designated medically underserved committed to. there is a higher party, -- poverty, you are primary care doctors, nader's that end up looking at the fact that it is an underserved communities such as a higher than average infant mortality rate. as a requirement is that they have to provide comprehensive health care services, and that beyond the type of services your generally thinking about. they have to provide care for everyone, regardless of their ability to pay. it's a standard, sliding scale the, set up of community services. when they go there, depending on their incomes, they will be charged inappropriate price for the services. and it thing that is unique to covenant -- committed dissenters is that they are governed by community board 351% have to be patients that are served by the health center. that is one of the reason that

they're able to address the needs of the community so quickly and target those needs for the community that they are serving. who are health center patients? you can see 70 been sent signed are under the poverty level and almost all the individuals and health centers are under to under% of the federal poverty level. you also see a much higher rate of under insured. 38% vs. only 15% of the population. and medicaid, you see a higher amount of people on medicaid. nelson to a great job serving minority populations. you can see from the slide that compared to the u.s. population, about 32% of the people are latino or hispanic,

21% are african-american and 50% of the population. only 30% are considered white non-hispanics. the kind of services -- when you think about services, to think about checkups, police shot, and being seen for your call. one of the things that is important is that they also provide general and mental health services, other specialty service, but a subset of the enabling services or supportive services, a couple of statistics said it. 89% provide interpretation and translation and services. sen & broadway production -- 79% provide weight reduction services. 89% are providing services, and what are its are you eligible for?

what happens? all of these services are delivered through centers and we have some great outcomes compared to the patients in centers and we've done lots of studies that have shown how they compared to folks outside of health care centers. a concern led answer more questions about that, but we a been writing that over the 45- year history of health services. when we provide services in this way into local communities, it's also cost-effective. you keep people out of the emergency room and keep them from being hospitalized unnecessarily. there are some studies showing about 10% -- $10 billion to $24 billion could be saved every year by providing more community health centers. and there are great study showing their reducing or eliminating health disparities for a variety of health conditions. low birthweight babies, more preventive services, it is

showing how minorities are actually doing better than average. lastly, and this is the point that the paper, one of the things that is so exciting. as something that is not focused on. when we invest in community centers, and would allow people on the panel talk about recently, there was a fairly large investment from that recovery act. and there were able to demonstrate this. when you think about investment in community health centers, if you think about the outcomes that i'd just showed you. but is less known and thought that if the extra economic activity that happens in these communities. these communities tend to be poor and hire minorities. what we are seeing is that overall we look at numbers that are in the affordable health care act, you have helped care law that just passed, and the centers will be generating economic activity of about $54 billion in these targeted communities.

and this is going to sustain or create 457,000 jobs. and then what we did is rut that down and thought, what percentage of this is directly as a result of that increased funding? the community health centers were identified early on in the health reform discussion as being a really unique place that we needed to put some more financial incentives and to make sure that they were there to ramp up to serve this additional 32 million americans that will have new coverage because of the health reform act. there's $9.5 billion in operating costs over the next five years and we wanted to see -- let's look at the investment? from that investment, not on the slide but on that investment we have an additional of the $54 billion, up $33 billion, up 1/4 to 57,000 jobs, 284,000 of them are because of this.

this light is showing, it is important realize that you put this money and community centers but it does not stay inside that wall. there's a fair amount that allows them to ramp up and see more patients, they have extra rooms that they said at a comic actor wings, sometimes an extra location. that is how they can see after patients. they are able to increase at the centers, but held professional jobs as well as an ciliary jobs. what this analysis -- and we worked with other partners, there is it's very elegant book -- what does that do outside the health care center? that is the indirect cost. the way that it rents up to provide services, they have to buy more furniture. they buy new computers, more tonner, all of those thin generate indirect costs in the neighborhood. this the cost for hiring more people, and some of them are having jobs for the first time and some have been better jobs.

they get to go buy a washing machine. taken by other cars. beard generating additional income. you can see from here up the $54 billion of total economic activity that will be generated by health centers in 2015, $31 billion is inside the health care center, but the rest is outside with indirect cost that was generated from what was done at the community center. in the same is true with extra jobs. so with 457,000 jobs, most of them are within the walls of a community center, and about half of them are held professional jobs, but about 40% of them are the ancillary staff that help within the health center. and 171,000 jobs are jobs that are created because of extra economic activity. that is the exciting >> and sense of it. what i'm going to do is turn it over to people were doing the

real work here, who are providing these services, there will be able to help you see what it was like and what they have been able to do inside their balls, but they have been able to do outside their balls, and a little bit of what they're doing because of the economy and what they have done to target those changes in the economy and how they have been ready and able and certainly very excited to be such a key player in health care reform and ready to ramp up and provide this. we're all going to walk up and the nestle will introduce the rest of our panel. -- and by nasa -- vanessa will introduce the rest of our panel. >> by stephanie kenyon. she is the chief operating officer, and used to be vice- president of a cancer research and prevention foundation.

she also served as the national spokesperson for recovery average for the red cross. she woke up really early to get here this morning. rebecca sze is that they want committee health center, overseen comprehensive women's health services to ensure that quality health care is provided throughout the different stages of a woman's life. she holds a master's in public administration from new york union -- new york university. she lives in queens, new york. and finally, dan hawkins, at the national association of community health centers. it provides membership federal and research, analysis, and leadership. he serves as a volunteer and a

director for communities helped center. is an assistant during the carter administration. he has lectured on health policy at harvard, johns hopkins, and other universities. he has also remained one of america's most influential hollis -- a policy makers. >> is my microphone on? dan, what we start with you? tell us about what we're celebrating, and who they assert, and why we take as part of the year to separate them? >> i want to thank the center for american progress, especially ellen-marie whelan, four fabulous report, some documents in a sometimes forgotten side of the benefits

that comes from the presence of a community's health centers. health centers -- this is the 45th anniversary of health centers. there were started in the mid- 1960s after direct response to: met needs from the rest of the health care is community. and so many communities around the country. we had a deciding some years ago that even for those who work day in and day out at the health centers, it can wear you down. everyone needs to pick me up. a way of celebrating the great work that health centers to was to designate a week as national health care be. we have done this now for the past decade or more, recognizing the work of the health centers and most importantly the work of people who are in the health center

providing care every single day. you mentioned that some many of the people who work in health centers are community residents. many of the professionals, many of the doctors and north partitions, and ceo's even, they come from the community. we have some that come to 90% better from the community that they work in and serve. and so this is a tremendous benefit to the community, not just economically, but in terms of the life of the community. mild help center, this was many years ago my old health center helped keep two pharmacies, a lab services company, a dental supply company, a light.

in that community, continuing to provide their benefits and services and supplies because of our presence in that community. chor.really are an an a couple of my colleagues here, one who ran at community health center back in sin vincent -- in cincinnati in the early days, and john marshall, who actually ran the federal agency that oversees it administers that health centers in the late 1960's and early 1970's, could see you both the day. -- good to see you both the day. >> [unintelligible] >> i always ask and answer a

question. what is the secret of their success? i think the first thing is that the centers are fully grounded in their community. in that community board, they are working or rick -- presidents. the answer is, i remember my own board early on in my tenure as a health center director. some of the consumer board members came to me and said to me in spanish, we do not know what we're doing here. we really think that it would be better if we step off the board and replaced us with a couple of doctors and make your dentist and an administrator an armistice. i blurted out to them, stop. that is not your job. your job is to know the community and to bring those needs in to the governing board

and speak to them and insist that we do something. whether it was teen pregnancy, family violence, obesity -- no one knows this more than the people live there. been grounded in the community is important for the second thing is that they occupied the most opportune place in health care system, but at the entry point. they could yield an enormous improvement to hell and save billions for taxpayer. as rebecca can speak to, the care that is provided, health centers are not only far above their peeress in private

medicine, but also well ahead of the healthy people 2010 goals. they have a lower infant mortalityamerica received treatm health care. mother and child are cared for at the health center as well. one out of eddie -- every eight pregnancies in america comes to it is that preventive and primary health care that helps. for those who have a chronic condition like diabetes or high blood pressure, health centers have shown they do a better job of controlling that through group visit, planned visits, literally putting the individual in charge of their health condition and saying you can do

it. all that matters. those are some of the major things that help center's focus on. they have been shown -- there are no health disparities within the four walls of the health center. if they need a specialty, salt or need to be hospitalized, they run into barriers but within those four walls, there are no disparities. not by race, not by ethnicity, not by income -- income, not by insurance eligibility. >> that is a gray segue to rebecca. you worked in the health center in new york city for a long time. your center is known for its innovative outreach program for

the community. can you tell us about that? >> we have been around for over 30-something years. i want to echo what dan was. we are community-health driven. everything we do is focused on the community's needs. we constantly do not want to do the same thing status quo. we accept what the community needs are based on the board's suggestions and based on the community use it. we have done surveys on an ongoing basis to see what the community is asking from us. recently, with the stimulus fund and the change in the economy, we have seen many, many changes. one of the local community health centers was closed down after almost 50-100 years.

[unintelligible] we help the same persons in the community. we try to recruit some of the staff who had a job in that center to work for us. we tried to create similar system to recruit and bring help to the patients into our system. that is what we have been doing. we worked endlessly with the state, with the city, with the federal government to be a pioneer and a testing site to make quality care better and bring it to a higher level and make the system more efficient . recently, we work with the new york department of health prin. usually, your primary-care read -- refers you for a colonoscopy

they probably refer you to gi specialist. in new york city, we try to break the disparity. they use us to try to create space similar system. if they pcp refers the customer, what is the percentage of compliance? 100% is the answer. by doing that, they will bring this usage as the example and bring it to the community to go and create a similar and more efficient system for the community. we are located near wall street. for many years, we have never seen any wall street bankers. [laughter] for the past year, things changed. i have actually seen more wall

street bankers lost their jobs and lost their insurance and then they came to an area -- they never thought bay would use our service parian -- they never thought they would use our service. i told them that if they use our service, they will move on and have a job that fits their needs. with the stimulus money, we want to better serve the community. in order to have an efficient system, you have to make sure that your staff are really capable and knowledgeable and ready to meet the challenge. for the past two-three years, we

have had the opportunity to increase the capacity and the knowledge of our staff at different levels, not the ceo, coo, but everybody. the front lines that are the ones that receive the patient at the door and they are the ones that have to do the job. do they know what they are doing to the best of their knowledge? do they know the change to the health-care system? we seek opportunities to bring them to a level to advance their knowledge and skills and better serve the community. that is what we have been doing at the community health center. >> you mentioned there was a clinic that closed that was close by? what percentage of the patients did you taken? >> we worked with managed care

to create a similar system. we took on about 40%-60% of their population and some of the staff. we did this in a proactive approach and make sure all the medical records came to us. that is very, very, important. >> your example about the bankers -- we don't have bankers but stephanie m. loudoun county,, with many jobs blanc, you have only been in existence for two years. you can when the recession was starting. what has been your experience in loudoun county? >> we are one of the new kids on the block. we have been in existence for three years but two of those three years, we were not funded

with federal funding. we were really struggling. about 10 years ago, the community leaders came together and decided to solve the problems that we were having in terms of health care in our community. there were many things going on. loudoun county is and what was the fastest growing county in the united states. we have a population of about 300,000 people now. it has probably tripled in the last five years alone. we are also now one of the top- 10 fastest-growing minority populations in the country. we have many things going on. while we were growing that rapidly, many people were attracted to jobs in the housing industry. we had home builders, realtors, we had landscapers, we have all sorts of people related to the big housing boom that we were saying. in terms of being a high-tech

capital for the east coast, we had, but is likeaol based there andci. aol recently moved from loudoun county to new york for their headquarters. when the economy fell into decline, there was suddenly this ush of joblessness that ghit what used to be a cooking community. we have many people who are out of work and houses are no longer worth the same. the realtors are out of business. people who had been employed by companies like america online no longer are working there but they have started their own businesses. entrepreneurs decided to stay in our community. typically, of entrepreneurs and small-business others cannot import -- afford insurance.

we have a large uninsured population. the hospital gave us a big start a branch. -- a startup grant. we were struggling to make ends meet. before we got the stamp -- federal stimulus funding, we were seriously considering layoffs. we started out with only five employees and we grew a little bit but we are not a big help center. and the time we have received the funding to continue, we now have 30 employees. we are growing rapidly. we have seen about 6000 patients in three years but the demand is still really high and we have a wait list of about 600 people waiting to establish care with us.

we just don't have the room or enough staff. in the future, this is what we hope to do and we hope to open facilities and hired new staff to meet the demand. it is out raises that there are 600 people that we cannot find appointments for. >> what do you think are some of the challenges that you will continue facing? other than the money coming from the health care reform, how will that help you and what are the challenges? >> space is our biggest challenge. with more space, we can see more patients. that means we have to hire more people. that means we have to bring on more computer equipment and all the things that you were talking about earlier. growth is our biggest challenge in being able to meet the demand. in northern virginia, we particularly have to face the challenge of transportation. out tot have metro

loudoun county. there is limited public bus routes. it does not go regulate like in an urban setting. we don't have taxis that you can hail on the street corner. transportation is a base problem in northern virginia. what we hope to be able to do -- we have a situation where we can tap in and get taxicab rides for our patients who do not have cars. we will have a taxicab pick them up and bring them to their medical of women and bring them back, dan. -- and bring them back home again. we will pay for a taxicab to drive our patience two hours to uva for specialist upon as the transportation will continue to be a problem. trying to keep up with demand

and growing and building new health centers where they are most needed will be the thing we are looking to the future for. >> there was an article today in"the washington post about s.taining talent sprin can you tell us about that, especially in rural areas? >> the single biggest challenge i see is that health centers, especially with the new funding that is coming to them in the health reform act is the work force, finding the health professional, the positioners -- the physicians, the nurse practitioners and others who will be needed to staff additional center sites answer the additional population.

fortunately, other parts of the health care bill contains a very good signs. the national health service corps and a young woman who is the subject of the story in the article in ""the washington post" this morning is a member. in return for the services she offers in an underserved or in the area, the national health service corps has received a big boost in funding both as a result of the recovery act when health centers receive some of the new funding that they could put to use. the unemployed wall street bankers and aol started coming to your centers looking for care, the recovery act included funding to expand by about 7500

health professionals. many of them have gone to help centers already and are working there. the young woman of the article today is one of them. the health reform act contains additional funds that would triple the size of the national health service corps allowing them to place 16,000 health professionals. every one of them will be primary care. medical care, dental care, mental health care, we're not talking thoracic surgeons. we are talking family practitioners, pediatricians,obgyn's. those of a kind of folks that the national health service corps will help wet. that is not enough. a young lady who grew up in the northern virginia area, the maryland suburbs, feels out of her element in our rural

southwest virginia. we need to grow our own. we are partners with an osteopathic medical school years ago and we are now producing 100 osteopathic medical students per year for primary-care going into residents say, many of home were actually sponsored by local health centers called operation home town. that school is now brazil -- producing about 100 dentists per year for primary care. that is good but it is not enough. we are seeking partnerships with the country's medical, nursing, and dental schools to find a way we can replicate this program and find more people from the community.

the woman who runs my old health center today is a pediatrician. she was a patient there when i was a director. the family brought her into receive care and to receive care at the help center for a number of years. it helped her to see. she was a student intern during a a couple of summers when she was in high school. this was enough to instill in her a real desire to learn a health profession and come back and give back to the community. that is exactly what we need more of. that will be the crucial difference. >> ellen-marie, do you have any reactions to what has been discussed? >> one thing we wanted to with this panel is to see the difference of community health centers. there are 8000 of them around the nation. when you have seen one health

center, you have seen one. they are run by community boards and these are very different centers. the ancillary services that we live up to the community board to choose, you can imagine that the translation services at one site, the dialects are changing. another service is transportation which is more important in loudoun county but not so much in new york city. the other thing is to highlight how we see the difference in the late economy. -- in this economy. loudoun county can't continue and expand but there is a difference in services that they wang center in new york city, it

is interesting to see how different they have become. you talked about going into the garment district and other places. they do out reach. you can't do it now because of your waiting lists. hopefully with the new bonds. i want to make sure that we highlight that there is a big fear and concern if there would be enough people served under the affordable care act. i think we can see how we have this at hand and have the capability in the foresight that n.e policy makers put in paren with the 8000, you can look at the other folks who are out

there who look very different. >> the point i was going to make was that back in 2000-2001, one of the things we are proudest of his bad health centers have enjoyed strong bipartisan support from republicans and democrats and independents over the years. 10 years ago, president george bush as part of his campaign claimed that he would grow the help center program and doubled in size in his term in office. he succeeded he pressed, chris to provide additional funding for health centers. congress responded and did. everybody worried if there was going to be enough primary-care practitioners to staff these new health centers? 10 years later, there are twice as many physicians, 2.5 times as many of nurse practitioners, four times as many dentists because the health centers has

six -- has expanded to accommodate dental services. they served twice as many people. with funding, they will double that number in five years. 40 million people by 2015. after 35 years of work in and with and on and about health centers, i am absolutely confident that they will succeed. >> that is a good point. people are concerned about the money doing what it is set out to do. we saw the money going from the recovery act and we saw things come from that. hopefully, they will do the not the same thing in the next five years. -- they will do the same thing

in the next five years. >> just last week, we learned that when the recovery act funding was first provided to help centers across the country and stephanie's was one of 125 new ones that were funded, in march of last year, the federal program managers projected that help centers would add services to serve an additional 2.9 million people over the two- year period of the funding. they were already at 2.1 million people last year and last week, dr. mary wakefiled announced that help centers had served an additional 2.7 million people in 15 months. they will blow past the 2.9 million target. their original target was the

1.1 million would be uninsured. they are already at 1.5 million. these folks are social entrepreneurs. they are not in it to make money but they are making lemonade every day. they are doing great work. >> ellen-marie, in your report, you outlined the economy in the communities. what were some of the highlights of that report? >> is important that we see employees coming to the health field -- to is important that we

see employees coming to the health field -- it is important that we see employees coming to the health field. we want to see how much the community is growing. in some of the rural areas, the community health center is the engine. they are the core in that community and the anchor of helping the community survive. when you see the jobs being created -- we talk about sustaining, as well. these are not jobs that were created necessarily because of the closing of st. vincent's but you could keep your center opened so it was not necessarily a loss. some folks lost jobs will get employed by bell local state polls -- employed by the local staples because you are using the local staples. >> i think we are ready for

questions. we have a microphone right here. let's go to the gentleman back there. >> thanks. i want to thank you for the great work you are doing. about 36 -- about 30% of school age health care is sponsored by chc. houses research apply to a school based setting? >> one thing that health centers do and what i studied in west philadelphia was a satellite. it was maintaining these jobs within the health care jobs community. what is important is that one thing is that what you describe as a perfect example of the ability to offer service in another place that does co-

located and coordinated with the site that is available 24-7. as a satellite, you can provide care where it is more accessible. the services can continue in a comprehensive way when you were court made it with something like a community center. the things you do predated the minutes clinics. you did not want to create two different isolated ways of delivering care. we would like to see more of the nursing centers, school based centers become incorporated into things like the community center and as we leave more toward electronic medical records, either by the the spoke from this of and the ability -- from the us hub and the ability to be

that important in the community. >> over here? >> i am with the institute of social medicine and community health. the discussion has primarily been the induced a fax -- e fax on the community -- effects on the community. as a model for health care delivery within the system, within the community and geographical area it serves, to what extent can some of the lessons of the effectiveness be translated into improving the efficiency of health care delivery at the geographical level of the community and the region? >> that is a great question. thank you for raising it.

the major purpose of health centers from day one was to bring health care to communities with too little. they were agents of care but also needed to be agents of change. to change the way health care is organized is the point. that is a lesson they can bring. in small but significant ways, it has had an impact on the rest of the health-care system. most health centers have gone through the health disparities situation. this was created about 10-12 years ago before. clinician tames, health professional teams, not just

positions or the dentist but a team of physician, nurse practitioner's, pharmacist would an environment ma using the chronic care model that term health care from a reactive system to a proactive health delivery care system. when i talk with my colleagues, i have found that not only did it fundamentally change the way that health care is organized and delivered to the absolute benefit of the people who receive that care, it also put those individuals in charge of their own health and their own destiny in many ways. instead of feeling like a victim of diabetes or a victim of hypertension or a victim of asthma, people would learn and could learn to take control of

their health condition and learn what they could do to improve and maintain their health. i cannot tell you the number of times i have heard clinicians' tell me about an individual who called them ecstatic because their hemoglobin blood sugar level for diabetes was now the lowest ever. they were thrilled and they were doing it. they were testing their blood sugar every single day. in many ways, this has allowed clinician's to be cared rivers but also to be cheerleaders, cheering the individual and a group of patients because the user group patients with diabetic and hypertension.

that is life altering for a person on the receiving end of the care. this is also fundamentally life altering for the clinician's to give care. this health disparities collaborative have been the biggest boosters for clinician's that felt like they were at the bottom of the cycle. all they could do was reactive to respond and not be overwhelmed. instead now, it is pro-active and is what our health care system should always have been about but it -- but it is not. we need to turn from success care to health care. that opalescent that: -- that is the lesson that health care professionals need it has contributed to different reports and studies that the care in health centers is superior in

many cases to that offered in other settings. >> a couple of years ago, we worked with the community to have a healthy heart coalition. we had commercial partners. we established the manual. at a restaurant they have a separate menu for the low calories. this is what is healthy for your heart. we worked with bakeries. they have a list of low, healthy, diet bakery pastry less. iat. they gave the community a

choice. that is what we have been doing. >> i think we will have a high cadre of people exposed to this kind of care. a wall street banker will not settle for different things. loudoun county people will want that from their health providers. there is a big discussion of moving to the medical home. i think of this as good primary care and coroneted and comprehensive. with the health centers, because they move beyond the care that is delivered in the health-care system but realize the importance of the translation is this moving towards the place

that helps you to negotiate the proper health care system. as we had more and more models of the new models of care and characterization's of medical homes, can have health center care is the model of how we move into the future and what we would like this and possibly at some point of health,. >> we bring this back to the last person? >> good morning. the metrics used to determine the medically underserved areas have not been updated since, i think, 1978. how is them reflect the actual need in under reserve populations underserved populations? >> first of all, the metrics are

proportions. it is the rate of poverty, the population over 65, injured mortality, low birth rate, and primary care room physicians to population. even though the demographic 7. have changed, and there are areas that have lost their status because of gentrification or something like that i am a believer, and by the way, let me say that because they are now 30 years old that the methodology, the criteria being used, even as they have been updated with new data from the census and from other sources, they are still -- so much has changed in america but they need to be updated. that is why last year we supported legislation that ended up in the health reform act that calls for a negotiated rulemaking process to specifically update both the

health profession shortage area in the process. i am pleased that it became law. it is now about to be implemented. i am pleased to note that i was appointed to lead negotiating room making committee. we strongly support meeting to update the process. having said that, one thing i believe in is that once the center is funded there's only one set of data that matters, okay? this determines whether it is needed in that community and that is the demographics of the very people it serves. fairfax county today does not have a community health center because the party in that community, and there is poverty, is washed away by the great wealth. it is almost impossible to get a designation even though you and i both know that there are pockets of people who desperately need this in fairfax

county. the sale loudon county will come back, it will be strong, what would happen? if the demographics were to lie about the designation that you have today? here is what i maintain. let's look at the stephanie health center data. what percentage are uninsured? what percentage are for? what percentage rely on public support like medicaid or the children got to health insurance program? what proportion are people of color? what proportion of people are at risk for for held comes and poor health status? to me, the measure of her success in her house hunter success will not be a demographic process. and now to be in the numbers she produces the their meeting a continuing need in this community regardless of what happens to the demographic of the larger community. that is what really need.

that is what i hope to be able to accomplish the negotiated rulemaking, -- process. once we fund a health center in the community, let's look carefully at the demographics of who that health care -- health center serves in making the termination of continuing to put resources in there and invest in the community in the future. >> off of what you just said, we have identified a tremendous need in loudon county for a pediatric center. there is one frequented in the county that only cares for adults. there is really not anywhere else for children to go. because of a 600 person waiting list, we cannot would return with children certainly. we are on target opening in a pediatric center for specifically low-income and children on september 1. this is without federal funding

because we cannot wait. the demand is there now. help in the future to get funding for the center, but we just cannot wait. we looked at the demographics and we know the demand is there. we are moving forward regardless of federal funding to meet our community's needs for a pediatric center. >> live up by wall street, yet your committee is one of great needs also. >> do is list of additional funding, right? how do think that money will be used for the community center? >> i will lead rebecca and stephanie tell you how they hope it will be used. here is a reno. the formal care act provided $11 million in new funding for health centers of the next five years. that is above and beyond the

current $2.2 billion annually fund -- annual funding that will continue to receive, we have, from the congress of the next five years. the 11 billion is in the bank already. was directly appropriated, guaranteed funding it will be released in growing amounts on october 1. of the $11 billion, or $1.5 billion is for facilities. other than work force, the next greatest challenge that health centers face is based. when i ran a health center, i had a mantra. always have something, it is either not enough money, not enough space, or not enough people. sometimes all three. typically all three. those are the challenges that health centers face. with the health reform act, the money problem is not totally solved, but it is a good way down the road toward being resolved. the space challenge will be a

great one. the $1.5 billion is about 10% of what is needed. for health centers now and in the future, to grow and serve those 40 million people. the other 90% will have to come from private sector, state funding, philanthropic support. it probably will not provide everything she needs. she will have to leverage other resources locally. that is a big point. the other 9 $5 billion will be released to support operational support. it will give stephanie and rebecca the resources they need to hire new staff, perhaps read some new space, buy supplies and other things they need to actually begin providing care. it is that $9.5 billion that

will be the capacity to serve 20 million more people on top of the 20 million served today with the $2.5 billion annually. already, last friday, the secretary of hhs, catherine civilians -- sibellius, announced they will have applications for the new access point. i believe it is $250 million of that $1 billion in fiscal year 2011 of new funding that will be available. applications of the accepted some time in the fall. hopefully, those new health centers will be funded sometime in the winter and can begin providing care. it will go that way each year for the next five years. >> how would you use the new money that would come?

>> welcome and we know right off the bat. [laughter] we've are out of space. we cannot higher support staff because we do not have any place to put them. the facility we are in is very nice, but it is a very limiting. the very first thing we would do would be to build a brand new building. we have an architect in the community that helped us design a plan for the building that would include 18 exam rooms, 10 dental offices, exams base for our mental health workers, prenatal care, you name it. it just depends on the other services we might identify in the community. we already have a really good base and a real good feel for what we would do with that funding and we have a space fixed out. >> that is great. >> for us, we tried to offset

the needs of the community. lots of patients want to be seen on the weekend. we have been opening on five days initially and then we increase it to six days. then we increased to seven days. in the community do they have ob/gyn services on sunday? for us, we are maintaining the level of service on sunday. with the capacity building, hopefully we will be able to expand service on the weekend, as well. just like we talked about by train the front line staff it will be on going. you want them to be quite ready for any changes in the future. >> if i could make one other point. healthcare is about the only industry that do not work and

banker's hours anymore. only the health-care industry works and 9-5. every single one of these has evening were weekend hours like this. this is what we need. the reason that they started a revolution health is because he had to sit in an emergency room one hour -- one weekend afternoon when his daughter was injured in a soccer match. he thought his time was worth more than that. it was a clear market. it points to the failure of the health-care system. it is not responsive to the people who needed care. help centers are trying. they are far from perfect and have a long way to go, but they are moving down that road. the rest of the health care needs to follow. back to your point, what can the rest of the system run from health centers? it is we need to stop working banker's hours. >> we will go to the back, the

needy in the back. >> i work for refugee works. i work for on workforce issues related to refugee and immigrant health professionals. they are already in the united states and trained abroad. they want to requalify to practice in this country. for the m.d.'s is the lack of residencies. hospitals have a lock on that. the want to recruit people who will become specialists. is there a possibility that in the future community health centers can have residency's available or in addition to hospitals said that you can provide the next generation of primary-care providers? >> that is a very good question.

i think that is one that, back to the point of needing to grow our range, it is not only finding people from the community who can pursue a health professional boxing career and a fleet combat to the community to give back and care for the community. it is really running an operating room and then tries to educate physicians, nurse practitioners, and others. in fact come in the health-care reform matting, that much maligned health reform, which has much wonderful stuff in there are a whole host of programs for improving training. one of them is called teaching health centers. it calls for funding to develop and operate residency programs. this with the four physicians. listen to programs that are based in health centers, not

just in health centers but in ambulatory sites where the vast majority of health care is provided today. it is not in an inpatient care institution. as you have pointed out, virtually all of the residency training in america today is run out of hospitals. we need to move much of that into the community, and to ambulatory health care centers, hospital-based residency programs are doing some of that of we need more. we know of at least one dozen health-care centers across the country that offering, managed come and run primary care residency training programs. we think that number could triple or quadruple easily. we know more than 300 health centers actually of residents who rotate through today. they might be there for 90 days or six months. they might be there on a

residency rotation, but there is some much more to be done. then there is funding for expanded nurse practitioner training. rebecca is sitting right here next to me, i want her to be my best friend of what her and her colleagues to be my best friend. i believe some of the most productive members of health care staff are certified nurse min -- nurse midwives. they do a wonderful job. we need to train more of them as well. it is the same with extended the due care practitioners. we need hygienists, dental educators. we need clinical social workers, marriage and family therapists from other mental health professionals to health -- to help with this stuff. they should be trained in

community-based settings. my hope is that more health centers will step up to service the training sites for them going forward. >> two other quick points. one of them is that theme health care reform and cuts the some requirements that had a lot of physicians in training in hospitals and has allowed them to prison. in the more community-based sites. the second is allowing the reallocation of some unused primary care slots. there are some places that do a great job in primary care and they are full. there are other spots not being used. we tried to move them and has some of the unused slots good place is going a good job providing primary care. that will be two chairs -- two ways. >> the match again, that will come back to the front. we have time.

>> i am with the committee transportation association of america. we thought we would hear what you would have to say about transportation. when the training and jobs happen to know we want to be a support of transportation does not become the barrier. is the same with patients coming in. the community transportation association is listening. if you have any questions for me, please do not hesitate. >> i want to thank you for making that point. i want to make another point. we talked about how in rural america, my health center was in rural america with the public service bustlines. forget a macro or in some way. it had nothing. someone did not have a pickup truck, they could not get where they needed to go whether it was to buy groceries or get health care. we had to operate efficient fans, literally running around

the two county area where i worked in order to bring in patients. right here in washington d.c., transportation is an issue. yes we have the metro. if you are a mother with four kids in southeast d.c. and the need come to gw or howard, it is a one hour or more in writing, four bus transfers, blossoms dollars with the kids in tow to get to a place where you can get care. thank god unity healthcare has sites in southeast. even in an urban area like washington, d.c., or new york city there are places where people can i get to where they need to go. this is in suburban and urban america as well that access includes access to transportation.

[no audio] >> we have worked with the children's health fund not only to bring their staff and our staff together to grow services, but also to do one-on-one transportation planning. there are two components we would work on the with which to be planning and the one-on-one delivery so you can empower people to find their own transportation. i think of us as community-based as well. >> i can give you one example. there was a young mother bringing her two small children in for an appointment. she lived in 87 miles away from where we're located in a town called sterling. we are based in leesburg. it is not that far, but the bus service is not local would and did it. she had to take the kids on to the bus, walk to the bus

station, wait for the next bus to come through which was not in an urban area where they come to every two minutes. it occurred two hours to go 7 miles. >> it is a real challenge. we go right there for the next question go ahead. you are the lucky one. >> i am from senior service america. we are labor department funded national organization that works with low-income seniors, many of whom i am sure our patients in health centers around the country. my question is to the two practitioner's asking when they have any current connection with the senior service employment community program in your areas and the possibility and if you do not of making those connections. the broader question would be to dance to do that in a broader relationship. we are in 16 states and in

multi-county areas. the potential is there for the placement of low-income seniors in 20-hour per week community service assignments to do lots of different interesting things they could do that our community-based in their own backyard. >> we work with our local agency on aging to reach out to our senior population. just like i described with the children, our local free clinic does not care for seniors as well. usually they would be going on to medicare. our local free clinic does not take insurance of any kind. the other problem in our community and many other is that a lot of private practitioners are not taking medicare. they are turning the patients away. we welcome them. we want them. there are an awful lot of key -- opportunities in our senior community, we have a lot of

retirees moving too loud in county. we would love to have helped to have us -- to other seniors. we have a large retired military population we would certainly welcome those partnerships. we try hard to reach out, but with a limited staff with volunteers or other outreach people to help us to that in a better way. >> we have a long history in terms of working with the seniors. when we did was a couple of seniors were our patience. then they register and work 20 hours. we gave them training. after they proved themselves and physically they were able to handle it, they become subsidized half of the time. we have someone working more than 20 hours so they can serve

as a messenger, making copies, analysts things. they are very helpful. >> ok, great. one more question right here. then you guys can talk afterwards. >> i am a free-lance correspondent. this paper -- i think this is probably more relevant. how many centers are involved? how many of the population is served? what is the money put in there? for the center in wall street, if you notice in the last couple of years the increase of environmental related diseases,

particularly respiratory diseases? if they have not been pace anemometers, i think they are numerous health conditions the should remind should. -- conditions should be monitored. for the future, i do not with the year is, but there was a 60 dozen dollars center. where will they come in from. taken the lead from the primary care. we are sure nine primary-care patients -- positions. -- we are short on primary care physicians. for the current center, how do you recruit staff? how much are they paid?

do you have a problem the turnover rate? thank you. >> in the four minutes? [laughter] one of the most poignant questions about the aftermath of 9/11. >> we are 10 minutes walk from ground zero. for the past so many years, after ground zero, we have been seen was respiratory definitely come and the children. we are lucky to have and as much initiative in our center, especially for pediatrics. we work closely with the city hospitals and the city department of health. educate,re to screen, and teach the parents help the

child maintain a healthy lifestyle and how to use the breather appropriately, but definitely you are right that we have been seeing an increase. >> let me see if i can answer couple of your other questions on this. in terms of the members of on the screen, in the year 2015, and this is all related to the year 2015, not a five-year time, but the total federal funding of the $5.8 billion. $2.2 billion, the regular funding, and 3.6 billion in new funding from the health center fund in the health reform act. that will be roughly $6 billion. the remainder of the $31 billion there and you're to come from medicare, medicaid, private insurance, state and local government sources, a private

philanthropic support, and from the patients themselves who are always asked to pay a little something although no one is ever denied care for the inability to pay. $6 billion of the $31 billion of the federal grant fund. that 6 billion leverage is. the other 25 billion in other revenues that will unable to serve the allow you to the c 40 million people in one year. that is twice what reserve today. we anticipate they will be served at twice the number of locations from 16,000, as compared 8000 today go what will it take to somewhere in the range of six-and 8000 physicians. 40005000 dentists. i know. these numbers are huge. a dental hygienists and others? among some of the confident, however, that health centers

will find them. they found them over the last 10 years when the shortage was only getting worse. they went from 4000 to 8000 physicians between two dozen to and 2010. they followed. in some cases, they were recruited. the fund for writers who were just tired of working for they had been working. they wanted something new, exciting, and challenging, so they were able to recruit them that way. i'm convinced we're turning the corner in the primary care. we have begun the process of revitalizing primary care. some of this is in a market phenomenon with respect to salaries. you mentioned what they're paid. if you work at a health center, you are paid a market which, a fair compensation compared to what is going on in the private sector in your community. that does not mean we have many former thousand dollar surges

-- $400,000 surgeons. that is because the health center needs to offer in order to recruit and retain them. i do not know what the turnover rate is. i will tell the the longer a health center has been in the community, the longer people work their stay. i'm sure rebecca can speak to that, and the stephanie may have experienced something. the first three or four years, it was like the whole staff turnover. by the time left, there were people who had been there for, 5, even six years and were committed to staying. >> with potentially have no turnover. >> good for you. >> we have no turnover. we just hired a new general

practitioner. he is a rather young man. he read -- he retired after 20 years in the navy. he was a doctor in the navy for the entire time he was there. is looking forward to come to work with us as of september 1. >> that is wonderful. >> and still young enough to provide many years of care. >> i want to thank our events team. thank you so much. thank you for taking your monday morning to come to this. >> over the next hour and a half, two views of national security. it is followed by the former treasurer -- director of national intelligence. after that, today's news conference with defense secretary robert gates. later, republican candidates from georgia for governor.

a couple of live events to tell you about tomorrow morning. the agricultural departments for diversity, the georgia commissioner on c-span2 at 8:00 a.m. eastern. at 10:00 a.m. eastern on c- span3, a briefing on the 2010 census. it will include data processing that is still ahead. next come the former head of the cia on national security. he answered your questions for about 45 minutes on washington journal. host: and general michael he did was the former cia director under the bush and administration from 2006 to 2009. let me begin with "the washington times" --

the fbi is now keeping tabs on him. he has supposedly taken over as the new al qaeda chief. guest: he was the no. 3 chief of operations. that is the position in which there has been a series of successions because we have been able to take off the battlefield the no. 3 position in al qaeda with great regularity. the operations chief cannot spend all had his energy hiding, as number one and two do, and he is not able to hide all day. it remains to see how long he will be in this job because his successors have not had very much longevity. the fact that he lives in the united states is a problem. he might be able to better

guide al qaeda operatives in their attacks, but this is it unprecedented. khalid sheikh mohammed lived in north carolina for awhile, so we have experienced something like this before. host: does that hurt or hinder the search for someone like this? guest: i do not know how it affects it. it perhaps makes him more confident about planning attacks because he is more understanding of the american culture, but it is yet to be seen if he will be more effective. host: will intelligence officials look at when he was in the country and try to glean anything? guest: yes absolutely. people tend to think about intelligence as current offense,

but history provides important material about what it terrorist might do. to talk to folks who may have known him, to understand who he is as a human being, allows us to be more productive about his actions. host: there was an announcement about an arrest of 14 individuals, most of them had been in the united states, or citizens. what do you make of these homegrown -- so-called homegrown terrorists? guest: this is a particular strain of home grown. it is dangerous enough to where it is different from others. these are somalis who have been trained in recruited to go back to fight al shabab in somalia.

they are fighting against what they view to be the ethiopian occupation. however, many of them are being trained in the of data -- al qaeda facilities by and al qaeda leader. sometimes they can be carried against the united states, and oftentimes, they do have knowledge of the united states. if they made that decision, it would be particularly dangerous. host: before this, the case of the russian spies. guest: it appears to be an oddity, more odd than dangerous -- and i do not want to trivialize this -- but it

highlights the fact that this is a dangerous world, countries to perform espionage on other states. from a professional point of view, this doesn't appear to be an efficient use of resources by the russian state, but again, i would be the last one to minimize it. it is still dangerous. this was not a surprise to most of us in the intelligence business. we have been aware of this for some time -- press accounts are pretty rich -- but we had known about these folks for an extended period. host: what does that say overall about the strategy for fighting terrorism? guest: we have had been taking the fight to the enemy since a few days after the 9/11 attacks.

some ask what is different, what has changed? the intelligence community has more resources, more money, but fundamentally, the biggest difference between pre and post- 9/11, we are playing offense. we are making him worry about his survival -- to use a sports metaphor. instead of playing in the goalmouth, making this a penalty kick situation, where the best we can do is stop the shot -- now we are moving downfield and making him worry about his own goal. host: who is in charge of intelligence gathering when it comes to fighting terrorism?

guest: particularly, in the american flavor, it is a team sport. they are all like pulling different positions on a sports team. what you need is a good manager to synchronize and harmonize all that activity so that we leverage each other's capabilities. by law, it is the dni, but most of us who have been in the intelligence community realize that he has more responsibilities than authorities. host: so is the dni useful? guest: absolutely. it has to work. i do not see us going back into the intelligence structure and doing major surgery again. right now, because the

legislation is weak, in the authorities that it gives the dni, but their powers rely a great deal on the powers, the relationships. the most important is the relationship between the dni and president. if everyone understands that that relationship is tight and reflects the president's personal interest, this will work. host: the nomination of james clapper is being considered. are we vulnerable without him? guest: he was confirmed by the senate. he is in the saddle now. we have chatted the last few days and he is going to do a fine job.

host: how do you know him? guest: we go back, he was my senior in the air force. i once characterized him as my mentor. he was the head of the national g a spatial intelligence agency. he was on my advisory board at nsa while he was out of government. we go back a long way. moscow we have lot -- host: we have lots to talk about regarding security, wikileaks, security. let's begin with the first phone call. patrick in west valley, utah. caller: i was wondering if anything has been done in a reference to combing data base systems -- co-mingling

database systems in the subject matter of deterring or stopping terrorism. guest: that is a great question. you use the phrase "co-mingling mingling database systems." when something happens, we often hear about the failure to share. i think you are referring to how much we are willing to share information. frankly, we shared better, certainly than prior to the 9/11 attacks, but there are some fundamental issues here. it is unlawful to use information for purposes other than which the information was originally acquired.

so beyond some bureaucratic inertia, which i believe we have largely overcome, there are policy issues that cannot allow you to dump this into one common data base and have everyone playing in the same tidal pool of information. there are restrictions, they sometimes get in the way of sharing information, but there are good reasons for those restrictions. host: springfield, illinois. john on the republican line. caller: in general, i heard you talk once before on cyber security. you made reference to the fact that you're catholic faith has some bearing about the way that you see an asset. -- see nasa.

guest: intelligence officers are inherent and thinkers. policy makers are generally the doctors. they think about the vision, the generalized principle, and then apply it to a specific situation. that creates an interesting dynamic when the fact guy has to have a conversation with the policy maker. you get into the same room, but you are clearly coming in from different doors. the task of the intelligence officer is to be true to the facts, but at the same time, be relevant to the policy maker and decisions. that is a fairly narrow sweet spot. host: cyber threats? guest: they are real.

you do not need to point to one or another bogeyman in order to be concerned about privacy, security. we built this domain to be efficient. we built it with ease of use being the dominant printable in its design. questions of security and privacy have come later. so if you build this for ease of use, you can imagine why it is so difficult to make sure our information is secure, that the network is not invulnerable, and that the information stays private. host: how many cyber attacks are there, how many are being stopped? guest: it is almost countless, given the nature of the internet. this began under a program

designed to limit the number of nodes coming in. the challenge was how do i move things quickly between trusted nodes? that is similar to the system on the internet. however, very few of them now should be trusted, and that is why we have the security problems we do today. the number of attacks is difficult to comprehend because, frankly, we built it that way. host: would we be able to track these types of threats? guest: it is a constant challenge. i am sure if you would ask my successors, they would say, we have a good number, but we need to do more. look at how quickly your

personal communications have changed over the past -- six months, six years? people charged with security in that domain have to keep pace with all those changes. that is incredibly difficult. host: we are speaking with former cia director michael hamdan. what do you do now? guest: and i am teaching at george mason university, i am teaching with the michael chertoff foundation. host: do you still have access to top-secret information? guest: all former directors maintain their clearances. at one time, director panetta invited all of the former directors in and asks for the use of his predecessor. i tried to stay plugged in. host: how many times have you

been to that type of meeting? guest: i have been to cia a handful of time since i have left government. leon panetta is the director and should have a free land to be so. host: eric on the democratic line. caller: it is an extraordinary surprise to be speaking to a man like you. i wish i had the time to speak to you face to face. i know that is not possible but i think you are in extremely brilliant individual. i wish i could speak to you. my concern is the post expose about the non-military apparatuses around the area.

i wonder, the specter of a cyber attack predicated on these individuals handling so much information may truly be a hindrance to our security. as you know, the internet changes every day and gets more sophisticated. sooner or later, something serious will happen. i wonder if you could have been on the selective drone attacks. i respect you, i do not know you, but i do not think michael chertoff is very fair, especially to minorities, blacks like myself. i wish i could meet you face to face. you are an intelligent man, but we are in on of trouble. host: two issues.

the drug issue, cyber attacks. guest: the issue in the post article with regard to contractors. some interesting things there, nothing new to people in the intelligence committee. if you want me to summarize it briefly, it pointed out inefficiencies. we have not been effective. contractors, in fact, are responsible for contributing to a large number of successes in the community. we could not do our job without them. but you raise a good point. you have to be as confident in them with intelligent as you are in your government work force. we try to be. they go through the same clearance process that we would use for a government employee.

on your second issue, the u.s. government has never confirmed or denied its drone program, and i will not do so this morning, but we have pointed out that a large number of al qaeda leaders have been taken off the battlefield since 2008. i mentioned earlier the difference between pre and post- 9/11 -- taking those people off the battlefield is an incredibly important point. i am disappointed with your views to michael chertoff. i see him as a wonderful public servant and a friend. host: next phone call. cynthia. caller: how are you this morning? my question considers the whole aspect of continuous improvement

mechanisms. we have so many security issues. what have i not come into federal regulations, gnp, everything we are trying to do to make things better, improve this mechanism system? i worked as a medical professional in houston, texas, and it is almost appalling house had the security service -- appalling how the security serves us. why is our national security being breached? they are regulating international trade and

intimating -- implementing rules. host: we will leave it there. guest: your knowledge of these things goes well beyond my own. let me talk about your content of continuous improvement. that is a wonderful phrase. in fact, i think it reflects a reality in the intelligence community. this is hard work. our enemy is a learning enemy. we cannot stand still. we have to adapt, react, and respond. to your question, when you are talking about security, there are balances to be struck. we have gotten quite good at detecting and disrupting the macro al qaeda plot against the

united states, iconic the tax -- a tax that we saw in new york, -- attacks and that we saw in the new york, over christmas day. how much you have to do to disrupt the kind of thing that we had happened in times square -- how much do you want the intelligence committee to squeeze privacy, commerce, were convenient in order to have high confidence you can disrupt that kind of attack? that is a devil of a problem, and one that has to be decided by policy makers after an open dialogue with the generalized population. there is a balance we have to strike here. the intelligence community needs to be guided as to where that balance should be. host: it sounds like you do not believe we are quite there?

guest: i think we have to understand, as good as we try to make intelligence, how good do you have to be to preempt a faisal shazhad-type of attack? at what point do we, as a nation, decide we want our intelligence professionals to go this far but no further, as it begins to push up against commerce, convenience. where is that line? host: the front page of "the new york times" -- a piece looking at private bradley manning. what are the implications of

this? guest: it is hard for me to calculate how bad the damage was. the callousness with which the information was put out there, allegedly by this soldier, is stunning. host: what do you know that others do not know? guest: he believes, by reading these documents, which are sensitive and which are not. the best i can say is he believes the contents of the document determined whether it is sensitive or not, whether it is legitimately classified. those of us to do this for a living now that it is really the content of on that determines whether a document should be caught -- classified. it is the source. he does not know the source. he puts a document up there that

suggests the americans knew ied's would be placed in the spring of 2007. he does not know that an american patrol -- this is purely illustrative -- that an american patrol team intercepted that team. at the time, they chalked it up to bad luck. now the taliban is looking at this report, which he does not see as sensitive because it is old, and they say, it was not locked in that the patrol stumbled across our team in 2007. this information was revealed to our enemy. i can see the conversation going on, where did we have that meeting, whose house was it? he has no ability to gauge,

predict that series of air vents, and he has put people at risk. beyond that, who will come forward now and help the americans? the battle for afghanistan is a battle for the population. now we have told the population -- he has told the population -- do not trust the americans. they cannot keep your secret. host: to do what advocates say we need to do in afghanistan and iraq, do you think it is good for the american people to read what it is really like to be in war, to read those memos put together by soldiers and realize how greedy it is?

guest: -- gritty it is? guest: no question, the war through the eyes of someone on the ground is much grittier than anything that we could possibly imagine. there is a kurd they a best seller that talks about a young man -- current best seller that talk about a young man in the war, and it is war at it's greediest. we do not need a complete account to understand what is really going on. host: next phone call. kentucky. caller: we need to secure the border and get rid of all of the

illegals. if we do that, we could take care of national security. talk aboutet's border security. guest: a good point, but it comes back to my question earlier. how much do you want to squeeze comfort and security? i know there are a good number of americans on either side of the issue. an undeniable fact of sovereignty is control of your borders. we can all agree more needs to be done. what that is is subject to debate. i have some personal debate -- news, but i hope -- views, but i will leave it at that. postcode next phone call.

-- host: next phone call. caller: i spoke to you earlier this year about terrorism. maybe one month later, indonesia got hit by the tsunami. how many terrorists have you seen come from indonesia since the tsunami? there was a u.s. mercy ship that went in to help, and perhaps that could be used as a tool against terrorism? guest: in fact, as we speak,

american helicopters are in pakistan trying to deliver aid to those areas that are going through a once-in-a-century drought. we did the same thing after the earthquake in pakistan. the general pakistani view of the americans improved after that, as we undertook that kind of operation. i agree strongly, you can do an awful lot, even in the nearly- defined area of security, to fully use your resources. host: is there enough volunteerism to this effort? we have seen hillary clinton ask

for more people to phone-in aid. guest: absolutely. sometimes in america we do not get much credit for the help that we give. so much help given through the private sector is not given through the government. that is how we have done it, it makes us agile, but we do not get much credit for it. host: maryland. logan on the independent line. caller: good morning. i always wonder, terrorists who are here, it would seem relatively easy for them to get their hands on explosives,

surface to air missiles -- they seem to be pretty prevalent on the black market. i wonder why they would not just start blowing up airliners to screw with our economy and then do it again six months later? it only takes a couple of them to make a big dent in the airline's -- host: and we understand your comment. guest: you are not the first one to raise that question, me included. but we have continually been concerned that al qaeda might change tactics. you recall what we were doing two years ago around thanksgiving.

there was a major hotel in mumbai that was attacked. that was conducted by a dozen individuals with automatic weapons and sell bonds, and -- cell phones, and it had a great economic and political affect. those types of attacks are difficult to detect and disrupt it. al qaeda seemed fixated on iconic targets. the world trade center, pentagon, multiple airliners simultaneously. the great fear is what you suggest, at these lower threshold the tax that collectively would have great political impact, could be something they went up to four. host: is that a greater threat than what al qaeda is obsessing about, these iconic --

guest: if you look at history, because we have been taking the fight to the enemy, let me characterize where i think they are, if i was there staff, what i would the laying out to them. their ability to conduct a complex, spectacular attacks is not the zero, but has been greatly reduced by the kinds of things that we have been able to do. al qaeda central in the afghanistan, pakistan region has been reduced, so they have had to go to franchisees. we have had made them less capable of carrying out complicated, mass casualties attacks. their attacks will have less percentage of success, will be

less spectacular. that is good. over here, there is a danger that they would be more numerous because they are easy to mount. this is unqualified success, and now we have to worry about these potentially less harmless, more numerous attacks. host: next phone call. caller: good morning. i am jealous of the professional role that you get to have to, with all of the data, and i am proud of what you did. i want to ask a philosophical question coming to the extent that you can answer, how active is the control factor of capitalism used to advance

freedom and democracy around the world, does it drive policy, or does it follow intelligence? i once had a friend named bernie hoffman who working in the shadow bank in washington and said most people walk around with a quiet understanding of freedom, what it takes to protect assets around the world. are there still a off-balance- types of problems like that? guest: and that it difficult for me to talk about because of my

knowledge. the intelligence guy is a fact guy. i cannot divorce my professional life from who i am. i am an american with american values. i believe mankinds natural inclination is toward freedom, economic freedom, political freedom. but i need to filter some of that when i am talking to the policy maker. the greatest service i can give a policy maker is for him to think i am actually adversary in the room -- not that i am advocating the goals. but i am reflecting to the president the adversaries thinking come as accurate as i can. mr. president, let me tell you how they are probably thinking about this.

you have to try to put yourself into the value system of the adversary so that the decision maker, a policymaker, understand what they are up against. host: let's go back to the terror suspects arrested by the fbi. either a neighbor terrorists before they came here and were able to get citizenship, maybe they were already citizens. there are questions about how come these people were not caught under your watch, how were they able to be in this country? guest: we are a free and open society. many people want to come and live here because of those freedoms that i mentioned. the security services of the country are charged with finding, who in that great flow

of people, might be enemies. it is a difficult task. in fact, is it is a difficult task. at what point does dissent become a danger? when does a belief in the same value system become a threat to the generally-agreed a value system? i do not say that we tread lightly, but the american people need to know that the security people doing this are sensitive to those fundamental american values, as we try to the sect, who among us, might be an enemy among us. host: and jenny on the democratic line. good morning. caller: i agree, the intelligence community does a terrific job.

i do not know how they do it sometimes. one of my questions is, on september 10, nsa intercepted a call from usama bin laden to his stepmother. they did not interpreted until september 12. why? if i had a friend to concerns me, could i ask someone in the government to look into this person to see if there is any danger? guest: let me answer your second question first. without turning america into spies of others, i would simply recommend that you identify the appropriate authority and pass on that information to them.

with regard to 9/10, there were no phone calls that i am aware of between usama bin laden and any relatives prior to that. there were some intersections on the 10th of september that were translated which were analyzed. they were non-geographic- specific. nothing in those communications suggested an attack on the american homeland. if we would have translated, analyzed, and reported those conversations prior to the 9/11 attacks -- there were two -- it would have been a 30 -- the 32nd 3rd warning that summer

that there was going to be an imminent attack. host: if sanctions do not work, what is next? guest: it is a difficult problem for the administration. you have un sanctions that are not very strong, but broad, you have the american sanctions which are stronger still, but they are only american sanctions. as that narrows, you have other countries coming in and filling in the spaces, more responsible

international actors. president obama spoke to journalists last week and admitted the iranian state may be so committed to getting a nuclear weapon, but sanctions it may not succeed. my successor, director panetta, responding to a question about that, said that they probably will not work. so that will leave us in a place where they are rushing forward to the step right below have been a nuclear weapon. permanent break up state. going from here to here will be undetectable by intelligence because the distance it is so short. we have to decide whether that state of affairs is acceptable.

if not, if we think it will be inherently destabilizing in the region, we have to look at what is a quickly-narrowing the list of options about what to do about it. host: windchills, north carolina. david on the independent line. caller: i wish some people would be very careful about certain terms they use, like security, protection. the use of the word freedom and capitalism, which i would equate to self-interest. general, are you familiar with the concept of the public duty death? for what is usually involved when a government official best to protect, and the victims' families choose a government agent for failure to protect.

the government usually comes back with the defense, a form of sovereign immunity, that they had no legal duty to protect the individual. there are many cases in history. thousands of cases across the american where americans are misconstruing the fundamental bullish -- between themselves and the relationship of government -- responsibility of government. when you talk about national security, many people may misconstrue that it personally means them. kaska at the end of the day, we are trying to protect americans -- guest: at the end of the day, we are trying to protect americans. i was interviewed before 9/11 and i was asked, you work hard,

but can you guarantee that you can protect america? i said, no, i cannot. even at the top of our game, i cannot promise that nothing bad will happen. this is a determined enemy. >> more about national security from the former director of national intelligence, carmichael mcconnell. he was at an aspen institute event focusing on cyber security. this is all a little less than an hour. >> thanks to all of you for coming today and thanks to admiral mcconnell, and many of us have children. we love all of our children.

all our sessions are our favorite but this is the one that i have been looking forward to. this is where we have an opportunity to have a condensed period of time with a person ideally positioned to explain a crucial issue to us. you know about his background as national -- director of national intelligence and the national security agency. if heard that if you worked at the national security agency, you never call it "the." >> that is correct. >> now you know. >> on my favorite wrench out, he rushed into my room and said that he had found a frog. ,e've been talking to grandma and when you croak, she is taking us all the disneyland.

[laughter] >> was that most or least favored? >> that made him the most. in your copious. time after the session, you might want to go to the website at of intelligence squared and check out a debate that he was in on whether the cyberworld threat had been hyped up? you are on the team that said it not been over-a new one. it was a formidable performance. we do not have a lot of time today and so my addition to allow for question is to go into some of these fundamentals. all of us have heard about the cyber threats, cyber war issues, but few of us are confident about what it means and what we should worry about it and dismiss and what is exaggerated and what is real. that is what i like to go through. let me start by asking you in

basic terms what is the threat we're talking about? if you had their rank banks to worry about, what would they be? >> let me start by describing as the nets. and when i say that, think about it as a global enterprise. you can move from one side of the world to the other side of the world in milliseconds. from china to the new york is about three milliseconds. you can be at any place on the globe and have access to your benefit, conduct benefit or exchange something of value or commerce for whatever, but you also in the remote location could have access to do harm. and that is the issue that we've attempted to identify -- how we continue to reap the benefits of this global enterprise that we

note as the global information technology revolution and what a the balance of the roles of the government and the private sector in causing it to be secure enough that we can conduct the nation's business and the global business in a safe and secure manner? and let me put a point on it that they will help people grasp the gravity of this. the real world cannot function without banking. that is a lot of dollars that flow through. the economy of the united states is $14 trillion's every year. there two banks in new york city that move $7 trillion a day. there's nothing backing up their currency, no gold, not even printed dollar bills. if you added up all the printed dollars in the exchange, it is a 2% of the value.

where is it? it is stored in a computer system or computer systems that allow all the world to exchange value and currency and reconcile in milliseconds. that is the benefits and that now has introduced all level of vulnerability. and it repeats in areas like electric power and transportation, everything that people depends upon, it some way is benefiting by or dependent on this thing that we call the internet. >> you mentioned the electric grid and things like that. it is not just the physical entity, but information systems, because that brings us to one of the most contested issues in this field, whether there is such a thing as cyber warfare? here is the analogy. you can make the. mancur -- you connect the point

that someone in china or somewhere could disable an electric grid or the highway system. you could also make the analogy that russians could send nuclear weapons, but that does not mean that we are at war with the russians. does the theoretical threat mean that we are at war? how we think about the terms cyber war? >> many of us are concerned about this and we use the term cyber war. if i had until this time to think about it, i might it used cyber conflict. it is a fact of history in a characteristic of mankind that if there is conflict, it is conducted with the instruments at hand. whether you're fighting with spears or a crossbow or form instruments or what ever it is, that is the nature of conflict.

what we're facing now was a situation where someone who wishes you harm or may have a different world you, they have the capacity to include catastrophic damage with a relatively small investment. so and are we at cyber war meaning there is some grew out they're attacking us in the manner of warfare, in a legalistic sense? i would say no. are there those out there that have all worldview that will like to change the world order? i think everyone would agree that there are such groups and you can pick your extremist group. those of us have talked about this history -- this issue and being around the from multiple points of view, the arguments that we are attempting to make is not to wait for a crisis. if you think about our wonderful democracy with checks and balances, we will talk about

a problem forever but we often do not take the steps necessary to address the problem. but wait until there is a crisis, and then we get a huge overreaction. why can we have this debate among all the parties to get the framing right, at the law right, and get the international relationships that we have to pull out of this adjusted in a way that we are partners in a global enterprise that will depend on and should be secure? >> i would like to comment on some of those constructive suggestions you have on international partnerships. let me ask the further clarifying point on this war there, and this is to have said. the you think about actual states with whom the united states might conceivably go to war, choose your state, whether china or somebody else, and if the circumstances were they were trying to infect our cyber structure, we would be presumably doing lots of other

things to each other. is that assumption correct? the second part -- for the non- paper that we worry about constantly, is there evidence that they are trying this try and -- this kind of actual or fair? >> i don't remember the exact number -- 200-odd nations states in the world and about 140 of them have a relatively sophisticated cyber exploitation capability. i used three terms -- exploitation, attack, and defense. i want to separate those three terms if it because they are often confused. if you are exploiting, you are reading the other guys mail. you want to know his secrets and the amounts of his military equipment and his intentions. you were falling in an intelligence since the capabilities of a potential adversary. attack means that you would use of cyber means to achieve the objective. we're mad at somebody and we're

going to go land troops, we turn off the air defense or because the lights to go out. we think of that as an attack. defense is the more challenging issue because you have to defend all potential vulnerable spots. every nation stayed out there that is doing contingency planning, that has military forces, as a strategy he for being successful in any kind of a small scale or large-scale conflict, is thinking about and planning for cyber conflict. i use china as an example. let's suppose that we had some disagreement with china over something like taiwan. let's suppose the china invaded tie 1. what would be our reaction? what would be the policy of the united states? if the policy decisions lead to conflict, there is no doubt in my mind that both sides would be using cyber to achieve or time

objectives. and that could be engagement of tactical forces at the front line. it could be an attack on surveillance capabilities so you understand the battle space. it could be an attack on command-and-control, or it because something to waddle back in the home state to cause uncertainty and fear. it could cause the clients to go out, lots of things. when you pick up the way that i try to introduce it, from any remote. you can touch another point, if you are sophisticated and you have a very sophisticated exploitation capability -- to exploit means you can be successful with no fingerprints -- so if you are a successful exploiter, then by definition you have the capability for successful attack in you should have the capability for better defense. and that is the debate space that we're in right now, what

are the right policy frameworks and the right legal frameworks and the international agreements that you might establish to secure the space? and one final thing on this point. if the chinese are having this discussion, they would recognize that the u.s. is not without resources in this realm. >> the u.s. is not without resources. if you recall, several things happening in 1992. the cold war was over. there was a peace dividend. we had a new administration, and a thing called the internet -- anyone heard of the internet thing? it was about to explode in

increase -- and create incredible wealth for many people in this room. i listened they're thinking of the relevance. i have an institution whose roots go back to world war ii where we were successful in reading and nazi germany's codes and japanese codes, opening their mail, their secrets, and historians will debate whether we shortened the war by 18 months or two years. the fact of being able to understand the other guys intentions in global conflict was very important. the leadership of the nation's decided that codebreaking wasn't born. they were going to institutionalize it. that was the national security agency. and i am its new director in 1992. a peace dividend, the cold war is over, and the internet is exploding. here's the way it was explained to me in those days. most of the exploitation

throughout world war ii and the cold war was wireless. there are only two kinds of communication -- wireless and wired. we made most of our hay on wireless. when i walk in, when a young engineer said, 90% of the world's communications will be inside a glass pipe soon. now you're the new guy avid agency being challenged. the question is relevant. how much do you start to change the institution, and this was a global institution? just think about exploitation in cyberspace, as think wider, and i have two startling conclusions after we started down that path. the first was that this is real easy. and the second, because the

other side of the national security agency, in addition to codebreaking, they are responsible for code making. and when you start to think about code making as the defender, the protector, you think oh, my god. we are the most connected. we're the most appended. united states at that point in time was the most vulnerable. -- the most dependent. the united states at that point in the time was most vulnerable. that was the realization in the early 1990's and i made it a passion of mine to sharon in sight and make a case for -- we need to think this through. it is worthy of the digital age , madison, jefferson, and adams to have this debate because it is such a fundamental change.

>> your article and all the details will be in the " atlantic" next month. he said the u.s. is the most of honorable. we're also the most open society. >> that is correct. think of the internet has anonymity for billions of people that can touch you, and not all of them have their bets -- have your best interest at heart. some of them do not like the way that we live or the current world order and they want to change it. that is what i am were about. the cost of entry is so low if you have technical sophistication, and what i would highlight, i focused very intently on terrorist groups and what they are doing and planning. there is an intent to have 9/11's on an over magnitude in this country and they are

pursuing chemical, biological, and nuclear cape -- technology. and they are talking about cyber. when they talk about cyber, it makes me worry because that would be the easiest to do. . >> let me have one more threat- related questions before getting to the federalist papers for the cyber rig. could you do a scale for us on two different taxis -- one is kind of threat, terrorism, governments espionage, and the other is by source, china, russia, and how should we think about the hierarchy? >> of the start with most people -- let me start with what most people think about. hacking is a nuisance, it is a pain. the next most significant is a crime. that is becoming more and more significant. it is a major activity. it is something i worry about

but i do not worry about it threatening us as a nation- state. nation-state threats, there is no doubt in my mind that if someone is mad at us, they ended catastrophic damage. however, i would add that most nation-states would be deterred. we often talk about china as unnecessary. i tend to think of canada as a competitor. we are in competition to do things. we need each other. the chinese need markets and may need access to raw materials and stable currencies. when you look at their holdings, the united states bonds and notes, and as the market, it is not in their self-interest. while they may have some ability, there is an inherent deterrent to deliver that. the group that i worry about that is not deterred, someone who wants to achieve destruction of the united states or the world order. that is to i worry about,

although i would quickly point out i don't believe they have the technical sophistication today. if the one thing i would highlight is that when you look back at some of the attacks, bonds and the killing of people, oftentimes those were very educated people. i think it was the summer of 2008 the attack failed, but there were two medical doctors that attempted to carry out those attacks. how much time is it until we have someone so radicalized that instead of kills -- skills in computer science or electrical engineering, and i find people that have inherent skills and understanding of how to maneuver through this space without formal training. if we go look -- get those with insurance skills and formal training and they have radicalized view, the possibility of damage is significant. choosing your call several times a day infrequently in your past

it -- in your presentations on the need to read frame and national and international consensus on how to think about the benefits in the vulnerabilities of the internet- connected world. tell us a little but about the big issues you think need to be resolved, and what will happen if these are resolved the right way? if they're not resolve the right way? >> in the group that i associated with, one of our guys was a historian. we did some thinking about this. he said, is this new? have we ever face the situation before? he did some fascinating research and started at the industrial revolution. there's some interesting personalities that have discovered this. there is a statistician and he can tell you that story. and one economist, he wrote about it from harvard in the and the40's,

argentinian economists. there is a cycle. the cycle is 50 years in the light, it could be 46 or 52, but it is roughly 50. the new technology creates new business. the new business and its side. but some get such significant gain, they start to abuse it. at that point, the government then actually has a role. it's easy for americans to understand railroads. the united states has been the largest economy in the world since the 18 eighties. the industrial revolution started in great britain and we had the cultural and the spirit can be connected border to border with the train systems. and we were enjoying the fruits

with that until the monopolist behavior of the trains, or the train industry, and started to do harm to society. that cycle has repeated itself every 50 years. another one easy to understand. how many people remember ralph nader's book, "unset at any speed?" debate about putting seatbelts into automobiles. i'll never forget the statistics. my dad took me to the highway department and is a had shoes of people who died on the highway. he gave me these numbers. 150 million people in this country, and 60,000 died on the highway this year. this is still a terrible number but there are 300 millions of us and 30,000 people die on the highway. remember the debate about putting seatbelts in? interferes with free enterprise?

or air bags or the interstate highway system? we are approaching the point now with information technology, it touches all of us as such a significant level, we're all set dependent, there is going to have to be a partnership between government and private sector how to balance this out, and what the united states' role in leading the world for the right set of solutions for this space. that is a tall order. and no one has picked it up at that level. week argue about pieces and free enterprise and argued that a cloud is coming, but the independence of the world wide web or the world while the web, i would call at -- the world wild web, i would call it.

are we going to transfer $1 billion? don't you want a basic feature of security? if you are in the security business, those of the things that you would highlight. that is the debate we have to have. i think it is going to take leadership from business, leadership from the white house, and it will take a partnership with the congress. i can guarantee you the organization of congress were committee chairman hold sway over some slides over government attack abided by a far do you with annual appropriations and authorizations. there are various pieces of exploit, attack, and the and are all aligned to different agencies across the government. with different oversight committees, with different appropriators. getting that harmonized is an incredible challenge. >> two to three more questions

that i want to ask and then we will go to the audience. the international understanding that you are recommending -- what is the most effective way the u.s. should try to get international consensus on this? if you were charged in -- if you are in charge of u.s. policy, and that they are not able to get international consensus, what should it do on its own? >> i will use two examples. if post-world war ii, we sat down and we decided how the world will be shaped. we cannot quite a compass that now but there is another example, the agreement or flying across national borders. it took 20 years to hammer out that agreement. you're going to fly an airplane with passengers across sovereign borders, you agree to certain principles. the language you speak when

piling up like plan, the safety of the airplane, there is this international agreement crosses borders of people who disagree with each other in a philosophical context, but we agree to do that. having benefits for citizens and a secure means of communication is in a nation-state's self interest. it is now starting to migrate. it is no incumbent on us to stake out -- to step up and take a leadership role to engage the world, political leaders and business leaders, to lay out a game plan. >> before asking you if we cannot get agreement, as you look at the correlation of forces internationally, you see the chinese in particular have been there only set of internet domains and some similar trends elsewhere. what is the leverage that we have to argue to a lot of the

other very large and technologically powerful nations that it is worth having the kind of agreement? >> merely self-interest. some of mentioned that the chinese have tried to screen and be severed, but if you're connected, you are connected. many people think, i am different. i have an independent net. hall and i smile when people say that i had a leased line. all leased line means that you have an agreement with a service provider or a priority. i think a cheating 5 -- achieving five 9's is their goal, but you cannot own the line. it is going with the past of least resistance. the communications that you want

to communicate -- think of it as a swarm of bees moving a loss. across the path of least resistance to is -- to lessen costs. it is having people understand the phenomenon that we have to deal with. and i've always understood from my time in china that what you say it is true of the world in general, there are only three things coming of thre in to china. if we cannot get the consensus, how we optimize our interests? >> there are a number of models and one is the one like china. we're one globalized economy. being an economics major from many years ago when i went off

to college, i will never forget adams met's book of a " the wealth of nations" when his plan the fundamental -- when he explained the fundamental concept of everyone working for other self-interest working for the common good. if the chinese understand that as well as the russian and on nation-states, then we will benefit and is it that way. >> my last question so please look for a microphone to prepare yourself. one of the emerging big trade all conflicts with security and facebook in the rest is the privacy trade-off, how commercial interest in national interest in the kind you are discussing can be balanced with individual privacy. how do you think the balance will be set out? >> i believe that we will have an internet much like we know it today, where there is anonymity. it will allow you to serve or

block -- surf or blog or whatever you like to do. the white house websites release the 25th of june credentialed services. it is third-party, the issue of credential, it is in your self- interest to have such a credential. you can authenticate yourself as who you are. does someone you want to do business with, the bank, a doctor, whatever. it may be as simple as the credentials that you are over 21. it may be everything you need to know about a person including the medical records. the best choice is a citizen, i cannot opt for the wild, wild weather in the anonymous, or i can offer for the secure path to do business with my doctor and whoever i choose to do business

with. and i will be some authentication process. the military is writing the same infrastructure that i am describing. they have the run demesne and taken control that. the government has decided to secure .gov. there is space in between those that we have to address. it is from being anonymous the way we choose to be on the internet today, to how we do the nation's transactions when a mistake or problem and others and it affects all of us. that is the space that we have to secure. >> sir, in the blue certification -- in the blue shirt. and the microphone to there. identify yourself and in your question. >> stephen kaufman.

i like to take you back to the military and ask you about something affecting the military. is my understanding that the conflict between russia and georgia was over with before it began because of cyber techniques the russians used to paralyze the georgian communications and their ability to act. was that a collapse -- did we learn anything about cyber work from that experience he the way people in the 1940's had a glimpse from the spanish civil war of what war was about to be like? our military as probably the most electronics in its fundamental means of delivering its force. are we the most vulnerable? >> we learned a great deal from that, and it was a very simple act on the part of the russians.

they will deny having done that as a nation-state, but the facts of what happened -- some decision was made with regard to -- i will start with georgia. what was unleased was a denial of service attack, the simplest of all attacks. you just fill up the channels. it is easy to do. in fact, a series of computers that affect other computers, and you keep transmitting. in the majority of the situation, but they depended on was not serviceable. there is a kinetic aspect to that and the russians rolled in with a kinetic force and carried out the actions that they intended. but this not the first time. it was also done in estonia before that. very simple -- denial of service. there has not been a nation- state to my knowledge that has used cyber to achieve military

objectives by taking down and your defense system -- and air defense system or the failure of some military capability to be successful in a conflict. the u.s. military has just stood up in may for the first time a cyber command. the cyber command would develop capabilities to be successful when called on to be successful in an attack mode. it also has the mission of defending things in the u.s. military operating forces. the question we have not addressed yet is when you look at the party sama, the authority for defending the united states is the department of homeland's security. they have 78 oversight committees. so getting the right kind of focus on that issue, when the capability on one side is under

appearance of the parties -- all authorities. >> i am william webster and i am the chairman of the homeland's security advisor recounts all in the department of common security. [laughter] i think our country knows the least about e m p. which you discuss for us the nature of that threat and how we can best approach dealing with it? >> great question, judge. not only the former director of the fbi but the central intelligence agency, and we go back a long way. he has been asking the emp question for 26 years.

electromagnetic pulse, causing the polls the shorts out the infrastructure. there are methods for causing catastrophic damage which would not be a cyber penetration or filling up the channel, think of it as a flash that turns everything all. >> and you want to say anything more about that? i saw another one over here and decided the room. -- on this side of the room. >> i believe you said it out -- don shapiro is my name. i believe that you said that a non-state actor is not terribly sophisticated in this technology, and i had the impression that you're saying that the cyber threat is a threat, but it has not happened yet.

there have been a lot of popular press reports that suggest that al qaeda is very sophisticated, they have done a lot, and that there had been continuous attacks, thousands per day on the pentagon and other places, that we have lost some very valuable intelligence because of those, and in fact i recall and could be wrong, that some group took over a big computer at oak ridge and ran it for awhile because it was better than what they have at home. are these just factoids? >> these are all true and is not thousands of attacks, it is millions. and it is not on small amounts of data, it is terabytes of data. those of you to run business computers, they probably have been taken.

most speakers on this subject lay of horror stories of exploited attacks. to exploit means that you copy somebody's material. what i am trying to describe he is attacking with the intent to destroy data. that is the part that has not happened. nation-states are capable but they have -- they are deterred. other groups have some capability but they have not been catastrophic. >> and maybe these are test for these other parties to be ready for a big of a pack? >> no, yes. from a nation-states standpoint, they are preparing. to prepare you go and look in test and probe, you leave behind things that would be useful at later point in time. has anyone read the news about the russian spies here in the

united states? if there had ever been a conflict, those were agents in place. think of all logic bomb in a rigid in that way. it is they're just in case. >> in this theory complicated, interconnected world, how we go about beginning to defend ourselves against another specific challenge, the manufacturer of a microchip somewhere in another part of the world who codes it so that when it goes into key -- when it gets installed in the united states in five years or six years, they can send the signal and close down power electric grid? >> that is a very serious problem. there was a point in time in the mid-1980s, and the acronym i

believe it is simitec, where we dominated the world in the production of microchips and all the sudden they moved away. we had a national policy to regain our pre-eminence. business and government came together, we had an agreement, and we regain our position. since that time, the production of most computing equipment has moved out of the united states. another reason that i keep being accused in the popular press of hyping the threat is that i am attempting to say there is an issue here that needs to be examined in debated, and we need a policy that would allow us to recapture what is the most important to us. and i would say this technology is that important. and to that answer, part of your federalist papers which i've seen, including this morning, a includes extensive public-

private partnerships. >> many people here remember sputnik. what was our reaction to sputnik? send people to school as scientists. i myself went to school as a result of the bill passed post- sputnik. if there are a series of things that we need to do. it is not just technology, there's education, it is culture, it is policy, it is international agreements -- this is a very serious issue. if we do not address it, we will our regret it. >> we have time for two more question. one will be here in kenya and the microphone to someone on that side. >> call on the soviet union, there was a concern that the nuclear arsenal could have gotten into the hands of terrorists groups. there are nations that have the capability of bringing down or do is a direct damage to the internet.

what is the likelihood of the possibility of nation-states of getting capabilities enhance of rogue nation-states or extremist groups to do significant damage? >> there is real and significant concern. the cost of entry is relatively low. how many times have you have a conversation with someone and they say, those are computers. i do die to computers. my 11-year-old does computers. pcr -- vcr's, how many of you know how to program them and turn off that dam bronc in light -- that blinking like? [laughter] your question is a good one. a relatively small group can

have a disproportionate impact on society. >> yes, back here. >> i'm a reporter with a german newspaper. what impact did the financial crisis have on the u.s. efforts in cyber security? and could you point out specific steps that we need to do now for the situation? >> i think the financial crisis was sobering. it introduced a level of appreciation for what might be possible. i think the last crash we had back in may, we lost $1 trillion in 16 minutes. whatever the cost, $1 trillion in 16 minutes, and our economy is $16 trillion a year, and we lost that in 16 minutes. if someone could cause that loss of confidence, making is based on confidence, economics 101,

the money is not there. we put the money there in the banks lend it out. if we go and take it out, it is not there. if you do not have the confidence -- to me, that is the lesson. what we're going to have to do is a cigarette how to make that enterprise resilience to where it cannot be attack successfully. >> in addition to the money is not there, what is the other thing that you want people to remember, and informed international law is to do about this issue? >> our wonderful democracy, washington, d.c. will react to one of four things. -- the good thing is balance. and not even cia.

the right folks. the second thing they will react to is money. the previous ministers in the current administration looked at this ed -- and agreed to spend a lot of money to work it. not enough to change the nation yet, however. the third thing that they will respond to this crisis. please do not let us have a crisis before we take some action. the last thing is loss. being a member of the united states military, i have served a debate that went on for six or seven years. it was about joint activities. every service chief and every service secretary stood up in testimony, sworn testimony, as it did congress, if you pass this bill that requires joint cooperation, it will ruin the

analysis military make as ineffective. the bill was passed. the president cited. and we went through desert shield and desert storm. how's the intelligence officer for general powell. i got the watch. they talk about how well they had done after the war. every service chief under oath said the goldwater-nichols is the best thing that ever happened to the united states military. if we get along right, we can address this problem but we need informed citizens that vote and have an opinion and the white house and congress and we can figure it out. >> please join me in welcoming him -- in banking it has have mike mcconnell. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> in a few moments, the defense secretary robert gates. then the debate with the

republican candidates for governor in georgia. and then the economic impact of community health centers. on "washington journal," we will talk about the special session of the house this week to consider an aid package for the state. our guest will be the chairman of the ways and means committee and republican representative. our week-long special on energy issues focuses on electrical cars with the ceo of compact power. "wise and internal" is live every day at 7:00 a.m. eastern. if the secretary robert gates today laid out plans to cut the number of private contractors employed by his pentagon and eliminate agencies sibiu's is unnecessary. he says the changes are necessary to ensure a stable pentagon budget in the future. this is about 50 minutes. our country is fighting two

worse. did leaves tuesday r proje modest growth and represent the minimal level of snding and to protect our interest and capabilities in a dangerous and unstable world. having said that, we must be mindful of the fiscal situation facing our nation. on a matter of fiscal and political rally, the cannot expect america of representatives to approve this each year unless you're doing a good job. as a for step, which began

performing military acquisition. programs that have cost more than $200 billion. additional program savings have been recommended on the budget was submitted this year, however, it is clear to me that additional changes are needed. i believe that sustaining modernization will consist of 2% or 3%. therefore, in order to use the capabilities, our spending difference will need to be made up elsewhere in the department. as a result, called on the pentagon to how the department

is regulated. i concluded that the headquarters have swelled to cumbersome and talk of the proportions. we of relied on contractors and grown accustomed to operating with little consideration. this manifest itself in vast increases in spending and staff. by nearly 1000 employees. in the proliferation of new organizations and senior executives to leave them. this expansion and its associated habits and attitudes were embedded by a near doubling of the budget since 2001 and further enabled by war for provisions. those factors will soon end. let me be clear. this is not to reduce the top line budget, but to reduce costs and apply savings to the

structure and modernizations. starting in june, we embark on a four track approach to move america toward more efficient and can't -- cost-conscious way. earlier this year, there was $100 billion over the next five years did the services will be able to keep the savings the generate. this exercise is well under w as these services are evaluating programs and activities. they are all planning to eliminate headquarters that are no longer needed and reduce the size of the staff. i have authorized each of the military departments to consider

consolidation or closure were for it. this is obviously a politically fraught topic. congress has placed restraints on the dod's ability. hart is not impossible and i hope that congress will work with us to reduce unnecessary costs. we are seeking ideas and proposals from outside normal official channels andhis includes soliciting input from think tanks and external boards. within the department, what we are soliciting creative ideas to save money and use resources more effectively. i would encourage all dot employees to. visit togov learn more. i directed a series of assessments on how this department is operad