research, highlight our association with hbcu's and talk about what the future demands that each of us. the theme of this conference is seizing the capacity to thrive. i appreciate its meaning. in the military we talk about

capability versus capacity. to us, capability means we have the wherewithal to accomplish a mission. it implies we have a ship or an aircraft to do a particular job and capacity means we have enough of it to do the entire mission. clearly america has talent or capability. out there in the many young minds to will run this country. what is not so clear is that a sufficient number of those mines will enter the challenging fields that drive science and technology. especially as the contours of our population continue to of all, we need to make sure we empower every inch of it to build the capacity to succeed. i mean numbers of graduates, members of professionals, numbers of teachers and

scientists. i spent about 35 years in the navy so far with about 20 of those at sea. it was a privilege and joy to commit two warships. i learned to appreciate -- the joy to command two warships. i learned how to expect a message from every member of the crew. command of a ship is more about command of hemans than it is of machines, -- command of humans, but it only works if everybody contributes. as the chief of naval research, i oversee an organization loaded with talent, bright program managers, brilliant researchers and people with a can-do attitude. they are the secret sauce behind the success of the navy. our history began with the establishment of the naval research lab in 1923.

across the river in maryland. the overarching office was created after world war ii around 1946. to build a link between the field of science and fighting needs of our sailors and marines. they have given us a gps, radar, the country's first intelligent satellite cut nuclear-powered ships, and synthetic lubricants great the old as man-made object in space was built right over there along the river at the naval research lab. they did their job well in the early days of the space program. they were pulled out to form a small organization called nasa. we have supported 56 nobel laureates.

we assist to provide advances were used on the battlefield, but many have applications for everyday life. one example is the new acoustic technology that was developed to track submarines and is used to detect early breast cancer. we work through over one dozen universities, non-profit organizations, -- over 1000 universities, at 3000 graduate students across all 50 states and in seven countries. we have offices in london, singapore, and tokyo to help innovation and avoid technological surprise. most recently we were ranked by several national magazines as the best place to work in the navy and performance-based rewards and advancement, and was

named by the most bridget was named the most admired employer. -- was named the most admired employer. this includes people from jackson state, north carolina, south carolina state and alabama state. we draw from the best to provide the best. we embrace the chief of naval operations philosophy that our navy must reflect the face of our nation. the relationships began in 1985 with funding for research. in 1989 a program was established supporting students at five schools. in 1992, that increased to 6 million and rose to 10 million in 1994. through 2004, programs at 22 hs bcu provided support for over 1100 students annually.

90% of those credit on time with undergraduate degrees, 80% of them went to our master's degrees. our programs include the summer faculty research program, the research partnership program, all dedicated towards increasing participation in disciplines related to the navy. the research and education partnership program is designed to improve research and disciplines important to the navy. it exposes students to engineering and science careers through summer internships at navy labs. the future faculty fellowship program helps develop engineering faculty for hbcu's.

people are slated for a study and serve on the engineering faculty. since 1992, this program produced 44 phd is. it also encouraged -- produced 44 phd's. finally, we are developing programs that encourage our government in the arts centers to partner with hbcu's to take advantage of the programs out there. it is not an easy field to navigate through. one quick success story, onr mechanics program sponsors research and three universities. the common theme is basic research on marine composite materials. at north carolina, anybody from

north carolina? [laughter] your team, led by one professor, is examining the use of composite materials for a submarine applications. they developed a fire resistant material with attractive properties. this material has been evaluated by n.c. and the naval research center for possible use in [unintelligible] which is an especially bad thing in a submerged submarine. in 2008, we ordered all lost $6 million of hbcu's. we provided 24 undergraduate scholarships. there are other navy programs, i just selectees' as examples. we do this because we need to -- i just selected these as

examples. on to the future. what is our interest -- and where are some of the ideas for tomorrow? came changing areas include power and energy, information sciences, speed of light weapons and human performance. we are sponsoring research in the fuel cells for long in durrance vehicles, rechargeable batteries -- for longer endurance vehicles. it is focused on human robotic interactions for adaptable systems. try saying that 10 times fast. information science is looking at quality of computing, a new communication architecture and weapons development, the electron program will produce [unintelligible] much of this work is done in

newport news at the jefferson led close to hampton university. human performance programs range from molecular biology to advanced medical -- it is about discoveries in the relationships, shifting demographics in the u.s. mean we must focus our attention in reaching a to diverse communities. the demographic chanctrends are- established. in order to maintain the health of the work force, we must continue to engage every bright mind to have the capability to help us and then the future. no segment of any population has and of the death to provide the capacity that our country needs -- nel population has enough depth or capacity that our country needs.

we need to convert the capability to capacity by attracting the best and brightest to follow careers in science and engineering. with a rich tradition and deeply rooted patriotism, these universities will play an important role in educating mines that will bring that future. the impact of you in this room cannot be understated. thanks for what you do. i look forward to working with you in the future. thank you. [applause] >> thank you admiral carr. we salute you for what you do for our country in your 35 years of service.

thank you. [applause] this morning our executive director gave us three charges. the third one was to discover, to identify and eliminate best research in the best brain power. admiral carr talked about some of that already in the 25-year relationship yearonr. i encourage all of us -- the 25- year relationship with onr. we need to increase those partnerships with the office of naval research. in 1947, president truman signed the national security act creating the central intelligence agency. it also created a director of intelligence.

the director is the principal adviser to the president for intelligence matters related to national security. today, as the agency responsible for providing global intelligence on the ever- changing political, social, economic, technological and military environment, the cia accomplishes this their research, development and deployment of high leverage intelligence gathering technology. creating a special centers to address such high priority issues as non-proliferation, counter-terrorism, counterintelligence, or national -- organized crime, and on intelligence. the cia forges strong partnerships between several collection agencies and takes an active role in the overall intelligence community.

today we have with us the director of the central intelligence agency. leon panetta became the 19th director of the cia on the 13th of february of this year. as director, the management -- it manages open source collection programs on behalf of the intelligence community. he has dedicated much of his life to public service. before joining the cia he spent 10 years could directing with his wife the institute for public policy -- he co-directed with his wife the institute for public policy. it is a not-for-profit center that seeks to instill in young people the virtues of public service. in march 2006, he was chosen as a member of the iraq he study group, a bipartisan committee

established at the urging of congress to conduct an assessment of the war in iraq. from july 1994 to january 1997, he served as chief of staff for president clinton. prior to that he was director of the office of management and budget, a position that build on his years of work in the house budget committee. he represented california's 16th district from 1977 to 1993, rising to committee chairman during his final four years. early in his career he served as a legislative assistant to a senator from california, special assistant to the secretary of education and welfare, director of the u.s. office of civil rights and executive assistant to john lindsay of new york.

he served as an army intelligence officer until 1966, and received the army commendation medal. he was not here when we talked about the football game, so i will not tell him. he holds a bachelor of arts degree in political science and law degree from santa clara university. he was born in monterey where his italian immigrant parents operated a restaurant. they later purchased a farm, a place where they continue to call home. they have three grown sons and five grandchildren. ladies and gentlemen, please join me in a welcoming director of the cia, leon panetta. [applause]

>> thank you very much. i would also like to thank secretary duncan, as well as dr. wilson for inviting me here to share some thoughts with you. it is a pleasure to be here. more importantly, it is an honor for me because several reasons. number one, your mission, which in many ways reflects the spirit of our democracy. because of the work that you have done to promote equal educational opportunity, a mission that goes to the heart of what america is all about, and because of my own history which in many ways tracks with your struggle for equal opportunity for all.

work at the white house initiative on historically black colleges and universities is in the finest tradition of what our nation is all about. it is about helping americans realize the dream of giving our children a better life. above all, that means access to higher education. higher education is the key to being able to achieve a better life. i know this from my own experience, as was mentioned in the introduction, i am the son of italian immigrants. my brother and i were the first in our family to go to college and to university. as the son of immigrants, the values i talked about in terms

of achieving a better life were what i believed in and what my parents made sure that we understood was the reason that we were to be educated and to be able to achieve that opportunity that this country is all about. i remember asking my father, why would you travel more than 3,000 miles to a strange land, no money, no speaking ability, very few skills? yes, they live in a poor area of italy but at least they had the comfort of family. what would you leave that to come to a strange country? my father said that the reason we did it is because your mother and i believed we could give our children a better life.

i believe giving our children a better life is the american dream. it is what this country is all about. in line with them is the importance of recognizing that as we give our children a better life, they have a responsibility to give something back to this country as well. my parents also constantly and the size -- constantly emp hasized the importance of getting back to this country is some measure of duty and responsibility in return for the opportunity my parents got in order to be able to achieve some degree of equal opportunity. so public service has been part of my bloodstream for a long time. you have heard my resume

beginning from being an intelligence officer in the army for being cheap of staff to the president of nine -- for being chief of staff for the president of the united states. all that public service has been because i truly believe that it is important to give something back to this country that gave my parents and my brother and i and the opportunity to succeed. my career tracks the struggle that you have been involved in in achieving equal education. early in the 1970's, i served as director of the u.s. office for civil rights. my responsibility was to promote equal educational opportunity. the primary responsibility we

had at that time was to break down the dual school system and desegregate schools that had been divided by law between black and white children, and to try to ensure that school districts were complying with brown versus the board of education and with civil rights laws. having worked on civil rights laws when i was a legislative assistant in congress i believed it was my responsibility in that job to enforce the law and the constitution but when duty to the law conflict with the politics of the time i decided that duty was more important. i have never regretted that decision. in the 1980's when i returned as a member of congress, i had the opportunity to work on funding

for black colleges and universities, worked with members of the black caucus, to ensure we would be able to provide funding. in the 1990's and i was honored to be a part of the white house initiative on historically black colleges and universities. early in his term, president clinton signed an executive order that a signed omb with oversight of the initiatives annual federal plan for assistance. as director of the time and later as white house chief of staff, i was proud to play a role in helping to strengthen your great schools. for 130 years you have been an invaluable asset for african americans and an irreplaceable source of talent and energy for

america. as different communities have become part of our social fabric, our country has become even stronger. with a dynamic vitality that nobody else can match, diversity along with freedom and the rule of law is at the heart of what makes america great. as cia director, i can tell you there is probably no other organization that stands to benefit as much from diversity. recruiting and developing a diverse work force is crucial to the cia for several reasons. first, this nation was founded on the principle that we are all created equal.

it is a fundamental principle that says america is going to ensure that all of us, regardless of our race, sexual orientation, whether we are disabled, regardless of what god we believe and, will have the opportunity to succeed. -- regardless of what got we believe in. its citizens want to serve his or or her country in the field of intelligence, it is wrong to let this issue is stand in the way of success. the other reason is equally important, because diversity helps us do a better job of keeping this country safe. good intelligence will choirs

officers from diverse backgrounds -- requires officers from diverse backgrounds who have different approaches to problems we face, who bring a wide , array of ways to solve problems. i would like to underscore how important diversity is to the cia by talking about our mission. our first responsibility at the cia is to protect the safety of this nation. today and tomorrow -- we are a nation at war. we are confronting a war in afghanistan, a war in iraq. we are confronting al qaeda and

other terrorists in pakistan who threaten our homeland in the paratroops -- and our troops. we are confronting the challenge of nuclear proliferation in countries like north korea and iran. we are confronting a whole new challenge of something called cyber security, which has the potential to bring down our markets, bring down our power grid system, bring down our water systems and cripple this country. and we are confronting the challenge of instability in the middle east, africa, latin america and southeast asia, and places like yemen and somalia.

the cia has to be an intelligence organization that understands what our adversaries are thinking. what are they doing? what are their secrets? what are their strategy's thanks what do they intend to do it -- what are their strategies? what do they intend to do that will hurt our goal of seeking peace in the world? we have to understand those dangers, those opportunities. as america faces a world that confronts a number of challenges to our safety. this is not about the past, this is about the present and the future. when president obama offered me this job he told me to call him

-- called them the way i see them. i told him that i will tell him the truth. oftentimes i will tell him things -- [applause] oftentimes i will have to tell him things he would not like to hear. but as director of cia my responsibility is to present him the best intelligence that we have, not because it is politically right or what he wants to hear, but because it is the truth. so what i emphasize with every cia officer is that our responsibility to the president and the leaders of this country is nothing less than providing

the truth. our mission requires highly- skilled people from many different fields and many different disciplines. the work of all of these officers who work at the cia, case officers, analysts, people who work in science and technology, people who provide support for our mission, it goes to the core of what we do as an agency. these are people who put their lives on the line every day. i wish i could take all of you to our stations throughout the world so that you could see the work of our case officers on a daily basis, men and women cannot sun international

clandestine service who are trying to see -- some who are in our national clandestine service who are trying to get people to spy for the u.s. to determine what is going on in other countries. what are they thinking? to try to develop a collection of intelligence so that we know what is happening, that are engaged in operations. some of those operations are incredible in what they do to save lives. our analysts, people who take that intelligence and try to determine what does it mean to write finished reports that try to say to the president and leaders why is this intelligence important? what does it mean in terms of our security? they are subject experts, that they are inclusive by nature and they are well-versed in the

analytics tradecraft. that is the kind of intelligence that goes to the president and to leaders in this country every day. that is what our job is all about. the best intelligence comes from officers who can operate credibly and effectively in just about any society in the globe. that means that they have to understand those societies. they have to speak their language. they have to be able to know what their cultures are all about. they have to know what makes people tick in these countries. otherwise intelligence does not mean much. a lot of this is about getting officers who understand the

countries that they have to engage in. for intelligence to be affected, we have to reflect the face of the world we are responsible for. it is for that reason that we reach out to seek out a diverse work force. that is why i am committed to making the cia look more like this nation that we protect, look more like the world that we protect so that we can operate effectively to help protect the country. [applause] our goal, michael is to substantially -- my goal is to increase the diversity of work force in the next few years.

the position that the cia is seeking is to be recognized as one of the top-10 diversity employers in this town. that is our goal and that is what we intend to achieve. [applause] by its very nature, diversity encompasses many dimensions, ethnicity, cultural, educational, religion, racial. behavioral, sometimes not easy to quantify, but one element which is minority representation, is the one area we would like to see our workforce closely approach the level of the population that we have in this country. cia needs to reflect the face of this country and that is what michael is as director of cia.

-- that is why my goal is. the cia is viewed as a great place to work, it is a challenging place. we get more than 140,000 applications, almost 400 a day. if there is a new james bond movie, we get even more applications. our attention rate -- our retention rate is one of the best in government. right now new officers to come and come up we lose less than 1%, so we have a great retention rate. almost one-third of our new hires are minorities. that is good, but we can do even better. we want to significantly increase the hiring of minorities in collection and analysis and their inclusion in

student intern programs as well. we aim to expand national origin hiring, first and second generation americans and boost the number of new officers with foreign languages. above all, we are widening our recruitment pool by going to more places that offer a variety of talented candidates. historically black colleges and universities are an important part of that effort. we have already started recruitment efforts at 17 schools this semester. we are conducting interviews and classroom presentations. we enjoyed working relationships with many of the career offices and will reach out to more schools in this coming year. our officers also participate in the intelligence community centers for academic

excellence, the innovative program led by one doctor. we are very proud to be part of the national urban league's black executive exchange program which does an excellent job of cultivating future leaders in government and industry. more than just a diverse work force, at this is a tougher challenge. we have to have a diverse leadership as well. my agency -- [applause] all agency seeks to give all officers the training and development they need in order to thrive in their work. we need to make sure that in every case, accomplishment earns a seat at the table of the leadership at the agency. by any measure we don't have enough diversity in our senior

grades. bringing in executives from the outside of the intelligence community is not easy. that is why we need to develop our jr. and mid-level officers so that they can achieve those leadership positions. achieving greater diversity in the senior leadership means giving up and coming officers what they need to earn, what they need to learn in order to be at that table of responsibilities. the bottom line is we are putting the cia on a track to better represent the best and brightest from all of the communities that contribute to america's greatness. it is good for all of us and it is good for the nation that we

serve. this month marks eight years and since the attacks on 9/11. all of us must remember the lesson of 9/11. that we must do everything possible to make sure that never happens again to this country. it is the tireless work of thousands of men and women in the military, law-enforcement and intelligence that is essential to our nation's security. president obama gave me the honor of working with some of the most capable and gifted people that i have known over 40 years of public service in this town. these are people who don't pay a

lot of attention to the noise in this town, but do pay a lot of attention to what their heart tells them about the commitment to service. more than half of cia's work force has come aboard since 9/11. the spirit they bring to the job is amazing. my goal is to begin a new chapter for the cia in the 21st century that provides the best intelligence possible with a professional and diverse work force that reflects the face of the world and abides by the highest values of our nation. ultimately, protecting america is not just the work of the cia, it is the work of all americans. it is the responsibility of all

of us to fight for a debtor nation. and -- to fight for a better nation. there is a story i tell that makes a pretty that point. the rabbi and the priest to decided they would get to know each other better. it got if they went to advance together they could learn about each other's religion. -- they thought if they went to events together. they went to a boxing match in the one boxer made the sign of the cross. the rabbi said what does that mean? the priest said it does not mean a damn thing if he cannot fight. [laughter] frankly, we bless ourselves with the hope everything is going to be fine in this country, but it does not mean a damn thing unless we are willing to fight for it. [applause]

i know that you are willing to fight for a better life and for a better nation. i look forward to working with all of you and being able to make sure that that american dream we all care about is real for all of our children. thank you very much. [applause] >> thank you for those inspiring words. we thank you for your service and the men and women of the cia

and the military. we thank all of us for being vigilant, because the most important thing we can do is protect our country. thank you sir. we have some remarks from dr. john huston, the senior research professor and director of african-american studies program at elizabeth state university. [applause] >> director panetta has to leave but i wanted to give them -- give him this award. i want to say very quickly that we hear a lot of presentations and very rarely is it that the person, the human being comes through. we understand him as a man now [applause] ] -- [applause]

we trust the authenticity that came with it and we believe he intends to do what he said he will do. that is a good thing and we celebrate that. [applause] the second thing i want to say is this is the hcbu community and we also generate intelligence and pursue truth, so we have some things in common. thirdly, because of something that you mentioned, i want you to know we can help you in a special way. one of our most prominent alumnus, my good friend spike lee is about to shoot a film called "inside man." he could very easily put a black james bond character in that and help you to recruit for the cia.

i will call him and let him know he can do that. here is an award for all you do and all you have done, leon panetta. [applause] >> he has to leave and we thank you again. let's give him another hand as he leaves. [applause] now we will have final remarks. >> this past sunday in japan come of voters replaced the party that has held power there since 1955. we will hear reaction from former state department officials moderated by bob schieffer.

that is live at 5:30 p.m. eastern. later, the views from the health-care system from one doctor and the vice president in charge of nursing. that is tonight at 8:00 p.m. eastern. then a maryland hospital director joines steny hoyer. you can watch that tonight. >> as the debate over health care continues, the health-care hub is a key resource. go on line and follow the latest videos and links. watched the latest events and share your thoughts on the issue with your own psittacine video, including video from any town halls you have gone too. there is more is c-span.org. >> republican national committee chairman michael steele from howard university in washington, one of the nation's historical black universities. it is one hour and five minutes.

>> good evening, i am the vice chairman of the howard university college republicans. >> why in the president of howard university college democrats. >> -- i am the president of howard university college democrats. >> i would like to congratulate chairman steele on being the first african american to leave the republican party. [applause] i am honored to participate in this historic event. tonight gives us the opportunity to come together as a community, regardless of political affiliation. although we may not agree on certain issues, we would like to

have a civil discussion tonight where everyone is treated with upmost respect. >> for the question and answer portion, questions were already submitted , but you were given a white sheet of paper where you could write down questions. please raise the paper when you are finished writing and someone will collect it. now we would like to turn the stage over to the director of coalitions for the republican national committee. [applause] >> good evening howard. how are you? we are so excited to be here. you have received us with a very warm welcome. chairmen steel is very excited about doing a free and tore at

this historic institution. -- doing a freedom tour. we appreciate the warm welcome. [applause] we have a lot of distinguished participants here today in terms of the faculty. we would like to make a couple of acknowledgements before we get started. we want to say thank-you to the president for allowing us to come to your institution, associate provost and dean donaldson, chairman harris, mrs. jackson, mrs. reeves who was very gracious to us and we don't want to leave town brian smart who has risen to leadership as the president of the student body. that's give all of them a round

of applause. [applause] on this stage we have three students who will dialogue with chairman steel throughout. i want to acknowledge them, brandon cooper, thank you for your leadership and working diligently to pull this together. taylor, thank you so much and skyler johnson, thank you. one of the things we like to do is to get on the road. we are headquartered in washington d.c., but this chairman is one that likes to get out into communities around the country. that is one of the reasons we are so honored to be here today. one of the chairman's top priorities is to be able to talk to young people.

he loves to interact with your intellect and to begin to engage you in the dialogue. civic participation is a very important activity in our country in terms of how we are founded. as african americans, it is a privilege we have not always have. it is important to take opportunities to do that. we just want you to know he is here because he wants to dialogue with you. he wants to be able to hear your thoughts and the things you are thinking and share perspectives with you as you are matriculating through this great university. chairman steele has been a trailblazer on many fronts. the political scene is one where he has made great inroads. as lieutenant governor of maryland, he ran a very tight

campaign for the senate in maryland and has been very involved in politics and the republican party in maryland. today he stands here before you as the first african american to serve as the chairmen of the republican national committee. i call handyman of the steel because the steps -- i called him the man of steel because the steps he has taken require him to have a steady course. the different leaders you have read about, she in terms of trail blazing. i want to turn it over to him and say that you had a great opportunity to dialogue with a phenomenal leader, and man of great compassion. i welcome you to rise to your feet and welcome him to the

podium. [applause] >> thank you all very much. what's up howard? how is it going? it is wonderful to be back on campus. i have had the privilege of spending time on this campus as the county chairmen from prince george's county when i served as the chairmen of the party in prince george's county, which lot of people were surprised there was a republican party in. i served as the state chairmen and had the privilege to come to campus and dialogue with students and work with students on a number of issues. and also as the national chairmen to come back, but even before then as the lieutenant governor of maryland.

why this is special for me is because this is home. i grew up about two miles up georgia avenue on eighth street. i was part of the eighth street crew. my sister gave us that name, it was just the two of us, but we were roughed. i grew up there and sell d.c. is my home -- so dc is my home. this is where i began in politics. i began in washington d.c. as a 17-year-old republican. i remember when i told my mother that after a long discussion and said you find what you want to do. whenever you work out that will be ok with me. i said i decided i wanted to be

a republican and i was going to register, she said why did you do that. that has been the story of my political career. why are you a republican? this conversation is not just about that. it is not just about being a republican or a democrat, it is being engaged in one of the most exciting times of your life at one of the most exciting times in the history of our country. before i get into that and engage other folks here, i do want to send out the welcome to our national committeewoman hear from the district of columbia, former chairman of the party, who is -- i want to welcome her husband. thank you so much for being here. send my regards to bob, our

chairmen and national committee man. the party in d.c. has been one of difficulties in trying to get going and dealing with the changes that are happening, but it has been consistent in its efforts to engage. when betsy was chairman, she has tried to find ways in which we can engage the entire city, because it is important from uptown to downtown, so i appreciate you being here. and to the president, thank you. it was an honor to meet the president and congratulate him on his tenure. i am grateful to be here with all of you. where to begin and what to talk about. i have two mcs, so i don't need this one. -- i have two mics.

where to begin? hi, how are you? are you a reporter? >> yes. >> ok. the times we are living in right now, if you have not figured it out yet, is all about you. president obama recognized it, a lot of folks are beginning to see it, and the question and the opportunity we have is not just the particular issues but what it means. what are you going to do when you walk out of this institution in four years or next spring? how are you going to engage in the marketplace of ideas? what is going to be part of your legacy of creating a pathway for

the next generation, particularly when you think about the great men and women who have walked through this institution and stood on those steps at douglas hall. the question is a very important one because right now you are watching the nation go through the pains and excitement and frustration of change. not just the kind you heard about in the campaign but the kind that comes from a people who are emerging into something else. where economies are shifting and opportunities that were once plentiful are now limited, where resources that are once plentiful are now limited. where ideas are going to be the springboard for your generation. as a young man growing up in this city, i think it is important for you to appreciate how i got here.

my mother was a sharecropper's daughter with a fifth grade education. she grew up in south carolina. my father was an alcoholic and was not a nice man. he died at 36 leaving us alone in northwest d.c. the question becomes all the statistics says michael steele should have a different path. . path. and that i should not be here. those of you have like or similar systems dances should also not be here. but the difference comes down to what you decide to do and others for a part of your life decide for a part of your life decide to do for you. mother invested in education even though she had little access to it. she put me on a path that led

made to be the first african- american to be elected statewide as lieutenant governor. that defied the odds. and then, having to fight for this job defying the odds. whether it is your first year or your last year at this institution, hothe question is w you are going to conduct yourself to defy the odds? you have to make choices on health care. you have to make choices on whether or not you're going to start a business. how're you going to engage with viet -- with each other and the broader community? a lot of folks thought that knows when to come here and try to convert all of you to become republicans that is a bonehead idea.

i got here because i was allowed to do the one thing and use the one thing that mattered most, use my mind. that is why you are here. this dialogue is to engage. you know what? republicans do not do this. we do not do this. we do not come up into the neighborhood, community, and actually engage in dialogue. when i became chairman, i made it very, very clear that this leadership would not stay stuck on capitol hill on first street and not get engaged with the communities, not talk to people, not take the hits that people want to deliver, not share the ideas, not talk about the future of our country and the future of this generation. so if you want to know why i'm

here, that is why i am here. i grew up two miles or so of the street. it is important to be here to show you that, from eighth streets nw to this moment, it happens. it can happen. and you are now poised to make it happen for yourselves and your community back home, it is here or somewhere else, as you leave this institution and as you prepare to go out there and changed the world. that is the message of president obama. that is my message today and it is consistent. did you ever think that, at this time, you would have two african-american men sitting on top of the political class in this country? one is a democrat and one is a republican. both have competing views and interests in government. both are reflections of the

african-american community. how powerful is that? what a story and what a legacy to be a part of. it is not about us individually. it is about the legacy that it has taken for us to get to 1600 pennsylvania avenue and here at howard university this evening. i remember having a conversation with a friend of mine a few months ago was complaining about the fact that things were not going quite the way he thought they should be going. he said, you know, the man is beating us down. he is not giving up. he said the man is and the man that. i looked at him and said, we are the man now. we are at that point where we have been empowered through the vote, yes, and also through that legacy to make decisions that is going to move a nation and changed the course of the

country. what i would like to talk about this evening is what does that look like for you? what does that feel like for you? what do you want it to be? do you want to really fall into the stereotypes or do something like mine monty python troupe says, completely different? that is what we have a chance to do. i asked three of your colleagues to sit up here and share some of their ideas and some of their thoughts. we had gw represented in the house. we have addison howard. we have some students from across the city. it is a cross-section. is a democrat, republican. it is black. it is white. we have a chance to do something and say something that, hopefully, will feed the mind

and give us a fresh perspective on some things. i want to a -- i would not use this opportunity to convince you to do what i do and believe what i believe. this is not what this is all about. but appreciating that there's a diversity of thought out there, some of which you will be surprised to find out that you agree with, some that you will said, have, i cannot follow that. that is fine. but to engage in the battle of ideas, we can all move this country forward. that is what last year's election was about for the first time, this generation to cold, engaged, and spoke. as these issues, flowing out across the country, do not stop speaking. do not stop sharing your ideas and engaging in the elected leadership of this country,

whether they are political, like myself, or government officials with the president, the congressmen and senators that represent you here and at home. so what is your expectation when you graduate? does anybody want to take a quick stab at that? do we have a microphone for them? we have a lot of folks here. we have cnn. we have c-span. we have fox. i want america to hear. we have howard tv. we have cbs. we have showtime? what we want is for folks to hear a little bit about what our college students are doing as they think about their next

steps. >> good evening, everyone. my apologies. can you guys hear me? hello? ok, good evening, everyone. when is sky led johnson. i'm a junior economics major my expectation for after college, which will be in the next year, preferably, is to become a u.s. economist and being bilateral relations between the united states and china. so, it is to have a job, actually. [laughter] >> so you want to work towards improving the bilateral relations between china and the united states. >> yes, sir. >> looking at it, and economic standpoint, china is one of the big dogs on the block economically in this country.

how did you see that coming about for you? how do you see yourselves taking the steps outside of howard university? is it graduate school? is it going right into service? what are the options and the opportunities that you see? >> hopefully, after howard university, i will attend school in georgetown and attend law school or stanford university in california and hopefully it obtain a lot of finances and bring it back to my communicate and to a broader aspect of the united states, to be able to become the voice of not only the african-american community, but to become the voice of my generation which will then, hopefully, transpire into a bigger voice that will influence not only america but also the world in respect to china. >> excellent. anybody else? >> hi, i missed to get -- my

name is taylor. i hope to go to law school and pursue a career in business law. >> more money. >> yes, sir. >> and business law. when you get out of business law, is it doing a law firm or doing something else? >> contract law, writing contracts between companies. >> excellent. how about you? >> my name is brandon cooper. i am a double major in french and political science. i plan on attending law school after howard. i have a couple of years of school and hopefully getting into politics. >> god bless you. >> i want to get into politics eventually and get back to the community. >> tibet to the community? >> yes, sir. >> what do you want -- give back to the community? >> yes, sir.

>> what do you want to give back? >> my mind. >> in a sense, to be an example of how we can continue the legacy that started a long, long time ago of creating a pathway to opportunity in. >> exactly. >> once you do that, what do you do with the road blocks apart in the way? what do you do with the lack of a job opportunity or the lack of your ability to create a job, like starting your own business? how you deal with the frustrations and the challenges of that will come, potentially, when the global marketplace is changing so rapidly? how do you see yourself as a young man stepping into that, making a difference, and trying to push against that kind of pressure? >> taking examples from you and obama, just not giving up. we have to work for it. people that re-electon to what this is very important because

they affect their lives. -- people that we elect into office is very important because they affect our lives. >> do any of you have expectations as you get ready? yes, ma'am. once you leave these hallowed halls, what are your expectations? >> i am a junior in political science major. i plan to attend yale law school and a plan to run for senator for the great state of maryland. [applause] >> that would be a democrat senator, right? >> yes. a democratic senator. [applause] >> and she is bipartisan good that is a good point. because what do you think happens when you are on the

pathway toward becoming the next u.s. senator from maryland? i am a resident of the state of maryland. i am a republican. and you may say some things that i may agree with, but a lot of it suspect about because, you know, how democrats are -- because, well, you know how democrats are. ok, you win, right? you are standing up there in the senate chamber with your hand on the bible and your hand in the air swearing deal flow office. what should my expectation be of your leadership? >> your expectation should be diplomacy. i said, i am bipartisan but it is not about a party. it is about the people. [applause] i want to go into politics to be a public servant. i feel like that has gotten lost.

being a public servant is observing all of your constituency. >> i do not want to put you on the spot, but since you are a public official -- [laughter] here we are on a national debate on health care, ok? and it is a very good and a very important debate, regardless of where you are on the spectrum and but your present me and a lot of folks in the state -- on the spectrum. but you represent me and a lot of folks in the state. where do you draw the line between what you believe, personally as a u.s. senator, and what you should do as my elected representative? i believe that my beliefs should guide me, that i shall also take into consideration the guidance of my constituency, because they give me my job. i should explain my beliefs and make sure ám

could you share that lesson with the others around the country, who have lost that principle? if you have the mantle of responsibility, as an elected official, representing the people in this room and across this country, you have to first respect the fact that they put you there, and then you have to be able to negotiate literally sometimes your personal views the reality on the ground, that maybe in the state or district that you are from, the general collective view on an issue is over here, you are over there, and you have got to navigate and work your way through so that at the end you come to a position where the people in your district or your state respect the fact that while they may disagree with you and that while you may cast a vote that they disagree with, that they

know that on this issue as on others you're going to be true to yourself and will be true to them and carry forward in a way that they can say they understand? others, you're going to be true to yourself and true to them and they can say, ok, i and stand. one of the challenges you're going to have -- i understand. one of the challenges you're going to have is being able to understand where that line is and in doing what you need to do to bring everybody to some sense of consensus. the debate we're having right now in this country on health care is lacking the simple approach toward not bipartisanship. in washington, bipartisanship is, if you get something, that means i have lost something. unless i am willing to give that something up, i am not in the mood to be bipartisan,'.

it is consensus. what is at stake is not my reelection, it is not my personal views, but the idea that they have that i am going to represent them ultimately in this fight. i am going to work toward some level of consensus on the issues. >> yes. >> and that is a challenge. what you see now and why the young people have reacted the way they have and why americans have reacted the way they have is because they moved past this a battle. they want to see leadership actually engaged. the frustration that a lot of folks in washington have right now is that you still have this tension between democrats and republicans. i am a partisan guy.

i can be as partisan as the next fellow. i like beating up democrats as much as they like beating me up. that is one aspect. when you're talking about something that is in -- that is what to impact your parents, is going to impact you, is known to impact your children and your children's job and, that complicates the amex. how are you going to engage in a way -- complicates -- is going to impact your children and your children's children, that it complicates things. how're you going to engage in a way that you can gain consensus? your voices or a variable import of this. you can sit back and be partisan and say that we have to do this and that appeared that is great.

but are you moving the ball -- this and that. that is great. but are you moving the ball? her goal is to try to work towards some consensus so she can at least achieve, ultimately, what people think they're going to get. some people are going to have to give up something to get something. that is part of this discussion that we are now engaged in across the country i do not know how it is good to turn out. do you know how it is going to turn out? >> i do not know, but i hope it is good to be good. >> i hope so, to. -- i hope so, too. who has another question? yes, sir. how're you doing. nice to me to. what is your name? >> and jerry garland. i am from memphis, tenn.. upon graduation from howard university, i want to enter law

school. i am not sure where i want to go. >> in georgetown is good. [laughter] that is just off the top of my head. >> my main goal is to choose a career, most likely in public service, that can impact people most at the local level and instill an idea in them that you can make it. no matter your situation, always try to find the good in it, to never fail. >> what is important about that is something that thurgood marshall said. we'll have the ability to pull ourselves up by our own bootstraps. but every once in awhile, you have to bend down and help somebody else. part of the legacy in the african-american community, in

particular, has been that, reaching back and pushing forward. you will find, ladies and gentlemen, as you matriculate through this institution and start walking through the various doors that you have outlined for yourself and others have, you're going to run -- two kind of people. it is when to be the person begin going to run into to kind of people -- you're going to run into two kind of people it is going to be the person -- two kind of people. another kind of person you're going to find it is the kind of person who keeps their foot jan the door and tries to push as many barefoot and jammed in the door and tries to push as many

people -- the kind of person who keeps their foot jammed it in the door and tries to push as many people through. i wish you well. when you get there, i'm going to need people who are going to be pushing people to the side. there are challenges. the challenges, particularly, when you look at statistically where we are as a community. when you look at the aids infection rate. when you look at the recidivism rate with drugs and presentpris. these are the things that people make presumptions and assumptions. your course, like mine many years ago, should be corrected at best, certainly rocky --

should be crooked at the best, certainly rocky. you are already so from power, by the time you're -- by the fact that you are here, to become a lawyer and do it however you want to do it. i spent a lot of time as lieutenant governor of maryland visiting with 13-year-old to 17- year-old young men in the baltimore detention center. my frustration was not so much that they were there. everyone was telling them that this was all they could do, that this was it. i remember talking to these young men in. -- i remember talking to these young men. we talk about the possibilities, that this is not the final definition of view, that you

have the opportunity to take some steps that everyone else is denying and say do not exist. that is what my mother was told about me and that is what i was told about myself. i want you to appreciate what it means to be here at the school at this time. there are generations of young kids right now who will be looking to you, not to bill them out of jail, not to sit in front of them in some correctional institution, but they're going to be looking to to oppose that $10 million deal that they're trying to get it done. they're going to be looking to you to help them build their new home. they're going to be looking to you to help them achieve what everyone talks about as the american dream. and that is the opportunity. that is also the challenge. i wish to the best. wells has something they want to put out there?

-- who else has something they want to put out there? yes, ma'am. i will come to you. >> [unintelligible] [laughter] >> hello. how are you? hanging in there. it is so nice to have you here. >> my name is ashley torrez. made second year doctoral student. >> that is a mouth student could a doctoral student of mass comm media's buddies. -- media studies. i am going into my 19th year of school. during that time, i have only had two black instructors. that speaks freely about the disparity of blacks in not only grammar school, but higher

education. i am interested in what you would do or what the republican party would do to increase the numbers of more african- americans in education to alter the perception of who is capable of educating the masses? >> that is a very important question. i am sorry. nice to meet you. [laughter] nice to see you. excellent. that is an important question because there are two pillars that you need to appreciate. one is economic and the other is educational. some people think that you can survive with one and not the other and you probably could. i think it is important to appreciate that you need both. if you have that educational

foundation, if you have that killer in place, then your ability to do the economic think -- if you have that pillar in place, then you have the ability to do the economic thing. we can afford more than one individual who rises above and creates wealth. a lot of folks gave me a hard time when i talked about hip-hop republicans. i tell you what was interesting about the response that i got when i made that statement. people went to a stereotype. black and white. it was interesting, the responses, because what i said was not talking about republicans walking around with the whole bling thing and the pants. that was not it.

it was not glorifying what many in the community were talking about the violence and some of the aspects of the music. it was about the ability to create wealth. it was about the ability to create a legacy well. you have, among steer right now, a generation of african- american entrepreneurs that are creating incredible wealth. and they are investing in the back into themselves and into the community. they are controlling that wealth. how are they doing it? instead of the publishing or the record company owning the rights to their music, they on the record company. that is a big difference. instead of someone else controlling the decisions they are making when it comes to their bottom line, they are the ultimate to determiner of what

that bottom line is. there is a very interesting challenge when you talk about education, in particular, because, to get to that point, you're going to need a that foundation. more importantly, it is important to have us in that process. one of my frustrations, as a chairman, is that, when i look around and looking for folks to help build the farm teams, i do not see a lot of folks that look like me. right? and it is a real frustration. it says that the party has not done what it needs to do to engage you and others to be a part of this effort to build this relationship between the republican party and the black community. community. it is also point important to stand as a simple as black broderick --

progress and inspiration. a lot of people talk to me about party and say one of the problems i have with the gop is that i do not see me represented in it. if they went to the national convention in 2008, 36 people out of 4000. dumb, because there are more than 36 black republicans in the country. the party has never engaged in a way in which we invite them to be a part of the representative family at a national convention. that is going to change. that is going to change. i do not know what field will ultimately look like, but it has to change. similarly, what can we do to

educate our own within our community? how do we bend down, reach back to do that? we need to those role models? it is tougher now to find them because they are not there. they are not there. it is going to be up to you and your peers to begin to change that dynamic. i do not know if you are ready to do that. the future is of such chaos that it is not very clear whether the job will be there, whether the opportunities will be there, and that is why it is important that we'll begin to engage right now, in this great national debate, about the progression of the country and the consequences to you and your family as you move through this institution

and move out into the world. there will be consequences. and they will be big. in some cases, they will not be pretty. you are a generation of young people who have never seen inflation. you have never seen double-digit interest rates. york college alone probably max is out at 7%? 8%? maybe 9%? but you're not spending 15% and 20% on that money. that is a real prospect in the future. why? because of the way the economy is changing and how we balance right now the flow of funds, the creation of debt matters. it is not just a political game in. it is not just michael steele and barack obama going back and

forth. there are real consequences on how the next generation of teachers are going to get paid. it is on how the next generation of entrepreneurs are going to create a legacy wealth. that is you. that is not 20 years from now. that is literally 20 minutes after you graduate from this institution. so while you are engaged now in getting this education, that will lead to your ability to create wealth later on and think how your engaging and ask ourselves what is going to mean to you and yours. again, i have my philosophical perspectives. the republican party believes very firmly that the government has a very limited role here, that you are the true engine of wealth creation. how many it of you know or knew that over 70% of the jobs in this country are created by

whom? ibm? xerox? small business. that is you. that is you when you wake up one morning and say, you know what? i think i am going to do that they have always wanted to do and start my own business. you're going to file some papers and put some money in the bank and you may or may not tell your spouse that you took out a second mortgage. i have been there. and you're going to make an investment in your going to take a risk. all of a sudden, it is your money because it comes out of the property you own. the question you have to ask yourself is how much of that do you want the government to take from you? how much of that do you want the government to control? that is part of the debate we are seeing unfold today. my coming here is to stimulate the discussion to engage in this generation in the battle of

ideas, yes, but to think of what the future's going to look like for you. i think it is a great opportunity irrespective of party differences and party lines and all of that. but it is a chance for you to be involved and to engage in a way that is unprecedented, that we have not seen before. this matters to you, whether you like it or know it or not. yes? >> we have a couple of questions that were written ahead of time and as people came in trade we are running a little short on time. >> ok. >> in the first question is from gary -- from gregory. he asked if republicans opposed to the public option in health care, what alternatives do you

propose that all americans are cared for when it comes to the cost of their health care? >> the public option is the center of the debate right now in health care for a host of reasons. the president has outlined, along with speaker pelosi and majority leader reid, what that should look like in turns of the opportunity for you, the individual -- in terms of the opportunity for you, the individual, to take the public option. you can opt into whatever government-run health plan if you want to. or, as the president says, if you like your current insurance, you can keep it. let me give you a very interesting sidebar. a few days ago, my son graduated

from boston university's school of design and digital parts. my wife and i were sitting in the car. we were talking and were very happy and very congratulatory of him and his work. it was an intense program and he got through it. i wife looks at him and says, you're going to have to get your own insurance now. and he said, what do you mean? >she said, you are over 18 and you are out of school and the law will not allow us to keep you on our insurance. you're going to have to get your own. you could see the look in his eye, why? how much does that cost? all of a sudden, that reality began to set in. it will set in for all of you. there will be a point where all of those 19 years of education and and you're doing your thing

and you have to take responsibility for providing yourself with health care. i know a lot of young people have this mindset that says, i do not need it. there are up to 12,000,020- something and 30-something-year old -- there are of to 12,000 20-something year-old and 30- something year-old who think the same thing. the party's position is that that is ok -- >> she died of cancer. everyone in this room should have health care. [applause] 96 million people in health care -- 36 million people without health care supper

without insurance let my mom. no one in this room should suffer that way. >> my aunt is losing her house because she can afford to pay for health care. >> i am sorry >. >> how about the fire department? >> once again, we are going to ask that you honor the procedure that we said we would use here and anybody got an opportunity to submit their questions. we will be respectful to the chairman as he is answering gregory's question. mr. chairman. >> thank you. again, i understand that there's a difference of opinion. the stakes are high.

this is part of the discussion. the problem with the discussion is that, when you close your ears off and you are not prepared to listen, you do not learn, whether you agree or disagree. whether you agree or disagree. what those who dissent do not understand is that i, fundamentally, agree. everyone in the country needs hairhealth care. while you have personal stories, so do i.. but you do not know that. i do not need to shout it to you for you to understand it. [applause] what you need to understand -- and this is the lesson for all of you who are going to engage -- if you're going to engage, you're going to get serious. you can shout and have people ignore you or you can engage and

have people pay attention and learn from you. you present something that they might not know, they may not appreciate, they may not have ever heard before. when people go to town halls and go out to the community and they are like this, it makes for great tv. you will probably make it tonight. enjoy. [applause] but you have not furthered the debate. and that is what institutions of higher learning are all about. they are about further in the debate, engaging in ideas. i may disagree with you all along, but i respect your ability to stand up and engage

me to teach me something i do not know. [applause] with that in mind, let me ask you a question. and the answer is very simply this. the problem that the republican leadership has with the public optioin is, number one, it is not defined in what it will exactly look like and what it means. no. 2, the problem with it is that, for small-business owners, think about it this way. i have had this conversation with a major company in this country who said, if there is a public option, why would i carry the costs to provide health care for 30,000 employees if the government is presenting an option?

in it is cheaper for me to pay the 8.5% penalty than to have to carry the health-care costs for 30,000 employees. the same is true for a small employer of 300, for a small employer of three. the concern is, unless you put in the language, the triggers a that will prevent businesses from offloading people into a system, you have created a back door to single-payer system. they are not going to carry that cost. you would not carry that cost, would you? if you have the difference between what you pay, what your employees pay for health care in your company and what you pay as the employer, that the

difference -- if the government says, we now have that, would you pay it? would you pay $100,000 additional to your bottom line? would you pay $100 million additional to your bottom line? we can discuss the intricacies and the back-and-forth about that, but that is part of the debate. getting clarification. understanding the personal stories that are involved. but recognizing that those personal stories can be impacted in a negative way as well. it is not just about getting universal health care. it is about what it looks like, what it does, and what choices you will or will not have if the government, like insurance companies right now -- have you tried to call an insurance company and ask about your claim? imagine it now being the federal

government and the bureaucracy that they have set up? that is one aspect of it. the other aspect is that we do not know who pays. who pays? who pays? you do not have a choice. that is the other part of this equation. how much, who pays? and that is an aspect we have to debate. yes, ma'am. it is not deficit neutral. nothing the government has ever done is deficit neutral. do not believe that life. name me, one program that grip -- that the proper -- name me one program that the federal government has run that is deficit neutral. amtrak is a government run.

the post office is how much in debt? even the government -- even the president himself has a admitted that particular problem everything that this is government done, not just barack obama's administration, george bush's administration, jimmy carter's administration, nothing the government ever does is deficit neutral. congress is visited by special- interest and of those who have something in stake -- something at stake. they changed the rules. then they spending for programs that you were told were deficit neutral. unless you put to the check in place in the legislation that actually locks that in, that is

not going to happen. yes? >> this will be our last question. terrance williams asked, with the current state of the economy, business, and the battles, and legislation going on on capitol i'lhill, do you tk we college students will inherit the political climate and should we be optimistic about our future? [no audio] >> regardless of circumstances [unintelligible] [laughter] this is not easy. i want to run for office of maryland. that will do it. that is not easy. i have always been a glass half full person. whether it is on health care or

the environment or energy or whatever the issue is, i believe, at the end of the day, but that view, americans, are going to make the difference. it is on. can you hear me? i have a big mouth your going to make that difference. -- i have a big mouth. you are going to make that difference. you're going to engage in the debate in such a way that is going to make a difference. you have a chance to help engage in a way that changes the outcome if you want to. you have an opportunity and that is why i wanted to come here to shape this debate, whether it is on health care or anything else, if you want to. it is not just to react, but to take command and to lay out a different perspective. someone is going to disagree

with you, right? that happens. but others may still agree with you and work with you. however it comes about, recognize you have an opportunity to make a difference. if i never believed that, i would not be standing here. i would not have been lieutenant governor. i would not have had my own business. i would not have gone to johns hopkins. i would not have gone to georgetown law school. someone told me that the glass was half empty. that is the difference. i think the future is bright because you're going to be a part of it, because you're going to have something to say about it, you are going to have something to bring to the table that is of value to me, my kids, and this country. that is what last year was about. that is why you engaged the way you did. i would have loved to have you

all look for john mccain and the republican party, but we did not earn your vote for your support. we did not earn your trust in our leadership. and now we have to for the benefit of the country that is how empowered you are. that is how much you have changed in this debate, the nature and the course of politics in this country already. if you don't take anything away from this moment, take that. the glass is half full and tomorrow's going to be better regardless of what anyone else says. i am proud to be here at howard university because, like a lot of hsbcu's in this country, you don't get the recognition, the kudos, the glamour, the televisions and cameras coming appear and seeing exactly how you learn and how you change and

how you make a difference. when they are cutting funding to hsbcu's, to scholarships,, the very dollars that it will take you to reticulate through this institution -- the very dollars that it will take for you to matriculate through this institution, you find a way and you make it work. it is important for you to be a part of this political landscape, of this economic landscape, of this american landscape. doea@a,7 >> japanese voters replaced the

party that has held power since 1955. to date we will hear reaction from national security council officials. live at 5:30 eastern on c-span. also, the fuse on the u.s. health-care system from a virginia hospital emergency chief and a vice president in charge of nursing. we are showing that conversation next and tonight at 8:00 eastern. afterward, steny collier for a town hall in health care. you can watch that at 9:30 on c- span. and it now views from one hospital on c-span. series on hospitals and health reform. today from the virginia hospital

center in arlington, va., about 10 miles to the west of the u.s. capitol. we will caltalk with three guests about what is going on in dc and around the country. here on our set is the director of the program, dr. john sverha. how many people come through the virginia hospital system every year? guest: every year we see about 55,000 patients. that equates to 150 per day. host: what is the peak time? guest: we track that. it ramps up by about 11:00 a.m. in the afternoon. about 10 people per hour were coming in our doors until about 10:00 p.m. it never stops. we see people through the night. host: have you been able to

track why it rahm. at certain times? guest: i think that is when the need arises. there's some components to people being awake and needing care and realizing that. there's also a component or other access to health care closing at 5:00 p.m. or 6:00 p.m. that's probably why are volumes continue into the evening and into the night. host: into the evening and on the weekend, do you see an increase in using the emergency room as a primary care unit? guest: there may be some component of that. truthfully, there's a spectrum of emergencies that, and every hour of the day. it is hard to generalize. host: is there a doctor on duty in the emergency room 24/7? guest: yes. in this department, during peak hours, we have four emergency physicians and two physician

assistants. host: do you have to treat everyone who comes in by law? guest: yes. host: does everybody have the opportunity to see a physician? guest: that is correct. access to a physician is irregardless of your ability to pay. it was established over 20 years ago by federal law. it is something that really defines what the emergency department is. we do not ask you any question related to insurance status until we see the reason why you're here and we initiate treatment. it is something that defines the emergency room and makes this a great. host: place: -- and makes this a great place to work. host: of those 55,000 people, how many get sent on their way? guest: about 20% of patients.

it just represents the illnesses in the community here. if you have a high gear pediatric population -- if you have a high your pediatric population, the rate is a lot lower. we are about 20%. that is pretty constant month to month throughout the year. host: there's a large hispanic population in arlington, va. do you have people who speak spanish on staff? guest: if a staff member is bilingual, that's a great asset. we are more likely to hire them. we have volunteer interpreters here through the week. during off hours, we use a language line. host: dr. john sverha is the

chairman of emergency medicine at the virginia hospital center. we will put the numbers on the screen. we will be talking with him and we will be talking to the head of the icu and the director of nursing in the next hour and 15 minutes in day three on our series on hospitals and health care reform. host: when the emergency medicine become a specialty? guest: over 30 years ago. it is an often misconception. i'm often asked where's my office and when do i plan to stop doing this. honestly, it is a career that i chose. every physician in this department really chose this. host: you are an employee of the

hospital? guest: it is slightly different than that. there are some models were the physician is an employee of the hospital. or a physicians group a can contract with the hospital. host: you work with a group of physicians? guest: that is right. i'm part of a group of emergency physicians that basically has a contract with the hospital to provide services. host: at the same time, you're the chairman of the emergency medicine department. guest: i worked closely with the hospital. they're my partner here. some days i feel like a hospital employee. i am certainly very active in the hospital here. i know all the medical staff on various committees. who writes my paycheck -- that is someone different from the hospital. host: why is that the arrangement that's best for you? guest: that is a good question.

there are groups that have done it both ways. there's a lot of work that goes into managing a physicians group a and motivating a group of physicians. that is something the hospital has traditionally left to the physician group. host: you volunteered here when you were 15. guest: that is how i got my start. i had trouble getting my life guard license in time. that is the short answer. i still remember some of the things i saw in my first days as a volunteer. it happened to be in this hospital, believe it or not. many years later, i came back looking for a job. host: did you know you wanted to be a doctor at 15? guest: i was not for sure. my father was a hospital administrator. my mother was a nurse. host: you're a graduate of stanford, yale university medical school. medical school.

the first call is from lincoln park, michigan. caller: i do not understand why we have such a health care crisis situation when anybody has access to see a doctor. as you mentioned earlier, whether a head cold or somebody that needs to be admitted, emergency surgery, the like, i had a situation happened to me, and they saved my life. that was the bottom line and they treated me just as good as if i had insurance at that time. even during that time, all i needed to do was go to the urgent care clinic. but there's still little pay as you go. if theyou need a little help, ty

will give you a sample, or a prescription for $10 at the drugstore. dental insurance needs more work. i have a big medical problem now. host: let's leave it there. let's go to the emergency room as primary-care facility. what would you respond to that? guest: yes, we are kind of a safety net for folks who do not have medical insurance. there will always be a role for the emergency department in that spirit as to whether the system spirit as to whether the system is working think it could work better. we can all give you antidotes on a daily basis whereby it would have been better if the patient would have had insurance. people sometimes delayed coming to the emergency department even with a serious problem because they're concerned about the bill. there are circumstances where we

may diagnose your problem in the emergency department, but treating that problem is not something we can always accomplish in the emergency department. sometimes getting the next part of your care is difficult if you are not insured. host: do you encourage people to use the emergency room as primary care? sometimes if you call your doctor's office, you'll hear the message that if you're very sick, please go to the emergency room. guest: i never encourage people to use it as their primary care. that is typically not the best setting for continuity of care. i'm also very understanding of the people who come in. every once circumstances are different. if you probe underneath, sometimes because they work 12 hour shifts and it off at 9:00 p.m., no one can see them, or if they're out of town. there's always something behind this. there is some misuse. there's often a decent reason. that's my experience. host: next call for dr. sverha.

caller: good morning. i have an issue with the hospital itself, where it is located. i do not see many poor people living in that area. it is an empty hospital. i have been looking at it for three days. the emergency room is empty. how can you have uninsured people coming to the hospital when they do not live in that area? host: thank you. guest: i think we are empty because the tv cameras are here this morning. if you came back a few hours later, i think you'd find this to be full. as far as our location, yes, we are in a more affluent area than some hospitals. we see a significant number of people without insurance. we see about 20% people who come into our doors to do not have health care insurance. host: dr. sverha, does your

group lose money when people are uninsured? guest: yes and no. if you provide services and you do not receive compensation, you are not making any amount of money and you cannot sustain the operation here. it is variable. some folks come in without insurance and receive a bill and they work hard to pay off the entire bill. we're very thankful for those people. host: next call, fresno, calif. you are on with dr. sverha. caller: i would like to ask the doctor's opinion. i read an article that the medical industry as a whole has been -- they more or less treat the symptoms of the patient rather than preventive care or trying to find exactly what the disease actually is.

the medical industry as a whole is set up that way. it's not really set up to cure a patient. i just want his opinion on that . guest: it's an interesting point be made that perception if you have a disjointed interaction with the medical system. it points to the value of having a primary-care physician, someone who knows you. you could get that impression if you had different interactions with a variety of different doctors. i could see how you could have that impression. it is my first time meeting you and i may not know you well enough to give you the best judgment or address all of your concerns. host: is it fair to compare what you do to triage? guest: to some extent. it comes from the words to sort.

we try to see everyone in this hospital within 30 minutes of arrival whether it is a sprained ankle a heart attack. there will always be some sorting process in the front end to identify the sickest folks. host: how many hours do you work? guest: about 20 to 25 in the clinic and about 20 administratively. host: so you do have a life outside the hospital? guest: yes. host: are you satisfied with your salary? guest: yes, i enjoy what i do. it is a meaningful job. i feel lucky to have this job. i feel like i am fairly compensated. i enjoy the job. host: is there high tech to emergency medicine?

guest: there is high-tech. there's a lot of low-tech. what we are trying to get better at is patient flow. we do see waiting times. there's a lot of tech to that. it may not be the radio device we are operating, but there is technology in running a successful operation such as this. people really need to go into the system, and go through it, and got out of it quickly. host: next call is a medical professional. you are on with dr. sverha. caller: good morning. guest: good morning. caller: i was calling to ask the doctor if it is true in that area that you have what is called a golden hour, when people come into the emergency

room with a gunshot or knife wounds, that you have what you consider a golden hour? host: why did you ask that? what kind of medical professional are you? caller: in a visiting nurse. i'm sort of continuing my great uncle's work. he was a doctor in the early 1900's in arkansas. he used to go out into the mountains on horseback and treat people. that is why i am a visiting nurse. host: bgolden hour? guest: it is typically used in the context of trauma and the injuries from trauma need to be identified as quickly as

possible in the patient needs to be resuscitated as quickly as possible. it pertains to other medical concerns. time is of the essence for part attacks, strokes -- time is of the essence for heart attacks and strokes. the patients we try to identify early on is those related to strokes. . the folks from the pre-hospital setting, a note to bring the patients to the hospital. caller: how many gunshot wounds

do you get? guest: not too many. there is the front door at where you drive up. then there is the back door when the paramedics come in. see 30 paramedics a day, 120 walk-in patients a day. we might get a gunshot victim every month or two, maybe every three months, perhaps. but if that was the case, they would come through our front door which creates a scene. host: flu season is coming up. we've heard a lot of talk about h1n1. a, are you worried about it? b, what's the prep that's been done for it? guest: i'm concerned. i don't know if i'm worried, per se. it's a focus in the hospital. the good news is we're able to build on our emergency planning that's been done over the last seven or eight years here. there's been a big focus. think it's part of our mission to be a very well prepared -- in regard to a lot of different scenarios.

we've had a pandemic flu pan for years here. we're not process of tweaking that plan, working with local hospitals. all the hospitals in northern virginia to heap sift in planning -- help assist in planning. we try to get a consistency on what the hospitals are doing. it's a complicated problem, the issues of getting the staff immunized, anticipate staffing shortages that may occur if our staff gets sick during this. where you would surge patients into if our volumes went from 150 a day to 250 a day. a lot to talk about but a lot to be done. host: do medical staff tend to get more sick since they're exposed to the different viruses? guest: my own personal experience is i think i've been exposed to just about everything under the sun. but as emergency physicians. but, yes, they do get sick. i think the concern is to get as

few of them as sick as possible. and if they do get sick, they can't come in and work. they'll only add to the problem. so it's a two-part message. to make sure that you don't get sick and use all the appropriate means to prevent it. and then if you do get sick, you have to own up to that and not come into work when you're sick. host: what was 9/11 like? you are six miles from the pentagon. guest: right. i was on duty that day. it was an interesting day. it was a challenging day. a sad day, obviously. when i was working in the emergency department, i guess we received a phone call through the radio that a plane had gone down somewhere near crystal city. we didn't know what it had hit. host: which is in arlington. guest: that was the last communication we received until we started receiving patients from the pentagon itself. they had come by vehicle and eventually by e.m.s. we saw about 40 patients or so in the hour or two after the attack on the pentagon.

the hospital responded wonderfully. i had a lot of support. host: and like you said, did that change your emergency procedures here at the hospital? guest: yes, it did. i think it woke us up to the different things at the hospital, in the emergency department, to be prepared for. i think that was the introduction to that thought and that conversation. certainly there's a great focus on that. host: chris in new york city. uninsured. please go ahead. caller: thank you for taking my call. many years ago i worked for the new york city emergency medical. the amount of care, prehospital, just to anybody that gets hit by a car or anybody that dials 911 is quite extraordinary. better than anyplace else. really in the world. america does a great job at that. and, also, when we look at

public hospitals versus private hospitals, the caller earlier made the comment, public hospitals are not well run. i don't think that we want to use them as a model for how to go forward. think if we really want to understand how to -- there is no crisis, really. but delivery of quality medical care is terrific. i think the real issue is, how do we manage that properly? i think the private hospital systems is a good example of what the public should model host: what do you think of his comments? guest: i can only say good things about the paramedics and the ems service. host: is that a public service? guest: it is a public service

funded by arlington county. we work hand in hand with them. one of our emergency physicians service with the ems service. i see these guys every day at work. they are like colleagues to me. host: one of our callers brought up health care reform. would you want to listen to the health care reform debates going on in d.c. and around the country, what are your thoughts and your fears? guest: i am with most people in that i think that things can be better. i see a safety net. i work in the safety net every day. every day. although, as i mentioned before, it's not an ideal system that we have set up right now. i think most emergency physicians would like to live in a world where everyone had insurance, basically who came in. the people weren't really worried about a large bill.

i think we'd all love to work in a world where it was easy to refer someone for ongoing care. that's not the situation we're in right now. host: what scares about health care reform? guest: i guess that it could be done wrong. i think that's everyone's concern here. from your emergency department standpoint, i don't really ever see a changing that we are not going to be the safety net here. i don't think -- i haven't looked at all the proposals on capitol hill, but i'm sure none of them say we're going to collect payment up front before you see a doctor in the emergency department. i don't think any of that will change. so i think my role in the emergency department will stay intact. host: do you set the cost? does your group set the cost for the emergency medicine? guest: not from the hospital side of it. from the emergency physician side of it obviously we have some controls as to what our charges are. if you come into the emergency department, you'll typically get a bill from the hospital and then from the physician group. and obviously the bill is

related to the intensity of the service you required when you were here. host: what's the minimum? if somebody walks in and sees somebody from your group, what's the minimum they will pay? guest: good question. i think it's about $20 or $30. that's for the simplest complaint. as the conversations previously revealed, it gets complicated. just like the hospital, we have contracts with insurers and payers and so forth as well. we negotiate rates with payers just like the hospital does. for the lowest level of service, that's the ballpark we're talking about. host: that includes you negotiate with medicare also as a private group? guest: i don't think medicare negotiates too well with us. i think they set our rates. but with some of the other insurance companies we do. host: next call from cliffside park, new jersey on our insured line. go ahead, joe. caller: i -- i'm a marine vet.

i've got the v.a. to fall back on. but i found in the state of new jersey that because of the different programs, the care, the way the hospitals operate with each other and state, not everybody can get health care because they may not have insurance. but god forbid they have a really big problem, they'll pick them up off the street, take them in the hospital. they don't ask them how much money they have. they just fix them. this may be an inefficient way to do it, but we've been doing it this way for 30, 40 years. something along that lines has to be fixed but i don't think a whole revamping of health care will do it. host: an interesting comment. i agree it's not going to

change. we're not going to start scooping people off the street or bringing them in the emergency department. we have people who fly into reagan national airport with their sick relative overseas and will come directly to the emergency department and we will start treating them. that's not going to change. i don't foresee that ever changing. i think there are problems on the other end of it. how does the hospital and the physicians get paid for that service? and how do we keep that person from getting a tremendous bill that they work years to pay off? those aspects i think still need to be fixed. host: do you know overall the cost of your education? guest: i was lucky enough some of it was paid for by my parents.

host: we've talked a little bit about a physician shortage. do you see that at all? guest: i guess i can see that coming to some extent. if we expand coverage, i'm sure to all the folks that don't and there's a demand in other services as a consequence of that, can i see that the number of physicians, nurses and everyone would increase. there would be a greater need for that. host: in our conversation with the chairman of the board here, the cardiac surgeon, he and his wife, who is a pediatrician, pay vast index malpractice insurance rates. what's the rate for an e.r. physician? guest: it varies state to state. can i tell you in our circumstances, i think i pay probably $7 or $8 per patient i see. goes to covering the malpractice for that patient. host: per patient? guest: yes. host: two more questions. what is facep on your jacket? guest: fellow of the american college of emergency physicians. host: is that a good thing?

guest: it's a good thing, yes. it means that you've done a little bit above and beyond the call of duty besides simply becoming a member of this professional society. host: we were talking earlier about your mission trips to honduras. tell us a little bit about this. guest: it's something to get involved in in the hospital. there's a group of about 75 physicians and nurses. all sorts of folks that come down -- go down once a year for the week-long trip. we see several thousand people from a primary care standpoint. we do about 100 surgeries, give out eyeglasses, physical therapy services. then we come back. it's a great thing. host: who pays for it? guest: we pay for it ourselves. we get some donations, but all of us take a week of our own vacation time, pay for our own flights, food. host: when you compare the two systems, u.s. and honduras, maybe not a fair comparison but what do you see? guest: they're very different here. there's such a great need, obviously, where we go. we go outside of the major

cities to some of the smaller towns. their access is very limited to medical care. they have some clinics that are very poorly stocked. they're always very happy to see the american doctors roll into town. it's something we enjoy doing. host: the doctor runs the medical emergency department here. thank you. coming up next, we're going to talk with dr. zimet, head of the i.c.u. here at the virginia hospital center. first, we talked to a couple of doctors here and we asked them whether or not health care was a moral right. guest: currently there's an enormous cost shifting going on. ok? if you're a medicare patient and you're in the hospital. your care is being subsidized by patients who were on commercial

insurances. and that's 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. so as a hospital, it's critical since medicare you have no negotiating power. so it's left to the commercial insurance companies to essentially make up the difference because medicare is not going to cover your charges and your expenses. so you have to make it up from the commercial. so i think the immorality is sort of that equilibrium between the amount paid and the amount received. host: in my opinion, everybody, anybody that lives in this country, americans should have a right to health care. the question gets very, very murky when you say, who's going

to pay for this? the answer in my simple way of looking, we're all going to pay for this. this is not something -- it's certainly not going to work by cutting what hospitals get paid what insurance -- what physicians get paid. that will not solve the problem. having said that, as mike is saying, it is a very complicated equation. but the question is a very basic question. do we have a right as citizens of this country to receive health care? my very straight answer would be, yes. how are we going to pay for it and how are we going to allocate care and are we going to restrict or limit what patients can receive because of issues of funds and money? the example throughout the world is most likely we cannot offer 100% all the time. we're not going to be able to have a liver transplant placed on every person because there's no country in the world where that is possible. and the second message is that every system of health care, it doesn't matter where you look --

england, canada, whichever ones we talk about recently are flawed. there's not one that works perfectly. do we have it right as citizens of this country to receive health care? in my mind, in my opinion, the answer is yes. host: the virginia hospital center in arlington, virginia. our set is in the emergency room. we've taken up a bit of the emergency room here at the hospital. we've left plenty for patients. we appreciate their allowing us in here. now we're joined by dr. steven zimet. doctor, why does the i.c.u. have a doctor who is in charge of the i.c.u.? guest: , well, i think i.c.u.'s around the country have medical directors. and our jobs in general are the to set poll i is is and make sure -- policies and make sure protocols are followed.

hopefully provide effective uses of resources. guest: are you employee of the hospital or private? guest: i'm private practice. i have a contract with the hospital. so i am reimbursed for those hours that i spend as medical director. host: so i would guess that most patients that go into the i.c.u. have their own primary care physician who's work with them. correct? guest: that is correct. host: so how do you interact in that situation? guest: well, i work with the nursing staff primarily in terms of making sure protocols are followed. and that people are having appropriate scultdions -- consultations with specialists in the intensive care unit. host: how big is the i.c.u.? how many people do you see there a year? guest: well, we have 24-bed unit at our hospital. we have four sort of emergency beds that we could use in an extreme emergency, thinking about the flu season coming up.

it makes you think about those things. we see about 1,100 patients a year in our i.c.u. host: and what are the reasons they're in the i.c.u.? guest: we have what's called a medical surgical i.c.u. so we see patients with medical problems, heart attacks, surgery problems, trauma. and people just overwhelmingly sick from infections, things like that. host: what's the minimum cost of staying in i.c.u. overnight? guest: one day in our i.c.u. costs $3,500. host: why? guest: well, mostly what makes it an intensive care unit is not the geography but the service that are provided to the patient. and we have primarily nurse that's are there. there's a concept in health care called nurse-patient ratio.

we operate pretty much on a one-to-one or one-to-two ratio with our nurses. then we also have the monitoring that goes on. and that cost includes test and other things that are done. so it's not strictly just the i.c.u. cost. that's sort of the hospital-wide cost. those patients usually demand the need of lots of services, blood tests, images, things like that. host: is it difficult -- what's it like to deal with the insurance company and with medicare and convince them that patients need i.c.u.? guest: great question. medicare is actually our easiest insurer to deal with because they just pay in an arbitrary way whatever they want and don't bother us in terms of what we do. the other insurance companies we have actually have case manager that have to call the insurance companies and justify the

admissions, continued admissions, of those patients there. host: on a case-by-case basis? guest: on a case-by-case basis. and some insurers on a day-by-day basis. host: of that $3,500, how much is medicar guest: i cannot give you a direct answer on that. we generally get 87%. we presume it is pretty close to that in the icu. host: we have the numbers up on the screen if you wish to talk to the director of the icu. an undergraduate at the university of virginia, trained at georgetown. the numbers are on the screen. besides being the director here, what else do you do? guest: i am in private practice.

i have a group of non-providers. we provide critical care and some work in our practice. one of my partners is the director of the sleep center here at the hospital. host: that is your day job. guest: then i do my icu job. i also served on the board of directors. i am a professor at georgetown. i am an associate professor at gw. host: how often are you there? guest: we teach their students and staff at the hospital. this is a teaching hospital. georgetown rotates residence. sometimes they come out to our facility. he average?

guest: not counting call, about 65. host: and counting call? guest: well, in the last year or two i've not been taking calls. so that's made life a little bit easier for me. my partners that do take call work in excess of 80, 85 hours a week. host: why did you stop taking them? guest: they said i was mature enough to deserve that. host: do you work too much? guest: well, i enjoy what i do. my wife might tell you she thinks i work too much. but as i said, i don't think so. i enjoy what i do. host: first call up comes from gaston, north carolina. bernard, on our insured line. please go ahead. caller: how are you doing, doc? i make about $60,000 a year. i don't have any children. basically i pay about 30% in taxes every year, pretty high taxes. i'm thinking that y'all guys with this whole insurance debate, i'm a single payer

advocate myself even though it will probably never go through. we can resolve this problem if people would just stop being cheap and pay a little more in their taxes, 1% 2% and we could cover these uninsured people. your hospital, that's not a good example because american medicine is good, but only if you can afford it. if you can't afford it, it's no good. and the people with money or got a little bit of money like myself, i'm ok, kick in a little bit more and then we could help alleviate the cost for the uninsured coming through. you know what i mean. host: thank you, bernard. let's get a response. dr. zimmet? guest: i think universal coverage is a clear goal that we as a nation need to move to so that people do have access to care. and i agree with you, how it's financed, you know, obviously it's a very complicated question. we don't discriminate in our

hospital whether patients have insurance or not. they get the same care. but it's a difficult situation in hospitals, in communities that don't have as many insured patients or suffer even more than we do. host: i just wanted to follow up on his call. he is an advocate of the single payer plan. what do you think of that overall, what you think about it? guest: part of the problem with these buzz words is your definition of single payer may be different than mine. i think competition in the insurance plans is a good thing. i think people giving people choices would be a good thing. but i do think we need to cover everybody. host: if you had your druthers, would you like the government completely out of health care? guest: well, from what i read about what happened with medicare, before medicare came online, when senior citizens didn't have coverage, that was pretty sad. and i don't know that it would be nice not to have the

government involved. but i think there is a role for government in providing a safety net for everybody and providing coverage for people who can't afford it. host: as somebody on the board of correctors, in charge of i.c.u. and in private practice, this might be delicate. but does the i.c.u. make money for the hospital? guest: i don't think it's a delicate question at all. i'm sure we don't. host: at $3,500 a day? guest: well, first off, that's our cost. we don't get that money paid in. reimbursement is not that high. i think that's the first issue. secondly, i'm not sure that very much in-patient business makes money for hospitals these days. i think most of hospital income comes from some of the ancillary and outpatient service that they provide. but i.c.u.'s are necessary parts of hospitals. so what we try to do is be cost effective as well as obviously provide high-quality care.

host: our next call comes from kansas. ryan on our uninsured line. guest: yeah, hi. as you said, i am uninsured. i am 25 years old, single. i'm self-employed. so obviously by definition i am a capitalist. i'm all for making a profit on things. i do believe that certain things should not be for profit. i've only heard this opinion from one person, which is howard dean, who has talked about treating the insurance companies as public utilities and basically making them not for profit, which is what the netherlands has done, for example. what i wanted to ask the doctor is what his opinion would be as to dealing with an insurance company that is technically a

not-for-profit public utility that is just regulated by the government and not, you know, making any kind of a profit whatsoever. guest: if i didn't have to deal with insurance companies every day, that would make my life terrific. certainly in the outpatient setting, virtually every patient, every test, the concept of preauthorization for testing, the concept of having to get medication as proved, particularly newer medication that come out that might benefit the patients. we have people on my office staff at 1-800 numbers calling, trying to get patients authorized. insurance companies have a large margin. i think they make about 15% of all the premium dollars. they only pay out about 80%, 85%. so i'm not a big fan of insurance companies. i think they need to be more competitive. how that's done i'll leave to

other people to decide. but is it a problem to deal with now? yes. host: in your private practice do you employ people simply to deal with insurance and medicare and the paperwork? guest: yes. host: is that a pretty big expense? guest: oh, it's a substantial expense. yes. i mean, we have -- we take up a lot of staff time doing that. host: next call comes from culpeper, virginia. kirk on our medical professionals line. please go ahead. caller: good morning. good morning, doctor. i'm a health care professional of 25 years, working in radiology. also an advocate of single payer, another of the millions of people out here who are advocating for national health care. you can call it whatever you want and whatever anybody else thinks is appropriate, but it's essentially expanding medicare for all that would be very simple act for the government to

take. i just wanted to ask you, doctor. there have been questions related to single payer. even your interviewer has asked that question. and you made a response. you responded to his question regarding simplifying what is the easiest entity to deal with as far as reimbursement. and you said, medicare. the question is, isn't it obvious -- there are many cases to be made for national health insurance, especially the morale imperative. but wouldn't you say that simplifying -- getting rid of the private insurers ultimately would simplify and save so much administrative costs and that your job would be much easier and we could lower that $3,500 a day i.c.u. cost by just cutting out all of these insurance and reimbursement challenges that we deal with every day and extracting the profit? wouldn't you be a single payer

advocate, sir? thank you. guest: , well, a couple of things. i said that administratively medicare was easiest to deal with. they only provide about 80 cents of the dollar of our costs. so if we have a hospital that has 100% medicare, we would probably be out of business in a relatively short amount of time. so medicare administrative easy to deal with. medicare reimbursing not adequate. so that's the problem there. if everybody had medicare and medicare provided coverage, and that would include a margin -- i think mr. cole and dr. garrett talked about it yesterday. to allow capital reinvestment for equipment and things that we need, maintaining buildings and things like that, that has to be added in. i think in fairness, though, even if they provided enough, we have to change the fundamentals of how people are reimburse sod that incentives are appropriate

both -- reimbursed so that incentives are appropriate for lifestyle and effective care on the physician and providers side. host: how quickly does the technology in an i.c.u. change? guest: often very rapidly. it's a very dynamic sort of thing. i think in the last maybe five years we've had some dramatically improved ability to monitor patients in real-time, to keep tabs of data and things like that. and that has really provided a more effective and i think more cost effective care. the technology costs money, but i think at the end of the day it does help. host: when we started this conversation, you mentioned you work with the nurses or are responsible for the nirses as head of the i -- nurses as head of the i.c.u. what's their relationship and what's their role in the i.c.u.?

how specialized are they? guest: well, my concept of the nurses in the i.c.u. is that the i.c.u. is a nursing unit. they are the people who run the unit. the doctors make cameo appearances there. provide services that we provide. the nurses do the hard work. host: and do they become, in a sense, the patient advocate also? guest: they become the patient advocate, the bridge between the patient, families and the physician. they are the glue that keeps the i.c.u. together. host: so are your duties up there administrative more than patient, one-on-one? guest: well, i have two roles. as a practicing physician, we have patient care responsibilities for the patients, particularly ones seen by my group. and then also as the i.c.u. director. so the nurses will come to me with issues that need to be resolved in terms of how the patients are being cared for,

even with those that i'm not directly involved with. we also have a policy here where we can intervene if it looks like there's an emergency and things need to happen quickly, where we can be more direct in the intervention. host: what's the importance of family members? guest: family members -- family and friends are vital parts of the patient's universe and needs to be parted of their care and recovery. host: are there instances when the squeaky wheel gets the grease? guest: i think the squeaky wheel always gets the grease. that just happens. but i think part of the issue -- part of the job with the nurses and the doctors is to manage expectations in the i.c.u. "think we watch a lot of television, see a lot of people have major surgery at 10:00 and eating lunch at 12:00, and people think that's going to happen. and i think -- particularly as

we get into discussion of end of life issues -- i know dr. garrett discussed it the other day -- appropriate expect it's as. and the nurses are often very, very useful, very, very helpful and effective in that regard. host: last call for dr. zimmet from providence, rhode island. cindy, please go ahead. caller: yes, hi, doctor. the reason i'm calling is it sounds so easy on the tv when your doctor gets on tv and explains all of these things. but there is people that really do suffer. like i have a husband, had an operation. another time he had a blockage. then an imagery on his brain. and i brought him to the hospital, 5:00 in the morning. and the doctor came in the i.c.u., intensive care, whatever they call it the emergency room. and until 9:00 at night they

didn't see him. the reason why i'm calling is because everything is so easy for you doctors to say that this is going to happen, we're going to do this, do that. but once you get in the hospital, no matter if you're covered, not covered, they push you on the side and they take their time to sigh if you're die organize not dying. in italy, my country, my husband went in on vacation. he got sick, was having chest pains, was having a heart attack. he went to the hospital. he didn't belong over there. he was an american citizen. they took care of him for three days. they did everything for him. and when he asked to pay for a bill, they said, no. when you go back to the united states, you tell your president this is what italy does. it doesn't abandon people no matter if they're italian, american citizens, any kind of citizen. we do not charge. let them know what they do. but the other doctor before you

said that it cost him about $100,000 to become a doctor. a doctor could make in a couple of days they like -- they make a lot of money to take care of people. they own all of these things. they overcharged everything. host: let's get a response to your comments. guest: the example of italy is an interesting one. and we will talk about that first. there is a lot we can learn from our allies in europe and canada in terms of providing health care. whether that model will be useful in this country, i do not know. most doctors today graduating from medical school have debt close to $200,000.

the doctor was very lucky that his personal bill was a lot lower. i do not think that physician's salaries are as abundant as the caller might think, particularly in the specialties of primary care and pediatricians and psychiatrists and people who spend their days taking care of people one on one. host: dr. zimmet is in charge of the i.c.u. here at the virginia hospital center. thank you for spending time with us. guest: thank you. host: up next, the director of nursing. but first we talk to a surgeon about getting reimbursed for an operation. >> i don't. i know what our charges are. i know that i am not paid what our charges are because i have contracts with insurance companies, as do most physicians. but i don't know specifically what that will translate to patients in terms of what their co-pay is, the 80/20, 90/10.

so for each patient i really don't know what that will translate to. and the patients don't know either. host: if you're doing a radical mastectomy what does that cost? what's the total cost of that? guest: the cost and the charge are different. >> what's the difference? >> so the charge is anywhere from $1,800 to $2,000. the payment is usually a medicare reimbursement for a mastectomy is usually between $650 and $750. >> is that your -- that money comes to you, the doctor? >> that money comes to me to help pay my salary, my overhead. i have five employees working in my office. i will have two associates. i currently have one. i have another one who's starting next week. that covers rent, malpractice insurance, supplies to the office. so one of the miss nomers for physician reimbursement is that money goes right to my house to my bank. that's not what happens.

as most small businesses or big businesses have overhead to cover so do physicians. and so that payment helps defray all of those costs. >> so it's $600 and something from the medicare if you're paid for by the insurance company, do they give you the full -- >> no. typically the insurance company rates are maybe the same or slightly more than what medicare will reimburse. and so if i am seeing patients and i'm a participating provider, i have agreed to accept what the insurance company contract payment is. if the patient is seeing me and i am not a participating provider, i have the ability to bill for the difference between what the insurance company will pay and what my charges c-span.. host: back live at the virginia hospital center in arlington, virginia. we continue day three here of our series on hospitals, health care, and health care reform. in our set in the emergency room

here at the hospital we are joined by the vice president and chief nursing officer. how many nurses work at the virginia hospital center? guest: we have over 500 nurses here at the time. that is not -- that is have you had individuals, full-time, part-time we have a robust staff. host: how specialized as nursing gotten over the years? as doctors specialize, nurse is the same. correct? guest: absolutely. nursing has evolved into medical different specialties. i think it's been a real benefit for both nurse and patients it gives the nurses an opportunity to find their specialty niche and really become specialists in the event that patients need that kind of care. and nurses are attracted to be specialists and that kind of level of care to patients. host: i just want to mention that we have set up our third line for this segment, for

nurses only if you're a nurse, the number to call is 202-628-0205. again, nurses only on that line so we have a chance to hear your story. tell bus some of the specializations. guest: right now in the virginia hospital center we've been spending these last few days in the emergency room. obviously we have emergency room nurses here. a very important group in our nursing department as they often see our first line of patients here. throughout the hospital we also have cardiovascular specialty nurses, cardiovascular intensive care and stepdown unit, critical care nurses. dr. zimmet talked about their role. we also have a robust women's and infants program here. we deliver 3,700 babies a year so those nurses are very specialized in labor and delivery, postpartum care. we have a 16-bed nicu care here. neo-natallal intensive care

unit. our departments are strong. we have a center of excellence for stroke. we have a center of excellence for hip and knee. a center of excellence for breast care. along with each of those centers of excellence we have nurse that are qualified to work there with their education and their focus on those specialty population patients. host: back in the day you could become an r.n. with a three-year diploma program. correct? guest: yes. host: what did today? guest: today, someone who wants to sit for the licensure has to be a graduate of one of three different state approved schools. there is still the three-year diploma school of nursing usually associated with hospitals. but those only make up about 4% of the schools that are out there today. there are also with it-year a.d. graduate programs. and there are the four year bsm programs. all of those programs qualify for the examination which our state government boards of nursing licensure examination.

host: is that an l.p.n.? guest: it is not. there are several practical nurse programs that range in the time frame of about 18 months. and nursing has always been looking at itself carefully to identify what level of nursing really makes up the professional nurse. there is more and more conversation on a professional level and movement towards the b.s.n. that's actually observed and recognized the professional nurse. can i tell you -- i can tell that you in this organization we have all of the nurses here practicing. we have all the nurses of all of the schools of nurse who's are absolutely excellent. we do encourage our staff nurse at every level to seek and pursue the b.s.m. level. host: what are the duty differences between an l.p.n. and a general r.n.? guest: a general staff r.n. is the r.n. who actually manages the patient in the patient care setting. we partner with l.p.n.'s. we also partner with patient care systems who in the past

used to be called nurses aides. they make up teams of nursing. there is a different level of responsibility that is placed upon the registered nurse in relationship to creating the plan of care, executing physician orders. they have higher level of responsibility for medication administration. especially when it comes to advanced protocols. so we work in tandem and teams up to the level of competency of each individual to provide that best care for patients. host: dr. zimmet called the i.c.u. a nursing center where doctors make cameo appearances. guest: i heard him say that. i think he's being very gracious. i like to see the i.c.u. and almost any unit within the hospital as a real orchestra. yes, the physicians are in and out. and the nurses are there 24/7 with our patients. our physician colleagues set the roadmap. and together they partner with us and we set the care plan together and really provide the best care for patients. that's the real combination of efforts of the whole team in a hospital.

the physicians are obviously at the front end of that, with nurses partnering. host: has the relationship between doctors and nurses changed over the years? guest: i believe that relationship has improved. and improved for the patient. i believe that nurses have always had a great respect for physicians. and as the education for nurses has been -- has actually grown and responsibility has grown along with that, physicians have always respected nurses. that's been my experience. but the level of education now is equalizing to some degree in that the level of conversation, the planning, the complexity now that is involved in taking care of our patients, that has changed greatly. so the dependence on each other, i think, has increased. and relationships and communication is always where that health care can improve and where the best outcomes are achieved. host: what's the starting base salary for a nurse here? guest: the starting base salary

for an entry level graduate nurse is somewhere around $53,000 plus. host: that's pretty good. guest: yes, it is good. it is very good. i think it's a reasonable -- particularly in the economic downturn that we see people who are really taking a second look at all health care professions. we have a clinical track nurse, track here for those people who progress through the hospital and their experience. and the salary gets graduated with experience and performance outcomes against that clinical track. a nurse who's been long in the field and is very specialized in their field can move upwards from that quite significantly, up to $80,000, $90,000, plus. so people are paying attention to this field more in these times. host: and salarie salaries for s has improved over the years. correct? guest: yes, it has. and, again, i think it has tracked along with the education, the responsibility that we have to manage.

host: let's take some calls. darlene is the chief nursing office and vice president of the virginia hospital center. our first call up subpoena is a nurse in kansas. -- call up for her is a nurse in kansas. caller: hello. i have been a nurse for 34 years. i graduated from one of the old diploma schools of nursing where we were hospital based, three-year program. i actually made that decision because i was so unimpressioned with the bachelors degree program coming out of k.u. med center nurses because i was working as an aide and i was unimpressioned with their clinical ability once they got to the floor in pediatrics. so i went into this school of nursing and was immediately into i.c.u. right after graduation. i have had a career in emergency

rooms, i.c.u., transport team, pediatric i.c.u. and i've been in the caj lab now for seven -- cath lab now for seven years. my question to you is, do you find there are any possibility for us to finally go to universal health care for the american public? and how can we nurses facilitate that happening? i have witnessed too many uninsured people coming in to the emergency room. i know that we will bill them later, after we take care of them. but i know that they will probably be unable to meet that obligation which puts a lot of financial drain on the hospital. we serve a huge community, outlying community. i'd like to see this hospital survive. but they seem more interested, and i see other hospitals also in the country, in building.

building new buildings. building new facilities, new equipment. kind of the bricks-and-mortar instead of actually hiring better nurses, more nurses. and i would like to see how we can get away from the money-making aspect of hospitals and get back into just providing care for all of the american public. thank you. host: patricia, two questions. do you enjoy your work? and could you give us an idea of how much money you make? caller: i enjoy my work. very much in the cath lab. i think it's a great combination of i.c.u. and e.r. it's exciting. the patients are basically conscious. so we get acquainted with each

of them. we get to actually fix a lot of what their problem has been, kind of immediately and see the end result of that. so that's exciting kind of medicine for me. and it also is challenging. and it's the best patient carry can give because i have three staff members to one patient. and when you go home at the end of the day, you never feel like you have given poor patient care. but my cohorts in nursing, i would say, by and large, are not happy people. they are not in the cath lab. they work on the floor. they're under staffed, over worked. and their management is unsympathetic to that. in fact, management changes so rapidly often times managers of particular units stay only a year