that is why when he is rushing to push the health care plan through, it is why i am very reluctant -- and c-span has been pushing the program since july, telling us what it is going to do and how it is going to help, when the fact is that the bill was not even written so there is no way to even ascertain what is going to do. host: that you, you have the last word on wednesday morning. it looks like president obama will continue to be at least-25- year-old tradition of pardoning the thanksgiving turkey. i want to close with a twitter message, because the reflects our sentiment here. we will join in that as well. thanks to you for watching and being such a great audience on this day before thanksgiving.

from all 280 of us as c-span, we are glad you are watching and taking part in the discussion. we will be back tomorrow morning, a thanksgiving day, 7:00 a.m., with more calls. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . change their vote? if not, on this vote, the yeas are 60, the nays are 39. three-fifths of the senators duly chosen and sworn having voted in the affirmative, the

moti >> with that vote the senate moved its. live starting monday and through december follow every minute of doe bait and how bill would affect access to medical care. the public option, taxes, abortion and medicare the on the only network that brings you the senate gavel to gavel. c-span 2. >> coming this thanksgiving on c-span, american icon, three nights of c-span original documentaries on the iconic homes of the three branches of american government. beginning thursday night at 8:00 eastern, the supreme court, home to america's highest court, reveals the building in ex quiz it detail through the eyes of supreme court justices. friday at 8:00 p.m. eastern -- our visit shows the grand public places as well as those rarely-seen spaces. and saturday at 8:00 p.m. eastern, the capitol. the history, art and architecture of one of america's

most symbolic structures. american icons, three memorable nights, thursday, friday and saturday at 8:00 p.m. eastern on c-span. get your own copy of american icons. a d.v.d. set. order online at c-span.org/store. >> regulating the internet. one of the topics monday with meredith atwell baker, the newest f.c.c. commissioner. the communicates on c-span 2. >> president barack obama hosted his first state dinner last night. the event honoring the india's prime minister was set in a tent on the east lawn. he hosted indian prime minister manmohan singh. here's a look.

>> ladies and gentlemen, the president of the united states and mrs. michelle obama, accompanied by his ex lensy, the prime minister of the mrs. kahr. [hail to the chief playing] applause applause

>> please be seated. good evening, everyone. on behalf of michelle and myself, welcome to the white house. afga bahboute. many of you were here when i was honored to become the first president to help celebrate devali, the festival of lights. [applause] >> some of you were here for the first white house celebration of the birth of the founder of

sikhism. [applause] tonight we gather again for the first state dinner of my presidency with prime minister manmohan singh and mrs. gorshon kahr as we celebrate the growing partnership between the united states and india. as we all know in india some of life's most treasured moments are often celebrated under the cover of a beautiful tent. it's a little like tonight. we have beautiful food, music and are surrounded boy great friends. but it's been said that most beautiful things in the universe are the starry heavens above us and the feeling of duty within us. mr. prime minister, today we work to fulfill our duties, bring our countries closer together than ever before. tonight under the stars we celebrate the spirit that will sustain our partnership, the bonds of friendship between our people. it's a bond that includes more

than 2 million indian americans who enrich every corner of our great nation. leaders in government, science, industry and the arts, some of whom join us tonight. and it's a bond of friendship between a president and a prime minister who are bound by the same unshakeable spirit of possibility and brotherhood that transformed both our nations, a spirit that gave rise to movements led by giants like ghandi and king, and which are the reason that both of us can stand here tonight. and so as we draw upon these ties that bind our common future together, i want to close with the the words that your first prime minister spoke at that midnight hour on the eve of indian independence. because nehru's words speak to our hopes tonight "the achievement we celebrate today is but a step, an opening of opportunity, to the great triumph and achievements that await us. the past is over and it is the

future that beck ons us now." so i propose a toast to all of you. does the prime minister get a glass? >> thank you. just logistically we want to make sure the prime minister has a glass here. to the future that beck ons all of us, let us answer the call and let our two great nations realize all the triumphs and achievements that await us. >> hear hear. >> cheers.

>> mr. president, the first lady, mrs. michelle obama, distinguished guests, i feel privileged to be invited to this first stays banquet, mr. president, under your distinguished presidency. you do us and the people of india great honor by this wonderful your part. we are honored by your hospitality, the courtesy you have extended to us personally, and the graciousness of the first lady.

[applause] >> you are an inspiration to all those who cherish the values of dempsey, diversity and equal -- democracy, diversity and equal opportunity. [applause] >> mr. president, i can do no better than to describe your achievements in the words of abraham lincoln, who said, and i

quote, "indians, it's not the years in your life that count, it is the life in your years." [applause] >> mr. president, we warmly applaud the recognition by the nobel committee of the healing touch you have provided and the power of your idealism and your vision. [applause] >> mr. president, your leadership of this great nation of the united states coincides with the timing of profound

changes taking place in the world at large. we need to find new pathways of international cooperation that respond more effectively to the grave challenges caused by the growing interdependence of nations. as two leading democracies, india and the united states must play a leading role in building a shared destiny for all humankind. mr. president, a strong and sustained engagement between our two countries is good for all our people, and equally it is

highly important for the world as a whole. we are embarking on a new phase of our partnership. we should build on our common values and interests to realize the enormous potential and promise of our partnership. our expanding troops in areas of social and human development, science and technology, enaur and other related areas will improve the quality of lives of millions of people in our countries. the success of the nearly 2.7 million-strong american

community is a tribute to our common people. they have enriched and deepened our ties, and i thank them profoundly from the core of my heart. [applause] >> mr. president, i convey my very best wishes to you. mr. president, as you lead this great nation and look forward to working with you to renew and expand our strategic partnership. i wish you and the people of america a very, very happy

thanksgiving. [applause] >> ladies and gentlemen, i invite you to join me in a toast to the health and happiness of president barack obama and the first lady, mrs. obama, the friendly people of the united states of america, and stronger and stronger friendship between india and the united states of america. >> hear hear. >> cheers. >> thank you, everybody. enjoy your evening.

[applause] >> from last night's state dinner, more state dinner coverage for you tomorrow. thanksgiving day you can watch at 1:45 p.m. eastern here on c-span. we're also covering an event later today with the indian prime minister. you'll see that later in our program schedule. the white house this morning announcing president obama will travel to copenhagen in december for the climate change summit and to accept the nobel peace prize. >> in our schedule the "new york times" reported this week the national football league is changing its policy on players' concussions requiring independent newerrologists to review those football injuries. it comes after a house here on the issue which you can see tonight at 9:15 p.m. eastern here on c-span. >> thanksgiving day on c-span at 10:00 eastern bill clinton is on hand to present steven spielberg with this year's liberty medal from the national constitution center.

also stanley greenburg and alex c -- a panel assessing the j.f.k. presidency. and nick burns and leslie gell on terrorism and nuclear weapons. at 5:00 hiphop artist and actor ludicris and -- thanksgiving day on c-span. >> the senate returns from the thanksgiving break on monday to begin formal debate on healthcare legislation, and a number of senators will be offering amendments, live coverage of that debate is on c-span 2 starting at 3:00 eastern on monday. in the meantime a number of groups are showing ads trying to influence that legislation. here's a look. >> saturday night as americans laid down for sleep, moderate democrats laid down their beliefs, sold out their constituents, rolled by pressure from barack obama and harry reid. they vote today move forward a

government-run healthcare bill our nation does not want and can't afford. one member sold her vote to the highest bidder. one member sold out his principles. two more lost what little credibility they had on fiscal responsibility, another put the interests of the left of his party before his own state. and another voted one way after saying she was for another. it's no wonder why democrats voted in the dead of night. [cheers and applause] >> so i think laughter is the best medicine. i have a healthcare reform joke. you want to hear it? so this woman goes to her doctor she says, doctor, my back is

killing me. she says, doc, i can't breathe out of this side of my nose. does my insurance cover a nose job? he says yes, it does. another woman goes to her doctor and she says, "my baby has encephalus. its brain is not there and it is fatal. does my insurance cover abortion? and he says no, it doesn't. >> sarah palin's book "going

rogue" is a national best seller after being released this month. the former republican vice-presidential candidate is on a national book tour. we found her in cincinnati as she talked to book buyers and signed their copies for about 45 minutes. >> you have line tickets, you've got your book, you've got your receipts. ok. fair enough. >> there's a bunch of different letters, roughly about 26 different letters. and then there's a small v.i.p. group. they were the first people to purchase the membership of the program, et cetera. and so when we let you in, at 10:00 we're going to close this door to people without the line list. so you're going to be welcome to shop the store, we're going to line people up by groups so you're not just going to be

standing in one stage for four or five hours. we'll line people up by groups. and then you'll go up. it is going to be very quick, though. i'm telling people in advance. she's going to be signing very fast. she has a lot of people that she wants to try to get through. so we're just telling people in advance that she has to leave on a hard deadline to get to columbus this evening. security is going to block it off. and she's going to come right up through our back entrance, probably stay in the back until she comes out and does the signing. >> we're just trying to tell people. >> thank you. >> what brings you here so early to the sarah palin book signing?

does it have anything to do with that sweatshirt you're wearing? >> it has everything to do with it. i went to some of her rallies and got up and stayed up all night to get there to get in the front row. got a hug from her. >> how can you explain to us your enthusiasm for sarah palin? >> well, because she stands for the values and the principles of what i believe in, smaller government, less taxes, strong military, and a big defender of the constitution. and she walks the walk, basically. she talks the talk. >> will you be supporting her in 2012? >> i'll be supporter her for the rest of my life. i'm just pleased to be living this long to see a politician like this, see a woman like this. >> what makes her different than other politicians? >> because she's not afraid to take on her own party. she's not afraid -- she has

impeccable integer tim she says what she means and means what she says. and she's not afraid to bring down her own party. or if she sees something that's wrong or corrupt, she tackles it. and plus she's not from -- she's not from inside the beltway. she's not been to d.c. she's just an unbelievable politician, somebody we haven't seen for -- mrs. pail ingoes to washington we hope. >> finally, if there's something wrong inside the beltway that needs to be fixed, what is wrong? >> well, i think we need to get rid of these what do you call them these long-term politicians that have been there 30 and 40 and 50 years. you just get entrenched with that kind of mentality. and they're corrupt. every time you turn on the tv there's another corrupt politician for an ethics charge. oh, and the main thing, they don't listen to us anymore.

they don't listen to us out in the heartland. they don't listen to us. she does. >> there's something you missed saying? >> yes. i wanted to say that she's a woman like i said with strong values. but she's a woman with impeccable integrity and a very strong faith in god. and she's not ashamed to let that show. >> i think that's the intent. i agree with you 100%. we heard your words and we believe in that. perfect. said perfectly. >> so you're all here very early. why are you here so early for this event? >> so we would have a chance to see her. >> we wanted to get in here. yes, exactly. >> do you remember when you first learned about sarah palin and what your reaction was when you learned about her? >> my reaction was that i went to the republican national office and started making phone calls for the campaign. as soon as i heard she signed on

and heard her speech that night. so a great inspiration. >> what about her inspires you? >> just her integrity, how she holds herself, her confidence in who she is and what she stands for. and she can express it to the average citizen in a comfortable way that's easy for us to say, she comes from the same background, same situations that we are in every day. so she's just a great inspiration to the country. and she'll make a lot of changes in whatever she does. >> i agree with that 100%. i think she is one of the best things. i think we are finally beginning to get people like herself. and i think we need to start turning our country around. we are becoming a socialist country right now with obama.

and i am totally against that. and i think sarah would be the best person to come through and come up. and i think she will help turn our country around. >> now, when you say we're becoming a socialist country, what do you mean by that? >> obama. obama. >> but why? specifically why? >> i just don't like his ideas. i do not like what he does. and i think it's horrendous. >> i think it's a mindset, too, in regards to socialism. socialism is that people that government does for the citizens. and we have to get back to the values of we do and we make our own lives and our own future, not because of what government is giving us. so it's a simple -- socialism is a simple term. it's not something that's

intricate in regards to the policies that he's making, it's a mindset that he's instilling in so many people in the population. so that's what socialism is. >> and i want to be able to create some feelings of support for sarah palin. i think she is a great leader. and i have to say in all due respect you guys who have been running our country for so long, you just can't seem to get it right. and i think we need a leader in the female gender to get the world turned around. we need to be on the committee. we need to run the committee. and sorry, guys, but you have goofed up too many times over the years. and we need new leadership. as far as obama, i think he is an abomination.

and to go before our troops and say, "you make a good photo op" that did it. i think he doesn't know what he's doing. and i think the sooner the better we get a lady, woman, who is the caliber of sarah palin. we can turn things around. thank you. >> so you think she'll be running in the next election? >> that's up to her. i'm not here to tell her to do that or not to do that. i think she's got a lot of spunk and a lot of leadership qualities. and whatever she believes she can do, i'm sure she will. and i think she'll do it with gusto, and i think she's got a lot of followers to help her along the way. i think that she's knocked at every turn by the loony liberals and people that want to tear things down. they do it because they know she is a force for good.

and i think they are only a force for evil. i'm sorry to say it. i'm 75 years old and i've seen a lot of changes in our country. but we are on the wrong road. absolutely on the wrong road. who does obama bring into the fold? people that haven't paid their taxes, people whose goals and whose leadership qualities are mao tse it is tung and leaders of that ilk. why are we letting some squirt who might have a good view and a good ability to speak turn us going in the wrong direction? we've made a great mistake. and we need to correct that mistake as soon as possible. and i urge every person in this country to get behind someone who can help us instead of taking us in the wrong direction. and at this point in time, one of the candidates for that event

is sarah palin. >> i'm charlotte will tim actually -- i live in oxford, outside cincinnati. i think she's a great role model for young women. i think she's what america needs right now. she's just great all the way around. i just love her. she's just great. >> when you say you like her conservative values, what do you mean by that? >> specifically she believes in the constitution. the abortion issue, i'm against abortion. just good american values. i just, you know, i just love that about her. she's a real person. she's one of us. she's not from washington, d.c. she's not anything that -- you know, she doesn't act like anything she's not. she's just herself. and i really like that. >> my name is nancy and i'm from

dayton, ohio. >> have you ever seen her in person before? >> no. no. so i'm really anxious and excited about meeting her and having the book signed. >> and have you heard anything about the book yet? have you read it yet? >> i've heard lots of things. no, i haven't read it yet. i watch fox news a lot. and they've had lots of interviews and stuff like that on there. and i've been just watching her. so i'm real excited. >> what is it that you like about sarah palin? >> just about everything. i like her. i like her conservative values. i like she's one of us. she's not -- like she said, she's not ever tried to be something that she's not. she's down to earth. she's got her head on straight. she's not like some of the people we're dealing with now in the government that seem to have their head above the clouds.

>> hi. do you have your line ticket? >> no. >> we're completely sold out. sorry about that, folks. thanks for coming out. >> hi. do you have your line letter for the event? >> i was just going to buy a magazine. >> we're closed for the sarah palin event. we're closed until 3:00. sorry about that. >> completely out of tickets. it's been entirely sold out. all right. >> we can't even buy a book? >> unfortunately we're closed for the event. sorry. >> all right. >> do you have your event ticket? >> no. i'm here to pick it up. >> you already paid for it? go right there. you're all set. >> do you know anything about an east clinton high school? well, anyway, two weeks ago when i was --

>> do you have your receipt and everything? >> my receipt? >> ok. you come on in. thank you all for coming. >> how do i get to the coffee shop? >> in and through the coffee shop door. thank you very much. >> [indiscernible] >> i think the current administration wants us to go downhill to the bottom. she represents everything i think is good about our country. i have five girls, five grand daughters. and we all feel that sarah is a really great lady. >> what is it about her that makes you feel that way? >> well, i think it probably is the simple fact that she seems truly like a real woman, a real person, really.

she raises a family, she does all these things that -- isn't that what we all want to do, be very versatile and live our lives? [indiscernible] >> did you already have tickets or wristbands to get in? >> we have the tickets. >> [indiscernible] >> and fox news, by the way, you guys are great. i don't know what we would do if we just had the mainstream med media. o'reiley, all of you.

>> i think she knows what's best for the country, especially from an enaur standpoint. i think she is a constitutionalist. she knows the constitution. [indiscernible] >> -- such a high turnout of people being interested in sarah palin just one year after the election passed makes me ask, what does it mean for the united states? what is going on in this country? >> we're finding that most of americans that voted for barack obama are dependent on the government. they feel that the government can give them [indiscernible] what we're trying to support sarah is by telling her that we understand that our future is in our hands, that the government is supposed to be there to protect the country and that's

their main position in society and in the united states. and we don't want any more social agendas. we need to instill hard work, integrity, and [indiscernible] and that is being lost in there. so [indiscernible] to tell people that government is not the answer. and that's what sarah is trying to do. >> after sarah palin was aspiring a position in government also. so how does she differ from the establishment? >> because she doesn't believe in adding agencies, adding departments of education to the federal government. >> hi. my name is thomas. i blog on the internet.

i'm originally from sunnydale, california but i live in cincinnati, ohio now. >> you were here very early this morning. i think it was a quarter of 8. what brought you here so early? >> i wanted to scout out the area, primarily to see how the parking would be and to see if any lines had developed. but there were not a lot of long lines here because they used a system here that was not a first come first serve but rather groups based on a letter. so it worked out pretty good. we didn't get a lot of backup of people in the parking lot. worked pretty good. >> your shirt says "conservatives for pail in, we've got your back.gov." what does that mean? >> conservatives for pail in.com is the premiere web site out on the internet that defends sarah palin against the media attacks. and also puts columns out on certain issues that are related to politics. it was originally started by a gentleman named joseph russo

with about $10. and now it's a very popular web site out there where people can go to get their information on sarah palin. it's very fast, very factually-based, very professional, and i strongly recommend it. that's www.conservatives4pail in.com. >> and why are you so enthusiastic about sarah palin? >> sarah palin and i came of age during the age of reagan in high school and college. we're both the third children. i am a middle son with the oldest being a sister. she's the reverse. she's the middle daughter with the oldest brother. our fathers were both schoolteachers, high school teachers and coached sports. also we are the same age, born in 1964, and our political blows are pretty much the same. fiscal conservatism, social conservatism. she's a western libertarian.

con server. we're both christian, i'm catholic, she's advantage cal. and also -- she's evangelical. she believes in a strong defense. so i believe reagan played a big part in the formation of our beliefs as we grew up. >> what does conservative mean to you? >> conservative -- there are many strands of conservative. i tend to gravitate most to ed mund burke or russell kirk, what i call kirk and burke conservatism, which tends to believe in an enduring moral order, and also the virtue of prudence. and i would recommend -- if you want to know more about kirk and burke conservative i recommend blogging edmund burke or russell kirk. if i could recommend one book, it would be russell kirk's "a conservative mind" which came out i believe in the 60's, 50's or 60's. but that was kind of a movement book. >> so if you look around at political leaders right now, who is closest to a kirk and burke

for you? >> i'd say right now it would have to be sarah palin. i think she's the premiere conservative. she has three things going for her. she has the convictions, she's got the charisma, and most important she's got the courage. the country right now is kind of heading very collectivist. and we see economically we're having problems with unemployment, a slowing economy and a growing government that's really kind of getting out of areas of the constitution really has promoted. and i think sarah palin right now is the champion of the libertarians and conservative movement in america today. >> we were allowed to release 1,000 kind of guaranteed line letters, people that we were pretty sure. and her team was pretty sure that she'd be able to get through in the three-hour signing. and then we also did 200 stand by tickets in groups of 50 to kind of run as time permits.

so we sold out of the guaranteed tickets last friday and out of the 200 stand by tickets sunday. so like two days later. >> she arrives at noon. she's going to come on her bus, which is completely draped bus. and she'll come in, get her family settled in the back room, and then come out to give a very brief hello to cincinnati and to her fans. and then she will begin a book signing. her team, harper collins and my team here have worked to get the signing area sort of set according to her requests. and then she will begin signing books very quickly.

no personalizations, no posed photography. and try to get through as many of her fans be a possible. the team's also going to have a photographer here who's taking a series of still images that they're handing out cards where people can go onto a web site and hopefully find a picture of them getting their book signed by ms. pail in. >> finally, how does this compare to other -- do you have other events of this size? >> yeah. you know, just in my time with joseph-beth book sellers in the cincinnati location, we've hosted caroline kennedy which had about 3,000 attendees, stephanie myer of "the twilight" fame. third book "eclipse" people coming in from six states away. shadow from the bengals. we've had a very large number of events here. johnny bench. so yeah, it sort of spans the gamut. >> how do these big events help

a book? or what's in it for you? >> i think the biggest thing is the challenge of letting people know that we do events is always tricky. you know, it seems like every time we do one of these big events we have people who live in the city or live in even the neighborhood that are like, oh, you know, i knew you were a bookstore. i didn't know you had authors. where we host probably 20, 25 authors a month. so getting people, getting that top of mind awareness is probably the biggest benefit. but also just having people experience an event here, how we do it with the line letters, and getting that muss em memory almost of what it takes to get from their door to our door to their door will hopefully convert people from an once or twice a year visitor to someone who comes in and just reads a lot more. >> my name is knee that i'm from here in cincinnati. >> what time did you get here

this morning? >> about 7:30. >> so you've been here over three hours now, going on four hours. >> i had breakfast while i was waiting for this to start. >> why did you come to early? >> i wanted to make sure i got in and i got a place. it's really important for me to be here today. >> why is it important for you to be here? >> because i wanted to meet sarah palin or at least see her in person. i think she's an up and comer. and i agree with her politics. and i voted for her. >> what do you like about her politics? >> she really follows what most of the people that i know, middle-class, mid-america is about. my kind of candidate. >> what are most of the people you know, what is it about? what are their politics? >> most of the people i know want want a smaller government. we don't want the government

interfearing with our lives to the extent that it is. we don't feel that we need a nanny state. my people in my family go back for generations of the united states. and we do not believe that we need to be taken care of. we take care of ourselves. the government should be very limited. and i think that's more her style than the current president, unfortunately. >> so you're not in favor of any kind of healthcare reform this. >> i think there's some things about healthcare that needs to be changed. but i don't think you have to take over everything to do it. and what they're saying, they said it was supposed to be originally they were going to cover everybody that wasn't covered. none of the bills they have are going to do that. instead it's going to tax us. it's going to create a lot more problems. i have medical problems that i know are going to be seriously affected. i read the bill. congress doesn't, unfortunately. we had one congressman get on tv

and speak and say, well, he can't read a bill even in three days and he couldn't understand it if he read it. now, this is what they're voting on? >> what are you going to say to sarah palin if you have a minute to say something to her? >> 2012, baby! [laughter] >> governor pay lynn will be joining us -- palin will be joining us pretty shortly. so thank you for your patience. lots of room in the store. enjoy yourself. shop! we love that! enjoy yourselves, please. >> i understand you came all the way from florida for this sarah palin book signing. can you explain why? >> for sure i did. i had to see this woman who represents middle america. she is our voice. >> why is that? can you explain a little more about that? >> everything she says pertains to the middle people. she is dynamic.

she is for middle america. she is -- she knows the issues. and i think that she's going to represent us more than we anticipate. >> when you say "middle america" what do you mean? >> just the come oners, people who don't know where to go to get information, don't know where to go to have representation. i think that she will be their voice. >> and did you vote for mccain and palin in '08? >> by all means i did. i did. >> and so why do you think they didn't win the election? >> i think there was too much outside influence. and i don't think that she was given the opportunity. i think there was too many people that were strategizing and kept her from speaking out. >> a number of people i've talked to seems to be sort of

upset about how she's treated by the media. would you agree with that? and what would you say about that? >> i think she was treated unfairly. i think that she should have been able to speak more openly and have her own platform. >> and are you a lifelong republican this. >> no, i used to be a democrat. but when she came in on the scene -- just george bush, too. but when palin came on the scene, i felt that i needed to vote for somebody who was in my corner. >> thank you very much. >> oh, what about you two? >> definitely. >> i'm sorry. you said that she knows what the country needs. what does the country need? >> the country needs honesty, they want to hear the truth. and we're not hearing the truth right now. we're hearing a convoluted

information that is totally confusing on matters. we can think we're voting for one thing, but really it can be alled around and tied up into another piece of the legislature that will then make it something that we didn't really vote for. and that's what scarce me. i think we need someone to tell us the your name and where you're from? >> my name is linda and i'm from cincinnati, ohio. and this is my daughter jill. >> hi. i think that sarah palin is a real voice for america. and she has a platform to stick up for us and to give america the change -- the actual -- people are talking about change. she is the change that we need. >> you look familiar. [laughter] >> yes. do i look a little like sarah?

>> you tell me your name and where you're from? >> carolyn from ohio. >> and are you dressed up to look a little bit like sarah palin on purpose? >> well, actually this is my look. and we just happen to look alike. >> why are you here today? >> oh, absolutely to meet sarah palin, get my book signed. >> what do you like about sarah palin? >> you know, i like her because i believe that she is -- she's just real. she seems like one of us. and you know, raising her children and also doing everything that she does in a running for vice-president and hopefully she'll continue. >> so if she were to run for president in 2012, why would you support that? >> i support it because i, you know, i believe that she -- she's a woman who, you know, knows what she's doing. and i just support her. and i like her.

[cheers] >> thank you so much for being here. oh, we're going to have a blast. thank you. >> thank you for yourness and your courage. even for being here. those of you carrying that book under your arm, you're going rogue with me. [cheers and applause] >> really it is good to be here on this book tour. and i appreciate those of you who want to read my words unfiltered. important for me to call it like i see it and not worry get out there and speak truth. i know that's how you guys are wired, too, otherwise you probably wouldn't be here.

so thank you so much. we'll get to work. i want to sign these books and i want to shake every one of your hands. and thank you so much for being here. [cheers and applause] >> sarah, sarah, sarah, sarah, sarah. [cheers] [indiscernible]

>> thank you. nice to meet you. thank you so much for being here. >> thank you. thank you. >> hey, i want you to be comfortable, guys. everybody here we're going to get you through quickly with the book signing. >> why did you come here to the book signing? >> it means a lot to me. she believes everything that i believe. she's a great girl and a conservative.

i just want to learn more about her. great mom. >> what's your name? >> tena. >> god bless you, too. >> it was so nice to meet her. >> did yes, a little bit. i had a few words to tell her. i told her i was the radar's bar and she needs to readjust that radar and we'll see her in 2012. >> can you show us the signature? >> oh, yes. i have my signature. [crowd noise]

>> thank you so much. thank you. appreciate it. >> joe and i'm from cincinnati. >> and what brings you out here to the book signing today? >> look around you. i mean, first of all, i believe that this woman's a lot different from the average politician you see today. she actually answers a question without trying to dodge it. and i think that's the best thing i like about her. >> also i think if you look at all the political books you'll

see, she dead kates it to americans just like mark levin. i saw his "liberty and tyranny." they're dedicated to the people. most politicians are dedicated to themselves. and i think that's the difference. but look around you. there's no northeastern or california people here. they're all midwestern and people that are like her, i think, which is not like the normal politician we see today. >> now, i'm going to have to ask you, what's wrong with people from the northeast or from california? >> nothing. i was born in new york. but you know, they think when you're leaving new york city you're camping out. and that's not true. you know, again, i think she sounds like the average american. and when you ask her a question she answers it just the way the

average american would instead of the politicians today that run away from most of your questions. >> do you think she has a chance to be president someday? >> i think she has. i think -- my own guess would be get on the campaign trail with other conservatives. she'll raise a lot of money for them. she'll be able to stand next to them and i think show that they're somewhat like her and not again like the average politician. and i think after the elections next november she'll sit there and say, you know what, i've got enough people out there that really think like i think, why not? i think she can. >> do you consider yourself a conservative? >> i do. you know, yes, i do. >> what does that mean to you? >> that means that i don't think government should be as large as it is. i think most of the freedoms that we enjoy we should

continue. you know, i think this healthcare thing really shows you the problems we have. we've got somebody with a broken leg and we want to take his heart out. i mean, there's a couple of things that we can fix, tort reform being one of them. i can buy insurance across states. we should be able to do that. that will solve most of the problems without having to go through extra -- the extra tax we're going to be putting on ourselves. and we are. and my grandchildren are going to wind up having to pay for this. >> thank you very much. >> rachel from lofland. >> you just came down from getting your box signed. what was it like? >> amazing. i just drove from ohio state today. i'm a student there. i just got in the car and came down. they today me i had a ticket. i love sarah palin.

i saw her on oprah this week. it was phenomenal. >> do you have a lot of fellow students at ohio state who also follow sarah palin and like her? >> yes. i'm also part of the college republicans club. so we have a strong following for her. >> what is it about her that you're attracted to? >> i just think she's a strong woman, like a good family, like a great mom. and you know, she's just a down to earth, nice person. >> did she say anything up there to you? >> just that it's wonderful, she's nice to meet me and she's really glad i came all the way from ohio state. >> thank you very much. >> thank you. >> -- event manager. we're about halfway through the sarah palin book signing. how is it going today? >> it's going really well. you know, it's still very early in the tour. so you know, just having them come in, get situated is still i think a little -- working everything through. but the people are incredibly

excited. and they've been going right through there. a lot of people who are very, very passionate about ms. palin. and so it's been a remarkable experience. >> thank you, sir. thank you so much for being here. thank you so much. >> the book officially released this past tuesday. our signing is today on friday. so there was just a couple of days in between. so they preordered the books via voucher for the book that they could then swap for the book. and when they bought the book they would get a line letter, a, b, c, et cetera. we called people up in groups of 50. they'd line up. that aloud people to browse the store, sit where they're comfortable and only stand in

line for a relatively short period of time. we bring them up in groups of 50 by letter. they go right up, right through. they get their book signed, shake ms. palin's hand, and then are free to shop or go home. .. >> after the first couple of years, the ones in national

decided to retire, and the succession plan was kind of selling to the owner of the company, and he has expanded into cleveland, his hometown, and charlotte and pittsburgh. it is seven stores. yeah, we kind of focus on being a regional booksellers. >> this thanksgiving holiday, we have for you what is of a book to be on c-span2. beginning thursday morning, -- four days of book tv on the c- span2 cou to even see taylor brh

on "the clinton tapes," the authors of "superfreakonomics," and norman paul horwitz at the miami book festival -- norman podhoretz at the miami book festival. you could follow book to be on the twitter -- can fall the book tv on twitter. happy thanksgiving. >> president barack obama will address the nation on his new strategy on the war in afghanistan on tuesday night at west point. he will lay out his plans for expanding the afghan conflict and ultimately ending america's military role. the president and his top military and national security advisers have held 10 meetings to discuss america's future steps in afghanistan. again, his speech tuesday night at 8:00 p.m. eastern.

"the new york times" reported this week that the national football league is repochanging its policies on concussions, requiring neurologists to examine the injuries. the hearing is tonight at 9:15 eastern. are 60, the nays are 39. three-fifths of the senators duly chosen and sworn having voted in the affirmative, the moti >> with that vote, the senate moves its health care bill to the floor. live starting monday and through december, follow every minute of debate and how the bill would affect access to medical care, the public option, taxes, abortion, on the only network that brings you the senate gavel-to-gavel, c-span2. >> coming this thanksgiving on c-span, "american icons," three nights of the documentaries on the iconic homes of the three

branches of american government. "the supreme court," revealing the building in explicit detail through the eyes of the justices. friday at 8:00 p.m. eastern, "the white house," beyond the public -- beyond the velvet ropes, to the rarely seen spaces. saturday at 8:00 p.m. eastern, "the capitol." "american icons," 3 memorable nights on c-span. get your own copy of "american icons," a three-disc tv set, $24.95 shipping and handling. >> congressional budget office director doug elmendorf talks about that deficit and the u.s. economy. the american association for

budget and congress posted the -- hosted the event. >> the ceo is passed -- cbo is tasked with providing objective and insightful insights about budget issues. he testifies frequently before the congressional committees. let's welcome into our symposium. -- welcome him to our symposium. [applause]

>> thank you. i really appreciate the invitation to join you all this morning and to kick off what looks to be a very interesting conference. to set the stage regarding the changing environment and the new normal, i want to talk about the economic and budget outlook a s cbo sees it. i we are currently in the process of updating our economic forecast and budget projections for the outlook we will release in january. the specific numbers are always changing. the qualitative patterns i will focus on today are likely to be very similar when we release updated numbers next year. i also want to leave plenty of time at the end of a

presentation to take your questions, both about what i am saying today and about other topics that may be undermined. let's get started. -- may be on your mind. let's get started. we heard this summer that the economic forecast anticipates a relatively slow and tentative recovery. that is still our view. that is the consensus view. let's began with the unemployment rate. we projected in the summer that it peaked at about 10.5% next year. it has already risen to 10.25%, of the above where we thought it would be at this point, and we are weighing the precise forecast going forward. but the general pattern in the picture i think will persist and i think is a consensus view in general terms. our particular forecast is that the unemployment rate is falling fairly rapidly. nonetheless, because it is so far above the long run

sustainable level of unemployment, which we put at about 5%, even with a fairly rapid decline, it takes years for the unemployment rate to get back down to this long run sustainable level. the current consensus view is for a slower return of the unemployment rate to the 5% range. if one judges the pain of recession by the amount -- but the excess of unemployment rate over logger levels -- the number of additional people without work, the picture is clear that most of the pain of the recession is ahead of us, not behind us. even if the economy is growing again, as we and most people believe is, is growing from a level that is well below the level that is achievable. to go on to the next picture of the gdp gap, the gap between the potential level of output and actual gdp, the gap is very

large and we think will be shrinking and shrinking fairly rapidly in some sense, but nevertheless, so large to start withthat it will take time before people are fully employed again. we think the stimulus legislation is having a positive effect on economic activity. it is difficult to quantify that effect precisely when we release analysis, we reported a range of possible effects. it is uncertain, but our view is that this is fairly -- our view is that the additional government spending and reductions and tax revenues in the stimulus package are pushing economic activity above where it would otherwise be. the fact that economic activity has been so weak and employment has been so weak it is tims, in

our view, a measure of how weak the underlying economy is. if you talk about inflation rates, this is a subject of a great deal of variation in views on economic forecasters. we expect inflation rates to stay quite low for several years, principally because of the great amount of unused resources in the economy. but there are other forecasters who think that the inflation rate will move back up, and i think they are focused primarily on of the great deal of liquidity that the federal reserve has pushed into the financial system. in our view, that liquidity only raises inflation to the extent that it pushes up demand for goods and services beyond what can be readily produced, and we don't think we are anywhere near that point, nor will be, for some years to come. if this is right, we will see

unusually high unemployment and low inflation for a number of years. let me push on and talk about the short-term budget outlook. we wrote this past summer that over the coming years, as the economy improves, and economic stimulus package updates, the deficit -- economic stimulus package abates, the deficit is expected to gradually shrink. if you look at the picture of the deficit surplus, you can see the very large deficit we experienced the last fiscal year, and you can see another sharp decline in the deficit over -- and returned to zero. it does not get there, of course. but a rather sharp change, not in this fiscal year, not in 2010, but the next fiscal year,

and a year after, and a year after that. this picture i have labeled the withdrawal of fiscal stimulus. the dark line is the baseline forecast. the deficit was just under 10% of gdp. we think that in the current fiscal year it will be slightly smaller relative to gdp. but then we think in 2011 and 2012 there will be a very sharp decline. what that means essentially is that the withdrawal of the stimulus is being -- being the stimulus comes from a variety of sources. some of that comes from the automatic stabilizers. some of it comes from the financial rescue package effects waning. some of it comes from the stimulus package waning. on this picture we have drawn a line which excludes the effects. you can see the gap between the dark line in the light in 2009. that is the -- dark line and the

leiter line. we are essentially right now at the heart of the biggest stimulus -- stimulative effect on our economy, biggest effect on reducing the government revenues and pershing of government outlays. as you look ahead to 2011, 2012, the gap between the lines narrow. there will still be lowering taxes and raising spending relative to what would have been true without it. but to a lesser extent than from the case and the last fiscal year or the current fiscal year we will be keeping the levels of output slightly higher, in our view, but not as much higher that the last year or this fiscal year. the growth rate of the economy going forward -- the stimulus package will start to be attracted -- start to be a drag.

that is the withdrawal of stimulus. this picture illustrates our estimates of the effect of unemployment. here is the range of spoke about. again, you can see that the biggest affects -- the employment effects like the output effect a little bit. -- lag the output effect a little bit but that wanes. the concern that many policy makers have is that the federal government posted fiscal thrust will be diminishing over the next few years -- federal government passed a fiscal thrust will be diminishing over the next three years, but we do not expect the unemployment rate to be coming down rapidly, or not enough to put as many people back to work as have lost jobs. there is discussion about options for for the fiscal stimulus, -- further fiscal

stimulus, and you can think about the options discussed and the debate earlier this year and the debate going on now. one category would be policy options that aim to create jobs directly through tax credits or private sector job creation or public sector job creation. there are also proposals that involve supporting businesses, like helping to make credit more available or reducing the tax burden in some way. and proposals that boost demand and put more money in people's pockets and more money into state and local government pockets, and there are proposals to modify housing and mortgage policies. given the outlook as we see it,

i would expect a good deal more attention to be devoted to these questions in the coming months. just to emphasize what many people are concerned about with the job market in particular, i showed you the picture of the unemployment rate before, but there are other things that are illuminating. these are the reasons people are unemployed people are unemployed and lives because they quit their jobs and they cannot find new ones right away. sometimes they lose their jobs. this letter line below is the share of people who have lost jobs -- lighter line below is the share of people who have lost jobs permanently. you can see it on the very far right edge of the picture that the permanent layoffs now represent almost 60% of the total number of people who are unemployed. that is well above any of the

previous recessions. to an extent that was not sure in past recessions, people have lost their jobs and are not going to be able to go back to those jobs. they are having trouble finding other jobs. this is another picture in which the lighter line is the separation rate. the darker line is the job- finding rate. you can see that that rate has fallen to a much lower level than either of the two previous recessions. a lot of people have lost jobs permanently. the rate of people finding jobs and that -- back from a plan is very low. we can go on and talk about the medium-term and long-term budget outlook. beirut to this summer that the fed will discuss it -- we road

this summer that the federal fiscal stimulation remains grim. once one gets past the next several years, in which we expect the deficit to fall sharply, you can see the deficit levels out, about 3% or 4% of gdp. if you look back on the left hand part of the picture, you can see that the government has said the visits of that size before. for example, the 1980's. -- the government has had as of that size before. for example, the 1980's. but the current challenge is especially acute. the current policy, as perceived by many people, would generate more deficits than currently captured in the cbo baseline. the salt lines shows revenues and outlays over the past -- solid lines shows revenues and outlets over the past decade or so.

our baseline forecast follows current law. the gap between these lines is the budget deficit that we project. 3%, to 4% of gdp over the coming decade. one particular feature of current law that not everybody understands is that the tax cuts enacted in 2001 and 2003 are scheduled to expire at the end of next year. the threshold for paying the alternative minimum tax will come under current law, it fall to a much lower level. tens of millions of additional people would be paying alternative minimum tax. those features of current law are incurred in the baseline -- included in the baseline. current policy tends to be crammed more in terms of current tax rates. -- framed more in terms of current tax rates. those tax cuts are extended and the amt threshold is indexed to

inflation, one gets a different picture, a much different picture of deficits of the decade. you can see a reduction in revenues in retrospect of making future tax law more in line with what we think of as current tax policy. the larger deficits produce more debt and much larger interest payments. spending goes up a little that as well. the gap between the two dash lines is over 6% of gdp taking a particular aspect of current policy and extrapolating it makes the deficit picture of the rest of the decade roughly twice as bad as it is under the baseline. another aspect of current policy not indented -- embedded to discuss as well.

the second reason why the fiscal challenge is especially acute is that federal debt is already large relative to gdp by historic standards. this is a graph a federal debt held by the public going back 70 years. you can see the spike in debt role to gdp over the end of the second world war. and the decline lasted for decades. the decline, but the, was not particularly because of the surpluses, but because the economy was growing and the debt was now being accumulated rapidly. -- was not being accumulated rapidly. just before the debt-to-gdp ratio makes the sudden move upward, you can see that the end of 2008, federal debt held by the public was 40% of u.s. gdp. by the end of this fiscal year,

2010, debt held by the public will be about 60% of gdp. it is a move from 40% to 60% in just two years. under the baseline projection, the debt-to-gdp ratio flattens out below the of -- flattens out a little bit above 60%. that is the highest ratio relative to outputs since the 1950's. if one considers this particular alternative that showed a moment ago, extending the tax cuts and indexing amt, the debt-to-gdp ratio it does not level, but continues to rise. but it did it would be pushing 90% of gdp -- by the end of the decade it would be pushing 90% of gdp. there are other countries, other developed countries, that have debt-to-gdp ratios that the broadwater% of gdp or around --

that are about 100% of gdp. but not that many. others have occasional moments of a debt-to-gdp ratios at or around 100%, but if you persist that way. the reason the united states can -- but few persisted that way. the reason the united states can bar all this money despite all the tunnel on the the financial markets -- u.s. treasury securities are still viewed as one of safest assets in the world. the interest-rate the government is currently paid is quite low. but that, many observers think, is a phenomenon that is distinctive to the current financial crisis and that as the crisis waynes -- wanes and investors turn to other places for the money, it will be more difficult for the u.s. government to borrow and the

government will have to pay higher rates. there are possible crises from the dead and there are ongoing costs of the dead. -- from debt and their ongoing costs of the debt. one crisis people worry about would be pressure on the federal reserve to increase inflation and inflation away some of the -- inflate away some of the value of the dead. crises, as we know, a very difficult to predict. there are ongoing costs that a much more straightforward. paying interest based on past government programs rather than being used to finance current government programs. another ongoing cost of brought -- it brought back for a, cost, reductions in savings -- a broad macroeconomic cost, reductions

in savings relative to what would have occurred otherwise. you can see that in the past decade, this is a much larger share of u.s. government debt now held overseas. another cost i alluded to was interest on the the debt, and the ways in which that uses taxpayer money to pay for past programs, not current programs. interest on the debt is fairly low right now, because the interest rate isn't fairly low. but with the debt -- because the interest rate is fairly low. but with the debt rising, the burden of paying interest on the debt rises considerably. you see a story in "the new york times" yesterday to this effect. the prices by about 2% of gdp over the next decade -- it rises

by about 2% of gdp over the next decade. the third reason the fiscal challenge is especially acute is the population is aging and rising health spending will continue to push up that will spending control law. i don't think this surprises people at this point. i've been coming to conferences like this for several thickets where the issue has been discussed. but it is much more upon us now that was when i first started going to conferences and that topic was raised. this picture shows revenues relative to outlays for key programs, just to give you a sense of how the pressures of aging and rising health spending are affecting the budget. the dark line is revenues, assuming the alternative fiscal path that i mentioned earlier with tax cuts extended amt

baseline. -- to the amt index. you can see the revenues with these policy changes and of being develo -- end up being a little bit more than 18% of gdp. the letter line shows the outlay in the quarters of a handful of government programs, with social secured, medicare, medicaid, and for net interest. this leaves aside everything else that the government does -- collection of entitlement programs, a very large collection of not discretionary spending. you can see that the light line, outlays, rising, and about to cross the dark line in about five or six years.

six years of now, the total revenues the government would collect under this scenario would stop being sufficient to fund even those programs. there would be nothing left for other programs. i think that is just a measure of how significant the imbalance is under current policies, and also a measure of how important a particular program -- are important to the particular programs are in treating that imbalance will the -- creating that indulgenc -- that imbalanc. this predates the august update to our 10-year outlook. if you look carefully at the jumping off point, it is not quite as massive. the general trend is not dependent on that. the line to the right is what we called the extended baseline scenario, and that assumes that

current law is as written -- if the tax cut its expire, amt is not indexed. current fiscal scenario assumes that the tax cuts are extended and amt is indexed. you can see that it is a matter of time under the extended baseline scenario that the budget deficit, or the debt, roughly sideways for a number of years, under the alternative fiscal scenario begins to move almost immediately. over the long run, one can see variability of the fiscal policies very clearly. let's talk about aging and health spending. this picture just shows the population of the country aged 65 or older as a percentage of the population ages 24 to 64. this the ratio of people who

will be collecting social security and benefits as opposed to those paying taxes to support those benefits. you can see this line has been drifting up a little bit but will over the coming two decades move up fairly sharply. retirement for the baby boomers. beyond that, at the line continues to drift up, especially relative to the longevity that people expect. but it is a very sharp move up. we're just about at the cusp of that. when the oldest baby boomers start to collect social security benefits -- the oldest ones are 63 this year. as the population retires, there will be a substantial increase in those collecting benefits rather than those paying taxes to support them. this shows rising health care spending.

this picture is excess cost growth, and as one familiar with the health terminology, "excess" does not mean that are wrong, but simply a mathematical calculation of held spending per person adjusted for age relative to gdp per person. it is a measure of how the burden of health benefits are growing knowledge to to other parts of the economy. the leiter line shows national health expenditures and the darker line shows medicare and medicaid. the few lessons to take from this picture -- one is that excess costs in health care varies a lot over time. this perhaps the crucial source of uncertainty in health care projections and cost estimates for health care programs that cbo makes. the path that will take is very uncertain. if you draw the line, you can imagine yourself only knowing

history through the mid-1990's or up to 2000 or any particular date. you could see how badly surprised you might be quite what came after that. notwithstanding variation, accessed cost growth is almost always positive and offensive -- excess cost growth is almost always positive and often significantly so. there are two factors, as i said, and many others have said many times over years pushing up spending on medicare and medicaid and social security. his next picture is our effort to decompose the importance of the effect. center, when things about population and aging and pushing up the costs, not just of a social slippery, but medicare and medicaid -- not just of social security, but medicare and medicaid, and health spending is pushing up not by

social security but spending in medicare and medicaid, there are two factors at work. there is also interaction between the factors. more health care americans is more expensive when health-care costs are fire. -- are higher. there is an interactive affect, and eat if you are interested in that sort of thing, you can read our report. you can see the population aging is an important contributor to rising spending on these programs, and accessed -- excess cost growth in health care is also an important contributor. you can see that health care spending is more and more important overtime, basically because the effect that he saw a moment ago or less levels out over several the kids, whereas health spending in -- the effect

that you saw a moment ago more or less bubbles out over several decades let's talk about policy options. the congressional budget office does not make policy recommendations. we do, however, produced the books of options for policy makers to consider, and you should you most of these items -- most of these items on the slides are taken from those publications -- you should view this as a shorter, more presentation-friendly version of those books. in social security, there are a number of broad classes of policy options that people discuss. what is increase of retirement age as you know, retirement age in social security is working its way up based on legislation passed more than 25 years ago. there are discussions about more of that, possibly indexing the social security normal

retirement age to population longevity, how long people elect to live. there are discussions about whether this should be just about social security or about other programs, like medicare. there are also options about benefits and some people have advocated reductions more or less across the board. others have focused on benefit changes targeted to a higher income and fisheries -- a higher income beneficiaries or the subgroups of the population. all of these options will be difficult for people, and thus, it difficult politically. and also, clearly, advance notice would be useful so the people to make other plans accordingly. that is what most of the discussion of policy changes in social security and other programs will hold a certain set of older people, not yet retired, but close to

retirement, hold them harmless under the proposal and focus on changing rules for younger people. this talks about policy options to reduce projected spending for medicare and medicaid. i want to emphasize to those who don't know -- medicare is directed to the older americans, and medicaid is directed at americans of less income. most medicaid beneficiaries are young. but each individual done that fishery of medicaid it tends to be relatively inexpensive on average older beneficiaries tend to be more expensive. in broad terms, there are two ways to reduce spending on health care. one is to decrease payments made for health care service. the other is to decrease the number of services provided. in terms of decreasing payments for health care service, reductions will to to current

law play a significant role in current reforms -- reductions a relative to current law play a significant role in current reform plans. one option being considered is how far those should be pushed, in particular, whether those reductions will lead to increased efficiency of the sort that many people hope, or lower income for providers, or whether the reductions will affect the access to care or quality of care that is provided. the second large bucket, decreasing the number of health- care services provided, raises a number for the questions. one is whether the government could adopt policies that would improve people's health and thereby reduce demand for services. the second question is the appropriate role for comparative effectiveness research, research judging which treatments or methods of organizing health- care tend to be more or less effective. it raises questions about whether payments to providers can be restructured in a way

that rewards the you rather than the number of services provided -- rewards in value rather than the number of services provided. and weather more should be paid in co-payments and deductibles. it changes the intensive -- incentive for people in determining the amount of health care that they get. the next slide talks about policy options to raise revenues. again, i think you'll see a least two broad categories. one is increased rates making changes to the current tax structure, and the other went raises revenues in new ways. there's been a lot of discussion about tax reform. that can be viewed as part of a plan to raise revenue, or not. people who think about reform and raising revenues as a joint

project will sometimes focus on the personal tax code, sometimes on the corporate tax code, raising questions about whether we should be taxing income or consumption, whether the base should be broadened. 1986, a little before i came to washington, there was substantial effort to broaden the tax base and bring down rates. that effort was by designed essentially revenue neutral, but could be decided differently. some people think it should be dealt with the question about whether to increase efficiency and change the distribution of the tax burden or reduced complexity of the tax code. and also discussions of new ways of raising revenues. people talk about the value- added tax, incremental taxes, particularly the possibility of a tax on carbon -- environmental taxes, particularly the possibility of a tax on carbon

emissions. that brings me to the bottom line, and i use this -- used this two weeks ago but i think it is the summary of the challenges the country faces. as i think you know but i think it is important for everyone to know, the country faces a fundamental disconnect between services that people expect government to provide, particularly benefits for older americans, and the tax revenues that people are willing to send to the government to finance those services. the fundamental disconnect will have to be addressed in some way if the federal budget is to be placed on a stable course. becky. i will stop there. -- thank you. i will stop there. [applause] >> doug has graciously agreed to answer questions. we have a microphone in the

middle of the floor. if you come down and state your name and where you come from, we will open the questions. you have given us a great foundation to highlight the challenges we face. we have had to think and a different ways about a lot of programs. i am wondering if you could address the much challenging aspects you face at cbo and how you of thought about some of those problems. >> there are many people in the room, including melissa, who can speak about the challenges thatcbo f -- that cbo faced. i have been at cbo 10 months now. as been an exciting 10 months. [laughter] one challenge we face is that policymakers are considering policies that are outside of recent experience in their scope

and the problems they are tackling. as we work on health care reform, as we work on climate policy, as we work on a financial market interventions, we are trying to analyze policies that we don't have good historical reference points for. we don't -- the easiest thing for us to analyze at cbo would be a policy change of the sort that has been tried in the past. the policies have gone back and forth several times over the last several years. much more difficult for us to try to decide what the effects would be of the overhaul of the health-care system, or putting a price on carbon emissions in a way we have never done in this country, or intervening in financial markets in ways we have not done in at least 75 years. part of what we've done that is challenging for us is the novel to an addition of the policy. -- the novelty and the addition

of the policy. a second challenge i would highlight is that we have macroeconomic conditions that we are not familiar with. if one thinks about the effect of the stimulus package or the financial intervention package, that happens against a backdrop of economic conditions, and the size of the stimulus package, the size of the financial intervention, is unprecedented, but so are the economic conditions on which they are being said. there are some parallels and other countries and there are some in this country with the depression. those are pretty far afield in the national context, and more difficult for us to get a handle on. a third issue i would highlight is on the financial side, which is how the government budget accounts or does not account for financial risk. the budget is mostly in cash flow accounting system. for certain credit programs

established about 20 years ago, a system for trying to account for the risk of default, for example, a future loans -- even that does not account for the more general market risk of the store it that we have been forced to confront -- of the sort that we were forced to confront when it arrived in tarp, and how to take a bunch that is basically, on a cash flow basis -- incorporating the risks that the financial government is taking on that it has never taken on before is another challenge that we face. >> other questions? >> very astute and pithy

description of the problem, but my guess is that if you show this paragraph to many people outside the beltway, they would say, "you can make up the difference by going after waste, fraud, abuse and the government." that is their view of the government. and members of congress often introduce waste, fraud, and abuse amendments in order to make various proposals revenue- neutral. could you describe how cbo estimates some of these proposals and how cbo looks of the problem? how big is it, what kinds of at this to you used to go after waste, fraud, and abuse? >> what we do depends of the context. a very important point to understand, although it is true that those words waste, fraud, abuse are used as a group, they actually been quite different things. i will give one example from

medicare. the numbers in the papers about amount of medicare spending in a year -- that does not follow the rules of payment for medicatere. when they do the audit, they find a block of money that does not follow the rules. maybe that is abuse. but an amount of misguided payments are misguided because the paperwork was not filled out right, a social security number was not filled out correctly by the patient, or some other mistake was made, but if that mistake had been corrected, the payment would have been appropriate. it is a violation of the rules in some sense, but it is not what most people would think of as true abuse or waste, and certainly is not fraud. when we look, for example, a

proposals to ferret out fraud in medicare, the amount of money at stake, according to most estimates, is much smaller than the number people hear about in terms of the payments that don't follow the rules. you look at the best guess people have about how much fraud for is -- fraud there is. with the tools that will be given to investigators -- investigators prosecutors we looked -- at the tools -- we look at the tools will be given to investigators and prosecutors. i think that the total amount that really is fraud is much smaller than the number people sometimes here. second, it is hard to stop all that is not that -- second, it is hard to stop all of that.

people working hard to discourage it. it turns out it is a cat-and- mouse game with lawmakers and it is not easy to stop all of the bad things from happening. i think more generally, again, one has to think about what you mean by waste. there are pure inefficiencies if the government is contacting badly or running a personnel system in suboptimal way, then there are opportunities for improvement in that. but what some people mean by this is that they do not like certain programs, and it turns out that some people do like those programs and we have to make a political judgment about what we spend money on . it is not waste in the pure sense of something we could all live without. >> george washington university

and district of columbia government. i was wondering, what i heard about the cbo forecast, we had a president of growth 10 years ago where people on unemployment could reach the were rates and maybe with stagflation in the 1970's, six cassettes that was the best we could achieve, and with the -- economic 6% was the best we can achieve, and with the economic situation now, is that goal gone, given what we know about the economy? >> but economists agree that the sustainable level of unemployment -- i think economists agree that the sustainable level of on the planet is not a natural constant like -- sustainable level of unemployment is not in a jar constant like pi or the speed

of light. the rates will move around, but it is difficult to know where it is at any point in time. the general view is that when economies have certain sorts of changes, in terms of the change -- deterrence of the change in policy can change -- the terms of the change in policy can change it. what we have discussed this with experts thought would be possible to bring the unemployment rates down and how far it would come down ultimately. and there is concern about th -- this recession has put people out of work without -- who will not be able to find jobs that

match their skills going forward. also, i think this and directs with problems in the housing market. -- this interacts with problems in the housing market. people move from areas they live in where jobs have been lost to areas where jobs are being created. but the sharp drop in house prices, the fact that so many americans now owe more on their homes than their homes are worth, is slowing the kind of migration. it will be harder for people, even if new jobs are created in some other states, to make that move. now, with these effects are literally permanent -- whether those effects are literally permanent is less clear to me. there is reason to believe that it will be lasting for a while . if you lose your job in some industry, the economy will

create the jobs in that industry in another state, and that will not get that person a job very quickly. i think it is a real concern. i cannot put a number on the effects, but i think it is always the problem of a dynamic economy like ours that is buffeted by various forces that individual people with particular focus skills, living in particular places, will often suffer heart in a way that the macro economic -- suffer heart in a way that the macro economic picture will not always reflect. >> government accountability office. i am sure everyone in this room

has heard the term "nonpartisan congressional budget office." we have all heard that. one thing i am curious about -- when you guys have numbers you are running, people often say, "they are making this assumption -- these numbers based upon assumptions they have been given a." and you make a recommendation. but as a taxpayer, i am often frustrated. you guys have been doing this a long time. if their assumptions in that that you know from experience are unrealistic or weihai, as a taxpayer, -- or are way high, as a taxpayer, i feel like i'm getting a disingenuous story. if i am going to hold a senator

or commitment or congress, accountable for a number -- or congressman or congresswoman accountable for a number -- do you feel frustrated about not doing this up front, or you go behind closed doors and said, "hey, here are the numbers"? [laughter] >> we will use health care as an example. it seems possibly to be undermined. first of all, let me be clear -- i do not do anything different behind closed doors that i do out here bridge i did not make recommendations behind closed doors. when i was interviewed for my job, i was in a fit simultaneously by democrats and republicans -- leading interviewed simultaneous -- i was interviewed simultaneously by democrats and republicans on the budget committee. when they are estimating assumptions, but is the responsiveness of a person to

pay policy, we are under no particular requirements there. we take what we think is the right answer. on health care, we released cost estimates of the legislation that passed the house and that harry reid introduced in the senate. those estimates say that those pieces of legislation would reduce budget of visits by around $100 billion each over the next decade -- reduce budget deficits by $100 billion of the next decade and slightly beyond that over the next decade. i have heard for flippers of criticism over that conclusion. -- 4 flavors of criticism over the conclusion. one is that we estimated wrong. people think we have underestimated the amount of subsidies. my answer to that is that this

is a very uncertain this is we're engaged in, and we sit and everything we right and every time i talk. -- we say that in everything we write and every time i talk. but we put in possible outcomes. in our professional, not partisan judgment, we balance the risks. the second flavor is that maybe you estimated the law as it is written correctly, but congress will change the law. a lot of the savings over time will come from the growth rate in payments to providers of medicare in a way that will squeeze them overtime, and ain the view of some people, lead to greater efficiencies, and in the view of others, put them in a bind or they can not access quality health care. people argue that congress

cannot change the law. we are required to evaluate the effects a law as it is written. however, in particular case, we want to evaluate the estimate of the current law in place. there are long discussions in the back about the importance of leaving the provisions in place, and we talk about the experience with the doctor payments in medicare, so called sustainable growth rate mechanism, or sgr, were a decade ago, there was an agreement to ratchet down doctor payments, but congress has changed the law many times and is considering changing it again. we raised that as an example of the difficulty of sticking with those sorts of payment reductions. we talk about how over the past

20 years, medicare spending per beneficiary adjusted for inflation has grown about 4% per year, but under both of these bills, the future medicare spending per beneficiary adjusted for inflation would rise about 2%. i think we've been very clear publicly about how sharp the change is in the policy that is embodied in these laws. but it is just not our place to offer a specific judgment about what congress might do in the future. our job is to illustrate the importance of this issues in our estimate. a third flavor of criticism i've heard is that some of the changes being made to policy to pay for the health care entitlements would have been otherwise in the face of the looming budget deficits. some people and said that what

we did a decade ago was reduced medicare payments and raise taxes on higher-income people and if those changes would be used again three to five years and now, if they are used instead to finance new health entitlements, there would be taken off the table for deficit -- they would be taken off the table for deficit reduction. that is a legitimate issue to raise, but in this -- it is speculation about what congress would have done under different standards. we do not make political projections. it is not something we can speak to. .

we continue to talk about options that can be used. i have been asked by different members at public fora what else can be done as part of health reform and the talk about some of the options we laid out before that has not been taken up in the bills. i think in all of those ways, we're doing all that we can do at cbo. i don't feel -- you ask about what i worry. i think the answer is, no. it is our job to follow the law as it is written and to give it conquers options around that. there is no alternative and i don't feel bad. that is the structure for us to work in. i think the most important thing

to do is to continually talk about effective alternatives and the list rate different alternatives and emphasize what is crucial to our estimates. disinformation the members of congress need to make their decisions. >> i appreciate your candor. >> other questions? >> i have a question related to the way you analyze and report on risk. you mentioned the risk factors are one of the challenges that you face. i was just thinking, when you report out an estimate, have you

thought about also reporting on the variance or standard deviations and the features of the distribution of estimate that makes it i very less reliable or more reliable? and also related to risk, whether you consider ways of including interaction effects between. one example being, for example, the housing tax credit that is likely to lead to a reduction in reserves of fha because of the requirement that homeowners will have to put up less on the house that the purchase as a result of the credit.

how it affects between programs that are likely to affect the risk that it is exposed to would increase. >> the answer to the first question about trying to describe the variation that exists. for cost estimates, the process, i think, the budget process, legislative process, really requires numbers, point estimates. we provide boats. we move beyond things that cost estimates. we do try, when we can, to offer ranges as a way of expressing the uncertainty. when we reported the effects of the stimulus package on the economy, ranges of gdp, employment, and so on. within health care analysis, the cost estimates, we have used point estimates. but we and other aspects have talked about ranges.

for example, an analysis of the bill put forward by the house republicans, we talked about the effect on insurance premiums and we offered ranges. whenever it is not something that has to be added up to fit into some budget resolution or in some total allocation, we tried to provide ranges. we often look for ways to do that precisely because i think it is the most direct way of reporting on uncertainties. there is a downside to ranges we are emphasizing, because of something happens causing it to rise between 1% up to 4%, those who wanted to rise a lot, they will say up to 4% and those who do not want it to rise will say a little of 1%. there is a risk in a range that people will pick up the endpoints' that suit their purposes. but i think on balance it is important for us to use them as we can but we cannot really on cost estimates. on interaction effects, we do

work hard to trace through the effects of a piece of legislation on all that aspects of the budget we can trace it to. the very challenging. it is a very complicated world. even understanding the behavioral response of people and businesses for individual policies is pretty difficult. then when you try to trace it through all of the other ways it can feed back to the budget, it is even more difficult. we try it. i think it is our job to provide economists the best estimates we can and that means including all the indirect effects that we can get our arms around in a serious evidence- based quantifiable way. >> thank you very much. [applause] >> one we talked in august about you joining us today, i think without the tuesday before thanksgiving would be a calm

time and it has not happened. i know you have a lot of challenges on your time and i appreciate you joining us. at a small token i have a mother for you. i am quite certain this fits within congressional ethics guidelines for gets and i expect to see it prominently displayed in your office. [laughter] >> the state department, this is the briefing room. in about 40 minutes we expect to hear from a police convoy george mitchell, possible reaction to news today that israeli prime as -- prime investor benjamin netanyahu proposed a 10-month freeze on west bank settlement construction. the briefing coming up at 12:45 p.m. eastern live on c-span. president obama will be addressing the nation on his new strategy for the war in afghanistan tuesday night from the u.s. military academy at west point.

the president expected to lay out his plans for expanding the afghan conflict and ultimately ending america's military rule there. live coverage at 8:00 p.m. eastern. a white house officials saying president obama will travel to copenhagen in the next month, early december, for the global climate conference. the official says the president will be on -- in copenhagen december night before heading to oslo to accept the nobel peace prize. is attendance had been in question until now "the new york times" reported the national football league is changing its policy on players concussions, requiring independent neurologist to review -- and this comes after a house hearing on this issue which you can watch tonight beginning at 9:15 p.m. eastern here on c-span. >> coming this thanksgiving, american icons, three nights of c-span original documentaries on the taconic homes of the three branches of american government. beginning thursday night at 8:00 p.m. eastern, supreme court,

home to america's highest court, reveals the building annex was a detailed three the eyes of supreme court justices. friday at 8:00 p.m. eastern, the white house, inside america's most famous home. beyond the velvet ropes are visit shows the grand public places as well as of the rarely seen spaces. saturday at 8:00 p.m. eastern, the capital -- the capital. american icons, three memorable nights -- thursday, friday, saturday at 8:00 p.m. eastern on c-span. get your own copy, a three-disc dtv said. it is $24.95 plus shipping and handling. order online. >> the senate returns from the thanksgiving break on monday. they will begin formal debate on health care legislation at 3:00 p.m. eastern. and number of senators offer amendments. live coverage on c-span2. and number of discussions on

the health-care issue on " washington journal" including on medicare this morning. from today. scully was the administrator of medicare and medicaid services. in 2003 when medicare part d was passed into law he was very involved in that debate and its early implementation. let's begin with the definition. what is medicare part d? guest: it is a relatively new program began in 2006. it covers seniors on a voluntary basis for drug benefits. it is about $50 billion per year federal spending. 90% of senior citizens are covered one way or the other. about 34 million seniors citizens are in a prescription drug-only plan that has been added on. about 9.5 million senior citizens are in the medicare

advantage plan that includes hmos. about 8 million more senior citizens keep their old health plans and the government pays a subsidy to their former employer. the remaining 10 million, about four million have opted not to be covered and the other at 6 million are in v.a. or some other program. about 10 million lower income senior citizens have subsidies. about half of them essentially pay nothing and have free coverage. host: we would like to focus on medicare part d. you're most welcome to call and ask questions. if you are not enrolled in the program and do not understand how works and want to know its impact -- and we're also happy for those who have been using it for the past two years to tell us of your experience, or ask questions. first of all, in the current

debate we have been hearing about changes to medicare. is anyone discussing changes that would affect medicare part d? guest: very little. there's some language in the house bill and some debate in the senate about closing that hole. it would expand coverage and give them more gap coverage. we can debate whether it is good or not. that is really it. there are some with amendments to what changes -- would like to ginger more structurally. but for the most part the plan is popular. some want to spend more, some want to spend less. but considering how controversial it was in 2003, it has turned out to be abroad level of public support. the changes should be fairly modest. host: 90% of those eligible have decided to enroll? guest: yes, that is right. another 6% of the senior citizens are not in because of v.a. coverage or other federal

programs. host: when you presented the plan to congress did you anticipate the rohmer rate would be this high? guest: yes, i think we do. you can debate how much money we should have spent, but when you give people a significant subsidy -- $1,000 per year for every senior citizen on average -- people are getting better purchase of drugs, and most get about $2,500 subsidy. it gave people a significant new benefit. people got much better coverage, much more subsidized. host: one of the critiques i have read is that unlike the va system of medicare cannot negotiate with drug companies for the price of drugs. guest: i think that the government does negotiate for drugs. it hires contractors. by 34 regions we send a pharmacy

negotiator -- here is the money. we will give you this much depending on income level, call us next year. if you spend $1,400 you win, if you spend $69, you lose. the data healthcare plan is an aarp and they negotiate aggressively with drug companies. companies. the engin the government basically handed to a contract. it is a philosophical issue. is the government better off taking its money and giving it to a private contractor with a financial incentive to negotiate to make profit or fixing negotiating prices -- and the rest decides what every doctor and hospital and every payment is going to be and sets the prices. i for this topical building that

is the right way. i think we are much better off having a well regulated private capital was making those decisions than we have make -- the government feared they do their best they can. but fixing prices generally from the government's point of view does not work. that was the philosophical debate we had in part d and that will go in the senate. there are legitimate views on both sides. host: what are the implications in cost and people's help of increased use of generic? guest: at it drives down costs. there are no poor people -- 6 million people will pay virtually nothing, no copayment, deductible, and premiums and that is what it was the originally designed for. the debate five years ago were people were splitting bills, cannot afford to eat, cannot afford rent and it was a terrible, horrible thing, and it was. i was one of the designers -- that was the primary goal, help poor seniors who were really

hurting. that was the huge russian now. there are no four people in the donut hole. that donut hole in effect is a wealthier people. it basically has one spectacularly positive effect -- you might design it differently and the singers on january 1 wonder how to avoid that donut hole -- they asked to switch to generics. it has a lot of people money. the behavior response to it has worked out well. people ask their doctors and pharmacists have to switch to generics. senior citizens are very cost sensitive. wealthier senior citizens do have a done a tall and it drives more rational behavior. host: given the increased

discussion about the federal deficit, this medicare part d was not paid for in the federal budget -- is that correct? guest: that is true. i worked for president bush ii as well as the first president bush before that -- there was a big tax cut and then an enormous surplus. it is hard to remember that now. the debate was that republicans wanted to spend -- mines version was not to spend more than $400 billion over the next 10 years democrats want to spend $1 trillion. we did a modest version of the public debate back them. but at the time we had a massive surplus. in hindsight maybe someone not again. at the time the issue was whether to spend $400 billion over 10 years or more.

now when you have a $1.50 trillion deficit -- in the biggest advocate for coverage, but look at this deficit. host: the donohoe was a way to save money? guest: it was designed for two reasons. we had a budget that had to be acceptable to the president and congress. it was designed to save money. we would have put a hole in there anyway to make people more cost sensitive. it is a huge, new benefit people did not have before. i think it has worked well. the cost which we estimate it at the time to be $400 billion over 10 years -- by all accounts those estimates were high. it is roughly $260 billion over the first 10 years that it will cost. host: most news stories so that it is one-third less than the

original cbo estimate. the last question before we go to calls. given the cost, was there ever any discussion of means testing for eligibility? guest: it is means tested. if you are relatively low and come, you basically pay nothing. your premiums are free and there is no deductible, co-payments. as you go further up there are various levels of subsidy of to about 10 million people. that is said about 50% of poverty. above that people pay the full premium. host: there is a lot there to begin to. we welcome your comments or questions for mr. scully who was the head of medicare when this law was passed in 2003. what you doing now?

guest: i fully spend half my time in new york at an abysmal firm. i'm a lawyer here in washington halftime. i have two very different jobs. host: let's take a first call from san diego. this is matt on the caller: democrats' line i would like to know the effects of having the medicare and actuary told the that the congress should not know the true cost of medicare part d -- threaten to be fired when he told congress. should we have confidence in medicare part d? guest: that is an old debate. it never happened. the medicare actuary does a good job. he is a smart guy. at the time the politics were intense and he did. we passed a bill that was scored at the time by the only one who counts -- the congressional

budget office. the $400 billion to not to be two-thirds less, so no one is right. -- it turned out to be one-third less. the actuary is a staff of about 50 and they do a great job. host: princeton, new jersey, of your sends us this e-mail.

guest: i'm surprised. that is the debate. i think all the cities showed that the cost as been significantly lower for medicare part d then getting them from canada. the average citizen save themselves tortured their rulertold hundred dollars per y. could there be people who have certain drugs or plans -- there are usually three tiers -- they each have affect some people -- overall, it has been a big winner for senior citizens. host: do you believe the program is simple enough for people to understand? guest: it is complicated. when you try to make different levels of subsidy and make it competitive, which we tried to do, a tightly regulated public

program that created intense competition -- 1500 medicare part d plus plans over 34 regions, it is complicated. i'm biased. i was involved in creating it. the first new federal entitlement program that has come in significantly below cost. i believe we said that the system of intense incentives for contractors to have intense competition and low costs. the average profit margin was probably about 3% for companies in this program. it has worked out to be probably better than i could have imagined. host: md., and become on the republican line. caller: i understand in the current house and senate bills there are provisions that change the employer subsidy. want that raised more costs in government? because the government will have

to pay more? i also understand that companies will have to take a big financial hit when the bill is signed into law. can you comment? guest: in the arcane area, in the effort to raise money to pass this bill, whatever the eventual cost will be, congress is stripping away to find ways to cover the bill -- one of the offsets is a provision -- 8 million people that get the retiree dregs of city -- we did this bill the subsidy was roughly $1,500. we said look if you work for john deere or general motors and are happy with your drug benefit, if we can create this new program most employers will drop their benefit. so, we created a 20% tax-frees of city to tell employers we did not want them to drop employees. keep them and keep your existing

plan and we will pay for a portion of it. the average subsidy was about $800 per head, paid through an employer. it is obviously cheaper. congress took away the tax-free portion of that subsidy. the average employer is going to lose about $200 per person on their subsidy level. the assumption is that it will raise taxes. i think that it may backfire. if you take away a big chunk of their subsidy of more people drop their plans. i don't think it is something congress balked through much. it will most likely cost us more money rather than save money. if you are a large employer, most will figure this out that it will lose a large chunk of

money for their retirees. host: the next call comes from north carolina on the independent line. caller: hello, i have been on the plan for three years. i'm getting ready to cancel this year. after reading their newest plan for this year i consider the plan i am with a bait and switch. it started out -- it is up 400% from the first time i started. -- from when i started. i have not even gone into wh the deductible has gone up. it is $300 for this year and only applies to this year. i can get generics from walmart for a three-month supply. i don't even need a generic. i am 71.

i can get the expensive drug that i need a broad for one- third of the cost compared to the prescription drug plan on medicare part d. i'm fed up with. i would rather pay the full cost than give the drug insurance co. another penny of my money. guest: obviously, it is a voluntary program. and people do not want to join in, they do not have to. the data shows that gives a significant subsidy to each person. the deductible does go up and it does apply to name brand drugs as well as generous. host: anthony sends us this message by twitter.

guest: uh, you know, it is a complicated issue. i don't have any particular view on it. both administrations have questions about how to control the importation of drugs from overseas fromfda safety. i don't think it would lower drug costs. senior citizens are large chunk of drug consumption. senior citizens could good prices on a relative basis through medicare part d. host: new york, eleanor, on the democrats' line. caller: i don't really recognized program efficiency and cost-reducing benefits that mr. scully per claims. i feel i was much better off on

street medicaid because now have to pay an up-front monthly premium in addition to the drug costs when i go to the drugstore to pick them up. so, i have two different costs now whereas before i just paid at the drugstore. i have had similar problems because my case worker told me because i have medicaid i did not need this medicare part d plan. i initially pulled the plug on it. then when i went to get my heart medication i could not get it. so, it has been very complicated. i asked the pharmacist -- am i the only one who has been having this problem? and they? oh, no, so many people are having this problem. i think was much better off when i just had straight medicaid. guest: medicaid as 50 different

state programs so depending where you lived -- senior drugs used to be covered by medicaid which is for low income seniors in the state and depending on where you live in a well at indifferent or potentially better. generally if you on medicaid and now you are dole eligible you probably should not be paying any co-payments or deductibles or premiums. a qualified for medicaid before, i am a little surprised you are paying anything. but, look, it is a controversial program, it is a complicated program. it is extremely popular. i was president bush #1's health care staffer and i was -- when catastrophic was repealed. my first job in the first bush administration and spent a lot of time trying to develop another drug benefit. is it perfect? i am sure it is not. is a much better? i think most seniors would have

what we have before 2004, which is nothing, or 2006, i think it is. could you spend a lot more money? obviously, you could. i think it is a spectacular benefits for low-incomeçó citizens, and a very good one for those who are not. it is complicated, but i think it works. i think it works partially because of the design. that complicated design makes it competitive and low-cost. host: this is a story from "the loss angeles timeos angeles tim" 60% of the plans will charge deductible from 15% from 2009. fewer plants will offer coverage in the donut hole.

more than two million people involved in extra help may face a premium of about $10 if they do not switch to a plan that qualifies for full premium subsidy. finally, more than 1 million people in extra help will be randomly assigned to a new plan in 2010 that may impose a different restrictions on their drugs. guest: you just gave great examples of confusion. host: yes, and at a point -- seniors in my own family find a more challenging to process all of this. guest: each state has a program , and non-profit consumer advisory group largely funded by medicare grants for you can phone to get. get they have a tremendous amount of information. you can call 1-800-medicare and

they will connect you. host: november 15, the enrollment program -- is that and you will? guest: yes, it is. from november 15 through december 31 is the open enrollment time every year. if you are already in a medicare part d and you want to switch, there is a time of 45 days after. you have the ability to switch. host: but if you do nothing? guest: you automatically stay where you are. in 34 regions -- and this keeps down the cost, each region has an average of 45 plants. the government puts up the bid in each region for the benefits. the ones that come in below the mean, if you are low income, you can join them for free. every year let's say that your

with one company or another -- if in the region in your price goes up above the mean, some seniors may have to pay more and others pay. a pay it is also because the clients do not want to lose those senior citizens. it keeps the bidding down. every year the whole thing gets drawn up for bid and if you are not among one of the half of the lowest cost in your region, people have to pay more. that is why low-income seniors have to move every year. it saves the government money. but it does cause confusion. host: detroit, on the republican line. caller: good morning. yes, a get injured about 12 years ago when i broke my neck at work. the retired me and i did get my social security, but what a done

understand -- i did not ask for the medicare part d and i ended up getting stuck with it. i just got my thing in the mail yesterday about coverage. i do have blue cross blue shield and medicare a, b, and d and these other benefits i'm supposed to be receiving and in pain for my interest. i only make $17,000 per year on income between my pension and my social security since i was injured. now they sent me something yesterday about costs. now, like i take eight prescriptions per month for seizure medicine and everything else. i'm paying the co-pay anywhere from $7 up to $27.

medicare or sdrs, whatever they call that -- they pay $1.20. you are saying that in low- income, but i am paying triple the amount that was pain when i was only on blue cross. guest: it would be hard to know without understanding your individual circumstance. host: so, what should he do? guest: if he is on disability he may have coverage through his employer, so it may not be medicare. host: if he calls that 1-800 #. guest: yes, call in michigan and ask them to talk to your non- profits committee to help senior citizens make these choices. they are very good. host: pat sends us this e-mail

at the heart of it. would you settle something for me? host: who is right? guest: both. at the time we had a giant surplus. president bush, now controversially -- but at the time it seemed appropriate to have a giant tax cut. we were looking to fix what we thought was the greatest social injustice at the time. that what senior citizens having to make tough choices between medicine and rent. it has been a spectacular benefit for them. it was not funded at the time because it did not have to be. congress had big surpluses. some republicans would probably have liked to have spent even less and many democrats wanted to. spend to at the time i think it was the right thing to do.

it has come in way under budget. -- and many democrats wanted to spend even more. the reason it is not that controversial, the changes will likely be modest because it has worked well. could you debate? it was a different context at a different time. host: the final vote in 2003 was 204 republicans, 16 democrats -- 189 democrats and one independent voted against the legislation. guest: i do not miss politics much. i have many friends on the democratic side. i worked with senator kennedy four years. senator rockefeller is a good friend. when you get into these debates it tends to be as much about the next collection in both parties as it is about substance.

i have been here since 1981 and started to work in the senate. the biggest vote was senior citizens getting the drug benefit. we would never have gotten to the debate about universal coverage had we not fixed that. many democrats told me i did the right thing. at the time most democrats did not want i republican president to get a victory. on health victory the same thing is happening in reverse now. i have long been a fan of universal coverage and fixing the commercial insurance system. but there tends to be a reaction of democrats that it has to be wrong, and if you are republican -- vice versa. when i began to work in the senate in 1981 it was a lot from

there, a lot more bipartisan. people tended to only beat each other up around election time. it has gotten tougher which is host: unfortunate in nexunfortu. host: our next guest will be here to discuss in the does. guest: his one of the nicest guys in the world. i worked a lot with them in the bush administration. caller: by the way, there was a projected surplus. at that time bush decided to give tax cuts to the rich and take astute two wars. if you do not take all generic drugs -- and 90% of the country does not, then that is a guaranteed revenue stream for pharmaceutical companies who lobbied hard for this bill at the highest price possible. because the government cannot compete in the private sector.

but the government will subsidize at a very narrow criteria for this to cannot afford it. that is government support of the private sector which i strongly object to. as a republican i think you do not like the concept of having the government financed the private sector. guest: well, i did not do taxes, and i did not do wars. the the drug companies never liked this. there is a lot of perception that this is lobbied for and negotiated by the drug companies. i did a lot of reform when i was in the cms and was not particularly beloved by the drug companies and still am not. anyone who looks at this rationally that senior citizens get a better deal -- and prices are lower than in 2005 -- is unavailable.

there are many other ways that you could have done it, but it has clearly worked, and clearly not in a way that companies like it. volume of drugs has gone up for senior citizens. the companies have done well on volume, but per prescription the margin has come down. we want and senior citizens to have more access to drugs then they have had. host: this is your says they don't know what this idiom of donut hole means? guest: about 6 million donut hole did not have -- for next year you have a $310 deductible. plants can vary. -- plans can vary. in general, and for next year there will be a $310 deductible.

you will still pay 25% of the cost and medicare part d will pay 75%. the garment pays 75% up through about $2,800. through the donut hole, the garment pays nothing. you pay it on your own. then you get to the catastrophic cap which is about $6,400 in total costs. when you hit it that for those who are really@@@@ there is a big gap and there, 3600, in the middle where you will get the benefit of group purchasing through the plan but if you are not low income you

are going to pay the bulk of the cost, and that is what the donut hole is. 75% of the seniors don't hit that, they don't spend enough when they hit the doughnut hole gap and 45% -- 35% did. what i mentioned is that seniors are smart and seniors of the beginning of the years say they don't want to pay all the cost so they moved to generics, asked the pharmacist and doctors and asked if they can do the generic and in many, many cases they can save significant amounts of money. people react to the dollars quickly and the goal to begin with was to help the poor people the most, and i think we did that. can you argue the subsidies could be bigger? it has been of thousand dollars of new additional subsidies for each senior and over 3000 for a poor senior. no one is going to be ever told me happy but it will be significant involvement than

before, which is nothing. host: this chart is about the donut hole. actual and projected out of pocket cost -- projecting by 2018 it would rise to 5755. how does it work? guest: out of pocket. total cost of those who hit the doughnut hole. host: if you are in it -- guest: that means you are a fairly high cost consumer, with a number of prescription. i think what has improved is that most of the plan is required to have what is called medication therapy management, which is increasing. a lot of seniors -- my mom -- one had eight drugs and some seniors taking 10, 15 drugs and they should not be.

talk to the doctors and pharmacists because many seniors are taking more drugs than they should, the cross-medications are not good for them. for the 25% of people who have relatively higher cost, and i think about 5% hit the top of the doughnut hole -- it covers a lot of the cost one-of that. congress is talking the closing bell. you can debate it. some people thought we spent too much money. this is $50 billion a year we did not spend before 2006. a big new program for seniors. again, my goal was to help everybody but primarily poor seniors. no debate -- for poor seniors it has been a spectacular benefit. host: four minutes left. pennsylvania. george. caller: i am a member of the va and i am under medicare. basically two questions. number one question is, were you

with the bush administration from its beginning, and if so, why did the cost -- the coal pay for veterans go from $3 to $7. bush was inaugurated in january and the cost went from $3 up to $7 in february. is donald rumsfeld -- wasn't he a ceo of a drug company? further, who wrote the plan d of medicare? i am sure the drug companies were very instrumental in writing the law and this is nothing but a great boon for the drug company. host: george, let us get a response.

guest: they want, -- or not. i was the cms administrator -- center for medicaid and medicare services. i was with president was number one in the white house -- and i was there for the first three years of president bush 40, the second bush administration. this is not written by the drug companies at all. i was the primary -- along with doug and bush administration. i have worked with the drug companies, have respect for their views, but -- not a close friend of the drug companies, policy wise. to say the drug companies were writing this is unfair. the va is a wonderful drug program. my father just passed away and he used part d but also the va. there are 6 million seniors out there that used the va and it is a great thing. the benefits are great.

the copiague, $7 instead of $3, that was passed by congress but put in place during the first administration but it went by from something congress passed. but a heck of a deal. the va benefits are spectacularly good on the drug's side. for most veterans qualify, certainly something you should think about even before you get to part d because it is much more heavily subsidized. host: next question. brooksville, florida. caller: i would not like to ask mr. sculley, the previous caller i think s -- hit the nail on the head. i'm a pharmacist in the state of florida and i'm a republican, -- in the law that you and george bush signed the drug plan, you make it illegal for a bidding process and that is why the democrats did not vote for it. when i saw that i said that is

unconscionable for republicans not to believe in free enterprise on medicare part d, the drug plan, is astounding. you know as well as i do, hospitals have a formulary. it goes out to drugs like the statins, cholesterol lowering, however gives them the best deal, the doctor writes for that particular manufacturer's drug. why shouldn't that be available to the american people? when i see is is what the republicans did is they signed the bill to make it look good and going forward in the out years, that program is going to be so astoundingly expensive it is going to be republicans politically can say, s.c., another cost ineffective government-run program. my point as a pharmacist, i believe americans deserve health

care. medication is one of the easiest proactive ways to reduce medical costs in this country. and when you put together a program like this where you are putting in a no-bid contract, the previous caller was right, the big farmer wrote that bill. guest: with all due respect, it is substantively incorrect. i would be happy to debate this all day. the real issue -- the negotiating of prices. the government has 1500 contractors. people don't really understand medicaid -- medicare well. i work with that for 30 years. medicare does not on the program. 15 blue cross plans are in the program. medicare has their checkbook to blue cross plans who writes checks out of the treasury. if you are a senior and you look at what the benefits come from from part a and part d, not for medicare but blue cross north carolina or blue cross of florida. no money at risk.

the government's -- whenever -- every hospital in florida it's the same thing for hip replacement, the doctor is paid to the same thing in there is no variation. the government fixes prices, in my opinion it creates a marble incentives. -- horrible incentives. what part d did that has worked, we said we would not put the treasury's money at risk. we are going to give you, say, $1,500 a year, set of stringent rules and let you negotiate with the drug companies and the money is at risk, which is the fundamental issue. whose money is at risk? treasury or private insurance. part d diggs bat to private insurance companies and a very aggressively negotiate. they have formularies -- just like hospitals. guest: by any standard, this

came in roughly a third less than expected. it is exactly contrary to what you said, that it would be a very expensive program. it is tough and confusing and some people obviously are not happy with it, but it has come in way under budget, and it is a model that i hope democrats and republicans look at for making it health care system tightly regulated, more competitively, and not fixing prices -- and not having the government fixed prices. my agency was $800 billion a year and we spent half of the other health care system and when you pay every doctor and hospital the same thing, you distort the whole system. we want a system that is to be like a lead that gives incentives to drive down prices -- that is tightly regulated that disincentives to drive down prices. the costs are way below what was anticipated.

>> we are live at the state department waiting to hear from middle east envoy george mitchell. he is expected to react to news on west bank settlements today. the associated press reports a short while ago that officials at the israeli prime minister's office says the security cabinet approved a 10-month freeze and new construction in west bank settlement. the official signing it is approved by an 11-1 vote. they spoke on condition of anonymity because most statement was issued. earlier promised to benjamin netanyahu said the halt was designed to restart peace talks with the palestinians. we should be hearing more about this from george mitchell shortly from the state department. in washington, president obama granted his first pardon to the turkey courage. another more serious news, though, the white house did announce the president will announce his new strategy for

afghanistan in a speech from west point, u.s. military academy tuesday night. he is expected to lay out his plans for expanding the afghan conflict and ending america pause in military role. coverage on c-span tuesday at 8:00 p.m.. also today the white of officials saying the president will travel to copenhagen in early december for the global climate conference. he will be there december 9 before heading to oslo to accept the nobel peace prize. his attendance has been in question up until now. we are waiting to hear from george mitchell, the middle east envoy here from the state department. while we wait for the news conference, more from this morning's "washington journal." host: sheila krumholz, executive director at center for

responsive politics here in washington, d.c., and they monitor campaign contributions. this year, what are you finding in the aggregate? guest: $422 million has been spent on lobbying by the health care and insurance sector. phar-mor is given in campaign contributions. @@@@@@@@@ h7hç

soda pop manufacturers, funeral directors, you name it, everybody is waiting in. host: $2.5 billion from the beginning of 2009 until the current time. guest: last the of $3.3 billion. host: we would like to go to your phone calls. we want to talk about money, how it is being directed and health care debate and we welcome your comments, observations, and questions. our phone numbers -- u also known you can tweak us or send us an e-mail as well -- tweet us. who is getting the money? does that it is being targeted to those members of congress who

have senior leadership positions. corralling the boats. chairmanship and ranking members of the importance committees and subcommittees that are governing this legislation, leading the fight. in addition, of course, there is a lot of focus now on the moderate democrats in particular, both in the house, the blue dog democrat, and in the senate, folks like blanche lincoln, then nelson -- ben nelson, on the right, columbia snow. -- olympia snowe. they had major roles and the passage of the votes to continue discussion on the legislation. host: are you able to attract -- >> "washington journal" returns tomorrow morning. we are leaving this recorded segment and taken to the state department with a briefing with the middle east

envoy george mitchell. >> the afternoon, ladies and gentleman. prime minister netanyahu has just announced his government's moratorium on new settlement building. i think it is important to look at this issue in the broader context, particularly how this affects the situation on the ground and how it can contribute to constructive negotiating process that will alternately lead to an end to the conflict and to a two-state solution. it falls short of the full supplement freeze but it is a more than any israeli government has done before and can help move toward agreement between the parties. as president obama has said many times, we believe that a two- state solution to the