a mixed system between the public system and a private system, where you have a public system at the bottom covering i kind of public good which is in health services faded out of taxes or payroll contributions with the right set of incentives, and getting rid of the bad things, and may be on top for everybody the public system for everybody and on top based on risk aversion or not, paid by private insurance companies who buy packages, whether you like. this could be a system so that there is no problems between the public and private system if the incentives are right. men may be both work together so that it followed the u.s. discussion you are surprised about the antagonistic use here. and we can draw on some experience from the public systems. >> the danger is there that they opt out of the public system and move into the private system?

that was the danger is that would become like medicaid. . but they always feel it's a the mix that you have now with about 10% of people buying private insurance, the 10% of the most wealthy people, 90% who are in the publicsome, that

actually is a very nice -- public system. that is actually a very nice match. in the u.s. where we have 20% of people in the medicaid although it pays for 40% of the births, there's not enough public support to sustain that in a good enough quality. but 90% of the public system, 10% private system, that works for me. >> you have a very brief follow-up. >> very brief one to eric. i was surprised by this question that a lot of americans believe that the doctors can do everything. have you ever checked this back against a sample of doctors? >> that's next. [laughter] >> thank you eric, tom john. thanks very much. [applause] >> thank you panelists. we'll take a 15-minute break and then reconvene to talk about making policy. [captions copyright national cable satellite corp. 2010]

[captioning performed by national captioning institute] >> up next david cameron talks about his nation's health care system. after that, secretary of state hillary clinton on security challenges around the world including yemen and iran. and later a report on u.s. health care spending. on c-span 2 tomorrow morning, a forum on long-term care services. panelists will examine who provides long-term services who gets them, who pace for the services and whether or not -- pays for the services and whether or not congress will include long-term insurance in their final health care bill. that's live at 8:30 eastern. and later in the morning on c-span 3 a forum on energy efficiency panelists from government, industry and academia will discuss clean energy resources and smart grid technology. that's live from the national press club at 10:00 eastern.ñi

now british conservative party leader david cameron in london he announced his party's health care agenda for the upcoming parliamentary elections expected this spring. he's joined by andrew lancely the conservative party spokesman on health policy and george osborne, the party's spokesman on economic and financial issues. this is 30 minutes. >> well, ladies and gentlemen, thank you for joining us. today we published the first part of our draft manifesto and it is significant that we've chosen to start with the section on health because that in itself is an indication of our priorities. and i'm glad the light's coming in to show what a positive start to the year we've had. members of the cap net and a large majority of the parliamentary party are in

britain today talking about our policies on maternity services and public health and improving the n.h.s. will benefit families and today we also launch the first national poster campaign of the coming electiobnñ now many of you would have seen our year for change ads in the newspapers on new year's day and these ads are now on some posters and phone boxes around the country. but this morning we add to them with this new poster, it's a poster that affirms that the conservative party and in particular david cameron is committed to cutting the deficit but not the n.h.s. this poster will now be appearing on close to 1,000 sites across the country so it's our first heavyweight campaign of the election. it is simple, it is positive, it is honest, and it's an ampleation of our values ofxd responsibility and aspiration. and i think the contrast between the way we have begun the new year and the approach of our opponents is striking and will reflect the shape of things to

come. we start positive, we have new ideas and we are talking about policy. labor's press conference this morning was negative and dishonest and old-fashioned. they didn't want to talk about their own policies. it's a new year but they have no new ideas and nothing new to say. let me finally say thisñi before handing over to david cutting the deficit while protecting real increases in the n.h.s. budget is not an easy commitment to make. we haven't made this promise lightly. unlike gordon brown, i will not pretend that the very large budget deficit does not pose a serious threat to economic stability and recovery. and i will not pretend that protecting the n.h.s. does not mean very difficult decisions on the spending in otherxd departments. there will have to be spending cuts. a word that the prime minister cannot bring himself to use in this new year. and i have set out examples of some of those decisions like a

public sector pay freeze for all but the lowest paid million like removing certain benefits like tax credits and child trust funds for better off families such as our proposal to bring forward the increase in the state pension age and i believe i'm the first shadow chancellor to have ever set out decisions like that. and of course there will be more that needs to be done. but we have made a choice, we will cut the deficit but we will protect the n.h.s. it is an ampleation what have david cameron promised -- ampation of what david cameron promised. david, over to you. >> thank you george, and good morning, everyone. on saturday i set out our argument for the general election that must be held this year. we want to make in the year for change. we cannot go on like this, we

need change to get the country back on its feet and that change needs to be based on the values of aspiration and responsibility. we can't go on with the same irresponsible economic policiesìthat failed to fix the roof when the sun was shining and gave us the biggest boom and the biggest bust and it now threatens our recovery with higher taxes higher debts higher instability, higher interest rates and higher unemployment. we can't go on with an old-fashioned left wing class war on aspiration from a government that has actually seen the rich get richer and the poor get poorer. we can't go on with the old start of politics that divides the country instead of uniting it. we can't go on with labor's bureaucracy, running everything from white hall, denying people control over their lives and undermining the professionals in our public services. we cannot go on in these difficult times with a weak

prime minister and a divided government. we cannot go on and we cannot go forward another five years of gordon brown. we cannot go on like this. we need change to get the country back on its feet.ñi a better n.h.s., an aspirational economy, a big society and a new politics. if we make these changes, then this country will have a great progressive future. a future that is fairer, safer greener and where opportunity is more equal. now today we are kick starting our campaign to make that vision a reality. we are publishing the first chapter of our draft manifesto yes, it is a draft manifesto because this is still an open document, open to the ideas of the millions of people it would effect. all our policies and plans are going to be published online on the conservative website for everyone to have a look at.

we're then going to ask people to get involved and to have their say on the changes that they want to see. over the coming weeks we're going to be publishing this draft manifesto chapter by chapter. and today we are starting with our number one priority, it was our number one priority four years ago when i became leader of the conservative party and it has remained so ever since. it is only three letters long, but its let -- in its letters lie the hopes of millions of people in our country the n.h.s. today the conservatives are the party of the national health service. but talk is cheap. you've got to back that with action. and we have. we are the only party committed to protecting n.h.s. spending. it is there in black and white behind me. i'll cut the deficit not the n.h.s. and don't for one minute buy the labor claim that they will do the same. they won't and their figures

show that they won't. unlike us, they have not committed to protecting areas of the health budget such as public health and capitalñi investment. and there's another big difference between us and labor. we're not just going to pump money in and hope for the best. we're going to change the way the n.h.s. works because it could be so much better. under labor the n.h.s. has turned into a giant merchandize controlled from above responding to politicians bureaucrats and managers. if we win this year's election, andrew lancely and his team are going to give the n.h.s. back to where it belongs. to the people. to the doctors and the nurses and the professionals who work in it, to the patients who get their care from it, to the families who depend on it. every policy we put forward every reform we implement every change that we make will have at its heart this simple idea, that we need to give the n.h.s. back

to the people. we'll say to doctors and nurses, those national top down targets you hate because they distort clinical priorities, they are gone. instead of answering to the people in white hall, you'll be answering to the people on the ward for the quality of service you provide and the results you achieve. it is patients that will have the power in our n.h.s. you'll be able to check your health records online in the same way you do your bank account, you'll have a relationship with a local family doctor who you can see at a time that suits you you'll have real choice prosecute about where you] get treated and you'll have information about how good different doctors are how good different hospitals are information about the things that really matter, like cancer survival rates the rate of hospital infections and your chances of going home to live independently if you have a stroke. our changes will create more

choice, they will drive up standards and they will make our n.h.s. better for everyone. and as and rue will explain today, we're announcing two specific plans which show our commitment to improving the n.h.s. for everyone. the first deals with one of the most unjust, unfair and frankly shocking things about life in britain today. and that is the gap in health between the richest and the poorest in our country. labor promised they'd do something about this. 2003 they said they would reduce the gap in life expectancy and in infant mortality between the richest and the poorest in our country by 10% by 2010. so now is a pretty good time to judge them. and the verdict is not good. the gap in life expectancy between the richest and poorest has actually increased and the gap in infant mortality between the richest and poorest households has also increased. health inequalities in 21st

century britain are as wide as they were in victorian times. we cannot go on like this. if the n.h.s. is not working for the poorest in our society then frankly it is doing a poor job. that is why we're going to introduce a health premium that targets resources on the poorest areas so we banish health inequalities to the history books. with our plans, the poorer the area, the worse the health outcome it's tend to be so the more money they can get. but instead of white hall telling them how to spend this money, local people will died -- decide. local councils and directors of public health will be able to use these budgets as they see fit and will get more money if they deliver better results. the health premium will mark a significant shift in the way money is allocated in the public health budget. as with our pupil premium in education where more money will follow the poorest pupils, it will help focus resources on

those who need our help most. that's what i say that's what i mean when i say we will return the n.h.s. to the people. nowñr the second policy we're announcing today deals with an area that desperately needs attention. n.h.s. maternity services. it doesn't matter that millions of women have given birth over the ages. for parents having a baby, especially your first baby, can be one of life's most daunting experiences and all of us really want the same thing as many mums as possible giving birth in a relaxed nonemergency, maternity-led setting with all the facilities for intensive health there for those who need them. but the government has just been reorganize from on high giving us bigger and bigger baby factories where mothers can often feel neglected with some even being turned away on the door step while they're in labor. parents in many parts of europe have a system that is more personal and more local with more choice. and they also have lower rates of infant mortality. why can't our parents have the

same thing? with our maternity networks they will. these will bring together in one network under one organizational structure all the ma ternltçó services in one area that a mother may need. local hospitals g.p.'s, charity groups will all be linked soup they can share information expertise and services. there will be clinical benefits as the more professionals communicate across the network the more consistent the medical practice will become the higher standards will be. and there will be social benefits as these networks will function as a meeting place for mothers as well asxd professionals. that's what i mean when i say we will return the n.h.s. to the people. all these plans for our

fit in. you can see the threads running through them, giving more people more power over the most important things in their lives encouraging responsibility, strengthening communities. remembering that when it comes to our public services, protecting them and investing in them, we are all in this together. we will cut the deficit not the n.h.s., because the n.h.s. is the bedrock of a fair society. and we will bring change to our n.h.s. because as in so many other ways, we cannot go on like this. so let us make in the year for change. andrew over to you. [applause] >> thank you. i want to say a word on behalf of the n.h.s. over these years i have been meeting the staff who work in

the n.h.s. and the patients who were cared for by the n.h.s. and one of the things they have consistently said to me that is reflected in the commitment to the -- the personal commitment david has given to the n.h.s. is how important it is to them and their families that the n.h.s. is there when they need it and we are being realistic about what those challenges are for the n.h.s. a rising population, an aging population increasing technology increasing expectations, new demands new opportunities for new treatments come along. but the people working the n.h.s. they know that they need change. what they need is the opportunity to change their own service to improve the service they provide for patients.ñr every meeting i have with theñi n.h.s. is always the same. they say, we cannot go on like this. they know that the services not seeing the money get to the front line, the number of managers is rising faster than the number of nurses, that the bureaucracy and waste seems to

increase but the improvement of standards in services isn't what they want it to be. they know that the tick box certainly targets aren't based on evidence and what's in the best interest of patients. the staff in the n.h.s. want to deliver what is best for patients, they want the resources to get to the front line. we know that we have to change this year and in the years ahead in the n.h.s. to make that happen. we have to ensure that the focus is focused on the raults for patients. as david said, to make sure that instead of saying we're patients seen within four hours that we know that patients are living after a heart attack, that they are surviving after stroke, that they are getting the care that they require. so we're going to focus on results and we're going to focus on patients. we're going to have a revolution in the information in the n.h.s. so that patients know what service they should expect, what service is being offered with what choices are available to them, how they can control their health care better. so that the staff working the

n.h.s., are not only focused on doing what's best for patients, not only accountable for the results that they achieve, but they're also answerable to patients for the service the quality of service and the results and patients themselves can exercise greater control. that can have a transforming effect upon the national health service. and we know also that the national health service, if it is going to succeed, we need to improve our public health. so we are going to focus as david said not only on dedicated resources so that communities can take ownership of their public health, and that is not an insignificant point because actually the n.h.s. at the moment in the most deprivinged areas of this country where the poorest health outcomes are where there has been so little improvement over the labor years, actually there is no more spending on public health than in the richest areas of this country. so we do need to ensure that there are dedicated public health fends -- funds that those funds are used to deliver

improving health care in the poorest areas of this country because we know that that sense of the n.h.s., of our health care, as being the bedrock of a better society depends on us knowing that where the health outcoming in this country are the worst we're ensuring that those communities have the resources and an incentive to take ownership of their health and to improve it in the future and i believe looking at george, i believe this is an investment for the future too that the results that we can achieve through improving our public health through the health premium we will give to the poorest communities in this country in improving their health will in itself transform the prospects in those communities in everything from incapacity benefit through to the costs of social care for long-term chronic disease. so the health premium is going to be dramatic and improvement -- important and the ma tent networks that we're announcing today demonstrate how in the n.h.s. services, the mobilization of choice is

instrumental to delivering better care. for mothers to be what they want is they want information, they want support, they want choice. at the moment, the n.h.s., in a bureaucratic process is trying to decide what services should be available why where and increasingly are saying, in order to be safe we must centralize all the chair larger and larger units and actually removing the access to services that matter so much to mothers. so labor promised that by december 2009, all mothers would have access to choice. in fact, what is happening is a lottery of care for mothers to be. so we are going to ensure all over the country there are maternity networks that brings together the services that are available to mothers, meet the standards that are required, meet the requirement for mothers to be able to exercise choice, both when they are first booking for their pregnancy and throughout pregnancy as their circumstances may change. so through maternity networks we will give an example of how we are going to mobilize a service

focused on patients and exercising choice. through the health premium it demonstrates how we are going to ensure that the n.h.s. is indeed that bedrock and fair society. right across the n.h.s. we are going to bring the change that the n.h.s., the people working in it, and the people who are looked after it, all know that we need. we are indeed today the party of the n.h.s. not just because we are committed to the values of the national health service, but because we have demonstrated that we are committed to its funding and because we have a vision for its future. thank you. [applause] >> thank you very much andrew. we've got time for one or two countries -- questions. nate robinson from the bbc. there's a microphone coming to you. >> thank you very much indeed.

mr. cameron why are you committed to spending millions of pounds on cutting taxes on inheritance, marriage, the highest paid and savers instead of spending it on public services? and isn't the cost of your n.h.s. promise the tory government will have to cut schools at the very time that you say you want to get britain back on its feet? >> no, that's not the case at all. some of the things that you read out aren't pledges at all. i think you may have been indoctrine ated by the previous press conference you've been to. so we'll have to take you through a program of reeducation. [applause] we have made some very clear commitments. the first commitment higher behind me, we're going to cut the deficit, that does mean we'll have to cut public spending. we're very frank about that. we don't you know, dance around it. we're going to have to cut public spending but we've made a big choice which is we're not going to cut the n.h.s. the n.h.s. is special. it will have real terms growth each year. every other spending pledge we

have made, every other tax pledge we have made is fully costed and fully set out. if you take, for example, the plengodge -- the pledge on inheritance tax which is not for a first budget but is a pledge for parliament, that is to be paid for by taxes the nonforms that people who live here but don't pay full tax here. every other pledge we have made is costed and when you look across to what labor have announced this morning i mean, it is difficult to take the conservative spending plan seriously when they haven't set out their own spending plans for the future. it is even more difficult to take them seriously when you consider that when this chancellor became chancellor he has underestimated our national debt by a staggering 543 billion pounds. so to take any forecast from him is doubly difficult. it is tripley difficult it is completely impossible, when in

virtually 11 seconds i spotted 11 billion pounds of mistakes in his document. to claim that we are committed to abolishing the 50-p tax rate immediately, that's not true, to claim we are committed to abolishing the changes of pensions at the top end that is not true to. claim that we are committed to abolishing stamp duty on share transactions, thank you not true. that took me about 11 seconds and that is 11 billion pounds. this document is complete junk from start to finish. >> forgive me, just for clarity you are are you not committed to spending millions of pounds on cutting inheritance tax taxes on marriage, taxes on the highest paid and taxes on the savers? >> let me take each one of those in turn. not, those billions could be spent on public services and not on tax cuts and that's the choice you've made, is it not? >> i think we need to take each

one of those in turn. if you take the inheritance tax pledge that is a pledge for a parliament fully costed by taxing the nondorms. the other tax changes you made are either not things that we have set out and costed and it's only when they're set out and costed that you can include them properly in our plans. so as i say the purpose of publishing our manifesto in advance is so that we are you absolutely clear about this and you can see the commitments when and as they're made. nick. >> nick from the guardian. david, can i ask but your pledge for a real terms growth in n.h.s. spending? what that means is you're giving a guarantee that spending will rise in line win flation but will not necessarily rise above inflation. do you not need to be honest with voters, after a decade in which n.h.s. spending has increased by between 4% and 5% above inflation a 0% rise

inflation is going to feel very, very painful and will feel like cuts. >> i completely agree we need to be honest and upfront and straight with people about this and i've said many times on platforms like this that, yes we are committed to small real terms increases in n.h.s. spending that's important. but let's be clear as you say these will be less than people have got used to over previous years and, you know, there will be tough decisions to make even within the health budget. that is absolutely true. but we are the only party as far as i can see that are actually guaranteeing that come what may n.h.s. spending will go up in real terms. now one of the reasons for making that pledge is we think that when you look at some of the costs coming through our n.h.s., the aging population, the cost of new drugs and treatments the cost of looking after children who are surviving for longer with severe disabilities when you look at these cost, i think it is unrealistic not to increase the

n.h.s. in real terms each year and that's why we're doing it. but i completely accept because of the appalling state of the public finances, because of the complete mess being left by this government, that we're going to have maicñi -- make difficult decisions right across public spending including health. this is a decision that we have made, that other parties have not made.çó gary. >> thank you very much. gary, channel four news. you kipe saying that you're very frank about the deficit and you emphasize your honesty and straight forwardedness and everything. but you've only shared with us a very small fraction of the cuts in the deficit that you'd make is that because you don't have a plan that goes beyond those or is that you're just not willing to share it stpwhuss >> if you rewind the party conference, it's quite interesting that at the time quite a number of people in the press said we'd been far too

frank, far too much detail, this is going to be a terrible error of judgment and all the rest of it. we thought it was the right thing to do of course the changes that we've talked about are not sufficient to eradicate the deficit. but what i would say is this we are the first opposition that i can recall in my political experience and i'd say probably the last 30 years or 40 years, that first of all has said very frankly we will cut public spending, not in real terms not freeze, but we're going to have to cut public spending and the second thing is we've set out a series of things that we believe need to be done. not just those things that actually we think we'd like to do like get rid of identity cards, the national identity database regional government, the regional -- shrink the size of the house of commons cut ministerial pay, that's all the things we'll do, yes with some relish, but we've also set out a series of things that will be deaf and -- difficult and tough but we think have to be done on the public spending side to get public spending under control

and that is things like freezingxd public sector pay asking people to retire a year later getting rid of child trust funds and tax credits for those on higher incomes, those are painful and difficultñi choices and you haven't heard any of that from the government at all. and we are the first opposition as far as i can see in history to set out a series of tough spending decisions that would start to make a difference on the deficit. and we've also said that we would start earlier than the government. they are basically doing nothing until 2011 and even then they won't set out any of the consequences what have their spending programs are. last question from tim. >> thank you. >> sorry tim shipman. that was very cunning. >> i can ask quickly about this extra money for areas -- poor areas and there are vast areas of scotland that get hugely greater amounts of health care provision but the outcomes are

no better. in a lot of cases they're far worse. what do you say toçó that? how will you make that actually work in practice? >> there are two things we're announcing today in terms of the health premium. one is that those areas of the country whose need is greatest will get more of the money. but the second thing is that they will be payment by results. they won't only be getting the money in as much as they can improve their health outcomes that seems to me that is absolutely crucial to use the payment by results idea to actually get changes in behavior and changes in outcome that will make such a difference and that is the key to our plans. tim shim. >> too many nautical vessels in the room. >> tim ship, i'm sorry. >> you said that talk is cheap. can i put this to you, you accuse labor of having 17% cuts

-- [inaudible] does that not require you to say that you'll cut the deficit by 20%? i, david cameron will cut it by 25%. if you don't do that -- [inaudible] >> i think there's a fundamental difference between what gordon brown is saying and what i'm saying. what gordon brown is saying and he said it very clearly on the andrew mark show yesterday is he is saying, i will increase public spending by not .8% a year. he's trying to give everyone the impression absolutely directly, that public spend something remorselessly going upwards to make everyone feel there won'ting cuts under labor. this is completely dishonest. you only get to the .8% figure if you exclude capital spending which is being cut by more than half and you only get to the .8% figure by including the cost of debt interest and the cost of

paying for unemployment benefit. if you took out debt interest and unemployment benefit under their plans what's actually happening to public spending is that programs would have to be cut by 17%. so that's what he's saying and that is the level of honesty you're getting from the prime minister. trying to pull the wall over everybody's eyes and saying that public spending is going to go up when actually it's going to be cut. what you're getting from me is a very frank statement. public spending is going to have to be cut. not increased in real terms not frozen, we're going to have to cut it. we're going to have to take some difficult decisions. and you're also getting something else which is we're going to start earlier than the government will. only protecting the n.h.s. and the overseas aid and we believe you should make a start in reducing public spending in 2010. you've got to start looking at making some savings earlier than the government are going to and we don't deny for one instant that there will be some difficult decisions within the

health service yes but there will beúemen more difficult decisions outside the national health service. i think anyone watching andrew yesterday and anyone listening to me today can see a real difference of emphasis in helping to explain to the british public what needs to be done. that is what we have done, that's what we did in that very brave conference speech where we outlined a series of public spending cuts and we couldn't be more positive or clear in this poster today. thank you very much indeed for coming. i'm sure there will be many other press conferences like this and many other conferences like this over the coming months. thank you very much. [applause] [captions cop cable satellite corp. 2010] [captioning performed by national captioning institute] >> on tomorrow morning's "washington journal," evan perez on national security issues facing the obama administration.

after that, jane oates from the labor department discusses shortages in unemployment funds in states. then richard phenomena dane of the center for a new american security will talk about al qaeda operations in yemen. "washington journal" begins each morning at 7:00 eastern with your calls. and later in the morning the carneigie endowment for international peace hosts a forum on the world economy in 2010. panelists include representatives from the world bank, the international monetary fund and other groups. that's live at 10:00 a.m. eastern. secretary of state hillary clinton talked about the security situation in yemen, the attempted bombing on christmas day and iran'sçó nuclear program. those comments came after a meeting with the prime minister of qatar. this is about 25 minutes.

>> good morning, everyone, and happy new year. it's good to see you here and i'm especially pleased that i get to welcome his excellencely the prime minister back to the state department. i hope you've all had a chance to rest and enjoy the holidays and i know that there's a big agenda in front of us which his excellency and i have been discussing. it's very important that this meeting be held at the beginning of this new year so that we can immediately get to work on the many matters that concern us. qatar is a friend and an ally of the united states and the partnership between our two countries is a model of the new beginning based on mutual respect and mutual interest that

president obama called for in cairo. so today we not only discussed a wide range of important issues but also how to deepen and broaden our partnership. among the matters that we consulted on, the situation in yermen is -- yemen is a top concern, how can we work together and with others to stable idse yemen? -- stabilize in yemen, the instability in yemen is a threat to regional stability and even global stability. and we're working with can at that tar and others to -- qatar and others to think of the best way forward to try to deal with the security concerns and certainly we know that this is a

difficult set of challenges but they have to be addressed. i also thanked the prime minister for qatar's efforts to facilitate an end to the crisis in darfur and to promote security and stability in the broader middle east as well as africa. we both have a shared mutual interest in moving toward a comprehensive peace between the israelis and the palestinians. we both share the goal of an independent and viable palestinian state and we are committed to doing what we can to help relaunch peace negotiations that would lead to a two-state solution. we believe that president abbas is a partner for peace and can help deliver that to the palestinian people. the prime minister and i discussed the future of iraq. it's important that iraq be

reintegrated back into the larger region and that it go through this next electoral cycle and create greater stability among the various constituents within the country. we discussed the importance of international solidarity and dealing with iran particularly with respect to its nuclear program and its compliance with various obligations under the united nations security council the iaea, the n.p.t., etc. and finally let me express our appreciation to his excellency and to his imaginiest the amir and his country for their actions in combating hunger and poverty and disease across the region and the world. we have a lot of work ahead of us but i thank you, your excellency, for your friendship, for your candid thoughts on so

many important matters and i look forward to continuing our dialogue in the year ahead. >> thank you very much madam secretary. happy new year. and i am very glad in the first working kay to be here with madam secretary -- working day to be here with madam secretary. asthma dam secretary mentioned we discussed -- as madam secretary mentioned we discussed all the issues that are important for both countries and i just want to highlight that -- about two or three issues, one of them is yemen is a very important disability of yemen and unity of yemen and we think the situation in yemen there is only one solution to be solved through a peaceful manner by trying to find a way to solve this problem in a peaceful way. the second thing is about the middle east track and the palestinian-israeli peace

process. we are hoping that this peace process could start again and it have to start an agenda and end game. we are looking to see where is the end game and i really thank obama and madam secretary's administration for their efforts which bring hope again to us to continue this process. there will be difficulties and there will be up and down in this process. we know this. but the most important things is how we can do a unity government between the palestinian so they can concentrate how to deal in the peace process and also the israely and palestinian have to know there's a solution to solve this problem is buy dialogue and the dialogue is a very important that there is no games in this dialogues because we know jerusalem is a very important part, we know the settlements there is a problem we know the water, we know peace land for

peace, you know, that's the main elements which all the international arena and all the countries agree on it in the process. so i hope both sides realize they have to work together. all of us we are ready to help, all of us rely on the united states' help and involving in this process. i think that's a very important matter for the region. the other problem if we are talking about iran, we hope that this problem could be solved through diplomatic means. we wish stability in the region and the stability will not come unless we realize that we have to comply with the international law and comply also in how to solve the problem by dialogue.

thank you very much madam secretary. >> thank you so much. >> happy new year, madam secretary, your excellency. >> thank you. >> on yemen, madam secretary what you can say about the latest you can say about the terror threat to the u.s. embassy? and given the longstanding concerns the u.s. has had about yemen and to the embassy itself, what is the u.s. prepared to do as you say to help yemen combat their growing terrorist problem? and given the embassy's discussions with the father, how much blame do you think the state department bears for not highlighting the fact this gentleman had a visa and could come to the u.s. at any time or pulling the vii and your excellency, if could you follow up on your comments, you said there's only one solution to yemen and that's trying to help in a peaceful way. could you expand on what that means and what you think the

region and the u.s. can do to help yemen? thank you. >> those were a lot of questions, your excellency. let me start let me start with yemen. as you know, the u.s. embassy closed january 3. it remains closed today. that is in response to ongoing threats by al qaeda in the arabian peninsula aqap.:9 r

conditions constantly and will make a[ decision on reopening the embassy when the security conditions permit. with respect to what happened with the terrorist on the plane coming into detroit we are not satisfied, we are conducting an internal review, the president has called for a whole of government review. based on what we know now the state department fully complied with the requirements set forth

in the interagency process as to what should be done when a threat is -- or when information about a potential threat is known. but we're looking to see whether those procedures need to be changed, upgraded, and that is my goal as secretary to do everything i can to make sure that not only american citizens but, you know, all people traveling on airlines of any nationality can arrive at their destinations safely. so we will be meeting with the president tomorrow to go over our internal reviews to hear what others in our government also have concluded and to take whatever additional steps are necessary. >> thank you. as you know, this is the fifth or the sixth war in yemen and for that reason we know that this problem have to be solved

through dialogue. as you know, doha hold the last dialogue between the two and there is an agreement being signed and we hope that we go back and find a way to solve this problem through meaningful dialogue. and dialogue which can give the lead for the state of yemen because we support the unity of yemen and that's a very important role but it's a very important also not to spread our power or our efforts to these kind of things and we have to -- concentrate on the terrorism and how we can fight the terrorism in our region and other so we don't export it somewhere else. >> thank you so much. happy new year. madam secretary, if i can start

by asking about -- the follow-up question on yemen what do you hope to get out of the meeting in london at the end of the month? and what can the g.c.c. countries play, specifically what role can they play specifically? and your excellency, if i may regarding the peace talks in the middle east, are there any conditions on the ground now that give you further hope that there can be successful talks with an end game? we're hearing difficult reports of the possibilities of quicker resumpings of talks. thank you. >> thank you very much and happy new year. i think that the meeting at the end of the month in london is an opportunity for nations that can play a role in helping to stabilize yemen, to come together and discuss steps that each of us can take individually and collectively. obviously qatar has played an ongoing role, as our g.c.c. nations have. this is in that region, the

spillover effects from instability directly impact the neighbors. obviously we see global implications from the war in yemen and the ongoing efforts by al qaeda in yemen to use it as a base for terrorist attacks far beyond the region. so we're going to listen and consult with those who have long experience in yemen such as qatar does, both his majesty his excellency, and others. and work together to try to encourage the government to take steps that will lead to a more lasting period of peace and stability. as his lens j said, there have been numerous -- excellency said there have been numerous conflicts in yemen. they seem to just get worse and worse with more players involved now and it's time for the international community to make

it clear to yemen that there are expectations and conditions on our continuing support for the government so that they can take actions which will have a better chance to provide that peace and stability to the people ofem and the region -- of yemen and to the region. >> happy new year. remind me again of your question. >> the regarding the peace talks -- sorry regarding the peace talks in the middle east and are there conditions on the ground now for successr talks? >>ñi there always will be difficulty in the peace process. we have a long history in the peace process and this history should not let us down, you know or not let our moral to be down. i think we have to continue and push as i said there is no magic solution. all of us know the right solution for this conflict and now is the -- now the parties have to take a decision to move to that and especially the government of israel in my

opinion, we have to move and comply with the international and united nations resolution and madrid agreement very important for them to know that this cannot be continue and it's an opportunity with this administration to bring us together to a long lasting peace between us and the israel. >> secretary clinton on iran, president obama said last year that you'd have a pretty good sense by the end of the year whether iran was seriously interested in pursuing dialogue. about its nuclear program. there aren't a lot of signs that they are and there are no signs that they're interested in carrying out the agreement on the enriched uraniums -- that was reached in geneva. is the l.a.u. deal dead? two, even if the door to talking about the l.a.u. deal is still open, is the administration now

closer to imposing targeted sanctions, particularly on companies or individuals that have ties to the revolutionary guard corps? and lastly, do you not perceive a dange that are additional sanctions could play into the hands of the hardliners who often make the argument that they are engaged in a struggle with foreign forces and try to rally people around them that way and they've made that argument even as they've been crushing the protests recently? >> ar shad, we remain committed to working with our international partners on addressing the serious concerns we have regarding iran's nuclear program. now, our approach, as you know, is always proceeded on two tracks. we have an engagement track and a pressure trackment. and as i said, the results of our efforts to engage iran directly have not been

encouraging. we're disappointed by their response to the proposal for the tehran research reactor. and the iranian government announced a deadline to receive a positive response to their unacceptable counteroffer. so yes we have concerns about their behavior. we have concerns about their intentions and we are deeply disturbed by the mounting signs of ruthless repression that they are exercising against those who assemble and express viewpoints that are at variance with what the leadership of iran wants to hear. now we've avoided using the term deadline oursselves -- ourselves. that's not a term we have used because we want to keep the door to dialogue open. but we've also made it clear we

can't continue to wait and we cannot continue to stand by when the iranians themselves talk about increasing their production of high enriched uranium and additional facilities for nuclear power that very lik%lá can be put to dual use. so we have already begun discussions with our partners and with like-minded nations about pressure and sanctions i can't appropriately comment on the details of those discussions now except to say that our goal is to pressure the iranian government particularly the revolutionary guard elements, without contributing to the suffering of the ordinary iraqis who deserve better than what they currently are receiving. iran is going through a very turbulent period in its history. there are many troubling signs of the actions that they are taking and we want to reiterate

that we stand with those iranians who are peacefully demonstrating. we mourn the loss of innocent life, we condemn the detention and imprisonment, the torture and abuse of people which seems to be accelerating and we hope that there will be an opportunity for iran to reverse course, to begin engaging in a positive way with the international community respecting the rights of their own accidents, but we're going to continue ourn -- citizens, but we're going to continue on our dual track approach. >> thank you. happy new year. happy new year to both of you. i'd like to ask you, actually both of you madam secretary and your excellency, whether there have been any progress or anything new regarding middle

east peace process guarantees that our countries have asked for and also have you discussed aid to the palestinian authority and i mean u.s. aide to the palestinian authority? thank you -- aid to the palestinian authority? thank you. >> thank you very much. yes, we have discussed aid to the palestinian authority. the united states has continued to provide significant aid to the palestinian authority. we also discussed the commitment that the united states and qatar share toward a relaunch of the peace process and negotiations between israel and the palestinians. we are going to do all that we can to try to bring that about. there are many complexities of this extremely difficult situation but we reaffirmed our commitment to keep working at this.ñi

we know that the palestinians deserve a state to fulfill their aspirations. the israelis deserve security to live peacefully side by side with their palestinian neighbors. the arab nations have made a very positive contribution in the peace initiative of the arab league and others. so we're going to be even more committed this year and we're starting this new year with that level of commitment and we're going to follow through and hopefully we can see this as a positive year in this long process. >> well, -- >> [inaudible] in arabic, your excellency. >> ok, i will answer in arabic. that's easier for me. difficult for madam secretary. >> i'm not that good at that. >> [speaking arabic]

[speaking arabic] [speaking arabic] [speaking arabic]

>> madam secretary with regards to the letters of guarantees you was asked of the arab countries in qatar today chairs the current arabic economy for another round and -- committee for another round and we have given a letter to that effect to the u.s. administration right after the u.n. meetings. we are still awaiting a response from the u.s. administration and we have -- this response will be very important to us as it will give us a clear idea about the u.s. perspective on the peace process and how the u.s. cease the end game or what it is called as the end game. .

they will discuss clean energy sources and green technology. that is tomorrow at 10:00 a.m. eastern. the federal government's reported on the growth of health-care spending in 2008. more now on the report from members of the center of medicare and medicaid services. this is a 55 minute event. >> good morning, i'm the editor in chief of health affairs. having a year. welcome to our briefing on the health spending numbers. this is a ritual at the center for medicare and medicaid services as willis health affairs to bring out the spending numbers every year. we are delighted to be able to do that once more. this year we have a historic set of numbers to help others

unveil. you will hear and perhaps you have already read the historic slow down in health-care spending in 2008. the slowest rate of growth in 50 years. on the other side of the story some health-care spending grew faster than the overall economy. we are not out of our long-term trajectory. we continue to outpace the growth in the gdp. with no further ado, i will turn into our fine folks who will explain the data further. this person is very knowledgeable. we will hear from another person

who is an economist at the centers for medicare and medicaid services. she was primarily on historical state based spending. she and her degree in economics as well. some of their colleagues are also on the panel this morning. they will be available to answer questions. one is an economist with the office of the actuary. she earned her degree in economics. in the deputy director within a group is also with us. we received his degree from university of maryland. we have several people that are here able to enter questions. they are projecting forward into

the coming decade as well as looking back at the numbers. we have many people available to deal with these questions this morning. let me turn this over to you. >> >> thanks. can everybody hear me ok? good morning. on him as michael. i am very happy to be here today to present our overall findings. and here with my colleagues. the information we will review today will be published in the journal of public health affairs which is set for publication

tomorrow. all the information we are presenting our in that update. let's take a look at the summary of our over all the -- of our overall findings. after spending reached $2.30 trillion. we are looking at the spending trends for 2008. despite the slowdown, we see an increase in spending. the first exhibit shows our trend compared to the growth in the gdp.

as you can see, in most years health care spending exclusive of the mid to late 1990's era. we seek growth in two dozen to as there is a backlash against managed care. following that peak, we see slower growth all the way forward to 2008. it is leading into the two dozen a recession that began in december 2007. -- leading into the 2008 recession that began in 2007 of december. this is one of our most widely known statistics related to health care spending. as you can see, health care spending reached a certain percentage of the economy.

what we have noticed is that during recessionary time frames, we see larger share increases in the share of the economy devoted to health care spending. we see a time of relative stability following. let's talk about the impact of the recession of 2008. there were three areas that it had an impact on our trends. the health-care spending is insulated from a downturn in the economy. the recession began in december to a dozen seventh and had a more immediate and profound impact. that is due to the fact that it is probably the longest and most severe recession since the one in 19 -- in years past. we see the effect in the american recovery and reinvestment act. what that did was provide a

retroactive adjustment beginning the fourth quarter of to just eight for the federal matching rate of the medicaid program. enhance that rate shifting more responsibility to the federal government away from state and local government. we estimate the impact of that to be about $7 billion for to the fate. we see private growth slowdowns. we saw a slowdown in other private revenues for hospitals. it is due to investment related losses due to the recession. we also see an impact in the insurance and our estimates. for private health insurance we

had a decline in of enrollment. taking a look at the will of public and private health-care spending of the last few years or so, we are focusing on the more recent time frames -- public health-care spending has been outpacing the gdp. the share of public health care spending has increased in two dozen for. there are a few reasons of public cut your spending has been outpacing the growth of private health care spending. it is due to medicare and medicaid programs that has grown as of this expanded medicare coverage. in 2006, it accelerated with the

public health care spending trend. in private, it has been growing at a interesting rate. taking a look at greater detail of the spending trend we want to focus on two dozen 6 2007, 2008. -- 2006, 2007 2008. you can see the medical beneficiaries ever given a prescription drugs. you see the impact of strong growth due to the medicare part

the program. we also see where these to pay years and return to their normal growth. you see a divergence in to the state where federal spending accelerates in-state local spending slows again. that was mainly due to the a a r ka. personal health-care spending growth as segregated into a couple of broad factors such as price and non price. that includes population growth use and intensity of services as well as revenue from non patients and rep -- operating costs. examining health care spending in this way can get spending in other areas. the non price factors were

displayed in the red portion of this exhibit. there are of recessions where you do not see it gets smaller until you see it in other areas. we see a more immediate impact of the downturn which is similar to the 1981 and 1982 recession which was longer and more severe. this may be an indication that of the types of spending that occurred during recessions. another way we can add context to the recessionary period is to take a look at spending by sponsor. we have different sponsors of health-care spending other private funds federal and state

ill local government. with that health care spending which includes all health-care spending and less investment. remove its to underline sponsors that make those payments for are responsible for those payments doing things like moving the employer portion to the business sector are moving your share of insurance premiums to the household sector. between 2007 and to the state we have seen an increase up to 25% of all state and local governments share declined from 18% to 17%. household share remained relatively steady.

we can look at the burden of health care spending from 1997 until to the aid. for most sponsors, there was not much change. we did see in increase of the burden to almost 36%. this increase in burden can be explained by dropping tax revenue due to recession changes to the tax code, and increases in the aftermath due to the aara. for state and local the burden did not increase. that was mainly due to the impact of the aara. with that, i would like to turn

the rest of the presentation over to ann martin. >> let's take a look at where the $2.30 trillion was spent in 2008. physicians in clinical services was at 21%. prescription drugs accounted for 10%. it was the third single largest category of health care spending. i say single biggest other spending accounts for 25% in includes smaller categories such s -- such as special services.

looking at growth and personal health care spending along with goods and services for two dozen 8 compared to 2007, we see the help spending decelerated to 4.4% in to defecate. we say there was across the board deceleration. these services grew within a 3- 6% range in two dozen 8 with a couple of exceptions. one area of health care grew 9%. personal health care decelerated rapidly from 518% in 2007 to 2.6% attention to those in a.

-- 5.8% in 2007 to 2.6% in 2008. ; following the end of the managed care era. it decelerated through 2006. it decelerated more revelation to dozen 7 and 2008. -- more rapidly in 2007 and 2008. a decline in operating revenue due to investment revenue losses due to the recession. we will look at the category of a position and clinical services

combined. it grew 5% in 2008. this was a deceleration in the slowest rate of growth since 1996. it accounts for 80% of the combined category this was driven by a deceleration in prices and slower growth in private funding. it is for private health insurance and out of pocket. it's like the beef? the impact of the recession as interest coverage was -- it likely reflects the impact of the recession. patients may have postponed elective procedures. since the recession began patient volume has declined.

, and services accounts for the other 20% in decelerated to 6.6%. looking ahead retell prescription drug expenditures, it increased 3.2% in 20008. this was a deceleration from 2007. it is a continuation of a slowing trend that began in 2000. part de was a factor. in two dozen 8, the acceleration was driven by an decline -- 2008 the change was driven by a decline in prescription drugs.

patients were not filling the prescriptions as much or they work cutting back by cutting the pills in half to make it last longer. one drug was changed from prescription drug status to over-the-counter status which also led to the deceleration. but we will look at who pay for health-care goods and services in 2008 to the highest fare is private health insurance. the second highest player is medicare and 20%.

total private spending accounted for 53% share. this is down one percentage point from 2007. there was a slight shift towards public player accounting for more of the health care bill in 2008. this is similar to the graph we looked at in services. it is among the different hair years. public payers remained unchanged at 6.5%. medicare growth outpaced that of medicaid and other private payers. medicaid decelerated to.

total private spending accelerated rapidly. all three components of private payers showed a deceleration. out-of-pocket spending showed a large deceleration. it was driven by a decline in out-of-pocket spending for prescription drugs. there was a deceleration in out of pocket spending for other goods and services. an obvious deceleration occurred in other private spending. it is primarily due investment income losses experienced by hospitals due to the recession.

we will zoom in on medicare spending. the graph shows medicare spending and its components of managed care. in total, medicare spending accelerated 8.6% in 2008. fee-for-service account for 77% of total medicare expenditures. it accelerated to 5.3%. this occurs as hospital spending it celebrated due to an increase in patient hospital admission after a couple of years of declining or flat growth. managed care increased 21.3% in to test eight.

this is a higher growth rate but it accounts for a smaller share of total medicare spending. most of the growth was due to growth and enrollment. and moment in medicare advantage that as. it increases only 6.8%. that is compared to 5.8% of overall medicare spending per enrollee. looking and medicaid expenditures, it in decelerated from 6.1% to 4.7% in two dozen a. this is the slowest rate of growth with the exception of 2006 when part beat was implemented. -- part d was implemented.

their budgetary challenges faced by many states. did to aara there was a decline since state and local portions of medicated. the federal portion of its celebrated. medicaid enrollment increase following some growth in two dozen 7 as more people qualify for benefits due to the recession. the majority of job losses occurred in the latter part of to the senate, there may be a lag in the enrollment and figures of this year. looking at a private health insurance. they decelerated is in 2008. premiums grew which was slower

than the growth and benefits. both rest their slowest rate since 1957. there was income and job losses due to the recession. there were slowing spending growth and individually purchase private health insurance. a like to summarize some and the major findings. national health spending growth slowed in to test eight to 4.4%. it reached $2.30 trillion or seven dawson 6 to $81 per person.

we saw slow-growth among payers in private spending. federal health spending growth increased at a faster rate than in two dozen 7. thanks for your time. we are having to take any questions you have at this time.

>> we will open it up for questions now. if you have questions, wait until the microphone comes to you and introduce yourself by name and affiliation if you would. while awaiting for questions to be as, let me toss out the first one. the recession appears to have hammered health-care to a very serious degree. the question we could ask is is there anything that suggests the effect of this will be lasting or is this a cyclical set of pressures on the health care sector that will disappear as the economy improves? >> as we have seen throughout most of the -- sorry.

for most of the history of national health expenditures, there has always been an increase of the economy devoted to health care spending. that has remained constant since 1960. the recession had a profound impact is something we had not seen in recent history. we discussed that in the report because it had a major impact on the 2008 trend. >> to the degree that health spending held up it was largely a function of the federal government stepping in as you mentioned the through aaraysj and changes made under medicaid. what can we read into that going forward? >> i guess you can say that may be just the beginning for to test eight.

but the court order that with impacted so there is no behavior impacts. w look out for in future reports coming out next year. great. that as open it up to questions here in the audience. over here. >> peter from "the wall street journal". how do we explain the relatively small increase in private insurance premiums whenever we talk to small business people that say my premiums went up by a certain percentage last year. it has continued to do so for the last several years.

how do we deal with that overall figure of 3%? >> what our premium no. we are showing is a mixture of enrollment and the actual premium charge. when you mix those together, i have talked about the stagnation in private health insurance. you have that stagnation which impacts the actual growth butte seat as a premium payer. >> let us move over here. >> i am from national public radio. is the amount of money that was switched on paper from the

federal government -- state government to the federal government now shows up in to test eight because the federal government reimburse states for the medicaid funding--- in the2008 because the federal government reimburse states for the medicaid funding? >> aes. >> -- yes. cresson did any of takeover reimbursement show up? >> -- >> did any of the cobra reimbursement show up? [unintelligible] spending did not impact until 2009.

>> here is a question right here in the front. >> i am with ap. what are the reasons for the stagnation in the private health insurance and moment? >> it is tough to determine from our data. one source that we have looked at is the kaiser family foundation report has shown a stagnation even a decline since employees working at smaller firms looking at health insurance. there has not been much change in the larger ones. what is presented here is more of an aggregate basis. it is hard to address that.

>> is there anything you saw in the data that suggest reaction to health care reform happening this year? >> i guess we had our hands full with everything going on to the recession. i am not sure. >> let us get a microphone over to rick foster here. >> the this was all about the election in 2008. -- the news was all about the election in 2008. i do not remember much in the way of discussion of people into

spending positive events of health care reform in translating that in significant ways into action. what we saw was what we thought at the start of the recession >> contracts and other prices negotiates typically done on an annual basis. a lot of that was already set leading up to emphasis for health care reform. >> could you also explain why medicare expenditures increase more or as if everything else increased less? >> the medicare increase was driven primarily by increased

hospital spending to an increase in patient admission. another big factor was an increase in managed care in a moment. those are the biggest driving factors. the reason why we are not fleeing a deceleration is because medicare recipients are insulated from the effect of the recession somewhat because they cannot actively participating in the job market. there was an unexplained drop in admissions in to the conflict and 2007. that is not really an explanation only to say that it has returned to its normal growth rate.

in medicare. >> question over here. >> i am with kaiser health news. on medicare spending, you mentioned one of the travers was increased enrollment in medicare advantage. did it cost more or is there a reason why that was part of it? >> enrollment increase because it cost more. the increase in cost is driven by increases in enrollment. many people had been-switching to managed-care because the packages they offer some additional benefits but we do not have specific information on what kind of packages and beneficiaries are buying.

usually health spending is driven by the increase in enrollment. the population, if you take the effect, growth was 6.8% on a per enrollee basis. that was a combination of price growth. >> that compares with 5.8% overall. >> yes. >> were we spending less or using less or have prices come down that is there any way to quantify the main reason for the slowdown than 5 overall --

>> we have a price chart. i am not sure what slide no. it is. when we look at prices those both declined. and mention with physicians, there are recent surveys that there is a slowdown in utilization. with hospitals, we did not see that. you can see if you look as chart that we have price factors and on price factors. the slowdown that we have seen in the current recession is

characterized by non price factors. that thing would show up in the number a factor. you can say that we sell left grove for non price factors but this of this slowdown in hospital prices as low as nursing-home and home health. the rate was 2.5% which is an acceleration. >> they question here. >> i am with medical news.

i have a question about one of the graphs. at the bottom is other private a category listed. what does that cover exactly that's correct -- what does that cover exactly? >> philanthropy. these are private revenue sources that different areas rely on to offset the cost of providing care. >> it may be things like hospital endowments and

securities which took a huge hit. >> and yes, that was a major driver of the category. it is not the majority of the category. for hospitals they rely on cafeteria sales in part cannot proceed and other sources of income. the majority and non-profit operating entities. they need some other source of revenue to offset this expense. >> thanks. >> this is the slowest rate of growth of spending in 50 years. we had some deep recessions in 1981 and 1982 in 1991 and 1992. these spending numbers are lower than those recessions.

what is a major difference between those that would have made this even worse? it's it's the stagnation of private insurance and how we see this reflected in private spending that is probably the single biggest difference of this timeframe? >> just in general, pr coming from some years in to that the eight. back in the early a.d. cookie we saw strong inflation growth. i think those would be factors the main factors. .

this is the place set apart from the other dimension. >> what about other factors? when one of the main drivers -- you cannot say the majority is coming from private health insurance. there is a contributor to the slowdown. out of pocket is slowing as dramatically. >> one possible interpretation is the economy was coming to grips with the rapid rate of growth and slowing that as we

stared into this recession and the recession pushed it even more strongly? >> that is a fair characterization. there has been a change especially for hospitals and other nonprofit which is something we were surprised by. i do not think that was the case where we had these nonprofit entities they came to us that their expenses. >> let's get the microphone over to you. >> i am trying to understand the numbers. yet out of pocket being 12%. in [unintelligible]

>> household is ever sponsor category. it'll include employee payments for private health insurance. it will include a pocket payments you that make as an injured individual and uninsured individual. those are the two main categories of household. you pay premiums as a medicare beneficiary. those would be included. >> our standard definition as like the final bill payer. the sponsor basis slide dimension is wheat shipped some of the spending to those that ultimately responsible for funding the health care.

[unintelligible] some of it taxes the households pay get moved back. >> premiums are taken other people's paychecks. but that is not the case in the out of pocket. >> it will be the dit deductibles and co-payments -- the deductibles and co-payments. >> is that money after tax or before tax? >> do you need the money we are accounting for it in the -- >> the money deducted from your

paycheck as your share of the premium. is it taxed or non taxed? it is pretax money. >> yes. your out-of-pocket spending would be after tax. >> since we continue to see how -- health spending about his overall economic growth, has been any change in those relative growth rates over time? how much faster has spending round? >> if you look back overall it was a wider gap than it is currently.

the gap did widen. the gdp slowed relatively faster than the national health expenditures. >> the second slide has the growth rate and he can see for 19 -- your question was about the differential between the gdp. in the managed care error they converge. spending peaked in 2002, came back down and converged again with the growth in gdp. most of you probably follow our annual report. you will notice the health care spending shares are a little different. it is largely due to the gdp being revised. winter a benchmark revision. it was revised up. if you compare it to the previous article that explains

the difference. >> let's get a microphone over to this woman. >> what happened in 2009? will we see similar slowdown? >> we would like you to stay tuned. we have an article coming out in february in health affairs from a different team. i will leave it at that. [laughter] >> do you look at jobs in the health-care sector in calculating this? and curious as to what the relationship is in terms of job creation. if you look at two dozen 9, health care jobs -- if you look

at two dozen 9 the health-care sector richar -- 2009 be health care sector has been adding jobs. >> that is a good question. >> so keep asking it. >> we may be able to look that number up later today on a conference call. >> have you looked at the impact on the hospital sector regarding closings? >> the just from the information a red related to the hospital sector profitability was down for 2008. other than that, i do not have anything further.

>> these are aggregate numbers. we did get data from a number of sources. we will look for reasons why that total increased or decreased. >> any more questions? >> if not let me ask a final one. as you have sorted through this data what are the biggest anomalies' you have discovered? what are the questions and to have left that is unexplained the to continue to do more work on? are there any or are -- or is this pretty straight forward >>? i think some of the things you were looking at work the impact of investment income in two dozen aid and non-profit

providers like hospitals and nursing homes. those are interesting because in previous recessions, we did not see the exact same effect. beyond that, it is a very interesting time for health care spending. it is noteworthy that in this batch of recession, it looks more like the 1981 recession. that was interesting to discern. >> i would like to keep tracking that recessionary action into two dozen 9. i will be reading the article that is coming2 out coming009 -- 2009. i will be reading the article

that is coming out as well. >> what can we expect? >> [unintelligible] we have seen private health insurance decline as we entered the recession more >> we are expecting ongoing increases in the public share of overall health spending? >> i do not know if i can go that far. interesting to look at what the trend will bring in this year. >> more reason for people to come back in february when we unveil that article. thank you for a terrific presentation and a great article and thank you for attending. fenty. -- it thank you. -- thank you. [captioning performed by national captioning institute]

[captions copyright national cable satellite corp. 2010] [unintelligible] >> there is less than a month left to enter this contest. $50,000 in prizes for middle and high school students. the top prize is $5,000. create a video on a challenge the country faces or on an aspect of our country's strength. into before midnight january 20. winning entries will be shown on

c-span. do not wait another minute. the to the website for more rules and information. >> coming up in 45 minutes a discussion from american university and efforts to shape public opinion on climate change. later a hearing on the use of broadcast spectrum. a contributing writer for the new york times talks about the role of the vice-president and compares former vice president dick cheney with vice president joe biden. this segment is from monday morning's washington journal. contributing editor to "new york times magazine." he wrote a piece on june biden. joining us from new york right now, good morning.

you wrote in that piece instead of the role every bus president wants, but which only his best -- predecessor had enjoyed to be the last voice in the room. so one year later is he the last voice, in terms of policy decision? guest: i think so. if there was anyone who was the last he is in it. being the last was in the room in the bush administration meant that you could drive policy. bush came into office knowing almost nothing about foreign policy and ended up to be enormously suggestible. dick cheney was influential because he was talking to george bush. that would never happen in the obama administration. whoever is the last voice is

still speaking to mr. obama but this is an administration formed by the president. the one who matters the most depends very much on the sun deck but within that circle, -- circle but within that circle, mr. biden is very prominent. host: otherwise, hillary clinton, james jones. the vice-president, what is his main focus in foreign policy? guest: there is a focus -- meaning, what place in the world are the most knowledgeable about? i think beyond that, this source of influence is this sense that

he is giving advice based on decades of experience in the world. he knows everybody, he has been everywhere. there is kind of a there is a deep knowledge of people and places with joe biden. when there are questions on how we balance our relations with russia what to do in afghanistan, joe biden is an important voice. . . came out a few weeks before the president announced a troop increase to afghanistan. do you have a sense of what role he played in that final decision?

guest: i would distinguish between the contribution he made those many weeks, and the outcome. he had a role in forcing people to me examine the three options that general stanley mcchrystal had given mr. obama. they were convinced that it was inadequate so in effect, they tasked jim jones to find a new set of options. not only that, but finding a new set of options that were the valuable. -- were valuable. mcchrystal gave the three scenarios.

he knew that we could send 80,000 troops, which he would walknot happen. he really wanted 40,000 troops. it was from that that the delivered of process began. by and played a key role in insisting that we rethink all of the assumptions that the basis of policy. for example we said we would train 250,000 afghan security -- could we actually do that? we talked about a civilian surge that would come along with the military. what can be accomplished with a government as corrupt and weak as them? i think his goal was to ask the hard questions. in some ways, make himself on

pleasant. asking the questions that no one was completely sure of. that is perhaps why the process took so long. did the answers come out the way that joe biden wished they would? i would say no. the number of troops -- which will still be close to 40,000 -- is far more than he wanted. the expectations about nation- building and i do not really know what we expected to on the civilian side of afghanistan are still more ambitious than what joe biden wants. he does not think we can do it in the amount of theime that is going to gel with our military objective.

host: the remains -- he remains suspect about the afghan government as well. guest: years ago when he met with hamid karzai at a dinner, someone said to him, mr. president, how are you going to address this problem of corruption? in fact, he said, what problem? joe biden famously -- dinner was over -- he threw his napkin down and said, this dinner is over and walked out. nothing has happened to defrost his relations with president karzai. both biden and richard holbrooke

have terrible relations with karzai. host: james traub is with us to talk about the influence of joe biden. republicans, 202-737-0001. democrats, 202-737-0002. independents, 202-628-0205. you can send us an e-mail or tweet us at . next phone call. caller: i think our president is doing very well. if we wanted joe biden as president, he would be president. i like the idea that our

president is intelligent. he is not a puppet, like the last eight years. i think he is doing what he is supposed to be doing. host: james traub? guest: i guess i would agree in general. he believes he could be a good president. i believe this is almost a desirable alternative. he is a very knowledgeable bright guy. i do not think he has those qualities of character. i do not mean to say that he has no character at all that americans look to have as their president. i think obama for all the mistakes he has made, has proved that people have a deep sense of comfort up and we did with him as a person.

biden is more of a hyperactive person. -- deep sense of comfort with him, as a person. host: franklin, new hampshire. caller: mr. traub i know you denounced the history of vice- president cheney, and you believe that he was just awful. if you would be kind enough to share with the audience what you know about the history of the vice-president? i would also like to know your opinion of what i would call ridiculous decisions of having trials in new york for ksm releasing the terrorists from guantanamo.

they do not even want to face the fact that we are at war. joe biden but it would be a great idea to dissect iraq into three pieces. what do you feel about the current president who has weigh less experienced than the former vice president ever had when it came to foreign policy? guest: there are a lot of questions there but i will try to enter a few of them. why am i being so negative about dick cheney? i can give you a couple of answers. obviously, he had a deep-rooted sense that after 9/11, this nation was under threat. i think what he never grasped though is we live in a world

where our actions are seen and judged. those actions affect our ability to get what we want in the world. when the world sees cheney arguing in favor of waterboarding and says that this is something that we have to reserve for ourselves even though other people consider it torture that affects our ability to act. if america is seen as a bully to torture in order to gain its own objectives that changes who we are, and who we are has an effect on our ability to act. if others feel that we are no longer committed to our human rights standards that hurts us. i also think the national security deliberation process in the previous administration was futilely distorted by the way in which cheney, in effect, unleashed his own chief aides to

ride roughshod over the process to make sure that he achieved the goals he wanted. by the way something donald rumsfeld was doing at the same time. if you look up the process now it is much more rational and much more likely to come to a good resolution. what you say about obama not having as much foreign policy experience as joe biden is right. what obama has though, is a deliver tiff gift, which -- is a deliberative gift. whether or not you agree with it they found out this process as well as they could. host: the chief of staff for

vice-president biden said that "jamie was his own --chen cheney was his own office of government." has vice-president biden benefited from the vice- president cheney's expansion of the office? guest: enormously. when i was hearing this theory, i thought, when the president decided to nominate sonia sotomayor, biden interviewed all the candidates. no one had done that before,

until cheney. so biden who was head of the senate judiciary had a perfectly good rationale for doing something that no vice- president had done before, until the cheney. -- dick cheney. clearly, the role that joe biden played in foreign-policy is highly unusual for a vice president, except it pales in comparison to the role that dick cheney played. host: next phone call. independent line. caller: i think mr. trumpaub is from the left, just like his publication. all the appointees that the

president has given us are also on left. i think the vice president is a buffoon. our president is an intellectual fool. everything he has done is against free enterprise and our country is going to turn into socialism. host: turn to his foreign policy purview. you are writing about nuclear nonproliferation. what role will he have in that? guest: that will be a big subject in the coming months. if you look forward a little bit and ask yourself what are we going to be talking about in february march, april? the issue of nuclear non- proliferation will be enormously important. in february the president will introduce the nuclear posture of

review -- posture review, the strategy of the administration. and that is shaped by the president paused deconditioned -- doing so as carefully and as strategically as possible. within that world joe biden has a couple of very important issues. one of these is the treaty that the united states chose not to sign. they did this in 1999 under the clinton administration. the nine sides does not test their nuclear weapons. -- the united states does not test their nuclear weapons. we are unwilling to sign a treaty that others have signed,

that we have declined to. we need 67 people to push this treaty with seven republicans. it will be difficult to get these people. that is the job of joe biden. another thing is to get control over -- nuclear fuel, and what is called nuclear lock down. there will be a summit with heads of state in the spring, that joe biden will preside over that will try to shape the new global regulation and also promote national legislation in the different countries to make certain that nuclear fuel does not escape, and does not become available to global terrorists or to rogue states. >> next is huntington, new york. >> thank you very much.

i have two things. as far as these trials compared to military tribunals, this is a war that we have no way of ending. , don't we and up giving extra legal powers to the government that we would not have constitutionally-given so we lose the deficit -- the essence of what we are fighting for, democracy and the rule of law,? secondly as far as hamid karzai is concerned we need to genuinely threatened pulling down of nato. he is blocking power control of afghanistan. we are better off without him. guest: two things.

your point about how we damaged our own well-deserved reputation for caring about human rights -- this argument about closing guantanamo is driven by deep fears. it is troubling to me to see that we have become so afraid the idea of moving these folks out of the facility, -- it does not seem like an act of national surrender. that is wrong. your point about karzai is fair but you cannot make a threat if you are not going to go through with it. should we say to him end corruption, govern better, or we believe? ? we leave?

-- we leave? i think the president would say on balance that is not in our interest. host: next phone call. caller: i have a problem with labels and i cannot get my head around them. i hear people refer to leftists, conservatives -- i have to give it some pause because i have to think about what that means. even when i call in, i have to think about that. i tend to vote on my conscience. based on that, here is my question. first of all this gentleman who called from louisiana he

obviously fits into this stereotype that i have about the redneck and tell the date. i wish you would give people like that more time and question them more about issues that might expose where they are really coming from. i can see him making a noose while he is talking. where is he coming from? i think that we canshould do that instead of ignoring them. not talking about the guy from louisiana. with regard to joe biden what is his relationship with hillary clinton? what are his political aspirations, and will they collide with the clinton's aspirations in the future? guest: let me start with the back half of the question, does

joe biden been that he can be president one day? i did not asking that question. i do not know why. if i did i am sure that he would have given some sort of have the reassurance. he never actually said in my political career will cease when i am done being vice-president. it will, but there is some part of his brain that believes that he will be able to run for president at 74. i do not think that will happen, but he is an ambitious person. how does this affect is a relationship with hillary clinton? not at all. these are very hypothetical relationships. they have practiced every tuesday morning at the vice- president's house. from everything i have heard

they have a warm relationship. they do not have radical disagreements. hillary could feel, at times that biden is intruding on her territory. if you expand the role of the vice-president, you are moving on to someone else's territory. in general this group of principals -- secretary of state, defense national security vice-president -- they seem to have a pretty smooth relationship. they have disagreements but it is not personal, that's not affect the way of deliberations the way that it did in the first term of george bush. host: and james traub talking

about vice-president joe biden this morning. talk about the role in which he has been fairly prominent, at least on camera, about the oversight of stimulus spending. a bit outside of his foreign policy forte. guest: yes, and you do not hear too much about that anymore. host: what is that? guest: foreign-policy has turned out to be so consuming. my guess is when this started in february march of 2009, you would have expected to see biden continuing to take domestic trips in order to promote the stimulus. i do not think he has done it as much now because he has had to take foreign trips abroad, and also he had this new iraq portfolio.

so he has become a smaller player on domestic issues as he has become a bigger player on foreign policy issues. . this crosses the domestic and public policy issues. my concern with the people that i talk to is that many of them believe that joe biden speaks too much, or they think that he is a buffoon as -- they do not think that he is a buffoon as someone suggested. he may be in love with his own

voice. but they think that he is knowledgeable and they like him. i think that he has left behind good feelings and he has a great relationship there over many years. this is with republicans and democrats. with republicans on one side of the aisle that they see regularly. side on the isle our people to me speak he spends a lot of time with them, and when it comes to the comprehensive treaty, that is entrusted to him because -- ban treaty, that has been entrusted to him because he has been working as much as anybody to try to push that through the senate. host: next up is connecticut anthony on the independent line. caller: you were talking about the first term of the bush presidency, and i totally agree with that because i read a lot

of articles and magazines about vice-president jeanie's secret meetings with the energy task force -- vice-president cheney's secret meetings with the energy task force. how is joe biden similar to that? or is he knockednot? where does he come in as a vice- president? i do not see him as deeply in as cheney was in the first presidency. bush was on his own. i'm looking to the obama/biden presidency a little differently now because i see the vice president is more for the -- the president has more for the country than the vice president.

do you agree with that? guest: in the first term, there was the feeling that there were different policies colliding with each other inside the bush white house and there was a rumsfeld camp, rather, rumsfeld himself and his aide. and there was biden -- and there was condi rice and her aides and, of course colin powell. it was a mess. there were policies being made by a president who had far too much confidence in his own gut. he would make a good decision. if you read over the accounts of how a decision was made to attack iraq, nothing could have had a more radical contrast with where you saw in the process in afghanistan. you do not see these colliding policies in this administration. i do not think biden conducts these meetings with constituents

in the dark in the way that cheney does. although, i suppose if he did i would not know about it. but everyone there in that administration they are acutely aware of how dysfunctional this process began in bush's first term and they're very determined not to have that happen amongst themselves. and so far, it has not happened. host: you do writing your article about questions raised about the senator biden's votes on foreign policy, etc. you write that his church and has scarcely been perfect in the past. -- his judgment has scarcely been her third in the past. "when was the last time biden was right about anything the military writer asks in his blog earlier this fall, apropos on his views aren't the current afghanistan. -- on his views on of the current afghanistan.

where has he been wrong on some issues tomorrow these to the wisdom of the time? guest: self criticism is not a big component of biden posing nature. i should add that and neither is it of most senior politicians. i never asked about the gulf war vote. i did ask him at length about the 2002-2003 timeframe. he takes the view that i never thought about bush would conduct the war as recklessly and bosley as he did. which of course, is what -- recklessly and flawlessly as he did. which of course, is what so many say. that may be a bit disingenuous. i tend to think that a lot of democrats have pursued a trajectory toward biden's. they were very uncomfortable with the use of force in the post-vietnam era.

he was very much a candidate against violence. his vote in the gulf war may have had something to do with that. then came the 1990's and a democratic president that had these humanitarian interventions in the balkans somalia haiti and elsewhere. suddenly they got this idea that force could be used wisely in some cases. but only in this kind of moralistic cents. when iraq came along they believed force could be used in a humanitarian context like in bosnia or kosovo, but in the defense. this was driving many of them to vote in favor of the war that they may have had doubts about. and now we are in another phase where some many people have discovered unexpected dangers that when things do not work out the way that you thought that

they would there is a realist mentality that you find and this is a long road that they have traveled. >> we have more from the republican line. >guest: i am not a regular republican, i am at an eisenhower republican. i have to say that joe biden has been outstanding for this state. we have quite a few republicans that complement -- are complemented by him. i have to say about dick cheney and donald rumsfeld, i wish we could find out how many millions of dollars they made. was an estimate of how many millions these people made due to the

wars they created. these were incredibly damaging to the u.s. and the world. somebody needs to look into their finances regarding how much money they made on the blood sweat and tears of our soldiers. guest: a delaware republican that sounds like a democrat. we will never know. i do not know. i think you can find plenty of other motives of those guys behalfs that for why they thought it was right to conduct the wars that they conducted and the way they conduct them. i'm not even raising the question and i honestly do not even know the answer. but even leaving that aside, it is clear that there have been few of the episodes as reckless as -- in the history of american foreign policy as the way in which we decided to go to war in iraq and the way in which we conducted ourselves after the initial phase of the war ended. host: james stroud, a writer

for the "new york times" -- james drogba, a writer for the "new york times" where are you working on now? guest: i have a piece coming out in january early february. before that, have a piece on west africa. i was just on new guinea and set a goal in a place that few people could locate on the map. -- end sunocoand senegal, a place that cuba could locate on the map. south american drug lords have discovered that if they route their shipments per liter west africa is less likely to be discovered. a big fraction of cocaine is now going to west africa. these are very weak, rickety and in many cases it enormously corrupt governments that are just being threatened and in some cases destroyed by this cocaine traffic. it has become a national

security problem for the west, not just that cocaine is flooding into europe. that is bad enough, but that this whole region is threatened by this tide of cocaine. that will come out toward the latter part of january. host: back to the calls ohio, ray on the democrats line. ray has gone away. houston, texas mike on the republican line. caller: i want every person to know that i am a republican. secondly, i would like c-span to know that you have too many seminar callers calling in as republicans and they are not. is pretty obvious that they do this. the last two callers calling in on the republican line acting like obama supporters and i find that insulting. as far as vice president biden i think he is a good example of a career politician.

he has been in the senate for 36 years and he is exactly the kind of politician that we tea party people want to eliminate from washington. we want people to go there and serve a term or true and get out. -- a term or two and get out. i am tired of it. i have no trust in government and it seems to me that too many people from the "new york times" go on and gabble about they're doing this and what a long and to read his career. i'm sorry, i want someone who knows what it is to pay their bills. we do not have the posture at all. host: mike, we will get a response. guest: first of all i do not think biden has had a courageous career. meet the guy likes being a politician and clearly, he is good at it.

the question is, is the value of the knowledge these guys have offset by what my considers there to be condemned the sunk into the world of power in washington. it is true. and republicans discovered this into their own grief as well, you get acquainted with power and you lose sight of what brought you there. it is a problem. but do -- but does that mean that we should be better off by having term limits, for example? i can only say the and i live in a state that has term limits for its public officials and i think it has been a disaster. there's almost no accumulated knowledge whatsoever. i would not want to have such a set of rules and not at all persuaded that having businessmen, as opposed to saying lawyers who went into politics, we would get a better set of policies and what we have right now.

host: barry on the democrats line, good morning. caller: do have some real concerns as a supporter. it is one thing to be the opposition and now that you find the realism of running the foreign policy, you also have this administration voting for $636 billion in the largest defense appropriations bill in the history of the world. and we have a drug trade in afghanistan the undercount berlin and the room, because it seems to be funding the karzai government, the taliban, and al qaeda. nobody wants to talk about it. i understand you want to talk about the drugs come across the mexican border, and we should do something about that. the what about the war we are losing people in and where the drug trade is the main source of income in the country? guest: you know, nobody has a

good answer to that question. i do not think that anyone is trying to avoid it, but in what is now, let's say 30 some odd years of drug eradication programs that this country has pursued abroad, nothing has worked. god knows that we have a lot of experience with drug in revocation in latin america and south america. you still at -- the drug in eradication in latin america and south america. and you still have enormous quantities of cocaine being produced there. in afghanistan, we have tried to do crop substitution crop the revocation. and we have somewhat gathered -- rebelthe opium harvest is 20% or so below what it can has been in previous years. the long-term answer is that you have stated -- you have to have a decently functioning economy so that people can live without

producing drugs. that takes a long time. if we think that war is worth conducting, we will have to conduct it even in the presence of an opium harvest. we can do what we can, but we are not going to wipe it out because no sensible farmer in a deeply impoverished place like that is going to agree to forgo a big cash crop like opium in favor of something that does not earn him very much money. it is a terrible problem. host: james traub with us talking about the role of vice president biden. guest: it is easier to stay in completed policies, but in terms of the state's -- is easier to say "in completed policies," but

in terms of the state if obama said "i insist on a freeze of settlements built by israel" that would in the end force a painful choice on the israelis and then they would say ok. prime minister netanyahu has agreed to a much lesser temporary halt in settlements. but that has hardly been enough to get the process of negotiations on the block. that is a failure. i do not know if there is an obvious better answer, but it was a failure. you could say it similarly with iran. obama hoped that if he adopted a less confrontational stance towards the regime in tehran, they would be more willing to enter into a negotiation process that would lead to their abandoning their nuclear enrichment program. they did not happen.

host: butler tenn., floyd on the republican line. caller: i'm a republican. you have a couple of callers in before saying the republicans were calling in and saying we are republicans and i cannot truthfully say -- i am a card- carrying republican all my life 68 years old. and since 1994 i am disgusted with republican greed. i have watched this country go downhill since '73. education has fallen 48%. no jobs, you cannot tell me that wal-mart -- i have lived long enough to see wal-mart the largest institution and employer in this country. the we are a joke.

them wars are a joke. we're still building the pipeline. everybody denies it. i made that a a, a vietnam vet. -- i am a veteran, a vietnam vet. i'm more disgusted with the united states in 73 when our country created to create that to make profits. host: let's get a response. guest: what is fascinating to me this morning is the matter of argument we are having with republicans to each other. i think a lot of democrats have called in and disagreed with each other but there is not that sense of arguing for the soul of the park -- party. it is striking to me to see republicans question each other as modified republicans. in a host: article about vice president biden, you write about

host: in your article about vice-president biden you write about steve clemons of the new america of foundation calling them progress of guerrillas and democratic neocons. and who are these folks and how do their views differed? guest: i'm smiling because not long ago i happened to see susan rice our ambassador to the u.n., and i cited her as an example of a democratic neocon. literally, i walked into a room and she turned to me -- her first words out of her mouth or "democratic neocon"? i said, ok, sorry. but are these meaningful distinctions? the first thing i would say is that there is relative ideological much of nighy in the administration. there are disagreements, but smaller -- ideological homogeny 80 in the administration. there are disagreements but

they are smaller. these labels are not applicable as they used to be. it is harder to find a right label. that distinction is a distinction between people who are basically focused on issues of power and of trying to manage power relationships as opposed to people who think of themselves as morally driven and are primarily occupied with humanitarian interventions. people who are more control and about trying to promote democracy and others that think that is a pipe dream. but those distinctions exist. we have one more call for you from georgia ben on the independent line.

caller: i like to your the people talk, but as far a as >> tomorrow morning on "washington journal"we talk about the national security issues facing the obama administration. and then we discussed shortages in unemployment funding in states. and then richard fontaine will talk about the operations of al qaeda in yemen. this begins at 7:00 with your phone calls. later on, but the endowment for international peace host a summit on the world economy in 2010.

there will be representatives from the world bank and the international monetary committee. that is 10:00 eastern. >> next on c-span a conversation on shaping the public opinion on climate change. after that, the use of the spectrum for wireless communication. and a report on u.s. health-care spending. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> now available "abraham

lincoln: great american historians on the 16th president." this is a perspective on lincoln, on his early years and his life in the white house and his relevance today. this is in hardcover at the nearest bookseller. you can listen to this any time available wherever the downloads are sold. >> now, a conversation on the efforts to shape the public opinion about climate change. this is the public affairs and advocacy institute and is about 50 minutes long.

good morning. we are in the second week of the institute that meets every day. the topic is looking at how we lobbied for and against cash and trade and the environment energy bill that is in the senate. we have a terrific speaker to lead today on this topic. a member of the family. part of the publicly -- public affairs advocacy group. he has a background in climate change policy, and he comes from the center for american progress. the progressive side of the issue on this important climate advocacy issue before the senate. he is a senior fellow and a director of client strategy. he is from the center for american progress.

for american progress. and before that he was the before that he was a lobbyist on the clean water act and the food and safety act and -- services where he was for a while he served for 16 years as the sierra club also. so he knows about the topic using paid media in climate advocacy campaigns but he also knows the content in detail about the cap and trade bill that passed the house is pending in the senate and will be on the agenda of the senate, i think after the health care bill. and he, therefore knows strategy of buying media but also he knows the details of this bill. we welcome dan weiss. thanks for coming. the. >> thank you jim and it's quite an honor to be your very first speaker of this decade.

[laughter] i'm sure that you'll remember it, and you can buy your souvenirs of this event in the lobby afterwards. [laughter] aaron, if you could do me a favor and give me, you know, like a five minute sign when it's like, fife after nine -- five after nine, that'd be great. good morning happy new year, happy new decade. it's always great to be the first person speaking. one year i spoke as the last speaker, like, 2:00 on new year's eve day and at the lobby institute here, and that was very challenging. i'm going to talk about using paid media as a tool in advocacy campaigns. we're going to talk about the two types of strategies for advocacy campaigns. the purposes you use media for the key elements of an advertising or paid media campaign the factors that help you plan your campaign ways to maximize the impacts of your

advertising, and some limits on issue advertising if you decide to go that route. it's also important to note i'm not going to the talk very much about online advertising which is a different creature and requires really somebody under the age of 40 to talk to you about. [laughter] i don't know are they having someone talk to them about online advertising separately? >> yes. >> okay. so you'll get that covered elsewhere although if you ask if you have a couple l questions can about that, i'll be happy to make something up. [laughter] >> rosen brat's already met with them. >> oh. my colleague -- >> a distinguished alum of american university. >> yes and that just shows you with a lot of hard work, you can end up working for center of american progress. [laughter] so we're going to talk about the two types of strategy for lobbying congress that are not mutually exclusive. and these are both highly technical terms. so i want you to get your pens and papers out and remember

these terms. first is the inside game. okay got that? inside game. then second is the -- anyone have a guess? outside game, excellent. have you sat through this before? [laughter] there's the inside game and the outside game. and, remember, you can do both together. they are not mutually exclusive. the inside game is based on tools of private persuasion. it's when you send in somebody to go talk to the senator you urban and the person is a big executive from her state or you send in the head of the afl-cio to talk to representative teller. and so those are kinds of private persuasion. over you go talk to the staff. those sets of direct contact with with either the decision maker or the staff. optimally, it's best in my view

for micro issues, small things that don't effect the larger economy or other major parts of american life. for example if you're trying to get a provision inserted into a tax bill, the benefits of one or several companies using the inside game going to talk to the senator or her staff quietly is probably the most effective way to do it. now, the best lobbyists to do this are former members of the body former senators or representatives, or their very senior staff. so, for example trent lott, the former senator from mississippi made sure that he retired from the senate, he actually resigned his seat in midterm in order to make sure that he only had a one-year ban on lobbying his colleagues ready or than a two-year ban that was about to kick in had he resigned a few weeks later. and now he's part of a lobbying firm, and he goes and lobbies his colleagues all the time. the key element of the inside

game to make it work is two things. number one is direct access to the decision maker the senator representative or her senior staff, and second is some sort of relationship to the district or state that the person's from. now, the latter isn't always required, but it's very, very helpful. so, for example if you're the president of ford motor company it's relatively easy for you to go talk to one of the senators from michigan. ford's headquartered in michigan, it's easier to talk to the senators. say they wanted some tax break that's how they would make it happen. gesundheit. and so those are the things that make the inside game work well. for the outside game, it really relies on using the tools of public persuasion. and it works best for macro

big-picture issues. a good example of that is the upcoming debate on clean energy and global warming. this is a macro issue it's going to effect a large part of the american economy it's going to effect a large number of american firms american workers, american consumers. it's a big-picture macro issue. now, undoubtedly there's going to be a lot of inside game played there as well particularly on the side of those who are trying to stop the bill. because since the public based on opinion polls supports action on global warming and supports clean energy reform, then if you're a company that is against it you may not want to trumpet the fact that you're trying to thwart the public's will. so instead you'll try and play the inside game. but you also might play the outside game because this is such a big issue. and, you know, the outside game

lends itself very well to a certain kind of issue that's different from cap and trade which is issues, in my view, that are that don't really have a corporate or economic interest. a good example of that are gun control or abortion. those are ones that don't really have an economic interest at play, that are more cultural and appeal to people's values. those are the kinds of issues that really lend themselves to the outside game. but there are also economic issues like health care, like global warming that also lend themselves to the outside game. it often helps when you're playing the outside game to get the public to be generally on your side. now, in an issue like global warming if you watch tv or read the newspapers, you've probably seen ads from either big oil companies or other energy special interests talking about how many jobs will be lost or how much gasoline is going to cost if we act on global

warming. those people don't really have the public on their side, so they're using it, paid media in a slightly different way. but for advocates they're using paid media to take the public opinion that they know is on their side and increase its intensity. and we'll talk more about this in just a minute. so you've got the inside game, tools of private persuasion, and the outside game, going out to the public and talking to them directly through paid advertising in the media. now, there are several ways that you can use paid media in your issue campaign. it's -- paid media is a communications tool that can be used to inform, raise the visibility of, persuade, thank or hold accountable. and during issue campaigns you might use ads at different times

for each one of those things. for example running issue ads on global warming on cnn or fox or msnbc in the washington, d.c. metro area is a way of increasing the visibility and seeming importance of the issue. you know, if you're running the ads on cnn in the washington, d.c. market, there's not too many swing members of congress here. but it does raise the visibility of the issue to the congress people and their staffs who often have cnn running all the time in their office. or to take out ads in outlets like roll call or congress daily or congressional quarterly is a way of raising the visibility of the issue. members of congress get bombarded with dozens of messages every day about dozens of issues, so the ones that they see paid advertising about it raises the visibility or

salience of the issue to them. come on in. in addition, you can use paid ads in outlets like roll call or congress daily as a way of communicating very substantive information most likely to congressional staff but also to other media that is covering the topic, and also to the -- sometimes the decision makers themselves. in fact, when i was doing advertising, we used to run ads in congress daily that were, like paid fact sheets. does anyone know what a fact sheet is? do you want to tell me what it is? i know it's monday morning but come on. no one can can tell me what it is? okay yes. >> well, it's just kind of you

look at various sides of an issue and you put -- normally used to leave behind once you visit a member of congress just to reiterate your points and what you want to get across mainly. >> that's right. gus is right. it is a way of leaving behind and reiterating the message that you just told them. a lot of lobbying and persuasion is a lot like teaching. this is what i'm going to teach you, this is what i'm teaching you, this is what i just taught you. and you use the fact sheet as the this is what i just taught you part. well, another way to get people's attention is to run those very same sorts of fact sheets, you know, one page with bullet points, with factoids on them or in them and leave those run those as ads. now, they're far too detailed to reach out to the general public or what i like to call civilians. but it is very