i was actually raised in another border states -- new mexico. i have spent almost all of my life along that southwest border. i have walked it. i have driven it. i have flown it. i have even written it on horseback. this is a border that i know extremely well. i share the frustration that border communities feel about the challenges that exist in that region. .

security strategy with a greater urgency and care than anything i have seen since i began my career in public service. and the strategy is showing real progress. let me point to a few reasons why. first, we have dispensed with the rhetoric, and we've just gotten to work. now, for too long we heard bumper sticker slogans about being tough. but looking tough just doesn't get the job done. we decided that we needed to add some smarts to toughness, and to make some changes to build a coordinated and

comprehensive strategy that included cbp, ice, the department of justice family, and our state and local partners. the statistics today reflect that this approach is working, and i'll get to a few of those in a minute. but second and most important reason we are seeing progress is because of the men and women working on the front line each day. and i'd like to pause on this for just a moment. we know that law enforcement in border states and throughout the country face a tall order when it comes to border-related crime and smuggling. the men and women who wear a badge and put themselves in harm's way each day do it because they, like each of us,

want to do the right thing for our country, and they want to make a real difference. we count on them for this, and they perform their duties with a professionalism and skill that goes above and beyond every single day. they depend on us for our support and for a tough and smart federal enforcement strategy. we owe them nothing less. we are giving them nothing less. and i will continue to do so as long as the president and i and everyone else on this dais hold these positions. we also know there are thousands and thousands of businesses around the country that are trying to follow the law and hire a legal workforce. these are small businesses, farmers, food growers, producers, and ranchers that

are the backbone of our economy. they, like our men and women in law enforcement, must have our full support. they deserve nothing less than a regime that cracks down swiftly on businesses that knowingly hire illegal workers to gain an unfair workplace advantage. to our partners in the business community who are doing the right thing, i say, we are with you. the government has stepped up our efforts through i-9 audits and intelligent workplace enforcement to level the playing field. we will not yield in this arena because we all have a role to play. businesses have a role, state and local law enforcement have a role, and of course, as i started out, the biggest responsibility rests with the federal government. it's a responsibility we take seriously, it's why we have taken the steps we have already taken, and it's why we are committed to doing even more, and are constantly looking for ways to improve our federal enforcement policy. so let me start with a status update on the smart, effective approach we've been taking over

the past 18 months. the personnel we've deployed, the technology and resources we've invested, the states we are helping through better information-sharing and increased grant funding, it's a very different picture now than it was before. now, you might not get this impression from those looking to score political points by saying that border and immigration enforcement are spinning out of control. and i say the numbers tell the story, and they do not lie. the border patrol is better staffed and more strategically deployed today than ever before. since 2004, the number of agents has risen. it has actually doubled from about 10,000 to 20,000 today,

actually a little more than 20,000. we've deployed more u.s. immigration and customs enforcement personnel than ever before to work strategically on investigations, intelligence, and inter-agency task forces to combat smuggling and human trafficking. we've also deployed more technology than ever to detect smugglers and their cargo. more airplanes, more helicopters, more unmanned aerial vehicles are working the border than ever before. and for the first time, dhs is screening 100 percent of southbound rail shipments for illegal weapons, drugs, and cash. in terms of infrastructure, the 652 miles of fencing that congress asked homeland security to build is nearly complete. the remaining six miles are expected by the end of the year. the federal government is also collaborating with state and local law enforcement along the border more closely than ever before. and recognize, i was in state and local law enforcement before i moved to washington, d.c. a year and a half ago.

we are leveraging the resources and capabilities of over 50 law enforcement agencies to deter, deny, and disrupt transnational criminal organizations. and we've increased the funding for state and local law enforcement that they can use to combat border-related crimet. on top of all of this, the administration has partnered with the government of mexico in ways that are simply unprecedented. we're conducting more operations together, sharing more information, and putting pressure on the mexican drug trafficking organizations that run smuggling operations into virtually every community in the united states. these efforts have produced results. apprehensions of illegal crossers, the best indication of how many are crossing, are at a fraction of their all-time high. they were down 23 percent last

year from the year before. last year, seizures of cartel- related contraband rose significantly across the board. we seized 14 percent more illegal bulk cash, 29 percent more illegal weapons, and 15 percent more illegal drugs than the year before. and these kinds of numbers tell the story about our strategy. we are focusing our energy on the most dangerous threats to communities. so the numbers of apprehensions+ and removals are beginning to reflect this strategy. in short, we are doing a number of things, and we are also removing a record number of criminals from our country. by all measurable standards, crime levels in united states border towns have actually remained flat or have dropped. we've also made important changes to the way that we conduct interior enforcement. we're doing it in a way that is smarter and more effective than before. we've strengthened oversight across the board, fostering consistency in immigration

enforcement and clearly prioritizing enforcement against convicted criminal aliens who pose the most danger to our communities. we've expanded the secure communities program, which uses biometric information to identify and remove criminal aliens in state prisons and local jails. since it began in october of 2008, it has identified almost 35,000 aliens charged with or convicted of the most serious, violent, or major drug offenses. over 8,500 of the most serious convicted criminal aliens have been removed from united states through secure communities. we've changed the way, as i mentioned, we approach worksite enforcement, moving away from raids that emphasize the number of workers arrested and focusing instead on the employers who exploit undocumented workers or commit criminal offenses,. already this year, we have arrested more than 100

employers. we've refocused our fugitive operations, prioritizing criminal fugitives. as a result, whereas in fiscal year 2008, only a quarter of all fugitives arrested were convicted criminals in fiscal year 2010, much closer to one- half of the fugitives arrested are convicted criminals. we have also expanded e-verify, which continues to grow by roughly 1,000 employers each week. we have made it more accurate, cracking down on identify fraud and abuse. our goal for this system is that it be effective, convenient for employers, and accurate, so that employers have a reliable system, and those who are here legally won't be inconvenienced or denied a job because of flawed or incorrect data. so in addition to the positive results we have achieved from our border security strategy, our interior enforcement efforts have also shown

positive results. so far this year, ice has removed more than 117,000 aliens convicted of crimes, 37 percent more than during the same time frame last year. indeed, of all the aliens removed so far in fiscal year 2010, as i said before, half are convicted criminals. and in fiscal year 2009, ice conducted more than fourteen hundred i-9 audits of employers suspected of hiring illegal labor, triple the number as the previous year. so while we've taken unprecedented actions to increase border security and improve interior enforcement, we are not satisfied. there is more work to do. that is why -- and that's what i'd like to move to now -- the new measures that we need to take.

that's why president obama has recently requested $500 million more to bolster law enforcement and security along the southwest border, and will deploy twelve hundred national guard troops to assist the ongoing efforts to secure the border and combat the cartels. these are commonsense measures to strengthen and expand efforts that have already proven successful. and today, i'd like to announce several new steps in our enforcement efforts. the first is a new partnership with the major cities chiefs association to create a southwest border law enforcement compact. this will boost law enforcement at the border, by creating a mechanism, a way for state and local law enforcement agencies that aren't on the border to detail officers to state and local law enforcement agencies who are on the border.

we're also creating a system that will fully interlink the information systems of all state, local, and tribal law enforcement entities, operating along the southwest border, with those of dhs and of doj. this will make sure that officers on the front line have the best information we can give them and that they can share what they learn back up the chain. we're also establishing a suspicious activities reporting, or sars program, for the southwest border. this will help local officers recognize and track incidents related to criminal activity by drug traffickers and utilize this information for targeted law enforcement operations on both sides of the border. next, we're strengthening the analytic capability of the state and major urban area fusion centers along the southwest border, so that they are better able to receive and

share threat information, improving our ability to recognize and mitigate emerging threats. next, we're partnering with the office of national drug control policy to implement project roadrunner, an automated license plate recognition system. project roadrunner was conceived to target both north and south-bound drug trafficking and associated illegal activity along the southwest border. we're focusing on money laundering and bulk cash smuggling operations in transportation corridors along the southwest border and targeting hot spots through roadside interdiction surges. for that region, i have now

ordered the deployment of additional border patrol agents, ice investigators, air assets, and other technologies to the arizona border, to conduct targeted operations against the cartels that exploit this part of the border, specifically around the tucson sector. we're also expanding the illegal drug program to additional southwest border ports of entry so drug traffickers, whose trafficking activity can be tied to mexico, are returned to mexico to face authorities. we're also expanding the joint criminal alien removal task forces. these are comprised of ice agents and local law enforcement, and they identify and arrest convicted criminal aliens who are living in our communities. now this also involves deploying surge teams to work with state and local jails that are within 100 miles of the southwest border to ensure the

identification of all removable convicted criminal aliens detained in those jails, who, if released, would pose a danger to public safety. i'm also proud to announce today that the federal aviation administration has approved the use of cbp unmanned aircraft system flights along the texas border and in the gulf region. cbp plans to base an unmanned aircraft system or uas at the corpus christi naval air station as soon as all necessary arrangements are finalized to sustain a permanent uas presence there. these types of flights aren't useful everywhere, but in some places they're part of the right mix of infrastructure, manpower, and technology that improves border security. this is the case for parts of the texas border, and we plan to move forward with using this technology there. and finally, we're increasing joint training programs with mexican law enforcement, focusing on money laundering

organizations, investigations, and human trafficking and exploitation organizations. i'd like to conclude on a point that i think bears repeating. there is a clear federal responsibility here, and this administration has taken this responsibility serious from the very start. we're attacking the challenges the border brings, and we're doing so in ways that are smart and tough and strategic. the policies and resources we have put in place at the border and in the interior constitute the most serious and thorough immigration and border-related effort ever. there is no magic bullet here, but we are addressing the problem in ways that are smart and unprecedented. now securing our border requires constant pressure. and maximizing our efforts,

especially against traffickers and criminals, will require more than just federal, state, and local resources. it will also require congress working across party lines to enact changes to our immigration laws, so that we have a comprehensive set of reforms that meet the needs of our country. and this administration is committed to taking that step. it's not just enough to address just one part of our broken immigration system without addressing the rest. for too long, all we've heard in this debate is tough talk without the smart comprehensive steps we need to truly fix the immigration system. the immigration debate is about accountability. it's about meeting fundamental

responsibilities. and as i mentioned earlier, the federal government needs to meet its responsibility to secure our borders. employers who game the system and hire undocumented workers need to be held accountable. and yes, illegal immigrants also need to be held accountable by requiring them to register, get right with the law, pay their taxes, learn english, before they can ever get in line to earn american citizenship. each of these components is related, and that's why we need a single, functional immigration and border policy. we cannot have 50 different state policies. it simply will not work. now too often, politicians' bumper sticker slogans are presented as real solutions. they are not. the american public knows better, and can be assured that this administration and the department of homeland security will continue to take every action needed to secure the border and pursue real immigration reform. and with that, and with that assurance, i'm happy to open up the floor, along with assistant secretary morton; deputy commissioner aguilar; director kerlikowske; major cities chiefs president rob davis, to talk about this subject of such

importance to the american people. thank you very much. [applause] >> well, madame secretary, thank you very much for those very, very good remarks, and we appreciate the update on all the new initiatives and all the accomplishments. i think sometimes that gets lost in the media. when we focus on all negatives, we forget how much progress we have made and how good our forces in the field are doing on a daily basis. and i think that that was an excellent job of highlighting that. you've already introduced the panel.

i'll just go through them very, very quickly here, just to point out some of their highlights. but next to you, you have director kerlikowske, who is the director of the office of national drug control policy and the nation's sixth drug czar. in his position he coordinates all federal aspects of the federal drug programs and implementations of the president's national drug control strategy. he haa 37 years of law enforcement experience. and prior to this, he was the chief of police in seattle for eight years.

next, we have assistant secretary john morton. he leads the principal investigative component for dhs and also the second largest investigative component in the u.s. government. he's a career attorney, doj experience in government service for many years. then we have deputy commissioner aguilar, a career border security officer for 30 years, and now is the deputy commissioner of the customs and border protection. and then lastly, we're very -- it's actually one of the honors we have here is chief davis, who is the chief of police of san jose, caliiornia, and president of the major cities chiefs

association, flew in on the red- eye today to be with us, and he's been with the police force there since 1980. so we're actually really privileged to have him here as well. i'm going to go ahead and take the prerogative of opening up the first question. and i want to tap into some of the local law enforcement experience we have at the table here, and ask a question about information sharing. we talk a lot about information sharing at the federal government level and how difficult and challenging it is, although information sharing between state and local and the federal government is probably going to be infinitely more difficult and infinitely more challenging. and particularly when we look at the southwest border, where you have multiple jurisdictions, including tribal elements and mexican government and the federal government, the challenges of getting the right information to the right people are significant. so i'd like to ask director kerlikowske and chief davis to get your thoughts on what are some of the challenges of getting the information that you how are we overcoming those as a government? i'll start with you, chief davis. >> thanks. when we discuss the issue oo sharing information, clearly from our perspective of the major cities chiefs, it's about relationships. you know, in terms of sharing information, criminal information, across platforms, be it state, local, whatever the case may be, we have had partners in the past. we've seen the fbi and others that have brick-and-mortar presence in our communities, and we have relationships with them. dhs, you know, has been around for coming up on a decade. we're still in the process of establishing those relationships. but make no mistake, there's been a huge amount of effort and a lot of success that's transpired over the last several years, as we have begun to create fusion centers and other mechanisms whereby local law enforcement can get together and begin to have a face-to-face contact with our state and federal partners. so that's the key there. and the other problem, i think, for us -- and i'll conclude on this -- is that you look across the country, and in california in particular, we're cutting services, we're cutting patrol officers. i'm standing to lose about eight percent of my work force the next month here.

so when you're trying to figure out where you're going to prioritize what you're doing, we really do have to get savvy and figure out how we can share information, take advantage of each other's resources. it's going to be key to success in the future, as we're dealing with dwindling budgets. so to the extent that local law enforcement can have that support from the federal government to try and make sure that we're standing up the fusion centers, and have those face-to-face relationships, that's where we need to be going. >> director kerlikowske? >> you mentioned my 37 years. thanks very much. >> a couple things that i think are important. rob mentioned fusion centers. the other, i think, hallmark of this administration in particular is to select people that have the backgrounds at the state level and at the local level. after 9/11, information sharing began to improve markedly, but i think that we've taken it a few steps further, and that is, looking at this problem, especially the drug problem, quite holistically, and not looking at it as just the border being that 1,960 mile

along that area. it is involving everyone in this effort, whether it was the seattle police department in3 that the secretary just mentioned. all of this is meant to supplement and augment and work closely with the federal resources. and, frankly, in that long experience, i have never seen better examples of the sharing of information, all in an effort to make sure that communities are protected. >> great. thank you very much both of you. okay. we'll go ahead and open it for questions. it's a little bit difficult sometimes to see people with the lights, but we'll go ahead and start with the gentleman in the blue suit right here. >> in this town everybody has a blue suit, huh? we have microphones coming around. please state your name and where you're from, and direct your question, and then i'll kind of assign it to a panelist. >> my name is grigor budas, and i would like to see if secretary napolitano and mr. aguilar can tell us which is the current status of the embassy agency with regards with

the shootings at the border and how do you think that more deployment of troops and personnel can avoid interference with the good relationship that you have currently with the mexican government. >> good morning and thank you for that question. and good afternoon everybody. one of the things that i think that we need to recognize is, as has been stated numerous times before, that we ask our men and women to deploy in a very complex environment at the border. it is an environment that is not only complex, but is a tough area. they encounter various

activities that until they encounter the activities, they don't know what they are up against. that being said, any time that there is loss of life it is very, very regrettable. the incident that you speak to is, in fact, being investigated. it is being investigated and looked into thoroughly, jointly with the law enforcement community throughout the area there. and once that is completed, we will put out the information in a very open fashion. so the investigation is ongoing as we speak. as to the national guard, the national guard deployments that have worked throughout the last 20 years that we have worked with the national guard has worked in a very, very coordinated fashion to the point that it increases our capabilitiee in such a fashion that it puts more boots on the ground, more border patrol agents and boots on the ground, support from the national guard, but yet a clear division of them not arresting, not engaging in enforcement activities directly attributed to any illegal crossings of either aliens, narcotics or things of that nature.

we have experience in this. it has worked out very well, and i can assure this group that the national guard, the citizen soldiers, will bring us a tremendous amount of capability in securing our borders. >> okay. we'll go to the next question. the gentleman in the front row right here. wait for a microphone, please? >> thank you. gavind berrera with the mexican news agency, "norte mexican." this is a question for secretary napolitano. madam secretary, i wonder if you can expand about two of the announcements that you made regarding the deployment of new personal to arizona and also the use of these that remain in greco, in texas. could you give us precise numbers? and i wonder if given the fail

of the sbi net program so far, if the u.s. government is considering the possibility to expand the use of this type of -- along the border with mexico. >> well, part of it depends on congress passing the supplemental that the president has requested, but that supplemental pays for a thousand more border patrol agents, a hundred and sixty more ice investigators, thirty more port officers, twenty more canine teams, and two predators to be used along the border. many of those, as well as some existing forces, are surging into arizona, but they're doing it in a coordinated way. so the numbers today may not be the same as the numbers next

week or the numbers the week thereafter, but we can get you some numbers after this program. the goal is, of course, to focus on the tucson sector. anybody that knows that border knows that we have done a pretty good job of closing off san diego-tijuana area and the el paso area, but that has caused a lot of the drug trafficking organizations and human trafficking organizations to focus their roots into arizona along that corridor. and our goal now is to shut that corridor down. >> great. thank you. let's try this side of the room over here, back with the red dress in the corner. >> for secretary napolitano. secretary of state hillary clinton has confirmed, and other sources within the administration have confirmed, that the administration will be filing a federal law suit against the state of arizona. and i'm wondering since you were governor of arizona and spent so much time there if you could comment on that. >> i'm sorry. could you just state your name and where you're from too? >> oh, sorry. carolyn presutti with voice of america tv. >> no. >> all right. could we go to the next question? >> listen. questions about whether, how, when or whatever to challenge the arizona law should be addressed to the department of justice. what i'm here saying today is that enforcement along this border in those border states is primarily a federal

responsibility that we do that and need more manpower, more technology, more infrastructure to assist. that's part of our plan. we need to be working with that's part of our plan and we need to work with state and local law enforcement. that's part of our plan as well, particularly when it comes to the organizations that are exploiting that border for their own gain. >> no more questions from this side of the room. you guys are in the penalty box. all right. we'll go back to the middle here. anybody with questions in the middle. the gentleman in the fronn row? >> david silverberg, homeland security today magazine. there have been reports of shots exchanged, and so forth,

with mexican military forces along the border and of mexican military forces escorting drug shipments and so forth. what impact is that having on these initiatives and on u.s.- mexican relations along the border for the future? >> why don't i take that and also ask deputy commissioner aguilar also to address that look. as noted, i've worked this border and this border area a long time. there are, from time to time, reports, some verified, some unverified. it's awfully difficult out there to attribute the identity of any particular group that is moving along the border. but as individual incidents arise, we deal with our mexican counterparts about that in an

appropriate way. let me say this, however. our cooperation with and working on day-to-day working relationship with mexican federal law enforcement has never been stronger, and, as someone said earlier today, part of it is about relationships and knowing the people who have basically the equivalent of my job on the mexican side of the boundary, of the border. and those relationships are very strong, and that's why we believe that with these additional resources, with the strategy, the smart effective tactics and strategy we've been employing, will be deploying, and then working with mexico, that is our best chance to finally get at these drug cartels that have, you know, played havoc with both countries for far too long. but, chief aguilar, did you want to say anything about that? >> on the issue of working with our mexican partners and our neighbor, i can tell you that

after 32 years of service our relationship with mexico, overall, has never been better, whether it be with the military, with the ssp, with any other government agency that works with us, and that is what has brought us to where we are today. there has been a brighter delineation, if you will, of the border, that did in the past cause some problems of inadvertent entries of the mexican military into the u.s. and, frankly, us into mexico also. but that brighter delineation by way of the infrastructure that we have put in place, but more importantly the collaborative effort that the secretary spoke to just now, where we collaborate on the strategies, on the application of racehorses, on mirroring efforts in order to bring greater control of that border.

as far as to your question about shots exchanged, i can't remember the last time that that happened. i can tell you that it has happened in the past, again, when there was those inadvertent actions that did occur, but i want to reinforce that our partnership with our mexican partners has been just tremendous, and that is part of what is also getting us to better securing the border as we move forward. >> okay. we'll go to this side of the room over here. okay. in the front row here. you guys are letting assistant secretary morton off the hook. >> hi. marissa leno with northrop grumman, but formerly with homeland security international affairs. i want to take a slightly different tack and ask, to the secretary or anyone, when i read

the title of "securing the border," i know everyone assumes that the main topic is going to be the southern border. but with all due respect to his excellency the ambassador of mexico, we also have another neighbor. and i wonder if you might comment on how many of these new measures or different measures might be applied to the northern border. >> let me take that and say that the measures i've described today are for the southwest border. however, we have other measures we've applied at the northern border, including more deployment of mobile type radar systems, more agents. we have met the congressional mandate for the number of agents that need to be at the northern border. we have excellent cooperation, of course, with the rcmp, and we have an aggressive program under way now to improve and provide better equipment and technology at the actual ports of entry all along the northern border. i don't know if you wanted to add anything to that. >> the only other thing i would add is the following, that we don't forget about the northern border. as the secretary pointed out, we are continually adding the border patrol agents and ice agents. we have the best teams. we have ibids and we work collectively with the canadians, with cbs arcmp. in addition to that, one of the areas that we're taking a look at now, as we work progressively with them, is

taking a look at that border, not just as a juridical line, not just that line in the frozen tundra up there, but as it relates to flows, flows of people, flows of cargo, and flows of transportation modes. so that to every degree possible we're looking at those flows literally from point of origin, as it transits towards the united states, as it arrives at the united states at the entry point, and then egress to where we work collectively with foreign law enforcement, domestic law enforcement, in partnership, to ensure that we do everything possible, not just at the juridical line, but throughout thooe flows. and ice plays a big part on that.

i don't know if you want to expound on that, mr. morton. >> well, i'll just add that first with regard to the canadian border, we do have three border enforcement security task forces. if the president's budget is approved as requested this year, you're going to see more, and that focuses exclusively on transnational crime coming across the border with canada. but to pick up on the point that the deputy commissioner made, it's much more aggressive than that. you know, when i come to work every day now i think about the border starting in our 44 offices overseas, you know, london, paris. you know, our biggest foreign office by a long shot is in mexico city. we have officers not only in mexico city but in cities throughout mexico, and we have an extraordinary level of cooperation with our law enforcement partners in those places. and it's because the idea of thinking about border security simply in terms of the line in the sand just is outdated. as the deputy commissioner said, it is all about flows, flows of a lot of things that we want to encourage, trade, lawful travel, and flows that aren't so helpful and lawful, and that we need to pay a lot of attention and try to shut them down. >> chief davis, did you want to add anything to that? >> no. well, just one quick thing, and

that is the fact that, again, we're talking about relationships. we've heard how they are working with our partners both in canada and mexico. we have seen that there's much better cooperation between ice and local law enforcement officials because of the fact that they've recognized some of our needs in terms of how we're working with our communities and trying to mitigate those issues that come up whenever you're talking about custom, or excuse me, immigration enforcement. but i do think that the point simply needs to be made that, look. you're looking at a group of people here that have made a lot of strides and a lot of progress over the last several years. nobody has been sitting around waiting for these problems to come at us. this hasn't just happened. all of these agencies have been very proactively involved. and, in fact, just one quick comment. we're very happy to have seen that the department of homeland security is really focused on making sure that they are

reaching out to local law enforcement. and i can prove that by the fact that we know the man at dhs on a first name basis, bart johnson, who is working with us in this effort. so the point simply is if you're looking at us, saying what are we doing to work together? we're local law enforcement out there trying to support what is it they're doing as well. >> all right. thank you very much. we'll go back over to the side of the room, the gentleman over there. >> chris strohm with congress daily. a question for secretary napolitano. as you know, republicans in congress say they won't support comprehensive immigration reform until the border is secure. so with that, can you give a timeline on when the border will be secure, or do you think that that argument is political posturing and they keep moving the goalpost? >> well, look. we think these resources we've asked for matter.

we think that they matter because they will argue the efforts that have been underway accelerated over the past 18 months. and the plain fact of the matter is, is that the border is as secure now as it's ever been, but we know we can always do more. and that will always be the case. it's a big border. it's nineteen hundred and sixty miles across that southwest border. it's some of the roughest, toughest, geographical terrain in the world across that border. and so the notion that you're going to seal that border somehow is something that anybody who's been involved in the actual doing of law enforcement, the front office work, the front line work of the law enforcement which say you're never going to totally seal that border, recognizing also that there's a lot of trade in commerce we want going back and forth, i mean, mexico, for 22 of our states, is our number one or two trading partner. i mean, it's huge the amount of commerce that goes back and forth. but this will make our border even more secure and we will

keep evolving as indeed border threats keep involving. but the notion that you're going to somehow seal the border, and only at that point will you discuss immigration reform, that is not an answer to the problem. >> okay. now, the next question. or, no. they're calling from csis. >> thank you, your honor. debal garcias. i guess my question is for mr. morton. how does one calculate the daily average of deportations of illegal immigrants. is it done on a daily or weekly or monthly basis? what is the average and what is the cost per deportation? >> in any given year, about 380,000 people, a little over a thousand a day. and we calculate that daily in some offices, actually, by the

shift. it's a major operation, and obviously we keep very close track on it. >> okay. great. this will be the last question. i think it's time for the middle of the room here and the gentleman in the front row, we'll give it to you. >> is it a question for all of us? >> yeah. is it a question for all of us? >> it could be. >> well, we form it that way. >> yes, thank you. in the next 24 months, in terms of your priority -- >> sorry. your name and where you're from? >> oh. mike connors, booz allen hamilton.

in the next 24 months given your priorities and the fact that you've alluded to the dynamic nature of border security, do we have the proper mix of people processing technology now with the changing nature of sbi net and other programs? where do we want to be in 24 months in terms of border patrol personnel, mobile radars, the whole system of border security, especially as threat compression occurs and you close off certain routes, and then the narcotics traffickers come up with semi-submersibles, small airplanes, and other types of means to circumvent our systems? thank you. >> i think that is actually a pretty good question for all of us given all of our relevant3 and look, border security requires manpower. it requires technology. it requires infrastructure.

it requires properly trained law enforcement at all levels who are working together. it requires prioritization because we really want to focus on, as john morton said, for example, removal of criminal aliens who pose a danger to the public safety of our communities, and, you know. so setting those priorities and making sure that everybody out to the front lines understands those priorities is another important part of the mix. i believe that the measures that we have taken and are taking now to augment our efforts will even further secure the land border between the united states and mexico; but if you look at our charter as the department of homeland security, in addition to counter- terrorism, which is always our number one priority, our next priority is securing our land borders, but also our air and our sea borders. aad so we are already seeing and dealing with drug

traffickers going out to the pacific, increasing their routes there, increasing atlantic traffic, and the ultralights trying to come across the border. and we're already working on the strategy and the technology necessary to shut that down to and we will not be satisfied, and i won't be satisfied, until those other routes are shut down as well as the land routes. gil? >> well, you mentioned the other side of the coin. a little over four weeks ago, president obama released his national drug control strategy from the oval office. 24 months from now what i'd like to see is americans consuming less drugs. there are some ambitious goals in that.

if we weren't such a huge consumer nation as secretary clinton, secretary napolitano and others have mentioned, we would be causing not only far less grief to people within our own borders, we would be causing far less grief to the people in mexico. >> so, secretary morton. we'll just go down the row. >> a few things i think you'll see in the coming few years from the perspective of ice and process and technology, one of the biggest is we're in the process of transforming immigration enforcement when it comes to criminal offenders. and i think if we were to reconvene in two years, we would be in a situation in which secure communities is in almost every state and local prison or jail. and technology is allowing us to identify, at the moment of arrest and booking, who you're dealing with. does a person have a criminal record? what is their immigration status? and that is going to have an enormously profound effect on the way we go about our

business. we are going to, for the first time in our nation's history, be able to get a full handle on criminal offenders who are not here lawfully. we are already well underway with that. and it works. and it avoids some of the concerns in the past about profiling and targeted enforcement. the beauty of secure communities is every single person gets their fingerprints run. i'd get my fingerprints run, you would get your fingerprints run, and the fingerprints don't lie. >> deputy commissioner aguilar? >> i think it's important to bring a little bit of clarity to border security. border security is about

illegal immigration. it's about narcotics. it's about weapons, illegal. it's about illegal funds. and, very importantly, it is about criminal organizations that are operating at our borders and between our borders. that's the first thing. we have done a lot and need to continue doing a lot, as the secretary is pushing into saying, with personnel, tactical infrastructure and technology. the one thing that i would add that i think all of us would appreciate is not only that balance of personal technology and infrastructure, but also the balance of how we approach the border and making sure that we mailed our investigative functions with our interdictive functions on intelligence basis. it is by melding those capabilities and those functions that we're going to bring the greatest force enhancement to this border. and then going back to one other issue that i think is critical is technology. technology, there are basically three ways to add to the border. there is a systems approach, which takes long. all of us are aware with what's happening with sbi net, and frankly the disappointments with sbi net. so there's a systems approach. there's off the shelf and there is evolving. it is a combination of all three of those that we need to approach in the right fashion that will get us to where we need to go. so from a priority standpoint, it's the personnel, the tactical infrastructure and the

technology by way of the three areas that i talked about. and then it is melding the interdiction, the investigative and the intelligence functions that we can bring to bear in a collective fashion domestically and with our foreign partners. >> and the last words, to our distinguished guest from california. >> yes, thank you very much. i'll begin quickly by saying what we want to see and then what we don't want to see. clearly, what we would like to see. in terms of local law enforcement and specifically for the major city chiefs -- again, these are the largest cities in the country -- we do need to see comprehensive immigration reform coming from a federal response. i mean, very, very clearly the secretary was clear when she mentioned it earlier. if we end up with 50 separate

state laws on how it is that local law enforcement are supposed to be helping in this effort, we're going to have a huge problem. again, keep in mind, local law enforcement across this country is getting squeezed. i've mentioned that we're the tenth largest city in the country. we're talking about cutting our patrol forces by eight percent by august. what do you, as local community members, want your local law enforcement police department to be doing? do you want us focusing on the robberies and the sexual assaults, and the domestic violence, and the burglaries and the traffic accidents, or do you want us to start shunting a lot of our resources to handling federal civil violations? remember, these immigration violations are civil in nature. local law enforcement has the responsibility of providing for criminal response. so what we don't want to see is we don't want to see local law enforcement agencies being required to enforce immigration laws. clearly, each local law enforcement agency and their local communities need to decide what is best for them. we're not saying that there aren't problems. we clearly hear the frustrations that are coming from across the country, and we've even heard frustrations from some sheriffs and others on the local border states, but understand that we can't put our local law enforcement in a position where all of a sudden we are shunting our very precious resources that deal with this issue. it's a federal issue. we are happy to help however we can, but it should not be the primary focus of local law

enforcement to enforce immigration laws. one of the last points on this is it's really beginning to hamper our community policing relationships. we've spent decades in local law enforcement trying to establish relationships with all of our different minority communities. san jose -- there are over a million people in san jose. there is not a majority of anything; 32 percent of our population is hispanic; 20 percent is asian. we've done great things to try and get inroads with these communities, and they don't always understand, because of language barriers and other things, what's taking place with this topic or this issue. but local law enforcement is the one that they look to, and they're fearful of us if we're coming into neighborhoods to respond to calls because they think somehow we're trying to do other things. be very clear. local law enforcement will be the first ones to step up if there is a criminal issue going on. if ice comes in and says we're looking for a homicide suspect -- he's an illegal immigrant, whatever the case may be -- local law enforcement across this country will step up and help. but do we want our local law enforcement agencies to be the primary focus of this enforcement on civil laws. and i'm telling you with the resources and the budgets, et cetera, and the community policing issues, it's just not the way to go. so we need to see the federal

response. that's what we'd like to see within 24 months, but we clearly do not want to see 50 different state laws telling local law enforcement how it is that they're going to be going out there to solve this problem. it is a no win situation for local law enforcement. >> secretary napolitano, you wanted to -- >> well, i just wanted to offer a friendly amendment for the chief. >> and that is congress -- congress has seen fit to describe initial entries as misdemeanors, and so it's a, you know, it's a minor offense, and, but the calculus is the same. do you want local law enforcement spending their time, mandated to spend their time on those as opposed to the homicide, rape, assault, and at the expense of very extensive community policing efforts that are created to supply the public safety architecture for communities. i just wanted to clarify that one point. >> well, before we thank our guests, it's going to be imperative that everyone remain seated until secretary napolitano and her party leave. but we would like to thank you all very much for your time. we realize you're very busy. we appreciate your comments. >> welcome, everyone. we thank you for coming for what is a really terrific event. my name is rick "ozzie" nelson. i'm the director of the homeland security and counterterrorism program here at csis. and we're absolutely honored and privileged to have secretary napolitano here to talk about

"securing the border: a smarter law enforcement approach." i'd first like to thank the sponsor of the statesmen's forum, which is the lavrentiadis group, who has supported the statesmen's forum throughout the year, and we appreciate that. obviously, a lot has been going on in the world of border security, particularly in the southwest border area. and obviously, as the former governor of arizona and now the secretary of homeland security, we have, obviously, a very, very unique perspective on this, and it'll be certainly a learning event for all of us. >> in a moment, new ways to counter the spread of terrorism ideology. then a look at recommendations on how to improve medicare. after that, at 7:00 a.m. eastern, it is washington journal. topics include government spending in the u.s. economy. >> today, steven harper holds a closing news conference at the g 20 summit. he is the host of the stomach with a number of other countries

attended including france, germany, china, japan, india, and united kingdom and united states. the summit, focuses on the global financial crisis and ways to cut high debt levels. watch the prime minister's news conference live this afternoon at 5:00 p.m. eastern on c-span. after that, live coverage of president obama's news conference as he leaves the g-20 summit in canada. that starts at 6:00 p.m. eastern also on c-span. >> starting monday, watch the confirmation hearings for a lionette cake and -- 40 leah kagan. you can see reid-paris on c- span2. -- a read-errors on c-span2 -- re-airs on c-span2.

>> next, a look at new ways to counter the spread of terrorism ideology which remarks from former officials of the bush administration. the report's authors outline their findings and then take questions from the audience. posted by the washington institute, this is 1.5 hours. >> this is an important report by the institute. first, a word of context. every four years, the washington institute convened a series of what we call our presidential task force to look at different aspects of middle east policy and engage with policy advisers to the major candidates for an offer a set of

bipartisan recommendations that any new administration can take with them into the white house. last year, the institute completed three of different task forces. one on u.s. relations, one on the nuclear challenge from iran and a third, which was this, entitled rewriting the narrative, an integrated strategy for counter radicalization which focused on how the united states can effectively work to counter the challenge of radical islam as tourism. i was delighted -- islamic extremism. i was delighted that the obama administration and congresswoman

jane harman had on these issues. it is a broad bipartisan group. since the issuance of this task force, you will hear from my colleagues more about some of the ideas of this task force that have made their way into the obama administration strategy and we are very proud of that and the contribution that this report made in the development of u.s. policy. there were some issues that have arisen in the course of the last 18 months, which convinced us that it was important to bring together on an accelerated basis, a mini task force. again, a bipartisan group to look at a couple of critical issues that remain in the obama

administration approach to countering violent extremism. i am delighted that today i's report is the recommendation of those many task forces. the director of our starting a program on counterintelligence, and that you love it -- matthew leavitt. he has been heading our counterterrorism program for several years dree we are proud of the work that he is doing on a broad range of issues.

our second convene their, j. scott carpenter is the leader of a project that is an innovative project designed to amplify the voices of mainstream muslims. . .

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something the republicans provided for when they adopted their original part d medicare legislation. we'll close the doughnut hole, provide preventive services without cost to the seniors. they won't have to come in with co-payments. we extended the life of the medicare trust fund. you would have thought we were ending medicare or putting the public on the british system. the hearing we're having today

is not the first hearing we've had on the whole health care system. the congress of the united states. in fact,, the house have 79 bipartisan hearings on markups on health insurance reform takeover past two years. we've had hearings and gotten full inputt from everybody. those who are in favor and those who are against. every bill we have considered in the last 1 1/2 hears years, the republicans have decided to vote no. they voted no on the stimulus and energy and health and financial reform bill. they are the party of no. and now when we're trying to learn more about what we need to do to keep medicare the program it is as a way to provide health care for our

seniors and low-income people, they want to complain. med pack fwave us our report. their report is always useful and they have suggested there are ways we should deal with medical repation to have it more based on quality not quantity. they are recommending what we should do with people both medicare and medicaid. the dualy eligibles. they've given us a lot of good, substantive things to look at and to work on and what i'm pleased at what they've done in the back, which is now law and i look forward testimony to other things we can do to strength at any program but let no one be fooled what we're seeing is a lot of propaganda.

the same thing we heard at every hearing at over and other again and that you're going to have ration care. meanwhile, they wouldn't even eliminate the barrier for people to buy insurance because of preexisting -- >> thank you. >> is gentle woman from tennessee, miss blackburn. >> thank you, mr. blackburn. as you can see we are going to have a very robust discussion today. and i think we all agree there are some 13wr06789s needed in the current delivery system but i don't need to tell you there's a lot of concern out there that obama care is going

to be detrimental to medicare and that it has has the potential not only to cripple the nation's health going forward but also to cripple and compromise those health care deliverry systems, and most recently we've had concerns expressed from physicians and i know you're hearing this, too, about being able to meet the cost of their practices while they are facing productions even while phasing out programs like medicare advantage. yesterday there was a "usa today" article, and i'm sure you probably saw this. the quote, the number of doctors refusing new medicare patients because of low government rates is setting a new high. this is a concern for us. the a.m.a. reported 31% of primary physicians are no longer accepting new medicare patients. we're hearing quite a bit about

this. and what we hear is that this reduction into s.g.r. is forcing more doctors to make those reductions and dropping those patients and seniors are very concerned about this. i think they are speaking up and expressing concerns, around one of the reasons we want to hear from you is my colleague across the aisle said twer party of no. i would change that for him. we are the party of k-n-o-w, no. know. what we have worked diligently to do is make sure seniors have the information in front of them. whether it's about the current medicare coverage they have or not. and they continue to come to us and say we thought we were going to be able to keep the benefits that we don't see how

this is going to work. and what we're hearing from ensurers is changes when you see being cut out of the medicare advantage, this is of concern. i will also highlight that we have to remember that our seniors, today's seniors, have prepaid their access to medicare. and we need to be mindful of that. we need to be respectful of that and we welcome your insight and look forward to the hearing. i look book to forward. >> thank you, mrs. blackburn. from the virgin islands. miss christiansen? >> thank you, mr. chairman and ref rund respector shimkus to

report to congress. the medicare program has been in many ways an indispenseible as credit to the -- asset to the elderly. and i look forward discuss anything that can be hoped the use a better quality medicare patients. roughly half of all beneficiaries are within 2% of the poverty line. these are the very beneficiaries who are most vulnerable and suffer most, and although medicare provides health care ack access to millions who would otherwise go without coverage, most were uninsureed or underinsured. this means often by the time they enroll in medicare. many of the health issues that

might have been addressed relatively easy with ack accessible care have now been compounded by poor care when it was available. because it was especially interesting to me to read the recommend daigles of the commission, particularly as it per contained to focusing on a pertain method that quality over quantity, -- geographically and associate economically diverse work fort. i'm interesting also to hear how med pack addressed the disparity. and so again, i thank you for today's hearing, and i look forward to a very informtive and thought-provoking addition. >> thank you. next for an opening statement, the gentleman from texas, mr. burgess. >> thank you, mr. chairman.

and couple reasons why today's hearing is notable. and once again we have the chairman dr. hack bar. time to take a look and see if -- that's the larger and grander goal. but today is also notable because doctors across the country who participate in the medicare system are israeliing 21% less for the services they performed last month for taking care of some of our nation's sickest -- allowing this dramatic doubt daycare place. i have voted for some very bad policy in the past. very bad policy that had at its base, stopping those cuts from

occurring. unfortunately, we have not had, in all the hearings that were rempsed by chairman waxman, since 2006 a hearing on the sustainible growth rate formula. and i think it's time we do that. i have a bill 4693. i'd like to see that get a full hearing. since this will not i will be holding a forum by myself dutch, astonishing, holding up the bill. ok. maybe it's delinquent, perhaps scanned louse so. but it's a repreview for the speaker because it won't let it go to the floor because it is not what she wants. i voted against this to -- the speaker should do the same thing. very few members in congress outside the physician members

have, have any delay for what this delay does. when off small physician practice, even with a smaller population of 15% medicare and you don't get paid for three weeks, that's a big deal. this decision will lead businesses to closings and we have price wrols. every private insurance company in the country pegs to what we do in medicare. that's why it's so creditically important that we get off our duff and do the right thing. people aren't hiving people. driving people into the specialties that we now decry around keeping them out of the specialties we wish they would go into, but what about quality over quantity? if the only lever you pull is to ratchet down the rates, the

doctors can only spend a little less time with each patient, the only way they can pay their overhead and let me remind members of this commow that doctors who could see those on the program haven't had a increase since 2000. i know we need a long-term strategy and i have not always agreed phenom layer upon layer of bureaucracy that defines our current program, but that in and of itself calls out for a dramatic rethinking of the program. as a committee we do need to have a bipartisan dialogue and unfortunately mr. waxman has left but i would remind him i met with him early in 2009 about was there a possibility to work on this bill? i met in 2008 to ask the same question. when he got a bill tround

trounced over 20. i have 50 eements. >> you're a minute over. >> and yet you say that the republicans controversy participate. where do you get this snuff >> you're over a minute, dr. burgess. >> well, i thank you for your indulgence. i look forward to the hearing we're going to have >> all right i'm going to have to rule you out of order. >> all right. come on. i recognize mr. barrow. >> i thank you. in the interest of time, i will wave the opening. [laughter] >> he's not yielding to you. mr. murphy of pennsylvania. >> thank you, mr. chairman. it's good to have you here today. i look forward to reading this book. i want to daw the committee's attention to something very

important where you say medicare often times lax the authority to deal with some respective -- similarly a change in lay is also necessary for medicare to implement -- medicare needs authority tore make a change hits in current payment system. a while ago when our president took office i sent a letter to his staff asking that congress and the white house put together a blue ribbon panel, which is designed in 1965. and designed really from the bottom up, what would medicare back when it was designed some of the most advanced instruments the hospitals had was an x-ray machine on wheels. ital worked with the limited things we had with treatments to pay a fee for the service system.

now we have a substantial amount of research that says quality is important and care smgget important and those things can indeed save money. when we look at some of the things that happened in medicare. and it will be interesting to hear your comments on this. 34 require an active dongs change it. >> for example, we're still in a system that doesn't pay for some of the nurse's office to coordinate care as though the oftentimes you can save money face off teleconference meanya. and even if both are equal demans time from the hospital. even though some therapies reduce the risk of infection. also things that have to do with how we order kanes and pairs harrisburg and pennsylvania they may get paid

the other side a rate that is so much lower that doctors addressing this issue that we cannot expect to prop up a system financially just with saying we're not going to pay. i believe the analogy is if someone comes to work on our home and we have two estimates. one estimate then another guy will say i'm just going to charge you for each item i put up and the hourly rate. we all know which is going to cost more. i hope you can let us know. it's extremely important as a committee and me that we've got revise this system of medicare and give medicare the flexibility to lit redesign itself. and putting on the backs of figures to just say we're not going to pay you is not going to work.

i yield back. >> thank you, mr. murphy. gentleman from texas. mr. green. >> thank you, mr. chairman. i'd like to wave opening statement but remind my colleague the health care tpwhail came out of the house had a permanent fix and lock step my republican colleagues voted against it. >> will the gentleman yield. >> i think the gentleman waived well didn't use his time but some how managed to get a statement in as well. >> anyway, let's move on to miss which a cow cows can i is recognized. >> thank you, mr. chairman. thank you mr. chairman for this opportunity discuss med packs june 2010 worth. report. i want to tank the staff at med pack for their work at putting this together. today's hearing is about improving the ack access to and

effectiveness of medicare. this congress has implemented historic reforms to our health care system that takes gigantic steps forward improve health care and quality to millions of americans. we have extended the medicare trust fund by an additional 12 years so we can keep our promise to elder americans. now to cut ack access payments to private insurance companies for medicare advantage, we've eliminated cost sharing and we are getting rid of the republican-created doughnut hole. more over health reform will reduce the deficit by more than $100 million and in the first decade. your testimony discusses the highly unpredictable and highly variable cost of medicare cost sharing. it's a point i fear many miss. according to aarp, people on

medicare spend an average of 30% of their income on identity of pocket health care costs including premiums. as co-chair of the senior's task force i often hear from constituents who pay hundreds a month for health care. and for most part b. premiums. they report part d. since 2006. and med packs' march support shows substantial increases in requirements from both grand name and generics in 2010. finally the naic results show med gap coverage costs policy holders pay $2,000 to $3,000 a year. med cap policies are expensive but can protect against highly bear basketball out of pocket

expenses you referenced in your testimony. it's critical to know medicare policies aren't being used by those tryyng to shirk their health care responsibilities but by americans who are a bit too rich for medicaid but don't have the noun pay for brick testimony today. i yield back the remaineder of my time. >> i'll wave my opening mr. chairman. >> gentleman waves. i think that's our opening statements. so we'll go now to our witness. first of all, let me welcome you again. i know you've been here before, and we always enjoy your insight. we have limited you to five minutes. i hope that's ok. if you need more you can use it, because you're the only witness. >> and thank you.

>> if you proceed -- >> thank you, chairman pallone, ranking member shimkus and other distinguished members of the subcommittee. i welcome this chance to talk about our june, 2010, report tore congress. let me begin by briefly reminding you about sex we are and how we do our work. med pack is a non-partisan waif riffers, the process for apointing the members is run by gao. for the commission that produced the june report had six physicians and one registered nurse on the commission. in addition, we had five commissioners that had executive level experience in running health care deliverry organizations. another five that had experience in running private health plans.

and some commissioners have more than one of these credentials in their background. as chairman of med pack, i believe we can best serve the interest of congress by wherever possible finding a con tense view among these perspectives included on med pack. usually we succeed in doing that and just to illustrate that point, we published two reports to congress this year in march and june. total there were 26 recommendations in those two reports, which represents roughly 400 individual votes by med pack commissioners. on those 400 individual votes were zero no-votes and extensions so we're able to take a diverse group of people and experiences in health care and find common ground on how to improve the medicare

program. our examination of any given issue usually spans multiple public meetings. we have eight public meetings a year. and often will take up a complex topic. have discussions that explore the available information, asks staff for additional analysis then we up the options and in each point in the process we reach out to parties in the outside world that would be affected by the rengeddeagses who have expertise to bring to bear and make sure we have the benefit for that information. so it can be a rather lengthy process to getting to final recommend daigles but we believe that approach allows us to provide the best possible advice to the congress. to provide a little bit of context for our discussion of the june report i thought it

would be useful for me to highlight some of the areas where med pack has made recommendation in the past and where there's a strong -- among commissioners. first and foremost medicare cannot go on as it is. the rate of growth and expenditures eventually will become unacceptable, and so we need to look in every way possible to find ways to slow the rate of growth and medicare expenditures while improving quality to o and ack access to care. in slow growth and increased value to beneficiaries, we'll have to act on a broad tonight. there's no single thing that we can do. among the recommendations that we have made in the past are, there needs to be consistent pressure applied to the prices for individual services whether they be for physician services and home health agency

services, whatever the provider typed. we need to look forward ways to cheaping -- i -- some of thee members earlier mentioned primary care physicians versus sub specialty physicians. we need to look at tints to change those relative values in ways that signal which sort of care medical beneficiaries need more of and reward the provision of that care. third, we need to look at reforming payment methods. using new payment methods. whether that's paying for quality or bundle services, medical home. those are several examples of what we consider to be repayment reform. third, there's the broad consensus in the commission that we need -- because private plans had the ability,

potentially to do things traditional medicare finds difficult. and finally and most relevant for our june report we think it's important for medicare to begin the process of reforming its contributions to graduate medical education. and mr. chairman, i'd like to close with just a few comments about graduate medical education. i have a slide here that bbiefly summarizes recommendations in the interest of time, i'm not going to go through all the points in the slide. i'd like to focus instead on the context for our recommendations. med pack commissioners believe that our system of -- is in many respect it is envy of the world. it produces thousands of superbly skilled physicians each year, physicians who are trained to provide the latest technology and technique to aid medicare patients and other

patients in need. on the other hand there's broad consensus that had the current system is not consistently producing the physicians we need to reorient our health care system toward a higher level of performance. >> i can't read that. i must be getting old. is that in the book somewhere? >> yes. it is. >> and actually i'll have somebody behind me find the page, and i'll tell you what the page is. page 103 in the red book, june 2000. >> thank you. >> so another element of the consensus in med pack is that the gme system is not consistently producing the physicians we need to move to a higher value of health care system and i would emphasize that's not just our judgment. that's the judgment of many other people that we consulted with, including many people

within the medical jaut education system types of deaf deficits in the gme system. one is in the miths of the -- that includes the specialty mix , the number of primary care physicians relative to sub specialty physicians and the like. but also includes the racial, ethnic and geographic diversity of the physicians we train. the other area of deficit is in the don't of training. while physicians are very well-trained in advanceed technology and techniques, we are concerned as are many others that there are important areas that are not as well focused upon, including evidence-based medicine and team care coordination and the like. it's important to emphasize

that as med pack sees it, the g.m.e. system does not bear full responsibility for these deficits. for example, in the specialty mixer, those with private ensurers strongly influence the choices that physician ins training make. it also influences the shot of programs teaching institutions decide to engage in. more over i would add the g.m.e. system -- credit for the reform for the content of training. for roughly the last decade. the acredit iting body has been engaged in what they refer to as an outcomes project which is designed to refocus training on new skills the physicians need to produce high-value health care. we believe that that movement is largely in the right direction, but we think that the pace needs to be

accelerated and we propose to do that by making a portion of medicare funding contingent on the development of and in adherence to new standards of performance to graduate -- and we urge all the relevant voices be includeed in developing those standards. not just people involved in academic medicine but also representatives of patients, purchasers and high-performing deliverry systems. thank you, mr. chairman. those are my opening remarks, i look forward to your questions. >> thank you. and we're going to have questions, obviously, and i'll start with my questions. the -- i want to focus on the g.m.e.'s. i'm concerned about the fact that we're -- you're apparentlyal suggesting taking some of the existing funding and redirecting it based on the standard of performance. and i'm worried about placing

further financial restraints on safety hospitals which i represent some. many have already called me about this proposal. and i also -- i'm not really sure, now again, i haven't read the report in all its detail. but what is the sfans of this empirically justified amount? in other words, what you're saying is if it's above the empirically justified amount, then that's the money that would be redirected. what's that criteria and empirically justified amount? >> medicare pays roughly $9.5 billion for graduate education each year and basically is broken into three relatively equal parts. the first is what we refer to as the direct medical education payments. those dollars pay for a resident salaries, faculty salaries, direct expenses of that sort.

the other two pieces are paid for the endirect medical education adjustment. teaching hospitals receive percentage add jan to each payment they get for medicare admission. based on the formula that includes the resident -- ratio. when congress enacted that adjustment back in 1983, it asked for an analysis of how much costs increaseed the hospital due to teaching activity. around that amount was calculated. congress basically doubled that amount. so we refer to the actual increaseed cost in hospital care is the empirical amount and then the additional doubling of it as the extra i.m.e. >> you see the problem i have is that you know, one could

argue that all of this is very artificial and that we should have a totally different method of financing medical education. and we could have a serious of hearings on that, maybe we should. but the problem is the reality. i mean, the reality is that these hospitals are depending upon this money. it may be somewhat of an artificial formula, but if you're going to say all right we're going to take some of the money away, i'm concerned that this is not the right time to do that. i mean, we can argue about how this formula was set up. but right now at this time, given the resession and all the things we face out there, why does the commission feel that this is a wise step right now? >> i'd like to emphasis we're not saying take the money away. >> isn't that in effect what would be happening? >> we're saying establish the accountability for the use of

the funds. >> my point is that you know, we get to the point where the way we've gotten to this formula now, you know, you can argue how we got there or not, but you have to be concerned or at least i do and i think many of my colleagues, about the consequences of it. and i'm just concerned that i mean, i want you to be innovate and come up with new ideas and many ideas we've incorporated in the health care reform but it just seems right now if the consequences are that if smun taken away from some of these hospitals that are barely -- that are in the red. i mean, have you taken that into account? >> we have. and what we've proposed is that the new standards would take effect three years from now.3 period to develop the standards that would decide new payment policy and to give the

substitutions -- institutions an opportunity to adhere to those standards. >> all right. i want to stop because i'm sure the other colleagues are going to delve into this. but let me just ask about the diagnostic test. you explore reducing payment rates for diagnostic tests performed would them slow growth of these services. but i wanted to ask you beyond the 2006 and 2008 data you examined, to what extent did you take into account the -- those occurred the impacts of the reduction act and reduction and payments due to january, 2010, changes in physicians fees schedule? the rates i have for these services, particularly advanced imaging have declined significantly in recent years. and so again, i -- i'm hearing from them about how you know

this is going to be a problem because of all the cuts we've already had. well, what we've proposed is a series of targeted reductions in payment for imaging, and we have taken into account the effect of those, and we think the payments would continue to be adequate to ensure reasonable as access. what we have right now is very rapid growth in high- end imaging, and a lot of people investing in equipment. and once it's in the office, using it, at a high rate, and to us it signals that payments have been quite -- in the past and what we need do is bring the payments more in line with the cost of that care and then we recommend redirecting those funds to higher value uses for the medicare program.

>> thank you. >> mr. shimkus. >> yes. thank you, mr. chairman. and i apologize for you getting involved in the health care law, food fight. but we only get the opportunity to openly discuss this, and i think it does call for a hearing. that's all we're saying. that's our point. if they are right, let's have a hearing. if weaver right, let's have a hearing. and there are problems that in this law we know need to be fixed. they are smaller once, so we just take the limited opportunity we have. to address our concerns. and in response to the chairman, we did pass a bipartisan bill, it's called safety bill passed out of here on a voice vote and passed on the floor. and we were involved in that. and when we are asked to work together, i think we can do so effectively. the health care bill creates a

$1 trillion new cost. i'm going to end on this $5 billion. $it wasn't all med dare. $20 billion was revision to the medicare improvement fund which was to help doctors continue to take medicare patient. $20 billion over five years. >> $156 billion came from ensuring medicare sustainibility. payments to hospital. $156 billion out of five years on this new law. payment adjustments for home health. $40 billion. so i would caution my colleagues that there is a $135 billion on the medicare advantage. that's one something they did mention. but i would question to make sure we do a total of in cuts, because some is to hospitals and some to individuals and

that's what this law did. i look at trying to find a mission statement and under the front cover it says medicare, you're supposed to help us on medicare advantage program and traditional fee for service and analyze care, quality of care and other issues affecting medicare. but i think for mack crowe versus micro. you've gotten into a lot of the micro aspects of, and you've done it for a long time and i can well respect it. we're worried about some of the mack crowe issues and i know because implementation takes time, it's you have to check the yes cases of the new law, especially in this report, but i think that's an important aspect top. look at, especially when you have, whether they liked it or not, $500 billion a cut it's not coming from -- it's coming from hospitals, physicians,

there's tax increases that are going to affect service. having said that. the people on the committee. i was going through the bios. are there any economists on here? >> yes. >> and the physicians are for profit or not for sfloft >> the hospital administrators are for profit and not for profit? >> currently not for profit. >> no for-profit hospitals? >> no for-profit hospitals. no. >> is there a reason, do we know? >> well. the g.a.o. does the appointments. we don't select our own members. and so i don't know the answer to that question. i wouldn't demapt we would never have a for-profit. >> no. it's a very impressive list. my point. i'm a market-based capitalist conservative. i believe in supply and demand and individual consumers giving the ability to as access

information will drive prices, you'll get higher -- and lower costs. i'm concerned about third-party payers and institutions that in essence try to set fees when individual consumer given the information and the ack access probably is at a better system. the g.m.e. issue is just one sliver of what you're doing but i understand it's a very important aspect for you. we have places in this country with not enough slots. and in the moving of, i want more slots is what i want. is there, in the calculations of the payment. is the payment safe for a g.m.a. spot in new york city is it the same as it would be if illinois for a teaching -- or is there a cost of where the education is going? is there a percentage ratio

there? >> well, we've got, as i said to chairman pallone. we've not two different types of g.m.e. payments. the direct payment for salaries and the like. and then we have the indirect add-on. the direct payments are set at a hospital-specific amount. so there's a base year. based on the actual costin occurred for salaries and in that year and then that's been inflated by the c.p.i. since. the indirect piece is a percentage add-on to whatever they get paid for medicare admission. so that does reflect different wage indices and different cost of care. >> so i'll end on this and i appreciate the chairman's permission to just finish with a statement. we need more. in this environment, with doctors talking about leaving the profession. we need more doctors. we need more g.m.e. slots.

and i believe in supply and demand and the higher supply you have the more supply you'll have lower costs, but we've got to debt them out and we've got to get trained in substitutions. >> chairman? >> yes. >> brief comment about the number of slots. >> it may well be true that we need more slots, more physicians being trained. that's not an issue that we've looked specifically at. there's certainly a lot of people that believe that. what we have said, though, is that before medicare decides to fund more slots, we think we would do well to step back and do a careful assessment of what our long-term needs are likely to be. we shouldn't just extrapolate from the past, but look at the mix of physicians and other health professionals that we'll need for more in the future and

then base our g.m.e. funding on that analysis. >> thank you. >> thank you. >> the gentleman woman from florida, miss caster? >> thank you, very much. i want to stay on this topic. i think you're generally on the right track when it comes to the g.m.e. to say we've got to look at these trends and specialization. i can't tell you how many young residents or med students i immediate, med students who are gung ho, they are going to go into family practice or general practice or pediatrics then i see them a few years later, and they are -- their loans have taken a toll and they are going to go into plastic surgery or some other specialization. so i think it's very wise to plan ahead and begin to look at how we create those incentives. so i appreciate that very much and the diversity mix. they have done a good job focusing in on kind of the lack

of how the medical field oftentimes does not reflect our population. we need to improve that. because that means better care. although women now are going gangbusters in our colleges and in medicine. i had really hoped med pack would also address this issue of the stat i can nature of the cap and what that has done to states that have grown in population since 1996 when that cap was put on, because it has created such a harmful dynamic in my state that has been a high-growth state in other 3 we've got three major g.m.e.-related issues. one, our resident to population ratio is in very bad shape. two, we don't have nearly enough slots to account for all of our medical school graduates. we have nine med schools but at least 2/3 of all students leave

the stite practice. and then we have hospitals operating above their caps, struggling to pay for those additional resident ins fear they may not be able to keep up with those extra costs that those slots require. >> so in the big picture, we can generally say more slots doesn't necessarily ensure better care or overall better training as asserted in your report. however, there is this other issue that i know we in our health care reform law we said we're going to do a workforce study, and you've mention that had here. and in fact, secretary sabiliou is announced now -- for primary care. but could you please address why didn't med pack consider the geographical inequities

here in this report that is so fundamental. it's really underliing the workforce she and the diversity issue? can you address that in the impact of cutting the limited g.m.e. funds in some states -- steats have already received. >> we did not make specific recommendations about either increasing the caps or rheal location of them. however, we did suggest that we needed to take steps. medicare needed to take steps to increase the diversity of the physician workforce of the future and make sure that we're making sure we bring into medicine the people who are indeclined practice in rural areas, practice in inner cities that may be underserved. research shows in that element and where to practice is where

the student comes from to begin with. 56r7bed so there are programs in the public health service authorized by this committee that are targeted at trying to change mix of figures being trained, increase the diversity. we think those programs that actually make a lot of sense. again, on the specific issue of how many physicians medicare ought to support. we didn't look at that issue specifically due to time and resources. but we do think that decision needs to be guided by careful analysis of future needs, whether they be geographic, diversity, specialty. in that the beacon that we aim for is a high-performance deliverry system. if we just double the number of physicians with the current specialty mix, we may well not

make our problems better. we could end up making them worse. we need to think first before we increase the funding. >> we've got to harmonize what was in the health care reform law that says the states that have these low-resident population ratios are going to get a little bit of help. and i was hoping in your report you would reference that. i know you mention in the report that you weren't sure when the law would be finalized. but there needs to be some harmonyization of those. and quickly on the i.m.e. patients. many hospitals feel redirecting the i.m.e. payments since the needed level of i.m.e. funding is difficult to quantify lead them to come up with indirect costs on their own and some states looking at dish payments

changing over time and the fact that we may still be serving many folks in this country that show up in the e.r. building will not be covered by the health care bill, that's very triple-doubling to see another challenge on the horizon. so if med pack recommends we not make health care funding for -- until an independent analysis of our -- is it premature to -- before the study's completed? >> i'm going to have to. i'm sorry, miss castor, i've been not paying enough attention to the time. you're like a minute and -- >> i'm sorry. >> why don't we send that in writing to you? >> yes. because you know i care about it. >> i know. i'm sorry. we'll send that in writing. >> next is the gentleman from georgia, mr. gein. >> thank you, mr. chairman. physician rei mean bursements under medicare were cut back

21% last friday. many physicians in my district have told me they'll stop seeing medicare seniors because of these cuts and indeed some in the more rural areas have said well they'll just move to an urban setting where the medicare case mix is not quite as high. today, this mitigation, which is passed the senate, that bill is being delayed by speaker plosey. that bill that would restore these cuts, the cuts that mean our seniors have a medicare card but no physician to accept them. given our current physician shortage on the problems medicare seniors are currently encountering, do you believe speaker plosey's decision to allow the cuts going forward will make it harder for medicare seniors,,especially those in rural areas to find a

physician willing to take them? >> it's obviously not my place to comment on speaker plosey's position. -- on speaker pelosi's position. but we do a large survey of medicare beneficiaries to ask them about their ack access to physician services. we survey about 4,000 medicare beneficiaries each summer. and we survey a like number, roughly 4,000 privately-insured patients that are just under the medicare eligibility age, so we have a reference point. our surveyed -- our survey done last summer, for 2009. it found generally beneficiaries have access as good or better than privately-insured patients in the 54-64 age group.

the primary concern is around primary care. part of the survey that we do is we ask medicare beneficiaries who are looking for a new physician whether they have any problem in finding a new physician. that's the most vulnerable group. and what we find is roughly a quarter. a quarter of medicare beneficiaries say they have difficulty finding a new primary care physician. again, this was 2009. the number for privately insured patients in 2009 was a little bit higher. a higher percentage of privately-ensured patients said they were having difficulty finding a -- the lesson we draw from that is the country has a growing problem with ack access to primary care. it's not theek to medicare. it's a broader, systemic issue.

so that was 2009. we are in the process now of doing our 2010 survey. i don't know what those results will be. i would say, though, that the uncertainty and even anxiety caused by the annual -- now more frequently than annual debate of risks can only be undermining the confidence? physicians and patients in the medicare program. >> and so i don't know what the new survey results would be, but we are concerned. we are concerned nat repeated athlete of very large cuts couldn't be ack accessed. >> i appreciate you bringing that information to the committee. because that's extremely important. and if i understood you correctly. last year in 2009. before obama care, patient

protection, affordable care act. 1/4 of new patients seeking a physician had difficulty finding one. around now we're in a situation where fully 10 million people -- medicare patients are on medicare advantage. that program is being cut. he said the number was $130 billion over 10 years. so maybe $6 or $8 million will lose their coverage medicare advantage. then you compound that problem with a 21% cut. so we put a mandate on it. so many will say i'm out of here thin you will get this deluge of new patients trying to find a dr. i hate to see what your numbers are going to show when you survey those 4,000 in june, july of 2010.

>> i just want to be very clear, because this is such an important issue, about what the 2009 survey results were. so we said that the most problem atic area was medicare beneficiaries looking for a new primary care physician. so that represents about the number of medicare beneficiaries seeking a new physician is about 6%. and it's a quarter of that 6%. of that 6% that report experiencing a problem. now we've got 45 million medicare beneficiaries. so even if we're only talking 1.5%-2%. we're talking 900,000 medicare beneficiaries. that's a lot of people and reason for concern, but it does represent 2% of the medicare population. >> around it's also fortunate emphasize again, that this is not unique to medicare.

the privately eninsured patients were also reporting problems in finding a new primary physician. >> thank you. i'm a minute over and i yield back. >> thank you. the zwra from california. >> thank you, again, mr. chairman, for having this hearing. chairman, i have two questions. the first one has to do with the report inclusion of a proposal that some of the graduate medical education funding provided to hospitals by medicare be made contingent on practice-based learning to encourage medical residents to spend more time in community health clinic settings. now so many some teaching hospitals in my district and elsewhere don't have the emphasis on outreach with am butly tory health care settings

right now. what does the commission think the impact on the current g.m.a. system will be under this proposal. and what is the commission advising the congress relative to the transition in order to incorporate what you've discussed in the proposal. and my second question is on self refrl. experts across the board agree that physicians self-refrl where doctors refer patients for medical services in which they have a financial interest is a costly drain on the medicare system. i agree with that. the report goes into quite a detail to demonstrate self-refrl ancillary services exemption continues to grow. but noticeably absent from the report are any concrete recommendations about how to address this.

so can you address it? >> yes. >> those are my two questions. thank you. >> thank you. first on the non-hospital-based training. the training in community practice. a few points there. first of all, that's particularly important for some specialties. obviously -- >> i'm not arguing whether it's important or not. but since you make the recommendation, about it. since you make the recommendation about it. and there are many that have brought up g.m.e. in their opening questions, my question was what's the impact? and how -- what's the commission recommending in terms of a transition, in order to accomplish this? >> well, the first step is to remove some of the barriers. and the current medicare rules.