control the growth of health care spending. for me, the best way to do this is to attack the core problems -- the explosion of chronic disease, the fact that we have a poorly managed chronic illness in this country. we can do better on both of those fronts. . >> built on these principles of primary prevention and improving

how we deliver health care. that is the direction we should be going. if we are serious about doing cost containment, those are the areas we need to focus on and not let it derail us from the objections of moving to universal coverage. >> i went to add one. which came to mind when ken did his opening comments. is universal coverage meaning everybody has health insurance? if one uses the pension exam and apply it to health benefit programs, coverage doesn't mean you have health benefits, it means you have access. participation means you have it. this goes back to the debate in 1991 towards the end of the bush administration. is the public plan, is it using

the term of universal coverage as the objective of everybody actually having health insurance, everyone as a participant in a program. if one looks at the group's ken just mentioned, the nfib explicitly says their definition of coverage is the old bush administration definition. it is access to the opportunity to purchase coverage, it is not participation. if one looks at other business group physicians it is coverage = access, not coverage = participation. -- coverage equals access not coverage equals participation. they are equating it to participation and arguing the public plan is the way to get

participation, and all the other places like massachusetts where you do not have universal participation or even the netherlands, where you do not have universal participation, you have 3% choosing not to purchase. i think the public plan issue ends up being this absence of a clear debate over and participation verses access, which underlies a bunch of it. >> that is a completely different issue. you can have a mandate for individuals to have coverage and not have a public plan. it is a question of how you want to enforce it. rather than talking about the public plan as the holy grail,

we ought to indicate what it is we are trying to accomplish and seeing whether it there are strategies. massachusetts has a soft mandate where they allow people without access to affordable coverage to not be fined. the fine itself is quite gentle. the question on whether you want to push required coverage is a good issue to have in the open for people to be debating and not hiding behind this debate about a public plan. we need to be sure we understand what it is you think it will do for you. >> i believe we have you here first and then we will go there. >> i am from the cleveland [unintelligible] what are the issues you guys think congress and president

obama will be able to achieve consensus on? what are the issues that will be too controversial that they will get tossed by the roadside? >> i am optimistic on the issue of cost that we can do something meaningful in modernizing the medicare program and do something effective in helping to slow the growth on medicare by improving the quality of care we provide in the program. those are the purchase that are well-understood in the private sector. they are approaches we have seen other states do this. they passed statewide legislation that would modernize the delivery system infrastructure in those states. it had wide bipartisan support, so those are areas where we can

build bipartisan support on. they are common sense things to do. there are things we have been talking about for the last year as central to doing health reform. the road to universal coverage always has been bumpy. i think we can make steps to get there. the question will be much do we chew off this time? whatever we pass is not going to be perfect. if we can pass something that is fairly major with the notion we have made in the right direction, that we can take another whack at it next year is the way to go. it will be difficult to get it passed in one fell swoop. we learned that 15 years ago when we had a comprehensive package. perhaps if we had broken it up

and had a trajectory of two years but an agreement on where we will end up, then maybe we can get it done. >> i don't read the answer to your question. it is a very good one. it will depend on how much can be financed. as a result of the tarp package and this stimulus bill, there is no additional appetite in the congress to have any additional unfunded expenditures which has made all of this more difficult. the question is going to beat where will there be agreement on funding, not just among congress by acknowledged by the congressional budget office as being real money in the relevant time range. i don't know how much agreement

will be possible in terms of what that package looks like. it may well be smaller than what we are talking about right now, $900 billion over 10 years. my assumption is that the subsidies at the higher end of the income scale will be cut back or possible eliminated so that more concentration will be on expanding medicaid coverage, and subsidies beyond that to purchase health care in a health insurance exchange, but how big and how much subsidy i don't know. i don't know whether or not this will be a go it alone strategy, as people have been talking about, where is only democrats and then through the reconciliation process which

would be unfortunate but is raised as a possibility. if that occurs, it not only lowers the bar in terms of only needing 50 votes, it may restrict the legislation that can be passed in terms of doing the kinds of things that's ken and i have talked about. the rules about what can be included in a bill if it goes through the budget process are narrower, and some of the health care delivery might be out of that. i don't know where that will end up. it is a big challenge, not just whether or not they are going to be able to find a bill that tracks several republicans, but with a more conservative democrats are going to be on this issue, the blue dogs in the

house and the six or eight conservative democratic senators in the senate. directionally, that is what i expect. i am hopeful we will see health care reform package of some sort. these issues at expanding coverage and slowing spending and improving quality of care are not going to be helped by just kicking the can down the road for five years. we have seen over the last 15 years that these are issues that will only be addressed by direct policy changes. we need to start making these changes in the course of several bills over the next few years. >> right here. >> thank you very much. my name is rita and iran for

asian pacific audiences. -- i write for asian-pacific audiences. there has been an assertion that illegal, undocumented people in the united states contributes in large measure to the health costs. other than eight being perpetrated in at talk radio but -- been perpetrated in the talk radio, but it has also been asserted by advocacy groups with data. would you be able to address the serious side of this question on how the health cost is being gobbled up by illegal people who

are not supposed to be here? >> that is a very hard question. about 30 years ago my activity in washington was focused on helping to put together the first of the large expenditure surveys called the national medical expenditures survey. it is now an ongoing survey that the department of health and human services collects. i have been curious about some of the numbers i had been seeing reported as to how many of the people either currently who are uninsured are people who are illegal immigrants and how many people who would remain uninsured are likely to be illegal immigrants. i have had some e-mails with some people i worked with who continue doing a survey research because my question had been how

would we ever know that? the answer is it is almost impossible to know then. the way we make estimates is to use annual current population survey, which is done by the census and every 10 years we have the full census. in the populations, they're blown up to the known number is 80 estimates based on 50,000 household population surveys are used to try to get estimates who does not have insurance. it is difficult to get estimates about the numbers of people who are here illegally. when you think about it, it is so much more difficult to

imagine getting information about the insurance status of people who don't want to have any discussions with people who are from the census. i think that there are parts of the country along the borders who face stress because when people are in acute illness, hospitals may not turn them away. it is one of the serious charges that a certain law that requires hospitals with medicare services to not turn anyone away if they are in an emergency situation. they will come get you if you are charged with pushing people away for what ever reason, including that they did not have coverage.

it is not that there is not care in the communities along the borders or where there may be unusual congregations, but there is very little that is known accurately about the impact of illegal immigrants. there has been some work that has been done looking at the impact of immigrants who are illegal, and i had thought that the use of services was more or less offset by the tax contributions and the employment these individuals were providing, but i don't recall the steady very well. -- i don't recall the study very well. illegal immigrants are having on cost or insurance estimates

with a large grain of salt, because we do not have good information. >> i stress gails'point on the senses. the numbers are out next week so you are likely to see some attention to this next week because of the numbers. the census does not ask people whether or not you are a u.s. citizen. studies we have done had looked at the border states specifically on this issue of. what the census clearly shows is in the border states the percentage of the uninsured of hispanic origin is exceedingly high, but it does not tell you legal or illegal status. that is one of the primary drivers for texas have been the highest percentage of uninsured and the state. to gail's his point, there is no

way to make the division because my understanding from hospitals is when they do provide this service they do not ascii there. -- they do not ask either. >> let me raise a broader point on this. it goes back to the discussion on healthcare reform. i agree with both, nobody knows the answer to that question. if they say that they do, i don't know where they're getting it from because we don't have the data. we do know that there are roughly 46 million people without health insurance. that is a mix of legal residence and illegal residents. if you look at total spending in the population, they encourage spending of about $60 billion a year. a lot of that spending is not explicitly pay for, which means

two things. we are spending a lot of money on the uninsured. we are not spending it wisely or doing preventive care. we could do a much better job. but if you look at how we pay for this, we are spending $20 billion a year in federal spending today to provide assistance to hospitals and other institutions to provide health care services for the uninsured. we already have $20 billion a year we are spending. what is not fully paid for gets bumped into the cost of private health insurance. we are paying for it one way or another. we either pay it from our health insurance premiums, federal funding. one hospital in atlanta, the

local taxpayers pay for it. a chip in about $110 million a year to offset these costs. i like the point because it brings us back full circle to what we are trying to do. there is a lot of money spent on the uninsured the not too late in terms of when they get their health care. -- money spent on the uninsured, too late in terms of when they get their health care. >> the uninsured use about half the health care of the insured population even when you adjust for health status. while it is true that the uninsured receive some health care now, usually fragmented, when they receive coverage they will use a lot more care and

hopefully care that will allow them to lead healthier lives. maybe over the long term to receive that care in better environments. >> let's go here and then i have been ignoring this side of the room. >> i am a finance writer. on the question of -- i think he said there was $100 billion in savings for better care coordination. he said there was money to be had by reduced hospital in missions. in the current political environment these are perceived as medicare cuts and we don't want the government on our medicare. what do you think will be in the final bill in terms of administrative changes that will improve the efficiency of the system? how can that be pitched so people don't perceive these as

medicare tcuts? you have to take 25 year time horizons. why do we have the entire economics profession raid against the idea that prevention will pay? >> i want to take on the second one first. the prevention one is a curious discussion, because there are a bunch of things we can do on the prevention side. 99% of the attention to this discussion has been on detecting disease. the primary goal of doing disease detection is not to save money. the primary goal is to intervene earlier to make sure people have healthier lives and hopefully live longer. there are other forms of prevention averting disease in the first place, i talked about

this in terms of making sure people who are pre-diabetic don't become diabetic. we have random trials that show that these work. we now do that in community- based settings that show that they save money. those interventions save money and work. there is another type for people with multiple chronic health care conditions to make sure we can manage their conditions so we don't have complications resulting from them. we have programs that are well- designed, and they save money and improve outcomes. there are three dimensions to it. detecting disease, which is not designed to save money, can work

if you target people appropriately to intervene earlier. on the medicare side, we have some good reforms build and after moving in the right direction, changing how we pay. doing something on the delivery system side. we need to build those out so that they are available nationally so we can make a dent in the growth and spending. if you think about care coordination, that adds to the benefits. that improves their benefit package. you have people working with you at home. you have a nurse working with you in the hospital to do it-a charge planning -- to do discharge planning. if you do it right, they state money. the combination of kaine it

changes -- the combination of payment changes enhances the value of the package. those are the things we should be building on in this discussion. >> the comments and studies you have seen with regard to prevention typically are focused on screening and narrowly- focused activities. whatever the purpose of using additional screening, even if it is a good thing because it provides a strategy for early intervention doesn't mean it will save money. you ought to make the arguments correctly. if you are doing it because it is a way to avoid a human cost

and medical costs down the road, it may or may not save money depending on how well you can target who is at risk. you may choose to do in any way and regard that as money well spent, but you should not make the argument that it saves money if it does not say if that system money. many of the specific prevention activities that are cited fall in that category. whereas if you could change behavior with regard to obesity or others, that would have a lot of the fact, or being able to intervene with diabetes. you have to be careful about how we phrase this witte medicare and what they are being willing to score. a lot of what we have been talking about is the right change direction only.

we don't know how to make some of these payment changes. there are a lot of demonstrations that are ongoing or included in the legislation. we need to make sure there is an ability to impose them as they show themselves to be effective. cbo will not give you a lot of credit and they should not because we don't know which ones will work in terms of changing away from a system that rewards more complex to one that attempts to provide incentives for chronic care. we know what we would like to have it look like. we are not sure how to get there. what we do know is the kind of spending we are talking about for expanding coverage is quick and certain. if you don't plan to spend unfunded money, you need to have quick and certain funding.

that is the dilemma that is being faced. most of the quick money is either lacking at reimbursements, which is antithetical to the changes we have talked about that will take it down the rhetoric, or if it is increasing rabbinate and additional taxes. that has their own issues, but that is the dilemma. can you tell a beneficiary on medicare not to worry, they will slow down spending by $5 billion? i don't think you can do that. i think there are a lot of things you could do to slow medicare spending that will cause money up front, the kinds of changes with regard to lowering remissions which would give you savings on spending

down the road. if you are using reconciliation, that is irrelevant window. and how much -- that is the relevant window. if a good change like lowering readmission by having people be able to have interventions for their medication fulfillment and their scheduling with their physician and nurse practitioner, you need to watch out about how much of that cost you up front and how much will you save in the second year? this will require some careful crafting, because if you want sure scoring by sbo, just whack at reimbursement. when government is pressed for money it usually goes after the

benefit the population served or it just wax -- it just whacks reimbursement. unfortunately it is antithetical to the changes we're talking about that would allow us savings in the long term. that is the attention that will have to get solved by congress. >> let me make three quick points because gail and ken have addressed this early. when someone speaks about prevention, my question is what kind of prevention are we talking about? whether you are talking about screening tests for community- based prevention, it gives you a different answer. we know that investments in making the community healthier yield a positive return on investment. studies have shown $5.60 for every dollar invested in five years.

the second is what is the outcome you are looking for? if you're looking for saving money, i would say you are asking the wrong question because what we're trying to do with prevention is prevent disability and allow people to have more productive lives, which will produce more benefit for the country. the third point is we have to think about prevention is where there were nine -- whether or not we are using the right time frame for understanding what the impact will be. if you look at how long it takes to get the negative impact of obesity, date is 10 or 15 years. yet cbo is scoring things within a 10-year horizon. in order to see the benefit of the investments we make you have

to look out beyond what we typically do. those are the three things that we have to ask ourselves when we are trying to assess whether prevention saves money, which is often the wrong question to ask. >> we have a couple more moments. i know there were some people trying to get a question in. we will go further left. >> i in with -- we have several health newsletters. i hate insurance companies. the thing i am interested in is what would the panelists say is their absolute bottom line on a bill being passed that could truly be called health care reform? >> for me, it has to deal with

these two issues. it has to do health reform, so it has to have things that improve the health of our population focusing on preventing disease, focusing on people who have chronic illness, improving their health to keep them from progressing in ways that are preventable. those are things we can do. we need to invest in them just like we invested in health information technology. we invested $19 billion to put into place in permission technology which we know is a critical infrastructure investment. we need to make the same investment in care coordination nationally. i think the bill also has to have a clear path to move to universal coverage. we need to have a track that we are doing both of these.

i think it is more important to get there in the not hold hostage the better goal of universal coverage to the approach of how we get there. >> i am hopeful that we will revert back to what had started as a discussion on health care reform and has morphed into a discussion on health insurance reform. i am hoping that was because of polling decisions and not because of intent to focus on health insurance reform. it is important, we need to reform the health insurance market, but sustainability and approving -- improving quality is even more important because they affect the 85% of us with coverage as well as the 15%

without coverage. a bill that is worthy of the name healthcare reform needs to have a lot of attention focused on how we are going to begin changing our delivery system so we reward the kind of changes we want to see and we don't move in the opposite direction. it better have a lot of authority given to the hhs secretary so that successful pilots that show that they can help move acute-care-focused health-care into more integrated corrugated chronic disease focused. we need to acknowledge that we don't actually know how to get from here to there, so we will stumble along the way. it is why you probably won't see

a lot of credit from the budget office in terms of savings that could be provided if we do it right. it is because there is so much uncertainty about how to do it right and how long it will take to see savings. >> if i take your question more narrowly which is an assessment of will there be a bill? my response will be yes, i think there will be. largely because of what i mentioned on the front end which is most all of the interest groups involved in this business, labor, insurance, farma are still sticking to we have a plan where we need health reform. driven by the factor that has been most readily stressed at this table, which is dealing with cost, dealing with quality,

in dealing with chronic disease. driven by a recognition of necessity to a highly-performing well work force, that they have health coverage, they have health treatment. employers are absolutely committed to the knowledge that in the absence of reform of any type, they have to continue to provide it. the cost curve is unsustainable, so they are in this conundrum. whether it is bipartisan or a single party bill, but i think all of that is going to come together and you will not see what you saw that killed it last time. that is a whole lot of those interests relatively early in

the process moving to plan b, which is kill it. back then there was nowhere near a consensus across surveys, back then there was not the absolute belief that it was unsustainable. today there is a belief that kids just repeated -- there is a belief that is just repeated a. there is lots of disagreement on the details, but even if it ends up having to be the interest groups just with the democratic party, i think you will see something that is relatively comprehensive because of this absolute recognized the necessity that you cannot accept the provision and sponsorship of health-insurance even if you want to and at any hope of attracting he and retaining

people you need to run your enterprises. -- attracting and retaining people you need. that is the belief behind the necessity of reform compared to prior points in history. >> let me _ that by saying the belief is backed up -- let me underscore that by saying this is backed up by important studies. whether you look at five years or 10 years, there is likely to be more people uninsured by 30% to 40%. the costs for employers for premiums will go up. cost of individual's premiums will go up, and that doesn't address the issues we talked about in terms of reforming the delivery system so is more efficient. at this point there is consensus that we need to have change.

it is probably going to require some evolution of policy in order to get it to where we will hit two big, but there is no question that doing nothing as not an option. >> that is the bottom line of the bottom lines. i don't want to hold you beyond our time, we have already done that a little bit. i know there are a lot of you that have questions. i know you will appreciate that, but let me take this chance to thank you for some lively discussions. i think the folks at the foundation for the support and participation -- i thank the folks for the foundation. we will convene on december 12

on the 100th day to see how far we have gotten. thanks for a much. [applause] c-span[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> we will review the health care debate in congress tonight with analysis by one analyst. and on friday night we will talk about where the issue stands in the senate. then a comparison of health care systems from around the world. as the debate over health care

continues, the health care hunt is a key resource. go on line and follow -- the health care hub is a key resource. go online and share your thoughts with your own psittacine video, including video -- with your own video. there is more at c-span.org. >> in about 20 minutes robert gates and mike mullen will take questions. until then, part of this morning's "washington journal." host: thanks for joining us. guest: it is good to be here. host: we spent the last few days looking at health care through the eyes of hospitals. wanted to take a look through a hospital facility. guest: unity healthcare is a non-profit organization. it has federal responsibilities

and certain federal privileges. has about 30 clinics throughout the city, but there are about 950 of these throughout the u.s. we essentially take care of those who are medically under- served, often lack health insurance. they may have medicaid, medicare, but not always the capacity to be able to access health care on the private market to. we provide what we call culturally-sensitive services. we provide not only the health care, but also wraparound services like social work and case management, linguistic translations. many who come to us out of that 90,000 are from other countries, or are from this country, but do not always speak the language current around here. our funding is a mix. we get federal funds, contracts from the district of columbia department of health,

corrections. also raise money privately through our foundation. we also get medicare and medicaid money because under federal law health care centers have to be reimbursed reasonable rate for the services they provide. host: why would someone go to your clinic as opposed to johns hopkins or howard university? guest: we are cheaper, firstly, but the important thing on primary health care is to keep people out of the hospital so they don't go there inappropriately. the hospitals you mentioned are all excellent and provide great care. getting care to people at the right time and place. the community health center, and environment on primary-care basis, it is where people should get the preventive care. then one must go to the hospital there is a continuity between the primary care and hospital.

the common use is that of the emergency room. it is not a standard, ongoing system of care. it is a very costly process. host: for patients to go to your clinic, one of the 30 in washington, d.c., how many have insurance? guest: probably about 3% have private insurance. some would have medicaid or medicare coverage. the district of columbia is quite generous. it has the alliance program. many of the people who come to us are economically challenged as well as socially challenged. unity can provide not only the health care, but the wraparound services. many people, the majority would be under the poverty level. they can pay a little amount

towards their health care which is required under the federal funding we receive. host: one of the things we learned is the number of contract employees, doctors who work outside the hospital are not employed directly by the hospital but work at fairfax or george washington university hospital. how does it work at unity? guest: unity has directly employed physicians, nurse practitioners, midwives and we also have dentists and psychiatrists. we have well over 120 of these professionals. they are directly employed by us on a full-time or part-time basis. there are some who are specialists who may work part- time with us and then we will work in a private facility, but ours are full-time employees employed by unity healthcare. host: we welcome you to phone

calls. and the numbers will be on the screen. for patients to go to your clinic, is in lieu of their own private physician? cspan.org. guest: because they do not have a regular physician to take care of the needs we become their physician. we are not really -- the quality of health care we provide is comparable to any health care you or i could get in the community. our physicians are well- qualified. many initiatives we do around disease management, health promotion -- all of the prevention, all contribute more effectively to the care of the patients then might be happening to you or to me in our private sector. host: as to emergency rooms, often people wait for crisis, those who do not have a private physician.

guest: yes, it is expensive and puts the burden on the appropriate use of the emergency room. additionally, it does not allow for the best continuity of care. it is like on a car. if you are on regular checkup basis, you prevent it needing emergency room. of course, there are always emergencies that will happen. but going for a non-emergency issue is counter-productive from a health care and a financial perspective. that is why community health care centers across the u.s. are a real answer to this challenge of the uninsured or people who lack direct access to primary care. host: what typically do you see? how different is it because 97% do not have insurance? guest: oftentimes the delay in care. by the time they arrive they might be in a chronic condition that if it had been seen earlier

would not have them. we see hypertension, diabetes, hiv, cardiology. a significant amount of mental illness. probably all of the factors that contribute to poor health outcomes generally. health centers are located in urban areas where historically there has been the lack of access where people are unsure. in rural areas sometimes health care centers are the only access point. we have to become a system of care for a defined population, eventually opening it up as a solution to some challenges right now in reform. the people who come to us, of those there are millions who do not come. that is why i believe health centers can play a very important role in accessing care for patients and getting them connected on an ongoing basis.

we need to remember that the health insurance card does not guarantee that you have access. there are 47 million that we're hearing are uninsured out there. bringing them into the system will be the challenge and insurerinsuring that the systemd doctors are there for them. host: what they want to hear as obama addresses the houses? guest: a solid effort toward reform. that would be recognizing that the 47 million uninsured people will be able to find access. the costs will escalate. do you or i need specific reform in insurance? probably not, although we will admit that our premiums and coo- pays are becoming more expensive. i also run a business and might cost for my employees is going higher. we also want to see the

president provide a commitment to ensuring that when reform of whatever nature -- there will be physicians and facilities there to care for this influx. of new influx host: our phone lines are open. vincent keane is the president and ceo of unity healthcare. good morning, caller. caller: i want to comment on the important aspect of health care that no one is discussing. i saw the rand report. healthcare is killing the economy. whirlpool went to mexico. 1200 jobs. it cost them $2 million per year for health care. we have probably lost 10 million jobs in industry because of health care. insurance companies are obese. i think that chuck grassley is

right, that they should be euthanize. people do need health care. unless a solve the problem of how to pay for health care, insurance companies are not doing it. and a capitalist. i want american companies to succeed. and they cannot do it with this insurance. it has to be changed. it is revolutionary. guest: thank you very much. but a very good question. the cost of health care -- is bad enough now, but if we do not do something it will only get worse. as we are hearing from the key players, the cost is going up. there's no sign that will be brought under control. reform has to happen around the insurance industry. it also has to be a cost- effective way to provide that care. particularly to communities you live in and in urban areas

throughout the u.s. that system is not always there to address the need. host: our guest is vincent keane and our next caller is jeff, here in washington, d.c. caller: good morning. mr. keane, it is refreshing to see you on c-span and thanks for coming. it is very important to have folks from the grassroots level and those who are working in the trenches, not to talk about medical policy at this time. i hear a lot of channel noise from people who are not involved in the actual dispensing -- dispensation of medical care. many people from the so-called grassroots are protesting the medical policies of the current

administration who has only been in office a fraction of this year. yet we expect these gigantic popular decisions from the obama administration. let me get to the point -- i see all these political pundits and appointees giving all this leeway and policy development -- more than anyone in the trenches during the war. i have worked all my life and have been under-insured. i recently had this surgery. the surgery was about $20,000. prior to that, talking about preventive care, i had fallen on my wrist about 20 years ago. i went to georgetown university. i had a job working at georgetown university. the doctor told me i had a

sprain, did not need surgery. i think this was a result of them perceiving that i was uninsured. at the time i had blue cross blue shield. apparently blue cross blue shield did not want to cover that level of care. host: let me jump in because others are waiting with questions. did you have a question for our guest? caller: yes, that is -- what level of service does unity healthcare offer? guest: thank you. sorry about your wrist. it is not uncommon for people who have -- for people uninsured to have delayed treatment, but you were injured. we provide all the basic primary services you would need from a doctor, dentist. if you needed some case management or mental health therapy.

what we do not offer specifically ourselves is inpatient hospital care or surgery. however, our doctors and support staff to arrange for that and make sure there is referral. @@@@ medicaid or medicare. if you do not have insurance unity has a long track record of working with volunteer providers and hospitals who have been very generous in allowing us to serve those patients who are uninsured. getting more difficult in a difficult time to deal with that secondary level of care, but we can take you all the way to that and sometimes do more than you can imagine. host: do you feel your organization are ready to scale up to handle 50 million more patience? guest: that is the challenge.

right now today no. there are 950 delivery sites today. the president has already seen the value of community health centers by allocating a lot of money for the stimulus, said the answer is we are ready, we are willing and able. however, it will have to be phased in. there are several billions of dollars needed for capital development so that the government and local states will have to support that effort. there is a need for 20,000 primary-care physicians. entities like unity are working with the federal government through the national health service to fill those positions so that patients get the primary care when they need it at the right time. the answer is yes, we are ready and we are planning over the next few years to be able to

serve 60 million people. today we serve 18 million people. host: john is joining us from south carolina. good morning. caller: i just wanted to say that i don't think it is the government's responsibility to provide health care for anybody, nor is it a business is responsibility. host: whose responsibility is it? caller: it is the person's responsibility. that is why they called them benefits. host: do you get health insurance? caller:no, the only health insurance i got was through va. host: but the government provides that. what struck me is when you said even businesses should not provide health care. caller: know, that is why -- no, that is why they call them

benefits. host: if you got sick who would pay for it? caller: nobody, i would not go. guest: that is a unique opinion. i think it is important we look at this not from a partisan perspective but the program i have been outlining in the last 20 minutes has a wonderful bipartisan support. there are not many programs in the united states senate that are supported strongly by orrin hatch and the late senator kennedy. they have -- this program has had bipartisan support, realizing the need is for the government to step in when people cannot do it themselves. i disagree with me caller that

is the responsibility for the government to provide it. host: our patience in serious need of emergency care turned away from unity health care clinics? guest: no, no one is literally turned away. the problem is if a person comes in with an emergency problem we cannot handle. that person would be referred to an emergency room. if they are referred to the emergency room, they have to treat them. we will go so far to the point of caring for them, but if it is determined by the physician to be an emergency beyond capacity. let's say someone is having a heart attack. we will do all we can to stabilize them until the ems gets there, but it is then appropriate care to be passed on to the emergency room. i don't know if the caller was

asking if they get treated. yes, they do get treated. host: last week for three days we took a close look at how medicare works. it included a conversation with a doctor from the virginia hospital center. . guest: it has some guarantee for poor people who are uninsured to

access health care. not every poor person in the united states is covered by medicaid. there are state regulations as to who gets covered another benefit package. -- covered under the benefit package. crandon women with children usually are covered. >> we will leave this recorded segment to take you to the pentagon for a session with robert gates and admiral michael mullen. >> i want to start with an update on where we stand with general mcchrystal's assessment on afghanistan, and then i will turn things over to admiral mullen for his perspective. first, some context. soon after taking office, president obama approved the deployment of 21,000 additional troops to afghanistan to help cope with the anticipated caliban -- taliban aspectoffensd

to provide security for the elections. our allies set up additional troops to provide for election security. in late march, the president announced a comprehensive new civil, military, and diplomatic strategy for afghanistan and pakistan with the goal of disrupting, dismantling, and defeating al qaeda to prevent them from launching another major attack against our country. a new military commander, general mcchrystal, was appointed to implement the military component of the new strategy when general mcchrystal took command in june, i asked him to report back to me in about 60 days with his assessment of the security situation and his thinking on the implementation of the president's new strategy. i received the report two days ago. and i informally forwarded a copy to the president for an initial read. i asked general petraeus, the commander of central command, the joint chiefs of staff, and

the chairmen to provide me with their evaluation of the assessment and the situation in afghanistan, and we will send their views and my own thoughts to the president early next week. i expect that any request for additional resources would follow after this process and the similarly discussed by the president's national security team. all of this is being done as part of a systematic, a deliberative process to make sure that the president receives the best military information and advicanda vice on the way an afghanistan. what prompted this assessment was the arrival of a new commander in afghanistan. my request, and general mcchrystal's response, are intended to help us effectively implement a the president's march strategy, not want anyone. >> thank you, mr. secretary.

i would add a couple of thoughts. first, on process. as the secretary has indicated, he has asked the chiefs and myself to review general mcchrystal's the initial assessment and provide our thoughts and advice. the chief and i have met twice in the tank this week to discuss and we are planning at least one more session later on. my intention is to wrap up our review by friday. my job, and it is when we take seriously, is to provide the secretary and the president our best military advice. we will do that with a clear i not only on the needs in afghanistan, but the needs of the force in general and the other security commitments around the globe. second, it is clear to me that general mcchrystal has done his job as well, laying out for his chain of command the situation on the ground as he sees it. and offering in frank and candid terms how he believes his forces

can best accomplish the mission the president has assigned to him. that is what this whole thing is about, the mission assigned. the strategy we have been tasked to implement. there has been enormous focus on troop numbers and timeline slightly. lots of conjecture, lots of speculation. i understand the interest in those things, and it is legitimate. those numbers represent real units and people and real families. but the true peace of this is just that, a piece. critical, but not total. what is more important than the numbers of troops he may or may not ask for is how he intends to use them. it should come as no surprise to anyone that he intends to use those forces under his command to protect the afghan people, give them the security they need to reject the influence that the taliban seeks. you have heard me talk for the last two years about afghanistan, you know how much i

remain concerned about the situation there. there is a sense of urgency. time is not on our side. i believe we understand that i believe we will regain the initiative. because we have a strategy, we have a new approach in implementing that strategy, and we have leaders on the ground who know the nature of the fight they are in. leaders who know that other people and the other families that matter just as much in this fight are the afghans themselves. our mission is to defeat al qaeda and prevent afghanistan from becoming a safe haven again. we cannot accomplish that alone. we will need help from other agencies and countries, but we will also need the support of the local population. in my view, the numbers that count most other members of afghans we protect. as one villager told a visiting u.s. lawmaker recently, security is the mother of all progress. >> a question for both of you

-- new polls show that public support for the war in afghanistan is eroding, just as you prepare to go to congress for funding to fulfill general mcchrystal's anticipated resource requests how muc. how much harder will that make the request to fill an how you feel about support fading among americans? >> first of all, i do not believe that the war is slipping to the administration's fingers. and i think it is important -- first of all, the nation has been at war for eight years. the fact that americans would be tired of having their sons and daughters at risk and in battle is not surprising. i think what is important is for us to be able to show over the months to come back the

president's strategy is succeeding. that is what general mcchrystal is putting in front of us, how best we can, at least from a military standpoint, ensure that we can show signs of progress along those lines. but i think it is also -- there is always a difference between the perspective in terms of timing, in this country and this city, and what is going on in the country. i think what is important to remember is the president's decisions were only made on this -- on this strategy were only made at the end of march. our new commander appeared on the scene in june. we still do not have all the forces the president has authorized in afghanistan yet. we still do not have all the civilian search that the

president has authorized -- civilian surge that the president has authorized an insisted upon in afghanistan yet. we are only now beginning to be in a position to have the assets in place, and the strategy, or the military approach, in place to begin to implement the strategy. this is going to take some time. of the same time, no one is more aware than general mcchrystal and certainly the two of us that there is a limited time for us to show that this approach is working. and certainly for the secretary of state and the president as well there is this -- as well, because there is this broader element of the strategy that goes beyond the military. but i would just say that we are mindful of that, we understand the concerns on the part of many

americans in this area, but we think that we now have the resources and the right approach to begin making some headway and turning around a situation that, as many have indicated, has been deteriorating. >> the only thing i would add to that is this has been a mission that has not been well resources, it has been under resourced almost since its inception, certainly in recent years. part of why it has gotten more serious and has deteriorated is directly tied to that. president obama has approved the troops, approved the civilians that, as the secretary indicated, are in many cases just arriving on the scene. i talked about a sense of urgency, and i believe we have to start to turn this around

from a security standpoint over the next 12 to 18 months. i think the strategy is right we know how to do this. we have the combat-hardened force that is terrific at counterinsurgency. to listen to general mcchrystal, he believes it is achievable and we can succeed. that said, it is complex and tough. we are losing people, as everybody knows. yet that is the mission that president has given us in the military, and it is the one that we are very fixed on carrying out. >> you don't fear that congress -- how do you feel that congress is going to respond to the resource request that will come? >> congress will respond as they see fit with respect to that. i am very aware of the debate. i'm a vietnam veteran, raised in a country that actually cherishes that debate. that said, for a military

perspective, again, we have a mission that we are doing the best we possibly can to carry out. >> secretary gates, you have said repeatedly in the past that you are concerned about the size of our footprint in afghanistan. in the middle of all this talk about urgency, we have to prove ourselves free quickly are you changing your view on the size of the footprint as it is clear that general mcchrystal ask for more troops -- [unintelligible] >> i will not speculate about what resources he is going to ask for. i would just point out that the number of u.s. troops in afghanistan has nearly doubled in the space of the last year, and i would say, giving due credit to our allies, the number of allied and partner troops has nearly doubled in the past year to 18 months. there's been a significant increase, a major increase, just in the last few months.

i expressed concern about the footprint, expressed concern, as the chairman referred to in his remarks, about the impact on the force and other worldwide responsibilities. by the same token, i take it seriously general mcchrystal's point that the size of the imprint -- of the footprint depends perhaps -- depends any significant measure on the nature of the footprint, and the behavior of those troops and their attitudes and their interactions with the afghans. and if they interact with the afghans in a way that gives confidence to the afghans, that we are their partners and their allies, then the risks that i have been concerned about about the footprint becoming too big and the afghans and seeing us in several other than partners i think is mitigated. i am very open to the

recommendations and certainly the perspective of the general mcchrystal. >> can i just add something to that? general mcchrystal has placed great emphasis on reducing civilian casualties, and they have been dramatically reduced. he has placed great emphasis on literally how we traveled throughout the country in terms of being mindful of those citizens that live there. and those kinds of things that he considers strategic of vulnerabilities to our ability to focus on the people and to partner, as the secretary has described, he has made this change is since he has arrived, and those are significant steps in the right direction. >> can you talk about how this war -- general mcchrystal's request for report to you for troops, and what he wants a troop increase -- will you be pressed for options?

in the end, if general mcchrystal says, "i need more troops," how can you turn him down? give us a sense of that and how this will be presented. >> assuming that he makes some sort of request, it would be my expectation that we will handle it very much as we if handled every other request for resources previously in both iraq and afghanistan, at least since i became secretary. his recommendations, or alternative courses of action, would follow the chain of command. they will go to general petraeus as the commander of central command, who will offer his view. that will then be forwarded to the joint chiefs of staff and the chairman, and they will evaluate it and add their point of view. i will then add mine and provide that to the president. there will be a discussion in

the interagency and the debate about the pros and cons of the various things. i would tell you -- i will use the iraq security situation as an example. a lot happens in this dialogue up and down the chain of command. i really do in by the chairmen -- invite the chairman to add in when i'm done here. when general odierno came in with his original time lines on where he felt this was acceptable to him in terms of when we would end the combat, the presence of combat units, in iraq, there was a dialogue back- and-forth between general odierno and general petraeus and between him and chiefs, and there emerged a consensus that we probably could take somewhat more risk than in general odierno originally had been comfortable with. that is how we move from general

odierno's original proposal of december 2010 to august of 2010. i expect, if there is a recommendation from general mcchrystal, there will be the same kind of dialogue that we have had repeatedly with respect to iraq in the chain of command, and then as it moves to the inner agency. >> earlier this week, the chiefs and general petraeus and general mcchrystal, to really have that kind of dialogue and to understand from his perspective, but at our level and general petraeus's level, he has a region. it is not just about afghanistan. there are lots of troops in iraq, challenges and tensions between those two theaters of accrued distribution. and the chiefs have a global responsibility includes the health of the force. that does not mean that general mcchrystal or general petraeus to not consider that, but it is

really our responsibility to focus on that and we've that into the overall discussion, and then make a recommendation based on how we see where general mcchrystal is and how we see the overall mission, and certainly, it is going to include risks, and risks associated with the various options if we get to that point. we are just not there yet but we are really trying to understand both the assessment, and then there will be a resource piece of this that will follow. >> could i just follow up on the footprint that elizabeth was talking about? that was an argument that general abizaid had originally about iraq, and he was widely criticized for that, that he did not want a big footprint of american troops. have you thought about that? >> no, because i was not here for that discussion. but i will say this -- i think it is a real mistake to compare

iraq and afghanistan. and i see that a lot, and i think there are real limits to analogies between the two in a number of different ways. for example, iraq has had a very strong central government for a very long time. that is not the case with afghanistan, and that is a huge difference between the two. again, as i told elizabeth, i think the footprint issue can cut several different directions. i have been concerned about the size of it. i would expect those concerns to be addressed that is one of things i asked, when we were in belgium, i asked general mcchrystal is it likely to address. -- specifically to address. >> specifically on afghanistan, what is the genesis of your concern about the footprint?

>> history. as a number of articles have pointed out, where foreign forces have had a large footprint and failed, in no small part it was because the afghans concluded they were there for their own imperial interests, and not there for the interests of the afghan people. how the footprint fits into this, as general mcchrystal suggests, also has to take into account how the afghan people look at that presence. this has been my issue, something that i have worried about, ever since i took this job. first we were not paying enough attention to afghanistan, but second, trying to figure out is there a tipping point where the afghans begin to see us as part

of the problem, part of the problem rather than part of a solution? i think that the way, the approach that general mcchrystal has taken in terms of civilian casualties and in terms of the way that our troops interact with the afghans, has given us a greater margin of error in that respect, because i think it does affect the way afghans look at our troops. >> if the new mission is to protect the afghan people, isn't that by its very definition berryman power-intensive -- very manpower-intensive? >> it is general mcchrystal's implementation of the new strategy that focuses so heavily on the people, and it is clearly a requirement to be distributed throughout the country, obviously, where the people are, and indeed, as we build up

the afghan security forces over time, to hand that off to them. but it is very direct, very face-to-face, and i think we understand that. he has made that literally job one for our forces since he has taken command. >> i would like your response to george will's column this week or he says it is time for the u.s. to get out of afghanistan. he says america can only do stuff off shore using drones and missile strikes and should focus on the border with pakistan. is it time to get out of afghanistan, given your concerns about footprint? how you respond to that? >> i had a lot of respect for mr. w -- have a lot of respect for mr. will, but in this respect, i disagree with him.

i absolutely do not think it is time to get out of afghanistan, and i think that the notion that you can conduct a purely counter terrorist type of campaign and do it from a distance simply does not accord with reality. the reality is that even if you want to focus on counterterrorism, you cannot do that successfully without local law enforcement, without internal security, without intelligence, and general mcchrystal probably knows more about counter-terrorism than anybody in uniform, in or out of uniform. the way he has been so successful has been and enter to process in which we have -- an iterative process in which we have killed or captured terrorists, exploited on the ground what we have found, and

used that for the next target. the notion that you can somehow have a campaign that focuses solely on the border and has no interaction with a local afghan s along the border or elsewhere in the country, or assumes that the status quo in afghanistan would not -- that there cannot be a status quo in kabul, that if you just walk away, the situation there will not deteriorate, i think just as unrealistic. >> the only thing i would say about that kind of approach is that there is no way to defeat al qaeda, which is the mission, with just that approach. you cannot do it remotely, and you cannot do it from offshore, for some of the reasons that the secretary laid out. again, i certainly don't think it is time to leave. we have that new leadership, new

strategy, resources moving in, and i think that this approach has great potential. but it is going to take some time to -- >> just a follow up, you talk about general mcchrystal, the concern about how u.s. forces are perceived by afghans. in light of the revelations with what has happened at the embassy with this core group and the parties -- guard group and the partisan behavior that was offensive to muslims, what you think should be done about that? >> i don't think we have the information to say what ought to be done, but if those allegations are true, those activities are not just offensive to afghans and muslims, they are offensive to us, and inexcusable. >> i would like your reaction to remarks yesterday by the russian ambassador to nato.

he suggested that russia wants to be in the planning strategy of afghanistan. what is your reaction to that, given the history of russia in afghanistan, or the then-soviet union in afghanistan? >> first of all, i think the russians have a very clear interest in the success of our endeavor in afghanistan. they are worried not only about violent extremists, but also the flow of narcotics into russia coming out of afghanistan. the russians have been cooperative and helpful anin terms of the distribution network, and we welcome that, and on a bilateral basis and throughout the russian council, there are ample opportunities for dialogue. >> their invasion, and

obviously, the sour note to the left with the world in afghanistan -- might that come back to haunt russian participation? >> whatever russia's goal on the ground in afghanistan might be is up to the afghan government. >> i want a follow up on the polling concerns, perhaps falling public support and mounting concerns on the help one of the reasons cited for that is not just casualties, but there is still not a strong sense among the american people what the mission there is. the president has defined it, but i wonder if you all can speak to that, and also whether general mcchrystal's report this week shed any new light in terms of what the military is to achieve. >> let me address that and then invite the admiral. i think is important -- i think it is important to keep our perspective. the fact is that 9/11 represented the first foreign-

based attack on the continental united states with a significant casualties since the war of 1812. that attack emanated from afghanistan under taliban rule. that have begun to not just -- the taliban did not just provide at safe haven for al qaeda. the actively collaborated and cooperated with al qaeda. it provided a world wide base of operations for al qaeda. it seems to me that we are in afghanistan last four nation- building -- less for nation building and we are for giving the afghan state the capacity -- than we are for giving the afghan state the capacity to oppose al qaeda, to oppose the use of their territory by other violent extremists, and for them to have that capacity that can

be sustained over a period of time. the reality is that terrorists locked in a number of countries -- lurk in a number of countries. but it is manageable because most of the governments are opposed to the activities and have the intelligence, law enforcement, and internal security capabilities to sustain that opposition and to be effective. it seems to me that in the context of the president's goal of disrupting, dismantling, and destroying al qaeda, we seek and afghanistan that is our partner in that endeavor and that can sustain that in never after we are gone. -- sustain that endeavor after we are gone. >> the intelligence continues to support that al qaeda and its extremist affiliates, one of

whom are the taliban, very specifically target this country, our people, and other western countries. that has not abated, and that is not going to go away based on anything i have seen. but the secretary has described is that they thrive in on governed -- ungoverned spaces. >> during the iraq debate, general petraeus was very effective and productive in testifying public to be the public face of the war. do you think the administration needs to do more publicly to clarify what the message is and reminding the public about the importance of the war? do you have plans for general mcchrystal or others in command to come back to the u.s. and testify as publics of its the way general petraeus did during the iraq surge debates?

>> first of all, i think the president's message in his speech to the vfw was crystal clear about what we're doing and what we are about. i think that clearly, press opportunities like this and other opportunities for us to talk about this and why we are in afghanistan and why is important are important. i think all you have to do is look at the front page of any newspaper or turn on the television to see that afghanistan right now, at least as far as the media and the government are concerned, are at the forefront. there are a lot of people out there talking about this. and debating the issue already in terms of the way forward. i think there is clarity in terms of our strategy, i think the president has described it, i think i just described it, and

we will continue this effort as we go forward. last question. >> ambassador holbrooke has said that progress -- ask what progress would be in afghanistan, said, "we will know it when we see it." could you address more specifically how you see progress in this goal of dismantling and defeating al qaeda. and is denying a safe haven in pakistan part of this mission as well, or removing the safe haven that is thriving there now? >> first of all, one of the most significant new elements of the president's strategy announced at the end of march was the recognition that this is a regional concern, a regional problem. the chairman has spoken often about the pakistani port of this, and he mentioned earlier in this press availability that this is a piece that is independent, really -- this is

not part of general mcchrystal's writ, if you will, but it is an integral part of the president's overall strategy and the military approach. i think that we do take that into account. >> and -- >> making progress? >> first of all, the in ministration has developed -- let me answer that in two ways -- the administration has develop measures of effectiveness, shared with staff on the hill, and they will be shared with members when the members come back next week. the deadline to have those completed is, i think, september 24. my view has been, and i assumed it is the case, that those that are unclassified will be made public. one of the things -- and we started this ourselves. this is not something imposed by the congress, this is something

so we can evaluate how we think we are doing and not keep rolling our goals in front of us, but in fact try to genuinely measure whether our approach is making headway or not. and i think that that is a very important thing. but i think that in this one respect, there is a comparison between iraq and afghanistan, and that is success is the afghan national security forces assuming a greater and greater role in controlling and protecting their own territory. as we proceed into an advisory capacity -- recede into an advisory capacity and ultimately withdrawn. >> with respect to the safe haven, the current safe haven in pakistan, the way we get that is

through a growing and sustained and trusted partnership with pakistan. one of the ways i measure progress is, if i look at pakistan over the last 12 months and the success of their frontier corp., the success of their military in terms of operations in the swat valley, and the movement in that direction to address extremists in their own country, and that kind of continuing pressure, that eventually will provide security for their own people so their own people, who now protect al qaeda, turn them out. and that would apply almost insure approach with pressure from the afghanistan. it will take some time to create that. but strategically we know how to get that done.

>> we will review the health care debate in congress tonight, with highlights from house committee hearings and analysis from martin vaughn of dow jones newswires. on friday night, where the issue stands in the senate. sunday, a comparison of health care systems around the world, with former "washington post" reporter t.r. reid, on " q&a." >> c-span's healthcare hub is a key resource. watch events and share your thoughts on the issues, with citizen video, including clips from town halls to have gone too. >> book tv prime time, "the daily show's" larry wilmore

talks about his book, and former lehman brothers executive lawrence mcdonnell talks about the collapse of that firm. book tv starts at 8:00 eastern on c-span2. >> lessons in leadership from the former head of centcom and middle east envoy, retired general tony zinni, on how leaders and organizations can best respond to the trends shaping the world. he discusses his book with former fema director julius becton, on "after words." >> in japanese elections last sunday, the liberal democratic party as it was ousted by the democratic party of japan after 50 years in power. cbs news chief bob schieffer moderate the discussion on those elections and the future of u.s. relations with japan. it is one hour.

>> i would like to think it was as brilliant that we were in third time the election with this event -- that we were able to time the election with this event. we are glad to have a chance to have everybody today. coming together and talking about this election in japan, this was one of the most monumental political developments in the last 20 or 30 years in asia. what does it mean? that is what we are going to explore tonight. we have a fabulous people to help us do that. that mean? that is what we are going to export to night and we have got some fabulous people to help us do that. this is the third of our series that we do jointly with tc-99 youth's schaefer school of journalism. we are really proud to have that opportunity in thank you so very much. i like you probably get a little tired with kind of shouting angry journalism in america and what i always admire about bob schieffer is his tough as nails

but cybil, a fair and honest spirit that he brings to his journalism but also brings to us in this forum. we are really grateful to have all of them. i would just like to say a special word of thanks to where friends at upc. this is a company that has a deep commitment to moving-- improving the quality of public policy in america. they have given us a chance to partner with them on this. the wall know them and you wrote down on one of their elevators and it is part of the products they have made possible for us. thank you for all of that. we are really grateful. but, we will turn over to. let me just say one last thing. i want to welcome back my very good friend kurt campbell. encourages over the state department and i was lucky enough to be his colleague for almost seven years and he went over to treat the center for american security and has done a fabulous job and of course he is now on the hill.

were so grateful and thanks for coming back. >> thank you very much dr. hamre and welcome once again. as they like to say in baseball, the partnership between csis and tcu, those of us at tcu hope it is good for both teams because it is certainly good for our team and we really enjoyed the opportunity to be here to join with csis into we have, the people who know most about japan with us today. i would also like two of knowledge the japanese ambassador, ambassador welcome and we will be calling on you when we go to questions here. but come here and the stage with us today, i have all of this written down. i don't need to write it down, but kurt campbell of course to is the assistant secretary now for east asian and pacific affairs. he has been in that job since june of this year. he was previously ceo and

cofounder of the center for new american security and has said several positions errett csis. as dr. hammer said over the years including senior vice president and director of international security program. they henry h. solutions your charen national security policy and was also an associate professor of public policy and international relations at the kennedy school at harvard. michael green is senior adviser and holds the deppan chair here ed csis. also an associate professor of georgetown and served as special assistant to the president for an national security force, senior director for asian affairs from january of 2004 to december of 2005. he joined the nsc in april of 2001. as director of asian affairs and worked at the council on foreign relations at the institute for defense analysis, speaks fluent

japanese and spent over five years in japan working as a staff member and the national diaz as a journalist for japanese american newspapers and is a consultant for u.s. business. steve clemons, senior fellow and director of the american strategy program at the new america foundation. he also served as publisher of a very popular blog, the washington note. he has been an executive vice president at the economic strategy institute, a senior policy adviser for center jeff bingaman, which is where i sit-- first met him when senator bingaman was making his first race for the congress and i got to know steve down to the years when he was on capitol hill. he for seven years was executive director of the japan america society for seven california, also co-founded, also co-founded the japan policy institute.

so, johnson and let's get to it. mr. secretary, let me just are with you. what does this mean, why did it happen and what does it mean for u.s.-japanese relations? >> first of all it is terrific to be here, thank you bought into my colleagues on the podium here into csis and john hamre in particular. these are wonderful forums and we are really grateful for the opportunity to explore something as significant as this historic japanese election. it is important just basically to take a few minutes to appreciate something that the united states and japan share, which is this tremendous commitment to democracy so what we have seen is an enormously important election that took place peaceably, in which there a new generation of leaders have come to power in japan, so at a very basic level we recognize

that we celebrate it and we appreciate it, and i would like to just say today, earlier today president obama reached-- at a very good conversation. key thanked cam for some statements of late of importance to japan u.s. relationship and he congratulated him on his victory. he told the japanese leadership that the united states stands ready to work with japan. over the course of the next several weeks and months to ensure that our relationship is important going forward. this is a very early time. we have to take great care during the initial steps. we are trying to send a very consistent message of our determination to work closely and to consult with japanese

friends. we have a schedule for fairly deep engagements over the course of the next several months to ensure the highest possible level of consultation, and i am confident that in terms of the basics, the fundamental issues that unite the united states in japan, that those will remain i we have worked closely together, and i think we have a lot of confidence that we will be able to do that over the course of the next several months. the work from our perspective right now about this is patients, commitment, and solidarity. we are excited about the path and the way forward. we take nothing for granted in terms of expectations associated with issues beyond our alliance, but we do think of the foundation is there for a very

strong relationship going forward. nce but we do think that the foundation is there for a very strong relationship going forward. >> michael green, you and many other analysts really nailed it, everyone saw this coming but it is still almost a shock that one party has held power since what come in 1955, and then they lose it just a total-- they not only lose but they lose big. 300 out of 485 seats are something like that. why did it happen? >> well, the japanese voters, it wasn't because of mr. on the. it wasn't because of the dpj policy. it was because they were sick and tired of the liberal democratic style of governance and the inability of the government to provide the japanese economy has grown at about 1.9% a year for a decade.

there is the sense that just can't go on and things have changed, so this was a massive, massive victory for the opposition. japanese elections lately have been massive. there was a massive victory just a few years ago, so there's a lot of swing with the japanese voters and they were ready to throw the bums out and give the new crew a trying that is mainly what this is about. it is not so clear that the japanese public knows what the new government will do or has complete confidence in what they will do but they are ready to throw the dice in. >> in other words this was not so much a vote for the new party as it was a vote against the old party. >> that's right, that is pretty clear. there are some things the democratic party promised come to cut taxes and fees, stimulate the economy in empowers civil society more. they are going to the centralized government. in terms of how to restore

long-term growth, there wasn't a clear affirmative vote for anything. it was just time to get rid of the old crew and i talked to friends in japan right to live who voted for the-- but they weren't sure what came next. >> steve, when something like this happens, there is always, america always becomes an issue it seems like. it was and that you heard anti-american statements from the new party as they were coming to this election, but you heard them talk about, we need more independence from america, we need is to separate. is this going to make a difference in japan american alliance? >> i was writing a piece today that hatoyama is going to find his inner obama and what i meant by that is that a lot of things that on the campaign trail are going to be softened, delayed

and priorities are going to be set. the great ariel sharon line, we were sitting behind the prime minister's desk and he was responding insane things look differently behind his desk and things will look differently behind hatoyama desk in what he puts forth. i think this is an exciting election in part because to be blunt many people feel the ldp's sort of lost its ability to be flexible in a lot of key areas. in the past the lpd was able to reinvent itself and that sort of banded but you also have the impression rightly or wrongly, that many japanese felt that the u.s.-japan relationship and a whole variety of fronts was just stuck too much in the past and i have been one to sort of suggest as well that there was a kind of brewing nationalism that i would consider sort of nasty right-wing nationalism. i am very happy that now we are going to see a negotiated nationalism and part of that will involve the relationship

with the united states and where they take it. recently hatoyama published in "huffington post" in all places, ps complaining about the negative consequences of the american-led minnick neal liberalism if you will and they made a comment that a lot of americans felt what hatoyama was saying and we have had the shift to some degree on these issues, but i think that when the real strong man behind this wrote his book on a blueprint for a normal nation coming in it he did not destroy or dismantled the u.s.-japan relationship. he talked about the importance of becoming a greater stakeholder, sorting out japan's interests while in their own in changing the image to the degree it still exists of japan just being a puppet or a satellite of american interest exclusively and having a greater role to play. i think this is part of the japanese narrative which has been growing and we should look at this as a healthy thing. i predicted a much healthier

come a lively and so much reinvented u.s.-japan relationship in part because of hatoyama talking about the need to create some distance. i think it's a good thing as opposed to what some people see in some sense that it will cost this influence. i don't believe that at all. >> go ahead. >> i like both of what steven mic is dead. i actually think for the alliance to maintain its relevance, and its influence over the course of the first part of this century, a degree of independence, of confidence is actually-- absolutely essential so i actually think these are not, it is just and reaffirmed the. [inaudible] in contrast with one another, they are actually is essential. it is important that japan feel confident and independent and in fact the united states supports that. we don't see any contradiction in terms of a close alliance and a greater independence in terms

of doing business. i think we will find that even in an independent mind said we will find ourselves taking very similar positions. i also think that one of the things we have heard from dpj is a desire to have a closer in deeper relationship in asia with both south korea and china and that has sometimes been positive as something the united states either against orth written by. nothing could be further from the case. weep like to see japan play a stronger leadership rules partners with friends in asia and we will support that. we also believe that the process they will come to appreciate and understand the significance, so in terms of the basics were very comfortable. i would also suggest to you, we see this in the united states. i wrote a book on transitions with my friend, nav deputies secretary jim steinberg, transitions of democracies are difficult. this will be different from

transitions that we have seen in the past. this is going to take a period of time. we are going to have to be patient. is probably going to play out not just over a couple of weeks but months. new means and mechanisms of making decisions will be put in place. if i had one caution, i would say by own personal experience and some of the finest professional phi have worked with in japan are bureaucrats. i would hate to see a period whereby somehow they are positive as the enemy and somehow to be gone after. i think over time many of our new friends that have just arrived in power will come to appreciate how strong these men and women are, how much they serve japan's interests over the course of the last several decades. of course there can be changes, but overall, there has been a lot of very good work done and we hope to continue our professional relationships.

>> from the united states standpoint, what are the most critical, the most difficult parts of this alliance? what means most to us on this side? >> well, let me just briefly if i could come and go back to what kurd and steve said. there is this rhetoric in narrative that is come out of the democratic party about distance to the u.s. closer to asia and it is important to understand where the japanese people are. i will go for a lot of numbers but recent polls with the japanese public was asked to you feel close to the united states, 70% said yes. and across the board, the public opinion in japan in some ways this never been better about the common interest, so lot of this rhetoric about distancing from the u.s. and moving to a shai thing comes of it narrative that the democratic party in japan use to try to attack the ldp

because the government corps raided very closely. and we are seeing that frederick still. i think is going to start dying have is these guys come into office and start looking at what they do about north korea, what do they do about rising china? they are very few issues where we disagree about japan. added strategic level, from the middle of the second world war, long-term strategic plan-- planners knew we had to have a strong relationship with japan and their foreign policy on a bipartisan basis has been based on that for 60 years. we especially need it now with the rise of china, not that japan or the united states wants to contain china but to provide a stable and environment or we can engage china from a position of confidence. japan is the second-largest contributor to the united nations and most of the international restitution so organizations to work we have to be with japan and we are. we are close to japan in the g7

in g-20 discussions. we need to ban on the north korean nuclear problem and for ford presents across the hemisphere are bases in japan are absolutely critical. the dpj has made some noises about changing the status of our forces, but looking-- blocking okinawa. i think the japanese public and the rest of the reason-- regioned understand alimport ceasar and that is a long list of critical interest. >> do you see any of those changes coming nor any of those things changing in any hard way? >> not the major things but i think there will be down the road, not on the front end of the hatoyama and streets and but changes on the edges, things that will make kurt campbell a bit crazy about one to renegotiate for the rights of military service men on base is in discussions about sovereignty and decision-making. i think there will be some of the. i think kurds will be in genius

that getting the japanese to move beyond the abductee issue as the bee all when they think about regional security and began to look there and i think we are going to see and what i hope happens comes into reify something like just laid out, japan has some of the best international bureaucrats in the system and one of the things that i feel working against it, you have lots sarah come clean up unesco wehr jesse helms supported going back. you had in the high commission for refugees in peacekeeping, him iaea. you have got in the bretton woods institutions in japan used to combine a kind of commitment to security three notion of independence of the system in ways that took the pressure off the united states for being the player and i think there has been some muting of that. i would love to see a return to that because i actually think it helped us and help the relationship and reminded people

of the vitality of japan. i think japan, if i can be blunt, despite the interest of this dormancies ben is taken for granted. i think japan during the second gulf war, during the iraq war decided to stop challenging the united states gun keach rate issues and become our power into subordinate with a lot of the tensions. if you don't have points of tension with another country, you are not taken seriously and i think somewhat the u.s.-japan relationship has a lot less visibility than it should have given its weight. that is why excited about this democracy 2.0 moment and i think we are going to see japan rise in relevance and significance in consequence in the eyes of congress, which i think has been on attending this relationship and underwear that, so when you look at this combined portfolio and asking, going along with what mike said, i think you are going to see renewed interest and hopefully to be in come back

>> are we on the same page with japan on korea, on the koreas? >> north korea? >> south korea, both. >> even before the average of president obama, there has been conversation between hatoyama- san and his korean counterpart and they underscore the desire to work more closely together. one of the things we've seen over several years is a tendency in certain circumstances for a lady of reasons to suddenly see japanese and south korean relations take a nosedive, and ultimately, that is not in our interests. we want to see our two closest allies working more closely together, if i may say, focusing more on the future than the past. there are real prospects of that

going forward. that is our basic issue, and i think we are going to see very good work in this area going forward. on north korea, i think at a very general level, the united states and japan share a basic belief -- we will not accept a nuclear north korea, we are committed to a diplomatic process whereby, through this six-party framework, we tried in some future period to sit down with north korea if they accept the commitments they've taken in 2005. i think you will see that the united states and japan will work closely together on north korea. we are pretty much in agreement here on areas where we think we can work together. the real challenge is i don't think we fully appreciate how

difficult it is, how wholesale change this is likely to be in terms of the whole new group of people. this is a new group of people, many of whom have never been in power, not only in the legislative branch, but in some capacity in the executive branch. . in the short we have to be patient and also

understand there are going to be some stray commons that will make people anxious and recognize we have to be much more focused on these larger issues that really unite the united states and japan. >> go ahead. >> i wanted to add one point. it has not been getting a lot of press, but this party with 300 plus members will have to hire staff people, educate them about legislative process. when you get beyond these sexy topics you are fighting over, 99% of this does not get the headlines. there is a whole infrastructure that has been there in place for decades that much of the internal organs of policy and legislative work don't exist in any mature way, not to the same level. there is another backed shop

questions, which are even more disconcerting. and i think while you will have a few public hanging of bureaucrats, they end up becoming a vital part of it. i just wanted to throw that out that they will have a lot of handicaps. >> the dbj has had the luxury of not having to come to a conclusion on key issues because they road this wave of resentment against those in power -- they rode this wave of resentment against those in power. i suspect what will happen is the politicians will learn how to work with the bureaucracy are the ones who will have the power to survive. the dpj has said they will have politicians run everything. the smart politicians are ones who will marry themselves to the

right bureaucracy and get things done. will marry themselves to the right bureaucracy and get things done. i also think curt as articulated exactly the right policy. be patient, help work through a strategy together, focus on the relationship between hatoyama and president obama. there are issues. they will have to decide which do about the indian ocean. they will have to make decisions on the north korean policy. what worries me will is, this is not at all, what kurd said i think it's right, what worries me as having not resolve some of these convictions. this government may not be able to come up with the aid decision and will sort of punt and pass on key decisions. the last thing i would say is, steve is right, they are people like ambassadors hatoyama and others who were international organizations. we should be actively supporting war japanese leadership ken personnel in the u.n. and

elsewhere. what i would disagree think it finders did you steve, the idea that japan been to the cult in becoming interesting is good for u.s.-japan relations or japan's position in the world. a lot of the narrative has been nearly focused on the u.s.. were sending to people and i would-- to iraq and afghanistan because of the u.s.. what i hope will happen is the new government will come in, step back and stop pouring about the u.s. and think about whether their policies on afghanistan, on economic reconstruction in iraq, on revitalizing their own economy, think about whether these are credible internationally because what is credible to us is going to be credible to india, britain, to candidate, to korea and so i'm hoping they will step out of this u.s.-japan prism and step back and think through what will make japan influential incredible globally. if they do that i think it will move in the right direction.

>> can i say one other thing? the of the thing is, let's reflect that our japanese friends and government are not just talking to us, they are talking with a range of other countries. it is gratifying how many other countries have gone to the japanese and said look, job number one, yes we want good bilateral relationships that make sure they europe japan relationship is strong. they are hearing that from a whole range of countries, not just the nation. >> i want to go to questions in the audience center than we normally do because actually have so many experts here today and first i would like to call on the japanese ambassador. mr. ambassador would you like to make some comments here or would you like to even ask the question? and would you go to the microphone? we would love for you to go to the microphone.

it is a lot of cameras. >> in my country, they are saying that if the free people get together produce food as wisdom. there's not much to add to what they have said, and especially it has not started yet and i'm not in a position to projected. but, i would like to just make a couple of points. on the economy, i think what he is saying is that he is not denying market forces and globalism but if we leave everything to market alone, we not-- may not produce the best result for wholesale and the guiding principle in adjustment

is to care about others. and i think as steve said, it is also here in the united states as well that government is having a bigger role in adjusting economy. the second point is about u.s.-japan relations. mr. hatoyama says he is seeking future oriented relations between japan and the united states, and i think it is true that there are some differences between incumbent governments and the incoming government on some of the issues. however, what is most important is that dpj as well as ldp is saying that japan u.s. relations

will continue to be the cornerstone for the foundation of japan's foreign policy. my last point is that i have always said that in managing partner relations like japan u.s., three points are important. i have been saying it has three notes. no surprise, no over politicizing things, and lastly, no taking for granted. and i think these are more truth than ever when the to the administration's get together. that is my personal comment. thank you very much. >> alright, other questions from the audience? if you could come a could you come up? you, go ahead. you are holding your hand up. there you go.

>> thank you very much. i want to ask you a simple but a difficult question. under the japanese political atmosphere of continuity in increasing frustration, seeking for change it is naturally getting difficult with the sensitive issues such as the okun know what issues. both the japanese and u.s. government both. this brings the possibility that the u.s. government allows for gives the japanese government some room for maneuver, such as the more time to cool down on

the relocation issue of the u.s. marines to qualm, ward to accept some new proposal from japan's government to reduce some u.s. forces agreement. thank you. >> i know mike will want to say-- i will just say something directly. first of all one of the things they teach you at the state the purpose is to repeat which are spokesman has said, so rusty demming taught me that. it took me years to other and but i have finally mastered it. and i think on this particular issue i would prefer-- refer you to whether state department spokesman said about our expectations about going ahead. i would say however there are expectations that are going to make progress. the shoes on okinawa have been with the sale of time. we have made some progress and we would like to continue and it is very important to us and we

feel like we are for closely with the government of japan and we will continue to work closely what i would also stand by the statement that our present their -- press secretary said yesterday. >> what is going to be the relationship between japan and china? i would just like to throw that on the table. do you see that changing? >> it is going to be fun and interesting rollercoaster ride. in mike within japan is going to be in a position where it has to try to work with others-- other states and moving 1.1 billion, in what we are calling it capitalist into a different arena and somehow deal with china's interests. i tillie joke that it was actually wrote a real issue a few years ago i was in beijing in visited the director policy planning and i said what do you working non-comment he said how to keep you americans distracted

from small middle eastern countries. i think at the time there was significant criticism by japan privately to communicate with the bush administration on the absence of high level american government officials at kiso myths in asia and one of the things i was very pleased by was secretary clinton cummins she is doing it globally, is the real presence, going to japan first, being in asia, putting in face time. i think there has been some distraction because of other issues and i think that that helps japan someone deal with china and its growth and its potential in the region at the same time japan is going to invest in china but it also has important issues that i hope you see more mature leadership mboh sais because i have often said that one of the negative consequences and moral hazards of the strong american military maceachen in the region is it propst-- promise irresponsible

behavior by korean, japanese and chinese leaders who want to exploit on a short-term basis a virulence nationalism because they know there's not going to be conflict because we are there, so we can get away from it and i hope the methot evette days. >> i hope that this mean that the conclusion is that the u.s. pulls out of asia-- they will be responsible. anyway, and not sure we want to assess the pieces or will, but japan and china come asianness historically had a hierarchical relationship and others have said this is the first time where japan and china are powerful of the same time. china is moving up in japan has an awful lot of national power and it is deeply uncomfortable. you can see it in the opinion polls in the deep anxiety about china in japan. it it is poisoned dumplings.

it is pretty broad. at the same time china has been japan's largest trading partner for about four years. a very complicated mix of rivalry that will not change. in the near term, at this government has been very clear, at this new government, they want to try to move closer to china. they will not emphasize history issues. that is a good thing. it is in el interests for japan and china to have a closer relationship. -- it is in our interest. there may be a danger that if the government tries to heart they will start provoking a reaction at home because of the deep anxiety about china. a complicated roller-coaster but some good steps. >> do you want to add anything to that? >> no. >> all right, right here. something? alright, right here.

>> a follow-up to bob's question. the question is for secretary campbell and other panelists. we all know that taiwan has long been a very important factor in japan china relationships in u.s.-china relationship speak how do you you see the taiwan being affected in the new japan china relationship and the new japan u.s. relationship? thank you very much. >> okay, i see continuity in the u.s. cents. i think the administration has started out very clearly in terms of our international commitments. we worked very closely over the course of the last several weeks in a humanitarian effort in response to the tragedy in taiwan with the typhoon and i

think you are going to see dialogue and appropriate interaction between the united states and taiwan. i am going to leave it to mike to talk about what we think we might expect to see between japan and taiwan and indeed other countries. i would say one thing about the overall campaign generally. there has been probably more of the focus on domestic issues then financial issues than there was on international issues. that does not mean anything necessarily going forward but as a general proposition that was the case. in terms of specifics outside of the u.s.-japan relations and some general statements about wanting to have a closer relationship with asia, one of the positives in some respects for any incoming government is that they are in some respects unencumbered by an enormous number of commitments. the platform is relatively general and i don't think

actually there has been much said about this or other issues but i will leave it to mike and others to comment on that. >> i think there will be a variety of views in taiwan just as there were a variety of views within the ldp just as there are a of the use within the republican and democratic parties. if you were watching this closely then i would say it was foreign minister because there is some in dpj it want to do a lot to improve relations with china. there are others who are quite pro-taiwan so i won't go into names, but there are different views on this. but in general i think curtis right, the falling of relations has made it easier for everyone else a lease for now, so i would not expect any big changes. >> okay, the next question. here. she has got a mic there think. >> paul of reuters news agency.

following on that theme, you know, i think this is probably mike green question, the dpj is a broad umbrella of factions and some are right leaning, and i'm wondering if it is possible that this sort of history view that they are going to deal with déàa will raise hackles on the side of the party and you could have another cabinet minister doing something provocative. you recall during the non-ldp government of the early '90s that were played by that because they assembled a group of right-wing people in the cabinet. >> i think there is briefings room on the history issue. i think that hatoyama promised the to go to the shrine did not cause any great backlash in the political debate in japan. on the history issue for the time being there is a little bit of room and i think there will not be pressure within the dpj but you are right to point out that they are very to confuse

within the party. there probably 40 or 50 members of the dpj for as conservative as the most conservative ldp. kurt makes a good point about where their going to focus their political capital and i think they are going to focus on changing the domestic political economy because the reality is we are all excited about this big change but is possible that in three months or six months these guys will be gone. so mismanagements could cause realignment. they have to win in the upper house election next summer, so if you are the architect of this victory and the guy he wants to win next summer for the dpj you don't want to push foreign-policy issues that split your policy, you want to fight with the obama administration. president obama has 82% support in japan. there's got a whole lot of political hay to be made with the big fight with the u.s. so i think that is one more reason why do you will see a lot more focus on changing the domestic

political economy, starting to steal away constituencies from the ldp and get ready to really talk to them which is what is hatoyama, vicaro rove of japan, is really all about. >> i would like to just quickly, you got to wait very good point. in the early 1980's henry kissinger wrote an article critiquing the ldp and sing one of the reasons you could negotiate with the ldp is because it had all of these factions and the eats faction thought something different about policy. i remember because it was my first letter to a newspaper that was published, dr. kissinger with all due respect you were quite wrong because it was driven by power differences, but henry kissinger's article which if it were resurrected we be completely about the dpj today. notch is power inside the party, you are going to have an incredible heterodoxy among the very large at friends institution which they have not figured out how to discipline that yet and how to create

conflict management mechanisms to move forward and we have seen that in the rotating leadership with con and akaka and hatoyama who are all themselves, are going to have to figure that out but it is not just them, it is other folks to. i will look up that kissinger peace and bring it back but in that sense that is a real handicap when it comes to moving and they have got to figure that out soon and from my sources i don't think they have. >> i would just add dr. kissinger called earlier and asked if you were going to be here. [laughter] >> keogh wees knows. >> it is also not clear that dpj will replicate exactly this actionable approach to politics that the lbj did in the truth is that approach sometimes makes it difficult to do the kind of policy concessions, dialogue, implementation that you see in

successful democracies, so i agree very much the jury is still held, and we will see but this is an enormous party, with a theory white set of views on almost every imaginable issue. >> factions were easier. >> ambassador paul wolfowitz is here. >> this has been addressed the guests with the last question but i am curious whether in it you think the desire to improve relations with china might push japan to do something more than just fewer visits to the shrine. it is striking when you compare japan and germany and what a great job the germans have done in addressing their past when the porch of the japanese have done. they talked about improving relations but it always comes up as an issue with china. do you think there is in the possibility with all the other

issues that have to dress? bead in the early '70s, this is trichet would take least three generations to reconcile. i've never known how long a generation is bemuddle think we are there yet. >> 20 years. >> not too long from now. the difference obviously i think between japan and china and france and germany is that the chinese have not done with france obviously could do which is internal reconciliation about their own history and the history of the communist party, i ended my view, until china can reconcile internally it won't happen with japan. not to put all the burden on japan but that is one big obstacle. .. >> we are entering a time were there will be some thawing and

maybe we will ratchet down for the long term. right here. >> thanks so much. mike said he was going to write my question but he forgot so i he forgotkurt. we are ready -- so i will ask kurt. how do we talk to with north korea and about what? the administration has says we will not talk with them except in terms of negotiations along the lines of the previous agreement. there is pressure to negotiate to see if that is possible to negotiate. until the germany's workout how they will think about us -- until the japanese work out how they will think about this, can you work out how you are seeing

this chicken and egg problem? what is the difference between discussions and negotiations. it will not deal unless they say in advance it will be about the bomb. cracks much of this is very far ahead of where we are right now. -- >> much of this is very far ahead of where we are right now. they are on a plane for consultations with our allies in japan and south korea and china to talk about the next steps. no commitments have been made about talks, discussions, diplomacy, at all. nothing like north korea. we are at an early stage where we are presenting some ideas about how to go forward with japan and south korea presenting some ideas how to go forward with both japan, south korea and china. i think the basics of that are

still very clear. we are committed to the six party framework. we think the most important agreements with korea are in bed in that process particularly 2005. we i think are united in our believe we must see commitment in a clear and firm commitment from north korea backed up by irreversible steps that commitment to a nuclear-free north korea and we have other issues we are going to want to discuss associated with proliferation. overall we are at your earliest possible stages. we've just come out of six or seven months of severe provocations. we continue to implement u.n. resolution 1784 and i would underscore on that despite some of the discussion about the next

steps in discussions or dialogue the most interesting things that have happened in recent months is other countries not just asia but the middle east and others are beginning to take steps to implement 1784 and aspects of the psi that is an indication as long just asia but countries elsewhere that appreciate and understand some of these provocative steps transfer dangerous technologies are not only bad for countries in the region but also globally. so i think overall where you will see over the course of the next several months are closer interactions clearly in the process of reevaluating their own interactions with north korea. china has been in the process of a rather deep reflection of north korea now for several months and clearly we have to give japan some time to formulate if they are going to have a different set of

perspectives on north korea we have got to give them time and we recognize their views on north korea and this process of five parties. it's essential to keep them engaged. that's where we are so why can't get in evidence will will >> do we have any women that want to ask questions? so far it has been all male. this lady right here. >> setting aside the larger security and economic issues for the moment, could you name a few things in the short term the japanese government could do to reassure the u.s.? you mentioned not throwing at the bureaucrats as the enemy. you said the china engagement would be good. are there other things they could do in the next few months? >> i am sorry, i did not recognize you there. >> just on the issue of the

bureaucrats, that is not a government-coordinated position on the part of the u.s. we said we got to keep the bureaucrats, that is not what i was suggesting. i was making a personal observation of people i worked with. >> despite your job, nobody looks at you as a bureaucrat. >> i think there are some issues we will look to see a commitment on the part of japan. the general assembly is coming up. the truth is as both of my colleagues underscored, japan's leadership in the un is essential. it is not a followship role. we want to see that activism continue at the u. n. we will hopefully see some evidence of that later this month. i would like to see a continuing commitment from japan on climate change in the associated -- the

associated with that. there are a range of global health issues. japan has played an important role in some of the aspects associated with the early steps of h1n1. those are some basic steps but i think overall continuing on the course japan has been on will be an important contribution to make its of peace and stability. important contribution to the maintenance of peace and stability and activist and global role. >> i think, i am not in the government so i can say this. i think the toe in "the new york times" and huffington post article about globalization and american capitalism is find during the election campaign and the transition. our candidates have said things we kind of scratch our heads and some at pfizer's get into a

speech and everyone else regrets and these things happen. an early indication -- [laughter] i won't give examples. an early indication to me will be if this rhetoric stops when they come into power. it's not particularly helpful. it helps explain the philosophy. you don't need it when it is a government. that would be one thing. i think right now my sense is the dj is testing to see what they can get away with from the promises they made about stopping the ships in afghanistan and indian ocean and this and that and an early good sign will be if they stopped asking which of the wish lists they could have and dialogue with administration about what they can do instead of saying we don't want to send ships to the indian ocean dialogue based on what can we do in afghanistan let's put the ships aside what can we do and hear our resources japan has. that kind of agenda with the obama administration. yes, we can.

here's the kind things japan can do. it will be their decision and will be a man you but right now my sense is interactions are what we set in the campaign we won't do this. move away from the can't do and start the agenda and dialogue and here is what japan can do. that would immediately be recognized long not only in the u.s. but other countries. these are people who want to keep japan in the international i was going to say the fight, but in the problem solving business internationally. >> if i can a short while ago a few months ago the society of southern california had its 100th anniversary i went back for that, a big dinner, universal studios may be some of you were there, the ambassador was there and this is cleared by him to put on the record. i joked about the importance of the former prime minister being barack obama as first official guest at the white house, first official foreign leader guest and i asked how high the price was and he says that is a decade

old thinking. we are not in that anymore but at the plate in my view y barack obama invited him to that, to have that place very important is on the international economic questions. i don't believe the global heart attack is over. i believe there's significant challenges ahead on how to deal with the problem of developing countries. japan still sits on today the largest capital pilot in the world larger than china in terms of when you do with financing is important. japan has severe economic problems but what it can do in parameters of the international economic order are absolutely vital and i think in my view the impression is japan has been somewhat internally consumed and not playing at its wheat if he will in this international level. one of the things i think it needs to do and barack obama is focused on is our partners and coast to words if you will of a revitalized international moving

into that and i think we need to show their ability to play in that game. >> i would say one thing. i am struck by his work. we are assuming or at least i assumed we will have a sort of plastic period leisurely in the sense where the new government can come up to speed. the truth is global politics has a way of testing new leaders whether the united states or elsewhere and we don't know whether we will have that luxury in japan or elsewhere. >> joe biden said six months he will be tested. [laughter] >> that's right. [laughter] >> csis, would you like to get a final question or maybe you have a comment. >> first i want to thank tcu and the school of journalism for sponsoring these programs.

this has been an outstanding panel today. we are glad to have you back, steve, mike, we are glad to have you here. you have to make great job and we appreciate the school of journalism both meaning the school after you and assigning you to this important task working with csis is terrific. i have been reminded today by the panel unanimous view that politicians should not on their own try to frame questions that we need bureaucrats and staff people for that purpose but nevertheless i will close with one question and that is energy and environment. did it come up much in the campaign. would either of those issues or do you expect any significant change in the new government? >> i am thinking that line for this panel which is tell japan be good to bureaucrats and staffers. [laughter] >> ponder more. [laughter]

>> steve made a good point about japan not getting credit for all it can do and has done significant pledges, but also very significant targets for climate change and the dpj his in the manifesto was not the ldp in the cuts they have pledged to make. i think they will find a very hard but they are definitely setting -- they are paid far forward on climate change and that is one. on the nuclear power it will be interesting. the dprk has a bit of a mixed set of views on nuclear power in japan. but i think generally japan will keep as everyone has had moving in the direction of nuclear power they have on the proliferation site without a lot of signals they want to do more on reducing nuclear weapons on article 6 of the conventional test ban treaty. not a lot of specifics yet but i

think there is a lot of potential for u.s. and other countries to work with the government and see what japan can do in terms of realistic policies to reduce nuclear weapons and deal with proliferation. there's a lot of idealism and what they have put out. i think the mainstream in japan is still very concerned about the credibility of extended. we shouldn't be confused by this. yes there is idealistic overtly and the desire to do this book right believe is a concern about the credibility of extended deterrence so this is a right. to not only be sure of japan but i think for curt and others to come up with a protective agenda to take some of these ambitious views the government has of the nuclear weapons and put them in practice. >> steve, why don't you -- >> just very quickly, i agree with everything on the nuclear weapons issue. these were very big issues. the dbj was talking about quality-of-life of the local

level to improve but also jumping from that to a sort of global quality-of-life and it's had a very speenineteen character and from the policy perspective talking a policy staff again to make a plea for the bureaucrats within the dpj they see lots of opportunities given the skills strengths of being innovative driving force of green economy and i think much more so than the united states is in the position to be and so on energy environment i think they see these as areas of collaboration, strength, skill. we recently had -- i think they look at the move the united states is moving in, the chairman of the folks recently trying to say we will give you our technology to help. we see all of this as a business economic opportunity for the revitalization and the dpj has been trumpeting that.

>> secretary >> to learn more about the recent elections in japan, we spoke earlier with a guest on "washington journal." he talked about new leadership policies and future relations with japan. this is a half hour. host: i want to welcome to the program michael greene. he is an associate professor of international relations at georgetown university in washington. thanks for being with us. elections in japan. what do the results mean for the u.s.?

host: a big victory for the opposition in japan. 308 seats out of the 480, so they have thrown out the old liberal democratic party that led japan for almost 50 years. no basic changes in u.s.-japan airlines, but we don't know for sure because this -- in the u.s.-japan alliance. to continue u.s.-japan relations but there are differences that we have had. host: what does he bring to the table? guest: he is a graduate of stanford university. his grandfather was the first prime minister of the liberal democratic party in 1955. he is very cerebral. he is not a powerful politician. voters who came out of the polls said, 3% said they voted for the

party because of him. so he prides over a group of -- prides over a group of different people. it is not clear how long he will be in charge. many think the power behind the throne is mother man who is the sort of karl rove who orchestrate and designed the >> this article points out this was in large part about the bureaucracy in japan. can you explain? >> the japanese government, the booker si, is very powerful. for americans it is hard to appreciate how much in a country like japan the bureaucracy makes decision persist people's lives. that worked great for them. they rose from the ashes to be one of the wealthiest in the world. but the last 15 years it has slowed down. people are anxious about their

future and they have lost faith in the government. so it is popular for politician toss blame the bureaucracy and beat them up in the elections as the democratic party did. they said we will let the politicians run things. not that simple. japan doesn't have a lot of think tanks or expertise. the bureaucrats have a lot of the information. it will be interesting to see how much the politicians tame the bureaucrats. host: we are talking about the elections it japan and the incoming prime minister will take over the middle of the month. michael green teaches at georgetown university the japan chair for csis and from "new york times" these numbers. of the 208 democrats elected sun, 143 are first-time lawmakers. of the rest only a handful ever held a cabinet post and they have few outside source toss help. japan doesn't have the u.s.'s vast number of reeverage group with -- research groups and

unlike capitol hill they also lack the large staff of aides knowledgeable of policy issues. guest: i think them focus on a couple of bureaucracies that affect people's daily lives. the ones that administer the pension fund. their equivalent of social security. a few years ago that bureaucracy lost 50 million pension accounts. so the voters are pretty mad. i think that is where the politicians will focus and start politicians will focus and start whip being the burea financial affairs, very technical. i suspect they will not try to tinker quite as much because that is that the area where japanese voters were unhappy. host: we will get to your calls and e-mails in a moment. you have the liberal democratic party and democratic party. can you explain the difference between these two? guest: it gets confusing because

the liberal democratic party is more conservative. the liberal democratic party was formed 15 years ago. for most of their history they had conservatives dominating. they had a socialist party during the cold war that was never that powerful. after the cold war when u.s.- soviet competition ended theological competition changed. you had the emergence of a competitive party system. while people are not sure what the future brings, people are hopeful they will have something like what we have with republicans and democrats where voters have two choices between parties they can choose from. host: when he was campaigning in february he made the pledge that he was going to fire every bureaucrat, and he backed away from that. why? guest: because the japanese politicians don't have a lot of experience, very few have been

in government. they don't have any tanks. they need the bureaucrats. that is why i think peck a few to fire, punish, whip in shape but chances are they will have to rely on the bureaucracy to get things done. that is why the people are excited they have thrown out the party and they will take it to the bureaucrats but they will have to get the bureaucrats to provide the information and sprs to run the country. host: how is japan's economy doing? guest: not very well. it has been the hardest hit of the major industrial economies and they have been in a slow growth pattern about 10 years, less than 2% a year, which is pretty anemic. on the other hand there are incredibly competitive japanese companies. just look at prius by toyota or sharp or sony. so they have a lot of strong high tech industries but there are a lot of problems in the economy. people are worried their income is notting if up. it will sound familiar to americans. but that is what a lot of

japanese are going through and have been for some time. host: we were looking at a map. north and south korea neighbors to japan. does this election and our relation with japan have any impact on what is going on in north and south korea, particularly north korea? guest: not so much. the japanese government is deeply anxious about what north korea is doing. the north koreans we know tested nuclear devices. they have over 200 missiles aimed at japan and they have kidnapped dozens of japanese over the years, just innocent kids on the beach scooped up. there is not a lot of room for good will and it do not seem north korea will be particularly forthcoming with the japanese. host: for michael green our first call is james in washington. caller: good morning. i'm calling to ask if you think that the strong reaction in the u.s. media to this election is

evidence of the historical role that japan has played along with taiwan and south korea as a sort of u.s. client state, japan being the strongest of the three ? guest: there's been a really remarkable amount of u.s. media interest in this election. japan hasn't gotten that much attention. 15 to 20 years ago when the japanese economy was very strong people worried about japan. there were opinion polls in the u.s. in 1988 where more americans said they were afraid of japan than the soviet union because of the powerful japanese economy. this election, because it is so historic, has brought a lot of interest, which i think is good. i don't think this election fundamentally changes the strength of our alliance with japan. it is good we think about how important japan is to us as an ally. it is the second largest contributor of funds to the

world bank. we host our major military bases in asia and japan and work closely with the japanese on everything from climate change to global development to afghanistan. so, the elections brought focus on japan and i think it is good people remember how important this relationship is to us in asia which is becoming the most important region in the world. host: one view we found from the financial times, that the japanese society has altered and that 70% of the electorate voted? >> very high turnout. there are very good things about the election. one, the japanese people really have demonstrated that they want control of their government and control of the future. they have broken the hold of this conservative party which did a lot of good things for the party but was rerigid and not very diverse. they have opened up new opportunities for women to participate, for younger politicians, more dynamic debate.

so, this will revitalize japanese politics in a positive way and reflects changes. it is not clear what the party stands for. they have ridden this wave of resentment against the government. beat up the bureaucrats. it is not clear what the plan is to get the economy going, what they will do about north korea, help in afghanistan. they have a lot of policy things to figure out. so there are question marks. but it has opened up a new era that is exciting for the people. host: which in part goes to it tweet. left and right means different things in defend countries. how distinct is the difference in japan guest: that is a good upon the. what we think of as left an right is different. the previous government was considered conservative and right. the new government is considered center left. but we you open up the two parties you have very diverse views. spanning from left to right in both parties. so, this is not quite yet a clear policy debate between left

and right with two clear positions. there is as much debate within the new government party as there is between the outgoing and incoming government. a lot of things to sort out. the prime minister, who is very popular, championed more of a free market, what we would think of as more republican free market ideology on the economy. the new prime minister is championing a larger role for government. more social welfare. so there are some similarities but there are some differences. host: michael green who is at csis, teaches at georgetown, graduate of johns hopkins, studied at tokyo university and m.i.t. form are advisor for the national security council. terry joins us from dublin, california. good morning. caller: mr. green, i read recently in the "new york times" that the national debt of japan

is about 1.5 times their gross domestic production. that was a staggering number to me. how does that -- what choose do as a drag on the -- what does that do as a drag on the japanese economy and how does it reflect in our present-day politics where we are really piling on enormous amounts of debt? guest: you are right. the japanese government since the economy started slowing down 15 years ago has enormous debt. the democratic party of japan, to system late the economy and win votes has promised to spend a lot of money over $3,000 a person on average, and create new entitlements and larger government role in social security which will drive the debt up turret. at some point this will cause inflation, weaken the yen and hurt the economy. that is one of the question marks about the new government. will is one important defense

2010 the japanese and ourselves. the japanese people have a very hey savings rate and over 80% of their debt is held by japanese whereas our debt is mostly held by chinese, japanese and other foreign governments. so, in that sense they are in a slightly better position. but like us they cannot keep running high deficits without consequences coming down the road. host: these are the words from the national journal in which they describe relations between president obama and the japanese government as hitting a speed butch over the issue of the previous ambassadors to japan. when president obama selected john huntsman the republican governor of utah the japanese government had what they called ambassador envy. can you explain is? guest: the japanese have measured their importance in many ways by how we treat china or anybody treats china of the

when china gets a better deal than japan there is a lot of rivalry and jealousy. john huntsman a fantastic governor of utah, moderate republican, china expert, was picked by president obama to be ambassador to beijing. high profile. the japanese wanted somebody who also would be a high profile political figure. they were isn't john russ not well known. but it turns out he is a good friend of president obama, a very astute expert on the economy and technology. and i think he is making a very good impression in japan. and at the end of the day i think people realize the important thing is who can get to on the gone with the president. i think they sense that the new ambassador can do that. he certainly has started off on the right foot. host: david joins us on the end line from outer banks, north

carolina. caller: good morning. how are you? i have two questions for you. first about constitutionality. i'm ignorant about this internationally. while i look at countries that are nonwestern like singapore and japan, i'm curious as to what constitutional -- from your vantage point and what you know, how problematic is it that they don't have the sort of classically liberal or enlightened principles within their constitution that prevents them from going too far and do they have a sense that they are violating liberties? do they have a limitation as far as self-evident truths and the second question, does -- how does the remarkable make-up in their country respect the trust they have in government? because we have disparate groups

that have more mistrust because they come from different backgrounds. guest: that is a really great question and there are whole course persist graduate school on whether cultural matters in these questions of democracy and civil liberty and authority. the japanese constitution was written after the war by a bunch of young american lawyers. one thing the new prime minister has said he would like to do is at some upon the see that we write the constitution on their on terms. the japanese people, you are right about home general nayity and it is, i think, broadly accepted that there is more etc., to accept a certain hierarchy to decision making. but never justin estimate the power of democracy to make

people empowered and take control of their lives. we have done a lot of polling on how asians view democracy and civil liberties and in asia we you ask what is the best form of government people say democracy. we have asked in polls in the future in asia what is the most important norm or value that should guide governments and the andersen is democracy. we have found in a pole in china that over half the people say free elections, democracy, rule of law. so these principles have a powerful hold in asia and i think what you see in the japanese election is that. a growing norm in a sense particularly in democracies in asia that people should have control of their own lives. our tradition is out of rebelling against booker si and against government and guaranteeing civil liberties. that is our tradition. but i think that the japanese, koreans and other democracies

are moving in that direction. it used to be considered bad form to say this because asians have different cultural traditions but it is quite evident in the polling that democracy in asia is having a powerful hold. host: to our radio audience michael green the topic is elections in japan sunday, what they mean for the u.s. we will continue for another 10 minutes. he is with csis. we have the congress, they have the diet. what is the difference? guest: the diet is the form of government they created in the 19th century modeled largely on german and to some extent british parliamentary system. because it is a parliamentary system the coalition that wins the majority in the lower house, the more powerful lower house, decides who will be in the cabinet, who will be prime minister. so, what a means is when they make legislation, when japan writes health care legislation, the government will write the legislation usually and the prime minister's own party will move it through the diet.

in our system individual members of congress as we have seen with our healthcare debate, committees, powerful chairs, really will have the expertise really will have the expertise and will write the legisla the parliamentary systems in japan come at the initiative is with the government and the bureaucrats which is one of the things the japanese people are starting to rebel against. host: part of the conversation is on twitter. they share the sentiment about u.s. troops in japan. when will be declared mission accomplished in japan and germany? do you think they can govern themselves? guest: absolutely, the japanese and our caribbean allies don't want u.s. troops in those countries -- and our korean allies. they look at north korea which is developing nuclear weapons which has been proliferating missiles.

they look at china's military buildup and their own japanese supply lines to the middle east for oil. they recognize that they benefit enormously from having u.s. bases. although it is difficult for american families for people to spend time overseas, it is in our national interest to have our presence be in the western pacific. . . ád i . they have been complaining about u.s. bases. we may have to make adjustments but i think there is pretty broad bipartisan support in japan and u.s.or marining this because it has worked well and been cost effective. the japanese pay about $5

billion a year to host our bases. we couldn't sustain that level of presence if they didn't help pay for the facilities and bases and we would not be able to provide for our security the same if we left a vacuum. host: the democratic party takes over the middle of the month? guest: that's right. host: john is joining us from canton, michigan. caller: i would like to ask your guest what he thinks about the new government if they are going to continue to supply the healthcare subsidies for the japanese industry, which gives them a big disadvantage. because it gives a big disadvantage over the american industries especially manufacturing which allows them to increase their research and development and why so few japanese citizens buy american cars but we sell millions offense here. i would like your answer to that. guest: well, japan's healthcare and pension systems are more

comprehensive, cover more than ours but they have a lot of problem . there is no healthcare system that not confronting problems because you face this tension between the quality of the care and how broadly you cover and it is more expensive. so, there is a lot of demand for changes in their system as well. japanese autos are obviously very popular in the u.s. but for about 15 or 20 years large numbers of those are not built by japanese workers but american workers. most of the nissan, toyota, hondas in the u.s. are built in tennessee or kentucky or ohio. the united states is very competitive in japan in some industries. airlines, microsoft does very well. we have a lot of competitive industries. it has been hard for our auto companies because for many decades the japanese protected their market. that is opening up. there are opportunities.

but that long history of a protected market makes it hard for the auto companies. it is one thing that the u.s. embassy and u.s. government is embassy and u.s. government is pushing to make sure that auto consist sell there. it is hard to overcome that historical deficit. and it is worth remembering a lot of the japanese cars we see in the united states are built by american workers in the u.s. host: what is the population of japan? guest: it is a hundred and some million. half ours. host: how many members in the diet? guest: 480 in the lower house which just had the election. host: out of that, 308 are democrats. guest: yes. a big victory. in our u.s. senate we talk about 60 seats as the miami number where you can pass things and get past filibusters. for japan it is two-thirds. they can override the upper house opposition and move things through . they didn't quite get two-thirds. host: how many political parties

in japan? guest: well, lots actually. and the beg ones are the liberal democratic which is second biggest. the democratic party which is now the biggest. then you have smaller parties, japan new party, clean government party. and when you watch japanese tv debates each party gets a chance it make its case and you find these obscure parties like the u.f.o. party that campaigns pledges to welcome aliens to earth or small religious sects so there are dozens of pares but four or five big ones. host: for michael green maurice from wilmington, north carolina. caller: good morning. thanks for c-span. my question, you touched on it earlier, i wanted to know with the japanese participation with the united states in iraq and afghanistan, contributing troops, to what extent will the new party move to amend the

nonaggression aspects of the constitution? guest: that is a really important question. the japanese constitution, which we wrote after the war, has article nine in which japan outlaws war, says it will not maintain military forces much the reality is they have a very capable and large military. they are called the defense forces and they are not allowed to engage in overseas combat. in iraq, the government of japan loosened that enough to allow about 600 japanese troops to do engineering and provide reconstruction. they have sent ships to the indian ocean to refuel our ships, british ships, australian ships that are fighting triumph in that part of the world. so they have started to allow more noncombat roles for the forces abroad. they have done u.n. peacekeeping that. will be one debate in the coming years, should japan

change that ban on more combat roles and on more overseas deployments. this government has a lot of form are socialists and will probably not move on that in the coming year or two. but i think in the years behind that -- in the yours beyond that you will see more changes because that is where the momentum is going in japan. .

when you get to southeast asia, japan is quite popular. they have given a lot of aid. there are different views depending on where you are in asia. there are -- they have quite strong relations and it depends where you are. >> as way of summary, what advice would you give the obama administration as they deal with a new party and prime minister? guest: they have campaigned on issues that could be problematic for us but rather than reacting to that, the obama team is saying let's talk to our interests. the white house seems to have confidence with poll numbers that show the japanese public is

very pro-u.s.. republic is very pre-u.s. and confident in their ability to talk through a new government and create an agenda where we can work together and continue what we've done for many decades, which is really tackling problems today, cooperating on economic development around the world. that is where we will end up. the new government may have missteps and stumbles. theyey may send some wrong we appreciate your expertise. thank you for being with us. >> we will review the health care debate in congress tonight with highlights and analysis bad on friday night with the issues stand in the senate. >> as the debate over health care continues, c-span's

healthcare hub is a key resource. go on line and follow the latest events including town hall meetings and share your thoughts on the issue with your own video. there is more at c-span.org \healthcare. supreme court week starts on october 4. we have been in there for about two months or so in the different rooms and spaces in the court as well as talking to nine of the justices about their job to give us an inside window of how the court operates, the processes, and humanizing it. we are grabbing a couple of final shots today to add it to the documentary. >> supreme court week starting

october 4 on c-span. >> steny hoyer in his southern maryland district at a town hall meeting. this meeting took place in a high-school in waldorf, maryland. it is about two hours and 15 minutes. th

[applause] >> good evening. i want to thank you for all coming out tonight. i am the administrator of calvert memorial hospital. i am honored to be asked to moderate tonight's health care town hall meeting. to moderate tonight's health care town hall meeting. for the last 22 years, i have been privileged to work at a nonprofit hospital serving our community. the men and women who work in our hospitals are on the front

line of delivery of care every day. we see the places where insurance coverage can and should be improved and where health care delivery can and should be improved the purpose of tonight's town hall meeting is to listen and share our communities and views on health care reform our elected leader. i think all of you for being here tonight to join our discussion. two weeks ago, congressman steny hoyer personally called me and asked me to serve as tonight's moderate. we agreed that my role would be non-partisan and neutral, that i would not take sides, and that everyone would be treated fairly and respectfully. in order to keep the meeting tonight moving, and because we want to hear from many people as

possible, we need to establish some rules. i would like to review them with you. they are going to be listed on the screen up here on the stage. if this sounds good to everyone, i would like to begin. first, there will be no signs in the auditorium. second, please stay seated until your number is called or you need to leave the room. also, make every effort to keep the aisles clear. so that we can get as many questions tonight as possible, please if you ask a question, keep it brief. it no longer than two minutes. please respect each other and everyone's opinion. to save time cannot no applause, cheering, or shouting. i ask you not to interrupt,

yell, or use profanity. lastly, i asked you that you refrain from personal conversations and allow your neighbors to hear the questions and answers. does the majority here tonight agree on these rules? great. here is how we will do the question and answer session this evening. people who wished to ask the congressman a question have been given a numbered ticket. it is a red ticket and looks like this. if you wish to ask a question and you do not already have a ticket, please raise your hand now and we will have usher's bring the tickets to you. i will randomly draw five tickets at a time from the box right here.

i will call the last three digits on your ticket. if you have@@@@@@@ @ @ @ @ @ buyer will call those last three digits twice so everybody can hear it. when your number is called, please come forward and lined up on the microphone which i believe this on the right hand side of the auditorium here. until it your turn to ask the question. terry is the congressman's chief of staff and he will help you with that. if your number is called, please come down here. please state your name and where you are from followed by your question for the congressman. if needed, i may interrupt you if you go over your time.

we make every effort to answer as many questions as possible so it is very important to keep your questions concise. as we will not get to every person who wants to ask a question. there are cards at each seat. please complete those cards so the congressmen can respond to you after tonight's meeting. there is staffed throughout the room that will come by and gather those cards after you leave here tonight. you can return them while you are exiting the auditorium. our program is as follows. congressmen steny hoyer will speak 15 minutes to give a brief outline on the bill, and then we have a few members here from our community who will make very brief statement.

then we will move to the question and answer period. please join me in welcoming a congressman steny hoyer. [applause] >> good evening. we are at a wonderful high school in a week -- in wonderful southern maryland. i have been in office for 29 years in the congress, 12 years before that in the state senate, and i have never had a town hall meeting as large as this. what a wonderful celebration of democracy. [applause] we have just been through an extraordinary week. you have seen on the screen, and i am going to quote from some of

them talking about health care, how we needed to make sure every american had access to affordable, quality health care. health care is not an option if we are a mother or a father. it is essential. it is and is essential assurance for us and our children. there are many in the room who are health care providers. thank you very much for all that you do to assure us that health care is available to us. tonight, i am here to talk about how vital health reform is. what the proposed reform bills will and will not do. and how it will ensure that you have affordable health care that you can count on. there is not one bill.

there are five different bills. we have not completed the process of consideration which is why this town hall meeting is so important so i can hear your views and get your input. i have been getting that at the grocery store, in the neighborhood, i have been hearing from many of you. health reform is vital to you, more than ever, the center for our families, our businesses, and our country. our families need help care reform. if we do nothing, the average american family can expect to spend $22,200 per year on health care in 2019, up from $13,000 now and $5,400 in 1997. across america, families are dealing with the same of control costs.

right now, 10,000 americans a day are losing their insurance. premiums have risen three times faster than wages this decade, meaning that health care eats up a bigger and bigger share of your family budget every year. at the same time, middle-class families who thought they could count on their insurance are losing it. right now, 10,000 americans today are losing their health insurance coverage. most people without insurance have jobs. 28 million out of 47 million people are independent. most people without health insurance have jobs. the ranks of the uninsured will continue to grow unless we act.

our businesses need health care reform. starbucks spends more on health care than it does on coffee. american companies pay twice as much for health care as their foreign competitors, which is a serious handicap. small businesses are struggling to cover their workers. their premiums have gone up by 129% just in this decade. the average family premium rose from $5,600 to $12,000. our country needs health care reform. in 1994, health care took off 14% of our economy. today that is up to 17%. by 2025, health care will eat up a quarter of our economy if we do nothing. eventually, one of every $2 spent in america will go to

health care. our country needs health care reform because our economy loses more than $2 billion a year due to poor health and a shorter life span of the 47 million uninsured. the problem is growing. the cost of car broken system have been with us for generations. every president since harry truman has called for health care reform. in 1945, over half a century ago, president truman said we should resolve now that financial barriers in the way of attaining health care should be removed. in 1962, president kennedy said this. whenever the miracles of modern

medicine are beyond the reach of any group of americans, we must find a way to meet their needs, fulfill their hopes, let this be the measure of our nation. in 1974, president nixon said this. "we must have legislation to ensure that every american has financial access to high, quality health care." he also said that health care was necessary to be adopted in 1974. as we know, it was not. what is congress proposing we do about the unsustainable cost of health care? first, a quick update. before that, i mentioned it three former presidents. let me mention one present president but let me mention as well the republican candidate.

this has been and continues to be as i quoted richard nixon, not eisenhower, a non-partisan issue. john mccain during the course of the last election just last year said we should have available and affordable health care for every american citizen for every family member. he does not support the bill that is pending but obviously was for health-care reform for all americans. mike huckabee said if they're real health care system exists, it has three components. it has affordability, quality, and it has accessibility. mr. romney said the right answer is to get people in shirt, all of our citizens in short it said they do not have to worry about losing their insurance if they change jobs or had a pre- existing condition. fred thompson said every

american should be able to get health insurance coverage that is affordable, fully accessible, and portable. rudy guiliani who did not support and oppose a government-mandated government insurance, he said what we should do is increase the number of people who have private insurance. i mention these not because they are supporting this piece of legislation but just to indicate as a think all of you know how universal and the bipartisan has been a call for health care reform. in the house, we have had 80 hearings over the past two years. we have seen an number of discussions on television. after months of intense work, the bills were passed down to the three committees of jurisdiction in the house. staff have been working over the

august break to combine the three so we have a bill that we could consider. your discussions here tonight will be helpful. in the senate, one committee has passed out a bill, the bill that senator kennedy when alive chaired. the two senate bills will be combined. they will be in a discussion to how that will be done as well. as all of you know, each chamber has to vote on its own bill and then they will have to sort out their differences before a vote on a final bill that the president has to sign into law. let me explain a little bit about where the substance of the proposal in the house stands. we keep what works. and we fix what does not.

if you have it, you like it, you keep it. building on the current system of employer-sponsored insurance. we have a unique system in america and we are building upon it. what is being proposed is not a government-run system. all americans can find peace of mind with health care they can count on. for seniors, we want a more efficient medicare with stronger benefit, and we want to level the playing field for small businesses. qualified insurance plans offered by employers would be unaffected. that is an important point. i know people are concerned about losing the insurance that they have. an insurer's plan has to cover basic services like hospital coverage, prescription drugs,

and general health. even though it builds on the system of employer-sponsored coverage, the bill make sure that if you lose to a job, you do not lose access to insurance. 10,000 people are losing insurance. many of those are losing their insurance because they lost their job. that means more peace of mind for millions of americans. as a parent of three children, four grandchildren, and one great grandchild, i want to make sure they are covered by insurance and have access to the best quality health care in the world. according to the nonpartisan congressional budget office, health care reform will mean millions of more americans getting employer-sponsored insurance. because it will be more affordable for small businesses to offer. small businesses will find it easier because the bill creates an insurance exchange which lets them leverage the purchasing

power of their larger competitors to get cheaper group rates and more affordable insurance for their employees. how many people are in the federal plan in this room? essentially -- thank you very much. essentially, that is an exchange. it is private sector insurance. it is managed by opn. i think that that model has worked well for me and for millions of federal employees, some 11 of whom are included in the health benefit. secondly, and this is critical and overlook, we reform health insurance to provide security and stability for the middle- class. these are the changes we make. first of all, we protect you from medical bankruptcy. no matter how sick you get, he will never pay more than $5,000

out of pocket for yourself or $10,000 for your family. a@@@@@@@@$1@ @ a@ @ @ @ @ should they be avoided but they cannot be afforded. it if you lose your job or want to start a business, he will have access to affordable, high- quality insurance through an exchange in which private plans will compete for your business. of a public option to increase competition. i support this option because i think it will provide another affordable choice to those who want it. nobody has to take it. this is an option. no one would be required to join the public plan. we and discrimination with

those with pre-existing conditions. -- we ended discrimination with those with pre-existing conditions. everything from cancer, diabetes, pregnancy, and asthma. we eliminate caps as well so no insurance company can tell you that you have gotten to sick. we will stabilize your health care costs. right now, if you have insurance, about $1,100 of your premium. $1,100 of that premium goes to subsidizing the care of the uninsured. by covering the uninsured, we can and that hidden cost.

third, medicare. i know seniors are worried about access to your doctor and keeping benefits. let me be clear the bill preserves your access to your doctor by reversing a huge doctor pay cut that is scheduled to hit january 1. that is a 21% decrease in medicare reimbursement. doctors cannot afford that and they may not take medicare if that happens. we can inshore in this bill that it will not happen. it also waives your co-payments for preventive care. we want to encourage people to get preventive care. we think that enhances health and saves money. it helps medicare provide more efficient high-quality care, and

rewarding doctors who coordinate their care. it does have some cuts to medicare by 60% of the savings are put back into improving their benefits, and help the program stay solvent. indeed for another five years after 2019. those cuts eliminate unfair over payments to medicare advantage plans, some of which get paid up to 50% more than it cost traditional medicare to provide the same service. fourth, small businesses. the reform bill creates and insurance exchange that will help small business owners cover their employees for less. it makes it easier to cover employees by providing a tax credit to 50% for small businesses. finally, 86% of small businesses, those with payrolls

below $500,000, are exempt from any mandate to provide coverage. 86% of small businesses are exempt. i want to expose some of the many myths about health insurance reform. this is what it will not do. first, it does not create death panels. i don't know how that got started. i have seen so many different people -- [yelling] >> [inaudible] >> if a patient chooses to discuss advanced planning board

and of life care with their doctor, medicare would reimburse the positions for that counseling and time. right now, doctors are not reimbursed for such costs. we want to encourage them to give the best advice and counsel to the patience that want it. [applause] [boing] -- [booing] >> i personally hope that these provisions give more americans peace of mind knowing that they and their families have had the opportunity to think about the choices that are right for them. those of us who have been to the experience of losing a spouse know how difficult these times

are for families. we know how much they count on good counseling and good advice. that is what that is about. this is based on legislation that was introduced by a republican senator from the state of georgia and builds on a provision passed during the republican congress a few years ago. it was passed and signed by a republican president. this is not radical legislation. this is sensitive to the needs of people. a conservative republican senator said this. how someone could take an end of life directive or a living will as a deft panel, he said, is nuts. you are putting the authority in the hands of the individual rather than the government. i don't know how that got so

mixed up. second, the bill does not put government between you and your doctor. right now, of course, insurance companies are between you and your doctor. [applause] [booing] >> deciding what they will or won't cover you ask your doctor, the conversations that they need to have not necessarily with insurance company executives but people that work with the insurance companies about what they can and cannot do. if health care reform passes, everybody will have insurance. if you get sick, you will get care. all decisions about care, all decisions about care will be between you and your doctor.

[applause] [booing] >> third, this bill does not provide health insurance to illegal immigrants, period. [yelling] i have read the bill. >> we really have to get to those folks who want to ask questions tonight. if not, we will be here all night. >> thank you, doctor. let me say this. read the bill, page -- first of

all, ladies and gentlemen, there are five bills. line three of page 143 of 3200, section 246. no federal payment for undocumented aliens. that is what the bill says. [yelling] >> we have rules that we talked about. i see a lot of students in this audience tonight. it is not showing a good thing for our students here. [applause]

we want to get to most people's questions tonight so we have to keep moving. >> fourth, the bill does not ration care. it does pay for what is known as comparative effect of research which is like consumer reports for health care. many of you read consumer reports to find out what works best. it gives doctors and patients information on which treatments work best. it makes that information widely available but it leaves the choice and the hands of doctors and patients. it does not require or forced doctors to deny or ration care in any way. the bill spells that out clearly. to ensure that we always have enough doctors and nurses, the build invest in training and scholarships for new health care

workers. that is essentially what the bill does. . . i have for people that i would like to recognize. psyche very much. i will be back. -- thank you very much. i will be back. [applause] >> thank you, congressman hoyer. before i introduce our panel, we

need special thanks to principle though, vice president wilson. let us give them a round of applause. it is a beautiful city. we are very proud. we have a wonderful resource. our life experience -- the experiences will be informative for all of us. each member represents a different voice and the health care reform discussion. that includes small business, seniors, veterans, and health- care providers.

i would like to introduce carolyn. carolyn, her friends called her could become that is the founder and owner and president of charles county office furniture which started as a home-based business in 1985. last year -- please, please -- remember the rules that we agreed to. last year the office furniture was named to the top 100

minority enterprise of maryland. [booing] the longer we shout, the longer this evening will take, folks. please, refrain from shouting. in 2002, the president of the chamber of commerce after being a member 20 years. she is also co-founder of the charles county small business network. [chanting and intelligentlyin a] we would get to the questions.

>> i do4@ @ @ @ )rr@ @ @ @ @ @ > please show her some respect. thank you. [applause] >> thank you everyone for being here this evening. this evening. i am a small-business owner. i get you want me to rest, so i will. my husband and i are getting toward the retirement age. with all the talk that we have had for so many years, it has not helped us. we are getting there. right now as a small-business

person, my rate are astronomical because there are only three of us. we cannot compete in the big insurance game because we are just not bring in enough money for them. every year my rates go up 18% or 20% more. i have hired a college student this year. i am ensuring her. i wish it could have done this with anybody i had hired. i hired her. i pay your premiums. it has drawn to my monthly payments $600. the time is drawing near. we need to do something. we can work them out. we have got to start. we cannot keep talking about it. charles county is small business. that is the majority of the

people here. please, look at the broad picture here. thank you. >> annette panel member is bob, a medicare beneficiary. he grew up in calvert county. for 23 years, he served in the air force and was mostly stationed in germany. after retiring from the air force, he worked for the national weather service as a meteorologist. since retiring, he has been an active member of our lady of the stars church, the american legion, and the knights of columbus. they have three children and four grandchildren. he is enrolled in medicare. as a veteran, he is also enrolled in try care -- tri-

care for life. he is also very active in the civic association and the national association of poise. >> thank you very much. it is an extreme pleasure to talk to you today. my name is bob priddy. i'm happy with my medicare coverage. as a veteran, i also have tri- care for life of this supplement my medicare. thanks to last year's improvement in this program. i think health insurance reform is imperative for the future of our country. it'll make our economy much stronger in a better america.

health insurance reform is essential to keep medicare strong for seniors like my wife, myself, and for my children for all the years to come. this reform bill does not, i repeat, does not cut medicare benefits like some people have been saying. it guarantees that we keep seeing our own doctor or doctors. i know that medicare has long- term challenges. i am glad that the democrats are doing something about it by making sure that the money --

>> [booing] >> this money in the medicare program, which goes to paying the seniors benefit and not paying the private insurance companies, keeping medicare solvent means that we can count on it for the rest of our lives. this bill also increase medicare benefits for the seniors. it closes the doughnut hole over time and makes it hard for seniors to for the prescription drugs. it makes it more affordable for us to have access to preventive care and get checkups so we can have a healthy and longer life. all in all, of this bill gives

me as a senior peace of mind that my medicare is safe and stronger. i think sometimes what an amazing accomplishment that medicare has been and it means that for generations to come seniors will be able to live out their lives in peace of mind and dignity. it will take the weight of their children. [booing] >> just a little bit more now. it is what i and many of us here have chosen for our grandchildren. i want to make sure that medicare lasts for many

generations i also feel that this is a moral obligation that we continue to support this program. thank you very much. >> thank you, baba. -- thank you, bob. >> we have to more panel members and then we will get to questions. -- we will have to to more panel members and then we will get to questions. she is a board certified pediatrician. she has worked in emergency rooms and has a private practice in general pediatrics. she served as assistant medical director for the transport team at the indianapolis children's hospital and chaired the pediatric morbidity and mortality conference.

the plummeting to marilyn, she has worked in the -- after moving to maryland, she has worked at the general hospital and the pediatric practice. >> i will be brief so we can get your questions. i am here to tell you that doctors support health-care reform so that we can increase the affordability and quality of the health care that all a few are getting are not getting today. every day in my practice, i take care plenty of children who are insured by the state of plenty who are not. all of them are missing some part of the health care that they should be getting.

it takes too long to get appointments with specialists. it is too hard for me to get their insurance companies to give them the benefits that they are already paying for. they do not have access to their doctors when they need to them. i know that this health care reform legislation will fix those things and will take the first few steps forward and fixing these problems so that all of our children and our families can get the health care they deserve so we can move toward our true better future as a nation. [booing and cheering] >> our next panelists is a retired colonel of the united states army. he participated with great distinction, including the vietnam battle of the green valley. during his 21 years of active

military service -- >> he did not come here to hear me. >> i just need to say one thing. about tri-care v.a. benefits. there is a provision in this bill that exempts military veterans and their dependents from any penalties or whatever that are in this bill. that is all i need to sit. how many veterans are out there? you are protected under this bill. [cheers and boos] >> thank you. now we will move to the question and answer time. [cheering]

all the members who are called, -- out of five numbers at a time. i will call each number twice. it is the last three digits on your ticket. 782. 782, please come right here in the section of the auditorium. the second number is 738. 738. the third number is 736.

the next number is 114. >> how about 666? [laughter] >> the next number is 038. those of the five numbers. 038 is the last number. >please, step up here. please state your name and where you are from. >> my name is april. i am from st. mary's county. >> my neighbor. >> congressman, when you are on

our local radio station, you said that you have not read the bill at that time. >> that is correct. >> that was about three weeks ago. have you taken time to read the bill and why are we you looking for federal health care rather than using what we have for the state also? at the state we have right now, my son and daughter in law are both out of jobs. they are covered through the state. i pay income taxes to the state so that they are provided on health insurance. why should i want to go and have the government get into my business? [cheers]

>> i said i had not read the bill. i have read it since. it is a long bill. it is a complicated subject. on the second part of your question, you are not in a state program now, are united? it is state, not federal. you have lost your son or lost his job -- i'm not sure what you said. >> both of them their >> both of them their jobs. both of them have lost their job. i would expect you to be for this program because it provides for private sector insurance to be in an exchange in which they could go.