was in part because he chose to go after the mutual fund timing scandal. >> host: one final point, you say the madoff scandal was the product of several bubbles, bubble in housing, in americans living beyond their means. >> guest: uh-huh. you know, the hedge fund industry was probably i would say 50 funds, sometimes starting in the 1980s. and perhaps 500 million dollars. by 2007, i believe that number was $2 trillion in assets. it's still nowhere near the mutual fund industry, but certainly growing. since the market collapsed hedge funds run about $1.4 trillion, i think is the number, maybe 15 to 20% of them have closed. it is still an enormous industry and i think hedge funds are where mutual funds were 20 or 25 years ago, they will be with us. >> host: after researching bernie madoff and looking into the case, what are the lessons?

>> guest: check who has custody of of your assets. go back to your portfolio manager and ask who is touching my money, who has control over the decisions? are there independent third parties making sure that no one can make transactionos my behalf? madoff had custody of his investors' money and that very unusual. >> host: the book is called "too good to be true: the rise and fall of bernie madoff," our guest erin arvedlund, the author. thanks for joining us. please come back again. coming up in just a moment, live at the brookings institution, vice president biden asking for the ability to speak to brookings and will be introduced by the clinton administration. the topic of the speech is reinvesting the reinestment act. the vice president will start momentarily. a reminder if you want to read

more from the report you can log on to our website at cspan.org and click under featured links. you can read the interview we just conducted with erin arvedlund. we're back tomorrow morning for c-span "washington journal." a preview of the oral arguments will take place next wednesday looking at a movie focusing on hillary clinton and impact on the 2008 campaign and early start for the u.s. supreme court. they will begin formal term in first monday of october and one other reminder, our new documentary on the supreme court will premiere first sunday of october here on cspan. thanks for being with us on thursday morning. enjoy the rest of your day.

>> here at the brookings institution in washington, all waiting vice president biden who will speak about the stimulus spending. he will say it has been more effective than the administration had hoped. we expect the speech to get underway shortly. president obama is at camp david

through for the weekend. he is planning a speech next week. we will carry it live next wednesday here on c-span. this morning on "washington journal," viewers weighed in. will show you some of those comments until vice president biden begins in just a few moments. tweets and e-mails. the president will flesh out his vision in a speech. aides say that the president will use the speech to add more specifics to his vision to overhaul the nation's health- care system. @@@@@@@@@ @ @ @ @ @ @ @ @ @ @ @

he has been mapping out ways to move congress towards pay single solution. that is the front page of "the washington post." this piece points out the white house is holding intensive talks with olympia snowe about her proposal to use the public plan as a fallback option. it would require most individuals to buy insurance or individuals could buy insurance and tax credits. >> a sample of "washington journal." we will take you now to the brookings institution. here is vice president joe biden. [laughter]

>> mr. vice president, this is not standard operating procedure. i think the stigma aggravation says it all. i am the president of the brookings institution. it is my pleasure to welcome all of you here today to join me in welcoming joe biden back to brookings where he has been on a number of occasions. he is one of morning -- he is one of many americans who is hard work on the eve of labor day weekend. he is working hard on behalf of all of bust. the same is true of the director of the white house office of urban affairs who is also with us today. the vice president will speak to was on the economy and the status of the recovery plan. on behalf of the president, it

is his leadership of the middle class task force, which looks for ways to help american families cope with the stresses of home foreclosures, loss of jobs, and the burden of school tuitions. the vice president also oversees the implementation of the $787 billion stimulus plan. in that connection, he is a frequent -- he is in frequent contact with all parties around the country. a number of his efforts coincide with what is going on here on his promises. our mature program has worked with federal agencies to brainstorm on how stimulus programs can support innovative ways in creating quality jobs

and developing greener, healthier, better educated communities. like all americans, we are looking for ways to track performance of the economy as it makes its way toward recovery. we will now hear how about looks from the highest levels of our government. after his speech, the vice president has agreed to take a few questions on the economy. and i stress, that is the topic for today. you have our attention and our gratitude for being with us here today. >> thank you. [applause] it is a pleasure to be back. i told upstroke that many -- i told strobe that i hope i have the opportunity to discuss other

areas at a later date. i want to talk about the recovery act. president obama an die or in the midst of what i referred to as the great recession. it seems that there was a new revelation to be added to the economic parade of horribles, some of which we have anticipated. americans have seen losses in the stock market. housing values have collapsed. and people were losing their savings and their homes. major banks were on the verge of failure, closure. people were talking about shuttering the doors. there was debate serious discussion for economists to be broadened about a bank holiday

may be being necessary. we were on the verge of failure. businesses could not borrow, much less expand or higher. economists were handicapping the possibility of a true depression. paul krugman, let's not mince words. this looks awful lot like the beginning of the second great depression. a look at some of the headlines about how precarious the situation was. "the financial situation cannot keep the economy humming." "economy strains." "bankruptcy looms."

"governments brace for hard times." "new lines of food banks." we knew that action had to be taken. we had to stabilize the financial system. we took the necessary step of rescuing the banks. eight out of 10 of the largest financial institutions in america as well as 16 smaller banks have repaid the government in full, and with a $4 billion profit for the taxpayer. we took action to stabilize the housing market. we're beginning to see the results of that. new housing starts rose 10% in

july. we are moving. 200 days ago, president obama signed a law. the american recovery and reinvestment act. it is working. don't just take my word for it. analysts and others estimate the recovery act is creating between 5000 and 750,000 jobs. some say it is as high as 1 million. economists say the package headed two percentage points to real growth in the quarter. 3.3 percentage points to the current quarter.

i highly respected economist and former campaign aide and roche, "the fiscal stimulus is fodder for lower sales with lower apparel tax withholding, checks to social security recipients are buoying household incomes. it is no coincidence that the recession is ending just one stimulus is providing maximum economic benefit." australian prime minister said this is a case study in bringing the world back from the brink. it was the american new ship from president obama that was the key. the recovery act has played a significant role in changing the trajectory of our economy, in changing the conversation of

the economy in this country. we're now talking about the end of the recession eight months after taking office. the recovery act still has its critics. one is it is a grab bag of too many different programs. the recovery act is a multi faceted piece of legislation. that was the intended design. our economy is so complex and so wounded that reinvigorating one segment alone and using one school alone would never do all that needed to be done. the recovery act is not a single silver bullet. i think of it as silver buckshot. the president cost recovery and reinvestment act isn't just working towards something.

-- is not just working, it is working towards a more transformative economy. this act was designed to do three things. most people when you talk about it, they think it was $787 billion for highway projects. they want tax cuts. it is part of it. it is a significant factor and benefit. people think it is a big $787 billion of public works projects. it is made up of three parts. it will bring relief to those hardest hit by the recession. republican critics think maybe we should not do it. i am not being facetious. it is a legitimate disagreement.

bring relief to those who were fallen into the abyss. jump-start the economy. there are desperate economic circumstances. reinvest in existing infrastructure and lit a platform for economic growth in energy, and health care. that is what it was intended to do. approximately one-third of the money, to under $88 billion, as in the form of tax cuts or tax incentives. we have delivered more than $62 billion in tax relief to businesses and 95% of wage earners in america. that will unfold over 18 months. it is not all paid out at once. there are almost 320,000 new

home owners who took offense of a home buyers tax credit, prevent life back into the housing market. we have encouraged banks to loan to small businesses by putting up front to wonder million dollars in loan guarantees. we have been able to leverage capital loans of $9.5 billion. for many banks who had not made a single loan in two and a half years. helping small businesses stay and some expand. another third of the money went to relief for workers, for working americans who were most badly hit by the recession. whether it was to keep police and firefighters on the job or to allow states to provide food assistance to people who were in danger of going hungry or for

people in desperate need of health care, to pell grants who fell below that $50,000 mark, to extend unemployment benefits. 54 million seniors and veterans have received a onetime check for $250. this gives relief to the billable. it also has had the economic effect of injecting nearly $90 billion in the first 200 days stimulating growth. i believe this was the right thing to do morally. that is not what we are about today. it was also the smart thing to do economically. the last third is about rebuilding our communities while laying a platform for growth. we have made major investments

in highways, bridges, waterways, but some resistence. this has increased the capital stock and has improved the safety in our highways for millions of americans. we're also investing in 24 centric economy. people say we are doing too much. , presidents in the past have been able to take the problems they have and segregate them. we will take these first and put the other five or six a side and we will get to them next. but name me one problem landed on the president's desk that would allow him to say we will focus on this and then focus on this in three years. does anybody think we can leave

the 21st century without it radically altered energy policy? can we sustain our position in the world without radically altered education system attacks does anybody think we can sustain our fiscal house without radical change with the cost of health care in this country? look, we knew we had to begin to lay off the platform while we were laying economic growth, why not let a platform? reno were needed a new smart grid -- we know we needed a new smartrip grid. we saved lives and money. expanding broadbent to parts of the country that were left behind. and having a significant increase impact on productivity.

high-speed rail, increasing efficiency, reducing pollution. electric motors for the next generation of vehicles. when all is said and done, we want an economy that is not built on a bubble. green energy and a modernized health care system, providing good jobs. that is our vision and the vision we are determined to fulfil. we do not think the recovery act is the horse that can cover that alone. that is why i've held a cabinet meeting every week that we have been in session. the joke is, it is my job to hold cabinet meetings? there is the added benefit of getting them all together and

watching the synergy among them. there has been ancillary benefits that have been a long lasting in terms of competence of government. every week, with notable exception, i hold a cabinet meeting. for the first 100 days, i was clear. never write a memo to the president suggested a job. undertaking that you do not want to have. [laughter] do not ever do that. we had lunch. i said you should do this. he said, to it. i did not volunteer for this job. but when he and announced biden was going to be the sheriff, for the first 100 days, dealing with the cabinet members, i made clear our focus have to be

accountability, transparency, and responsiveness. i wanted them all to set up systems where there would have a high degree of confidence that as it implemented what they were in charge of, but it would be done efficiently. i what? ej in trouble -- i will? ej in trouble. he said will happen when you plan to attend dead trees in central park? opposite you'll have to plant 100 good trees in another part. what could have derailed that in the beginning where those stories. millions of dollars wasted and all of the things that everyone was predicting. the first 100 days was the dog that did not bite.

i wanted to make sure that the county executives knew this was not business as usual. i have now spoken to every governor except one, who is now a former governor. it was not by design. she was going to be on but could not for other reasons. i have spoken to other governors twice. i spea fivek to five to it -- i speak to five to seven governors. i said i want every question they have answered in 24 hours. pick up the phone and call any governor or mayor. we have given them an answer within 24 hours. if we do not have the answer, we will call them within 24 hours.

this was all about establishing credibility. this was with accountability and transparency. otherwise, it had no chance. the criticism was a legitimate, that will work moving too slow in the first 100 days. we had to set up a system to show the tax funds were not wasted. i think we're beginning to prove is an incredible important element over the next 18 months. i am very proud of the job the agencies have done in each of the departments. for the second 100 days, i instructed the cabinet that i wanted them to be much more aggressive in implementing the

programs. i take responsibility for the mistakes that were made. i wanted to put more pace on the ball. this was also the season of building. you are able to go out and build highways and late broadband because of the season. it was the planning season. it was time to get the programs up and running. they would let us know what happened. i asked them to set goals. someone said you are going to announce these goals? you're going to ask every cabinet member to tell you what they are going to do in the next 100 days and you're going to announce it? and i said, yes.

reason wasn't any nobility. it was the only way to get credibility and accountability. we publicly announced the goals for the second hundred days. i am here today to report on the progress. we said we would have more health centers to be able to provide expanded health service. we have exceeded that goal by 200,000 new patients. we wanted to fund more education and jobs. i heard about the fear of closing down schools, laying off tens of thousands of teachers. there was a case in new york where 15,000 got their pink slips. they were not going to be able

to teach in the fall. i wanted to make sure this occurred. we set a goal and we have met that goal. we set a goal of keeping 500,000 law enforcement officers on the job as a crime rates began to go off. we met that goal. we set a goal of having construction crews working on highway projects. we exceeded that goal by 94 airports and other highway projects. we started to build 200 water sanitary systems in rural america. we have matched that goal. approximately 4 million 500,000 people will have clean drinking water the did not have before.

we set a goal of speeding up the cleanup worked of 20 superfunds sons. how many speakers have you heard talk about the superfund sites that exist in america? we met that goal. in some cases, we're taking years of the expected completion dates of cleaning up these superfund sites. we met our goals with the summer youth jobs and veteran facilities. contrary to what many have heard an unusual practice, we have achieved them ahead of schedule and under budget. look, let me give you an example. the faa committed $1.1 billion to about 300 airport improvement projects. we will finish those projects with to wonder million dollars

less than originally estimated. they can fund an additional 60 airport improvements. we're seeing the same thing in the department of defense. there are hundreds of millions of dollars in savings. the same can be said for some of our highway projects. we have so many highway projects out there. i had numbers but now we did not have the accounting for all of them. the gsa has also seen projects, and under budget, a% to 10 ^ under cost. they are the facts. 100 days ago, i stated that we had saved or created 150,000 jobs in the first hundred days. i went on to say over the

objections of some by more cautious and advisors that we will create another 600,000 jobs in the second hundred days. they plan to report to the nation the projection of jobs created in the recovery act. i am confident that report will show we have met or exceeded that goal as well. to state the obvious, we will emerge from this great recession. i believe that is necessary but not sufficient. we have to emerge better positioned to lead the world in the 21st century as we did in the 20th century. the last cycle is generated billions of dollars by high- speed trains, this cycle needs to make real investment in high- speed rail.

in this one, we have to bundle and sell it technologies to promote clean energy. with the benefits of productivity, they have not flown in the past. productivity grew 20%, but the income for households fell 3%. we are determined that productivity does not elude the law work and middle class. if you look at the recovery act as a two-year marathon, we're at the nine-mile mark. 200 days in, the recovery act is doing it more effectively than most people expected. some of the most exciting initiatives are just about to get under way. we will be ramping up in the

fall of the loan guarantees self-help guarantee thermal energy. i have an announcement tomorrow on this score. 30 days since the renewable grants program was open, we have received applications for projects that could produce over a gigawatt of energy, enough power to power 500,000 homes. what is the leveraging effect of what we're doing? that will be -- that will remain to be seen. i believe it will be consequential. this will be energy that is clean, renewable, and does not pollute. it will wean us off the other

energy. a new super highway of connectivity that will allow consumers to have real information about how they are consuming their energy rather than decide to turn on their dishwasher on at 11:00. people are building smart toasters, smart washers, smart dryers. this is real stuff. that is what i mean by the leverage in effect. i do not know how to measure that. but i know it is a real. investment in broadband will wrap block in november. -- will ramp up in november. we have over $30 billion of requests, seven times the amount of money we have to distribute.

the result will be that rural hospitals to get consuls' from specialists who are hundreds of miles away. adults can go to a virtual classrooms. ranchers can get real-time price information and sell their cattle online in online auctions burning them more money with less consequence. it is real. these are tangible things that thus far have been denied significant sections of the population. our $7 billion will not answer it all. but once this begins, i believe, as the recovery increases and get stronger over the next several years, you will seek a commitment that did not exist before. we will connect people from the

inner cities to areas that were worlds away from them. we will start investing in better rail travel. i am a bit of a hobby horse on that. the joke was that i was pushed for money on high-speed rail and there goes biden again. all kidding aside, it can be transformative overtime. we have received three applications for thousands of miles of new real, for train cars go 1 under miles an hour and for two that would allow for trent says over 140 miles an hour -- and for transeprain set

over 140 miles an hour. it will allow detroit to produce vehicles that would get the equivalent of over 200 miles a gallon. you need gas stations. you need plug-in stations to charge up these vehicles. we're beginning to fund that. it is having a leveraging of fact, making people realize that this is the future. we will continue to invest in modernizing our health care system so that doctors can have access to individual records by the press of a button. there will be hundreds of thousands of unnecessary tests eliminated. my colleague's driver had chest pains. he pulls into the delaware hospital. he happened to have a

particular element that had -- that, had they known this, it could have dealt with this hypertension. instead, he had several thousand dollars' worth of unnecessary tests. a doctor i met with pointed out the order of a cat scan. he had electronic record-keeping in this office he is set up, and a big orange marker said, are you sure if you need this? eight former kasten have been done just two weeks earlier. this is real. -- a former cat scan have been done just two weeks earlier. are we going to do what? no. we are investing in new platforms. i believe other people will build off of them.

we were about the necessity in the first 200 days. the next 200 days will be about possibilities. these investments are about more than creating jobs. they are about creating and renewing a sense of hope and possibilities. it is easy to sit in washington and talk about what is and isn't happening. i have had the opportunity to travel the highways of this country. i have crisscrossed on highways and interstate highways in large states and small towns. i have met with officials, business officials, farmers, the most oft-heard remark, and i mean this literally, we would go by and they would say, that used to big -- that used to be.

this used to be a steel mill. this factory used to employ 1200 people. this company used to have their headquarters here. the use to was the most oft- heard phrase. but because the investments and the confidence is building, i am now hearing a different refrain -- literally, not bigger fleet. "this is going to be." this is going to be a factory that makes super efficient windows. this is a place still make batteries for cars. this is going to be the hub of a new smart grid to let the cities of the midwest. this abandoned factory is going

to house hundreds of families in adequate, low-cost housing. this factory is expanding, not closing, because we are building new transformers. we will be adding two classrooms. this school will not shut down. these are real stories. the recovery act is helping to write them. not totally responsible, but helping to write to. there will be a lot more of them in the days to come. we're at the nine-mile mark in this marathon. we know there is a great deal more to do. as my grandfather said, the recovery act is not the horse that is carrying out the whole sleigh. thanks to the recovery act,

where we are today is a much better place than we cannot possibly been without it. even more exciting is where i think we're heading. the road ahead will remain very bumpy. there will be positive and negative economic news. i believe it is going to be three steps forward, one step back. that is the wake recovery's work, particularly in the past four decades. we know we're on the right road to recover. we will be able to sustain the growth longer and more reliable. real jobs will pay real wages and allow people to live middle class lives. i thank you all for listening. i yield the floor to the president, as i always do.

>> thank you very much, mr. vice president. we have about 15 minutes. he is already in effect called on ej in advance. did they see a hand go up? antoine. >> try mind. >> thank you very much. -- try mine. >> thank you for the optimistic speech. when the administration --

things looked very dire. things are clearly better. would you say it is just the economic recovery, or was there perhaps an assessment at the time that was perhaps worse than it should depend on what the situation was. you talked about it all depends on oil. your department of energy has wait up to the estimate for gas because of the shield gas. how dependent are we really on for an energy tax >> let me take the first question. do you think the recovery act is responsible for the recovery to the extent we are seeing it? no. i think it is part of it. everything from the intervention of the fed and what we did with

regard to the banks and the housing markets and other things are combining to generate this impact. a local black and reference -- and i believe they are right -- the economist at goldman's. you cannot argue whether it is 2% or 3% -- you cannot argu arge whether it is to% or 3% economic growth in gdp in the third quarter. i think it is about right. had we done just this and not on the incredibly unpopular thing of bailing out the banks, have we not done this and try to stabilize the housing market. had we done only this, we would not be where we are. had we done the other things and not done this, one thing is

certain -- millions of americans would be a much more dire straits now. think of unemployment and cobra and f-map and all the things that were needed for people and extremists. that is for sure. i believe we would not be in a position, you would see an absolute catastrophe occurring in the all but two states of america, who would know possibility -- ask them, republican and democrat -- without the billions of dollars of the recovery act stabilization fund coming and could they maintain. the central services in their states. in the state of pennsylvania, they would've had to lay off 10,000 additional teachers and officers. it is not like you are laying

off the local elevator operator, which is not insignificant, but it is a lost job. these are the essential jobs. pick up the phone. i know you reporters at will. call in the governor and ask them about the impact of their ability to balance their budget without decimating the essential services. the third piece i am confident of is that the infrastructure, which as been badly neglected -- we have been devoting. a% of our gdp to maintaining our infrastructure. china has gone as high as 8% of gdp. they start from a different platform. this was necessary anyway. those of us running for public office, we're talking about investment in infrastructure before we had a recession. part of this is economically

sound and worthwhile in and of itself. it is worthwhile to take some of those 5000 bridges out fare better ready to collapse, a la what happened in the midwest, and fix them. it has the added benefit of giving good and decent jobs and stimulating growth so the barbershop stays open and the deli dozen close. i do not think we translate it that way. this is in the economic bloodstream. there are $90 billion in there now. in terms of the tax cuts. do people spend at all? no. do we wish they would spend more? people are not stupid.

they're spending a lot of it, but they're trying to give straight. they are trying to get right. i think it has been very helpful. with regard to oil, i am not sure i understand your question. for an energy. we're going to continue to need foreign energy. it is not in our interest to be energy independent. we have to be secure enough that we do not need any one source of energy. if tomorrow someone decided they're not sending any more oil, we would be ok. there is a second reason, moving away from fossil fuels. it is the environment. there are multiple benefits that flow here. the other aspect is there has

been studies done here and others think tanks that shows the green jobs pay more for the same kind of effort and a more sustainable looking down erode. many of them are not exportable. there are a number of ancillary benefits that flow from some of the things we're doing. i am not making the case that this is the be all, the end all, the answer to all our economic problems. i am saying that without it, we would be in much deeper trouble. with it, we're doing some really good things, and i believe we're changing the attitude in a number of areas of concern -- education, energy, and health care, modernization of the health care system. i think that has long term

leveraging impact on what is going to happen over the next 10 years. >> i know you like hand-held microphones. we can get one back for you. darrell. >> mr. vice president, you mention projects are coming under the estimated costs. very impressive cost savings. do you think it's time for the american public's to think that the government is wasteful. >> on the last point, i think it's too early to make that decision, to be very blunt about it. i am running the risk of setting myself up for a test on might not be able to pass 18 months from now. i have asked the cabinet members to do in number of things beyond transparently and

accountability distribute the moneys that are in their jurisdiction. i have asked for us to put together a literally handbook on how to responsibly in the future for every government program that is administered from washington, be more accountable, be more transparent, and done more efficiently. i hope the end result of what we're doing -- up until now, you could not find -- if you were to determine whether or not the toilet built in a rest area have been built and how much it cost and how many people in it employed and you went to the interior parts, you cannot find that answer. you can now. we have never done this before.

we've never followed the dollar's like we are following them now. this should be the start of a new way of doing business rather than the implementation of a single program. with regard to the first part of your question, which are forget what it was. [laughter] the a% to -- the 8% to 10% of projects. everybody knows that i am looking to hang somebody. not a joke. the guy who heads up the staff of 10 ig's. when i met with him -- he does not work for me. i asked what he was looking for. i said you would be doing make a big favor if you told me if something was wrong.

i said i want to announce it. he said, that is not awful. to gain credibility, to be able to do this kind of work, but we have to demonstrate and technology when we screwed up, when we have made a mistake. folks do not have a lot of confidence in washington. there is a second reason. people badly needed the work. contractors might have a different circumstances, in and say, i will bid $1,000 to do this job. i am really hurting. they will bid $920 to do the job. i think it is both. are we to gathering and gathering for it and are we making it work for leveraging those dollars to do more to employ those people and to generate a new infrastructure?

>> we will give one last question to the floor from in me. i like to append what amy will ask you and say a word or two about health care reform. what you see is their prospects for a bill emerging and reaching the president's pascal -- desk. >> make it a long question. >> good morning. thank you so much for your remarks. thank you so much to you and your team. we have been working with a number of local elected officials, business leaders, civil leaders around the country who are interested in making sure the stimulus dollars are used in catalytic ways.

just like you, they do not want to waste their prices. they really want to not just focus on short-term job growth but making sure we achieve your third goal of transformative power comes and laying the outcome for that. but they are, as you learn, they are running into some challenges, linking up broadband and smart grid investments, the desire to do neighborhood stabilization with mass transit investments so we really stabilized as neighborhoods and brink market fell you to those neighborhoods. they want to do this across jurisdictional lines in partnership. they are running into some challenges. there are 17.2 more miles left in this marathon. i think on behalf of many of

these folks who are your partner in recovery, what kind of tools or flexibilities are you thinking about to make sure the next 18 months bring the changes about? >> you go put your finger on the biggest -- is is working? there you go. let me make a broad statement first. compare the recovery program and how the moneys are being dispensed to a program that i had a hand in years ago, the cops program. there was a big fight and i insisted in not go to governors and not go to the states. go directly -- you could directly apply. you would put pressure on the mayor was the chief said we want

to apply to get to more cops in town and the mayor had to decide whether or not he would write the application to get a consensus of whether you could do that. it also had a direct -- you can get out of jail, you do not have to do anything other than -- you pass go and you apply for the grant. that is what we wanted to do for an awful lot of what was done in this legislation. the congress decided that the governors should have a bigger in. they might be right. they may be right and the governors had a bigger say, which has caused real conflicts some places. i have found myself in a place, just like you should never volunteer to negotiate a

marriage difficulty. you should never volunteered to settle a dispute between a big city mayor and his governor about whether or not an off ramp that is needed should be funded verses 1 1/4 miles of highway in rural missouri that is needed but is arguably not needed as badly. and so what is happening is the first 100 days, i spent, as you know, negotiating those things. i had no authority to tell the governor or the mayor, but i would get them together on the phone and say, cannot you work this out? cannot you do this? i have done, like it did in the cops the bill, the criticism is i am two hands on. a lot of this is cross

jurisdictional. in some cities -- let me give you one of the big problems. governors now have a problem. everybody has to account for the money beginning october 1. we have a new modern website debt is going to blow you away in terms of how detailed it is. you'll see it in the middle of september. everything has to go up on the website. governor's call and say, joe, i need guidance. you give money for a school district. i did not control that school district. .

as well as a transportation becoming. we're trying to myrick these things together. it is not perfect because we do not have an overall legislation that is called an urban policy. that is what i meant about the catalytic impact that i am finding when you get all of these cabinet secretaries to get there. most of them -- these guys are superstars. watch them. we have sean, these guys are innovative. they are exciting. there is a lot of cross colonization going on. -- cross polinization going on. we have no ability to dictate how in fact the governor and the county executive and a year get

together. last example is broad band. when i am asking the people if they are calling in the conference calls and they say broadband is a big deal. they're saying that by the way, we should have this cost date. i said why don't you get to get their? -- why don't you get together? the governor of state aid, the governor of state be -- the governor of state a and b get together and make a single commission to us. and you will be surprised, i hope, not on what, that all lots of innovative step is coming at this. -- that a lot of innovative stuff is coming at of this.

can we still qualify? i have not bent the law, but i have let the imagination take colhold in some places where i think it is spirited with the law. i should stop. health care. i do foreign-policy, i do not do health care. i am often introduced as an expert on foreign policy. i say an expert is anyone from of town with a briefcase. the reason i choose foreign- policy is it is a lot easier than health care and a lot less complicated. that is not a joke. the thing i can speak to now is the part of the health care of modernization of the health-care system that has nothing to do

with anything from public plans to how many people get covered. think of it as raw, simple terms. if you ran to our businesses from an i.t. standpoint, like doctors are forced to run their businesses, you would be out of business. you could not do it. literally. think about what happened 20 years ago it york law firm or think tank, when you are just sitting at computers. -- but think about what happened when you were just setting up computers. basic stuff. we have to modernize the system that allows for the transfer of the information. it is archaic. it is absolutely archaic. i got trouble forcing once you

have to spend money to save money. my right-wing friends said look at that fighting, a typical spending got. -- look at tahhat biden, typical spending guy. i.t. is that one area. we put that platform down in this legislation. and beyond that is nothing to do with health care, other than also providing money for health care clinics, expansion of those clinics and increasing services. now, i am now about to go out of my brief. with regard to the question of whether or not or what the health-care system will look like they're bored to get, stay

tuned for wednesday. one thing i have learned, do not step on you bosse's lines. [laughter] there will be a major speech with clear terms on what the administration wants to happen with health care, specifically. i can answer the question, do i think we will get? i think the prospects of success are high. i think they're very high. they are high for three reasons. most of the stockholders -- stakeholders, have an overwhelming state in the fundamental change the way the system functions. many of you covered the impact of health care on american businesses. how can they compete? how can american business compete with the ball and chain

they're dragging in terms of health care costs? competing with an international economy, companies from countries where they have a fundamentally different health care system and it is not all laying on top of them. how can they do that? i never thought i would give the dates -- i would see the day where dr. show up at political functions. doctors desperately want health care reform. american business one's health care reform. hospitals know there is a need for reform. -- american businesses want health care reform. and not withstanding all the scare tactics, the vast majority of the american people still know that the system that exists

is not serving them very well. those that have bid are desperately afraid they will lose it. those that haven't had had to dip into it, and know that their premiums go up without any rhyme or reason in their mind. small businesses are getting clobbered as a consequence of that. there is a real sense of need. those details factors are the reason why, i think, that as bleak as it looks, think about every major change in health care. they passed by a couple votes. there are not a whole lot of republicans going for medicare. find a number of people who want to eliminate in the republican party. there are not a whole lot of people falling over themselves in the late 1930's quinto security came along.

it only covered windows and orsondows and orphans. we will get something substantial. i know the president will lay out for you very clearly on wednesday what he thinks those pieces have to be and will be. that is as much as i should said. the president will tell you a lot more on wednesday. thank you. [applause] can i go now? >> you bet. good luck to us on the 17.5

miles that remain. thank you. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> vice-president joe biden speaking at brookings. saying the stimulus plan is working, despite public criticism. also mentioned president obama's speech wednesday before a joint session of congress. live coverage here on c-span. more live rich predict more live coverage coming up in an hour

on the future of health care legislation. on c-span 2, michael chertoff will talk about public safety and first responder communications after the september 11 attacks. that is at 12:15 p.m. eastern on c-span to. >> we will review the health- care debate in congress with highlights from house committee's hearings. on friday night, with the issue stands in the senate. -- wehrhere the issue stands in the senate. supreme court week starts october 4. >> today what we're doing is one of our final days of shooting our documentary on the supreme court. we have been in there for about two months. we have talked with nine other

justices about their job to give us an inside window on how the court operates, the processes of the court, and humanizing it. while we're doing is describing a couple of final shots that we will add into the documentary. -- what we're doing is describing a couple of final shots that we will at into the documentary. >> this is just under one hour. >> good afternoon. welcome to the second session. our topic this afternoon is titled " intelligence, science, and technology, the way forward. my name is george ross. i am president of alcorn state university.

i am pleased to be joined on this panel by a very distinguished senior officials of the federal government. the chief of naval research and the director of the central intelligence agency, the cia. i will introduce them momentarily. we also have the pleasure of two other distinguished gentleman. we have dr. john wilson jr. and dr. john e. houston, the senior research professor at the elizabeth state university is

also with us. [applause] historically 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 to insurgency modeling to applications as seemingly mundane as cleaning products. technology transfers among the u.s. governmental agencies, corporations, h pc use -- hbcu's, and other institutions are impacting our national security and affecting our daily lives. there is a great deal of talent on the campuses of 105 institutions. programs at the office of naval research and the cia will allow

these government agencies to tap into the talent. by tapping into the innovative ideas and research that is being carried on at hcbu's around the country. today we will this -- we will explore how they can build capacity and partnerships by jointly collaborating with the office of naval research and the cia. as we seize the capacity to thrive 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 and their professional and personal lives. between 1946 and the founding

of the national science foundation in 1950, the office of naval research was the federal government's only agency whose principal mission was the support of basic research. over the past 63 years, the office of naval research has evolved into a more diversified agency. today the office of naval research is responsible for basic and applied research and technology development as it ordinates, executes, and promotes the science and technology programs at the united states navy in the marine corps. these programs produce research and technology portfolio to serve as several constituencies, the united states congress, the fleet, of course, industry, and universities. -- the fleet, the force, industry and universities.

admiral car is a navy veteran. he started in the navy when he was 17 years old. i did not ask how old he is now. he is navy admiral at sea. he is been deployed to the indian coast, north and south atlantic, south pacific, baltic, caribbean, and red seas. he served on the u.s. asking, uss mccandless, uss dwight d. eisenhower. and among others. and he commanded the uss cape st. george, winning gold and anchors and both tours -- wining ning golden anchors in both

tours. he has served in office of the secretary of dispense where he worked on that our early bird. he later served in the office of the chief of eight new -- @ chief of naval operations. he was executive assistant to the commander of u.s. fleet forces command. and following promotion to flag rank in 2006, he was assigned as deputy director of surface for air 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 be a from -- by earning a ba.

the admiral and i have wanted. [laughter] -- ahvhave bonded. he completed the advanced management program at harvard business school. in december 2008, she became the 22nd chief of naval research with the additional duties as the test and evaluation and technology requirements director. ladies and gentlemen, please join me in welcoming admiral nevin p. car jr. [applause] >> thank you. distinguished colleagues, thank you very much for the opportunity to join all of you here today. to say a few words about the critical role of science and technology in our country's

future and the key role played by america's historically black colleges and universities in the success of that future. the 105 voices of history that many of you heard on sunday night are also the voices of america's future. today i would like to touch on who we are and what we do at the office of naval research, like a long association with hcbu's and offer some thoughts on what the future demands from all of us. in the military we talk a lot of capability vs capacity. to weus capability means we have the wherewithal to accomplish a

mission. it means we have aircraft are weapon to do a particular job. capacity means we have enough of it to do the entire mission and fill the entire need. clearly america has talent. out there in the many young minds that will one day run this country, what is not so clear is that a sufficient number of the bright young minds will enter the fields that drive science and technology. especially is the contours of our population continue to of all, we need to make sure we of power and leverage every inch of the in order to build the capacity that we're going to need to succeed. by that i mean numbers, numbers of graduates, members of professionals, numbers of teachers, researchers, and scientists. i spent about 35 years in the navy so far, as you heard. about 20 of those at sea. it was a privilege and a joy to command warships.

i learned to appreciate the importance of relationships, community, and engagement. and the need to take care of every single member of the crew. commander of the ship is, of course, more of the command of humans and machines. it only works if the entire group contributes. as the chief of naval research, i oversee an organization loaded with talent. right come enterprising, program managers. brilliant researchers and people with a can-do attitude. our history began with the establishment of naval research lab in 1923. this was at the urging of thomas edison, right across the river in maryland. the office was created after world war ii >

, to build an enduring link between science and the fighting needs of the marines. this has given us dps, radar, radiography, the country's first intelligence satellite, and nuclear-powered ships, the first global atmospheric prediction model, and synthetic lubricants. the oldest manmade object in space was built right over there along the river at the naval research lab. and they did their job well in the early days of the space program and as a reward there were pulled out to form a small new organization called nassim. -- called nasa. we exist to provide advances for use on the battlefield, but many of the advances have application for everyday life. one example is a new acoustic technology for processing.

it is in use today to improve imaging techniques for early detection of breast cancer. we work through over 1000 universities, non-profit organizations, 35 principal investigators, 3000 graduate students and in 70 countries. we have offices in london, singapore, tokyo, and chile. most recently we were ranked by several national magazines, including black engineer, hispanic engineer, women of color, and was named the most admired employer. our talented team includes graduates in leadership positions from jackson state, north carolina, south carolina

state, st. paul college, and alabama state. in short, we draw from the best to provide the best. we embrace the philosophy that our navy must reflect the face of our nation. this began in 1985. in 1989 and dedicated program was established according undergraduate and graduate students for five schools. in 1992 that investment increase to 6 million annually and rose to 10 million in 1994. we supported programs in 22 hbcu's minority institutions. 90% of the students graduated on time with undergraduate disea degrees.

we have a research partnership program, dedicated toward participation in disciplines relevant to the navy. the summer faculty program provides opportunity for faculty members to participate in research at u.s. navy laboratories. the research and education partnership program is designed to improve research and discipline important to the navy. it exposes students to civilian careers within the naval research enterprise through summer internships that may be labs. recipients are selected for study and research leading to the editorial degrees in engineering. -- leading to the pictoriadoctos

in engineering. finally, we're developing a program set encourage our government, university affiliated research centers to partner with us to take advantage of the numerous grants and programs out there. it is not an easy feel to navigate through. -- not an easy field to navigate through. the common theme is basic research on marine composite materials and sandlin structures. at north carolina and chiea &t,r team is 6 examining marine --

is researching material. this has been evaluated for possible use in bergen areas to save lives in the event of a fire. this is an especially bad thing in a submerged submarine. in 2008 we awarded almost $6 million to hcbu's. the naval sea systems command provided 24 undergraduate scholarships to students studying engineering. i just selective use as examples. -- i just collected fees as examples. -- i just selected these as examples, there are other programs.

we're looking into power and energy, information sciences, direct energy, speed of light weapons and human performance. we're sponsoring research in fuel cells, portable power applications and rechargeable batteries for unmanned underwater vehicles. in autonomy, investment is focused on robotic interactions, and architectures for adoptable autonomous systems. in weapons development, the free electron weapons program will use new technology. most of this work is being done in jefferson lab. finally, human performance programs range from molecular biology to advance medical therapies for saving lives and

the study of protection of our environment. we are but discoveries and relationships. shifting demographics in the u.s. mean we must focus our attention on reaching out more to the first universities -- on reaching out more to reverse it universities. we must continue to engage every bright, young mind that has the capability to help us invent the future. no single segment of any population has seen of debt to provide the necessary capacity that our country in future need. we need to tap the entire crew. i would like to conclude where i started. we have plenty of capability in the untapped talent of our community. which are rich in private

addition, and deeply rooted patriotism, america's historically black colleges and universities will play an increasingly important role in educating and inspiring the bright young minds that will build that future. the impact of view, the leaders of those universities and colleges in those roois rooms, t be understated. i look forward to working with you in the future. [applause] >> thank you. we all thank and salute you for what you do for our country into a 35 years of service. thank you. [applause] this morning our executive director give us three charges.

the third one was to discover, identify, and eliminate an best research and best brain power. the admiral talk about some of that discovery is that our schools and the 25 year relationship have discovered. i encourage all of us to build in that capacity and capability to increase even more so of those relationships and partnerships with the office of naval research. in 1947 president harry s. truman signed the national security act, creating the central intelligence agency. the acts also created the director of intelligence. the director is the principal adviser to the president of the united states for intelligence matters related to national security. today as the premier agency

responsible for providing global intelligence on the ever- changing social, economic, technological, and military environment the cia accomplishes this mission through research, development, and deployment of high-leveraged intelligence gathering technologies. creating special multi- disciplinary center is to address such high-party issues as non-proliferation, counterterrorism, counterintelligence, international organized crime, environment and arms and intelligence. the cia forges strong partnerships between the collection agencies and disciplines and it takes an active role in the overall intelligence community. today we have with us the director of the central intelligence agency pa.

leon edward panetta came the 19th director. as director, he manages to men intelligence and open source collection programs on behalf of the intelligence community. mr. panetta has dedicated much of his life to public service. before joining the cia, he spent 10 years co directed with his wife the leon and soviet and at the institute for public policy base at california state university -- leon and sylvia institute for public policy based in california state university. from july 1994 to january 1997

mr. panetta served as chief of staff of president clinton. prior to that, she was the director of management and budget, a position built on works from the house budget committee. -- he was director of management and budget, a position built on from works in the house budget committee. early in his career mr. panetta serve as a legislative assistant to thomas could show a california -- thomas cucho of california and the executive assistant to mayor john lindsay of new york. he also spent five years in private law practice. he served as an army intelligence officer from 1964 to 1966 and received the army commendation medal. he was not here when i talked

about the football game, so we will not tell them. [laughter] she holds a bachelor of arts degree in political science and law degree, both from santa clara university. he was born in monterey. his parents purchased a farm, a place with the director and mr. panetta continue to call home. they have three grown sons and five grandchildren. ladies and gentlemen, please join me in welcoming the director of the cia, leon edward panetta. [applause] >> thank you very much, dr. ross. i would also like to think secretary duncan -- thank

secretary duncan for inviting me here to share thoughts with you. it is a privilege and honor to be here. more importantly it is an honor to me because of several reasons. number one, your mission, which in many ways reflects the spirit of our democracy. because of the work you have done ito promote equal education 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 i think 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 that 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 and our family -- in our family to go to college into university. as the son of immigrants, the values that i just talked about in terms of achieving a better life are what i believe in and what my parents make sure that we understood was the reason that we were to be educated and

to learn and 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, and a speaking ability, very few skills? and yes, they lived in a poor area of italy, but at least they had the comfort of family. why would you leave that to come to a strange country and travel all of those miles? my father said the reason we didn't -- we did it is because your mother and i believe 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.

and in line with that is the importance of recognizing that as we get our children a better life -- as we give our children a better life, they have the responsibility to give something back to this country as well. my parents always emphasized the importance of giving back to this country some measure of duty and responsibility in return for the opportunity that my parents got. so public service has been part of my bloodstream for a long time. you heard my resident beginning from being an intelligence officer in the army to be chief of staff to president of the united states and now as director of the central

intelligence agency. all of 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 the opportunity to succeed. in many ways, as i said, my career tracks the struggle you have been involved and in achieving equal education. early in the 1970's, as mentioned, i mserve as the director for civil rights. our responsibility was to promote equal educational opportunity to all of our children, and primary responsibility we had at that time was to basically breakdown the dual system and desegregate schools that had been divided by a lot between black and white

children. it was in trying -- it was trying to assure that school districts were complying with civil rights laws and brown vs. the board of education. having worked on civil rights laws in congress, i believe that it was my responsibility and that job to enforce the law and to enforce the constitution. when duty of the law conflicted with the politics of the time, i decided that duty was more and corn. i have never regretted that decision. -- i decided that duty was more important. i had the opportunity to work on funding for black colleges and universities. i worked with bilbray and members of the black caucus to ensure that we would be able to provide funding.

-- i worked with bill grey and members of the black caucus to ensure that we would be able to provide funding. president clinton signed an executive order with oversight of the initiatives and will federal plan for assistance. as director at 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 the diamond at -- with a dynamic fatality that no one else can measure, diversity -- with dynamic vitality that no one else can measure, diversity 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. recruited a divorce work force -- recruiting eight diverse work force is crucial to the cia for several reasons. first, this nation was first founded on the principle that we are all created equal. it is the fundamental principle that says america is going to ensure that all of us,

regardless of our race, regardless of our sexual orientation, regardless of whether we are disabled, regardless of what god we believe in will have the opportunity to succeed. citizens want to serve his or her country in the field of intelligence. it is wrong to let those kinds of issues stand in the way of success. the other reason is equally important, because very frankly diversity helps us do a better job of keeping this country safe. good intelligence requires officers from diverse backgrounds who have different approaches to the issues that we face, who bring a wide array of

skills to our mission, and are products of the cultures of which we have to operate. i would like to underscore how important diversity is to the cia by talking of little bit of what our mission. -- by talking a little bit about our mission. our mission is to protect the safety of this nation. today and tomorrow. we are a nation at war. we are confronting all war in afghanistan, a war in iraq. we are confronting al qaeda and other terrorists and pakistan -- in pakistan who threaten our homeland and troops.

we are confronting the challenge of nuclear proliferation in countries like north korea and iran. we are confronting a whole new challenge, something called cyber security, which has the potential to in fact bring down our markets, bring down our power grid system, bring down our water systems and cripple this country. we are confronting the challenge of instability. instability in the middle east, in africa, and latin america, and southeast asia, in 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 strategies, what do they intend to do that will hurt us? 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 future. when president obama offered me this job, he told me to call 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 very best intelligence that we have, not because it is politically right, because he wants to hear it, but because it is the truth. what i emphasize with every cia officer is that our responsibility to the president and to the leaders of this country' is nothing less than providing the truth. our mission requires highly- skilled people from many different fields, 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 the support for our mission, it goes to the core of what we do as an agency. these are people, i have to tell you, 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 art case officers on a daily basis. men and women, who are out there trying to see if we can get people to spy for the united states, to determine what is going on in other countries,

what are they thinking? what are our enemies thinking? to try to develop a collection of intelligence so that we know what is happening. some of the 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. that right finished reports, that try to say to the president and leaders of the country, why is this intelligence importance and what it means in terms of our security. they are sector -- subject experts and their well-versed in the analytics. 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, 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 be able to know what makes people tick, otherwise intelligence does not mean much. a lot of this is about getting officers to understand countries that they have to engage in. intelligence to be affected, we have to reflect the face of the world that 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, goal, and it is our goal is to substantially increase the diversity of our work force in the next few years. the position that the cia -- what we're 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 attend -- intend to achieve. [applause] by its very nature, diversity encompasses many dimensions. ethnicity, cultural, educationally, religious, racial, behavioral, sometimes not easy to quantify, but one element which is minority representation is the one area we would like to see our work force closely approach the level of the population that we have in this country. the cia needs to reflect the face of this country. that is what michael is as director of cia. -- that is what my goal is as director of cia. we get more than 140,000

applications at the cia, almost 400 per day. if there is a new james bond movie, we get even more applications as a result of that. [laughter] our attention -- retention rate is one of the best in government. right now and new officers -- right now new officers that come in, we lose less than 1%. almost one-third of our new hires this year are minorities. that is good. but we can do even better. we want to significantly increase minorities and their inclusion in student intern programs as well. we aim to expand national origin hiring. and substantially boost the

number of new officers with foreign languages. above all we are widening our improvement -- recruitment pool by going to more places that offer a rich variety of talent ed candidates. we have already started recruitment efforts at 17 other schools this semester -- 17 of your schools this semester. we enjoyed working relationships with many of the career offices and will reach out to more of your schools in this coming year. our officers also participate in the intelligence community centers for academic excellence, the innovative program that was led by dr. lenora gant. we are very proud to be part of the black executive exchange

program, which has an excellent job of cultivating future leaders in government and industry. i have to tell you that more than just a diverse work force, we have to have a diversity leadership as well. [applause] my agency seeks to give all of our officers, obviously the training and development that they need in order to take pride in their work. we need to make sure that in every case accomplishment earns a seat at the table of leadership at the agency. by any measure, we do not have been that 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 they can achieve the leadership positions. achieving greater diversity in senior leadership means giving up and coming officers what they need to learn in order to be at that table of responsibility. the bottom line is we are putting the cia on the track to better represent the best and brightest from all of the communities that contribute to america's greatest. it is good for all of us and it is good for the nation that we serve. this month marks eight years since the attacks of september 11.

all of us must remember the lesson of 9/11, that we must do everything possible to make sure that that never happens again to this country. it is the tireless worker 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 high honor of working with some of the most capable and gifted people that i have known in over 40 years of public service in this town. these are people who frankly do not 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 commitment to service. . . >> 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 better nation, and to fight for a more secure nation. it is a story i often tell that

makes a pretty good point of the rabbi and the priest who decided they would get to know each other of the better, and they thought if they went to events together, they could learn about each other's religion. one evening they went to a boxing match. just before the bell rang, one of the boxer's made the sign of the cross. the rabbi nudge to the priest and said, "what does that mean?" the priest said, "it does not mean a damn thing if he cannot fight." [laughter] now, frankly, we bless ourselves with the hope that everything is going to be fine in this country, but frankly, it does not mean a damn thing unless we're willing to fight for it. [applause] i know that you are willing to fight for a better life and for a better nation, and i look

forward to working with all of you in being able to make sure that that american dream that 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 our military. we thank all of us for being vigilant, because the most important thing we can do is protect our country thank you, sir. net we will have some remarks --

we will have some remarks and the senior research prof. and director of the african-american studies program at elizabeth state university. [applause] >> director panetta has to leave, but i want to give him this award before he leaves. 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] and we trust the sincerity, the sincerity and authenticity that came through, and we believe that he intends to do what he said he is going to do. that is a good thing.

we celebrate that. [applause] the second thing i want to say is that this is the hbcu community, and like you, we generate intelligence, and we pursue truth. we have some things in common. thirdly, because of something that you mentioned, i want you to know that we can help you in a very special way. one of our most prominent hbcu alums, my classmate and a good friend spike lee is about to shoot a film called "inside a man the." some of usyou saw part one and he is doing part to print some of us could use a black james bond character. we could call you to recruit. here is an award for you, leon

panetta. [applause] all right, he has to leave, and we thank you again. let's give him another hand as he leaves. [applause] and now we will have a final remarks. >> we are about 10 minutes away from a discussion on health care reform from the alliance for health reform at the robert wood johnson foundation. live coverage on c-span at 12:15 eastern. at the same time on c-span2, a former homeland security secretary michael chertoff will be talking about public safety and first responder communications after 9/11. that is it 12:15 on c-span2.

we will review the health-care debate in congress tonight with highlights from house committee hearings and analysis by martin vaughn of dow jones newswires. friday night, or the issue stands in the senate. sunday, a comparison of health care systems around the world with a former "washington post" reporter t.r. reid, on "deal in." the president makes a speech on health care before a joint session of congress next wednesday. c-span will cover that speech live. the worst talked about it this morning on "washington journal -- viewers talk about it this morning on "washington journal." the president will flesh out his vision in a speech. aides say that the president will use the speech to add more specifics to his vision to overhaul the nation's health- care system.

meanwhile, the store from the front page of "the wall street journal quality -- obama re- launches the health bid. -- the front page of "the wall street journal." the overall under discussion would require most individuals to buy insurance, a federally operated exchange, where individuals and small businesses could buy insurance and tax credits to help people buy the plants. -- to buy the plans.

and also, this morning a front- page as the president heads off to camp david. he will spend the labor day weekend there. he is trying to resuscitate his push for health-care overhaul and has decided to address a rare joint session of congress next week to make a revamped argument. first up is david joining us from miami. caller: i'm a first time caller. host: it is early. you are on the independent line. caller: listen, i just heard about that.

i got a bit some ridiculous hour this morning. what i wanted to say is that about the joint session. i have listened to a number of the town hall meetings and i had passed judgment on them. i think it is very odd that those hosted by the democrats seem to have a lot of hecklers and people who just boo and mr. of the speakers. i have not noticed that at all from the republicans. i don't know what to think of that, frankly, but it just seems like somebody is up to some shenanigans on this. host: david, if you are interested in watching the health care hearings we have covered, go to our website at c- span.org. we have the health care hub that has indexed each of the town hall meetings we have covered

over the past month. it includes some of the ads as well. outside the beltway, the pittsburgh paper has obama to address congress on health care on the front page this morning. we're joined on the republican line from north carolina. caller: good morning. thanks for taking my call. i know that president obama is going to speak to congress during health care, but also noticed your headline but said "seize control" -- i think a lot of people are missing the ball. the real story is the changes coming from the white house via the czar cabinet that has not been approved by congress. i like to see investigation into that. national endowment of the arts, all kinds of other avenues to pass the message.

host: thanks, bob. this is the headline you were referring to from the front page of "the washington post." margie is joining us. caller: i really missed hugh. y you. you cannot force the american people to go pay the bully who stole your money when there's the public option. that is immoral. the second thing, in chicago there is a major medical center for some people to give flu shot even if they are allergic, or

there will be fired. what is that? there is a carcinogenic in that. now that i have cancer i might think about it. forcing people and there is no public option -- if they don't have the public option, i really losing the fight. not in my life, you have to keep áighting -- but this %abr guest: in june. i got medicaid. let me tell you something, they don't are deeply they pay. -- they don't argue. they pay. i want to be bankrupt. i'm already pour now read but to have people with no jobs that are kept like wal-mart purposely without health care, telling them they have to buy it from the bowleys and still get nothing, they have to -- from the bullies and stop at nothing, they have to go to work sick --

republicans, if you give up on the public option, i cannot even anymore look at you, because it is worse than we expected from people who hate their own citizens republicans, democrats, i love you. i fought for 30 years to take care of your health. please take care of your fellow person. don't use people. we are like joseph mengele at the top. >> how was your health today? >> it is all is cracked up to become not chem -- suppose to be, chemo. you find out who your real friends are. i will survive and be a better nurse, a stronger nurse. but i cannot keep up this fight. we need to fight the american

hospital association for a safe nursing and staffing. we want to take care of people we do not want to get out and make money. if you do, go somewhere else. >> thank you for your phone call, and good luck to you. this morning, the financial times, congress to -- obama to push congress on health. "the address on congress's second day back after a summer of frenzied lobbying, particularly by republicans opposed to the administration's plans, will mark mr. obama's return to the center of the debate did it will only be the second time since taking office that he is addressed both houses of capitol hill." independent line. caller: my heart goes out to the last caller. i'm a liberal independent. i was a democrat for 24 years,

and i went to become an independent in may, because i was mad at the democrats going against president obama is on numerous issues. however, there are three bills in the congress for the public option. senators ted kennedy's health committee has a public option, and they are organizing for america, which i volunteered for. we serve it on a public option -- surveyed on a public option for almost two months, and public option was heavily supported. with the mixed messages from the democrats, i just stopped a voluntary, because i got really mad at listening to kent conrad and some of the conservative democrats. they don't belong, they will do not work for an nancy pelosi or

president obama. one thing about senator kennedy's funeral -- after they read a letter he sent to the pope, no one said about the letter that the pope sent to senator kennedy but i guess that was a conspiracy to keep the religious right man at the democrats -- mad at the democrats, so they believe that the democrats will go to hell. this the first time that i've seen the pope's letter kept a secret. host: "cardinal o'malley issued a forceful defense of his decision to participate in the funeral of senator edward kennedy, and parents that has drawn criticism from some conservative catholics because of kennedy's support for abortion rights.

he revealed the substance of a composition had with president obama near the altar of the church. he said that he told obama the catholic bishops are anxious to support a plan for universal health care, but we will not support a plan that will include a provision for abortion." more details on line at boston.com. this headline from "the daily news." this is as a result of his new book that is due out later this month, the 14th of september. "the new york times" has obtained a copy of the book. "it does not ignore the low episodes," says that line. "senator kennedy called his behavior after the 1969 car accident inexcusable and said that the events -- >> the worst thoughts on health care from this morning's "washington to c-span.or-- vie'

thoughts on health care from this morning's "washington journal." the alliance for health reform and the robert wood johnson foundation is hosting this discussion just starting on c- span. >> america's largest philanthropy, working to improve health and health care. you will hear in a few minutes from the ceo, risa mourey. we are on the cost of getting a substantial initiative for reshaping america's health-care system, or we will not but what is at stake is not just $2.50 trillion we will spend this year on health care in the u.s., and more in the years ahead, but the quality of lives, maybe even the fact of life, for millions of people who lack access to at

affordable, quality health care. privott as that president obama will probably launch this next phase of the debate -- everybody knows that president obama will probably launch this next phase of the debate in his joint speech to congress next week. you may have heard this before -- there is still a level of disagreement about what to do on some of the major issues in health reform. in fact, there is some controversy about almost every major element of the packages that are being debated. congress and the president may have to come to some agreement on these major issues, or agreed not to decide some of them, if there is going to be a significant reform plan enacted. that is what occasioned today's meeting. brought together some of the best health policy analysts in the country to address many of these issues in response to your questions as we can cram in the

next 75 minutes or so. without further filibustering, let me present my co-moderator, doctor risa lavizzo-mourey. she's a geriatrician by training. she still sees patients. she runs the largest lathery develop it a pretty -- largest philanthropy devoted to improving health care for americans. thank you for being with us. >> thank you for hosting this and inviting me to be co- moderator. this is a critical time to have this conversation. the robert wood johnson foundation has been working on this for a long time. back in january, if we can all remember back that far, when we began talking about this debate in earnest, we laid out six big areas that we thought it needed to be addressed in order to

achieve what we all want, which is a healthier population and health care for everyone. first, we need to have coverage. i think we agree that having the equivalent of 24 states without having health coverage is unacceptable. it is unacceptable because if we do not cover everyone, it is hard to see how we will get to the second thing most people agree we need, which is higher quality, higher value health care. and more equity in health care. you cannot get to that without having everyone included. we have to address issues of health care spending. we are spending, as you have already mentioned, more than any other country, and yet, we don't have the highest -- [unintelligible] the next. we identified is prevention. we have had a lot of debates

over the last couple of days about prevention, but most people agree with the data that primary prevention and community-based prevention leads to a healthier people, and that will be needed if we are going to reduce the burden of illness in this country. and then there are a couple of other things that are absolutely critical -- improving the public health system, and addressing what makes us healthy in the first place, those things that happened outside of the medical care system, the social determinants of health. it is hard in today's environment, with all the heat we have had over the last month, to see how we are going to get to all those things in the next hundred days. but i hope that as we have this discussion today, we stay focused on the fact that most americans want affordable, high- quality care that is accessible to them when they need it. that is something that i think

most everyone can agree on. hopefully we can bring out during this debate that doing nothing is not an option. the institute's study recently that show that if we do not take action, we will have more uninsured, higher costs, and probably higher costs of the government as we need more people to be enrolled in medicaid and the like. doing nothing, i think, does not lead to universal coverage, just universal pain. with that, i turn it back to you. >> thanks very much. i think the urban institute paper about the cost of inaction is in your packets. a quick logistical notes, you have in that not just that paper, but extensive biographical information about our speakers and background information. if you happen to be watching this on c-span, and have access to a computer, you can see all

the materials on our website, which is allhealth.org, and follow along, and in a week, there will be a transcript of this session that you can read on that same website. i would commend it to you healthreform.org, organized by the robert wood johnson foundation. you stole the url i wanted, but it has useful background information. we will kick this off by asking each of our panelists a single question and then giving you a chance to weigh in with your questions. any problems or questions that you have, our communications director, who did all the heavy lifting of putting this session together, will be delighted to help you. and someone for the foundation is also here who can answer from the west -- answer some of your

questions. let me give you the briefest and least deserved introductions that i can get away with for our panelists. we will start with gail wilensky, an economist and senior fellow at project hope. she has served as president george h.w. bush's health policy adviser. her current areas of concentration also include military held issues, which she has described as one of the greatest fascinations she has run across, and comparative effectiveness. dallas salisbury, on the fourth need on my left, is the ceo of the employee benefit research institute. if you of not discovered the resources yet, you have been missing out. what else does not know about employer-based coverage, you do not need to know.

at the end of the table is ken thorpe, head of the health policy department at emory university and a member of the partnership to fight chronic disease, a group of more than 100 organizations of every stripe that is trying to shape a health care system that treats chronic conditions better. now let's get to the questions to start this off. gail, why don't we start with you? i mentioned your connection to medicare, and medicare place big role in the plants that are being developed, for generating savings to offset expansion of coverage costs, to testing new models for payment, a whole range of other things. abbas did these provisions likely to survive -- our most of these provisions likely to survive? how should and fisheries feel

about those provisions? -- how should and fisheries feel about these provisions? >> i regard to proposals regarding medicare that we have heard thus far in many ways as a metaphor for the challenges that we are facing in health care reform in general. the medicare program has a clear is sustainability issue. there are clinical appropriateness and quality issues, as is true for the rest of health care. in some ways, it is lagging even further behind the rest of health care in terms of moving towards integrated delivery systems and more management of chronic disease. we see the challenge that medicare and health care reform in general face a very clearly in the proposals that have been laid out to raise money. what the administration is looking for in order to finance

health-care expansion is quick money, because it is clear that we can spend money very quickly in order to expand coverage. massachusetts has made that very clear. the problem is that many of the changes, while ultimately likely to benefit the system, medicare, and produce savings over the long term, might not do so in the short term. i will use two examples to clarify the tension and challenges that the administration and congress faced in trying to come up with the money quickly vs things that are in the long term likely to provide sustainable spending that will not be scored by cbo in the short term but one is producing in appropriate emissions. this is a -- reducing

inappropriate admissions. one out of a five admissions is to free emissions. -- r eadmissi -- readmissions. he might say what is the problem here? the problem is the way you reduce inappropriate in missions best is to get nurses to follow patients when they are discharged to make sure that the medications have been fulfilled and are being taken and that the doctor's appointments or nurse practitioner appointments that are necessary are in fact scheduled and met all of thes. all of these take money in the short term. it is problematic when you look at hospitals with higher readmission rates. they have a lot of medicare and medicaid patients.

since medicare reimburses hospitals at a -6% rate, not covering the costs, and medicaid frequently does worse, it means that hospitals that are most likely to have these inappropriate admissions are the least able to be able to finance the kinds of strategies in the short term to fix the problem, those that have a lot of medicare and medicaid. can it be done? absolutely. will it produce savings? it will. the problem is the tension -- you want money now for expansions. most of what we wanted to will take some time. the second thing is nursing home rates. it has been now for some time that medicare is a relic of the generous pay your four nursing -- a relatively generous payer for nursing homes. if you pull out money for medicare, which is a former

medicare person, i have th sympathy to, you are going to put what has been a pretty fragile area of health care into a real financial distress. nowhere do i see additional money for that. these are the tensions. you need to slow spending. you can do it, but the ways that you get money quickly are not the ways that reduce -- that produce the kinds of changes you need to get quality. it is a dilemma. >> thanks. let me turn to dallas , if i can. many of the plans we see emerging from the democratic side impact employers. alternative taxes that would have to be paid to provide or pay for the coverage for their workers. how do you characterize the position of big employers, or

for that matter, a small employers, all the reform proposals we have seen so far? >> some things are a sense of deja vu as we started doing surveys on this in 1981. consistently, if you think about employer opinion, the number one issue they have always cited is similar always citedgail just -- i have always said it is similar to what gail just cited, cost. the on sustainability of the existing system, be it public or private, on a cost basis. the second reality that employers deal with across the spectrum, and have a four decades, is the key role that they recognize health insurance pays in attraction, retention, and even in the exit decision. our value benefit surveys that

go back to the early 1980's repeatedly underline that 80% of workers say that health insurance is the number one most important supplement to pay. if you then say you can add a second benefit, what would you want, 36% say more help insurance. when you ask are you willing to take a reduction in current wages in order to have better health insurance, over 50% consistently say yes. then you take another factor -- about 1/3 say they are in their current job because of the health insurance. if you want to keep people, that is a good thing. you what labor force mobility, some employers do, that is a bad thing. 35% say that health insurance was the key factor, the most important factor, in taking the last of that they talk. -- taking the last job that they

took. it is in very important to job selection. and players are in a catch for -- employers are in a catch-22. the employer wants choice and flexibility. that comes down to what big business has supported since the early 1970's, when it was enacted in the employer retirement income security act. it allows employers to "self- insure close " to avoid 100% of state law, a state mandate, state differentiation, and maintenance of that has been a number one priority of all businesses since that point in time. in the current debate, if one tries to find a differentiation on that one cannot, because one

of the strongest points made in the website and speeches and testimony by the small business and, the chairman and national federation of independent business, but they want out of health reform is to have for every small business the equivalent of an aggressive pre- emption without having to self- in short. they want the government to sit here is a high deductible, catastrophic protection program that is the bitterest of bare bones coverage and avoids personal financial disaster, which any small business should be able to provide on a nationally consistent basis through state cross border purchase, etc., with a structure, be it a co-op or association health plan, so that they can avoid 100% of the current state mandate, regulation, etc. the other piece of that flexibility that comes through from all of the groups is most

readily identified as a total repudiation of tax change of employment-based health benefits, which the largest businesses say maybe a little, but as the months have gone by, that seems to have dropped off in any willingness to discuss that. in the clinton years, and during the 1980's, this was very heavily debated on capitol hill. the tax reform act of 1986 included many, many debates and discussions and the so-called treasury one in 1983 and 1984 would have a fundamentally change the tax treatment of employment-based health benefits. this is not an issue, but the positions have not changed. the most important issue in the context of the house and senate bills, beyond the changes in the house bill that are uniformly

opposed by businesses, are issues related to mandates, be they individual or employer- mandates across the business spectrum, when one looks or listens, any form of employment pay or play amended at this point is generally uniformly opposed, even though they have been willing to live with some of that in massachusetts. that was the price of the inevitability if you read some of the surveys. on the issue of the individual mandate, some flexibility, but not much. the general statement that this does is make across the board in their trade associations is that any cost savings need to come out of the system in order to pay for the universal coverage, and it should not be done in a way that leads to cost shifting. you'll also find in the positions fairly uniform opposition to the public plan or

a government takeover. i will close with the final irony. the only business group at this point that has been willing to be aggressively what one might describe as negative is the national retail federation. almost all of the business entities and business groups have taken instead the position of the necessity of comprehensive reform, because the current system is unsustainable. there is no plan b, they all say. there must be reform. if you look at the letters and the statements that they send to capitol hill -- for example, one dated june 8, "we have problems with any change in taxation of health benefits, we don't want accretion about public plan, we favor no employer mandates, no employees opt outs, and we

oppose all provisions of the house bill, but we still strongly support comprehensive health reform." if you go to the nfyb web site, you get similar. if you go to the business roundtable, the website has a full verbatim text of a conversation in early august, and it is the same type of thing -- support for most the provisions that risa mentioned, expect when one gets to the specifics. i was born and raised in washington at the feet of great senators, and one's staff produced a book called "the dance of legislation," good for this topic and others. henry jackson said, "paid no

attention during the process, because legislation is like making sausage, and at the end of the day, you just want a compromise that has a tasting good." that is where we are at here. tremendous disagreement over the details, but a recognition that employees want health care, that employers must make sure they had it. but employers don't like being told to do anything, so they want a free rein it tied to the current pre-emption. that seems to be universal. >> okay, see how easy this is going to be? let me finish off this initial round by turning to ken thorpe. everybody u.s. spoken so far has talked about health care costs. -- everybody who has spoken so far has talked about health care costs. they have been criticized severely for not doing enough to hold down health-care costs.

i wonder if you think that is a fair criticism. if it is, what changes would you advise congress to make and the president to make in this final plan? keeping in mind what the nfib and the chamber were saying. >> it is a top starting point, but thanks, ed. we started this discussion about health care reform trying to address two major issues. one is to move towards universal coverage. i think it is broad agreement about that as an objective. obviously, there's a disagreement tactically about how to do it. but i think we have a broad agreements about moving to universal coverage. 9% of the attention and discussion and reporting on the issue has focused -- 90% of the attention and discussion and reporting on the issue has focused on the discussion of moving to universal coverage. the other thing we are trying to

do, when you look back to the campaign and the candidates talking about this, was to control the growth in health care spending. that was a major objective of health care reform. i think that while the reform packages, as they stand, are a good start, none of these things are going to be perfect. the question is, directionally, be it moving in the right direction? i think so. but i think if if we do this in steps, which i think we have to -- this will not be one bill and then we go home and forget about it -- we will pass something, i hope, and then come back and improve on the legislation. but what we have to do is focus more on the coming months and years on finding ways to control the growth in health-care spending in addition to moving to universal coverage. if we are going to be serious about it, we have to go back to the basics about what is driving the growth in spending. gail touched on one of the issues. one is that the share of adults

that are clinically obese in this country has doubled since 1993 that doubling by itself accounts for 1/3 appropriate -- doubled since 1990. the doubling by itself for 1/3 of the growth in health-care spending. the rate of treatment of chronic illness in this country is rising at a very rapid rate across the board. kids, adolescence, and young adults, seniors as well. we have to pay attention to a broader toolkit than we have traditionally used to attack this issue of lifestyle, but to do it in a way that is not punitive, do it in a way that is awful, do it in a way that gives people options about four -- do it in a way that is thoughtful, do it in a way that gives people options on how they work. no. 2 is when you look at how we spend the money, 75% of the spending is on chronic illness.

in medicare, 95% of the we spend is related to chronically ill patients. the irony is that medicare is probably the only program where we do absolutely no care corp. nation. of any program needing to have care coordination built into it, working with patients at home, making sure they are not admitted to a hospital in the first place, as gail talked about, reducing the rights of free admission, improvements in the program would improve the quality provided to the beneficiaries at the end they would save money. one of the things we could do is provide care coordination overtime nationally in the program by building on this medical model but rebuilding community-based prevention. using nurses and nurse practitioners and care providers to work with patients and keep

them healthy, keep them out of a hospital, and keep them from being readmitted. we will have to invest in this. this is an important change in the delivery system infrastructure, one well worth making. it will provide dividends over time, no question. i would be a quick financial example. if we are going to build kerik what a nation into the program nationally, -- bill to care coordination into the program nationally, based on things in vermont and some other states that do this with a population, it would cost about $25 billion, $34 billion over the next 10 years. that sounds like a lot of money, and it is. but in the context of the numbers we are talking about in the overall package of reform, those are the second and third decimal points of what we are looking at. but yes, it is going to cost money to do this.

if we took readmission rates in the program from 20% and cut them in half, which we know we can do -- we have programs in place in pennsylvania and colorado and other states that have been showed through randomized trials can cut readmission rates in half. medicare has high rates. mission. if we build that program into this care coordination model, medicare, we could save $100 billion over the next 10 years on just that one aspect of care coordination. we now do this. we just have to make the investment. -- we know how to do this. we just need to make the investment. if we are really going to deal with the long-term deficit. we have to address per capita growth in medicare spending. if we are going to improve the quality of care in the program, we need to make the investments in primary prevention, but we really need to change the delivery model to improve the

quality of care provided, improve the health of seniors, and we did a lot to reduce readmission rates in this program. but we cannot do it within the current payment structure and delivery model that we have. as part of the promise of reform, we should not just doing health insurance reform. that is a major piece of what we should be doing, but we should also be giving health reform, which is really trying to find ways to improve the health of the population, redesigning, re- engineering the delivery model to improve the quality of care, and at the end of the day, but the the public and private sector, we have the chance of producing a better health care system that generates better outcomes. >> thank you. let me just say that there are green cards in your pockets to buy questions on. given the array of eager people in front of me, i would urge you

to actually ask a question or early, because you probably like it has to have your question read -- probably will not get a chance to have your question read, if that is the way you choose it. we have microphones, so raise your hand and please wait for the microphone to reach you so that those of us around the room and around the country can hear you. identify yourself and keep your question as brief as you can. right in front of me is our first questioner. >> i was curious how each of you think the threat of death panels has been addressed in recent weeks. and have any of you at the opportunity to read this book that the veterans are suppose to have the opportunity to receive injured veterans that may

actually give them, it seems, the option of choosing death over life. it was addressed on fox news and the former bush administration -- it was addressed on fox news on sunday morning a week ago. >> i have not read the va booklet. i will not comment on that. i would like to comment on the death panels' charge, which i have done a number of times. i think is really unfortunate that this has been raised and receive some attention -- received so much attention, because there are serious issues to debate in the health care reform -- how we finance the money, the whole notion of a public plan, whether it is or is not compatible with private insurance, whether we are not talking enough about reforming health care costs and only about health insurance reform.

many issues. i regard the death penalt -- death panel as a red herring issue. to the extent that we're proposing payment for physicians that are asked by the beneficiaries, the patients, to have counseling on high that the hospice benefit or end of life directives once every five years -- the reason it is unfortunate is twofold. in the first place, the hospice is already a medicare-covered benefit now. in addition, and nursing home administrators and hospital admissions individuals are supposed to ask people who are on medicare when they are admitted to hospitals and nursing homes if they have the advance directives, and if so, to mark it in their cars so that this advance directives can be

followed. -- market in the chart so that the advanced directives can be followed. i regard this as a way to pay physicians to provide counseling if they are asked to buy their patient. and finally to empower patients -- fundamentally to empower patients to have their wishes known about advance directives if they choose to do that. i do not know how many you have advance directives. i do. when i was at medicare, this is when this was first arose with medicare. to allow people, not when they are -- to allow people to have this discussion with their physician or their nurse practitioner or their family members, to try to help them think through what is an issue that individuals may face, being put in a position when they are not able to register their own will in turn is of how they would like to be treated, is an

important part of life. it does not require people to have these discussions, just like medicare does not require people to have the hospice as a benefit. it allows it. i think it is a major empowerment for seniors, but any senior that does not want to have this discussion, either about a hospice benefit our advanced directive, may not do so, and that is why i find it so upsetting that there is this notion of death panels. >> i think that you said it beautifully. as a geriatrician, i have to comment, because what people don't often appreciate is that the vast majority of people don't really understand what kind of care is available to them at the end of life. what kind of palliative care they can access that would actually make their quality of life better. our foundation has funded a lot of this research.

it is critical that people get this information. you said it so well, but i think that for those of us who have actually had to counsel people at the end of life, this is an important part of being able to do but we want to do, which is to deliver high-quality care. >> if i could personalize it, i recently lost my father just short of his 95 but they. -- 95th birthday i had advanced directives for 25 years. at 93.5, and 92, my mother and father were both awfully glad that medicare provided for the hospice care that he got at the end of life. i think it is extremely unfortunate that this has been turned into political rhetoric. that is a personal view, but it is something that i fully agree with what has been said.

>> managed alpa executive magazine. i'm wondering if the panel thinks that the public plan option at this point is dead, or, if it is not dead, whether it would be advisable in order to have health reform legislation, for it to fade away quietly and disappear. >> it clearly is not dead. it is one of the most contentious issues, and unfortunately, it seems to have dug itself into a prized possession -- position that is going to make it hard to negotiate around, because you have people like the speaker of the house and howard dean, in a program that i did with him, indicating that without a public plan, health care reform is not

worth doing. other people who have set having a public plan is going to impact of the rest of health care and have a lot of negative consequences. as i indicated, i think that a public plan is not desirable as and addition, because i do not believe that a public plan will avoid using the power of government to set below market reimbursement -- that is, to not, in fact, paid for the cost of health care being provided. we see this in medicare. medicare pays physicians 20% less than private plans. medicare pays hospitals about 6% less than their costs. if you have a public plan also doing this, you are going to do what medicare does, which is push costs into the private

sector, which will come over time, unravel private insurance. there are a lot of ways to accomplish, in my view, what a public plan has been postulated as doing in terms of driving change, making sure that there are choices available, and making sure that insurance companies don't discriminate according to health status and pre-existing divisions. which is a part of any insurance reform that is likely to be a package. but it is very unfortunate, and particularly, in some ways, frustrating, because as several of us have mentioned, many of us -- medicare in many ways is the least desirable model to think about driving to and an integrated delivery system that focuses on chronic disease management and moves away from disease focus an acute care and into one of wellness in managing

chronic disease. medicare is even a step behind the private health care system, which is typically too little of that as it is. -- which does pitifully too little of that as it is. we have to be clear as to what people look to for a public plan and other strategies to achieve them, which i think are achievable. but when people in leadership positions making statements that without this contentious strategy, health care reform is not worth doing, you put yourself in a box that i think as a politician you never want to be in. >> i want to comment from my experience working on this 15 years ago with president clinton. at that time, we really had a strategy that was universal coverage or bust.

and we had l bust. my concern with this discussion -- i want to take a step back -- we are trying to accomplish the slowing of health care spending in the public sector and private sector to make it more affordable for families and business to keep health insurance and improve the quality of care that we get. and we want to move to universal coverage. we are having a technical discussion on how to do -- tactical discussion on how to do it. one of the things we should be doing is adding to and building on some of the good pieces that are already in the legislation on cost control, and overtime trying to expand and so that we can do these programs nationally. discussion about the public option speaks volumes to the fact that we need to d