stringent? what do people in europe why think about us? -- what the people in your reply think of us? >> allotted at to do with accountability and quality control. they are very interested in our systems of accountability and monitoring hist -- and modern trend that we have developed. i think other countries are surprised that whereas technologically -- >> do you get a reaction among the generous or non-generous continuant? our people surprised there is as much support for education or there is not more support for cash or a medical safety net? . . ben bernank

that much risk in our country? or we would not want that much opportunity? is there some set of values that -- >> actually, my reaction in talking to other countries, and i know there are some here from other countries as well -- i was

struck by the similarities across countries, in values, in social values -- so, for example, in many countries, the biggest problem that you have -- in russia, for example, the social workers and the administrators said it was serious concerns about kids aging out of their orphanages. that sounds familiar to one of the biggest problems that we have here with kids aging out of foster care, issues around women with children, a round problems with substance abuse, domestic violence. a lot of the similarities are what struck me, more than the differences. we were not necessarily holding out the united states as a model, nor were we saying the united states has done everything wrong and you should not do what we do. so the implementation issues are what seem to be striking a lot

of questions with them, and they were very interested to learn more about how would we in this country implement some of the programs and how some of the problems were identified. >> audience questions? the man in the blue-ma'am, in the blue coat? we have a microphone, over. >> this to answer your question that you would just getting at -- what we have seen in the discussion with different countries, i have seen three sort of reactions orq differences. the first one is values, the second one is implementation. the third is influence. values -- there is a difference between the u.s. in perceptions of fairness and why are people pour? in the u.s., where you have a

bottle of individual effort and the focus on work, about 2/3 of the population, according to these surveys, believe that the poor are poor because they are essentially lazy, that they are not making the effort they need to get themselves out of the situation. where in latin america, they believe the poor are poor because of the process of historical exclusion. that leads to a different solutions. in the u.s., our welfare system does have to have some work done, but it does in latin america, the emphasis is on trying to break the intergenerational transmission of poverty through linking to health and education conditions, trying to get the pork out of that process of exclusion -- to give the poor -- to get the pork

out of the process of exclusion. in western europe, where the emphasis is also on work and trying to get people included in the work force through more work support activation programs, training, job readiness, etc., and a bit less on the work requirements, as in if you do not work we are going to punish you and take away the benefits, that type of thing. there is a difference of philosophy, from those different attitudes of society. in europe, latinç america, 2/3f the population are poor due to exclusion, you get different solutions coming out of those different values. another thing that the countries are interested in is the issue of implementation, which sounds a bureaucratic but it is the nuts and bolts of how these programs get conducted. one of the things that my colleagues in brazil, for example, where i used to work, where very surprised, is that

the u.s. does not have a national registry. there is no way to track time limits across states, with individual state registries. how come we do not have a national registry in the u.s.? in brazil, they track, and as people move that registry gets updated. we do not have that here. some of the things that the u.s. does do really well is they do make some of the automated class checks to get income. so from the welfare databases, social security,ç linking of te databases, etc., to try to cross check. some of the i.t. solutions in register. but there is no national registry here, and that is often a surprise to our clients in other countries. some differences that we find in dialogue with different countries around philosophy solutions and implementation. thanks. by the way, i was very keen on

your point about the response in crisis because we are checking that also in other countries. i am really keen to track that. thank you for sharing that. >> thank you. t(microphone is coming. >> this question is for ron. there is a view out there that the kind of downturn we are in right now is not the garden variety downturn, but a credit- induced downturn. there is too much debt, people cannot borrow. with your emphasis on work, you have six people looking for every open position and people having a different -- a difficult time finding work, more and more difficult than any time during the postwar period. how do you feel about the extension of unemployment compensation that can go into a year, sometimes up to two

years, and what are we spending on training for skilled positions relative to unemployment and so forth across the country? >> if i had complete control, i do not think i would have an unemployment benefits for a year. one thing, if you were an economist, you might have impacted recovery because the states are going to have to repay a huge amount of money, falling unemployment insurance. after the 1975 recession, it took them forever to pay off their debt, so they had to keep anteing their trust fund, their trust fund was virtually empty. at some point someone has got to pay for it. there is no way the government can make a recession painless. i think with that a good job in putting a tremendous amount of money out there, plus the stimulus bill. so i think government has

responded, and that is why i am so concerned because it is so out of line with other programs. i think i would rather have broader coverage. and more people covered then a couple people per year. as for training, we have a long lishistory of people who know more about training programs than i do. i am not as optimistic even as harry is. i think training programs certainly have not gotten back what we have invested in them. probably the most successful thing we have done so far this -- it has had an impact. it has increased marriage rates. most programs have not done that. we have long-term policy results that are fairly modest but the critics say are spending on the programs has been modest, too,

but that is not true. so training programs, i would keep trying, investing in demonstration programs that i could probably support. but i am not optimistic they will work. the long-term prospects for employment, jobs, i am worried about that. you know, my parents were raised during a recession and the use to tell me all kinds of colorful stories. i have already admonished you for talking about things like that. i was close enough to the great depression to understand and feel that what you think is an unemployment, that is really, really a problem. i had a lot of relatives growing up that were unemployed. then i say that the american economy has always come back. there is no reason to think that it will not come back this time. let's watch it, let's keep an eye on it. clearly, if we do not have an abundance of low-wage jobs in

our economy, the requirement of work has to be modified. >> marty has a response. >> if i could add one point, i agree with ron and his comments were eloquent -- an eloquent example of the centrality of work. thank you for saying that. i agree that we should emphasize work more. one of the things -- and none of james is here today, but another in the urban institute but that we wrote called "the government we deserve" looked at the long- term trends of employment and to what extent is the current situation different than what we have historically had, and when many of the economists have identified is that -- and what many of the economists have identified is that the unusual

trend was the post world war ii era, where we had an unusually strong economic growth over a sustained period of time. since the mid-1970s's, the trajectory, the plans have returned since before the world war ii era. so while i agree with ron that certainly the economy is going to rebound, it is not likely to rebound to the way it was in the early post-world war ii era, and we still are in the middle of a major structural transformation in the economy. that said, i think we need as a nation a more serious discussion of the government as an employer of last resort in the new economy. ron mentioned the great depression. i am not necessarily saying we need a wpa type of jobs

program, but if in fact as a shared value the nation holds the importance of work and the current or the near future structure of the economy is such that not everybody will be able to find a job all the time, maybe we need to think more seriously ab]ut public employment as a guaranteed job to reinforce the value and the importance of work in the new economy. >> does the severity of recession leave you open to the possibility of public jobs? >> yes. community work experience is essentially public jobs. they give you money through the welfare program to work. that was really the vision of welfare reform. nobody had any idea -- i think a lot of republicans thought they were not all these low-wage jobs out there, and there were bits

of people left welfare for low- wage jobs that they did not a me-that they not need. -- that they did not need. >> they are not collecting welfare checks either. >> i am saying if unemployment continues, let's say we come out of this recession 8% unemployment is to visit -- is typical and it is hard for workers to find jobs. we have two alternatives. we could just pay people welfare. i am saying i would prefer the former. >> i am not suggesting we need government jobs, would the government subsidized jobs. to get to your other point about training, while we do know that a lot of training programs have not had a very positive impact, the ones that have had the most positive impacts are the ones that are work-related, occupational the specific, employer involved, and some of

these subsidize employment programs that are not just work experience from the 1970's to the highest net return that we have on job training are the ones that are more real work not make-work. >> you are talking -- run at one point said that he was not confident that our programs met the goals that they were supposed to. part of the problem is there is not a share definition of what the goal is. if you will permit me for a four-lashed back, the woman had been disabled toddler, very disabled toddler she had a housing subsidy. she had medicaid. and she was living in just terrible squalor and destitution, roaches and clutter, stuff that she had scavenged enough the side of the

road. you could look at her situation as an example of a terrible failure in that she was left in great need and hardship, not a lot of dignity. or you could say that she at least had medical care and a place to live and food stamps, so each of those programs was serving -- was meeting, if limited need, not satisfying a vision of mobility or uplift that we would all hope for. so is medicaid working in that situation? it would depend on what you think the goal is and what you would define as work. >> well, if she gets food stamps, certainly the child is covered by medicaid. >> she does, right. she is exactly what you're saying. it is a very generous set of

programs. on the other hand, you would say, gee, look at what the government is doing, a program agreed a democrat would say look how terrible that is. >> i can see that she would say that, and i would not trash her for saying that. but the state has a responsibility. there is church, family, and it should not all fall on the government. >> we said this in the beginning and certainly in our book, it is more than just income. ron is talking about a certain important part in the income support are important. >> in the second to last row, there is a person dying to ask a question. thank you for your patience. >> this is related a little bit to the last discussion you just had, and that is whether or not any of you would want to opine whether the difference in the

postwar period compared to what happened after the 1970's had to do with a unique kind of government employment that we do not see quite anymore, and that is there was a military draft. when young people got out of high school and were immature and hadç no job, many of them profited by two years of service where they learn some discipline, grew up, some of them learn a skill, some of them got an education, some of them stayed in the military because there was no alternative for them. the left certain communities where there were no jobs, and i wonder instead of throwing money and jobs programs, many of which we have trouble figure out if they work, that possibly, you know, in large, the army corps of engineers can do projects and things like that, if that is

affecting the whole way we see jobs now? >> i should contextualize ron's response. i think he is the only ex-marine on our panel. >> not yet. >> i can go for that. i spent -- the last few years i have spent a total of a month on that, which makes me a expert on israel. we talked about that in the united states and we have expended some of these programs. there is a program now, random assignment everettevidence. the national guard new challenge program, a study that has an impact on kids as well. for ge acquisition and a few other impacts.

if the military knows about our -- that our school to not about disciplining young men and young women, how think the values are such that the possibility of a national draft especially for the military, even in a republican congress, i do not think it would pass. but a national service where you had choices, the bill that could pass. it would cost a lot of money and maybe you have financing. but the concept i think is very solid. >> back row. need a microphone? >> i am janet from aarp. i know, in demetra, it called for a commitment to end national poverty. i wonder how you would define poverty, how you would define success, the longstanding and much-needed recommendations to measure poverty? >> we do have at least one cheverly, more than one chapter on that in the book.

-- we do have at least one chapter, when one chapter on that in the butt. as a nation, we are primarily measuring poverty based on income quantitative measures, and one thing that we can do is expand that with other kinds of well-being or consumption measures, drawing from some of the analysis that other countries are doing as well. but certainly the base standard of poverty -- and we now have many different measures of poverty that are there -- are more than just income. so at a minimum, we should have a dialogue about incorporating in kind non-income benefits and also some consumption measures as well to raise the floor to what we consider unacceptable in the modern u.s. society.

>> anything else that you wanted to say? let me go back to something that kathy was saying earlier about the reactions of people to the presentation. how often do you -- i have done a little bit of overseas reporting about low-income populations of other countries. typically, i am surprised to learn -- people are surprised to learn that there are poor people in the united states and cannot imagine why. many have spent years trying to figure out how to get into the united states and think of a peasant and less land of opportunity. the youth-you hear thatç -- do you hear that a lot? >> i can state this in income terms and then in elements with assets and all that. one can explain that poverty is

relative across the countryçi]d people living in the united states, in absolute terms, probably they will not be considered poor in other countries. >> so people are puzzled that there are a large enough -- a large number of people who are unable to access whatever opportunity structure exists in the united states? >> yes. >> i think there are some that are surprise, but most of the people who are in positions where they are administering programs for delivering services, the world is becoming a smaller place, so it is not that the u.s. is such a big mystery plays that nobody knows anything that is happening here. they think that the word is out that we have problems. they know about gun violence. we hear discussions about urban violence and issues of that type.

i think that there is a bit of surprise that the federal government in the u.s. is not as involved in education and in the schools, and that there is so much local control of the schools. i think that is often surprising as they are aware of u.s. policies and culture. >> do you think the u.s. safety net would be more generous if the united states was less multi-cultural, if there was less racial and ethnic diversity, that was -- that there was a more generous provision? >> there are books written on that. >> you probably wrote them. >> i'm going to let them knemil handle that. >> i am going to handle it by deflecting it. there are studies by a professor

at mit, glazer, that they are looking at not the social figures decide in this book, but at the whole welfare state's generosity in the united states and in western europe. and one of the elements, one of the coalitions that they found in the generosity in western europe has to do with -- it matters. >> ron, what do you think? >> the data says it does make a difference, if you look at states, that states with high minority populations have lower benefits in general. so i think it is a factor, but i would point out it is one of many factors. i do not think is determin ative. obviously we do not want to base our social policy at the federal

or state level on ethnic preferences. >> one of the controversial issues, i think, with that thesis is that some of the scholars conclude that because of both the diversity and the historic discrimination, that there is not much hope for the future of the u.s.. i think that many of us would disagree with that, because it seems that each generation is changing in terms of the openness for exceptions of some of the diversity. and certainly the current administration, led by president obama, will have a major effect, i think, and changing some of the underlying cultural parameters that have defined us

as a nation. so while emil correctly summarize what some of the feces are, i think that the conclusions are not as -- what some of the theses are, i think the conclusions are not as well defined. >> we need a microphone up in the front row. in the green sweater? the front row. thanks. >> hi. i am a case managerw3 at a shelr in downtown d.c. here. i was wondering if any of you could touch on prevention. there is a lot of talk about people in crisis, but to what extent the current policies or policies you would like to see enacted focus on prevention of homelessness? i guess the factors that lead to

homelessness may seem a lot more simple to me. >> prevention of homelessness, or poverty more generally? >> i guess poverty more generally. >> right. marty is the nation possible expert in that, maybe the world s not here.hat, maybe the world sheç would do a much better job çat that than i would. but let me take a crack at answering. i think that one of the points that martyok makes is that muchf the problem that arises today in the area of homelessness are problems that could have been minimizedw3 with more of an investment up front or at younger ages around health and mental health counseling, and more investment in developing integratedç services for continuing of caret(, both

throughout the last time and across the different services that might be needed. so by more investment up front, you could minimize sort of the damaging effects of long-term homelessness, chronic mental illness, and drug abuse. and around that, sort of investing in populations that are at high risk at young ages, investing in children who are at high risk of difficulties related to criminal activity, criminal engagement and risk of substance-abuse at young ages, and affording them educational and employmentç perversion opportunities at young ages would minimize theçó need. so iç think marty's answer woud be more early investment in prevention, that that would

minimize the severity of the crisis of homelessness to begin with. and certainly more investment for the neighborhood revitalization and environmental issues, and the bricks and mortar need for housing. >> ron has a quick question as we wait for the microphone to migrate over to the woman there. our last question. >> a common, excuse me. prevention. in a magnificent new book called "creating opportunity society, there is an analysis of a very complex set of rules. here is what they are. graduate from high school, get a job full time, get married, have children. if you follow that sequence, you will have a 2% chance of being in poverty, a 70% chance of

making $50,000 or more. if you did not follow any of those rules, you will have a 74% chance of being in poverty and a 70% chance of being in the middle class. >> ma'am? >> this needs right to my question. the investment in the early childhood, not adjusting the pathology of popuna(%=91ñ but basically inç good early education, leads to the kinds of life choices that we want to see people make. what has always amazed me, though, is when we talk about in this current crisis investing in infrastructure, i hear much more of our roads and bridges than i do about kids. i never hear -- and i would love to get your reaction on why not -- the amount of jobs that it would create to have a comprehensive early education system in this country. i cannot imagine a bigger job program and in a worthwhile

way, so why is that link not being made, and one of the prospects of getting that program? >> can we get a very brief response? >> we spend about $26 billion on preschool programs if you include child care. it is going up at the state level, believe it or not. so we're moving in that direction, but very slowly. i agree with you that it would be a good investment, but there is a very big problem here, which is the small-scale components have produced spectacular results. a large scale, they're much more small and controversial there is no doubt that they are much smaller, and there are some that say they are really small print, that kind of investment in those occupations also to be -- the wages for the workers in those sectors. >> thank you all for coming.

thank you, the naturof the mait, and ron. [applause] kççç >> so in washington today, president obama meeting with some 20 government officials, revealing -- reviewing the

flight 253 plot. the president will announce airline safety measures. live coverage later today on c- span about 4:00 eastern. the president will be meeting later with democratic leaders from capitol hill. speaker pelosi and house democratic leader steny hoyer will meet with the doesn't this evening on health-care negotiations. the house and senate are back next week -- will meet with the president this evening on health-care negotiations. the house and senate are back next week. again, the u.s. house and senate back next week. they came in today for performance sections -- sessions with the senate back on gender 20, the house back on january 12. coming up tomorrow, the house of governments, the british house of commons returns. the first prime minister is

questioned. >> there is less than a month left to enter c-span's 2010 student cam contest. $50,000 in prizes. top five -- top five -- top prize, $5,000. creag a five-minute video on one of our country's greatest strengths or a challenge the country is facing print show varying points of view printer before midnight, january 20. winning entries will be shown on c-span2 not wait another minute. go to since tstudent cam.org. >> a decline in spending for healthç care in 2008 was reported. more on that report from the members force -- on the seven centers for medicaid and medicare is of such services.

>> the morning. i am susan dencer. happy new year and welcome to our briefing on the national health spending numbers. this is a ritual at the centers for medicare and medicaid services as well as for health affairs to bring out these spending numbers every year, and we are delighted to be able to do that once more. this year we have a historic set of numbers to help cms actuaries and other members unveiled. as you were here and perhaps already read, who have had a historic slowdown in the rate of health spending, the slowest rate of growth in 50 years. of course, the other side of the story is that health spending still grew faster than the overall economy, so we are not out of our long-term trajectory of health-care spending growth continuing to outpace the growth in the gross domestic product. with no further ado, i am going to turn it over to our five

panelists to present the data further. you will be hearing from mika hartmann, a statistician in the health statistics group. he works primarily on historical and age-based national health estimates and earn his bs in economics from thousand university. we will also hear from dan martin, an economist and the national statistics group with the office of -- ann martin. she earned her b.a. in economics from the university of maryland, baltimore county. two other colleagues are also on the panel was winning. they will be available to answer questions. they are olivia nuchio, with the office of actuary. she earned her b.a. in economics from the university of maryland, baltimore county.

and erin kaplan's -- and arraron kaplan. and rick foster, who will be available to answer questions but there are many questions at this point. not just looking back at historical numbers, but projecting forward in the coming decade, particularly in an environment of a potential national health reform. we have many folks available to deal with those questions this morning. let me turn this over to you, michael hart -- likmikaca hartmann. >> thank you. can everybody hear me ok?

good morning. i am very happy to be here today to present to you our overall findings for the expenditure accounts for 2008. the information that we are going to review today is going to be published in the journal of health affairs, which is set for publication tomorrow. as susan has already mentioned print all the information we are presenting is embargoed until that date. let's go ahead and get into the summer of our overall findings for 2008. as we continue national health care spending was at an historical low, 4.4%. health-care spending reached $ 2.2 trillion, and the current recession has had a more immediate and profound impact on our spending trend for 2008. the slowdown was partly based as most health care goods and

services slowed in 2008. yet despite the slowdown we see an increase in the share of the economy devoted to health care spending, increasing from 15.9% to 16.2% in 2008. this first exhibit displays our health care spending trend back to 1980 through 2008, on the gross domestic product. as you can see, in most years health-care spending outpaces the gross -- the growth in gross domestic product. we as lower spending in the managed care era. following that period, we see a peak in growth in 2002, and it was a backlash against that managed care. following the 2002 peak, we see slower growth, a decelerating trend all the way forward to 2008, leading into the 2008 recession, the recession that

began in the this -- in december of 2007. on this exhibit, we can see the national health care expenditures of the should-as a share of national gross domestic product. this one of the widely known statistics. as you can see, health care spending was at 16 -- grew 16.2% of the economy, up from 15.8%. during recessionary periods and following them, we see larger increases in the share of the coming devoted to health care spending. following this, we see a period of relative stability for an extended period of time. so let's go ahead and talk about the impact of the recession for 2008. there were three areas that we saw the recession had an impact on our 2008 trend, and it is often thought that health care spending is insulated from the impact of the downturn economy.

but the recession that began in december of 2007 had a more immediate and profound impact. that is due to the fact that it is probably going to be the longest and most severe recession since the recession back in 1933. we can see three areas where the recession had an impact, first in the aara, passed in 2009. that provided retroactive adjustment in the fourth quarter of 2008 for the federal matching rate for the medicaid program, and enhance that federal matching rate of shifting more responsibility to the federal government, away from the state and local government. we estimated the impact of that shift to be approximately $7 billion for 2008. we also had a slowdown in private spending growth, as all three components slowed, including private health insurance, out of pocket spending, another private spending. the slowdown in other private spending was mainly driven by a

slowdown in private residence -- which for hospitals, declined due to investment related losses. also we see an impact in our insurance estimates. we saw that for medicaid insurance the moment actually a seller in from 0.7% in 2007 to 2.6% in 2008. private health insurance, we had a decline in enrollment of 1 million enrollees, or -0.5% in growth. taking a look at the role of public and private health-care spending over the last 18 years or so, we can see if we focus in on a more reason. from 2004. public health care spending has been outpacing the rest of private during that period of time. the share of public health care

spending has actually increased since 2004, up from 45% to 47% by 2008. there is a few reasons why public health care spending has been outpacing the growth of private health care spending. is mainly due to medicare and medicaid programs, which have been growing at stronger rates, as well as expanded milk -- expanded health care coverage. you can see in 2006, the accelerated for the public health care spending trend. for private, you can see it is growing at a slower rate of growth, mainly due to this stagnation in private health insurance and roman, which has been hovering at around -- enrollment, which has been hovering since 2004. taking a look at even greater detail, the public health care spending trend, we break apart between federal, state, and local papers. i just really want to focus on

2006: -- federal, state, and local payers. you can see the impact of legislation on our spending trends. in 2006, you see the shift responsibility for funding for the to the eligible medicare beneficiaries that were getting their retail prescription drugs through the medicaid program. in addition, you see the impact of stronger growth, a convergence of 2007 where these two payers return to their normal historic rates of growth. then you see a divergence in 2008, mainly due to the impact of aara. spending slows again, and that was again due to the aara. that does not necessarily come out very well. first of all, health care

spending can be disaggregated into two broad actors -- areas -- price and non-price. as well as all of the other factors. examining health care spending in this way to help determine whether it is driving personal healthcare's both -- personal health-care growth in the. the non price factors, indeed in the red portion of this exhibit, shows that the labs go down after the 1991 and 2001 recessions. you did not see the red getting smaller until after the 2008 recession. we see a more immediate impact of the downturn in 2008, similar to the 1981-1982 recession, which was longer and potentially more severe. is maybe an indication that --

another way that we can add context to the recessionary period is to take a look at spending by sponsor, and what we have here are the different sponsors of health care spending, the private businesses, other private funds, federal, state, and local government. looking at health care spending on a sponsor bases is done by taking all health-care spending to the services and supplies level, which includes all health-care spending, less investment. then we move the responsibility of health care spending to the underlying sponsors that make those payments or are responsible for those payments. doing things like moving the employer portion to the business sector, or moving your share of insurance premiums to the household sector.

between 2007 and 2008, the federal government share of health-care supplies increased 25 -- increased to 25%. state and local governments decrease to 70%. household share remains steady at 31%, and it has been doing that since 2005. sponsors also allow us to take the -- a look at the burden of health care spending from 1992- 1987 to 2008. we can look at health care spending in our numerator, and that would be an indication of the burden of health care spending. for most sponges that was not much change in 2008 in the burden, however, for the federal government, we saw a dramatic increase in the health care spending burden, increasing from 20% to almost 36% bring this

increase in burden can be displayed by a drop of revenue due to the recession, changes in the tax code from the economic stimulus act of 2008, in increases in the aftermath of the aara. additionally, it is important to note that for state and local we saw it not increase, and that was also due to impasse from the aara. with that, i would like to turn the rest of the presentation over to ann martin. thank you. >> thanks. my portion of the presentation is going to focus on these services and pairs of health- care goods and services in 2008. let's look at where the to plea $3 trillion was spent in 2008 hospitals accounted for 1/3 of total health-care spending.

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to grow as a share of this total combined category. prescription drug expenditures increased 3.2% from debate.

this was a decelebration from 4.5% growth from 2007. and a continuation of a slowing trend that began in 2000. i should mention that obviously part d caused expendituresed to accelerate in 2006. so in 2008 the deceleration was driven by a decline in prescription drug use per person. which was likely influenced by the recession. reports have indicated that people were not filling their prescriptions, that they were cutting pills in half or skipping doses. also there was a decline in out-of-pocket spending on prescription drugs. also likely due to the recession. in addition, there was a low number of new product introductions in 2008, and also continued safety concerns. finally, the switch of zyrtec from prescription drug status to over-the-counter status contributed to the decelerationk

we are going to turn to look at who paid for health care goods and services in 2008. the single largers payer is private health insurance at 1/3 total health careñiq'ding. the second largest payer is medicare at 20%. total public payers which are medicare, medicaid, and other public accounted for a 47% share in 2008, this is a slight increase from a 46% share in 2007. total private spending which is private health insurance out-of-pocket and other private accounted for a 53% share. this is down 1 -- one percentage point from 2007. in 2008 there was a slight shift towards public payers accounting for more of the health care bill. this is similar to the one we looked at in services showing the comparison of growth rates in 2007 and 2008.

this is among the different payers. and at the top again is total national health spending. so public payers actually remained unchanged, growth was flat at 6.5%. in both 2007 and 2008. we can see that medicare growth outpaced that of medicaid and other private payers. medicare growth accelerated to 8.6%. while medicaid decelerated to 4.7% and other public payers decelerated to 5.6%. total private spending, however, decelerated rapidly from 5.6% to 2.6%. and as you can see, all three components of private payers showed a deceleration. private health insurance decelerates to 3.1% due to slower growth in both premiums and benefits. out-of-pocket spending showed a large deceleration from 6% to

2.8%. that was primarily driven by a decline in out-of-pocket spending for prescription drugs as well as deceleration out-of-pocket spending for most other health care goods and services. a very obvious deceleration owe kird in other private spending from 10.8% in 2007 to .1% in 2008. that's pry hairly -- primarily due to the investment income losses experienced by hospitals due to the recession. we'll zoom in on medicare spending. this graph shows medicare spending and it's two components, fee-for-service and managed care. so in total medicare spending accelerated to 8.6% in 2008. fee for service compend spending accounts for 77% of total medicare expenditures.

and fee-for-service spending ack set rated -- accelerated to 5.3% in 2008. this occurs as hospital spending accelerated and that was due primarily to an increase in in-patient hospital admissions after two years of declining or flat growth. managed care or medicare advantage expenditures for medicare increased 21.3% in 2008. and although this is a higher growth rate than fee-for-service it accounts for a much smaller share of total medicare spending. and most of this growth was due to growth and enrollment. enrollment in medicare advantage grew 13.6%. when you look at per enrollee spending figures, actually medicare advantage increases only 6.8%, and that's compared to 5.8% of overall medicare spending per enrollee.

looking at medicaid expenditures now, you can also see it decelerated from 6.1% in 2007 to this was the slowest rate of growth since 199 with the exception of 2006 when part d was implemented. the 2008 deceleration was driven by a deceleration in hospital spending, and also due to budgetary challenges that were faced by several states that resulted in reduced medicaid payments to providers. in addition, in part due to the american reinvestment and recovery act, a temporary chiang in f map percentages caused a decline in$e state and local portionç of medicaid. while the federal portion accelerated. also medicaid enrollment increased 2.6% in 2008. following 7% growth in 2007.

as more people qualify for benefits in part due to the recession. and finally, because of the majority of job losses occurred in the latter part of 2008, there may be a lag in the enrollment and spending figures presented here. looking at private health insurance, private health insurance premiums and benefits both decelerated in 2008. premiums grew at 3.1% which was slower than the growth and benefits at 3.9%. and both grew at their slowest rate since 1967. the deceleration was driven by a decline in private health insurance enrollment, which was .5% decline or by one million people.ç this was due in part to income and job losses influenced byç e recession. also there was slower spending growth forç employer-sponsored private health insurance

premiums and individually purchased private health insurance. so to conclude, i'd like to summarize some of the major findings from the 2008 national health expenditure accounts. national health spending gross load in 2008 from 4.4%, the slowest rate of growth in the health expenditure accounts, but reached $2.3 trillion, or $7,681 per person. as a percentage of the overall economy, health spending represented a 16.2% share as compared to aç 15.9% share in 2007 health spending growth was faster thanxd overall economic growth which contributed to the higher share of g.d.p. a broad basedi] slowdown in heah care goods and services was experienced in 2008. this was similar to slowdowns seen in past recessions. slimmer growth in hospital

spending was a major factor in the overall trend as hospitals account for 31% of total national health spending. among payers, we saw slower growth in private spending, in addition spending for state and local sources of funding slowed, while federal health spending growth increased at a faster rate than in 2007. so thank you very much forç yo time and at this point we would be happy to take any questions you have. >> great. we will open it up for questions now. i would ask those of you who do have questions to wait until the microphone comes to you and then introduce yourself by name and affiliation, if you would. while we are waiting for some questions to be asked, let me toss out the first one, if i might. micah, an interpretation of this -- these data clearly would be that the recession, which we know is very severe, hammered health care, particularly hard

also. not so much perhaps as the rest of the economy, but to a very serious degree. i guess the question we could ask is, is there anything that suggests that the effects of this will be lasting, or is this in effect a cyclicalç set of pressures on the health care sector that we could imagine will disappear as the economy improves?ym >> as we have seen throughout most of the -- as we have seen throughout most of the history of the national health expenditures that there's always been in most years an increase in the share of the economy devoted to health care spending. that's something that's remained relatively constant back to 1960. the fact that the recession had a more kind of immediate and ( that we had not seenxd in recen history. that was something that we

thought was noteworthy and wortd discussing in the report because it had such a major impact on the 2008 trend. >> to the degree that health spending held up, we know it was largely as a function of the federal government stepping in, particularly, as you mentioned through the changes that were made in fmap under medicaid, what doç we read into that goi forward? >> well, i guess we could say that that may be justç the beginning forç 2008. it was just the fourth quarter that was impacted and it was a retroactive impact, so thergç ws no behavior impact. the spending already happened. it was an increase in matching rate between state and local to the federal. the $ million is theç -- $7 million is the beginning impact and something maybe to look out for, look for in future reports coming out next year andç projections article somei] -- coming out soon. >> let's open it up to questions

for those of you in theç audience. over here, please. please introduce yourself by name and affiliation. >> peter landers, "wall street journal." how will you explain the private insurance premiums whenever we talk to small businesspeople, they say my premiums went up 15%, 20%, 30% last year. and they have continued to do so for the last several years. how do we square that with the overall figure being something more like 2% or 3%.çç >> the answer to that question is, what we are showing is a mixture of both enrollment and the actual premium trend or charge. so when you mix those two things together, obviously i have talked about that stagnation in private health insurance enrollment between 195 million to 196 million enrollees since 2004.

when you have that stagnation in private health insuranceq enrollment, that would impact the actual growth you see in that figure, premium figure. >> did you have a follow-up? ok. great. let's move over here. i think we have a question in the rear. >> judy from national public radio. i want you to clarify. i think w3i understand this. these are obviously the 2008 numbers. yet you are talking about era passed in 2009. is that so the amount of money that was switched on paper from the federal government -- from the state government to the federal government now shows up in 2008 because the federal government went back and reimbursedç states for that medicaid funding? >> yes. that's what happened for the fourth quarter of 2008. so the spending had already happened in totality. then there was an enhanced federal matching rate tied to unemployment on a state by state basis. >> also there was a look back for people going in terms of

getting cobra reimbursed starting with people who lost their jobs in september. did any of that show up in the 2008 numbers? >> the look back overlaps our time frame, but the actual kick-in for the enhancement for the cobra did not happen until 2009. you were just eligible based on 2008 loss of job or loss of insurance. but the spending didn't impact until 2009. >> a question right here in the front please. >> erica warner with a.p. a couple of things. what is the reason for the stagnation over since i guess 2004 in private health insurance enrollment? >> it'sq tough to tease out of our data. we go to a bunch of different sources for private health insurance enrollment. one source we use that we have looked at, the keyser family

foundation report, has shown a -- i guess a stagnation or even a decline in smaller employers both offering and employees that work at smaller firms taking out health insurance. there hasn't been much change in more of the larger firms that we have seen in that data.w3 the estimates we are presenter here areç moreç an aggregate basis. we don't(h@ve anything specifically from our data that can pinpoint that or adjust that. >> is there anything at all that you saw in the data that seemed to suggest any reaction to health care reform potentially happening this year? >> i guess maybe we had our hands full with everything that was going on with the recession. i'm not sure -- i rick --

>> let's get a mike over to rick foster here, if we could. >> if you think back to 2008, what was the news? the news was all about the campaign, the election. and both candidates, of course, were promoting health careçóq reform. but i don't think, at least even anecdotally, i don't remember much in the way of discussion of people anticipating the possible effects of health care reform and then translating that in any significant way to action. i think what we saw as we talked about was much more due to the start of the recession. >> i guess just to add on. typically contracts and other prices and things like that you negotiate for health care are typically done on an annual basis. a lot of that was already set

leading up to theççxdç empha health care reform. >> could you also explain, sorry if this is -- should be obvious, why it is that medicare expenditures increased more whereas everything else increased less? >> well, like i mentioned the medicare increase was driven primarily by two things, one was increased hospital spending for a fee-for-service which was due to increase in in-patient admissions, and the second biggest factor was an increase in managed care enrollment. those were two of the biggest driving factors in the acceleration. and the reason why we are not seeing a deceleration in medicare like we were seeing in a lot of the other payers and services is because medicare recipients are somewhat insulated from the effects.

recession because they are not usually actively participating in the job market. >> what's the reason for the increase? >> well, there was an unexplained drop in admissions in 2006 and national park 2007. -- and in 2007. there really isn't an explanation other than to say it's returned to its normal growth rates. >> in medicare. >> in medicare. >> question over here. >> jewel -- julia appleby with keyser health care news. on the medicare spending you mentioned one of the drivers was the increase enrollment in medicare advantage. is that because it costs more to have folks in medicare advantage than traditional fee-for-service, or was there another reason? >> enrollment would increase

because it costs more. typically the increase in cost is driven by increases in enrollment. and many people have been switching to managed care because the packages may offer some additional benefits for the same prices. but we don't have specific information that teases out what kinds of packages beneficiaries are buying and aok good comparin for similar types of beneficiaries in fee-for-service vs. managed care, but at the aggregate level, usually health spending is driven by the increases in enrollment. >> it was just a population change? >> the population, if you take the effects of enrollment out, like i said before, growth was 6.8% on a per enrollee basis. that was a combination of cost

and price growth the 6.8%. >> that compares with 5.8% overall. it was the cost per enrollee in medicare advantage went up faster than overual. >> yes. >> just to tease out the overall slowdown. was it mostly that we were spending less or using less, or is it that prices have come down? if you had to pick one or the other. prices or utilization, is there any way to quantify which was the reason for the slowdown? >> overall. you want to take that. >> sure. can you hear me? i would direct you back, i think -- i know in the article we have a price vs. nonprice chart. i'm not sure what slide number it is here. when we look at prices for the two largest services, which are hospitals and physicians, those both declined.

then as ann mentioned, with physicians there's recent surveys have indicated since the recession began there is a slowdown in utilization. with hospitals we didn't see that. we saw slightly faster growth in hospital utilization. but you can see if you look at this chart where we have the price and the nonprice factors, that as mike had mentioned, the slowdown that we see during this current recession, which is marked by that one line, since we don't know what the end period is yet, is characterized by a slowdown in nonprice factors. the nonprice includes use, intensity, as well as other things like the issue with the income losses for hospitals, that type of thing would show up in the nonprice factors as well. so you can see that in this particular recession it's more like 1980, 1981 recession in that we saw much less of the growth accounted for by nonprice factors like use an intensity.

we did see the slowdown in physician and hospital prices, as well as i think nursing homes and home health. the drug price growth rate was 2.5%, which is an acceleration, but historically it's relatively slow. >> question here, please. >> medical news with a question about one of the end slides. it's the one that breaks down growth in health spending by sources of funds, 2007-2008. it goes to different categories. the very bottom is other private. which in 2007 was 10.8%. then in 2008 was 0.1%. wondering what that covers exactly.

>> sure. the majority int( that categoryç going to be these nonpatient other operating revenues. as well as philanthropy. so these are other private revenue sources that different areas of the medical sector rely on to helpç offset the costs o providing care.ç >> it might be things like hospital endowments that are invested in securities that obviously took a hugew3 hit. >> yes. >> that sofert thing. >> that was the major driver of the slowdown in the category. all those it's -- although it's not the majority of the categ)áv there are other components. for hospitals they relyfá on cafeteria sales and receipts from other sources of income. the majority are nonprofit operating entities. so they need some other source of revenue to help offset those expenses. >> thanks. >> sure.

>> i want to come back for a is the slowest rate of growth in health spending in 50 years. we had two very deep recessions as has been mentioned in 1981 into 1981 and also 1991 to 1992. those were deep recessions also. these spending numbers are slower than occurred in those two recessions. as you-all have established outstripped or lower than any rate of growth we have experienced in this country in 50 years. what wouldxd we say is thexd ma difference now as betweençç 1 and 1981 and 1991, 1992 would have made itç worse?i] is it theç stagnation ofçç p see this reflected in the declines in private spending that is probably the single biggest difference between those earlier periods. >> just in general we are coming

off a six-yeari] competitive slowdown or fifth year leading into the sixthç year in 2008.ç that's one main difference. leading up to those other recessions we saw accelerated growth right before and maybe through theç recession and the following it we saw impact. back in the early 1980's we did have strong inflation growth, both general andç medical. and i thinkkoç those would be factors, probableç lith main factors. mçt rate of growth since the mid 1990's during theç managed car isq% definitely setting this period apart from those other two that you mentioned. >> again, very closely linked to private health insurance or other factors in particular?ç >> i guess one of the main drivers is the other private. we can't say that even the majority of the slowdown in the private category is comingokç private health insurance. justç talking in general over e

period, you are correct since 2004 we have this stagnation. that has beenççw3 aw3 contrib this slowdown during that time period. for 2008 and the more immediacy of it, it's out-of-pocket slowing as dramatically as it did. and alsoç seekn the slowdown the other private revenues. >> one possibleç interpretatio that is thatçó the economy was really coming to grips with the rapid rate of growthç of healt spending and slowing that as we steeredç into this recession, then the recession just pushed them as forces even moreçç strongly? >> i guess that would be a fair characterization. just potentially to add i think there's been a change especially forç hospitals and other nonprofits on this reliance on this income. which is something we are surprised by. to see it had such a dramatic impact on the trend for 2008. i don't think that was the case leading back earlier in those

otherç periods when you had the other nonprofit entities relying on stock market income and investment income to help offset their expenses. >> great. meryl. -- merrill. let's get the microphone over to you.t(ç >> freelance. i'm trying to understand some of the numbers. one chart had household spending 31%. then you have out-of-pocket being 12%. what does the household number refer to in that chart? 31%. >> the household is our sponsor category. it's going to include as an employee, your payments for your private health insurance. it's also going to include out-of-pocket payments you would make as abinsured individual through co-pays and deduct imsbibles, as an uninsured individual through just paying for your health care. those are the two main categories of the household. additionally, as of medicare beneficiary, you pay premiums for part b and m.m.a., part d.

those would be included under that cat gorery. >> there are two different looks at the n.h.a. our standard definition of sources of fundsç is more like the final bill payer, the programs like medicare, the slide that you mentioned on the sponsor basis is where, micah just mentioned, we take some of the spending and shift it into sort of ultimately responsible for funding the health care. so that's where as micah mentioned -- if you look at private health insurance, our out-of-pocket estimates and standard view of the sources of funds isn't going to include employee premiums. the employee share of premiums, we move that back to the household. as well as some of the taxes that households pay get moved back. it's a different categorization of the n.h.e. >> this is just a related question. so premiums that are taken out of people's paychecks, that's in the household number but not in the out-of-pocket? >> it would never be in our

out-of-pocket number. that's just going to be the could he pays, deductibility, and payments you make as an uninsured individual. >> i realize this question does fit into health care reform. so is that money taxable or after tax money? if it's taken out of your paycheck? do you know the answer to that question? >> you mean the money that we are accounting for in the national health expenditures? >> is it deducted from your paycheck as your share of premiums? that's in the household number but not the out-of-pocket. what i'm asking is, is that tax or not tax? >> pretax. >> it's also pretax money. >> yes. your out-of-pocket spending would be post tax. exclusive of like h.s.a.'s and other flexible saving account arrangements, things like that. >> thank you. >> question here.

>> could i just ask, since we have continued to see health spending outpace overall economic growth, has there been any change in those relative growth rates over time as far as how much faster health spending has grown compared to the overall economy? >> i think if you look back overall, it was a wider gap than it is currently. but in 2008, that gap did widen. so the gross domestic product slowed relatively faster than growth in the national health expenditures. >> i think if you look at that, i think it was the second slide that has the growth rates, you can see at least for 1984, your question was about the differential between the g.d.p. and n.h.e. growth rates. you can see in the managed era they converged. and then spending peaked in

2002. came back down and health spending converged again with the growth in g.d.p. one thing i'll mention for i know most of you probably follow our annual report. so you'll notice that the health spending share's different this year for 2007 than last year. that's largely due to the g.d.p. being revised. they went through a benchmark provision and revised their numbers up. so g.d.p. was revised up. in 2007 we have a lower share. so if you happen to compare it to the previous articles, that explains the difference. >> julie appleby again, get a mike to her. >> give us a snapshot what happen since then. what happened in 2009? are we going to see a similar slowdown? >> we would like to ask you to stay tuned. we are going to have an atticle --article, not our team, but short-run projections team in february in health affairs.

i'll leave it at that. >> do you look at jobs in the health care sector numbers at all in calculating this? i'm curious what the relationship in 2008 in terms of job creation and health care was compared to 2007. because i do know if we look at 2009, health care jobs have added almost every single month. we don't know december until this friday. every month this year health care secretary has been adding jobs. i'm curious what the ratio was in 2008 relative to 2007 in terms of jobs creation. >> that's a great question. it's not something that we did for this analysis. we wouldn't have those numbers right here in front of us. we did include it in the report. it's a great question. >> keep asking it. >> we may have it this afternoon on the conference call.

might be able to look that number up. >> sort of related to that. in the slowdown in spending on hospitals, have you looked at what the impact has been on hospital sector, hospital closings, other things like that? >> just from information that i have read related to the hospital sector, definitely profitablity was down for 2008, but other than that, i don't have anything further to add. >> again these are aggregate numbers. we do get data for the hospital sector from a number of sources, but we tend to look at it in total and then dig into the data. for reasons why that total increased or decreased. >> any more questions? if not, let me ask a final one. as you-all have sorted threw these data to come up with these

numbers, what are the biggest anomalies you have discovered, if any? what are the puzzling questions you have left? what are the things that are unexplained that you are continuing to do more work on? are there any? or is all of this now pretty straightforward? >> i think some of the things that we found interesting when we looked at the data this year, mention add couple times the impact of investment income in 2008 on the nonprofit providers, like hospitals and nursing homes. that was interesting because in previous recessions we didn't see the exact same effect. there was still some slowing that went on. beyond that i think it's just -- it's a very interesting time for health spending. with the effect of the recession that we detail in the article, that was definitely noteworthy in this particular recession looks a little more like the 1980 to 1981 as opposed to some of the more recent recessions

where health spending didn't slow until several years after the fact. it's commonly thought there's a slight impact. that was also interesting to us. i don't know if you have anything to add. >> i would like to keep tracking the recession or impacts and interested in 2009. i'll be reading the article. >> among other things clearly we'll see the spending projections going forward would be off a lower base because the recession dampened down spending. anything else that we would just obviously expect given the circumstances? >> just through past history we have seen increased growth in the medicaid program. we have also seen private health insurance stagnate and sometimes decline. we have already seen a hint of that in 2008. looking for that in 2009 and forward. >> we would be expecting ongoing increases in the public share of overall health spending in the u.s., at least in the near term.

>> i don't know if i would go that far. just interested to look at what the trend will bring in 2009. >> ok. all the more reason for everybody to come back in february when we unveil that article. thank you. all of you very much for a terrific presentation and a great article. thanks to all of you for attending this morning. thank you.

>> health care negotiations continue on capitol hill. a little more than a week after the senate passed its version on christmas eve. the committee chairman who helped write the health care bill are meeting with speaker pelosi and her leadership team this afternoon. speaker pelosi's going to talk with reporters about 3:00 p.m. eastern. we'll have live coverage and both the house and senate leadership will participate in meeting later today with president obama on health care at the white house. they'll be meeting this evening at the oval office. the senate democratic leaders joining him by phone. ahead of that, the president has been meeting with a number of his top leaders on the flight

253 bomb plot. he will be speaking this afternoon at 4:00 p.m. eastern on airline security measures. we'll have that live for you as well. back to capitol hill for a moment. the house gaveled in today to start the second of the 111th congress. business was very short. bill debate begins in about a week in the house much the senate starts the second session on january 20th. they plan to consider a judicial nomination and increase in the federal debt ceiling. following the house here on c-span. the senate on c-span2. the british house of commons, meanwhile, returned from its holiday break this week and we'll have live coverage of prime minister's question time when prime minister gordon brown takes questions from members of parliament. live coverage tomorrow morning at 7:00 eastern on c-span2. >> the new c-span video library is a digital archive of c-span's programming from barack obama to ronald reagan and everyone in between. over 157,000 hours of c-span video now available to you. it's fast and free.

try it out. at c-span video.org. >> next british conservative leader david cameron, monday in london he announced his party's health care agenda for the upcoming parliamentry elections expected this spring. he's joined by the conservative party spoiksman on health policy and the party spokesman on economic and financial issues. this is a half-hour. >> ladies and gentlemen, thank you for joining us. today we published the first part of our draft manifesto and it is significant that we have chosen to start with the section on health because that it in self is and indication of our priorities. i'm glad the light's coming in to show what a mossive -- positive start to the year we have had. members of the cab debt and large majority of the parliamentary party are in every part of britain today explaining our 308cies on maternity

services and public health will benefit families. and today we also launched the first national poster campaign of the coming election. now, many of you will have seen our year for change adds in the -- ads in the newspapers on new year's day. these ads are on posters and phone boxes around the country. 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. it's our first heavyweight campaign of the election. it is simple. it is positive. it is honest. and it's an affirmation of our values of 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 don'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 this beforehanding it 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 will i not pretend that the very large budget deficit does not pose a serious threat to economic stability and recovery. i will not pretend that protecting the n.h.s. does not mean very difficult decisions on the spending in other 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 sent out examples of some of those decisions like a public sector pay freeze for all but the lowest paid mignon.

like removing certain benefits such as tax credits and child trust funds from better off families. such as our proposal to bring forward the increase in the state pension age. i believe i'm the first shadow chancellor to ever set out decisions like that. of course there will be more that needs to be done. we have made a choice. we will cut the deficit. we will protect the n.h.s. it is an affirmation of what david cameron promised when he said his priorities could be summed up in three letters -- n.h.s. of the david, over to you. >> thank you, george. good morning, everyone. on saturday, i set out our argument for the general election that must be held this year. we want to make this the year for change. we cannot go on like this. we need change to get the country back on its feet.

that change needs to be based on the values of aspiration and responsibility. we can't go on with the same irresponsible economic policies that failed to fix the roof when the sun was shining and gave us the biggest boom and the biggest bust. and now threatens our recovery with higher taxes, high debts, higher instability, high 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 prime

minister and divided government. we cannot go on and we cannot move forward another five years of gordon brown. we cannot go on like this. we need change to get the country back on its feet. a better n.h.s., an aspirational economy, a big society, and 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, opened to the ideas of the millions of people it will affect. all our policies and plans are going to be published online on the conservative website for everyone to have a look at. where they can ask people to get involved and to have their say

on the changes that they want to see. over the coming weeks, we are 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 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 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 capital investment. and there's another big difference between us and labor. we are not just going to pump money in and hope for the best. we are 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 machine, controlled from above, responding to politicians, bureaucrats, and managers. if we win this year's leaks, andrew and his team are going to give the n.h.s. back to where it belongs, to the people. to the doctors and 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 save the doctors and nurses, those national top targets you hate because they distort klein cal priorities, they are gone. instead of answering 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 rechoice 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. as andrew lancey will explain today, we are 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 to do something about this n 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 expectency between the richest and poorest has 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 are going to introduce a health premium that targets resources on the poorest areas so we banish health inequalities to the history books. with our plan, the poorer the area, the worst the health outcomes tend to be, so the more money they can get. instead of white hall telling them how to spend this monny, local people will decide. local councils and directors of public health will be able to use these budgets as they see fit and 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'll return the n.h.s. to the people. the second policy we are announcing today deals with an area that desperately needs attention. n.h.s. maternity services. it doesn't matter that billions of women have given birth over the ages. parents having a baby, especially your first baby, can be one of life's most daunting experiences. all of us want the same thing. as many moms as possible giving birth in a relaxed, nonemergency, maternity-led setting with all the facilities for intensive help there for those who need them. but the government has just been reorganizing from on high giving us bigger and bigger baby factories where mothers often kneel neglected, with some being turned away on the doorstep while in labor. parents in many parts of europe have a system that is more personal and more local with more choice. 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 networkçç under one organizatl structure all maternity services in one area a mother may need. so local hospitals, g.p.'s, charities, community groups, maternity consultants will all be linked up so they can share information, expertise, and services. there will be clinical benefits as more profotionals communicate across the network, the more consistent the medical practice will come and heighter standards will be. there will be social benefits as these networks will function as a meeting place for mothers as well as professionals. that's what i mean when i say we will return the n.h.s. to the people. all these plans for our health service from scrapping tomorrowdown targets, publishing health outcomes, health premiums, maternity networks they fit into our wider vision for our country. you can see the common conservative threads running through them.

giving 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 this the year for change. andrew, over to you. >> thank you david, thank you george. i want to say a word in the sense on behalf of the n.h.s. of the over these years as shadow secretary of state for health i have been meeting the staff who work in the n.h.s. and the patients who are cared for by

the n.h.s. one of the things that they have consistently said to me that is reflected in the commitment, 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 as new opportunities or new treatments come along. but the people working there 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. every meeting i have with 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 frontline, that the number of managers is rising three times as fast as the number of nurses, the bureaucracy and the way things increase, the improvement in standards of services isn't

what they want it to be. they know that the tech box central targets aren't based on evidence and they aren't based on the best interest of patients. the staff in n.h.s. want to deliver what is best for patients, they want the resources to get to the frontline. we know that we have to change this year and in the years ahead in n.h.s. to make that happen. we have to ensure that the service is focused on the results for patients as david said, to make sure that instead of saying were patients seen within four hours of a&e, we know pashe are living after a heart attack. they are surviving after stroke of the they are getting the care they require. so we can focus on results. and we are going to focus on patients. we are going to have a revolution in the information in the n.h.s. so patients know what service they should expect, what service is being offered, what choices are available to them, how they can control their health care better. so that the staff working n.h.s. are not only focused on doing what is best for patients, not

only accountable for the results that they achieve, but they are also answerable to patients for the service, the quality of service, and the results and patients themselves could exercise greater control. that could 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 dedicated resources so communities can take ownership of their public health, and that is not an insignificant point because the n.h.s. at the moment in the most deprived 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 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 fair society depends upon us knowing that where the health outcomes in this country are the worst, we are ensuring that those communities have the resources and incentive to take ownership of their health and to improve it in the future. 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 that 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 cost of social care or long-term chronic disease. the health premium is going to be dramatic and important. and the at that americanity -- ma teshity networks we are announcing today demonstrate how in the n.h.s. service, 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 n.h.s. in a bureaucratic process is trying to decide what services should be available where and increasingly is saying in order to be safe we must centralize the care in larger units. as you are removing the access to services that matter so much to mothers. 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. we are going to ensure that all over the country there are maternity networks that bring together the services 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'll give an example 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 andaire society. right across 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. >> thank you very much, andrew. we've got time for oratorry questions. b.b.c. a microphone is coming to you. >> thank you very much, indeed. mr. cameron, why are you

committed to spending millions of pounds on cutting taxes object inheritance, marriage, the highest paid and savers instead of spending it on public services? isn't the cost of your n.h.s. promise today that the torrey government will have to cut schools at the very time you say you want to get britain back on its feet? >> that's not the case at all. some of the things that you read out on aren't pledges at all. i think you have been indoctrinated by the previous press conference you have just been to. we'll have to take you through a program of re-education. we have made some very clear commitments. the first commitment absolutely here behind me, we are going to cut the deficit. that does mean we are going to have to cut public spending. we are very frank about that. we don't dance around it. we are going to have to cut public spending. we have made a big choice which is we are 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 pledge on inheritance tax, which we have said is not for a first budget but a pledge for a parliament, that is to be paid for by taxing the nonnew orleans the people who live here but don't pay full tax yet. every other pledge we have made is costed. if you look across to what labor have announced this morning, it is difficult to take their conservative spending plan seriously when they haven't set out their own spending blans for the future. it is even more difficult to take them seriously when you consider that when this chancellor of the exchequer became chancellor, he has underestimated our national debt by a staggering 543 billion pounds. to take any forecast from him is doubly difficult. it is troubling, 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 is not true. to claim we are committed to abolishing the changes on pensions at the top end, that is not true. to claim that we are committed to abolishing stamp duty on share transactions, that not true. that took me about 11 seconds. that is 11 billion pounds. this document is complete junk from start to finish. >> forgive me, for clarity. you are, are you not, committed to spending billions of pounds on cutting inheritance tax, taxes on marriage, taxes on the highest paid, and taxes on savers? >> we don't -- let me take each one in turn. >> whether you have costed it or not, those billions could be spent on public services and not on tax cuts, that's the choice you made. >> i think we need to take each one of those in turn.

if you take the inheritance tax pledge that is a pledge for parliament, fully costed by taxing the nondollars. the other tax changes you made are either not things we have set out and costed, and it's only when they are 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 we absolutely clear about this, can you seat commitments as and when they are made. nick. >> from the guardian. david, can i ask you about your pledge for a real terms growth in n.h.s. spending. what that means you are giving a guarantee that spending will rise in line with inflation but not 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 zero percent rise inflation is going to be

very, very painful and will feel like cuts? >> i completely agree we need to be honest and up-front and straight with people about this. i have said many times on platforms like this, 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 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 can i see, that are actually guaranteeing that come what may n.h.s. spending will go up in real terms. 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 costs, i think it is unrealistic not to increase the n.h.s. in real

terms each year. that's why we are doing it. i completely accept because of the appalling state of the public finances, because of the complete mess being left by this government, that we are going to have to make difficult decisions right across public spending, including in health, but people do need to know we have made a special case of the national health service, this is a decision we have made. that other parties have not made. gary. >> thank you very much. channel 4 news. you keep saying that you are very frank about the deficit and you emphasize your honesty and straightforwardness and the rest of you. but you have only shaferede with us so the cuts in the deficit you have made. is that because you don't have a plan? because beyond those. or is it that you're just not willing to share it with us? >> if you rewind the party conference, it's quite interesting that at the time quite a number of people in the press said we have been far too frank. we spelled out far too much detay.

this will 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 have talked about are not sufficient to eradicate the deficit. what i would say is this, we are the first opposition that i can nrl my political experience, i would say probably for the last 30 or 40 years, that first of all has said very frankly, we will cut public spending, not hold in real terms, not freeze, but we are going to have to cut public spending. the second thing is we have set out a series of things 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 quango, shrink the size of the house of commons. those are things we'll do, yes, with some relish because we think they need to be done. we have also set out a series of things that will be difficult and tough, but we think have to be done on the public spending side to get public spending under control. that is things like freezing

public sector pay. asking people to retire a year later. getting rid of child trust funds and tax credits for those on hiring coats. those are painful and difficult choices. you haven't heard any of that from the government at all. we are the first opposition as far as can i see in history to set out a series of tough spending decision that is would start to make a difference on the deficit. we have 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 of what their spending programs are. last question from tim. >> thank you. >> tim shipman. sorry. that was very cunning. i must get that right. >> could i ask quickly about this tax breaks money for poorer areas. the areas of scotland that get hugely greater amounts of health care provision, but the outcomes are no better and in a lot of

cases they are far worse. what do you say to that? how will you make that work in practice? >> there are two things we are 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 onlying getting the money inasmuch as they kimm prove the health outcomes. it seems to me that is crucial, to use the payments by results idea to actually get changes in behavior and changes in outcome that will make such a difference. that is the key to our plan. that is the key to our plan.  

>> then-president just wrapping up a meeting this afternoon but his key apartment officials on the flight to hundred 53 blog pot -- 253 bomb plot. we spoke to of washington official about the meetings today. here is what he had to say. we are joined by jonathan

weisman. >> it will be proper gates, secretary of balaton no hnepali. robert muller from the fbi. it goes on and on. basically anybody who might have anything to do with terrorism. steven chu will be at the meeting. >> what will he hear from these people? >> they are going to go over reduce that each one of them was supposed to conduct on how it

was thatñi the nigerian man who tried to blow up the airliner on the way to detroit, how she got on to that plane and what they're going to do from here. the president will be speaking for, and we are expecting the announcement. >> any inkling on what the substance may be in the commons this afternoon? >> the transportation security administration has been the unveiling a lot of different assets of screening -- methods of screening. odds are it will be something about bolstering the central dni. >> how likely is it that

personnel changes will happen? >> we have got no indication from the white house that heads will roll out of this thing. obviously there are certain people on the hot seat, dennis blair -- it was his job-relate to connect the dots. the president has said this is where the bill year has come. we have no indication that his job is on the line. nor have we gotten an indication that homeland security secretary is under threat, even though she came under a lot of criticism when the day after the bombing incident happened she said everything had worked fine. i am not looking for jobs -- >> we're going to take you live

to the comments of nancy pelosi. >> it is great to see you all. we just had a very productive meeting with the chairs. i want to commend all of them. chairman waxman, chairman of the energy and commerce committee. chairwomen clarice slaughter for the important work they have done and are doing. we are pleased that conversations continue with a counterpart in the senate. the leadership loveloceavel leve have much in common in the bills. it will have affordability for

middle-class. with that, i would like to yield to the distinguished majority leader. >> we passed a very historic health care reform bill. we have not pass the health care reform bill. obviously it was necessary for us to reconcile the bills. there are significant differences. we will discuss these over the next coming weeks. we expect to move very forcefully on this effort to bring these bills together. we are very hopeful that we will pass her a conference report in the near-term and send it to the president for his signature. teddy roosevelt started this up for almost a century ago and said we need to make affordable, quality health care affordable to all americans. over the ensuing century we have accomplished that objective.

we have now merged further than any time in history on a bill that many presidents said we needed to accomplish. we are here working on that effort. we're going to be successful. i know the president looks forward to setting a health care reform bill, which provides affordability and accessibility and accountability. thank you very much. >> thank you, madam speaker. i am trying to hide today. [laughter] i do believe that all of us heard from our constituents over the holidays, and we know they are looking forward to us using the time between now and when we reconvene to have legislation

well on the way to reconciliation. we're trying to reconcile two bills that are good bills. there are real good things in the senate bill, great things in the house bill. what think we have to do is mill them together and do that in such a way that the american people will feel that the time and energy and effort has been worthwhile. thank you. >> we are particularly delighted with the leadership of the president of the united states. without his leadership and vision and encouragement we would not be tried on the verge of passing this historic legislation, which will be place, i think, in its rightful place alongside social security, medicare, and now health care for all americans. any questions? >> a number of senate moderates have said [inaudible]

>> we want the final product to ensure affordability for the middle class, accountability for the insurance company as it provides accessibility by lowering costs at every stage. those are the standards that we have, which i think are shared and house and senate. >> [inaudible] >> we need to hundred 18. -- 218. the public option, i prefer to call it the public's option. option to hold the insurance companies accountable in and increased competition -- there are other ways to doing that and we look forward to having those

discussions as we reconcile the bills. unless we hold them accountable, we will not be able to have affordability for the middle class. the reforms of the insurance industry that we must have to end discrimination on the basis of pre-existing conditions, cap payments and copays and all of the rest. it is about affordability, which is essential to accessibility. we will have what we need to hold the insurance companies accountable. i contend that what leever we he will be held accountable. >> c-span wrote a letter about having this process transparent. any response on that? [inaudible] >> there are a number of things

that he said on the campaign trail. [laughter] i have referred that letter to the speaker. >> thank you, madam speaker. let me point out first that the health-care debate in this piece of legislation has been subjected to an unprecedented degree of public scrutiny and input. the original bill was put on the internet. we have thousands of hearings around the country and town meetings. we had a whole series of shearing saihearings. we heard from 181 witnesses. 83 hours of marquette. the list goes on. we will continue to have that kind of open process as we go

through this next phase. there will obviously be discussions between members of the house and senate, but we will continue to keep the american people informed as we have in the earlier stages. we do not know whether there is going to be of conference. it is not clear whether that will happen. >> [inaudible] 1 of your colleagues told me it is an assault on democracy. >> i do not know who you are talking about, but i will say there has never been a more open process for any legislation. as mr. van hollen said, tens of thousands of people participated in the town hall meetings. over 100 witnesses and the bipartisan hearings that were held in the conference and the list goes on. i am not going to repeat what he

has said. we now have another town than you and that is the internet. -- we now have another town venue and that is the internet. what i will say is i completely disagree. we do not know what route we will take. we'll take the route that does the job for the american people, that gets this done in a timely fashion in a city where the special interests are so entrenched. we will do what is necessary to pass the bill for affordable, accessible pop legislation, which holds the insurance companies accountable, and we will do it in a timely fashion. >> [inaudible] >> we think we have the fairest approach in our bill.

when it comes to tax policy around here it is like a mirror. the senate thinks there's is fair, we think ours is. we will proceed in a way that is fair to the american people. think you. -- thank you. >> what ever the funding mechanism, the president, the senate, and we have pledged as this will be paid for. it will bring down costs and bring down the deficit. >> [inaudible] how will we know what is going on? >> [laughter] my experience has been you know

before i know. i presume that will continue to be the process. thank you very much. >> congressman waxman -- >> house speaker nancy pelosi and democratic leadership on the status of health-care negotiations. several questions about cspan's letter of request on coverage of health care negotiations. you can read the letter on line. it is in the pink feet shouatud linkk session. we love the president's comments after a meeting at 4:00. has doubled in to start the

second session of the one of the 11th congress. business was very short perio. >> we want justice. i think you. -- thank you. >> comments from henry waxman as we were saying the house will be back to work next tuesday, january 12. the senate returns for legislative work on january 20. but for we brought you the live news conference, we were bringing you a conversation we had earlier with jonathan weisman on the meetings the president is having today. we will show that interview to you now in its entirety. >> we're joined by jonathan weisman. president obama gets back to work in a hurry with a couple of key issues. a meeting on the review at the

attempted attack on flight 253. who will be at the meeting and what will he hear? >> you do not have time for me to list everyone that will be there. robert gates, janet napolitano, the home security department, eric holder, steven chu, dennis blair, leon panetta, it goes on and on. basically anybody who might have anything to do with terrorism. as i said, stephen shoot that secretary of energy will be at the meeting. -- steven chu, the secretary of energy will be at the meeting. they are supposed to go agency by agency over reduce that each one of them was to conduct over how it was that the nigerian man who tried to blow up the

northwest airliner on the way to detroit, how he got onto the plane and what they are going to do from here. the president will be speaking at 4:00. we are expecting him to make an announcement. there has been a big drum roll up to the meeting. we do expect something of substance to come out of it. >> and the klan -- any inkling as to what the substance will be? >> the ts sa has been implementing new methods of screening. we think it will be broader than that. we think it will be something of about bolstering the central dni. >> how likely is it that personnel changes will happen or resignation will be part of the fallout? >> we have and got no

indication from the west that heads will fall at this. -- we have gotten no indication from the white house that heads will roll from this. dennis blair's job was to connect the dots. that was where the failure has come. the president has said that. we had no indication that dennis players job is on the line. nor had we had an indication that kate janet napolitano is under threat, even though she came under a lot of criticism when the day after the bombing in dissent -- incident happened she said everything worked fine. i am not looking for jobs to be lost here. i think the president is probably going to have sternward u words.

>> president obama also meeting on the hill. what is the purpose of that meeting? >> that is to get the ball rolling on the conference meeting, the meetings between the house and senate to try to get the final deal on health care. the emphasis this week really will be on the house. whether the house liberals will go along with a version of the senate health care bill. the fear is really that they will lose one senator, not that

it's the policy will be able to round up her people. -- not that nancy pelosi will not be able to round up her people. the white house made a concerted push to win at least one republican to the senate bill. the senate personally focused on olympia snowe. in the end, all of the efforts, which in a dozen phone calls and meetings at the white house, that they ended with olympia snowe since she could not support the bill. >> keeping his eye on the white house today, jonathan weisman.

thank you for the update. >> think you. >> a white house officials say there will not be any airline security announcements after today's meeting. he is planning to tell the american people just how the plans to try to prevent future terrorist attacks. we will have the president's comments live at 4:00 here on c- span. british house of commons return from the holiday break this week. we will have live coverage of pride ministers questions time when gordon brown takes questions from members of parliament. questions at 7:00 tomorrow morning. discussion from this morning's washington journal on democrats and health care legislation. perez from " losses -- from " washington journal joins us -- from "the washington

journal" joins us this morning. what are the officials saying? guest: ranging from the director of the national intelligence, the cia director, the fbi director, it runs the gamut. if you bring them all in, as you know they have turned in reports over the last couple of days that essentially are sketching out what problems they have found inside of their agency and how they plan to fix them. the president is basically trying to go through those reports and find ways to address them down. host: this goes to my next question. will this be a meeting where he is mostly listening to cabinet members? or is he giving marching orders? guest: judging by what is in some of the reports, i would expect that the president might

do a lot of talking. you see what is happening as many of the agencies are pointing fingers at each other and in some cases asserting that the system worked, at least they're part of the system worked. perhaps not a lot of taking the blame for themselves is going on. i think the president might do a lot of talking after that. host: is it fair to describe this as a coming to church meeting? guest: come to jesus would be more accurate. [laughter] host: regarding the revisions in homeland security, what is he going to be saying? guest: more security measures, more on the ways that the different agencies deal with each other and share information. that has happened repeatedly, most recently in november when

there were the shootings at fort hood and we found out that there were actions that were not acted upon. this has been a bigger problem than anyone realized and the president is going to try to address that. host: terrorism and homeland security is our topic for the next 45 minutes. if you would like to be involved in the conversation, for democrats, 202-737-0002. for republicans, 202-737-0001. for independents, 202-628-0205. you can also send us messages on e-mails board twittered. or twittered. -- twitter. guest: the president, since he came to office, has travel

overseas, trying to a least make the words coming out more cooperation, and so on. he will try to incorporate this theme, the concern about terrorism, and perhaps the thing that has been pushed into the background of his presidency until now. he will try to merge those things and we will try to get him to talk about cooperation overseas to make everybody safe. host: our first call comes from jacksonville. william, good morning. caller: good morning, good to see you. you are informed. hello? host: go ahead. caller: how can we fight someone who wears no uniform, number one. that is the craziest thing i have ever seen. nobody can even go over there and speak the language.

the people that live there, they know that you are hope that. same question, why is my second question is, [inaudible] you have a happy new year. >guest: the question of fighting a war with an enemy that does not wear a uniform has been a big topic for the government since 9/11. the bush administration handled it one way. the obama administration is pretty much of the view that it is a war, and whether someone is wearing a uniform or not, it is a war. they have had differences over

whether or not they should use certain methods and systems like the military commission systems, but i think both administrations viewed this as perhaps of war that will go on for a long time. uniform, it is a war. host: the caller mentioned security measures for what he called high-risk countries, including afghanistan, algeria, cuba, iran, iraq, lebanon, cuba, and saudi arabia. guest: those are countries that have been kicked out for further screening, and there is a lot of criticism of that. incidents like the one on christmas day, like richard reid

in 2001, carrying a british passport on a flight into miami. if you criticize people from nigeria, somalia, focus on those people, we would not have picked up on richard reid. i think that there is valid criticism of what, exactly, are we aiming for. i do not know that the administration has explained that fully. host: washington, missouri. republican line. caller: i was just calling to talk about the security that we have. i think that jan in the paula pagano, eric holder, and president obama -- janet napolitano, eric holder, and president obama have not taken this into account. before he can to work for us,

eric holder was in a law firm that did pro bono work for terrorist. they have no clue. they think it is a joke. they will make us safe. good luck, america. guest: eric holder work for law firm that, like many big law firms, volunteered sometimes to represent some of the detainee is in the war on terror. there were many legal issues that were raised. so, his law firm was not unlike many other big ones. host: in "the baltimore sun" this morning they write "there will be an addition of more names to the government terror watch lists after u.s. officials closely scrutinized a larger data base of suspected terrorists. people on the watch list will be checked additionally before

entering this country. those on the no-fly list are barred from boarding aircraft headed for the united states." how are they going to make that determination on who heads from which list? is there a specific criteria? guest: there is a specific set of criteria, the question that many people who are skeptics, like i am, but as this is how did that happen? çóhow did it suddenly become dozens of names being mgv d from one database to a more stringent database? why did that not happen earlier? what new criteria or information have you discovered that made you move those people's names over? is it just a political issue? did you try to make sure that you covered all the bases and so on?

i do not think that the explanation of what occurred is forthcoming from the administration and i think that a lot of people should ask the question of what the criteria is in order to move those people over. host: virginia beach, virginia. democratic line. good morning, welcome to "the washington journal." caller: i would like to comment on homeland security. and i think that there was a break and probably homeland -- probably terrorist activity in homeland security. too many people have been able to infiltrate handshaking with the president for it not to be an inside job. that needs to be address. çóit unnerves me that i have sen a lot of lax security, just as they practice universal precautions for health care, i think that there should be universal precautions for

terrorist activities. everyone should be treated that way until otherwise notified. host: are you still with us? as a frequent flier, what do you see that could be improved in terms of securing the airports and making sure that everyone who's tried a lot -- traveling is safe? caller: i have been able to carry aboard perfume's and liquids, they were not regulation size. i got away with it. i was not trying to, it was in there by mistake, but i got away with it. i have no plan to do anything wrong to anybody, but if i can get away with it as an individual, hundreds of others can. i fly to month not to be searched often. i fly all the time.

i have to work out of town. there are things that i have seen that really need to be crack down upon. i am in very much agreement to the scanner. host: thank you for your call. the caller is echoing the sentiments of many people. the system is imperfect and there is a lot of lapses that happened. it is also clear -- i have spoken to former senior officials in the government, he said that he and his family were detained at the airport in search because they found that he had traveled to afghanistan. that person was searched and scrutinized but others are not. clearly there are ways to improve the system. host: we are talking with evan perez about ways to improve the system, as well as the president's meeting this

afternoon in his announcement from the white house. our next call comes from north carolina. justin, go ahead. caller: how're you doing? host: just fine. good morning. colorado i was watching fox news sunday yesterday, mr. brennan admitted that there was no attempt to try these individuals in criminal court. my question is, does that not imply that there is an upside or downside in determining the factors of whether or not these individuals are tried? second, what is ever the up side of keeping terrorists off of our soil in the first place and holding them somewhere else? guest: on the first question, you have put your finger on

something that this administration is struggling with, how to explain why they decided to put some people on trial in criminal court and why some of them need to go to military court. the fact is that they do not have a good answer, the administration prefers to use the civilian courts. the president was very critical of the bush administration and their system, but then he got into office and saw the evidence that the government has against some of these detainee's and he realized that some of the evidence probably could not hold up in civilian court. that is when he decided to basically go back and rejigger the military commissions system. something that the administration essentially does not want to essentially put out there, the fact of the military commission system is different and, in some ways, a lesser

system and internationally is viewed that way. this is why you see them struggling to explain why they decided to go one way on some h and the other way and others. host: we got this clear message from twitter -- how much of security is outsourced to corporate contractors, like the cia, and do their employees have security clearances? guest: a lot of what to do is done by big contractors. billions of dollars are spent on this stuff. many of these people have security clearances that they had when they were government officials and then they move into the private sector, carrying their top-level clearance is with them. host: one element coming into

the news lately is that some of the employees of the tsa are trying to organize. how much of a factor is this going to be in the debate regarding homeland security in the coming weeks and months? host: it depends -- guest: it depends. for republicans, this is a big issue. there's a big divide, politically, between democrats and republicans on this. republicans will try to make an issue of this, pointing out that this is not safe. democrats will argue, probably a bit more quietly, that people should have a right to organize, just like anyone else. host: michigan, brian, republican line.

caller: going back to the first world trade center bombing, i was amazed at how little scrutiny was put on the boy -- on the clinton administration when it was turned into a so- called criminal court issue. president obama, who i am really trying to support, says that he is worried about our image overseas. but when this major that should have been booted from the service prior to him doing the damage, the murders that he did, he is worried about damage, but he comes right out on television and says that this man is going to be tried and found guilty. how was that laid out in the arab world? we know that it was a ridiculous statement. i am sitting with my mother,

she is still smart, in her 80's, and she asked me what i thought of that and i said it was the dumbest statement i had ever heard a president make. . guest: i do not know what comment the caller is referring to. obviously the president has been a al there trying to figure out a way to make the peace on the issue of muslims and the u.s., and i think that is one of the things that they are trying to focus on. host: there is an editorial that

response to the president's announcement to tighten security and it says the new procedures are clearly discriminatory, and ordering on ethnic profiling. the same can be said of those from the rest of the countries around the world, which is why the new procedures are so unfair. the editorial goes on to say that no one, not the nationals of the countries on the new list or the nationals of any of their country is likely to object to enhance security measures, so why not allow all of us equal standing in the fight against terrorism and amid all this to the same procedures? guest: if you decide to focus on these 14 countries, nationals from these 14 countries, then perhaps you might be missing

other things, which from our experience shows you is something that is a very real problem. i think the administration -- i do not think the administration has fully explained what into this legislation. ihost: is it just nationals usig these as a country of origin or if they passed through a country, would he be subjected to more sacredness security measures in amsterdam and halass the country's key originated from? guest: if the alleged bomber had gone from dubai to amsterdam and

on to the u.s., she would have been subjected to the same scrutiny because of where he originated from. if he had originated somewhere else and gone through saudia arabia, for example, that scrutiny would be there as well. host: back to the funds. mary on the line for democrats. welcome to the program. world is so against us? i don't understand that part. what did we do to make them hit as the way that they do? the second one -- could you explain something, from when 9/11 happened, the bush administration had intelligence on the proposed attack for five months and did nothing about it and went on vacation. could you verify that that he had five months' advance

intelligence? he did nothing. the next thing i wanted to ask, is it possible that something can be done about the republicans? they just keep on talking about the president not knowing what he was doing and i think he is doing a good job because of what was handed to him. as far as what is left over from the bush administration. guest: regarding the bush administration, that has been something for debate. the was intelligence the government had indicated something going on. the cia knew that a couple of the hijackers were in the country. knew that there were not supposed to be here. did nothing about it. there has been a lot of debate over how much knowledge rose to the level of the president and white house.

i don't know that anyone really knew something was coming on that day and its extent. host: next up, indiana, on the line for independents. caller: good morning, i would like to talk about the definition of terrorism and terrorists. the record is "terror" which is extreme. extreme extreme fear to this country has not only lost the people who have been killed by the terrorist act which is just the head on thenail. it has also affected our economy, paranoia of the citizens who are remember were out after 9/11 buying plastic and duck tape. the terrorists have also made us go to war with them and send our

troops who are our citizens over to the majority of our enemy. it gives them a chance to kill more american citizens. i just don't understand where this is supposed to stop. what war on terrorism, the final goal for winning the war is? guest: i think this administration or the previous administration -- neither really knows where this is going to and. i don't think there is any explanation for the origins. people try to cite the troubles in the middle east, the occupation of palestine. but really there is a myriad of reasons and no reason.

host: in "the financial times" and others -- al qaeda seeks to make yemen its safe haven. explain to us what they seem to be moving there and tell will shift the u.s. response to the war and terror? guest: it is like water. if fines -- always finds a place to go. there are extremist groups taking advantage of the instability. it is a very poor country and has political issues internally. the government does not have full control of its borders. host: next up, ann in baltimore on the line for republicans.

caller: i just wanted to see what your views are. i think it is ridiculous when we can read where the british citizens, mousavi was a french citizen -- al qaeda is not stupid. the algerian boy radicalized in london. it is not the poor ones --- the next person will be someone from europe or even domestic. justly believe certain countries, maybe some in the middle east i guess is reasonable, but just labeling countries and a saying that people coming from nigeria or other places will make any difference. al qaeda keeps changing. not addressing the ideas of radicalization in different

countries of europe is going to cost us down the line. guest: the caller encapsulates everything a lot of people are saying. the problem is if you focus on certain countries you might miss other things. if you remember, just before this christmas day attempt we were having a lot of discussions in this country about radicalization here. there had been a spate of incidences' involving u.s. nationals are people with permit residents here who were radicalized by the internet with some of these imams. the caller points out a very good question. if you just focus on people from where the last attack came from, then you will miss the the next one will come from. host: the wall street journal reporter joins us for the

discussion, the justice depart reporter for "the wall street journal." previously he started there back in 1998, worked for the journal in miami and most recently in atlanta covering aviation and hurricane katrina. lakewood, colorado. the line for democrats. caller: thank you so much for taking my call. i would like to speak to the issue of politicizing terror. we have heard people from the republican party wishing that obama would fail. holding nazi signs. we have nationalist socialist in germany that use the idiom that liberals are weak. they used very effectively to downtrodden of jews. here in this country now we have and dick cheney sayingtdaá

the cia knew about this man that was going to board the plane. why did they not report it? guest: the political angle of this is quite surprising. especially from the charges that you see going on. i do not think there is much substance to a lot of what has been set in the past few days, except that obviously people are looking forward to the 2010 elections. what the caller is pointing out to is perhaps some of the feelings that the cia and the state department and other agencies have to explain, but to

find some political motivation behind the failings or some of the responses is perhaps reaching. host: there is an article that questions like to but is on the list. -- that questions why cuba is on the list. i live nation would have to be among the last places on earth where a al qaeda with try to establish a cell, let alone plan and launch an attack. guest: i lived for a long time and miami. they are probably the reason that cuba is on the list.

very big population of cuban exiles in miami. they are very listened to by previous administrations in this administration. i think there have been incidents in the past and which the government has supported things that we would consider terrorism, and so that is one reason they are on the list. until relations improve between us and cuba i do not see the u.s. premiere of into the from the list. hos-- i do not see them removing cuba from the list. they looked at the state department lists, and basically they decided they were going to use teh list.

-- the list. if you remove any of theñi other countries -- i think there's probably some of that, but the simpler explanation is probably true. host: staying on the topic of state-sponsored terrorists, why do you think north korea is not on a list? guest: that is a good question. there are not a lot of flights that go through north korea. that probably is something that will not be a problem. i think that is a good question. if you're going to use the lists, then use it. host: jacksonville, fla. on the line. caller: good morning.

i would like to know -- i am not trying to be funny, but argue really just educated to understand -- but are you really does educated to understand that cuba is on the list to be compliant with what the united states wants because we get what we want. i in the terrace and all united states citizens are terrorists. are you there? guest: what i was pointing to is the political nature of this. cuba is the big issue, especially in florida where i live for a long time. it is something that is going to had complications to anything like this.

i think the government and the administration looked at this and decided to go the state grow and add cuba in there. host: why wouldn't they just put everyone on the terrorist watch list on the no-flight lisy list? guest: that is a good question. there is a lot of examination in to watch these cl-- into what the lists include. there is a large compilation of names. from that they decide to get a more narrow list, which include a few thousand people who are banned from flying on any plans to the u.s..

this is used by other countries by the way. then there are other thilsitsis where people are presented with extra scrutiny if their turn to fly. the government has all these different lists. right now they're trying to figure out a streamlined way to move people back and forth or to make sure that the right people are on the list that are at least elected for certainty. host: how much discussion at the white house will involve upgrading that technology, particularly the body scanners? . .

caller: there is a pocket here, a pocket there, and the terrain is horrible. they would understand why the people are coming over here, and

there have been individuals so brainwashed, they think the only way to get to heaven is to kill people. which is a sad, sad thing. i believe that that is a good book and in explains not only that terrain but the mindset of the people there. and the trade-offs that have to be made. host: are you familiar with the book? guest: i am not familiar with the book. host: the line for democrats, go ahead. caller: it distresses me that we are so divided. i sincerely wish that for 2010 we will find a way to get together as americans. present obama like the rest of us loves his country. i have a couple of questions for you. my first question is, if i am

walking in a secluded area and there is someone behind me, i am concerned. if there is a line behind me, i am going to be concerned. what is wrong with profiling? in my second question is, my wife lives in another state. i think that the tsa and its other agencies to an excellent job -- to an excellent job because i fly a lot. it seems as though we are always fighting the last battle. i wonder, is there some organization or some agency where people are imagining what could happen? i can imagine people secreting

explosives in breast implants or stuff like that. guest: it is a huge problem. it is part of what has happened here. in 2006, there was a plot to put -- to bring liquids on the plains and use them as explosives. the government had known about such plots for a long time before that, but it was only until there was a specific plot that they decided to roll out these new procedures, whereby you could not bring in -- only of little bit of liquid, 3.2 ounces, i think that it is. the government is set up that way and it happens in this administration and the previous and it will probably happen in the future. there is always that reticence and reluctance to do too much,

because of the privacy concerns. the other thing that the caller just raised, which is profiling. you talk to people in the national security arena, a lot of them will tell you that perhaps our country should relax some of its expectations on privacy. a lot of people at the aclu would not agree with you. a lot of people said a profile in does not work because it focuses you on the wrong thing and does not allow you to think outside the box of possibilities that you have encountered a going to your profile and. there is a lot on the issue of privacy and profiling because this is something that we are struggling with constitutionally and culturally. host: in the meeting later on today but the president, who will the president 0.point to,

not necessarily to blame, but for the responsibility on christmas day and who will he expect to shoulder the most responsibility in this new step and homeland security, this new phase? guest: there is plenty of blame to go around, that much is clear. i think that he will look at people -- the director of national intelligence, people who are running the national counter-terrorism center, the cia certainly did not do some things that it should have done. and the state department -- yesterday i saw comments from secretary of state clinton about the actions of her agency. i think that misses some of the point. people are wondering if the

father of the alleged bomber comes into the embassy and gives the specific concerns that he has about his son, and yet you do not cancel the visa, there is clearly something wrong there. it may not be the procedure that you follow that the time but certainly you can admit that that should have been done. host: is anyone going to lose their job over this? guest: that is a good question. recent history indicates that that is not the case. they will have about to do better next time. host: terry abbott bryan, ohio on the independent line. caller: as far as the security, what about a plan where we would have six major hubs around the world sending flights into the united states? have americans assumed total control -- it would seem to me

that have a lot more control over who would come in and? >> the airlines would tell you that that is not workable. the world economy depends on the free movement of people and goods and so on. the u.s. setting up security people overseas -- that is something that is already being done in some places, in the caribbean for example, in cancun and i believe in jamaica, places like that. very high tourist traffic and there is some screening allowed on the shores of other countries. in europe and in other countries, i think you get some resistance for sovereignty reasons. they do not want the americans doing something that they have the capability to do. host: this article in the "washington times" this morning. european airports slow to implement. it sounds like they are having some of the same problems that

we're having, not having enough people on the ground to do these kinds of security tests. guest: a lot of us did not understand yesterday's exactly what were their requirements. i think that there were airports in france and the u.k. where they did not know whether the rules that the u.s. was now trying to promulgate were legal in their system. i think that there is a general -- this is a problem that most countries have, which is this is not jobs -- these are not a job that you will pay a lot money for, the screening jobs we're talking about, and so therefore you attract a certain level of candidates. that all follows from there. it is whether you want to pay the money to be able to increase security. host: we see summons with leaders of various nations, economic summits and recently

that climate change summit in copenhagen. any thoughts that having some sort of anti-terrorism summit in the near future? guest: there have been some speculation on that front. the u.k. -- sometime summits, as a result of leaders who are in trouble. someone in europe might decide to host a summit like that to be able to bring all of these leaders and show that they are doing something. host: our last call comes from taxes, and james on our line for republicans. caller: i am wondering why we're so concerned about the traffic. i will go to latin america or canada and come in to really do damage. i can't believe they don't do something about our borders before the start of this crap

about the air traffic. another thing, why you having so many democrats calling in today? i have watched you for years. usually are pretty well balanced. host: sir? guest: i think the caller is pointing to our government not thinking of the box. it is a good question as to whether people can arrive from other places. i have not been any attacks coming from the south. there haveve been plots through canada.eá9 >> thank you very much for being on the program. >> president obama is expected

to make remarks here shortly at the white house after meeting with his national security team about the attempted airline bombing on christmas day. political writing that robert gibbs said today that president obama will deliver a stern warning to his appointees at a meeting. he will not tolerate efforts by the cia, the state department, and others to shift blame for the recent intelligence foul-up to other parts of the government. here is the white house briefing. >> it got quiet all of the sudden. to everyone that had a seat, they stood. before we get started, let me make buckwheat -- a quick scheduling announcement did the president will travel to ohio on friday, january 22. the next hop on the white house to main street door.

he will meet with ohio workers, local ceo's, small business owners, and other local leaders about ideas for continuing to grow the economy of the americans. >> what county? >> lorain county. happy new year to you guys. the boilers will the president the unveiling his new steps or would you characterize this as a recap of what the government has done since the incident? >> let me break up the meeting, which is scheduled for 2:30 p.m. in the situation room. the meeting is scheduled to go almost an hour and a half. at the conclusion of the meeting, the president will make a public statement. not getting ahead of what people

say, but i think you will hear the president give a candid update on where we are in the review, outlined the specific steps that have been taken to strengthen security in our country, particularly our airports, over the past several days. and go through some timelines about additional security announcements that may be forthcoming. say again? no, he is just making a statement. >> not necessarily steps to be announced today. >> correct. >> will he be challenging the agency heads about in their purview what went wrong and seeking some accountability there? >> as you know, the president requested this review right after the incident that took place on christmas day. many of those reports -- the reports have come and and one agency came and of little bit

late because of an incident that happened that you are all aware rub. -- aware of. the president has had a review of those reports with mr. brennan in the oval office for about an hour yesterday. along with other members of his national security team here at the white house. i think you heard the president's statement of the break. the president has a series of questions that he has asked all of us to look into, and he will start going to those questions and looking for answers that are satisfactory to him into the american people. >> is there any talk in the white house to speak about any kind of military response? again suspected terrorist or extremist facilities, for example? >> i do not want to get into information like that. you suppose that question to the

pentagon also. suffice it to say and you have seen this over the past several weeks, we are strongly supportive of the efforts by the yemeni government to take strong action and root out terrorists that are members of al qaeda and the arabian peninsula. we continued to -- we will continue to do so and be supportive of those efforts. yes, sir. >> the president to come back from the holidays with quite a bit on his plate. now counter-terrorism has taken a greater prominence. because of the bomb threat. is there any concern within the administration that this may distract him from his domestic priorities, such as jobs, economic recovery -- >> the president understands and believes wholeheartedly that keeping the american people safe and secure is his first job.

nobody here would never describe that as any sort of distraction. secondly, i think that you will hear the president discussed this today, if you look at the actions that we have supported in afghanistan and pakistan and somalia -- and as i mentioned, and yemen -- these are not things that have happened since the 25th of december. those things have been happening for quite some time. the notion that this just got put on the president's plate in the intervening 10 days, i think, is something that given the amount of time that he spent working on these issues -- i did not think that somehow this is something that has been put on his play of the last few days. -- on his plate over the last few days. obviously these threats and

these places in the world that are supportive of terrorist and terrorist organizations had been something the president has been dealing with since the transition, before he was even sworn in. >> he spent his first day back yesterday's in very intensive meetings of about fixed problems. >> my point would be that i do not think -- we did not have the mindset that this problem did not exist prior to december 25. the president's plans, as you know, each day getting a daily intelligence update. >> but they are saying that you blew it. >> helen, let me just answer maths question and we will get to your question. >> the president has spent part

of every day since he has been here working on terrorism, working on terrorist threats, working on dealing with the extremists. we have talked about afghanistan, we've talked about pakistan, we've talked about many of these issues. i would not quibble with the fact that the president has a full plate. i don't think you would find that the president would find his plate all together a lot fuller than it was, quite honestly, than it was a few days ago. he is used to carrying a full wise -- a full plate. >> some of the measures that they are talking about, including tighter security, more stringent safeguards on visas, people being added to the no-fly list, and other assumptions -- could you look at the path from

yemen to going to to nigeria to amsterdam to detroit and tell us how these new reforms would have perhaps detected him all along that path? >> let me not get into that. i think the president will get into that some today and in the coming days as the review continues and wraps up. i think what you'll hear from the president is to go into a number of steps that we have taken but also to walk people through the systemic failure that the president pointed out had happened in his remarks last week. >> he also mentioned human failure in his remarks. so far, as far as i know, nobody

has lost their job or have been reprimanded. not to take on admiral player, but it is the job of the director of national intelligence specifically -- that job is created to connect the dots. is anybody at all going to lose their jobs over this? >> jake, the review is ongoing. i think you would hear the president began to address that review to date. i think the president is anxious to sit down and has obviously spoken with a number of these individuals over the course of the many days and he is anxious to sit down with them as a group and walk through this. i think the president has discussed ensuring that adequate steps are taken to ensure the american people's safety, and that is what he will be discussing and working for today. >> how cooperative has addulmutallab been since he was

arrested and got a lawyer? >> the suspect, as you know, was taken from the plane in detroit. the fbi interrogators spent quite some time with him. i do not want to get into all of the specifics, but i think that they would agree and i would say that he has provided in those interrogations' useful intelligence 3 >> ever since he got a lawyer? >> i am not going to get into all of what he said, but again, the interrogators believe that he has provided them with useful intelligence. >> what the president say to the american people who have deep concerns that some of the same questions being asked now were asked after 9/11? all of these years later, there has been some breakdown -- communication breakdown, information sharing within the intelligence committee?

>> i think the president will get into some of that today. i think you will hear directly from the president today on some of those failures. i did not want to get too far ahead of them review itself. i think that there are some substantive differences from what we saw in the pre-9/11 days that have and were dressed between that incident over the past eight years. >> but there is skepticism. >> while there are some -- what this involves intelligence, i think some of the problems are not completely analogous. you will hear the president talk about that. you heard john talk about that over the weekend. the president's charge in these

reviews but then watch listing and the capability of review of the department of homeland security -- look, the president is as frustrated as i am sure many of the american people are. we have spent a lot of money in the intervening years. we've set up new positions and stood up new agencies, so to speak. we have to ensure and i think the president will strive to do so, to reassure the american people that all that can be done is and will be done in order to protect them. >> on health care, c-span television is requesting leaders of congress to open up the debate to to their cameras. i know that this is something that the president talked about on the campaign trail. is this something that he supports and will be pushing for? >> i have not seen that. the president will be in some

discussions about health care in order to iron out differences that remain between the house and the senate bill and try to get something hopefully to his desk quite quickly. helen? >> i had a couple of questions. before pearl harbor, the navy did not talk to the army and the war department did not talk. was there a lack of coordination on all the security information? and what is the reason that you or the lieutenant thinks -- >> i thought it was our president. >> you had a white power and i came up with your. i'm sorry i interrupted your -- you had a wide "our" and i came up with "you r."

i think the president said quite clearly that there was a systemic intelligence failure. yes, the president will discuss that more today and what the review has shown preliminarily. and we'll get through some of the things that we have done as well as the team will begin to work through all the additional steps that the team in the president believe must be taken to assure the safety and security of the american people, that as i said to dan, i don't think that when we get through the review -- i do not think that it is completely analogous to some of the walls that the bureaucracy had

constructed prior to 9/11. i think some of that obviously has been not them -- has been knocked down and there is a greater amount of information sharing and there's a greater amounts of sheer intelligence that is collected. the president wants to know where the systemic failure happen and what we are going to do to ensure that we can do everything in our power to make sure it does not happen again. >> is that possible, and what is the core region -- reason? >> i did not know that i am the best person to speak for some of their actions. >> you had some information, you said. >> again, i think that for whatever all fall and murderous reason that people seek to get

on planes and do innocent people throughout the world harm, i cannot speak to that type of deranged mentality that lead someone to do that. >> you do not know what is motivating all this? >> i can certainly name a few of them. i think that the president, though, his job is to in this incident do all that we can to ensure that every step is taken to prevent it from happening again. >> you're not answering my question. >> i may not have understood it. >> what is the core reason why this happened? >> i think that there are a number of reasons. they have stated in various messages and videos all sorts of reasons for why they seek to do what they do. i do not think any of it in any way what ever rationalize what we saw on christmas day. >> i would like to return your

original question. there's some people that believe this is not a catastrophic disaster was lot, that addulmutallab screwed up and making this device work. and a lot of people are saying that this administration simply blew it. >> i don't think i am going out on a limb that the president said that there was a systemic intelligence failure. >> other people would just say that they blew it. >> i do not know what the substantive difference between that tw are. the dollar so it is the same thing. -- >> so it is the same thing. >> the president said that a failure of the american intelligence service happened in allowing what we saw on christmas day to potentially transpire, absolutely. i think the president said that

about a week ago. >> does the president take any personal blame for that? does he believe he did not pay enough attention to these issues? the dollar's no, i do not believe that that is the case. public the fact that he had this incredibly cold plates did not, as you say, distract them from spending the time needed. >> we spend an awful lot of time -- you of asthma lot of questions, most of which i cannot answer on camera, about different activities. nothing has distracted the president from keeping us say. >> in hawaii -- while he was an all white, a lot of critics said that he was slow and weak and said that he should have come home from hawaii on a full-time basis. how does he feel about that? >> you are in the light, right? -- you were in hawaii, right? you know that he was somewhat

busy. the president worked on this throughout his time in hawaii. he worked on that before that and he has worked on it since he has come back. >> his initial response was three days. >> 8 keeps pundits employed. >> on the pull bodies can, how important is privacy in all of this? does the president think the american people just have to get used to the fact that they have it undergo these embarrassing procedures? >> i believe that the administration believes that we can easily achieve the balance that allows us not to give up our privacy but at the same time protect us from those that seek to do us harm. >> of the follow ups. first of the question about rolling out u.s. military

intervention. is it fair to say that the president's position during the campaign on pakistan, for instance, if they do not act, we will -- it is that his tradition and to all things al qaeda? is it fair to assume that? >> i did not want departure question, but at the same time, suffice it to say that this government and this administration makes use of actionable intelligence. >> and when it comes to al qaeda and pakistan, there is no reason to think that yemen -- there's no reason to think -- >> chuck, i think that answer the question. you understand that i am not going to get into what we do with actionable intelligence. >> fair enough. on the question about addulmutallab it has been reported that he has clammed up

over the last few days. does the president believe that if he were an enemy combatants, that they would still be able to get intelligence out of him? >> addulmutallab spent a number of hours with the fbi investigators in which we gleaned useful, actionable intelligence. the decision to reject the decision was made in this case previous tests similar decisions that were made with richard reid, with zachariah miss a moussaoui -- the investigators believe that they get useful information from these terrorists. despite what you hear otherwise, i do not see -- i honestly do not see the point that is being made when you look at past decisions that were made by

others administrations. >> you said that the fbi that actionable intelligence. >> and no, i am not going to go into it. >> without saying what it is, have there been plans implemented since you received this intelligence? >> i am not going to get into -- i think it would be a bad precedent for me to discuss that intelligence from here. the boilers and on the meeting today, is the president going to be interest -- issuing to the intelligence gathering aspect, after seeing these reviews how was he going to make sure that the review process -- is he setting benchmarks? is he going to say, i want to know what is happening now? >> at the end the day, i think

we will have more on this in the next few days. one part of your question -- i do not think that -- we have to make sure that we are not in the mindset of looking at homeland security and intelligence as to different silos. what we're concentrating on is to make sure that information can move across, and the problems that were gotten into 3-911 caller3-9/11 are going ton into. >> you're dealing with systemic failure and human intelligence failures? more in the security side. >> yes, though i will say this. again, you know the president has two refused. one of those is detections capability review, based on

substances and this individual getting on the plan with what he had. >> the british government yesterday said that they had passed on information about addulmutallab in britain to u.s. intelligence. commenting on that, do you have any description of the nature of that? >> i am not going to get into intelligence matters. as well as discussing that aspect of the ongoing review. >> we know from these agencies already that a lot of these reports were them saying they were not to blame someone else was to blame. >> this is based on what? >> these agency. and secretary clinton said yesterday -- a >> a week ago the president went

out and said that we had a systemic failure, okay? when the president did that -- we are going to move beyond the agency failure point. we are going to break down whatever silos exist with information that is collected and shared. that came from the president. i don't think anybody should misunderstand how that should flow to leak and every agency. this is a far more serious game been trying to figure out with eight -- which agency can blame which other agency. that is not the point. the point of this is to take every conceivable and knowable action to make sure that what we collect is processed, that as it is gathered, it is processed and used to prevent something like this from happening. the president will inshore and i will assure you today that the president will discuss this in the situation room. the president will not find it acceptable, a response where everyone gets to a circle and

points to someone else. and the people -- and the american people will not this -- accept that. >> can you give us a little bit on what the president talks -- intends to talk about what democratic leaders this afternoon? >> we will have a few sentences of a readout afterwards. it will talk about -- look, in terms of talking about health care, they will talk about the great, vast majority of the two bills that coincide, and i think we will begin to talk through how we worked out what limited number of differences there are. >> there has been talk about putting up formal conference committee on capitol hill, or behind closed doors. does he have a deal about it

being negotiated now? >> the president is anxious to get the difference is worked out and passed out of both houses. i think you can look through the past many years and see where situations -- where they worked out the differences between two bills and it happens very similarly to what the president is engaged in. >> we are leaving this recorded program to go live to the white house to hear from president obama after meeting with national security officials about security lapses that led to an attempted bombing on christmas day. we're going to take your phone calls after the president's speech.

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>> we are waiting for president obama to speak at the white house after a meeting with 20 of the nation's top intelligence officials. in the daily briefing today, robert gibbs said that the president shares many of th americans. and that president obama will deliver a stern warning to his appointees at that meeting today. he will not tolerate efforts by the cia, the state department, and others to shift blame for a

reason intelligence foul-up to other parts of the government. again, waiting for president obama. >> good afternoon, everybody. i just concluded a meeting with members of my national security team, including those from our intelligence, homeland security, and law-enforcement agencies involved in the security review ordered after the failed attack on christmas day. i call these leaders to the white house because we face a challenge of the utmost urgency. as we saw on christmas, al qaeda and its extremist allies will stop at nothing in their efforts to kill americans. and we're determined not only to thwart those plans but to disrupt, dismantle, and defeat their networks once and for all. indeed, over the past year we have taken the fight to al qaeda

and their allies wherever they plot. be it in afghanistan and pakistan, in yemen and somalia, or in other countries around the world. here at home, our intelligence come home and security, and law enforcement agencies have worked together with considerable success, gathering intelligence, stitching it together, and making a rest from denver to texas, from illinois to new york, disrupting plots and saving american lives. these successes have not come without a price. as we saw last week in the loss of our courageous cia officers in afghanistan. but when a suspected terrorist is able to board a plane with explosives on christmas day, the system has failed in a potentially disastrous way. it is my responsibility to find out why and to correct that failure so that we can prevent such attacks in the future. and that is why shortly after

the attempted bombing over detroit, i ordered two reviews. i directed janet napolitano to review aviation screening technologies and procedures. she briefed me on her initial findings to date. i am pleased that this review is drawing on the best science and technology, including the expertise of secretary of energy steven chu. i also directed my counterterrorism and homeland security adviser john brennan to lead a our review into our watch listing system to fix what went wrong. as we discussed today, this ongoing review reveals more about the human and systemic failures that almost cost nearly 300 lives. we will make a summary of this preliminary report public within the next few days. but let me share some of what we know so far. as i described over the weekend, elements of our intelligence community knew umar farouk addulmutallab had traveled to

yemen and joined up with extremists there. it now turns out that our intelligence community knew of other red flags, that al qaeda in the arabian peninsula not always fought to hit -- hit targets in yemen but in the united states appeared we had information that this group was working with an individual who was known -- who we now know was in fact the individual involved in the christmas attack. the bottom line is this. the u.s. government had sufficient information to have uncovered the plot and potentially disrupt the christmas day attack. but our intelligence community failed to connect those stocks, which would have placed the suspect on the no-fly list. in other words, this was not a failure to collect intelligence. it was a failure to integrate and understand the intelligence that we already had. the affirmation was there,

agencies and analyst who needed it had access to it, and our professionals were trained to look for it and bring it altogether. now i'll accept that intelligence by its nature is imperfect, but it is increasingly clear that intelligence was not fully analyzed nor fully leveraged. that is not acceptable and i will not tolerate it 3 time and again we have learned that quickly piecing together information and taking swift action is critical to staying one step ahead of a nimble at this very. so we have to do better and we will do better. we have to do it quickly for american lives are on the line. i made it clear today to my team that i want our initial reviews completed this week. i what specific recommendations for corrective actions to fix what we're wrong. i want those reforms implemented immediately so that this does not happen again and so that we can prevent future attacks, and i know that every member of my

team that i met with understands the urgency of getting this right. and i appreciate that each of them took responsibility for the short falls within their own agencies. immediately after the attack, i ordered concrete steps to protect the american people -- you screening insecurity for all flights domestic and international, more explosive detection teams at airports, more air marshals on flights, and deepening cooperation with international partners. in recent days we have taken additional steps to improve security. counterterrorism officials have reviewed our system including adding more information -- more individuals to the no-fly list. while the review is found that our watch listing system has not broken, the failure to add umar farouk addulmutallab shows that this system needs to be strengthened.

as of yesterday, the transportation security administration is requiring enhance screening for passengers flying into the united states from or flying through nations on our list of state sponsors of terrorism or other countries of interest. in the days ahead, i will announce further debt -- steps to disrupt attacks, including and his passenger screening for air travel. finally, some have suggested that the events on christmas day have caused us to revisit the decision to close the prison at guantanamo bay. let me be clear -- it was always our intent to transfer prisoners to other countries only under conditions that this security is being prevented -- being protected. with respect to yemen in particular, there's an ongoing security situation which we have been confronting for some time along with our yemeni partners. given the unsettled situation, i've spoken to the attorney general and we have agreed that

we will not be transferring additional detainees back to yemen at this time. but make no mistake -- we will close guantanamo prison, which has damaged our national security interests and become a tremendous recruiting tool for al qaeda. in fact, that was an explicit rationale for the formation of al qaeda in the arabian peninsula. and as i've often said, we will do so and close the prison in a manner that will keep the american people safe and secure. all reviews and the steps that we have taken and will continue to take the to the heart of the counterintelligence and homeland security that we need in the 21st century. justice al qaeda and its allies are constantly evolving and adapting their efforts to strike us, we have to constantly adapt and evolve to defeat them. because as we saw on christmas, the margin for error is slight and the consequences of failure can be catastrophic.

as these violent extremists pursue new haven's, we intend to target al qaeda wherever they take root, forging new partnerships to deny them sanctuary as we are doing currently with the government in yemen. as our adversaries seek new recruits, will consular review and rapidly update our intelligence and our institutions. as they refine their tactics, we will enhance our defenses including smarter screening and security at airports and investing in the technologies that might have detected the types of explosives used on christmas. in short, we need our intelligence, homeland security, and law enforcement systems and the people in them to be accountable and to work as intended, collecting, sharing, in a grating, analyzing, and acting on intelligence as quickly and effectively as possible to save innocent lives. not just most of the time, but all the time. that is what the american people deserve and as president that is exactly what i will demand.

i think you very much. -- thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> present obama's first extensive comments since the bombing -- the attempted bombing on christmas day. we will -- he had just held a meeting with many others. he spoke for about 10 minutes or so. we wanted to give you a chance to weigh and with what he said. your experience with airline travel since the attempted bombing on christmas day. here are the numbers to call. make sure you meet your television set to call in or you're ready of -- you mute your television set the call and for your radio. he reiterated toward the end of

his comments his intention to close guantanamo prison, although announcing that he and the attorney general have agreed at least for the short-term that the u.s. will no longer send back detainees to yemen, at least for the time being. the president speaking again about u.s. efforts to disrupt, dismantle, and defeat al qaeda. we want to give you a chance to see the president's comments later tonight, tonight at 8:00 p.m. eastern here on c-span. let's hear your thoughts from tampa, florida. marcia is on our democratic line. caller: i wanted to make a couple of commons. i think the president outlined pretty clearly what his administration plans to do to these new terrorist threats. one of the things that we have done as a nation is to be to open with our plans. so that people who seek of our

citizenry. and the second point says the attack occurred on christmas, we've had a lot of people coming out same things against the president. and they always talk about what the american people want. they talk about that different polls and everything that they administer. i would like to say, who are the people that they are talking about? i have never been told. -- polled. i think it is posturing by those who would seek to undermine the administration. host: faq, marcia. let's go to our republican line. caller: that was a complete joke, the speech that the president gave. host: what did you hear, joseph? caller: he is on television more than oprah.

the fact is this guy has no clue. i have not heard a speech like that since i heard jimmy carter give one since he was president. and that was the start of this whole mess, when the iranians took our hostages -- to our embassy people hostages. this guy does not have a clue. and dick cheney was right, someone needs to call the president on obama or whoever is advising him, jack napolitano i guess. this is a really ridiculous joke. host: the president spoke about the two refuse that he had ordered in the aftermath, that attended bombing on christmas day. a look aviation screening on the homeless security side, and then on the counter intelligence side, john brennan looking at the watch listing system. in his comments, the president said he is looking for initial

reports in the matter of the next couple of days. albany, new york, charles on our independent line. caller: thank you for having this program on the greatest nation in the world. there seems to be a lot of party strife and egos involved. instead of all the hoopla and getting down to the basic needs of america, what the federal government should do is protect our borders. listening to the comment as before me, janet -- what the caller? it is not about that. they are in this position because of their great minds and their love for american. but their egos get involved, and that is really horrible, because americans to take it upon themselves to protect their own neighborhoods as well. host: was this the kind thing that you think a department head or some individual should be

fired or personnel change? caller: someone should lose their job, whether corporate america or even the neighborhood store, get rid of them. they are putting something in jeopardy. our nation's livelihood, our ability to live free the way that we want within a lot, and it starts in the basic neighborhoods. if the local police see something and passes up a command -- a chain of command, who knows how far it will get? but it stops from that point, you go from where it failed at a certain point, and you make changes. host: they may be taking a look at what happened in flight to 53. we will look at the incident, including the senate judiciary committee's scheduled a hearing on january 20. here is our caller on the democratic line from maine. caller: i like to comment on the president's speech.

i like to see him pull off his boots by his bootstraps and start naming names and firing them and replacing them with intelligent people. host: who is to blame in this? who to fire? caller: the top two managers in the cia and the fbi, and maybe the nsa. host: from washington state, hear a speech from the independent line. caller: have any agencies does it take to figure out we're at war with these extremists? it is all about corruption and america should be ashamed. host: the caller mentioned medicare and the president will be meeting today on capitol hill with leaders talking about how to move full word in creating conference legislation for the house and senate versions of that legislation. taking your calls for the next

few minutes of the airline security measures. there some 20 officials that met with the president. we will speak tomorrow with eric clapton on "washington journal" tomorrow at 7:00 a.m.. from pennsylvania, tim on the republican line. caller: i am basically going back to when the vice-president had mentioned it is not a matter of time of wind, but if -- or if not if, but when this is going to happen. now it appears that there are obviously -- they are obviously trying to make it happen. it seems to me that if they assume that from the beginning of the administration, why have they just now, when something is happening,