about the book ""poluted and dangerous." washington journal is next. .

host: democratic stanford soldiers are asking obama to take a more assertive point -- democratic foot soldiers. he will beginning on wednesday when he addresses congress. want to find out what you think about this. more from the washington post article here. the headline, the change agenda

at a crossroads. he writes that obama built his successful candidacy and presidency around a leadership style that seeks consensus, but is entering a time when consensus may not be possible on the issues most important to his administration and party. whichever approach he takes is likely to upset some of his most ardent supporters, many of whom are unwilling to compromise at a time when democrats controlled the white house and congress. on the jump page in "the washington post" -- headline, in polls obama remains more popular than his policies. the article goes on to say that his spending plans that will require $9 trillion in new borrowing over the next decade have alarmed conservatives in his own party. he could not head off an investigation by his own justice department into the bush administration's interrogations policies that he made clear he did not want.

unemployment is still rising. his decision to expand the war in afghanistan the plane thousands of additional u.s. troops has not come with a clear plan for how to leave. should obama changes leadership style? -- change his leadership style? here are the phone lines. our first call comes from adam on the line for republicans out of east strasbourg, pa. caller: i really do not feel that his style is as much an issue as is the content of his policies. whose content is failing miserably.

these policies are not working. the american people are suffering. foreclosures and job losses are still up. that is the main reason you see this meltdown happening. this will only accelerate greatly within the coming months. the will be another collapse of the financial system. everyone on wall street knows it so your see note trading at all. -- you see no trading at all. if you want to see his style change, it will change greatly within the next month and a half because the american people will only be more incensed by his attempts to bailout this corrupt system. but he really needs to do is

drop all his policies. with the american system as constituted under article one, section 8 which clearly states that we can coin droned currency and denote its value by the legislative branch and not have the fed and private bankers control the system. the whole thing has been put through bankruptcy. host: will move onto hampton, south carolina, on the line for democrats. caller: it is anecdotal, but i think that the celebrity is overwhelming -- his personality seems to be very cautious. he seems to have a clear strategic vision. i think his vision will take hold in coming years.

host: in the beginning of the article it says democratic officials and foot soldiers who have experienced the volatile mood firsthand, urged the president to be more assertive this fall. what do think? caller: he could be, but i think his plans, once there is more momentum -- his approval ratings will stay where they are. in coming years one she has -- once he has solidified his views that he can be more assertive. people are very agitated now. i don't think people want an overbearing president right now. this is very new. we have not before had a

president who wants to nurture our views and let us come out. host: john, on the line for independents in sarasota, florida. caller: what a treat. c-span is a national treasure. the last six weeks or so -- in an independent probably leans left, but do not consider myself either republican or democrat. i cried the night obama got elected. i still think he is a good man. i'm astounded the way he has allowed his programs to be defined. i think this is john kerry all over again. this has been a swift voting once again of -- swift boating

of policies from the democratic party. you have an aging percentages of the population who actually believe there are debt panels in this legislation. there are those who believe illegal immigrants will be eligible for health care. i don't know whether it is obama or his chief of staff, but the message out of the white house -- is astounding how pathetic. host: the next call comes from gaithersburg on our line for republicans. abby? caller: i think the president has been trying to reach across the aisle to give a chance to do

bipartisan legislation and fix this total mess that the bush administration left us in. i worked in banking for 25 years. the bush appointees at the head of all the banking regulators emasculated the regulators said they did not have manpower to do their jobs. -- so the did not have manpower to do their jobs. i think obama is trying to be bipartisan and get them to work with him, but they're not. since the day he was elected they started screaming about too much spending. lookit the budget deficit that he inherited. it is still left over from eight

years of a greedy, killing off of regulators. host: let me get your thoughts on this. in this article they say activist presidents have always been political capital pursuing their goals of, and obama has proved the same. the article goes on to say that major reform targets particularly in healthcare and energy would not be staged one after the other, but pursued simultaneously at a time when the private sector had been battered by the financial crisis. caller: first of all, everybody knows there's an incredible health industry, health care crisis that has been going on for years. everyone agrees the system is broken. if he had not inherited such a

mess, he would have been able to work on that and focus only on that. but because he inherited such a mess he still has to get that done first. the whole system is so greed- filled. we are still in it. i do not understand how any bank or banker -- there is a huge distinction between investment banks on wall street and main street banks. host: we will move on to kathy in norwich, n.y. caller: yes, the biggest problem here is the healthcare issue and

he needs to change his leadership on that. if people have less money paid out to insurance policies and to begin to see oboes -- and money to spend on ceo's, but do not have money to spend on the children are getting their automobile fixed -- it would bring economic problems back into reality. the money should be spread to all professions, not just health care. if he does this he will solve two problems. host: we're talking about president obama's leadership style," think it needs to be changed. more from this article. governing requires the ability to appeal to congress and the electorate simultaneously.

obama's is attempting to do that with the patience that was the hallmark of his no damage campaign. -- no drama campaign. back to the phones, hartford, conn., on the line for independents. caller: good morning. thank you for the opportunity to speak on c-span today. c-span is good for this country. obama promised the american people that he would give healthcare for the entire america. now is letting republicans define his message. if he does not define his ground and do what he promised americans, he will be a one-term president. host: as we continue the

discussion of obama is a leadership style we will look at other items in the news. this is from the ap. his environmental adviser dan jones became embroiled in a controversy over past inflammatory statements and has resigned his white house job after when he calls a vicious smear campaign against him. the resignation was announced early sunday. it came as obama is working to regain his footing in the contentious health care debate. jean, on the line for republicans. caller: he needs to go back to what he promised when he cwas collected. he has not seemed to have gotten trends proceed. the policy seems to go back to

blaming president bush. he did a lot of things right, and a lot of things wrong. there seems to be so much against talk radio, town halls. if talk radio had that much power he would not even have been elected. i think it is the people. the democrats in power now need to know this is not -- you can blame anyone you want, but the people are speaking out. make things more transparent. do not go so fast. honestly, just listen. callerhost: thanks for your cal. more on the resignation of dan jones, the president's environmental advisor -- van jones.

new york, al on the line for democrats. caller: good morning. two issues a think president obama needs to change his style on. first, he has to become more independent of what i think are the left wing of the democratic party. he needs to demonstrate backbone and pushback on some of the more liberal spending issues. he has put himself in a corner with healthcare. he has hamstrung himself. the second issue, i believe he

needs to get regulation to make health insurance, private insurance premiums more affordable, and the delivery of medical expenses curtail the expense of what it costs to go in toin to give procedures done. they are exorbitant. the cost of private health insurance itself is exorbitant. he needs to become more of a middle-of-the-road democrat, a bit more conservative, pushback and the liberal side of the party. if he does not, he will be a one-termer because he is losing the middle class. host: you can send comments by twitter.

cspanwj is the address. the next caller is on the line for independents. caller: in chuckling as i'm listening to everyone finding fault with our president. i think he's doing exactly what he planned to do. he did what leaders plan to do, present the problems to the people, and said to come up with ideas. find solutions, a build consensus. congress on both sides has failed. they express a lot of self- interests and are running at an endless campaign for reelection. i worked in direct health care for 13 years as a financial counselor and patient advocate. the road he is traveling is a

good one. is there a perfect answer? no, there is not. as far as not giving information, my god there's a much information out there on what is going on you cannot even get through it all. i just ask people if they want to keep spending 30 cents of every health care dollar seen that the insurance companies can take their people to hawaii for reward benefits, give them big bonuses, pay $20 million per year to ceos? host: let me ask you this, sarah. here's a message from twitter. what is your response to this writer? caller: i do not see that.

i see him as someone willing to consider all sides of the issues until it is time to come to a conclusion. it is an example of what i think it's a bad leader -- those are nancy pelosi and harry reid who want to prove they are in charge rather than the president. i do not see a lot of cooperation there. host: the lead story in the philadelphia paper this morning talks about job losses possibly slowing recovered. the unemployment rate hit its 26-year high. as a result discretionary spending has fallen. the spike in the u.s. unemployment rate last month to a 26-year high _ the weak labor market remains a menacing threat to economic recovery.

baton rouge, louisiana, build on the line for republicans -- bill. caller: no one seems to want to blame the president for anything, but he is the one who was appointed all these czars and stuff. this is just the tip of the iceberg with van jones. there are 40-some in there and they all need to go. they do not want to blame the president, but he is the one who appointed them. they are trying to take over the radio now with mark lloyd.

people better wake up. we are in deep, deep trouble. host: how the think the appointment of all these czars has affected the way the president does business? do you think he is giving away too much power, stretched himself too thin? caller: no, he is not. he is the one appointing, guiding them. they are just doing what he wants, that is all. people better wake up. all these -- they just need to wipe them all out of there. host: we will leave it there. the lead item here in the baltimore paper.

obama hopes to turn the tide in healthcare debate after camp david. derek, in rome, ga., on the line for democrats. caller: first, --

president obama, he is an intelligent man, constitutional lawyer. this is in contrast to george bush. george bush could not get in the university of texas law school or business school, but his father pulled strings to get him admitted. basically, obama does not need the legal counsel such as steven chu of who wrote these for the cia to torture people. but republicans know they cannot help. they have not come up with any solutions. they just criticize president obama. some of it is racist, some political, but it is total criticism on everything he does.

i am a black man. everything that he does to me is in the best of the majority of people. he was elected by 52%. you have another 46 million people who are against him. what you have, these people are just mad, angry. they do not want to help, they are very unpatriotic. everything president obama does, there's something wrong with it. host: in about five minutes we will talk with dr. ara darzi, the british ambassador for health and life sciences. he will talk to us about the british health-care system. this segment will be simulcast live on the bbc parliament

channel. that discussion comes in five minutes. we will continue our discussion right now regarding president obama's and leadership style. good morning, indiana. caller: i believe that mr. obama will definitely need to change his leadership style. however, the problem i see is that like his predecessors, this style is really not the issue. we need substance rather than flash. host: what kind of substance are you talking about? caller: constitutional obedience. the constitution has very specific, limited power for all branches of the government.

the reason i think american people are so desperate for change and to maintain their hope is the very thing that got mr. obama alleged did, this need to obey the constitution -- that got mr. obama elected. ivorone everyone in washington,. who has gone awol, they're not obeying the constitution. that is why it ron paul had so much support. the american people want to see constitutional government. host: this morning, the u.s. and south korea seek to fix the north. this is from the ap. top nuclear envoy is from south korea and the u.s. held talks on saturday on a strategy to bring north korea back to disarmament talks. that was one day after north korea claimed it is in the final stages of enriching uranium.

next up is ken, in casper, wyoming on the line for republicans. welcome to "washington journal." caller: i want to give back to the president and assertiveness. he has not controlled his congress. another gentleman mentioned that he turned over too much power to nancy pelosi and harry reid. he says one thing and they are just doing what they want to do. they have their own agenda and are not helping the health care situation. they are completely out of line with all the spending and need to pull that back in.

i'm very upset that people say republicans are not working with them. they are not giving them a chance, not letting them into the committees. there have been have700 and then rinse by republicans that are being voted down -- there have been over 700 amendments. that comes from the greed of nancy pelosi and harry reid who did not want to listen. they have not listened to him. host: do you think the president needs to go over it senator harry reid's and nancy pelosi's heads and speak directly to congress? caller: yes, something needs to be done because there is gridlock there. we need to give bipartisanship

back in control. spending is completely out of line. our country cannot afford what they are spending. we all know this will hurt our grandchildren. we all need health reform. i'm a moderate republican, and do not consider myself to be a conservative republican. myself, i want to see the country advanced and do good. i have grandchildren and children and i don't like the bird and coming up on them with this over-spending. host: thanks for your call. thanks for all those who participated in this last segment. we will talk for the next hour about the british health-care system dr. ara darzi ara. he is the british ambassador for health and life sciences -- with dr. ara darzi. our guest tonight is t.r. reid.

in the conversation he discusses the european healthcare philosophy. we will take a look at what he says about that and then get into our discussion with dr. ara darzi. >> this doctor in germany told me -- she thought this was so funny. there was an american ex-pat living in her town. he had something minor like a hangnail. she told him to pay 10 euros. he came back again and he tried to pay again -- she said she did not understand. it did americans try to pay every time? >> so, if i worked in germany and did not have insurance, did not pay for, what would happen to me?

>> is taken from your pay. even have the choice. if you do not have a job, then the government takes the role of your employer and pace the employers part of the premium. most people in germany get health insurance through the employer. they split the cost. this is called the bismarck model, invented by the first chancellor of germany. 150 americans are on the planning of the big difference is in germany if you lose your job you keep your insurance. the government takes over and pays your employer's part of the premium. many people in europe -- there'll mystified by our health-care system. why would a rich country leave so many people uninsured? as i say in the book the health minister of sweden said to me

once -- i was friendly with her, she said mr. reid, could you explain something? in sweden we feel when you lose your job that is when you really need. health need but in your country when you lose your job they tickle your health insurance. why would you do that? do you have an answer for that one, brian? i've never figured that out myself. it is arguably the cruelest of all the cruel twist of american health care policy. when you need insurance most is when you lose it. that cannot happen in any of the country. host: dr. ara darzi is the british ambassador for health and life sciences and is here to help us understand a little more about the british health-care system. welcome. guest: thank you. well, the british health-care system is a national health system. it was created back in 1948 by a

very charismatic politician. we celebrated its 60th anniversary last year. the principles and values are the unique -- very much in our country as part of our social fabric. health care is provided at the point of need, in respect of of your ability to pay and everyone in the u.k. and england has the right of free health care. it is universal coverage to every citizen in this country. host: so the people in great britain have a choice between private and public if they cannot afford private? then they go to the public? or is everyone under this public health care system? guest: firstly, the majority of health care provision in the u.k. is public.

there is however a 10% market in private insurance. that has been a constant feature over the years. and has reduced of the last four or five years. i will explain in a minute. as far as choice is concerned you certainly do have the choice act you wish to speak private insurance, but more importantly in our public system there is a legal right -- and this was part of the reform i took your parliament -- there is a legal right for every person seeking health care to have free choice of any provider in england. that is a very powerful lever for the patients. the whole reform agenda of the last decade is how do we

empowered the patients and the public? the right to choice in the public sector is one of the most powerful levers we have in england. host: we have a little more from tonight's show with the author of the "killing of america, a global quest for better, cheaper, and fairer health care." we will look at that and then have more conversation with our guest. >> we moved to london in 1998 and our kids and you're risking my life. my wife and i said we would make the transition as easy as possible. my 13-year-old goes over to a neighborhood, pretty dodgy one, and finds some stores selling for 10 pounds brass earrings. you have to have pierced ears. the guy goes ahead and pierce's

her ears. two days later she wakes up with a swollen here. it is very painful. we have been in the country for four days and did not know where the doctor was or anything. we got into a taxicab. the driver says no problem, took this to st. mary's hospital next to paddington station. this is solana. as you walk in the hospital and there's a gold plaque that says on october 28, 1928 sir alexander fleming discovered penicillin in this hospital. it looked like it had not been painted since 1920. british hospitals are gross and a bucket sketching leaking rain, not reassuring. but a woman comes -- she is the head of award. she takes my daughter into the room. 10 minutes later a doctor comes along. after a while she comes out and

they have fixed the air, given her stern lecture on hygiene. she was cured and fine. you can imagine how i felt. i felt great. i walked over and pulled out my checkbook. the matrons is with great pride, no, you put away your checks. we do it differently here. free, go home, no bill, paperwork. no co-pay or deductible. but turned to my wife -- and i said there are different ways to deliver health care. they haven't figured out. host: dr. ara darzi, british ambassador. is this a typical experience with the british health-care system? guest: before i begin to answer i have to declare an interest. some of your viewers may not do this, but and the surgeon, a surgical oncologist. in a fully active clinician.

-- but i am a surgeon. i actually work at st. mary's hospital for your guests visited back in 1998. may i also suggest that, or at least clarify that yes, alexander fleming did discover penicillin at st. mary's hospital. the answer to your question is, absolutely. that is what our health-care system is all about. you obviously had a very friendly driver. may i just make a plug for our taxi drivers who took the child and family to the right place. matrons are very powerful figures in our hospital and i'm glad to hear the doctor did the right thing. this is back in 1998.

if the treatment was satisfactory then, a lot has changed since 1990. i was appointed in the hospital back in 1994. -- much has changed since 1998. the whole health service has been completely transformed. host: we appreciate your candor, sir. we want to let listeners and viewers know how they can get involved. we have a special line for residents of the united kingdom. we will be simulcasting live on the bbc parliament channel. for those across the pond would

like to get involved in the conversation, please do. you can also send us an e-mails or a message by twitter. let's take all look at some comparisons of united states and u.k. health-care systems. the source for this is a "the guardian newspapers." everything seems to be

relatively equal in these comparisons. your thoughts? guest: i agree. the comparisons you are now making are after 10 years of major reform. that is why we are very proud of the healthcare system. the only difference as you have highlighted are the costs. there's a huge difference in the cost between $6,800 and $2,600 per person. if you took those very high indicators, they are equal, but there's a big difference in cost. host: how is the healthcare system paid for in the uk? guest: it is paid through

taxpayers. it is through the taxes collected at the national level and the government makes the assignments are budget expenditure as in most other public services. our current expenditure in healthcare is about 8.3% of gdp. the me give an example. back in 1998 for your previous speaker visited st. mary's hospital, our expenditure then was about $43 billion -- 43 billion pounds, which is about $90 billion. now spend 110 billion pounds which is nearly $200 billion. we have seen significant growth in the past decade.

it has come with major reforms, improving access, improving the quality of health care. i had the privilege over the last two years of working with many clinicians and colleagues to design the next decade. host: our first call for dr. ara darzi comes from california on the line for independents. caller: thank you, doctor, for taking time to address these issues. i personally am on social security in the u.s. and the simon covered basically on what is public health. -- and i am basically covered on

public health. i have been on the other side where i have been denied services and have had to suffer many of the problems my fellow countrymen have over the years. there is an obvious disconnect in this country with the idea that we can have the best of services. i would like to address this. maybe tell my country how this can work. guest: yes, well, thank you, sir for that. i support that. one of the challenges we have when we look at the debates in the u.s. is in the u.k. every

person has a bright to access to health care. -- has a right to access. it is part of our social fabric. when we look at the u.s., and i speak as a condition -- depending on the figure, up to 45 or 50 million people having no access, that is quite disturbing considering that we all look up to the u.s. in all aspects of life. on the other hand, it is quite important to make this point that in the u.s. you also have some of the best health care providers in the world globally. you should all be very proud of that. i have had the privilege of working with many organizations

in the u.s., spend time in kettering in new york, no people in the cleveland clinic, at the mayo clinic, and these organizations have got it right. they have worked very hard to improve access locally. the differences unique in the u.s. from the u.k. are different parts of the u.s. which have different local access and quality issues. that is why for me as a condition we're looking with great interest on what you're trying to do here in the u.s. it is the opportunity of a lifetime to sort out your health care system. you have the best on one hand, on the other you have issues of how to really provide universal access. could i also make a point about the universal access?

i am not suggesting that our system could be transplanted. you need a u.s. solution to your problem of universal access. how you find that is a completely different debate which must be debated and the solution found within the u.s. system itself. host: were the u.s. to try to go to universal system, how would the differences compare between a u.s. system and a u.k. system? what needs to be established here? guest: a universal health-care system as we have it is a single-payer been funded by taxation. universal health care system in the u.s. will certainly not be single-payer, or universal taxation because you have other vehicles and which you have

provided coverage to many of your citizens. ultimately, if you look at the expenditure, who pays for it? either the individual as in the u.s., or the employer in the u.s., or the government in the u.s. there is no other source of funding. if you look at those three, then you try to identify it away to provide universal health care by these three different mechanisms. that debate and the solution for it has to be the leadership of congress and senate to find the right solution. i do not believe, and neither do i think that the model we have which is 60 years old is the model for us, the model you employ in the u.s. the principle of having universal cover, whether by the

individual or by the government, i believe strongly is the correct model. if you look at most industrial countries they have universal coverage of some sort. but the mechanics are very different. host: we're speaking with dr. ara darzi, the british ambassador for health and life sciences. the next call comes from manhattan, kan. on the line for republicans. caller: hello, it is always great to be able to speak on c- span. i watched the show on a daily basis. first of all, i would like to think the doctor for his kind complement's to our health care providers. i'm sure the u.k. provides the same courtesies to their patients.

there are a couple of questions. on the universal, we showed an example of an individual who took his daughter in for an ear infection. my first question is, what about a more extreme case such as cancer or long term medical condition? is that also all paid for through the taxation process? the next question then is, what are the taxes per individuals in come? how does that compare to the u.s.? one of our major concerns is right now we're looking at robbing peter to pay paul.

people in the u.s. are more concerned about their taxes being raised to provide for this care. eventually, i know we will have to raise taxes. host: thank you for your call, austin. guest: as far as cancer -- my specialty is cancer surgery. i'm a surgeon working at st. mary's hospital. the answer is yes, it irrespective of your condition, cancer is very much -- every healthcare is universal and free at the point of need. many things have happened in cancer. if you look at two decades ago

our cancer mortality rates were not as good. a significant amount of reform and funding has gone into cancer treatment. one area i should qualify is that every u.k. citizen is registered with the primary care physician. if you have any symptoms you good to see that primary-care physician who then makes the referral to a hospital. say a patient has a high -- the general practitioner feels there is a suspicion the individual might have cancer, that patient is referred to my clinic. i have to see the patient within two weeks. once a i see the referral letter, the patient who might have the suspected cancer is through the whole cancer pathway to see me, it get the diagnostic tests done, the

diagnosis established, the treatment which is surgical it that cancer needs it, and then referral to the oncologist if the patient needs further chemotherapy. the first part including the surgery is done within 18 weeks. if the patient is receiving chemotherapy, then that one goes through treatment course for up to six months. all that is covered. as far as long-term conditions, and you're absolutely right to ask about that question -- one of the impact of technology and innovation of the last 50 years -- we have in away transformed something that is a legal into a long-term condition. in england we know that we have

17 million people with long-term conditions. the biggest or diabetes, heart failure, as my, depression, and others. the management of those are mostly done in primary care by your general practitioners who are well-equipped to manage them. as the burden of long-term conditions is increasing we are investing more in primary-care. we are improving care to prevent readmission to hospital, the costly bit of long-term conditions. because if you look at some figures, not necessarily in the u.s. but in other parts of the world, long term conditions is one of the big challenges facing us in the next decade or two because it could be extremely

costly if you treat long term conditions in hospital environments. it is best treated by prevention. how you prevent someone getting a relapse of asthma? someone getting a relapse from the chronic obstructive airwave disease? such as with emphysema? the best, most effective and cost-effective way is through your primary care physicians. that is what we call the general practitioners. that is the rock of our health- care system. host: your next call comes from london. caller: good morning, we are in anglo-american family. my husband is 72 and a u.s. resident and u.k. residents. we would like to use his example and that of my 86-year-old mother to give the lie to the fear mongering spreading in the

u.s. regard to -- were guarding the palace. my husband has had non-malignant carcinomas removed recently superbly. two cataract operations, success super. he contributes as a u.s. citizen to american medicaid and is happy to do so because we believe is right for all citizens to pay towards the health care of all. regardless of whether he personally will ever benefit from that. my 86-year-old mother had a heart attack last year. her post-heart attack care has evolved ct scans, specialist, hematologist, cardiology, diabetes care, specialist nursing, and this for a 86-year- old lady. please, please, pass the message

to all our friends in the u.s. -- do not believe in that panels. they do not exist here. thank you. host: dr. ara darzi? guest: i'm delighted to hear this, someone who works in this and has the experience. it is the pride of what we do. that is what we hear from our patients. that is a fantastic example of someone with good experience. we may not do this with every patient. no health care system is able to do this with every patient. this is why over the last two years some reforms we have introduced -- and i have taken the bill through parliament. from now on every provider in england will publish on an annual basis something called a quality account. besides the financial accounts of the company, a hospital, they

will provide the quality accounts. the patient experience -- we all love to hear the experience of patience as with one of your previous speakers -- will be published openly, a transparent, and patience will make choices based on these. the concept of death panels -- yes, it has alarmed many of us when we heard some of these statements made. as one of your -- the person who just spoke to us, people are very proud of our health-care system. however, people always want to improve it. there is no health care system that should stay. we're always trying to improve it. how do put the investor sure to

actually improve your health care system? host: we have a message from twitter. on top of that i will ask you, how are doctors in the u.k. actually paid? guest: it depends on the specialties of the different doctors. that is no different than the u.s. the pay is very different in the u.s., but in the u.k. hospital doctors have a salary. it is a nationally-agreed salaried negotiated by the professional bodies and that has been seriously reformed over the last five years. . .

guest: we are paid not differentialism that great between us and the u.s. one difference is the fee of salaries and that has different impact on the actual clinician, if you are a doctor providesing

that health care. host: these doctors that are salaried, they are considered government employees? guest: they are not government employees but provided by the health care. there is a misconception in the u.s., most of our providers are called foundation trust, they are independent of government. but they provide care for patients who are obviously through the single-paired system are funded by the government. so they are governed by the organization employing them. but we have a national agreement of what the salaries of such doctors should be. and there are local bonuses and incentives and others provided at every organization and at the local level above the

level. host: ara darzi is a member of the doctor of sciences and he's a practicing health surgeon and at the imperial college at london, and provides information in the use of surgeon robots and he was knighted in 2002 and considered lord darzi, a former member of the house of lords. back to the phones, elria, ohio, wally on the line for democrats. caller: that's ok, thanks to c-span and the hosts and the great guests you have on both sides of the story. my comment in question to dr.

darzi is this, most of us agree that last year's economic collapse was predicated caused by greed on the parts of many people, the people mainly making money hand over fist. you know, for many years. and would dr. darzi agree if there isn't any fiscally-responsible health care reform passed through the government, that would be caused because of greed, does dr. darzi believe that wall street and greed would cause no reform to come to our government? host: dr. darzi. guest: i will try to give my own views about this. i think -- well, firstly the economic collapse is straining

all countries globally. and that point is well made. however, i agree with the question, one of the challenges facing any country at the moment and the escalating cost of health care. and certainly in the u.s., if you look at the international figures, you are most challenged with the coast -- cost of health care. it's about 16% of your g.d.p. and the growth of that , which is above your economic growth, interesting enough, over the last four to five years, will have a huge impact on your economy as well. i agree with you, something needs to be done about the cost of health care. as long as you do it without damaging what works. you live in ohio, you have the cleveland clinic there, something you should be proud

of. they have sorted the cost issue, and there in cleveland it's cheaper than many providers i wouldn't know about. so the leadership and responsibility of reforming your health care has to take this issue of cost very seriously. i can give you a large number of reason why your cost is escalating. i believe there is an overhead issue that needs to be looked at, the administer of cost, not the doctors and nurses that provide the care, but the administration of the health care is much, much higher than anything else we have in the u.k. or europe. secondly, there is a lot of fragmentation of health care in the u.s. in other words it probably starts having a general practitioner in the u.k., and

that personal is responsible for your health. he or she coordinates your health and makes sure you remain healthy, you are constantly screened for your blood pressure, for your sugar levels, for your cholesterol levels. so the preventative system is strong where we are. and in the u.s. there is a lot of fragmentation. and if i can say this

decade, which is life-style diseases such as obesity and others. we are treating it as seriously as climate change, and we need to be sure that preventative is pursued. so the answer is yes, you need reform and that needs to deal with the cost. i am not sure supporting the insurance companies. i think it's important from insurance -- what is happening in the u.s. is that the escalated cost from a provider level is shifted on the insurer and that shifted to the employer and it's the employer that is w5$suffering to this co shift to the system. so the insurance system needs to look at the way in which these costs ever -- costs are

much more controlled at a provider level. if you don't look at this, the economic i -- viability will be an issue. they are adding $105 to care for the insurers in that manufacturer. so that's taking the competitive edge away from you. you are right, we need to do something about the cost. and how you allow it in the system and put in the right incentives to ensure that cost is controlled. host: dr. darzi, recently mike enzy was talked in a health care discussion and claims that the health care system rations its treatment, this is what he had to say.

>> this would prevent the government from quality adjusted life year, called qual in the united kingdom. they are measurements to see if patients need treatment and this leads to the elderly and w disabled deny care. and this would deny care to elderly or disabled patients. and some of the uses it's been used for is repeatedly blocked breast cancer patients from receiving break-through drugs, and forced patients with

multiple sclorrosis from getting the treatment they need and for patients with osteoporosis and denied patients with brain tumors. i don't want that to happen in the united states. host: dr. darzi, your comments. guest: to be honest, these are the comments i have heard from the senators and others that made me come to these programs. because these are the most ludicrous things i have heard.

the concept of rationing. what is rationing. and would you describe 48 million people who have no access to health care as rationing. i think there is a lot of misinformation in relation to appraisal of new drugs and technologies. and that's fair, i will give the benefit of the doubt to the senate. we do have an organization caused the national institute of health and individual excellence. it's independent from government, with its main purpose to produce evidence based guidelines for doctors and nurses to practice and provide health care. that's their function, and also the appraisal of new drugs and technologies. and they do that appraisal to

document the doctors, nurses and taxpayers what is the benefit of such drug. and what is the evidence to support that such a drug would have a major impact or a major break-through in a treatment of a condition. they do that independently. and it's about 11 years old. it in itself was a innon innovative krzprocess, there ar lot new drugs and we wanted a way to appraise them independent of the companies. yes, in some drugs there were debates a few years ago, some in cancer drugs. and a lot has happened over the years in relation to these

drugs. but they do not discriminate in age or even know the patients. it's independent and chaired by clinicians and scientists who are looking at the evidence-based to support that. we have a system, we can't be spending taxpayers' money on completely new and unproven therapies to our citizens at a significant cost. but on the other hand, we are a varied team, and we have been, your first interviewer that came on, mentioned penicillin. we have a strong track record of being innovators in the sciences that we are proud of. i can tell you many discoveries including the m.r.i., and these

major break-throughs and discoveries are very important to our health care system. on one hand we are constantly working with the pharmaceutical industry and devices industry. because we 7!zdo want innovatio because this produces quality and reduces cost, it doesn't increase cost. your notebook computer in front of you is cheaper than the main frame sold to washington in the 60's. and we are looking at these technologies and need them to be effective. host: i didn't mean to cut you off, but want to get in a few more calls. we will go to west norwood in the united kingdom.

west norwood, are you there? ok, to athens, new york. caller: yes, i was diagnosed 11 years ago u7/with tongue cancer and treated by a doctor in beth isreal, and it was the most up-to-date surgery, and successful. and a treating physician was a doctor from england that had left and set up practice here. at the same time one of my neighbors had a brother from scotland come over that was diagnosed with cancer and on a six-month waiting list being treated. he subsequently died and blamed that he couldn't be treated in england at the time. i don't know if that was true but the thrust of the idea.

host: dr. darzi, go ahead. guest: first sir, i offer my congratulations /to you, tong cancer is a serious condition and you should be proud to be well. and you should be proud of israel, as one of many good facilities in the u.s. and scotland may be different, but in england where i work, if a patient has a suspected cancer through their general practitioner, they have to see a specialist in two weeks. otherwise that facility would be penalized. we found clinicians quite tough or four five years ago, because we felt that the system is telling us to do this. and to be honest, most of us accepted that, because it had a tremendous impact of improving

the cancer care. so two weeks, it's an indicator that is measured. and i can give you the figures of how many patients who have cancer, and 98-99% are seen within two weeks. and i can tell you since last april, all patients with a diagnose are treated within 18 weeks, that's three months. from the time you are inferred from a suspected cancer to the treatment for that cancer. so some stories and some experiences may reflect what the health care was in the 70's and 80's, and now we are in a much better shape. if you look at the parameters than we have been. and reemphasizing the point, any health care system, has to be constantly, constantly reforming, changing themselves

to meet the expectations of the patients and public. host: dr. darzi is talking to us from london today on the british health care system. thank you very much for being on the program. guest: thank you. host: in just a few moments we will talk about civilian contractors in afghanistan with moshe schwartz. we have a guest, wayne clough who wants to see resources including the subject of climate change. >> we at the smithonian, we will do our best to be presenting information for

people it make their own mind up. the fact is that climate change is an ongoing issue, and it may be happening but it hasn't happened yet. i was wyoming where we have a botanist making predictions when global warming happened earlier, and why are we there? we are there to look at rocks and looking at palm leafs in wyoming. so 5500 years ago this earth was very warm, and what is happening is natural and man-made influences. and our job is to provide solid information on this story. it's a complex story because carbon comes from a lot of places. >> how can you trace the time

frame, if -- 55 million versus 555 million. >> well, you can date the profiles and measure the carbon isotopes in the layers, and see what kinds of carbon were there and where the sources came from. that was about the time that mammals were making a run after the dinosaurs were gone. they disappeared and mammals came in. they survived that period. they were tiny, horses the size of cats. so you can see a lot of interesting things going on in that period. host: you will be able to see news makers today and following this program, and our guest is wayne clough, the smithonian

institution secretary. and now we have moshe schwartz the congressional policy analyst for civilian contractors. what is the current status of defense contractors in iraq and afghanistan. host: of course, and i want to say that the opinions i express are mine and not my employer. that said there are 285 contractors in iraq and afghanistan combined, that's the entire region of operations. and that compares roughly to a 1:1 ratio of contractors to troops. host: why is it that contractors outnumber the uniformed troops? guest: that's interesting, they

outnumber at a 1:3 ratio in troops, and it's just under 50% in iraq. there are a .--yof reason, after the cold war there was a reduction of the size of force, and therefore we don't have enough people to deploy. so this the ability to increase the leverage of u.s. troops by having support contractors. host: define for us the responsibilities of these contractors. and how what they do as civilians differs from what the uniformed services do in afghanistan. guest: sure, we will take iraq for example, because that has a large are number of contractors. 75% are doing base support, construction or security work.

and there are other things like communication and transportation, but by and large, that's what they are doing, to build the bases and keep them going forward. such as the largest base support in iraq. and security is a topic. and construction, which is part of not only helping building military installations but reconstruction efforts. host: let's look at some numbers provided by the crs support regarding the number of contractors versus troops. in iraq in march of this year.

chy host: do you see that this may change any time soon? if we can get more troops either into this pipeline from the united states or by moving troops out of iraq into afghanistan? is this going to change the make-up or is it always going to be these numbers? guest: since those numbers you discussed came out, the june numbers came out in that same report you mentioned. and in afghanistan troops increased by 9%, and in iraq they went down from 10,000 hoto 120,000 contractors. and if you look at that d.o.d. is attributing the increase in afghanistan for preparation troops falling into theater. and the anticipation from

there, as more troops come in, you need more contractors to prepare and support those troops. in the decrease in iraq that is offset by an increase in contractors in kuwait and that area. host: we are talking about moshe schwartz and his opinions are his own. if you want to call in, the numbers are listed on your screen. our first call comes from buffalo, new york, on the line

from democrats, carl go ahead. caller: yes, good mow#@ is it not true that in the past all of these functions that the contractors are providing were provided by uniform members of the military? now here we have a situation where it appears that there is not enough military members, so we fill it up with contractors. the question is should we reinsuit the draft. if we did, i would suggest we would have thousands of young people in the streets like we did in vietnam, and have those people who are apparently in favor of the military operations in these two countries, their own sons might have to serve. so what we have done is privatize it to avoid the military, is my suggestion.

your comments, sir. guest: as far as reinstate the draft, that's a policy issue, not mine. in the last 15 years there are three major conflicts, iraq, afghanistan and the balkans, and if you look at the ratios, it was 1:1 in the balkans as well. and there is increase on reliance on contractors and it's been rather stable in the last 15 years. back to the contractor congress, there was reliance for the revolutionary war. and in the civil war there was a tremendous problem from the perspective of congress, and congress wrote three separate

reports, each of a thousand pages lamenting the problems with contractors. host: the next call is from an air force base that doesn't want to give their name, we respect that. first, are you in the military service? caller: i am not. host: what kind of work do you do? caller: my question is you would tell the c-span listeners, whether or wnot ther are foreign contractors on the ground in afghanistan and/or iraq, and have there been. and specifically would you answer the question, whether or not any of these contractors are in fact israeli? thank you. host: hold on a second, are you still with me?

he's gone. guest: in the entire iraq/afghanistan region, and surrounding countries of the 240,000 contractors, overall there by the department of defense, approximately 50,000 are american, which means that the rest of foreigners. and you can go further, if you look in afghanistan, about 70% of all the contractors are from afghanistan, local nationals. and in iraq approximately 25% of them are iraqis. and there is a large contention of third-country nationals. so yes there are a significant number of people in iraq and afghanistan. but i don't know the specific nationality of some.

host: tyler, you are next. caller: good morning, i am independent and did a short stint in iraq, a two-year tour. what i want to know, i understand the difference between contractors who have to peel potatoes and contractors who have to fire a weapon. and i want to knows how many contractors are peeling potatoes and how many are firing weapons. which would bring me to black water now known as "z". since you made your disclaimer about your opinion, you know how it's not exactly the opinion of your bosses. what is your opinion on black water? guest: ok in the total number of contractors working in iraq and afghanistan, approximately

15,000 in iraq are considered armed security contractors, for the purposes of providing security specifically. and in afghanistan that number is 5,000, and those numbers are recent. the potato peelers would fall into the category of base support, and more than half of the contractors are base support. that provides a sense of how many contractors there are, in iraq 11% of all contractors are armed-private security, and in afghanistan it's about 8%. as far as blackwater, it does not have and has not had over the last years a contract with the department of defense to provide armed security in iraq, and i believe in afghanistan.

host: recently last month in a national press club news conference, former c.i. a. director talked about the responsibility of the contractors versus the responsibility of military or uniform services. this is what he had to say about responsibility. >> what people generally accuse us of doing, and i saw it reflected zgzin the "time" stor yesterday, that we go to contractors when we do not want to take responsibility for activities. let me yell out loud and kick the podium, and say that's absolutely not true. a.c.c.officers have the same moral and legal responsibilities of the actions of the government employers and

contractors operating under our authority. we do not use contractors to carve out something we want to deflect responsibility for. that simply is wrong and you should not believe that. you can crittize us for not have inherent skills we should have in the agency. and we may be vulnerable that we have to go outside for something, i got that. but we do not go outside to deflect responsibility for ourselves, period. host: mr. swharlz your comment. guest: first that was to c.i. a., and i am department of defense. one of the reasons we contractors is to free up our military personnel to go in and

perform what they need uniform personnel. there are a number of goals, to free up uniformed personnel to engage in activities that they want uniformed personnel. one distinction is security, and by and large is to use personnel to allow them to get more bang for their buck with military personnel. host: back to the phones, we have ron on with mr. schwartz. caller: yes, good morning. i would like to know that this whole thing with the private contracts, if there is a cause and effect. i know the former vice president, i hate to mention his name, cheney was

instrumental years before the first bush administration was in office, to bring about a report from halliburton, and to push the private sector. and at time they gave us the impression that we would be saving money. well, if you look at what they pay the private sector compared to what they pay our own soldiers that are really the brave people fighting. they are not there for the money, they are there to defend the country than these mercenaries, they are mercenaries that we are hiring to do the dirty work and paying huge amounts of money to these corporations. guest: one, halliburton isn't providing private security,

when you use the term mercenaries and that refers to private contractors. but halliburton is involved in generally non-private security issues. the idea of whether it's cost effective, in 20007 in the area of iraq, the department was defense was responsible for $75 billion, and that's a lot of money. but others will respond it's cheaper to use contractors in the long-term, but in the short-term it may be higher than personnel, and you need them 20 years before in place and carry them 20 years later. and a lot of people argue it's cheaper to pay them more in the short-term than spread out over

the years. host: there is writing about managing contractors, and in the report they say that some analysts assert that d.o.d. has not sufficiently provide for contracts across military services. can you explain that? guest: absolutely, there was a lot of concern about a number of agencies, a report by the army, that discussed the state of preparation and execution of contracts by the department of defense. and the question was do they prepare for the number of contractors and the roles that will be played in the contract before it occurred. and to what extent were they w[ç effectively managing the contracts in the field. and a lot of analysts concluded

there wasn't sufficient planning and preparing and effective oversight. and i will give you one example that a number have discussed, the idea of contract officers management. and those people are responsible for on the ground managing contractors. and a number found that these corps were responsible for managing personnel and didn't get training for managing contractors. and it wasn't a topic in the military to the extent that many liked. as a result you had people managing contractors who didn't have the training, experience or knowledge. and sometimes it wasn't r)rthei primary responsibility, it was their ancillary responsibility, where they had to do a, b, or c and that was the state. since then the department of

defense has taken a number of steps to improve that, to send more acquisition personnel who have training, more into afghanistan and iraq. and they develop more robust mechanisms for managing contractors, and instituted more training on how to manage contractors. the message was received by the department of defense, and they are currently engaging in a number of efforts to improve that. that doesn't mean by any stretch of the imagination that everything is solved, and the department of defense would say it u[ñtakes time to get where t want to get. but they are pursuing that path. host: we are talking about contractors in afghanistan and iraq, our next call is from oregon, jim. caller: yes, i am repeating what a previous caller said,

that mercenaries is what we used to use instead of contractors, both being the same. i am wanting to know why is the real reason we are in afghanistan. it used to be in world war ii people who resisted the german people were called resistants. and now we call the people who are against our being there are insurgents. which is the meaning of resistants. host: jim, we will leave it there, mr. swarltz is there a difference between mercenary and contractor? guest: in the book "the prince"

the term was used mercenary often, and when he used it, it was military that you send into war, it would be the troops, you invade iraq and war where we want. some people use the term mercenaries and others don't. as the department of defense defines them, they are used purely for defense. in other words they are not allowed to engage in operations. that's not the way that mercenaries were defined in the 1500's. and a lot of people will quibble over this debate. i would say that a distinction when one looks at private military contracts or military companies, are they a company hired to get involved in offense

operations or defense operations. that's one distinguishing point. host: dan, you are on "washington journal." caller: good morning, thanks for having me on. just a woint, i am behind a lot of comments made this morning. we haven't used a lot of contractors in the past, going back in the history when it comes to the united states and war and going overseas and different wars. my point is that it seems to me that a lot of things are being skewed when we have an all-volunteer army going into war. and using all of these contractors to help support that war effort and they are getting paid a different rate. it seems to me what was going on in iraq, there was a lot of

shady things going on with contractors and not going by the same set of field manual, the united states military and following those laws. and it really skews how our country is to operate when it comes to war. and something as big as our country going into war, it really be out in the open just what is going on, rather than using different avenues to accomplish different things. host: thanks dan, we will leave it there, sorry for the cut-off. guest: i think one way it look at it, currently we have a current size of the military force, that's today. and we have as we discussed approximately 120,000 contractors in iraq. the question is could the department of defense currently execute its mission in iraq

without using contractors. that's a way to look at it. in afghanistan they would need 120,000 boots on the ground, and that doesn't include rotations. and if you include rotations where they are in iraq and go back later, you are doubling the numbers, talking about 340,000 troops. could we accomplish the mission without contractors, and many in the department of defense say, we cannot do it without contractors. the second question, just as important, going forward how do we constitute the forces and the mix for future operations where the department of defense is deployed. do we want to use contractors in a 1:1 ratio. if we don't, how do we make up

the draft, others suggest the military and others suggest don't get involved in these conflicts. so the question is not only what we are doing now, but also are we thinking through what we are going to do in the future, and are we taking the steps now to figure that out. so we are not in a situation where we rely on contractors because we have no choice, but we rely on them to the extent that we chose to. host: does the 1:1 ratio of contractors in iraq and afghanistan, is that an example of short-sightedness of how they were going to execute the military operations in these two theaters? or just a circumstance unique to these two places? guest: that's a good question, a number have suggested that the department of defense has

not defined the role of private security contractors. i have heard one c.o. d. official say that, and the question is have they thought to review that. next year there is a q.d.r. that comes out every four years and talks of the direction of the department of defense. and the last one considered contractors as a the total force. but there is some belief that the future q.d.r. has a sense of that discussion and give us a sense of the direction on this issue. host: mike, go ahead. caller: yes, it seems that the use of defense contractors is a wiser choice. i think that á"some believe i'

a big conspiracy theory. but i can't see what is wrong with it regarding the costs that the gentleman mentioned. that's my comment, i would like to ask one question, are the training costs as low. someone building housing for fighting forces to go through boot camp and all those things, seems to be like a waste of cost. my point is that it's an effective use of assets. there is no conspiracy and i have a question about the training expenses. guest: regarding training expenses, a number of things, contractors are not trained to the extent that a marine would be trained and retained for years. in afghanistan roughly 70% of all contractors are iraqis. clearly not much of a training

cost involved there. and a significant number of contractors are involved in construction. as you would see driving down the street, for roads and buildings and wall. from that perspective you don't have an expensive training cost from that. a lot of training costs brought up are with private security contractors, particularly those from america and britain and those countries are former military personnel that are trained by the united states. and we are bearing the burden of some that of training. host: before become department of defense analyst, mr. schwartz had weapons acquisition and assistant district attorney in

brooklyn, new york. back to the phones, ed, your question or comment. caller: it's more of a comment, i am a disabled vet and i just returned fromn0p kuwait. and to the guy who said that everyone goes there for a money. i wasn't alone in this. but a lot of people go just to serve their country, because they couldn't do it in the military, whether older now or couldn't stay in the military. and to go back when i was in military, and i did see the contractors doing the jobs. i was real happy they are doing it and i wasn't, it's a relief to have down-time than the details. i wanted to stick up for the

contractors, who are getting beat up there. host: ed, what did you do before in the military? caller: i got hurt before deployment to iraq and had knee surgery and got out there. host: and that's why you had to separate from the military? caller: yes it was. host: and what kind of work as a contractor? caller: well, for the first year, i was an armed securities forces and i guarded the bases for the military. and after that i worked in the environmental department. and i had about 30o:q third-country nationals underneath me. host: where were you working? caller: i don't want to say what camp, but i was in kuwait. host: as a contractor, how much were you paid?

caller: i got paid a decent amount. host: define decent. >> i w3ñwas paid $70,000 a year. host: that's decent. guest: as whether the contractors relieve the burden on the military, that's true. and when in the military, there is a mess hall and a question, do we want uniformed personnel of people that we have trained for years, standing in front of the mess hall, or send a private contractor there and send that personnel out to perform missions. and there is no question, that is one the questions. and not only for security but also for transportation and construction. host: next up rochester, new

york, rosemary. caller: good morning, i have a question -- i have two questions. my first question is i would like to know exactly who runs this congressional research policy? is it a government agency or is it put together by private industry? guest: i am sorry i will have to defer on that question, it's outside of the scope of contractors being used by the department of defense in iraq and afghanistan. host: ma'am, i am sure if you go to their website, you can get that question answered. what was your other question. caller: my other question is, if the private contractors that are armed are only there to be security forces, then why have we read in the newspaper that

groups of them have gone in as a unit and killed people? host: give me a specific example, if you don't mind. caller: yes, the blackwater guards now that are being charged with going into a house and killing the people inside. guest: sure. and i think that's an excellent question of what are private security contractors doing in iraq and afghanistan and other places around the world. just to clarify, the blackwater company now known as "z", they changed their name, they were working for the state department, where 17 iraqis were shot. and the facts surrounding that, those blackwater guards are

doing in-escort, they were protecting someone. but there are three private security activities, one is static security, where they protect a fixed sight, and the second is convoy, and i am talking for the department of defense, convoy where water or ammunition and they are protecting that. and the third is security details that is protecting individuals, between transport areas. those are the three types of security generally, but it's an interesting question what should private security contractors be doing? do we only want them to protect the sights or people or protect

amnuition, some think that's purely defense, some think it veers from the purely defensive and is operational. one other example do you want contractors to work under force and extract someone that is underfire from the green zone, some would consider that a defensive extraction, and some say when you send contractors by helicopter to extract someone and that you are sure they will be engaged in shooting, that's crossing the line. and that's going on. host: we have this tweet, security contractors don't take the same oath as soldiers, can we ensure ta their interests are in line with the military? guest: i think you are asking

the question that was in "the prince." and that's a question that was brought up in a number of places. there was one colonel that wrote a paper where he raised the question whether the private security contractors in iraq and afghanistan, could they be the force of the future, are we training militias that could come back. host: next, we have joseph from palm springs. caller: thank you, for receiving my call. which of the type of civilian contractors in iraq receive the greatest percentage of the 85

billion budget for the contractors? guest: i am sorry, i am not familiar with the break-down of how that money is dispersed and it goes in general and the skill areas like private security and analysis and other areas. and third country nationals tend to bevajñ cheaper and that depends on the skill sets. host: in a recent article in the "new york times" they refer to figures out of the c.r.s. report and say that congress has appropriated at least $106 billion from 2003 to the first half of 2008 fiscal year, does that sound about right?

guest: i know from 2003 to 2007 in the iraqi area it was $75 billion, and in fiscal year of 2007 to first half of 2008, it was about $30 billion. that seems to be the appropriate ballpark. host: our last call we have sidney. caller: yes, i was curious, why since we always prepare for a two-front war and then have a military draw down, and now we are exactly involved in two-front war, why the military won't admit that it has stretched beyond its limits? guest: actually i think one of the reasons we are using contractors in department of the defense, and state, will say this, we don't have the

uniformed personnel without the contractors that we have. there is a need to rely on contractors to that extent. host: moshe schwartz, thank you for being on the program. when we come back, open phones. . >> this author has analyzed and critiqued the american education

system. today he will take your questions live at noon eastern. >> september 1 march -- marked the 70th anniversary of the start of world war ii, night, angela merkel, vladimir britain, and the polish just elected president. >> the supreme court has a rare session on wednesday, hearing oral argument on the campaign finance case. it marks the first appearance on the bench for judge sonia sotomayor. the before her formal ceremony takes place. here is justice ginsburg on what it is like working with the other justices. >> you'll be surprised by the high level of collegiality here. this term to think we've divided 5-4 in nearly one-third of the

cases. one might get a false impression from the degree of disagreement. justice scalia once commented that in his early years on this court there was no justice with whom he disagreed more often than justice brennan, yet justice scalia considered justice brennan his best friend on the court at that time. he got the feeling was reciprocated. the public would not know that from reading an opinion by justice brennan, or a dissent by justice scalia, or the other way around, but these were two men who genuinely liked each other, it enjoyed each other's company. >> hear from other justices during supreme court week as c- span looks at the home to

america's highest court starting october 4. "washington journal" continues. host: in this morning's "the washington times" -- obama announces retirement savings plan for america, announcing changes to the 401k. we will talk about that for the next half-hour, but first we want to listen to what the president had to say regarding retirement plans during his weekly radio address. >> first we will make it easier for small businesses to do as large businesses, allow workers to automatically enrolled in an 401k, or retirement become. it has made a big difference in participation rates by making it simpler to save. that is why we will expand to more.

second, we will make it easier for people to save their federal tax refunds. today if you have a retirement account you can have your refund deposited directly into your account. with this change will make it easier for those without retirement plans to save their refunds also. you'll be able to check a box on your tax return to receive your refund as a savings bond. third, we'll make it possible for employees to put payments for unused vacation and sick days into their retirement plans if they wish. right now most workers do not have that option. fourth, the irs and treasury department are creating a plain english, is a to follow guide as well as website to help people navigate what are often complicated waters. especially for workers changing jobs or often unsure how best to continue saving for retirement. because the rules ought to be written to encourage people to save rather than discouraging it. host: for the next half-hour we

want to get your thoughts about president obama's administrative, his administration's retirement. retirement -- his administration's retirement initiative. more from the article in this morning's washington deeper. it says the president one day after the labor department announced unemployment reached 9.7% said the economy is turning around but the u.s. cannot go back to an economy based on input of profits and maxed-out credit cards.

our first call regarding the administration's retirement of initiatives comes from detroit, mich., on the line for democrats. caller: i'm curious as to how this will affect the lesser people who are unemployed and if there will be an alternative for them. let's say someone has money but are unemployed and when to put it into a fund to have it go

down the road. host: how would you propose unemployed people put money into some kind of retirement plan? caller: that this is my point, could they put small amounts? let's say they took some unemployment money they did not spend with gillette said they had about $100 here leftover -- a lot of people would say they're living in multiple home dwellings who live under the same roof, you know? what if you wanted to try to invest some money for the future, you know? do you understand? host: ideal understand. seattle, washington, on the line for republicans. -- i do understand. caller: i do not understand why the military does not allow

people who have not served when there were younger to join. it could help to expand without paying so much to contractors. instead of bringing back a draft that would be a compromise were people like myself who are qualified and in shape could join. i would like to comment on this segment and say that if you go to the report we're not going about of the recession. the figures for the next few years are being shunned and we will be at negative growth until the mid part of next year. -- the next few years and we are showing negative growth. i called the beginning of the year and said to the guest, why are we borrowing money from china? why doesn't the government just reduce taxes and get everyone the opportunity to deposit 50% of their income into the bank

untaxed? that would have given the banks all the money they needed. the government, at least the left side, the democrats and bureaucrats, would never give the people a tax break. if they did they would have to lay off a lot of their state and county workers. then people would realize we do not need that much government. there is my answer. i think that the government is broke. last night i saw in the news that there would like to see people get savings bonds in return for their tax return. host: in the newly times -- in "the new york times" -- under automatic and run the plant's employes are automatically sign it unless they explicitly asked

not to participate. many large and medium-size companies have already adopted automatic and rohmer plans, but white house officials say the new initiative was aimed at very small firms. back to the funds, detroit, michigan, on the line for independents. caller: i have not worked in three years. my unemployment ran out last week. if you talk about saving money, it is time people in this country will come up and see what is going on here in michigan, especially the tour.

i went through retraining, and still cannot find a job. i will be evicted him. i'm going to get a gun and take what i need. host: md., on the line for democrats. caller: i think it is great. if they want to encourage people to save instead of just spending now this chinese junk. every three months they would come on online network and said it would lower the interest rate. what is that going to do? all of a sudden, there was it went down .5 and everyone would refinance their homes and buy a bunch of junk they did not need. of course it was a bubble. it burst. there is a documentary coming out on private contractors. it is three years of investigative reporting on how the production and big pharma --

how they have been making huge profits. host: let's move on to los angeles, calif., on the line for republicans. caller: this retirement plan, i am sure the intentions are good. it makes no difference to the worker in terms of what he gets for tax breaks. it is basically them saying we will do a direct deposit for you instead of giving you your paycheck. there is no difference. it is like retirement savings for dummies. host: more from the article this morning. in the second move it mr. obama says the internal revenue service would allow people to

check the box on the tax returns and receive their tax returns in the form of united savings bonds. back to the phones. monroe, louisiana. caller: thank god for c-span, thank you. i called to just say that i agree with the president's direction for this country. i think he is doing everything that the reasonable man should do to get this country back on the track it should be on, being that he was build such a bad hand. i also have a comment. i have noticed that the media is ducking the main issue here. they can say they do not want

president obama to talk to the children, and they do not won a pass a health-care plan that will help all americans. -- they do not want to pass the health care plan. the entire media is ducking the fact that it all comes down to race. they do not want to help support this black man because it is all about race. host: in the ap report -- out of kabul this morning, afghan officials have turnout votes turnout447 polling sites because of election fraud -- they have thrown out votes at 447 polling sites. caller: good morning. i'm familiar with the fair tax book written by one of our republican representatives.

i have been doing my own research. i have come to understand that the system we have in place of placing taxation on income seems to be anti-savings by nature. just the paperwork involved, the schedules you're talking about producing, the changes in the labor department -- how much money of our tax dollars is going simply to produce paper work about taxes? to me the retirement system is based upon avoiding paying taxes on money saved.

before income taxes all income was tax-free. why don't we look of the possibility of making taxing income as not the best way to raise money for the government? host: in the baltimore paper this morning, obama sparks run on bullets. the reporter writes that there is a bull market for bullets. the article goes on to say that bullets are in demand as the united states interest in firearms has spiked.

rochester, n.y., dan, on the line for republicans. caller: good morning. i have not yet read the morning paper as i'm watching c-span, but i'm very encouraged at first blush by the comments by the president who make it easier for small businesses to allow employees to invest in a retirement plan. this opens options. i do not want more mandates, but a direct deposit option is a great idea. host: how much of their salary can they put into those 401k and how much do match? caller: there are restrictions. the maximum is $16,500 per year except if you are over 50.

those are very high numbers, especially for those who are starting to work. people put away generally by% of their salary and i match 25% of that first 6%. -- people generally put away 5%. if you start at an early age it is a great way to save money. many people are trying to save. this goes with what the american public wants to do. i am not pleased that the president wants to allow a check off on the1040 for rather than people getting a refund back rather th-- if you could put ita 401k, that is different. it sounds like a president is trying to do backdoor financing. the message i want to give today

is that people across america really are trying to save. the president's plan will help, but it cannot be away for the government to do backdoor borrowing. the government is spending more than it should. this is a discussion point as the congress proves these new changes to talk about what the government can do to get it spinning back under control, like american citizens are, then i think this country would be a lot further ahead. host: ark., on the line for independents. caller: i did not exactly have a 401k, but i am retired military. it would be wonderful if the military could get it since the military is only paid one quarter or one-third of the amount of these people they bring in -- as those of getting

jobs over there are paid. they get their disability. i retired at of service with 10% disability and i do not draw a check. maybe you can explain that to me. host: you do not draw a check based on your disability? caller: no, sir. there is no one on know who has anywhere from-10from 50% visibility who draws a check -- from 10%-50% this ability which does not come out of their retirement. host: how much they paid you get now as retirement? caller: i do not know. i have been retired since 1977. host: in "the washington times"

of eds page this morning regarding a cia investigation into alleged torture, this reporter is a fellow and senior legal analyst at the american civil rights union. the piece goes on to say that president bush specifically tasked mr. dick cheney to be involved in security decisions, drawing on his vast experience as a former white house chief of staff and wartime defense secretary.

back to the phones. stanton, mich., on the line for democrats. caller: well, number one, i love my president. i think anything he does has been well-thought out and has the people in mind. anyone who does not believe that, i think it is just very hurtful to me. i hate to criticize him in any way, but i do have to say do401k's -- i do have to say that 401k's have not worked well

for me. i had $400,000 when i retired and i give it to someone else to take care of for me. it was great at first, but since i had it transferred from my work because i cannot keep it there back in 1996. now -- since then, twice i have gotten up to $13,000 or $14,000 and was making 25% per quarter. i was tickled pink, but twice since then i have been right back down to $4,000 when i woke up one morning. -- i had $4,000 when i retired. we're talking all these years. everytime i get somewhere is gone. i do not have a lot of wealth.

i like the company that handles my money, but i do not know why it is disappearing. twice in this amount of time is crazy. host: palm beach, fla., a republican. caller: i agree with the earlier caller about the president's using this to finance through the back door. the interest rate on these bonds, what would be it? what would be the maturity rate? who is to say it would not be eaten by inflation down the road? no, it is my money, give it back to me. host: in "the n.y. times" -- but it is fighting. -- hamas is fighting.

also, this op-ed by former president jimmy carter. he writes that he was in damascus when president obama made his historic speech in cairo which raised high hopes.

the former president goes on to say that a more lively -- likely alternative to the present debacle is one state which is the more obvious goal of israeli leaders. harry hayrack' james, on the line for independents, go ahead.

caller: i think the president's ideas with the savings bonds, it is great. i love my president and think he is really working hard to promote the best interest of this country. both on the international scene and here at home. what i think all this opposition rally comes from -- we have to be honest. we are witnessing the ugly face of racism. there are people in this country who should be ashamed of themselves. the whole world is watching. we are trying to demonstrate what democracy really means. when we can have bush addressing school kids, when 9/11 is occurring, in the classroom reading books, but yet a black president who wants to speak to the school kids, people are threatening to boycott the schools.

host: in venice, fla., on the line for democrats. your thoughts of bell the obama retirement initiative -- inverness. caller: the problem is not that he is not the greatest president we have ever had. we're still fighting the problem of prejudice in this country. we always have fought it. prejudice is all over the world. we all tend to have double- standards. host: what does this have to do retirement initiatives? caller: because they will not listen to him no matter what he says. the president is not being listened to. until we fight these problems of prejudice we cannot do a thing about it. we have had only white, and wood-sex and presidents and they never had these problems. --anglo-saxon president.

all his ideas are great and wonderful and we have to give them a chance. host: we will take a short break and when we return we'll talk about this book. justin hollander will be our guest. ♪ >> in more than a dozen books, a kozol has analyzed and critiqued the american

education system. he would take your questions live at noon eastern today. >> the supreme court has a rare special session on wednesday hearing oral argument on a campaign finance case. it also marks the first appearance on the bench afford justice sonia sotomayor. the day before her formal investiture ceremony takes place. here is justice ginsburg on what it is like working with the other justices. >> you'll be surprised by the high level of collegiality here. this term i think we divided 5-4 in almost one-third of the cases. one might get a false impression from that degree of disagreement. justice scalia once commented that in his early years on this court there was no justice with whom he disagreed more often

than justice brennan. and yet justice scalia considered justice brennan his best friend on the court at that time. he thought the feeling was reciprocated. the public would not know that from reading an opinion by justice brennan, a dissent by justice scalia, or the other way around. but these two men genuinely liked each other and enjoy each other's company. >> hear from other justices during supreme court week. starting october 4. "washington journal" continues. host: justin hollander is the author of "polluted and dangerous." his here to talk to us about the renewal of abandoned factory sites.

tell us first -- one of the expressions used throughout the book is brownfield. what is it? guest: it is a piece of property that has already been developed for some purpose and either is contaminated or likely to be. because of that inhibits new development there. it is juxtaposed with a green field which is like farmland or forest. host: you also talk about high- impact, temporarily obsolete sites. word is that expression come from? guest: the idea is that it is a significant light on this neighborhood, a site that brings down property values more than one-quarter mile away. think about a healthy neighborhood and all of a sudden

an abandoned factory near it. host: give us an example? guest: in rochester, n.y., the delco appliance factory. it sat there for about 40 years with no activity. kids would break in there and get her. there were a couple of incidences of arson. it was seen by the surrounding area as a problem. no one wanted to invest or live nearby. it just further depreciated values. host: what did delco produce there and what did it become polluted? guest: it was originally an appliance factory. they built during the 1940's and many of those jobs went to the south or overseas. host: has there been any sort of

designer plan to refurbish these brown fields or high-toads? guest: generally i found that local governments try to regenerate the economic activity. as with this company it wanted to build appliances, but could not find anyone to realready bud appliances in rochester anymore. that is the game people play. it does not usually work. in my research when a local government tries to recruit someone to take a factory, often times it does not work. they are left with a neighborhood crumbling. host: you also talk about areas, these site in pittsburgh.

what is that? guest: pittsburg is often seen as a success story. they nicknamed themself a renaissance city. there are a couple of examples, one particular steel mill converted into a technology park which brought many new jobs related to universities there. that is a success story. there are also sad stores. a steel mill literally across the river, 1,000 acres, which has sat there for 40 years. there is a group of non-profits which have gotten together. but the local neighborhood is really suffering. pittsburgh is a mixed story. host: earlier in july we had mayor john betterment of braddock, pa. and he talked about -- fetterman to talk about converted mills.

>> we have these old steel mills in that area. would you like to do with the town as relates to clean energy and the economy? guest: there are many things that could be done. i'm here because i fundamentally believe many of these sites must be and can be ready purpose to as a green enterprise zone. we have of they can't sim-- a vt stelel mill -- this will be a primary where companies would like to get involved in research and development could relocate to. there are multiple sites not only in western and southern new but all about the rest bell. host: your thoughts about his plans? -- all around the rust belt.

guest: he has some good ideas. the idea of taking advantage in current interest in sustainable energy. the problem is you need to have a plan b. mayors across the country are facing this. how the you try to attract a growth bet at the same time prepare for the worst? of anywhere, braddock, pa. knows. for half a century they did not prepare. they had only a plan a. it is a pretty big lesson. this book shows you need to have a plan b and prepare neighborhoods in case the new high-tech company, that new solar power company does not come. host: we're talking with justin hollander.

if you want to get in the conversation, the numbers are on the screen. the first call comes from detroit, mich., on the line for democrats. please turn down your television. caller: i want to ask your guest if he has been to detroit, michigan? the people who own the land, aren't they supposed to be taxed or fined if they don't keep up these properties? or can they just cut and run, just like bush did with the war? there are many people who had

homes. the city will come by and give them funds if they don't clean the yards. i do not understand. -- the city will come by to give them a fines. how can the city get away with this? guest: yes, i have been to detroit. you're speaking to a serious problem. the owners of properties, the vast majority of them are gone. they basically walked away, either legally or illegally. in many cases it is up to the city government's to take care of them. most are not equipped to be able. when you do not have someone taking care, maintaining, you get a disaster. host: the areas you addressed

include new bedford, mass., pittsburgh, richmond, va., trenton, new jersey, youngstown, ohio. was there something about these that made them so interesting, and how do they differ from detroit? guest: my strategy was to get a range of different kinds of cities, and range of sizes. prior research indicated most of these sites are in the northeast and midwest. in terms of turn to a creed of book and learn, i needed access. -- in terms of trying to write a bucook. that accounted for part of the challenge. host: travers city, mich., on the line for democrats. sue.

caller: are you familiar with two-multinationals? conrad and united technologies? both have a site at the mouth of the river here in traverse city. i believe that united technologies is probably long gone. the other has been amending their remediation plans for years. it has been only due to the force of the citizen movement against such grievous pollution and a legacy of industry, and it is basically abuse that has forced them to do anything at all. look at your politicians. our governor for eight years who is now running the national manufacturing association succeeded. president obama should look at

the actions of some leaders who overwhelmed enforcement and regulation and shifted the burden of pollution pay on to taxpayers. guest: i'm not familiar with those sites. host: let's move on to little rock, ark. on the line for independents. caller: if some viewers who are truly interested in the subject should go to epa.gov. how much of your research included the super fund that the epa has undertaken for the past 25 years? what is your conclusion on what the government has done with these considering how much money they have spent? guest: they have spent a lot of

money. probably about 30% of the properties were on that program. i did not do an evaluation of that super fund program. i can speak impression most thickly -- impressionistically. it is like any government program, needs proper oversight and accountability. host: the expression "the high impact temporarily abandoned obsolete sites" -- where does that come from? guest: that originated from a professor at rutgers university. they were doing the research back in the 1990's. i borrowed the concept from them. host: this addresses more of the

disuse of the property rather than the pollution aspects? guest: the pollution is sometimes not the most important problem. it is sometimes just the fear of pollution. host: the next call comes from the line for republicans. caller: the previous person addressed what i was concerned about. basically, you touched on it a little. my impression would be the abandoned properties, the largest propertproblem is undere ground degradation and pollution. i do not know what the percentage of your studies show

that the majority of degradation was occurring underground, but i think that is where the major cost of cleaning up these would be. two immediate groundwater pollution. -- to remediate the ground water pollution. guest: the underground, under water contamination can be extremely costly often because it could take 20 or 30 years. what i was really concerned about was the neighborhood quality, social dimension even though i do think that the environmental dimension is important. when you have above-ground problems at a site in beating

the ability to read the use it, it will contribute to overhaul neighborhood -- overall never had declined. host: what strategies did you find to be most effective? guest: the problem was most local officials took on what mayor fetterman took on. they just won a new jobs, new economic-generating ventures. so many sites are ill-suited. the most creative and successful strategies were those focusing on just improving the quality of life of those living in the neighborhood. for example, trenton, new jersey has been working on redeveloping industry four sides

are abandoned into a park. this is a long-term strategy. i saw the same in new bedford. taking old mills in neighborhoods and turning them into parks. it does not create new jobs. it at least ameliorate the negative impact. host: back to the phones. north carolina, on the line for independents. caller: when you wrote your but did you consider the possibility of instead of building windmills and solar panels that we should take some and provide the necessary infrastructure for nuclear power? what is your opinion on the pollution of nuclear power? many people perhaps misunderstand it.

guest: that was never something that came up. i visited over 100 sites and nuclear power was not considered. host: edward, on the line for democrats. caller: i used to work in the manufacturing industry. why are some of these facilities being revitalized -- why aren't they now that we are in the recession?

one of put them back into the system to create jobs? they're just wasted by sitting there. host: things for the call. guest: that is the heart of the matter. -- thanks for the call. guest: you see that the market is a feeling. these sites, many of which have a fairly new equipment and are configured well for manufacturing, but there is no interest. when they linger for one or two decades it is sometimes appropriate for government to step in and say the market is not working. what can the government do? my recommendations at the end of the book is, those resources

should go to right-sizing those plans to improve quality of life for people in the neighborhoods. if it means parks, wildlife refuge, parking lots -- it does not have to be new jobs. host: in the case of trenton where they created the parks, was there any sort of indication that there was new infusion of cash or sources of revenue that came on because quality of life had been improved? other companies decided it was a place to look at? necessarily on the site, but because of the improvement, parks, quality of life, does it then attract new sources of revenue? guest: not enough time in trenton has been to evaluate

that, but much research shows it will. central park in new york city is known as the preeminent example. host: central park has been around more than 100 years, though. guest: exactly, time to measure. host: good morning, caller. please turn down your television. caller: all right, got you covered. yes, sir. i would like to comment. i appreciate justin for writing his book. we live -- i worked in the red reindustrialization where they tried to come back around the manhattan project, k-25 were

they made the nuclear bomb. i have had several rounds of cancer, several of my colons busted. we have a class action suit, which my son will probably not even see that money. i am sure you have probably heard of all the people who worked down there who had cancer. they have paid a lot of people off, but the government has not even try to clean up this place. no way near what it was. when i worked on merit there were barrels of stuff laying down there. i'm sure you did not get in there because they would not let anyone in without certain clearance.

guest: i did not look at any federal government site in my project, but in my prior career i did work for the federal government and saw many of these. i do know what you're talking of. there are significant health risks still posed by these governments sides with energy and nuclear. it is a longstanding, serious problem. the government needs to devote more resources to clean up the mess. host: we're talking about the renewal of abandoned factory sites with justin hollander. he is "polluted and dangerous" autho" -- the author. caller: i'm originally from new york, long island.

in that area, grummans used to be there, and republic. they moved off and left these buildings. i'm sure they could be revitalized and retooled. suddenly, in pittsburgh -- secondly, i do not understand what they cannot retool the steel mills, industry to hydro- electric. guest: i cannot comment on retooling, but the important

lesson from my research is that it is really critical for communities to be creative about reducing these sites and put all options on the table. for example, not to say a still has to become a new steel mill, but what other synergistic industries might fit? host: how active anis the federal government in trying to get these up and running again? guest: the environmental protection agency did develop a program providing public grants about 10 years ago. that program has continued with some success. the problem is that many of

those funds and other federal agencies are tied to job creation. if you have a contaminated, abandoned site most of the time you will only get money if you promise it will create new jobs. most communities really just need some way to demolish the buildings and cleaned up. just take it back to nature. host: greendale, south carolina -- greenville. caller: i used to live in the northeast corridor in maryland. the situations are relatively similar here in north carolina. there is not a park in the area. business leaders in the area because regulatory and taxation laws are so difficult they cannot make a profit.

if you give them incentive and means lowering taxes, then you get the structure back up and running. detroit is a prime example, so is toledo. that is high taxes and driving out of business. host: justin hollander? guest: there are a lot of factors that contribute to decisions by companies whether to stay or go. in this project i was trying to accomplish managing the impacts of that dislocation. to understand what cities are doing well, or not. there is no doubt there is a way for a community to make it more palatable for new development. when you have a site for which nothing is happening, that is causing blood, what did you do?

host: next up, on the line for independents -- causing blight. caller: thanks for your research. this might seem harsh. i have a couple of comments, a suggestion, and question. first of all, i had a teacher who taught me to not only listen to what they say, but also what they do not say. i'm a bit disappointed. many of the callers have been asking for direct questions. we understand these abandoned factories have been around for decades. how old are you? in 38 years old.

i have seen this ever since i was a teenager. host: i need for you to get directly to your question as we're running out of time. caller: who did you talk to? one caller asked about the fines placed on some. who do you report that to? exactly who do you work for? the you think the factors can be used to produce green energy as opposed to parts that do not produce jobs? guest: i have been doing this research project for about four years. the question about bring energy, yes, certainly many of these sites can be used to create new jobs. host: what is the level