>> well, the stimulus package did save a lot of teachers' jobs and the school board and school districts are very thankful. cities have gotten some firemen and some policeman have stayed on the job and other people and they are thankful and the district i represent, jobs went for infrastructure and people are working. and i was saddened to say it was not a bipartisan bill, not by my choice but because people felt it didn't go far enough, which may have been my colleagues' reason for not voting for it or because they didn't want to spend the money but the reality is we have made attempts to create employment and thank god people have stayed in the job and will continue to do it. i support infrastructure development. i will join mr. la tourette.

there is water treatment plants and bridges and i agree with it. hopefully we can get a jobs bill that creates more infrastructure but it is greatly needed. . . we need to work together. i guess both of us need to quit looking at the next re-election and look to the nextçó generati as i heard it in the state of the union. we're willing to do that. and i want to thank or the emphasis on the budget on safety. i have to tell you that sometimes we overlook it. the whole taxing issue, the dis-- texting issue, the distraction for drivers is very important. adds people are driving and wanting to text and not text, but the whole issue of how people are not paying attention to their driving, it's very

important. the issue i have -- it's not an issue, it's just a question, with next-gen. with next-gen. i have to tell t three years ago i was greatly disappointed because i saw a lot of disarray and confusion in how to get it going and it seemed like things weren't happening because some agencies weren't involved and probable the priority was not there. today you're telling me that there is a project over the gulf of mexico and it's becoming a reality. i can wait for the administrator for more specifics, but overall, is it underbudget and on-time? i guess that's my main concern because we can't spread it out like we have other programs dealing with navigation in the sky, so this is very important, but it's very expensive and so underbudget and on-time is a very big concern to me.

>> well, we have a good plan. we have some very good resources in the budget that's being proposed to all of you. we have people that think about this every day. as i said, we have had lots of discussions with the airlines last year about how they can pay for what they need to implement in the planes. we're pretty far along on this and we think we will have it sooner rather than later and there is a commitment from congress. there is a commitment from the industry and this is, if not the top priority, which is safety, it's right up there for us to implement this. and the white house is behind us on this also. >> i'm glad to hear that the airlines are involved in this. >> absolutely. >> the other is air traffic controllers. i remember sitting here in heargs when i was trying to discuss the screen and the mouse so hopefully they're

involved. the other qui i have -- and i support you for the high-speed rail. one of the disappointments i guess that i heard this morning is that they still will be using lines accommodating most hearings i sat through here, if you try to accommodate three partners or two partners, it's always that you're not going to have that speed that you're looking for above, even to get to 90 is quite a challenge. and so i just i hope you can resolve that issue. itçóñriñ; +kwú) a problem in current infrastructure, especially the rails. >> thank you. >> thank you, i'll try to get through this in five minutes, mr. chairman. first of all, mr. secretary, the largest transportation

project in ohio1o> thank you. thanks for your leadershipship in the community. >> thank you, it's taken many, many years. thank you for your openness to that. number two, i have two quick questions. one is the administration is about to make $1.5 billion in tiger grants funded through the recovery bill. and there is an additional $600 million that we provided in the regular budget in the f.y. 10 bill. do you anticipate recompeting the tiger grants for the new funding, the extra funding, or

are you in the next two weeks going to roll out an announcement that spends the entire $2.1 billion. the second part of my question is -- if ajo project scored hi in the initial round of scoring but is not funded, are you going to make those projects compete again? >> we're stat torl to make announcementsñv=9át $1.5 billion by february 17, which we will do. and then we will -- there will beñi competition for the initially -- additional money. i take your point on programs where we didn't have enough money but they're valuable programs or projects, you know, i'll get back to you on whether they can compete those funds. >> thank you. i will state the record and provide more detail that the top project in our regions which was the modernization of our shipyard was not able to be

funded. and i talked with the secretary and you have been great in trying to explain what happened. it was a top priority of our city, county, myself, our governor, everybody else but here is what we ran into. in the recovery act, there is a section, 601 a 8 that defines project if located within the bound "desperate housewives" a port terminal to include surface transportation, infrastructure modifications that are necessary to facilitate direct intermodel interchange transfer access into and out of the port. our state thought that a port project would be eligible, our shipyard would be eligible. what happened is once it got over to d.o.t., it then got administered by the highway administration. that is where we ran into difficulty. we will explain that, but we're hoping that in the new jobs bill, assuming the senate passes it, that if a project,

our state d.o.t. director was in here yesterday and if a project is eligible for any d.o.t. program, it should be eligible for the recovery jobs program. we ought to find out a way to do that and not have any stove pipe inside of d.o.t. tell us we can't do it. it seems there is a conflict in the law. we will try to clarify to the best of our ability, we wanted to make you aware of it. >> thank you. >> the final question that i have is just a request for information and that is are there any programs that usdot, authorities or funding to help urban communities, urban counties consolidate all of their public vehicle fleet maintenance and management to go green? is there anything in the law, is there anything in what you're doing over there because i think this would save us a great deal of money because we have state fleets, city fleets, county fleets and a transit

authority fleets. everyone has their own garage. every garage leaks energy. the vehicles are not that green. so i'm looking for any type of incentive program or demonstration program that might exist through d.o.t. that we might be able to look in, if it does not exist, create an authority to have it it exist. >> we'll get back to you on that. >> i thank you very much. thank you, mr. chairman. >> thank you. mr. lay them for your -- latham for your final round. >> thank you very much, mr. chairman. mr. secretary, there are many states in the country that don't have large transit system like iowa. in our case we put about $60 million a year into the mass transit account with the gas taxes that we pay. we get back about $35 million in the formula. we still have tremendous needs as far as new equipment certainly as far as the systems

we have. is the department doing anything to address the funding inequities for the smaller transit systems and like in the state of iowa? >> well, we're -- our transit administrator is trying to work with states like iowa and why don't i get back to you with some of the specifics that he's been doing. >> ok. >> i'll have him come up and meet with you. >> great, thank you. as you know in the f.y. 2010 omnibus, there was a provision in there that authorized the use of heavy six-axle trucks on interstates. highways in maine and vermont, the committee didn't really have a chance to have a hearing or to really debate anything about that. and there is a lot of interest from other states obviously for the same types of provisions. i just wonder what your

thoughts are on a country-wide pilot program that would allow states to increase the allowable weight on the interstate and would you be in favor of considering such a pilot? >> our administrator for truck safety is working on this and we -- i'll get back to you with the specifics on what we're working on. >> ok. obviously, we have -- >> this is a very, very controversial hot topic and i'll, either i'll come up and brief you. >> let's get into one that is real easy. what about mexican trucks? mr. rodriguez -- >> we're working with the white house on a proposal. >> i know, we have had discussions between the two of us that this is, with nafta, it's a commitment that we made with nafta and to make sure

that it has to be done in a very safe way, obviously. >> right. >> you're going to get back to me again? >> no, i'm just going to tell you we're working with the white house on a proposal. once we have that, i'll be happy to come up and show it to you. >> is there any time line you're looking at? >> soon. >> soon? ok. in the interests of time, we have votes on the floor, so i will give back my time and i appreciate that, thank you, ray. >> thank you. >> thank you, mr. secretary, for being with us. i have a couple of just very quickies and we will close. if when we get around to passing this bill sometime later, some months later in the process, if it's in regular order, a limited number of months, and the -- if the economy looks like there is

need, what would your thought being going above the 10% that has been allowed, several people have expressed an interest of going above the 10% allowance for capital funds that go out by formula going to a higher percentage? >> i think that if you all decide to get into that kind of debate, we'll talk with you about it. i think you know where we stand on the principal of doing it and so if you all decided to do something else, we'll talk with you about it. >> the other thing that i hear several people mentioned it at one point or another is the steam lining of the processes. it is clearly the processes where one does planning and environmental work and design and finally at some point some 10 or 12 years later get to a construction on a project that people are concerned about.

does the administration have any kind of preparatory work to work directly with the t and i, that's an authorizing issue. we have to somehow streamline these processes for major capital programs. >> yeah, i mean we talked to the -- i talk to the chairman all the time and also we're working with her staff and so we'll continue to do that. >> i thank you for that. i just also want to thank you very much for the rail money out of the recent announcement a couple week ago announcement that involved connecticut and massachusetts and vermont in the connecticut river valley. that's a very valuable program that i think can, much of it can be delivered within certainly 2010 and 2011 and a

large portion of the work will be done during this calderon year -- calendar year that we are in. a good deal of time will be saved in the trip for people that are using that amtrak corridor. we greatly appreciate. >> thkts for your leadership in the area and the regions -- thanks for your leadership in the area and the region. >> a lot of members have said that you have come to your states. i haven't been with you in iowa and you haven't been with the chairman in massachusetts. we would invite you. >> i have been to iowa but i wasn't to your district. >> what? you didn't call? >> i spent a half a day in dubuque and that's when i learned about the new i.b.m. employees and the mill works area. whenever i'm invited, mr. latham, i will be in your district.

whenever i'm invited, mr. olver, i'll be in your district. when mr. rodriguez invited me to san antonio, i came. >> we'll see. finally, i just want to thank you for your very strong leadership in this field and really if there is a little bit of testiness that are coming from members who have great concerns, not with you, not in any kind of a personal way i am quite certain and i want to thank you for the steady communication with the subcommittee. it's very much appreciated. >> one of the values i bring to this job is i sat in those chairs. i know that when the congressman speaks, he speaks with great authority and great sincerity and i wouldn't question his motives at all. i know there is a great deal of frustration being expressed and so we have our job to do and we

will continue to work with all of you on the way forward here. >> thank you very much. >> thank you. >> this hearing is adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> after this hearing, secretary law coulahood clarified his fees on the toyota recalled. / in a few moments, house and human services secretary kathleen sebelius on the president's plan for health care. and washington journal is live

at 7:00 eastern would segments on the jobs bill, the war in afghanistan, and an update on grant's tomb?" %y>mt now forqy educators, csn offers the new cspanclassroom .org. it has timely and useful cspan and videos for use in your classroom. they're organized by subject and topics. it has listed education news and the chance to connect with other cspan plus from teachers. >> male house and human services secretary kathleen sebelius on the president's plan for health -- health care legislation. this is part of the conference for health care analyst and researchers. the comments are to the group

academy health and or 40 minutes. did think that there is a lot in common between working and planning for months and having a clear agenda and knowing what you will do and having 30 inches of snow interrupt that brilliant planning. it feels like the day after the massachusetts election. here we are. i am delighted to have a chance to visit with you. i was struck looking at the agenda about how much there is in common with the kind of topics you will talk about for the next couple days and what we deal with in the office each and every day. you have a terrific lineup of speakers and panelists.

i am pleased you're going to get to hear from dr. peggy memb ham. i get to hang out with brilliant scientists and policy advocates and you have assembled them today. issues like how to use the the -- the new technology to empower consumers and create incentives for providers to deliver better care, how to invest effectively in prevention. those are some of the challenges that we are dealing with within the department each and every day and the same exact questions that we are asking. i am sorry i cannot join you for the full presentation but anxious to -- david will share with me all the good strategies and ideas that you come up with. i want to start by giving you

the administration's view on health reform as it stands now and where we see things heading. let me tell you from the outset the president and the administration are as committed to delivering on comprehensive health reform out as they have ever been. the president is very determined that not only does this need to happen for the citizens of this country, but it is essential for the economy of this country. every day that goes by and every report that comes out reinforces his notion of how intimately what is going on in the health- care system is tied to our economic survival and our economic progress. this is not about a legislative victory or approving -- or proving a point as he said i

thought, very eloquently in the state of the union address. it is not about his political standing or you would have chosen something else to start with. he feels strongly, i feel strongly that this is one of the determining issues about the future of our country, about how prosperous will be in a global marketplace and how healthy are citizens will be in this competitive world in which we live. we know a lot about the human stories. the monsoor paying for hospital bills because of a pre-existing condition and they cannot get the insurance they need or a steel worker who every year sees his pay go down because more of that salary is diverted to trying to pay for health care plan for seniors going to the

hospital to get treatment for urinary tract infection only to end of dying from a staff infection they get from the hospital. one of 100,000 people who die in this country. the people who are worrying about whether or not the promise of medicare may now -- ever be there for their future. there are lots of individuals around this country who are worried about the system and do not know what the answers or solutions are. we had our interesting moment, a little bit about the glitch in the health-care market where i am the mother of two 20- something sons, when they

graduated from college, neither were in a health care situation where they provided health care. they had not a lot of trouble finding affordable insurance and we have resources to pay for that. i watched their friends, a number of kids to, one had a previous football injury and another had some treatment early on in high school for a series of challenges he was facing with drugs and alcohol, neither of whom could get insurance in the marketplace and had to spend some time struggling and figuring out what the options were in helping to not be in a situation where they ran into an accident or disease that they could not cope with, knowing that they face a lifetime of crushing bills. there are lots of people -- looking through the lens of the uninsured or the underinsured or even those who have insurance

understand that is a tenuous situation they're in. we know that the process over the last year has been confusing to a lot of folks. when you talk to people, when i have the chance to travel around the country and visit with people about what are the elements in the house and senate bills, there is overwhelming support. sometimes they're confused and disgusted with the process than they do not want anything to do with it. they are way too afraid that what ever is going on cannot possibly be good for them or their families. we know from beyond the personal stories what this is doing to our economy.

i deal a lot with people in the small-business market. my friend, karen mills, who is the small business administration tells me that conversation goes on all over the country. business owners who are in the crunch of the marketplace. either they drop coverage altogether, because they simply cannot afford the dramatic increases they're seeing, or they lose employees to people who could afford much better coverage. the cannot stay competitive in this marketplace and the are choosing between keeping employees and keeping health coverage. they cannot do both. we know that our entitlement programs of medicaid and medicare on track to be broke in medicaid budgets are crushing states all over the country. medicare is due to run out of

money in the next seven years. we're at a point in this country where we spend almost double what any nation on earth spins on health care. we are according to the report last week spending 17% of our gdp on health care. the largest one-year increase in the last 40 years is the jump in health-care costs. compared to what is going on with the rest of the economy. we live sicker and i agree that many countries on earth. danish ministers were coming to the u.s. to talk about the work we're starting on prevention. i was struck by the fact that in denmark, the their per capita health care costs are $3,300 a year and we're up over $7,200 a

year. their health measures in virtually any area you can choose our better than ours. some of that can be explained with the relatively homogeneous cultures and issues we may not have with diversity of health experiences. there is too large a gap and we are spending too much money and getting worse results. both congress, both houses of congress have worked on this for years. there are numerous good ideas and they have much in common. when the push for reform

started, a lot of people said we cannot do it now. we cannot take this much time. i think once again that it is so intimately tied to our opportunity for economic recovery that we have to do it and we have to do it in a way that not only are the bills paid for, and did not add to the deficit, which is different than most recent health reform that was passed by the previous administration the plan b drug benefit that was not paid for in part of our growing deficit. the president is committed to having this paid for but also, looking at ways that the system is transformed into a much more cost-effective, higher quality system in the long run. if we pay for what we're doing and continue to do it into the future and add 45 million to the

existing system, we have not made any progress. we have not change the trajectory which is now indicating that we will not be able to afford this system into the future. the future. @@@@@@@ @ @ @ @ @ @ k@ @ @ @ @ we have to have a different way of changing the delivery of the medical care in a way that tackles some of the underlying causes of our extraordinary costs. again, those are all key elements in the reform system. the president has invited key members of congress to join him

on the 25th of february. he is hopeful that this will not be just one more conversation about various components of a plan but really hopes that the republicans are willing to come forward with their own plan, not just criticism, but a plan. $1 trillion of the deficit as a significant step forward from where we are now. covering all americans, having a delivery system that begins to focus on wellness and prevention and not just wait until we deal with acute-care. come together and move forward. a lot of people have said is the starting over and the answer is absolutely not. there are comprehensive proposals on the table. he is ready and able to add to or at various elements that may

be missing. we have to -- the republican members have to greengage. i think it is not acceptable that half of the legislative body is pushed away from the table when the conversation began and say we do not want to participate in this process. discussion was we do not want to participate in anything that has a public option. we cannot talk about any kind of insurance strategy. as far as i can determine, the public option is no longer part of the plan. no one has come back to the table and said we will talk about how to move forward with the private market strategy. we're hoping that will happen in february. we will continue to work the house and senate leadership -- the house and senate leadership

are willing to discuss with each other what is the best pathway for. the president remains committed to the notion that we have to have a comprehensive approach. the pieces of the puzzle are too closely tied to one another. it is disingenuous to say we're for the insurance reform and yet do not support the notion that everyone would have to come into the marketplace. if you have a private market system without rules that allow them to cherry pick the system, and do not require those who are well to buy insurance, you have effectively destroyed the insurance market. he will have an adverse selected pool and you will only have six people in its and the costs will skyrocket. i do not think it is a genuine step forward to set want to provide coverage for all americans and yet, not recognize

that there are lots of working americans who cannot bear the four -- cannot bear the costs of providing coverage and they are not in a job situation where there is an employer contribution. without some subsidized assistance will have an offering of coverage which we do now but not the affordability of coverage. pieces of the puzzle are necessarily tied together if you have a comprehensive approach and cost containment has to be part of that comprehensive approach. i think both house and senate have made sure there are ideas on the table which we feel will not jeopardize benefits. but actually move us in a direction where [unintelligible]

for not following appropriate protocol. cause for reform in -- and the case for reform is still fundamentally before us. it is a conversation we have had in this country for 70 years. i also was not part of those original conversations although some days i feel like i was part of those original conversations. the message is pretty straightforward. we need to finish this job. we need to step up and finally deal with a comprehensive health reform in america because our economy cannot afford us to do anything less. our health system is fundamentally broken and needs transformative infusion of

assistance and i think there's no question that millions of americans are desperate for some sort of health security that they do not have now. reform itself, the comprehensive look at the health insurance system and changes in delivering prevention systems does not magically transform all the issues facing us in our health system. it would be a huge step forward and be the biggest step we have made in 40 years. our health system did not begin and end with health reform and was never going to stop when the bill passed. which is why for the last year, we have been working on some underlying features of the system and will continue to work in all kinds of strategies with proposals that are contained in the 2011 budget which fit as companion pieces to

comprehensive health reform bill moving forward. one of the first bills that the president signed into law last year was the expansion of the children's health insurance program which has been enormously popular and enormously successful. in insuring children across america. we put out a report last week which looks at the baseline numbers and in spite of this economic downturn which has been experienced by every state in the country, to a half million more children have insurance and a year ago. either enrolled in medicaid or in schip programs. states have work to expand their coverage options for kids. in spite of tough budget times and choices, they understand that that is a fundamental step forward if you want to have a prosperous state, if you want

our kids to do well in school, they need to be healthy at the outset. children's health insurance continues to be expanded. we have a challenge. we think there are approximately 5 million american children who car -- currently qualify who are not yet enrolled. for the first time with the passage of the legislation last year, congress appropriated some average money and we're working diligently with partners, not only across my cabinet colleagues and government looking at the various programs that people enroll in that we might make it more an auto enrollment in children's health insurance, we would alert parents at a minimum but conceivably and roll folks, but working with states, our faith- based partnerships, with average organizations, and i am asking all of you when you return to

your home areas, if there are ideas or strategies that you have about enrollment opportunities. what we know is that some parents still have no idea that they may be eligible. others have listened to the discussion, we have heard this a number of times about health reform. they have to wait until health reform is passed, they think, in order for their children to qualify. they do not understand that bill was passed and written into law. some have been enrolled and because they move door because they did not fill out the proper forms are not enrolled and we need to reach out to them. we are looking for great partnerships to make sure that at this tenuous time, when families need it more than ever, that we actually have an aggressive and non-traditional outreach effort to try and get the word out to folks that they are indeed available for

coverage. another huge investment in the public health infrastructure which i think is essential moving forward and continues to play a major role is the continued expansion and investment in community health centers. during the recovery act, there was a major new investments, not only updated centers that are currently in place, but a major new footprint in areas underserved by health centers. what we know after a member of years is that -- a number of years is that high quality low- cost break care delivered effectively in neighborhoods centers and health becomes a component of what is available and offered to families but often it is everything from child care services to job counseling, certainly mental health services become a component of it. in the president's budget for 2010 and again the proposals for

2011, that footprint would continue to expand and be strengthening our primary care delivery. what i have seen in the creative strategies going on around the country is community health centers working in close partnership with community hospitals have developed some really strategic health plans, where the patients if they present through an emergency room are referred to our health center for primary care and family assistance. averages than to the family. it reduces the strain off and on hospital settings and cages a family with a home health -- engages a family with a home health provider and is cost-

effective and culturally sensitive. we have a major investment that started in the recovery act and has continued in the budget. we need more health care providers. we need more doctors and more nurses, mourners practitioners, more mental health professionals -- more nurse practitioners, more mental health professionals. we need an increased emphasis on non. -- non-traditional providers. men and women who will serve in underserved areas and providing a reach for spanish-speaking providers and multiple language providers. often the health barrier deals with cultural continents' and unless we make an enhanced

effort to have a diverse health work force, we will still have lots of barriers to health care delivery. the president has made it abundantly clear to members of his cabinet that he takes very seriously the stewardship of taxpayer dollars. one of the areas that we know has a great potential for recovering tax dollars is in the area of fraud and abuse. there are all sorts of estimates about what kinds of fraud made take place in the medicare -- may take place in the medicare system. i do not know who has accurate numbers. there are national groups to say that you can estimate that in any enterprise, 3% of business

is likely to be fraudulent. that is a huge number for a system like medicare. it could be as much as $60 billion if that were accurate. what we know is that there are billions of dollars. medicare is a system which pays over $1 billion of claims each and every day. a lot of money moves in and out and that makes it a huge target for fraudulent activities. what we have seen over the years is the activity used to be pretty unsophisticated. mom-and-pop operations. it now is a target for a much more serious, organized criminal activity. we need to actually really stepped up -- step oup our activities to prosecute and prevent fraud. thiwe have been asked to convena

multi agency operation, the task force we put together and part of the goal was to use data to analyze@@@@@@@ @ @ @ @ @ @ @ @ you'll get a call from the set or american express saying did you make a charge in buenos aires on the 10th of january. this does not look like your billing practices or were you really in boca raton on this date.

they actually have analyzed what the billing practices and want to get out ahead of what may be fraudulent activity. various patterns to try and have boots on the ground to go and quickly check out what in the world is happening. the strategies are paying off. later today, you have a panel dealing with geographic variation in health care. let me give you an example of how we are using our current tools. miami-dade county is home to 2% of the medicare beneficiaries who are receiving home health benefits. in recent months, they have 90% of the home health patients receiving more than $100,000 of care every year. you do not need a ph.d. in statistics to see that something

is going on. in fact, we moved one of the strike forces into the miami area, one of the first places that we targeted within a short time, literally billions of dollars in home health billings dropped, just having the presence of people on the ground verifying. they have moved someplace else, unfortunately. this has to be, we now have seven strike forces throughout the country. we have asked in the new budget to have resources for up to 17 cities. more than that, i think the data sharing, the verification we started doing new pre-screening spoor providers coming in. we need to -- make sure that people are not just hanging out a shingle and making themselves out to be a medicare provider.

there is tha service being provided. making sure these activities are legitimate but it is something we're taking very seriously. no question in this country that we are behind a lot of the rest of the world in our use of technology in the health system. it is still fairly stunning to me that in the vast majority of hospital systems and doctors' offices, we are using paper records. i cannot imagine any small operation in the manufacturing sector that would be using a written list and hand mailing it to someone in hopes the delivery would take place. that is the kind of technology that is in most providers'

offices today. congress and the president made a significant investment in developing a national electronic health records platform in the recovery act. what we're hoping is that we can provide enough incentives to have the tipping point that the market will took over. this is not that the government will provide the technology, but what we know is that without a platform, without some assurance that these systems will be interoperable, without some incentives and assistance, particularly for smaller providers or community hospitals, we will stay in our papered world. the technology move is under way. we have already seen systems in

place in pockets of the country where very positive patient outcomes are achieved because of the use of technology and health systems. one health system was using electronic health records to identify older women not receiving osteoporosis screenings on a regular basis. the screenings went out and identified some folks with real problems. one-third of diabetes patients in another system were receiving regular eye and foot exams as is necessary in a diabetic. the tracking of patients, monitoring with electronic records and following up carefully in terms of who got exams doubled the amount so

that two out of three of the patients is now receiving the appropriate follow-up care. the recovery act investments, the ability to put extension systems on the ground to do outrage to particularly small providers in underserved areas, to be the kind of tech centered helper's led by dr. david blumenthal, who is not only a great leader in this area but comes to this perspective by a practicing physician who uses electronic records. when he deals with providers, he describes himself, i am not the technology gate. we have those folks in the system. i can tell you how as a doctor this informs my practice and made me a better health-care provider to the point that i would never go back to

practicing any other way. it is a way to virtually integrate a lot of health care practices. doctors and hospitals do not necessarily need to be in the same system. not even in the same city but the kind of opportunity for coordinated care and bundled care and follow-up and monitoring. we know it can have enormous successes and when used appropriately, the opportunity to lower medical costs and increase the high quality care delivery is extraordinary. that also is under way. we continue to understand looking at the data then again, we have a huge problem in this country with chronic disease and chronic disease driven by some very clearly identifiable

underlying causes. smoking, obesity are two where there is a huge opportunity to change your health care cost estimates into the future if we can deal with some of those underlying causes. i am pleased to be joining the first lady tomorrow in her kick off of her childhood obesity initiative which she sees as a multi-year effort to tackle what is the true health crisis in this country, where we now have one out of three american children are overweight or obese. that is double the number 40 years ago. it is getting no better. there is enough childhood type 2 diabetes that is no longer called adult onset diabetes, we just collotype to because --

call it type 2 because more children are presenting with diabetes. we have the first generation of american children who will have shorter life spans than their parents. alive right now. it is a serious issue. we know that smoking dropped dramatically in the u.s. over the years but has unfortunately level off at 20% and it has not dropped in a number of years. not only is there a new era -- new aggressive effort at the fda which i am sure dr. hamburg will talk about. there is a host of strategies to see what it is that can influence people, smokers to stop and hopefully influence our

younger americans never to start in the first place. congress made a major investment in prevention and wellness as part of the recovery. -- recovery act. programs will be in place around the country, mainly aimed at tobacco cessation and be city and community grants will be announced later this month. we will have 37 communities, urban and rural, some tribal communities that will be looking at strategy's dealing with obesity and tobacco cessation. we will be able to figure out what works and drive it to scale. when 75 cents out of health dollar -- every health dollar is spent dealing with chronic diseases, the more that we can have early intervention and the more we can change that pattern into the future, the more we can

make sure that 50-year-old still not end up with diabetes but deal with it when they are 12 and 13. not only to lower our costs but to be healthier. those are important steps already under way to make us a healthy, more prosperous country. we're going to keep in our department working on this and a host of other strategies, dealing with health disparities, continuing to work at -- look at innovative medical countermeasures, trying to make sure that we are on the forefront of a number of initiatives, not only in the country, but around the world. there is no question that a comprehensive health reform is an important and integral part of this strategy moving forward. if we did all of those other initiatives and we did them very well, we still would have a huge gap in our health-care

system in this country and we would still be in many cases, just moving money around the system where those with insurance are paying and extra costs for those who do not have coverage, where we still have millions of americans who can access high-quality preventive care on a regular basis and do not seek care until they are often too ill to be treated appropriately, or dealt with adequately. we will still sees to be competitive in the global marketplace where virtually none of our comparecompetitors are dealing with the kind of major health gaps that we have here in the u.s. these pieces of the puzzle are tied together and we at dhs -- hhs take them seriously.

i am confident we will have a comprehensive health reform measure passed and signed into law this year and i am also confident that we have an opportunity with that piece as well as these initiatives in technology and prevention and wellness, a new way to look at health in america to make some really transformative changes that will yield a more prosperous, healthier nation over the next decade. now, another new course we have in the department is our effort to build a 21st century food and drug safety system. it is a charge that the president has given to us and we take very seriously, given the fact that our marketplace looks different than it did 25 years ago. we need a regulatory structure that looks different than it did

25 years ago and i am delighted that you are going to hear from another of our great new leaders at hhs, dr. peggy hamburg, who were wer were able to convince o be with us. thank you for braving the weather conditions. i understand we have another six to ten inches. we love having you here. we can use your expertise on a regular basis. we have lots of challenges to deal with. deal with. into the spring and summer. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> we will talk about the jobs bill working