teaching people to manage their own health. so i want to encourage you to do that. we have the defense department now doing this for pretee employment for soldiers -- predeployment for soldiers going over to hopefully prevent a lot of post-traumatic stress that goes on when they go in battle. so i want to encourage you to do that. if you can talk about the panel that will be created to evaluate preventive measures in the health care reform bill. >> first, congressman, i'm all for looking at any strategy we can find that is successfully reducing stress.ç i would be grateful for that evidence. i think çthat, whether it is i this instance or the framework for the services with the exchanges orç others, certainl

we will put together a very broad based group of experts and lookçç at what the evidence s. and in this area i think there are a number of cost effective sort of patient centered strategies that really do work. so,ç i look forward to getting the information from you and making sure that is part of the discussion. >> i will get it to you. i think the younger people -- i was at a conference this past week and there was somebody from the university of minnesota offering basically a stress reduction class for incoming freshmen and there a 50-person wait list. i think your leadership on this could be critical. another question i have and one of my colleagues mentioned the shortage of nurses. the issue with primary care physicians, if you can touch upon that and how we are going to bridge our way through that. >> i think that there is no

question we need more healthcare providers all together but we also need more of the providers to choose primary care. germanto ger ger geronology. one is using more loan and scholarship ability to attract people to those fields at the outset and pay off more of the debt for healthcare provider training in the areas into we see the biggest needs. as you know, the affordable care act had a feature that actually moved primary care providers for a couple of years with 100% federal funding from medicaid rates to medicare rates, which i think is again a big step forward to more 5 -- >> how about the bridge between those kids that are going into school now maybe and saying it looks like primary care will be an opportunity for me but at

2014 they will be just getting their before lore degree -- bachelor degree? >> we are changing the medicare pay rates. i think that payment of debt, payment of once you get your medical degree are a pathway to a much more robust primary care system. that is what i hear from medical students all the time. that they are in a real financial box in terms of not being able to pay off loans and being inadequately compensated once they become providers. >> so you think they will move ov over? >> i do. we have seen an increase already this year in primary care choices made by first-year residents. it is up about 20%. >> thank you.

>> thank you for your efforts to pass what is historic legislation. i know that your department is working overtime to make sure we begin the implementation of this legislation and that people can experience the benefits as quickly as possible and whether they are small business owners or seniors or young adults or people with a preexisting condition. we have already seen a couple of instances where insurance companies seem to be changing behavior in response to the bill. on the positive side we have seen several companies who plan to move ahead of schedule to let adult children stay on parents' plan until 26. but this are instances in which we will need to watch insurance companies closely to make sure they are following the new rules that have been laid out. for example, some reports including the senate commerce committee indications that insurers may be manipulating the medical loss ratios, reclassifying certain expenses to make it look like they are

spending at a higher percentage of the premium dollar on medical care to meet the standards in the law. the affordable care act included review provisions to stop insurance from hiking premiums to unacceptable levels. this law bans a host of insurance companies abuses, rescissions, denials of coverage, skwrerpbtd rating and -- gender rating and health status rating. let me lay out the three paces of the -- pieces of the question. what resourceses and tools does h.h.s. and the department of labor need for enforcement of health reform and holding insurance companies accountable with regard to medical loss ratio? how are you going to work with the national association of insurance commissioners to ensure terms like clinical

services, activities to improve are defined appropriately that do not routine activities more typically administration expenses? and today in the "new york times" there's an article that says senate bill sets a plan to regulate premiums and it is the federal government could regular lit rates in states -- regulate rates where they do not have the capability to do so and let me ask you to comment on that. so if you could address those three pieces, i would appreciate it. >> in terms of the resources and too tools, congresswoman, we are working very closely with both labor and with treasury that has sort of pieces of some of these puzzles on the initial regs and that has got pretty well. we have put together our office on consumer information and insurance oversight.

it is going to be led by a former insurance commissioner who also has worked in many states around country on regulatory oversight. we are working very closely with my former colleagues at the national association of insurance commissioners because this has to be, frankly, a state-led on-the-ground program. they are the ones that have this ability and information. and i think there is a very robust discussion. they are in the midst of identifying the terminology and definitions for the medical loss ratio. we are looking at some laws in place and what the actuaries can look at. so it is something we will take very seriously. in terms of the rate review, the original senate bill had a provision that senator feinstein was promise muulgating of a rat authority that would be the

interim strategy between the time the bill passed this year and new exchanges were in place. it was not part of the reconciliation measure and, i think, would set up a framework where, absent state review authority, this would be a fallback review authority. so i think that debate is likely to go on and may be an important piece of the puzzle. because right now, unless a state changes the laws and takes on this responsibility there really is no fallback other than highlighting what rating is under way. but there is no rating authority right now with the department of health ap health and human services. and we are encouraging states to do just that. >> i'm really pleased to hear that. as you know i come from connecticut. we have -- we are probably the insurance capital of the country but as my other colleagues have experienced we have lived in their world a long time. it is now time for them to live

in our world. thank you, mr. chairman. >> thank you very much, mr. chairman. let me join the color -- core rust of gratitude for your leadership but it does seem as though you are paddling up stream against the current. you look at your budget, about 85% is not under your control. it is reimbursement after people have gotten sick and it is to the elderly, to medicare and most of medicaid is still nursing home care for seniors. but something dramatic is happening in the health care of this current generation of young people that bodes ill for the future costs of care. asthma rates have tripled in this past generation. one in every six american children now has a developmental

disorder, attention deficit disorder, mental retardation, dyslexia. one in 59 boys is diagnosed with autism today. after accidents, cancer is the leading cause of death among children. primary brain cancer has gone up 50%. childhood obesity has quadrupled in the last 10 years and -- diabetes is out of control. about 25 million and one in two minority children are said to develop diabetes during their life time. it would seem that we have to get a handle on prevention. what is causing all of this? because it is a dramatic change in the last generation. the first lady's emphasis upon obesity, on what people eat, is critically important. i would like to know how you are integrating that in terminals of your program priorities. but it also may have something to do with the chemicals in the

air we breathe, or the water we drink or the food we eat. in fact, there was an analysis of umbilical cord blood in 2007 and 2008 that showed that the average infant had 232 industrial compounds present in umbilical cord blood. so, many people think there may be an endocrine disrupting effect on healthcare that is contributing to the massive increase in certain diseases. i ask you because you have responsibility for the national institute of environmental health sciences. i know they have some indication this may be what is behind these massive changes in childhood illnesses. i wonder if you have any plans to enable them to take a more robust, aggressive approach in

terms of the environment's effect as well as what you are doing in coordinating with the first lady's initiative on obesity. >> thank you, congressman. the statistics you recite are alarming and, unfortunately, very real and ones that we have to take incredibly seriously. the shorthand is that we spend more, live sicker and die you younger than most developed countries and there is something fundamentally wrong with that puzzle. the first lady's initiate stiff not only focused on kind of what you eat -- that is a piece of the puzzle -- but is a strategy that looks across the areas and understands that kids are impacted and the health of kids is impacted by what they eat in and outside their houses, what goes on in school, how much exercise they get, whether there

is a safe place to play and walk. a whole host of strategies. and i think it provides a template for the kind of thing you are talking about. first, reporting is better in this situation. some of what you highlighted is from better monitoring or reporting but that doesn't compensate for the incredible increases. some of it is preventible in terms of what we are doing to ourselves and some of it is likely to have environmental impact. my assistant secretary on health, dr. coe has re eengaged our department in work with the environmental protection agency and others in looking at the health impact of environmental issues. our h.h.s. had kind of withdrawn from that space for a while and we are very much back at the table. so, whether it is looking at

carbon content, or water based diseases, or air which has a huge impact on asthma, the kind of air quality, there are huge health impacts on environmental issu issues. and i would suggest also that the food and drug administration is taking very seriously a whole host of investigations in terms of food content, chemical conte content, which may well impact people in terms of not what they are eating but the kind of cans, bottling, a whole host of other areas. so, this is all something that i think we are reengaging in in a very active way and share your alarm at what the current health profile is for this country. >> thank you, madame secretary. >> madame secretary, i have a

number of questions which i would like you to answer for the reco record. one on health professions workforce, another on pandemic flu, one on healthcare associated infections, oral health. health information technology, and several others. but let phame ask a couple of questions about the bill we just passed. mr. tiarht and i are friends but we often disagree. we are not disagreeable friends but we are disagreeing friends often. in light of his characterization of the healthcare bill as a government takeover let me ask a few questions. is the v.a. a government agency? >> yes, sir. >> is medicare a government program? >> yes, sir.

>> is medicaid a government program? >> yes. >> i thought so, too. did we add to that list by making -- let me put it this way. in this healthcare bill, is this like canada or britain, or is it more based on a private sector system? >> the system is based on building out a private sector strategy with new health exchanges. >> will doctors, under the system, work for the government? >> not unless they do right now. some do for the v.a. as you know and for the department of defense. but no. >> and what about the nurses? are we adding millions of nurses to the federal payroll? >> no, sir. >> what are these things called

insurance companies? are they public entities or are they private? >> private sector companies. >> and are they usually a profit-making profit entity? >> from everything i can tell, yes, sir. >> i thought so, too. what is this bill doing for the fiscal solvency of the medicare program? >> the estimate that was made when the reconciliation bill was proposed was that it added a minimum of 10 years to the life of the medicare trust fund. >> what does it do to change the payment system from one based on frequency of procedures to one based on quality of medical outcomes? >> congressman, it sets a direction that for medicare to become, i would say, a quality based purchaser as opposed to

the current strategy of fee for service, which is more about content than about quality. >> well, i agree with all of that. let me just tell you a story. because we have had such controversy about -- and such points of disagreement -- about the details of this plan. between 1930 and 1938 a fellow named jerry boyle represented my congressional districtment he was the last of the lafollette progressive republicans. when fiorella laguardia became mayor of new york he succeeded laguardia as the progressive spokesman in the house. then he was beaten in 1938. my dad ran a supper club when i was much younger, and jerry came

home and became a local judge. he came into our place one evening and we started talking and i finally asked him, jerry, what beat you in 1938. he said senior citizens. he said i was strongly for social security and in my district seniors were against it. i said what on the are you talking about? how can seniors be against social security? he said in those days it was different. he said in those days we had social security as one alternative which was a contributory program, then we had the townsend plan, old doc townsend from california, who didn't want to have a contributor plan. he just wanted a $100 welfare payment to each senior each month and we knew that couldn't

survive because the country doesn't like welfare. so i strongly supported social security and doc townsend came into my district and organized townsend clubs and they beat me. the point of the story is this. we look today, shortly after this bill is passed, and we see all of these little fights that we had, regional, ideological, philosophical, but i think 20 or 25 years from now we are going to look back at this bill and say what on earth was that fight all about? how on earth could we ever have functioned without this program? and i think all of these little fights that were so important to people as we were going through th them, none of them will be remember remembered. what will be remembered is we finally put this country in the

rank of civilized societies that do not require people with very little money to beg in order to get healthcare. that to me is bakley -- basically the lesson of jerry boyle's story. i lost a lot more fights than i won on this bill. i favored publicç option. i have no objection to single payer. i frankly didn't care as long as we got two things. as long as we covered as many people as possible and as long as we changed the rules of the game so that little people weren't squeezed by corporate giants called insurance companies. that's basically all i wanted. everything else is candy. i just want to thank you for the

work that you did on this package and to thank everybody who voted for it and thank those who opposed it and raised constructive questions along the way. because the obligation each of us has is to make this baby work and to think through whether there have to be adjustments down the line, make certain we have plenty of oversight and especially make certain that we have a huge packages of our efforts to go after waste, fraud and abuse. because you have lots of >> in this -- lots of jerks had will try to take advantage of people and rip off customers and if we believe in expanding services we can't let that happen. >> i appreciate that, mr. chairman. i spent easter weekend with my

father, who turned 89 on the 22nd of march and he served in the united states congress on the energy and commerce committee 45 years ago when medicare was passed. and he told me a number of stories about how ferocious that battle feels -- how ferocious it was. how ferociously a number of people opposed medicare's passa passage, and how differently it looked then than it does now where he is now a pleased beneficiary and reminded me that over 45 years there have been changes, there have been a number of improvements, but the basic tenet that once you turn 65 in this country that you have health security was a promise made then and a promise that we intend to keep now. and it was interesting having his historic perspective on this beginning of this new chapter in

american health security. >> thank you. i'm going to have to go to the house for action on a bill that going to be pending shortly. so, if i have to leave before the hearing is done, it is nothing you said. i just have to get over there. >> i'm pleased to hear that. >> meanwhile, what i would like to do is run a second round for about three minutes apiece and see if we can get everybody in for a second round. >> thank you, mr. chairman. i want to say the hearing isn't done so maybe there be something that comes up that will make you not want to leave. one of the things a concerns me greatly is the cost of this. because frankly we have overspent. this year by more than $800 billion this fiscal year. we know there are at least 80 programs that are in the bill

that require discretionary appropriations. we have about $110 billion for these 80 programs. there are also 36 programs at least, three dozen programs, that are open-ended. i have asked the congressional budget office to give us some estimate as to what they will cost and they don't sound like cheap programs. i will give you a couple of them. community health insurance option, designed implementation of regional systems for emergency care, trauma care centers and service availability, oral healthcare prevention activities. programs related to congenital heart disease, multistate qualified health plans. community based collaborative care networks, to name a few. in addition to -- it my understanding c.b.o. has mated that c.m.s. and the i.r.s. will need an additional $20 billion to set up the systems just to implement obama care. has your department developed a

cost estimate for all these new programs that are not in the president's budget? and when will you be sending an addendum to the president's budget for next your to cover these costs? and where will the money come from? >> congressman, you have our 2011 budget presentations, and there -- >> let me -- >> there's not an intent to send an addendum to the budget. >> how will you cover the cost of the programs not in the budget? it says in the law such sums as required. where are the such suls going to -- sums going to come from? >> my understanding is the way the process works if there isn't authorization in the bill itself, this will be a discussion that you and your colleague also have here in congress. >> so we are going to have to come up with the funding for these programs? >> if the priorities are congress are to move ahead on those programs i assume they will be funded. but you have our 2011 budget submission before you. >> so, the 302-a allocation and

302-b allocation doesn't have a request from the president for such sums as required on these 36ç programs in >> that's correctment >> mr. chairman, where are we going to get the money for the programs that we don't have any budget for and won't have any allocation for ? i guess he is involved in other conversation. my concern is we don't have the funding for this and we have no idea how much it will cost and we don't know where the money is coming from. china is not lending us money on long-term treasury bills now. the fed has loaned money to the united states. they -- we owe them $35.5 trillion. where will the money come from? >> congressman, again, i think that the programs are likely not to exist unless they are funded by congress.ç that is not currently part of the authorized bill. i think that the very good news for the american public is, unlike the last major health initiative move forward, the

prescription drug benefit, this bill is paid for. it is paid for over time. congressional budget office has estimated $100 billion decrease in the deficit in the first 10 years and closer to $1 trillion decrease the next 10 years. so it is fully paid for over the life of the program. >> you can't count medicare dollars twice. we are taking money out of medicare and adding it to the program you will administer. where is the moneyor $5 billion from medicare. they are not in the president's budget and how will we fund them? >> let the chair say first of all the gentleman's time has expired. but let me answer the question by saying there is a big difference between programs that are authorized and programs that are mandatory. these are not mandatory progr s programs, to my understanding. >> are we not going to fun the

community health objection or oral healthcare prevention activities? >> ç givenç the fact that we a good $17 billion hole in the budget on pell grants i have no idea what we are going to fund object anything. i don't think anybody else does either. >> thank çyou, mr. chairman. >> who is next? ç >> secretary sebelius, several of us have been working together for over 10 years to reduce the dangerous incidence of underaged drinking. we are very pleajp" that your administration recommended more communities to address the critical problem. we have heard however that the h.h.s. is looking to further expand its efforts in underaged

drinking prevention. the questions thatç i have are first of all, c.d.c. and niaa are recognized leader in volunte developing strategies on underaged drinking. what are you doing to ensure pá the rest of h.h.s. uses their guidance and guidelines iç implementing programsç directe atç preventing and reducing underaged drinking? how will you ensure that the state public health agencies with their own rich experience in tobacco control and other public health issues are fully engaged in collaboration with state substance abuse agencies? and what will be the roles and resources available to the various h.h.s. agencies to ensure that all of this happens? >> as you say, congresswoman, we do have a recommended budget increase for those and i think that is a step of directing more

resources. we also have a talented new leader in the agency as my assistant secretary of substance abuseç and mental health ser s services, pam hyde, who not only has run state systems but work in the private sector and run medical systems and is very tuned in to this issue and is very much at the table looking at collaborative çstrategies. so we have the agency for children and families at the table. we have our scientific based evidence from c.d.c. and strategies that work on the ground. and we are working in collaborative with -- collaboration with state and local partners to make sure what we know is effective is drilled down. so, this is one of the things the president made clear to all of his cabinet officers, that he wants us to leverage our assets across our departments and in agencies so we have a number of cross-agency collaborations and

this is one of them. >> that is great to hear. as you know, in fact you mentioned earlier in an earlier statement the 317 vaccination program. this program historically has been used for vaccinating children. however, each year hundreds of thousands of american adults are hospitalized and tens of thousands die from diseases that could have been prevented through vaccination. it is estimated that the cost of the health burden to society from vaccination prevent abible diseases is approximately $10 billion annually. how will h.h.s. use exist funding streams to address the issue of increasing adolescent and adult vaccinations? and has the department considered developing an adult immunization strategy? what could be done to increase

vaccination rates among healthcare workers? >> could we have a fairly short response, please? >> we are working on this. i just was at theç 44th annual vaccination week-long conference. we learned a lot of lessons from h1n1 that we intend to applyç d one is how to deal moreç effectively with not only minority communities but with healthcare workers. >> hopefully youúchn follow that up. thank you. >> thank you, mr. chairman. i was listening to that wonderful story about jerry boyle and i must say the moral ç drew was that progressive republicans always get beat by liberal democrats that say they love them.ç so it is kind of a warning for me. on a more serious note, i share -- >> he got beat by another republican. >> i share mr. tiahrt's concern

about the financial bases. the one he highlighted by the transfer of medicare funds out for a new entitlement when we have a baby boom generation hitting medicare age. i don't think it is going to hold. let me ask you about another part that concerns me greatly, madame secretary. right now we assume that -- and i think you said the majorityçf people moving into the system would be ensured by private insurance. i'm not 100% sure that is accurate because i thought about half would be medicaid patients. at best it is pretty close as to whether they willç be purchasi insurance. as i understand it, frankly those younger people are going to have an option -- well, while if is mandatory they can pay a penalty asç opposed to buy insurance. the penalty is cheaper than the insurance and i suggest a lot of they will will do what most people in the 20'sç and 30's d is take the cheaper road. whether that wise is debatable

butç i think that is true. how confident are you that the new people showing up to be insured, given the fact many are medicaid and many of them have a way out when they are young and healthy are going to provide the revenue stream that the bill envisions? >> well, congressman, the experience in massachusetts, which is one we looked to and there are other states who have -- wisconsin, again, has a pretty near universal insurance avenue. but in massachusetts a fairly similar structure. an individual mandate with a relatively low penalty for failing to buy insuranbe, plus a low income waiver or hardship waiver, i'm sorry, has produced 97% toç 90% insurance coverage. the experience that they found is that people really wanted

insurance. they just felt that there were too many financial barriers or health barriers to get into the marketplace. so, at least in the instance of that fairly similar structure there was a very robust take-up in spite of some skeptics who thought that the people would opt out if they were younger anç healthier. >> my time is about to run out and it is a totally unrelatedç question, but one of the provisions of the bill that concerned me the treatment of physician owned hospitals. i realize there is a philosophical divergence in congress over that particular iss issue. in my state there are some of the highest performing hospitals that we've by every rating they provide excellent care and we have been very pleased with them. what is the general attitude of the administration toward physician owned hospitals looking forward in >> i can honestly tell you i

haven't ever been involved in a sort of philosophical discussion. there isn't any directional discussion. i think it has come more from congress and the alarm in certain areas of the country of the deliver ration to what some -- proliferation to what some have seen as the disadvantage of community hospitals trying to run emergency rooms and contributing to medical education and being cherry picked by provider based hospitals. but i don't think the department itself has a directional strategy. it really is looking at high quality, cost effective healthcare delivery. and as you say, some are are in physician owned hospitals and others are sometimes in community hospitals. but that is really our goal. >> i just say in closing on that so you know, in our state most of the physician owned hospitals operate emergency rooms, they take medicare patients. so they really stack up pretty of any

of anily -- favorably. i'm glad it hear there is not an administration position per se. >> mr. honda. >> thank you, mr. chairman. the health reform issues areç also going to be including our concerns of children's health issu issues. children probably comprise 50% of our medicaid rolls. will there be any thought about establishing a children's health task force? ç my county in santa clara county recently had the third highest rate of t.b. in california and it hasç grown from almost an elimination of t.b. in the county to being third in the state. given that rise, and given the work you will be required to do

as far as traveling and that i was concerned that you had sufficient resources to do the kind of travel and create the kind of presence that is going to be expected when you are going around the country to make the negotiations and be an advocate for this program. those two questions. >> congressman, i think in terms of the travel and presence responsibility, cloning would come in very handy in this instance because i do think there is a lot of confusion and concern and alsoç a lot of eagerness about performance wanting to know about the bill, how it is going to work and be implemented and i assure you i will do my best. and as there are lots of members of our department to be out and about everywhere. the children's health insurance program, which you all extended

in 2009 prior to the passage of the affordable healthcare act, i think, is a great focus on making sure that children have appropriate intensive care particularly at the youngest stages and we areç undergoing very aggressive outreach effort with faith based and neighborhood groups with healthcare providers, with state and local partners to identify and enroll the approximately five million children who are eligible but currently not enrolled. it continues to an challenge. the good news is even last year in very difficult budget times states and local governments signed up an additional ç2.5 million american children. we would like to see that continue to rise. i think that is, as you know, the schip program continues during the life of the affordable care act and i think that will focus that kind of

attention and services on the children's population. is one we take very seriously. >> madame secretary, you know ohio well. i represent the district in youngstown and akron. in youngstown we had two health care systems. one isç forum health which employs approximately 4,000 people in the region. it is now trying to emerge from bankrupt bankruptcy. youngstown has about aç 15% or 16% unemployment rate. warren has one similar in adding 30 million new people to the system and many in ohio and westernç pennsylvania i don't think now is a good time to see a hospital close down. i was wondering if there is anything in your sights or from

the administration that could address this issue. >> my understanding is we solved one of the problems in terms of a paymentç stream that will continue during the discussion, which i think is important. again, i think thatç the framework of having a payment system under the individuals who will seek hospital care in the future is a big step forward. i also think there were huge improvements made in the bill over the course of the discussion dealing with d disproportionate share allocation where originally there was a thought that it could disappear entirely and i think that was recommunicated appropriately -- recalculated appropriately based on the fact this are huge disparities of the patient load that is likely to hit various hospitals. but i think you are right, we need a robust healthcare delivery system and it is something we will be working

with local communities, looking at ways we can provide resources in this bridge strategy to make sure they continue to provide services. >> in the meantime, until 2014 when everyone comes in, hospitals like this could potentially close down. i tphknow i think the departmenf agriculture there are loan guarantees and maybe we could come up with ways to help the hospitals çrefinance. because between now and then a lot could happen. the other hospital in town can't handle the influx that they could receive. >> the community development block grant money, which is in ag and some other funding streams, i think we have to be more creative about bringing other agencies in. the h.h.s. really doesn't have either operational money or construction money with regard to hospitals. but i think having that dialogue with my cabinet colleagues is something that i am going to pursue because it has come pickup a number of areas and --

it has come up in a number of areas and it is a critical piece of healthcare. like clausing a -- you can't close a hospital or people won't stay in the community. >> i look forward to working with you because it is urban development, health, >> everything. i appreciate that. >> thank you, mr. chairman. let phame ask a food safety question of you. the volume of f.d.a. regulated imports has increased substantially the last decade. the statistics say f.d.a. recorded 8.2 million imported food lines in 2007ment fewer than 2.78 a decade earlier. you have just over 1% of these lines were physically examined or tested. it is often reported that even with increased funding the congress has provided to the agency, the f.d.a. will still

inspect less than 2% of import lines in 2011. this is mainly because the f.d.a. relies on a very weak borderç inspection system. there is also indication thatç there potentially will be more inspectors but we could have fewer inspections. can you tell usç how the f.d.a can improve in this area? there is the f.d.a. food safety bill pending before the congress and the senate. how can that change the equation? and how do we deal with the improving the inspection ratios the next five years? >> congresswoman, first of all thank you for yourç longtime leadership in this area and it is one that has changed

dramatically over time. we no longer have an americanç based food system, and iç thin that the regulatory framework has -- is 20th century at best and the systemç is global and increasingly global. have our -- half our fruits an vegetablesç começ outside the borders. about two-thirds of the seafood comes from outside the border just to name a couple of products. no question the new framework paced bush passed by he the house is a huge step forward and has a lot of the expertise of this committee's stamp on it -- not this committee but your expertise as part of moving that ahead.h-i do think that part of strategy also is the f.d.a. establishing a much more robust footprint in other parts of the world so this are now four new

offices in china, there are offices in mexico, there are offices elsewhere to not wait until products actually come across the borders but look at the origins of the products. secondly, i think it is critical that we have a much more robust and different relationship with theç private sector.ç the food industry often takes the hit atç a time of a recall. they have enormous financial risk risks, but have been, i would think, not as engaged and involved in self-reporting, identification, quick recalls. the f.d.a. needs additional subpoena power, automated recall power but engagement of the industry at a much earlier stage which is part of the framework moving forward.ç >> mr. chairman one final

comment.ç for years and years and years the whole issue has been that trade inç this area of foodç safety has trumped public health. i will be vigilant. i'm hopeful but vigilant that that will continue not to occur, that trade will get in the way of what we request do with regard to the public health as it regards food safety. thank you. thank you, mr. chairman. >> i appreciate it. thank you so much. [captions copyright national cable satellite corp. 2010]ç [captioning performed by national captioning institute]

>> todayç game russellç chad and scott wilson discuss the major news developments and look at the week ahead. the president and c.e.o. of spirit airlines talks about why the airline will begin charging for carry-on bags. laura hayman discusses child hood obesity. that is 7:00 a.m. eastern on c-span. >> this year's student cam competition asked students to create a five to eight-minute video dealing with one of our greatest strength or a challenge. here is the first prize middle school winner. >> more than 30% of u.s. school

children are obese. the number one crisis children face is the advent of childhood obesity. >> a child who has obesity or high blood pressure has a huge problem. obesity crisis in the united states cannot be overstated. >> things were different 50 years ago.ç kid played outside after cancel and on weekends. moms stayed at home and prepareç meals their families. kids rode bikes or walked to school. now kids have about five hours f of screen time a day including tv video. kid no longer play outside after school. they take the bus or parents drive. as of 2008 about 70% of children under 18 are in the labor force and we have become a fast food

nation. as a consequence childhood obesity has more than doubled since 1980. now one in seven low income preschool children are obese. this is a challenge that effects us all. to get a medical professional view on childhood owe beet i talked to my pediatrics. >> can you define childhood obesity for us? >> obesity by definition is actually measured in the percentage of growth curve that we have or by a calculation called the body mass index. >> what are the medical consequences of childhood obesity? >> hypertension, which is high blood pressure. high cholesterol. they also have bone and joint problems and some of their organs can have problems like lung and heart.

there's another entity called diabetes and there is a specific one for kids that are really ov overweight type two diabetes. some of the causes for obesity is children that probably have too much to eat or take in too many calories but don't have enough calories burned up. sometimes it takes just little adjustments, perhaps not eating the high calorie food, or high sugar drinks. sometimes it is as easy as getting a little more play time or activity. >> we live in left-hand of abundance surrounded by tastyç calorie rich food. it is easy to take in too many calories. calorie dense foods are cheap and plentiful with brand familiar with shoppers and kids. even when families want to serve healthy food they may not have the resources to get healthy

ingredients. after all, nutritious foods are expensive. few treurbs foods also require time-consuming preparation. while calorie dense foods are easy to eat. eight to 18-year-olds spend about four hours a day watching tv, d.v.d.'s and video games. the nilson company reports kids ages six to 11 watch about 28 hours of tv a week. that time not being spent outdoors getting exercise. at the same time, school exercise programs are being sharply cut back.ç but it is hard to make the balance of nutrition an exercise work out. in fact, childhood obesity has been recognized as a national problem. >> it clear childhood obesity is oneç of the most pressing challenges facing our nation.

more than nine million american children areç overweight and t department of health and human services estimates by 2010 one in five children in the u.s. will be obese. >> the number one healthcare crisis children face today is not cancer, notç accidents, its not drugs or alcohol. or smoking. it is the advent of childhood obesity. >> by the fourth grade they are sentenced to a life of challenges and physical problems associated with obesity and hypertension and high blood pressure, they may never live to their fullest potential. >> economic factors are a big part of this problem. >> in many communities you could buy a weapon sometimes quicker than you can find fresh vegetables or fruit. >> there are not a lot of super markets in anacostia in the district of columbia you would

be hard-pressed to find many super markets, few transmissi transmissional desert. >> many kids don't have a lot of options for living a healthy lifestyle. >> kids are not walking to scho school. a far greater personal are taking a bus. when in school there is little physical activity. out of school some of the fields and gyms are not available. some kids can't play outside and there are parents that are very afraid. there is not enough parks or recreational centers for them to go. as a matter of fact, they should not go without their parent at a certain age. >> for many kids schools are the only life lines that they have. they are the safety net in encouraging kids to eat well and get enough exercise. >> i really do believe it has to be in the kreurbg alumni of the school. we know that it is virtually impossible to develop healthy mind without a healthy body. schools are unique ly positione

to address childhood obesity and should be encouraged to ensure kids are active during the day. >> supporting schools must be the first step. what else can we do? there are they healthy habits children should follow each day. first, never skip breakfast. second, play outside one hour a day. third, eat five servings of fruits and vegetables every day. >> the government will need to help out, too. >> first, on a national level we can pass the fit kids act. co-authored by congressmen to bring back physical education. go to the schools and encourage physical fitness. >> the government can also enforce regulations about how food can be marketed to kids. and require more information on products that families can use to make smart food choices. we can move more farmers to grow healthy food and help families

especially low income families to buy few treurbs products. childhood obesity, it is a complex problem that requires complex solutions. but the challenge is clear. we must improve nutrition, we must encourage exercise,ç and must all work together to raise a generation ofç healthy, fit citizens for the 21st century. >> to see allç the winning entries on the competition go to stude studentcam.org. >>ç you are watching c-span.

. >> up next, "washington journal " and our guests include gail russell chaddock and scott wilson of