failure to conduct this on time could lead to a unilateral declaration of independence. as the south sudan president says, -- of course, it must be recognized that even a vote for unity would not be a guarantee against new conflict without resolution of many outstanding issues. none of which were resolved in the five years that have passed since the conclusion of the 2005 comprehensive peace agreement. should china perceive that its energy sources are being compromised by american support for southern independence, there is a very good chance that this could drive a downward spiral in chinese-american relations. given the wide ranging economic, political, and security ramifications of a new conflict in the sudan, current concessions over poorly made cargo bombs emanating from yemen

and airport pat-downs, these pale as security issues compared to the ticking time bomb in the nile basin. thank you. [applause] >> that was certainly scary. we have time for only a couple of questions. i want to be mindful of the next panel at 3:00 on yemen. perhaps we could take one or two questions and i also encourage you, if you do not get a chance to ask your question, i get in touch with the analyst directly. it will be here for the afternoon. the first question from this gentleman here. >> thank you. i'm from the canadian government and thank you for your excellent presentation. i think my question is for jean- luc about the recent statement

from aqim in which they informed the french public, they are often the cozy 84 hostages with osama bin laden directly. to me -- could you give your assessment on whether this is a sea change in aqim strategy moving to hostage-taking in support of global jihad? and could this lead to further tensions within the groups, those more focused on the regional agenda versus at those on the global jihadi agenda, and what does this tell us about the relationship between al qaeda and aqim, and the level of difference? >> the french mind -- prime minister has made a very strong

statements. he said there is no way that the front of our do you will do that. it is almost impossible to negotiate with osama bin laden since we do not have a way to have a communication with him. i think that was mostly rhetoric coming from aqim. after that, i think one lady has cancer, so negotiators have been able to provide for some medication. which means that there is a sort of direct connection. but frankly, i do not know anything about that and i do not want to know too much about it, actually. but at the political level, that

is a stupid demand, and none since demand. -- and nonsense demand. >> it seems to me a sort of desperate attempt to grain of bit -- to regain -- it seems that there is a central leadership but they are no more in control of the factions in the south, and moreover, if you want to, you should provide that telephone number for osama bin laden. [laughter] >> this gentleman over here. >> this is for them again. any indication of aqim connected

cells or individual inside europe engaging in lower level distribution on a consistent basis? >> frankly, there is a lot. a few weeks ago, a few days ago, there is an american citizen arrested in barcelona for doing some stuff for aqim. again, there is no membership card. we're not talking about the scandinavian political party either. connection that can be for sure is who has contacted to, and to intelligence thinks. but in many ways, the old name of the group in europe in the 1990's is still more or less

there. there is still remaining at work, more central than the guys who had been freed, and some of these guys can have connections. that is moving, but by definition they are there. they were in canada a few years ago. in the u.s., actually, i do not know. you have an algerian community in the u.s., so maybe that is also here. that does not mean that they have a threat capacity. you also have this -- i do not believe in the concept -- but guys who are particularly sensitive to the aqim, everything is moving, and there is a continuing between then and now. there is a guy, mathematician, ph.d., if he was from the old

group in jail, now he is out, so he is probably under scrutiny by the french intel, but he was freed and he is working in a french public library. that is gray and moving. >> i think that he hits it. there is no membership card. i can talk about what is going on in italy. in the past three months, there have been different allegations about the presence of cells collaborating in my city with local criminal gangs. but still, the amount of the affirmation released from the , it has notrities

been really high. i think again -- if i decide to turn jihadi and i tried to carry out an attack in naples, they will say, ", he has been trained, and does it mean there is a sort of connection? i do not know, liquid or defined? >> fluid. >> yes, that you cannot say the border between membership and who is part of a group or not. there are some self-reminding of the heritage in europe, that is sure. but still, they can be

dangerous and there can be a sort of -- someone who can tell them what they should do, but i do not think there is this kind of problem right now in europe. >> thank you very much. we are out of time. it is her coffee break, and that. please join me in thanking andrew and dario and jean luc. [applause] >> up next on c-span, a look at some of the challenges and implementing the new health care law. then a conference called no labels on reducing partisanship in politics. the senate continues work on the arms treaty with russia and

known as start. they also take up the government funding measure. live coverage begins at 9:30 a.m. eastern on c-span2. the federal census determines how many lawmakers each state will have in the congress. later in the morning, the government will release the results of the 2010 census. live coverage at 11:00 eastern. to in the c-span network. we provide cover to politics, public affairs, and nonfiction books, and american history. it is all available on television, radio, on one, and on social meeting in networking side. find our content any time forsees bantz video library. we take c-span on the road with our digital boss, local content vehicle for bringing our resources to your community. is washington your way. the c-span network -- no available in more than 1 million homes, created by cable, provided as a public service. >> now discussion on

implementing the new health care law that passed earlier this year. we will hear from the director of the white house office on health care. the center for american progress posted this one hour 20 minutes event. >> hi, everybody. welcome to the center for american progress. i am the chief operating officer. the center and i oversee the help team. i want to thank you all for coming. today is a band on accountable care organizations and how to make them work effectively will kickoff the center's work on efforts for payment reform. the center for american progress believe strongly in that promise. this is historic and it is the

progress of goals. we work that we ensure that we're lowering cost over the long term. that is why we have today's panel which we are excited about, as well as a serious the will be taking place over the next several months to illustrate how we can work on the promise of payment reform most effectively. discuss howl will to make the affordable care act worked in terms of the accountable care organizations. we have a great panel and leading off that panel is a speech by nancy ann deparle. we're very honored to have her as the president's counselor and director of health care reform. she led the effort of health reform. when i was in the obama administration, i served on the health-care team under nancy ann. she was a fantastic general.

we are likely to have her. most importantly, she has a history of reform in these efforts, because she was the director of cms. she brought that expertise to the discussion of lowering costs, increase in quality, and taking care better for all americans in the lead up to the legislation. and we're honored to have her here today, my friend, nancy ann deparle. [applause] >> thank you, neera. i am glad to be here today and i would think bring this together to talk about the implementation of the affordable health care act and in particular affordable care organizations. neera and her team have been busy working on some of these issues including how to really

make sure we are lowering costs in a way that makes health care more efficient and effective for patients. that includes the work you have done on collapse and other areas -- on co-ops. i want to think many of the people here today including some of those on the panel and my colleague john blum. they have created ideas to make this more efficient and effective for patients. our goal is to make sure that health care is high quality and high value. the affordable care -- the affordable health care act have deliver the provisions. this is the nine month anniversary of president obama signing the affordable health care act. it seems like just yesterday in some ways. 2010 has been a remarkable nine months. on sunday morning before the bill passed in the house, president obama was already focused on implementation and

made clear that he wanted the process to be careful and expeditious. our administration team has tried to achieve his vision. it is an incredible honor to work with many of you in this room on the president's vision making health care more affordable and accessible for americans. as we approach the waning days of 2010, we are finishing up the last pieces of what i call phase one of the implementation of the affordable health care act which really has two parts. one is setting new rules of the road for insurance companies and gives consumers more control over their health insurance and, more importantly, more transparency over what is happening in the health insurance market. secondly is expanding in stabilizing coverage for some americans, especially early retirees, people with pre- existing conditions, and young people have been most at risk losing coverage. it has been a very busy nine months working on those two areas of phase one.

we have implemented a patient's bill of rights that will give consumers an unprecedented protections. under the new law, americans in the new insurance plans of preventive services without additional out-of-pocket costs. nine adults will be able to stay on their parents plans until they turn 26. already, this change has brought relief to americans and their parents used to worry about how they would get coverage first starting out. consumers in new plans will have the freedom to choose their primary-care providers within their network without having to get a referral. patients in the new plan to receive less services in an emergency room of a hospital -- who receive services in the emergency room of a hospital who are not covered. insurance companies will not be able to discriminate against children with pre-existing conditions. insurers cannot impose a lifetime limit on the care and

annual limits are restricted until 2014 when they will be eliminated. consumers will have the right to appeal a decision made by their insurance company to an independent third party. these are just some of the new rights that americans have received and consumers have received as a result of the affordable care act that we have been rolling out over the course of the last nine months. importantly, we are also easing the burden on seniors by providing medicare enrollees have hit the construction drug coverage, called the doughnut hole, a $250 rebate to help defray costs. by 2020, we intend to close the hole completely. starting this january, the prescription drugs that seniors purchase will give a 50% discount. over time, the doughnut hole will close. in 2014, the law will not only prevent insurance companies from denying coverage for pre- existing conditions, but it will ban insurers from charging

people more based on their gender or healthcare status. i do not need it to you what news is that change will bring to the marketplace. all of these protections are key to ensuring that americans have access to quality coverage and can take advantage of the delivery system along with the private sector efforts helped to boost. if you look forward to 2011, we are now beginning to work in earnest on phase two of the implementation. again, this has two pieces as well. one, working with the state's deceptive changes for marketplaces where there will be affordable health care choices for consumers and small businesses to have not had them before. we just had a meeting at hhs last week were 44 states and the district of columbia came to washington to work on the planning for setting up these exchanges. the second piece of the work we are beginning now is what we call a delivery system reforms, working with employers,

hospitals, doctors, nurses, consumers, leaders in the health-care community and system to implement reform to our delivery system to make the health care system work better for patients and over the long run lower-cost. this is crucial work and it is why the timing of this conference and discussion today are sold important. i think everyone in this room agrees that while we have a very good health care system in the united states that we can improve it. we can improve the quality of care we provide. in a paper released today from the center of american progress points out, our health care system does not reward doctors and hospitals today to keep patients healthy. in fact, it does the opposite. we pay more for more care regardless of the outcome which does not make sense. we all know that delivery system reforms need to happen to recruit patients safety and quality, to save lives, lower costs. in many instances, the good news is there are proven strategies

we can implement to improve the strategies. that is why the affordable health care act makes delivery system reform that will take critical steps in keeping patients healthier and better preventing and manage elises. one delivery system reform is accountable care organizations. glenn hackbarth, i remember the discussion we had when we served together on medpac. it is kind of a wonky name. it can make it easier for doctors, nurses, and other members to coordinate provided care. the council care organization program goes beyond the direct provision of care. it is a shared savings incentives aligned so the medicare accountable care organization program will encourage investment in the health information technology and innovative ways of delivering care that will improve the quality of care for patients. caner the new law, aco's

deliver all the care beneficiaries need in a court did way to provide value to the medicare program and deliver improved quality of care to the patients. another aspect of the reform implementation efforts of interest to the people here today is a national pilot program on payment bundling. the law calls for a national volunteer pilot program that will encourage providers and hospitals to better coordinate patient care and paper of the health-care services a patient receives during hospitalization in a bundle the payment. in makes a lot of sense but it is a significant departure from the existing medicare payment methods right now. under the rules of this pilot, providers of able to distribute payments they deem fit among members of the team instead of in compliance with medicare's existing administrative pricing system. there are a number of other provisions in the affordable

care at that are excellent opportunities to innovate and provide care more efficiently. the payment changes to address hospital-acquired ellises and unnecessary. missions. two areas of unnecessary expense that are so costly to patients as well as the medicare cost medicare, patience, and payers millions of dollars each year and these avoidable situations where people get an infection in the hospital or they are readmitted just because the care the first time was not what was needed, they lead to tens of thousands of avoidable deaths and illnesses that are a real burden on the parents that we're supposed -- the patience with her supposed to be serving. through the newly established cms innovation center, we have both the authority and resources to take bold, innovative steps right now. the innovation center will test models and include establishing an open innovation community that serves as an innovation clearing house for best

practices in the health-care renovation. as i said, there are lots of things going on that can show you can serve patients effectively, save money, and also create a better, high- quality health care systems for the patients. we need to get that information out of the places around the country. the innovation center will work with stakeholders to create learning communities to help other clinicians, doctors, and nurses to rapidly implement these new care models. i am proud of what we have accomplished so far and what we have in the pipeline, especially many of the delivery system reforms which we believe will make patient care safer, improve quality, efficiency come and save money for employers, the government, everyone. as you know, as we convene here in washington, some people want to go back to the days when insurance companies, instead of patients and their providers were in control of our health- care system. frankly, on the of the defenders of the status quo can produce a

plan that will meaningfully help people and meaningfully improve the health care system the way the affordable health care act does. repealing the law would mean that 32 million americans who would have gained coverage and the affordable care act would remain uninsured. it would mean insurance companies can once again in pose double-digit premium increases on americans that we've been seeing for the past decade with no real oversight, transparency, or accountability. all of the landmark consumer protections i mentioned in the new bill of rights will evaporate. these new promising efforts to help doctors and hospitals improve the way they deliver care, such as the council care organizations we will talk about today would come to a screeching halt the law were to be appealed. it would eliminate a significant debt reductions and over $1 trillion over the following decade of the affordable care

act were to be brought about. digester feeling some of the key cost-saving measures in the medicare, medicaid, and schip would it reduce the deficit. i could go on and on about the countless benefits that the law has already, and will continue, to deliver to americans in this country that will go out the window at this is repealed. i think all of you here get the picture. one thing that you can all do it helps is to educate your patience, friends, and neighbors about what is in the affordable care act and how can benefit them. there has been enormous disinformation and the public has been evenly split four months about those who favor maintaining the affordable care act, expanding it, strengthening and, as opposed to those who think that the law should go away. there is a lot of cognitive dissonance. people hear one thing, here that the law is bad, then they experience getting a very

different thing. a friend who is helped by the pre-existing condition insurance plan, a person who has not been able to get insurance on their home -- on their own and then they are assisted. a child who does not have coverage and graduated from college, has an internship that does not provide health insurance, and now they can stay on their parents' plan. it is not surprising that a lot of people do not quite know what to think. you can help them. many of the people here today have played and continue to play a vital role in the successful implementation of the affordable care act. that does not mean that we all agree. people are playing a successful role by helping us address the questions that they have and work on the regulations that we need to implement lot and make sure that we do so in a way that is not disruptive. i want to thank them as well. moving forward, the president and their team in the

administration is focused on implementing this new law to me this and americans. thank you for having me here today, and again, good luck on your discussion and overlooking forward to hearing your ideas. thank you. [applause] >> the afternoon, everyone. i am judy feder from the center for american progress and a fellow at georgetown. i am very pleased that nancy-ann was able to join us. i am sure this will be an interesting discussion on payment reform in a particular the affordable health care act. we know that whether the issue is a success of health reform,

the sustainability of our existing coverage, or the fiscal health of the nation that the key to future success is slowing the growth in health-care costs. key to our success in that effort are decisions that hhs and the center for medicaid /medicare services is now making in implementing the tools provided by the affordable care act. it is these decisions that we are here to discuss today in will belar how aco's defined. broadly speaking, they are i'm -- date delivering coordinate care needed by a specific set of patience. under terms, and allows them to benefit financially as long as they inshore and improve the quality of care that patients get. when these will really be in practice and whether they will

truly deliberate from the emphasis on volume to the emphasis on value, as we typically same, depends on the kind of decisions we turn to now. i will give you a quick overview of recommendations that my senior fellow, a harvard economics professor, who is not able to be here today, made in a paper that we have just put out and we will discuss the issue we raised along with other issues that will come up. glenn heart -- glenn hackbarth, steven lieberman, and debra ness, leader of the consumer coalition campaign for better care. first, my two cents with david, the paper is available to you and available online and i will start with the issue of who

becomes an accountable health care organizations. the law allows many to form and hospitals seem to be leading the charge. they are actively engaged in connecting to other providers, acquiring physicians, practices, or hiring physicians hopefully to work with the broad set of providers engaged in in the delivery of care to better coordinate. more needed is a reduction of hospital years. hospitals working with ever providers can and have achieved that goal. and hand, they can share in the savings. what they actually do is an open question. it raises some concerns about whether instead hospitals can use this as an opportunity to enhance their domination of local markets and use their

market power to protect existing patterns of care rather than promote change. if, alternatively, physicians take the lead, they can gain rather than lose revenue in the process in making hospitals compete for a set of count on the referrals they provide in order -- compete for instead of counting on the referrals they provide. john, i will keep looking at you, on this recommendation to recommend that cms works alongside hospital-led aco's to emphasize when it takes good physician care to deliver. for example, reductions in preventable we admissions and emergency room years -- readmissions and emergency room

use. managing in coordinating patient care and to the range of tools made available to the affordable care act, encouraging better primary care especially if your innovations. the second issue is how to pay account will care organizations, which we hope will also be affordable. the aco concept aimed to entice physicians and hospitals to produce a paid in the new behavior primarily by offering financial benefits if they reduce spending relative to projections while achieving benchmarks for quality of care. in a section of the law that establishes accountable care organizations, it is called the shared savings provision. it's specifically allows the secretary t as other payment models to improve quality and efficiency -- to use other

payment models. first asto offer aco's a choice and after three years, payment share with the aco's some of the risks. we give them the option of saying it -- taking some of their payments in a lump sum rather than a fee-for-service to give them up front support to invest in technology, staff, and other mechanisms to truly to be able to manage the care they provide. so why a share of risks as well as savings? evidence suggests simply allowing rewards to lower savings without some responsibility in our over- spending is likely to be too limited of an incentive to overcome the benefit of providing more and more services under the fee-for-service system

and is unlikely to be as effective as we help in changing provider behavior. from the get go, we want providers to not only participate in the arrangements aimed at better delivery, but we want to make sure the arrangements will achieve the delivery reforms that we want to produce which requires an alternative payment arrangement simultaneous and on the same scale as the shared savings approach. also is the role of consumers. the emphasis in aco development on measuring and assuring patient-centered care as a position for financial benefits and on sharing risk and not delegating to the providers, we show a strong commitment to truly changing patterns of care and not generating the backlash that met hmos years ago. to that and the coming in even more importantly, to promote the shared decision making that

leads to better care, we recommend a strong focus on consumers in implementation, specifically that consumers know the rules through which their positions are playing in have a choice to participate as well as a choice to continue to use providers as they see fit, that they get a share in the financial rewards derived from using care more efficiently as their providers recommend, they have someplace to go for recourse if they question their aco. and physician-led aco's consumer engagement and protection, david and i argued that cms cannot launch the medical care system that the affordable care act has in mind. that is our defense for the administration and it is food for thought. i am delighted to have the

others with expertise. john should go first, but as we discussed, we will have others speak first then we will turn to john to discuss a little a monster ourselves that we will open the floor for conversation. -- to discuss a little amongst ourselves. as nancy-and referred to, we have been working on this at medpac for some time. you have offered comments to cms on the issues we addressed as well as other issues. i was wondering if you would speak on where the commission is and what they recommend. >> thank you, judy. i appreciate the opportunity. the point there recommend will overlap with what judy and david

presented in their paper. i will try to add in a few different things as well. let me begin by saying that we are an organization that agrees with the basic premise of the aco provision and many others namely that if we are going to have a better performing, high- value health-care system we need to change how we pay for services, and encourage more effective forms of health care delivery. of course, the aco is one such provision but it is not the only one in the law. nancy-ann mentioned the following provision, and the like, which we think are also very important. the provision with the basic sharron model, we think it is a

good starting point towards creating organizations that and great care across the full range of services. we are concerned that the gain- sharing a model may be too weak and model, but it is an inviting starting model for new organizations that are just beginning to coalesce, having a model where they can gain without being at risk i think will attract people who may otherwise be discouraged from for dissipation. in that sense, it is a good thing. -- otherwise would be discouraged from participation. it would be good to see the gain-sharing model as the starting model from which organizations must eventually graduate.

this does not provide for graduation. it is viewed as an enduring model. if we were to seek to require organizations to move on from gain-sharing, at some point that would require a legislative change. that is not something john could be expected to do on his own. something that cms may be able to do on their own is think about adding other models, two- sided models, that have but the gain-sharing and downsize risk and create incentives for organizations to move down the continue on overtime as the gaining experience in better managing care. one variable that may be used to encourage that migration is the percentage of savings that the organization gets to keep the. as i read the statute, there is much in that dimension.

you could say if you go into a two-sided model where the organization, they would get a higher percentage of the savings on the upside if they are successful. another issue we have spent time talking about is how to set the targets. specifically whether the targets and the aggressiveness should vary based on the historical cost level of the organization. let's take the example of an organization that has been a very efficient in the past but it is a market that has a low per-capita medicare costs. if you set the target based on the historical experience, it becomes more difficult for them to achieve additional gains and

rewards them for reorganization that is created in a very high cost area where there is a lot of wasted to be eliminated. on the face of it, that seems inequitable. having said that, it is a tricky issue once we start to think about it. the natural instincts may be to say to set more generous targets for their organizations operating in low-cost areas and set more aggressive targets for those who operate in and high- cost areas. the rescue reinecke go too far down that path is now one participates in the high cost areas -- the risk you run if you go too far down that path is that the risks are too aggressive. everyone is participating in the low-cost areas because they offer more money than what has historically been in the area. then you have the aco's were you do not need them and none of

where you need them in the historically high cost areas. make -- you have a potential tensions situation between equity and what makes sense in encouraging the long-term evolution of the medicare program. >> you came out where on that one? >> we came out on encouraging cms to make modest changes in the name of equity to make targets more generous in the lower cost areas and a little bit more aggressive in the high cost areas but do not go too far. >> a balancing of participation? >> yes. my last point to emphasize is one that judy has already mentioned which is the role of beneficiaries. it seems to us very important that beneficiaries been notified, at a minimum, that the

providers caring for them are adopting the new payment model. indeed it to the extent that we are moving away from gain- sharing to a more aggressive modeled that have upside and downside risks, the importance of the notification, we think, gets more important. we are very concerned that if we are not careful that we could end up with a replay of the managed care backlash of the 1990's which seems to have resulted from patients feeling like their care was being changed without their consent and that others were benefiting from the change, providers, insurers, employers, and they were not. it was the carsten aspect of it that caused concern -- it was deemed the coercive aspect.

there were more than happy to be that concerned. the same set of ingredients could exist if we are not careful. it is critically important that patients buy into this, be informed, be educated, and now with the benefits of aco's are for them. >> thank you and we will turn to deborah to talk about the patient's side. first, i want to turn to steve it is working on the delivery system is provided on the ground trying to build new organizations. what are you hearing? what do you want to tell cms to do? >> thank you, judy. a pleasure to be here. i congratulate you and david on a really terrific paper that captures in a nice way some of the critical issues and some of

the issues that need to be grappled with. i think that i am struck by not only the thoughtfulness of glenn's comments but a lot of the trade-offs. there are a lot of nuanced choices. it is important to differentiate points where people have agreements of being left of the decimal point and how best to deal with the deficit. they are important issues, but they are to the right to the decimal point. in exploring this concept, it is important to distinguish when we are talking about alternative ways to improve the concept of verses fundamental questions of principle and how to design aco's and how they should work.

my second introductory comment is i want to apologize and recognize how hard the job that john and his colleagues have at the cms. they are being asked to regulate something that is basically never existed. we have analogues, but we do not have aco's. there are two dozen sections where it says there is a discussion with the secretary of how to implement these things. there is a lot of punting the ball down the road a little bit and hoping cms figures it out. i think it is a very challenging task for them, and this is a bit obama article coming out, but i would like to

cover four quick topics. aco's are creating systems of care. the fundamental belief is systems are better than non- systems. the empirical literature shows that and partially because we do not have systems of care than you cannot have a large enough to lift patients to either do meaningful projections of budget and a measurement of financial performance. equally importantly, you cannot do meaningful measures of quality and outcomes. the need to have size and someone saying, i, as a provider, and taking -- "i, as a provider, and taking responsibility." you mostly to bundle the payments anyways. building systems is important. try to think about howaco's -- how aco's differ from hmo's,

they have structural features to lock people and leaving the you have to be enrolled, part of a prison that work, there are benefits differentials if you got out of network, them prior authorization and relatively strong ability to influence what patients a day. the second mention of hmo's what type of the delivery systems, but what systems of care? how do i improve care? disciplinary teams, mrsa mines, going through a list of things that people have done. -- disciplinary teams, nurse hotlines, going through a list. i look forward to debra's comments on how best to engage the beneficiary. the second point i want to go to be on the importance of systems is the notion of shared savings.

glenn and judy both covered that well. it is somewhere between fee-for- service and as an anti-and said it is a system, from an economist's perspective, that says you are a revenue center. the more you do, the more you get paid, and the incentive is maximize revenue. providers become cost centers. therefore, what we want to do with share savings is to have a moderate balance between the two. jim house suggested the idea of payment system was to pay on average and to have equal margin, marginal cost. they had an incentive to do one thing or the other, what would drive them would be what is clinically appropriate. as the lead noted, and as you noted in your paper -- as you and glenn noted, it has very weak incentives.

as we start to move towards an arrangement where providers will get more of the rewards if they do better than budget but will be financially responsible with lower fees, if they exceed budget, there is partial capitation to build stronger incentives so the requirements on a system in terms of fiscal solvency, licensure, beneficiary protections, becomes very important. i just want to take a minute to follow the money. if an aco has a 5% savings, which many people would say is a significant reduction, and would be 5% net savings and it typically it costs a fair amount of money to achieve these things in the upfront investment. just for the purposes of this discussion, my target is 100 and i achieve 95.

the first 2% and the formulations would go to the pair because the statistical matter of projecting budgets is very noisy and there will be random winnings were people win by chance. if i go from 100% down to 98%, the remaining 3% in many formulations would get split 50% to the pair and 50% to the provider. for every $5 i caut, the aco ges which is 15%-20% of what you would normally spend on primary care. it is more like 4%-5% spent on physician care and a 2% on what is spent on physician and hospital care. the savings start to get watered.

that is one of the reasons that i think i agree with your recommendation to build in a ladder of escalation said the system can start with training wheels where it is a bonus on the system and then progress -- bonus only system. as they get licensed and then can move to partial capitation. one of the ways we would suggest cms use its authority is to limit the number of initially type ofaco's, not the but the number, but this is an explicitly experimental system where we do not know what works and this is somewhat unorthodox in a medical context. use the secretary's discretion to limit the numbers of providers to make sure that we get a real representative sampling because what is

possible in california, where there is lots of experience with delegated experience, is very different than what would be possible in parts of the country without that infrastructure. just to quickly windup, the last thing is who forms aco's? this is a critically important issue. if i am a hospital cfo, most of the low hanging fruit in terms of the 5% of savings will come out of the hospitals. if i have high fixed costs, that means a reduction in my top line revenue translates into a worse off the bottom line which means as a responsible hospitals cfo that i want to avoid that. you say hospitals are already a major force that will be likely to be forming systems. unfortunately, that may undermine the degree of competitiveness in many markets.

physicians had shown themselves historically to not be very good at either organizing or having capital to fund the organizations. the returns to not look attractive enough for venture- capital money. where i think that leaves us are with two non-hospital alternatives which are existing systems of care where you have delivery systems that have the infrastructure that can expand from capitated patients to a fee-for-service patients or pco's. it is an interesting question of trying to a line and short sentences with delivery system incentives. let me stop there. how that gets done is a really interesting question. i will just leave as a conclusion the point that, which i think is consistent with what you were saying, that if the problem will just be a lack of capital at least to start these things, working capital, the

question is whether this is an attractive play for insurers and try to avoid hospital-dominated aco's. >> thank you. a lot of food for thought. i want to turn to you, debra, because you are engaged actively in this discussion. we talked about not wanting to receive a backlash about deliberate and operating responsibly there. we also talked about the initiative of payments--- patient-centered care. we look to you to tell us how best to have patience engaged in the process and the public engaged in its success. >> a great. thank you very much. i want to add my compliments to you and david for your wonderful paper. let me say a word about the campaign for better care. it is a growing coalition of more than 160 organizations,

state and national, that of come together to work on payment and delivery system reformed in ways that will make care more coordinated, patient-centered, comprehensive for those who need it the most especially older adults and people with multiple chronic conditions, those who are the most vulnerable, highest users, highest risk, and generating the highest costs in the system. your paper is actually quite exciting and quite in sync with the consumer coalition is. he asked me to talk about specifically about our reaction to the payment recommendation and the patient recommendation. first, i will say i could not agree more that this is an evolutionary process and we are walking a careful line for both providers and patients. at the end of the day, we need them both to make very significant changes in their behavior. at the same time, we needed to

work so we needed to build aniline enough accountability -- we need to build in and accountability and incentive to participate to patients see enough in and to feel like they are betting -- they are getting better care, better costs. given that, i think your proposal that we need to transition from a system of that yearly bonus or share the savings to one which would include a share risk and moves away from fee-for-service is absolutely essential. the people who are getting hurt the most by fee-for-service our patients who suffer from the fragmented and overly expensive care that it produces. there are a few things i want to add. the accountability issue is critical. at the end of the day, whenever the payments incentives are, we need to make sure we are holding this accountable at the end.

you propose in your paper one of the most powerful measures of accountability, one of the major cost centers, which is reducing unnecessary hospitalizations, preventing unnecessary readmissions and e.r. use. we agree with that. we think most of the costs in the system are generated by people with multiple chronic conditions. we need to look hard and good coordination measures. it seems -- and things like medication management as well which can cause a huge problem for the elderly and those with multiple chronic conditions. finally, the law does a pretty good job of saying this and we will do everything we can to push the fact that one of the major ways to hold these models accountable has to be with patient-centered metrics. that means coming to me, collecting patients reported data about their experience of

care and their outcomes of care. at the end of the day, whether the care is better, better coordinated, whether you are getting better is proceed through the eyes of the patient rather than through the eyes of the provider. strong accountability for both cost and quality is critical. the second thing i want to say is when it comes to the financial incentives and the protections we build in is that we need to make sure that these models really serve our highest risk population. when a deep worries that the consumer community has is that to get these savings -- one of the deep worries the consumers have is that they will either skimp on care or cherry pick their populations. we need to build in payments incentives and support to not allow that to happen. one thing that is very important is to make sure we have risk-

adjusted payment to that complement's the complexity of the patients that are being carob. we need to make sure there are adequate resources for those providing the care management for those manage patients. finally, we need to make sure that we are monitoring this populations that are most at risk. i mean making sure that we are not exacerbating but rather that we are reducing the disparities that riddle the system today. to do that, we need, from the ghetto -- get go, built into the language these types of things so we can track the population and now at the end of the day if we are making care better for those who are the most expensive and hardest to cure or making it worse. it is also another safeguard

what glenn had to say. on the payment front, some of those shared savings going back to the consumers. this is about getting consumers to engage differently and they need to seek care getting better and costs getting lower. one way to do that is to give them a share of the savings just like we are talking about giving the payers and providers a share of the savings. there are many ways to do that. now, you asked me to talk about the patient's engagement peacie. you talk about about patient protections and engagement. they are related, but they are different. from the get go, if you want patience to embrace this new model of care, than patients and

consumers need to be at the table from the beginning helping to shape, implement, monitor, assess, and determine what should and should not be expanded. too often we make the mistake of thinking, "if we build it, they will come." what we really need to do is build this the way patients needed to be built to meet their needs. that takes me to a major paradigm shift that needs to happen across the board which is that we really have to start believing that it is important to listen to what patients say they need and want. one of the reasons we think it is so important to do patients experience surveys and get patient-reported data is that the work we have done when we ask patients what they need and want from these new models of care, they tell us the very things that will help us to get the better outcomes. they tell us the very things that will help them be more

engaged in their care, to be better partners, to be more adherents in their medication years, better manage their chronic conditions. it is not just patient satisfaction. it is not just the nice thing to do. and it is an essential thing to do if we want to build these new ways that results in better care for patients and get us to better clinical outcomes. plus, again, if we're talking about people with multiple chronic conditions, if we are not talking about asking them about their experience with care coordination then my guess is that we will not, for a very long time, have condition- specific clinical measures to ever tell us if someone has five different clinical conditions is getting good care. we will never get to that population if we did not take seriously asking patients to report on their experience and outcomes. finally, on the patient protection front, i think we are

all in agreement from what i have heard that the idea of not telling patients they are enrolled in these things up front makes no sense. if we want patient engagement, they have to know and they have to be clear about what it is, have a clear understanding, clear expectations, clear in creating and buying and to those expectations. there needs to be complete transparency about financial incentives that the providers are operating under. patients need that because they have had a bad experience in the past and because this model does have a risk of cherry picking and skimping on care. we need to make sure that there will be experimentation that there needs to be network adequacy. we need to figure out what that looks like. until we know what that looks like, how could you not have that choice is and flexibility for beneficiaries? the idea of the lock-ins or

requiring people to stay in an aco, not one of us would want that arrangement foisted on us. network adequacy, flexibility, choice, we needed to build these systems into something that consumers embrace and want to be a part of. finally, you mentioned in your paper an omnibus or an appeals process. again, during this evolutionary time, we are trying to figure out what works and what does not, how could we not build that in? patients need to know that this will be something, the part of patients engagement where they feel if they are not getting the care that they need, that have somewhere to go.

>> i think you are, in large part, determining what this is and how it will go forward. i would love >> thank you for the opportunity and the paper. the one thing we need to think about with the atl program is how it ties into other changes that are happening to the overall medicaid program. the affordable care act puts in place tremendous changes to the medicare program to help we think about paying for and financing services. the aco program only applies to the fee-for-service program which applies to the -- applies to the 80% of people today. at the same time, cms is putting in place a stronger pension program trout -- for the private side of managed care and a five- start bonus payment system that will start in 2012. we are putting in other pimmit

reforms for hospital services, physician services, the full gamut. while we think about the aco program , we're putting in other delivery reforms to approve the overall system. it is important to keep in mind that the aco program is to demonstrate something better than regular fee-for-service medicare it needs to be on top of the other pension reform changes that are going into place, payment pressures that are going into place to the affordable care act. we are seeing the aco program as the overall baseline of service when all of these changes take effect. the statute contemplates a very flexible model to the aco program. we are going into this notion with the premise that we have to create a program that can serve multiple aco models, meaning

hospital-based models, physician-based models, and a combination of the two. clearly, the statute does not have a one size fits all model. that is very much our premise. right now, we are in a phase of the kind of pre-decisionmaking for aco. we anticipate having proposed rules sometime out next year. the notion is that we are all starting from scratch. we are trying to figure out the program together. cms will go in with a true proposal wanting comments back from all perspectives. consumers, providers, physicians, health plans will help inform our decision making. the statute requires that the program starts january 1, 2012 very we are very much committed to seeing this program up and running. as all cms leadership talks

about talksthe aco program has the promise to think about how we think of patients and health- care journey. today we have physician, hospital, a post-acute -- if this works well, patients will have journeys of care with a well coordinated handoffs. it will be very well coordinated handoffs of care, not the current solo approach that we have within the medicare program. we are grappling with hard decisions that have been raised here today. several hard decisions that we are grappling with, is how we think about risk. do we think about -- we as organizations to take upon these risks. some organizations have come to cms and have said they are

ready to stick on more risk. they want two-sided rest are we have to think carefully because some organizations are coming to us with clear intent to roads to dominate market places. those who are coming to attend to the organization's that currently dominate the marketplace or want to dominate their health care marketplace. we have to think carefully what it does it means to take on risk and what the implications are when organizations asked to take on risk. the second part issue we are grappling with is how do you assign patients to an aco model? this is not where the beneficiary chooses to sign up with an aco. rather, the cms pass to a side benefit to n aco model. do we do it after the factor before? we have heard arguments on both sides of the issue.

that will be a hard decision that cms has to make. how do we think about data? organizations that come to cms wanting to be in aco talk about payment data that cms holds. physician organizations come to cms and said they don't have data on hospital use or drug use and for us to be able to manage patient care, we have to have access to the data that you have within your fee-for-service payment systems. that is very protected, confidential the data. we are thinking about what it means to provide more organizations than organizations currently have. it is a very hard issue. how you notify beneficiaries that they are being signed to a

aco? the private side of medicare, cms has a tremendous oversight capability to see how plants market and communicate to beneficiaries. do we have to think about those process ceased to ensure that aco organizations do not mislead beneficiaries and over- promise. ? they have to understand their physician might be part of than aco and might have incentives to change care hopefully to best manage care. a real tricky issue is how we think about communicating and informing beneficiaries that there is a physician or hospital is part of an aco organization. with that, i will stop. let me say in conclusion that cms believes they aco program

has a way to better manage care. all things go well, the aco's will do better on cost and clinical management for beneficiaries. we are going into this notion with a full understanding that we need to hear from the community to help inform our roules. this will be best response and best ideas. we will not go into this having all the answers but we expect lots of comments coming to us that will inform our final rules. we will issue them sometime next summer. thank you for the opportunity and i am happy to answer any >> >> thank you. you write that the issue of market dominance which we have been talking about and did talk about the concerns of who is coming in.

does somebody want to -- go ahead >> i think this is a very important issue. i think the decisions that cms makes, at the margin, could make the problem worse. it is worth remembering that there is a problem regardless of what cms does. we have many markets where today already, there is an extreme concentration of market power and it is having a large impact on the rates paid by private pay yours. --payers. the implication is not just high rates relative to others but variation within the markets for the exact same service. there are huge variations for the price of a given service within a single market. that is an indication that you

do not have a competitive marketplace. all that the exists today regardless of what happens on aco's. one of the risks when you say we will factor this in and do our decision making process -- for example, cms could say you ifnot qualify if yoas an aco you already have a certain share of the marketplace. if they are negotiating with private insurers or exists under medicare advantage, to say that you can't do it in aco but you can do it in the private marketplace could end up having a distorting effect on the mark of a different sort. i think we need to deal with the market power issue. will notdo on aco's solve the problem and it will

not create a problem where one does not exist today. i think we need to be careful and put it in context. >> that is very helpful. let me pick up on one other issue which talks about informing consumers. what do you think about whether consumers know in advance or find out after the fact? should we let them know in advance? john is raising issues about how we ensure that consumers are getting appropriate information about what they are getting into. >> obviously, you can't expect consumers to engage effectively and change their behavior is to come -- to become more involved and better partners in their care if they are not informed. it is not impossible to imagine creating upfront information that makes clear what being in

means.an aco that would probably be best delivered by their individual provider in the context of a trusted relationship. it is almost a two-way agreement. here is what you can expect from me in terms of better care, and here is what we hope you will do to support us in providing better care. that is not impossible to do. there are examples of programs out there that have done it with great success. soft social contract -- i think it starts with us making sure that the thing we are offering actually response to what patients say they want and need. building in the right thing,

patients what the things we actually believe will make for better care for the one whole person care, they want better communication, they want their information at their fingertips, if they want their doctors to talk to each other. those are the very things that we think will make for better care. those are also extremely compelling to patients. understanding that is what this is about should not be impossible to convey. let me go on for one more second -- this points up something else which is that, for this to really work particularly for the most high-risk patients, we have to build this on a basis of primary care, on a strong primary care foundation. it is only with a strong primary care foundation that you can have that kind of trusted relationship, that kind of coordination, that kind of communication, that kind of engagement of patience, shared a decision making, linking people

to the right support services in their community. none of that can happen without a real strong foundation of primary care of. >> which takes us back to what john was saying that this was one of the tools in blog and one of the areas where we also need attention to make sure that we have a stronger primary care. thank you. let me open the floor for questions. yes? >> i am with a politico. you have talked about the importance of physician- organizer aco's. could you speak about how you would best to encourage those? >> we talk about that a little. others were indicating that it is a challenge. we do have examples of a

physician organizations particularly in california that can successfully and have demonstrated their ability to deliver care and take responsibility for all the patient care. as we move from a system in which we have many, many small practices of the physicians to a system more integrated, we see lots of physicians being hired by hospitals which is one way to go. we suggested that there are alternatives in terms of providing organizational support perhaps with certified management organizations which does exist in the real world. it would be a new initiative for cms to take on to provide an external support to physicians' organizations and not expect them to take this on themselves all the patient management tasks and health information technology that they would need to manage patient care.

we want them to work with other organizations to bring them together. we talked about providing them loans up front to be able to invest themselves in the kind of practices or the kind of practice redesign that enables them to have battle -- better management systems to achieve their goals. we also recommend that we think about the criteria for aco certification so there is an emphasis on being able to demonstrate that these organizations can do what we need physicians to do which is to provide the appropriate care and the coordination to really manage their care. we think it is a challenge but we are calling attention to addressing that challenge so the we don't exacerbate concentration that already eggs

zests. we don't want to fall into a situation in which we cede the ground to hospitals. >> i will echo what you said it emphasize what glenn saidif aco's are a revolutionary change with incentives, in this sea of the very 15-year, maybe 20-year provider consolidation, it has to be seen in that context. when i worry about the caloric effect of meat eating a hot fudge sundae and eating the cherry on top. --that is what i think about. [laughter] one of the key questions is trying too's are

improve the delivery system but there is a statutory requirement which is they have to save money or not increase costs. as far as i can tell, i spend most of my career doing but it's tough, there are multiple payments for every dollar of savings. the question of creating an up- front care management fee that cms pays to be recovered from future savings? there is a pretty basic bookkeeping question. this requires up-front money. the question of what a source of that money is becomes a very important question and it becomes a difficult policy call for cms. the last quick point about this is diversity. there is enormous heterogeneity

within every market was certainly across markets. the way care is delivered in bend, oregon is different than salem which is different than phoenix which is vastly different than this area. about letting 1000 flowers bloom, letter later it is tougher regulator to create a program good things happen but it is difficult not to have bad things happen. this has to do with allowing for diversity while still having suncor is essential protections. that is an extraordinarily tough balancing act. >> sure. one thing that has not come up is that over time, one of our objectives should be to move toward multi-payer models and alignment of the public and private sector. i don't know how we can expect

to transform the way care is delivered in individual practices if there are a million different kind of incentives programs, etc. we need to move to a place where you cannot have the kind of cost shifting but goes on between the public and the private sector and all the incentives and the measures and data collection gets aligned. that will make it so much easier for these primary care and physician practices to actually make the transformation that they need. >> yes, sir? >> mike miller, i'm a public consultant.airs i want to talk about dealing with market-dominating organizations.

areseems that the wayaco's implemented could be to get a changing the dominant nature of those organizations particularly since there is a provision law that is supposed to give preference, i think, for private payers. from my experience, the employers like nothing better than partnering with medicare to say that they are market- dominating organization and we will not go against you. a toolthink there's there? >> with the medicare context, we don't have to worry about market consolidation. for hospital and physician services, cms as ic-schedule.

there also were about private payers. they have to worry about consolidation. it is easy for cms to say to bring in organizations and we don't care whether they consult it marketplaces. doesre mindful of the cmjs downstream to private payers. they don't want to have to negotiate their own payment rates. we are mindful of what cms does could have downstream and back to private payers such as market consolidation and higher price points. it is not as big of a worry for cms/medicare but we have to know that we are saving the entire health-care system, not just cms. >> you'll also want to be protected on the price side. >> i agree what -- with what a

democrat has said. our goal is to change health care as delivered. we are using payment policies leveraged to change in the care delivery. the power of lever will be a function of how many papers you choose to use this particular lever and whether they do and a well synchronized way. i am all in favor of the idea that would need be great if we could get medicare to aco's but also get important private payers using the same tool. it is easy to say that and hard to do because of the diversity of u.s. healthcare in different markets and how many different players. it would drive john crazy to try

to coordinate with all the idiosyncrasies of different players and a different markets. i don't think it has to be the exact same payment system to have some of the synergistic effect we seek. if there was coordination at a higher level in terms of payment methods and the metric, i think we can get considerable benefit from that. there are two distinct issues here. one is coordination of the payment methods and the other is the payment rates. you can imagine a system where we coordinated the methods and matrix with private payers but still continue to pay markedly different rates. or you can imagine a system whereby over time you reduce the differential in payment rates but when you start to do the latter, you have implications in terms of budget impact whether

you are leveling off on the rights or down on the red. ates. short run, i would say let's focus on trying to get coordination on the payment methods and leave the more difficult task of synchronizing rates somehow down the road. let's walk before we run. >> that is helpful. yes, sir? >> cq health beat. what difficulties do you anticipate under the pen ding cr? >> i haven't had a chance to read cr yet. we are a c rightms regulations

-- we are writing cms regulations at the moment. the aco program is one of our highest priorities. as the program has been spoken about, it as one of the biggest potentials in the affordable care act to improve quality, to reduce costs. it is one of our highest priorities. we are very much committed to the program. >> questions? >> i am a primary-care physician. if you want to know how an aco looks to a primary-care physician because we are on the bottom, they will publish something of ahealth fair

website in a couple of weeks. in europe, they deliver better care to more people for a lower price with a outco's. aco's. this will be very disruptive and expensive. complication breeds transition -- makes for transaction costs. >> to you want to take that? >> our observation with cms is the greatest faults we have within the service of the medicare system is that we have a system that gives a strong incentives to sometimes provide more services than necessary or are under-provide services that focus on prevention or focus

unwellness. if the aco program is done well and rights, that will change the incentive isth. e aco statute as primary care meaning an aco has to demonstrate they are a primary- care based organization and have the capacity to serve at least 5000 medicare beneficiaries. the aco program transforms the mindset of how we think about the fee-for-service medicare program by being focused on services, focused on primary- care wellness and -- prevention. how we set the target and clinical requirements, we will be very aggressive. babel said strong incentives and better -- better patient care. handoffs will be well afford it

and not just left to the position to navigate by himself or herself. >> which takes us back to the patients and this is about the patients. we have to the -- we have to use the tools we have to move this system forward. i think everybody knew before we had this conversation that you have an extremely challenging job. it is not easy to change the inefficiencies and shortcomings of the american health-care system. i have long talk c aboutms -- i've long talk about cms as the engine of reform the white house is committed to moving this forward. we very much value your

participation, all our panelists, in this conversation. thank you all for coming. [applause] [captioning performed by national captioning institute]

>> tonight, on c-span, a coalition of democratic republican and independent politicians attend a conference called "no labels" which has the goal of reducing politics. that is next. later, a look at some of the challenges in implementing the new health-care law. >> on tomorrow's washington journal, bob wise talks about improving the education system through digital learning. after that, the new health care rules of and what they mean for federal and state budgets and then the professor and author on the united states constitution. washington journal, each morning at 7:00 a.m. eastern here on c- span.

the house comes in at 10 eastern and the work on a resolution that will fund the federal government for the beginning of 2011. they will also debate reauthorize a number of science, technology and education programs. live house coverage on c-span. >> you are watching c-span, bringing the politics and public affairs every morning with washington journal, a live call- in program with the news of the day connecting you to officials and journalists. during the week, was continuing coverage of the transition to the new congress. also, supreme court oral arguments for the concede our signature into the program and on sundays, newsmakers, q&a and prime ministers questions from the british house of commons. it is all searchable on our c- span video library.

c-span, washington, your way, a public service created by america's cable companies. >> the group "no labels is of great -- >> the group "no labels" is attempting to bring people from different political persuasions policy issues. we will hear from david brooks, houston joel brand, -- kirsten gilibrand. this is an hour and 20 minutes. >> please welcome our founding leaders. >> it is important, before we

began, that a conversation that started a year ago with a handful of people have led to the insured. republicans, democrats, and independence, by word of mouth on lay, brought together and united -- by word-of-mouth only, brought together and united. never give up your label, but put it aside so we can do what government should do and solve problems and find common sense solutions. problems and find common sense solutions. today, we met the first test. they said it could not be done. they said we did not have a passion. they said you could not bring it together. but today, it is just not true. in my 35 years in politics, i have not seen more interest in a project i have ever worked for. [applause]

this is your movement to build and to grow and we are here to help you in every which way. we have the power to build this voice and change behavior in washington. i look -- i look forward to working with all of you.

>> usage ourselves. nobody paid for you to come. if you are here on your own dime. many of you braved the blizzards and congratulations for that. this is as old as america. throughout our history, this is the way the country has changed and this is the way the future has been built. in the past century, both political parties were transformed from the bottom of, over and over again starting with progressives. progressives. in our lifetime, the country has been transformed by social movements almost too numerous to count, starting with the civil rights movement, the women's movement, the anti-war movement, the pro-choice and pro-life movement, the religious right -- the list goes on and on and on.

now it is time to do it again and why? we have been brought together by a shared concern, a politics that has ceased to work for america. we're sick of that politics. we are sick of the politics that myers the system and puts their leaders into unless debate. we want them to come together and solve problems. [applause] you may be saying, "how can you do it? how can we do it?" this is a pretty big room, but it is a much larger country. in a year, this group will be multiplied tenfold, 100 fold, a thousandfold. with your leadership, this

entire country will be organized and elected leaders who do the right thing will get your congratulations, your encouragement, your support. and those who do not will get called out. let me leave you with the thought that has become an unofficial motto for this movement, the words of margaret mead. "never imagined, never a doubt, that a small group of thoughtful, committed citizens can change the world. indeed, that is the only thing that ever has." thank you very much. [applause] >> and we're here today because we believe that hyper partisanship is hurting our

country. it is getting in the way of solving the problems we face. the professional polarizers are promoting division. it is our essential tradition. we are trying to reaffirm that basic message, out of many one. we can only do it by standing up and being the change that we want to see and by showing a bit today, you have shown that there is conviction, that this is a place of principal and passion. we understand that the politics of problem solving is what has moved our nation for historically, that the extreme bargaining has led to gridlock. but there is a drum beat out there. this is a rebellious project that we are all engaging in today. it is so countercyclical to the attitudes that dominate

politics. the impulse is to drive people out of parties, ideological purges and party purges, and they often masquerade as courage, that somehow walking lockstep in a party today is courageous. the last time i checked, that was conformity. that is the opposite of courage. that is cowardice. we have to stand up and practice our civic backbone. we know we can do it because we have the numbers. that is the big secret in american politics. our politics have been hijacked by comparatively small number of folks on the extremes of either side. we can do it by uniting together to add support to those political leaders who have the courage to reach across the aisle. we will play offense pin we will look at creating a political action committee to play in this post-partisan committees.

because many of us are from a different generation, not invested in a generational grudge match, we will start advocating for responsibility in our politics again that will be a big change, thinking beyond our labels. [applause] >> there is a flag that has been flown at a lot of rallies this year. it is a great flag from the revolutionary era. but in our current political movement, what we are talking about today, i will like to recommend a different flag. benjamin franklin's flag that shows a state cut into 13 parts with one urgent reminder -- join or die. those are the stakes that we need to fight for.

that is the flag we need to rally enter. if we do that, we can move the nation, not left or right, but forward. [applause] >> welcome to our little woodstock of democracy here. [laughter] this is so exciting. we get asked about this effort and people say that there has always been partisanship. there has always been this poisonous environment enter politics. but the reality is that it is worse than it has ever been before. it is worse at a time when we face in arguably the greatest challenges we have ever faced. when we come visit with you, is completely different. we heard people say yet these meeting, emotionally and

enthusiastically, that you do not feel like you have a voice anymore in washington. you feel like there are partisan voices on both sides of the aisle. the system, the way it is set up, it punishes people for good behavior. and it rewards bad behavior. we know that, while there were partisan party before, we got a lot done by not questioning each other's motives. we did not call the the people the enemy. we did not call the racists and socialists. we did not call them names. when you have a system like today in washington where literally by members of the opposite party never even talk to each other -- they do not have lunch together. they go to washington and do their business and go home. the ability to get together and forge consensus -- consensus is when we come together, recognize we have differences, build on those differences, and create a

pathway for work. these are all volunteers here. the reason that we have done this is because we care passionately about the problems that we see. but we know it will take you to fix it. we cannot do it. politics is a market. you are the market. you can move markets. and i think you will move markets with this effort. politicians and elected officials respond to numbers. the fact is that you have not had a vehicle to express yourself. others have. they have very loud microphones that suggest to the elite and media that they represent the whole country. they do not. you represent the majority of america. all we're hoping to do is be a catalyst for you to create a vehicle where we can amplify your voices so that we begin to reward good behavior out there. thank you for coming. [applause]

it is the general reflects to be cynical but what we are doing here. they make their profit and their attention through conflict. the only thing that changes that is if we really show them and numbers. we need you to go out and organizing your community's and raise a voice out there. we need you to go out there and raise a ruckus for democracy. we are counting on you. [applause] we want to apologize in thadvan. i want to thank all our efforts extraordinary job. [applause] this is grass roots, baby.

i want to show you a little film to get things started. the program may changes little from what you saw. democracy is messy, but it is what we got. here is the film. >> right now, there is no incentive in our political system for people in either party to work together. we're beginning to think that people more liberal or conservative or on the other side of the aisle. >> they're not putting america first. >> that starts to fray at the threads of our country. there are organized groups on the left. >> they're not putting solutions first. >> and there are organized groups hundred. >> they are being controlled by their parties. >> both the democrats and republicans are working against each other. >> we have a situation in our politics where we are confusing to permit the with courage.

-- confusing conformity with courage. we know it takes courage to think independently. we may not understand the whole process and how things go ♪ and just an ordinary man trying to live free and god knows ♪ be a man with a blue tie ♪ be a man with a red tide togetherwe tie things and get it done for america? only one man with a voice ♪ that is something we have in common >> as an american, i know is that we can fix it. >> rebound. >> you need a social movement that expresses those voices at the grassroots of two political parties that actually have a lot in common, but whose parties to not commit that common ground to

be expressed very often. >> they should be thinking of our country first. >> we will leave our children and our grandchildren a stronger and more prosperous country. we need to build a politics that is bigger than this polarization. in the race fight ♪ who is going to win? ♪ i wish they did not have those labels ♪ there would be more change with new labels ♪ my kids will grow up ♪ your kids will grow up, to ♪ would do not like them to be raised up next to hospitals and good schools? time, you could have made a difference ♪ but you decided to go with the

party >> i think we will realize that people who are in the center of the republican party and people in the center of the democratic party actually agree with each other more. >> we need to provide a new space where people felt comfortable to actually get the work done. >> i want our leaders to know that, when extended to do the right thing, there are millions of americans who will stand up and say "keep going, we are here, do not be afraid, you're not alone, we are coming with you." ♪ all you need with you is some honesty ♪ i am only a man with one voice ♪ that is something we have in common ♪ he is a democrat ♪ he is a republican ♪ there are too many people suffering ♪ i wish they did not have no labels ♪ there will be more change with

no labels >> please welcome award winning author, commentator, and "new york times" columnist david brooks. [applause] >> thank you. i cannot believe they chose that song over mine. [laughter] i will start by talking about america. go out to suburban st., 3:00 p.m., watch 8-year-old commander second grade, they have 80-pound backpacks, the wind blows them down like beetles, and they're stuck on the ground. they get picked up by their over moms -- their uber moms.

the moment of conception, doing but exercises, staying thin, driving up in their audi, volvo -- it is socially acceptable to have a luxury car so long as it comes from a country that is hostile to u.s. policy. they take them over to wholefoods and get a snack at one of the socially-enlightened grocery stores [laughter] . [laughter] my favorite section is the snack food section. they have these seaweed-based snacks. it is for kids to come home and said they want a snack that will help prevent colon and rectal cancer. [laughter] go to a home depot and watch a

man by it a bbq because that is when he is most emotional exposed. he takes it out to his uconn xl, one of these big box malls -- his yukon xl, one of these big box where you can get 200 pound boxes of detergent. who comes here shopping for condoms? the quantities are so big? [laughter] and i started off by describing america to make one elemental point. american society is in good shape. we have the hardest workers, the most productive workers. we have more patents in this country every year than the whole world combined.

the country is in good shape producing fantastic things. today is taylor swift's 21st anniversary. we created taylor swift. [laughter] it is the government that screwed up. we're not a decadent country with a bad culture print but we have a government that basically does not function. what will curtail that that we are careening toward national bankruptcy. there's no democrat that neither -- there is no trust between the parties. there is no intellectual flexibility to make a deal. there is no ability to work out complicated legislation. and there is no moral authority in washington right now. the second we fell that, we fail our human capital. we have not kept up with educational standards. we need to ship for -- shift from production to consumption.

we need to reform entitlements, the tax code, and many other things. all of these things have not happen because the people not wanted, but because government has not responded. why is government the way it is? some people think it is structural. we need to do a little re redistricting, campaign finance -- that is not the main problems. they make the -- some say it is our politicians who are rotten. i interviewed three politicians every day. i can tell you that they are pretty good people every day. they are emotional freaks of one sort or another, but that is a separate thing. [laughter] we have good people stuck in a bad system. the main problem is that we have good people stuck in bad social relationships. it is a system that incurred as bad character, bad social norms, and bad ideas -- that encourage

bad character, bad social norms, and bad ideas. many people do not get their ethnic identity from their political identity. we have people suffering from laziness that comes from living in an information cocoon where all the facts are sorted for you before you even have to think about it. party leaders demand total party discipline and get everybody to say the same thing and stand in the same lines. we have the intellectual and securities, people who do not know members in the other said, will not have lunch with people, will move across the room to the other side of the senate to make some contact. we have people in the son system -- we have people in the system that encouraged triviality to win the message of the day and you get distracted from larger concerns.

we have reached a point where all human contact in washington is distorted by a terrible system that makes people, even the people who are in the middle of it, makes them miserable. so what we need? to my mind, we probably do not need a third party. this is not about a third party. we need a social movement under the parties. we need a new code of behavior, one that create some fosters competition. the founders were more vicious than we are. they were plenty partisan, but they had a code of gentlemanly behavior in which they could reach deals and create the the constitution and create institutions in this country does bipartisanship. [applause] -- in this country despite partisanship. [applause] we need to celebrate people who behave in the right way.

we need an intellectual agenda that is not representative. if you go to a conservative dinner, there are a lot of think tankers and scholars. you go to a liberal dinner, there is a lot of think tankers and scholars. this is tragic because we have a tradition in this country which is a moderate-centrist tradition that started with alexander hamilton and went out with abraham lincoln to give poor boys and girls the chance to succeed. earl warren and pat brown treated biggest school system in california. the treated water projects. they created a great infrastructure -- they created water projects. they created a great into structure. we need an intellectual revival as well. [applause] the first thing we need our institutions.

presidents need outside institutions. when they do the orthodox thing, there are institutions to support them. when they do something unorthodox, there is nobody at their back. and we need institutions that will bring people together and support politicians, who will rise up when they do the right thing. [applause] finally, we need a social movement. we had moved on, the obama movement, the tea party movement -- this is a country that year's national decline. we need a thousand people to change the norms, -- that fears national decline. we needed thousand people to change the norms. the structures and the mentalities that make washington the way it is our strong and deep and entrenched. it is only love of country that is strong enough to overcome these obstacles. [applause]

we need to ask people and forced people to confront the few questions. how can you love your country when you take the other half of it? do you love your tax deduction more than you love america's future greatness? are you really unwilling to sacrifice your social security cost-of-living adjustment when soldiers and marines are in afghanistan site professing their lives? [applause] -- in afghanistan sacrificing their lives? [applause] those are the sort of questions we need to ask to change minds and behavior. when winston churchill was about 21, his mother invited to his house for lunch a french diplomat who served as ambassador to england for 20 years. so he asked the guy, you have been here 20 years, what have you seen? and he said, have seen a revolution. when i got here 20 years ago,

400 families controlled everything. it was an agricultural economy. in the last 20 years, that has changed completely. you have had the french revolution without spilling a drop of blood. and what he was describing was a gigantic social change that happened gradually, step by step, with both parties contributing step-by-step day- by-day. they had partisanship and politics, but they had constructive politics, where each side contributed to a larger project of reviving the country. because each side contributed to it, it took to advantage of both sides wisdom. because each side contributed to it, there was a deep social change that was widely expected. that is the sort of revival we need now. we need constructive challenge in politics. we need one that brings up the

best and with the country has always been and that what we have had in the last couple of decades, a system that brings up the worst. thank you very much. [applause] >> please welcome nationally syndicated radio host and author michael -- >> i appeared with regularity on cable television. my view is that, any move away from hyper-partisanship and towards civilian needs to begin with the media. [applause]

for a long time, have said and have written that the climate in washington is being shaped by an artificial presentation of opinions on cable television. there is no room for new philosophical issues. either you operate consistent and artificial or you don't get a say. this is awarded with ratings. ratings are rewarded by passion and not universal appeal. it comes at a time when polling and voter registration information suggests that political power could lie in the middle, in the hands of those for whom no label seems to

apply. i often say that the only people that i meet who view the world entirely through liberal or conservative lenses are the host or the pundits with whom i rub shoulders when i do the different programs. when i am buying gas, when i am buying groceries, when i am at a back-to-school line for our four children, i speak to people who defied labeling. the politicians, unfortunately, do not take their cues from them. the elected officials seem to emulate the world of punditry. no wonder then, when elected, many treat the legislative colleagues the way they would a pundit on a split screen. today, it is political kryptonite. it becomes a self-fulfilling prophecy and it is robbing us of the substantive dialogue that the country so desperately

needs to solve big problems. that needs to change. [applause] one of your founders, nancy jacobson, i thought, said it very well. no labels is an attitude, not an ideology. that sums up why i am here. i thank you for the invitation. because we have some initial interest figures, someone needs to be tasked with keeping time. that responsibility also falls to me. the only label that fits our next speaker is a public servant -- dan glickman spent 18 years as a member of the united states house. he was also a secretary of agriculture under president clinton. secretary glickman. [applause] >> thank you, michael. thank you to nancy jacobsen and her team. thank you to david brooks for what could be the next preamble to america, which was just

spectacular. he deserves a hand for that. [applause] briefly about myself, i was a democratic congressman from kansas. that is an oxymoron. kansas is the longest-running state that has not elected a democratic senator in the country and it is probably the most republicans did in the country. then i went on to the secretary of agriculture. as some of you know, the agriculture department represents, in many cases, some of the most conservative political constituencies in america. but you learn that you have to be -- that you have to have a dialogue with different perspectives. then i went on to be the chairman of the motion picture association of america. i guess my agricultural department gave me the qualification to do that. i used to say that the biggest part of the word "agriculture" was "culture." it involves human attitudes and

emotions and you have to work with both sides of the aisle. now i am at the bipartisan policy center started by senators-lee, dole, and baker. dole, k ors and baker. i always did my best to try to be in the center as much as i possibly could. those incentives are out of the system today. i do not want to quit the belief that nostalgia is what made america so great in the past. there were things in the past that were not so good. but the fact of the matter is that there was a greater incentive to work together in years past, certainly during the 18 years i was in the house.

there seems to be right now, tax reform, energy bill legislation, education and education, things that impacted america. it is not the same as it was before and the country is being hurt by that process. it is being weakened by that process. chris like this that can provide a grass-roots efforts to help politicians -- groups like this that to provide a grass-roots effort to help politicians is critical. daniel burnham was a famous chicago architect. he built a lot of the chicago buildings. he built union station in washington and other places. he made a very important statement. "makes no little plans for they do not have the power to stir men's souls." america is a big plan. our political system has become a lot less resistant to keep america bay, making big plans. the futures of people in this room and throughout the country are being threatened by a

political system that just does not seem to work as well as it used to. i am not arguing for fundamental radical change. i am arguing for the need of a grass-roots movement to help political leaders reach across the aisle to seek common ground, to try to find solutions so that america can be at the place that the founding fathers intended it to be, to be great, to provide leadership at home and around the world that i think we were set up to be. this current system where more -- this current system rewards the status quo because the conflict we have today becomes personal and results do not tend to follow through. there ashonored to be an old politician who served a long time ago. but remember the system that was more resilient and a stronger america because of that. with no label's help and places

where i work now, we can try to change the focus of america to a political system that really does serve the people. thank you all very much. i appreciate it. [applause] >> thank you very much. thank you very much, mr. secretary. during this portion of the program, we will hear from citizen leaders as well as voices from social media. the first of the citizen leaders is from the great state of ldson.ticut, darnell olso >> good morning everyone. [applause] i am a city councilman in new haven, conn., aa democrat, an accident of birth. my crime was that i endorsed a democrat for governor and a

republican for senate. as soon as i endorsed the republican, they started calling for my ouster from the party, for my removal from the city council, and, of course, they aid my home -- they egged my home. it is part of the political system that you cannot have a different opinion. you cannot march outside of your party. no labels, for me, is a way of being able to express what you feel and what is good for my city and what is good for my country. i love the fact that this movement has started. i hope that it moves forward and i hope we go back and organize their areas. i certainly will. thank you for having me. [applause] >> thank you, darnell. hello, kiki.

she has a view from the social media world. >> we got comments from friends around the country who could not get here. one says, "i have seven children and 10 grandchildren and i want the beauty that is the united states of america to always be there for posterity. we can do better if we look to the vision of our forefathers with the constitution as our guide. i want my country back. and i will go to any lengths to ensure that the future is bright. i pray that you, as their leaders, will >> thank you, kiki. please join me in welcoming a man who is the epitome of rational thinking in the united states house of representatives, from the great state of south carolina, congressman bob english. [applause] >> i have to live up to that

epitome thing. i was in front of a fairly liberal audience this week and observe one of the most irrational responses ever. the speaker said that the president may not defend the power of the epa to regulate condoms. the crowd hissed. it was the most irrational response from a group of people who should know better. and for the republican audience, eight guys stood up and said that the president was so unpatriotic -- a guy stood up and said that the president was so unpatriotic because he did not hold this hand over his heart when the national anthem was played. i said to the guy, "it is just not true. i have been with the president.

i have seen him put his hand over his heart. the president is a loyal, patriotic american who loves his country, loves his wife, and loves his kids." i just disagree with him on everything. that is our challenge. you get an irrational response from the conservative argument and you get an irrational response from the liberal audience. democrats are into fairness and republicans are into merits. the country needs both. the bonds that tie us as a nation are stronger than the ties the blind us to an ideology. people like me are conservative

and we conservatives, by golly, know how to get things built. the conservatives know that risk must be followed by reward. we're also here to say that liberals know that the grape -- the great will squash the small unless there are fair rules of the road. a businessman in the gaza strip said that god give us to eyes. one to see the situation from the perspective of another. we are here to say that it is not left or right, just forward. when the internet and the pc created enormous wealth and productivity and too much revenue to balance the budget in the late 1990's, we are here to say that it is not left or right, but forward to reinvent the car. it would not be left or right, but forward for us to win the triple play, national security,

better jobs, and cleaner air. i have had the opportunity to be in iraq five times and in afghanistan four times to see the most amazing people in the world. not to the iraqis and afghans, you understand. they're fine. the americans serving theire. i never ask a soldier or sailor or a marine if they are a republican or democrat. because in a war zone, you're just an american. the least we should be able to give to those willing to serve and die is people willing to die on figurative political polls by reaching on the other side and pulling the best out of both parties. let's do that with no labels. thank you very much. [applause]

>> thank you very much, congressman bob english. now we turn to another of our citizens leaders, all the way from tucson, ariz., miss bonnie davis. >> thank you. good morning everyone. from tucson, arizona. i am here primarily because i have two beautiful granddaughters who also live in arizona. and i implore you to look to arizonan if you want to see what the plans are of the extremists in this country whose only goal is to divide us so that they can conquerors. our state is in a terrible state and the only thing in my view that will save us and actually save our country is something that is starting today. we need to speak with each other. we need to find the best in each other. we need to work together to find

solutions. we have solutions to real problem so that we can see beyond the trumped up kinds of issues that are so rampant, especially in my home state, my beautiful adopted state that i have lived in for 40 years. i'm so thrilled to be here and i am so happy that all of you have come. again, please, if you need a context for what we're trying to do here, look to arizona, understand what is going on here, and you will be plenty motivated, a few were not already, which i am sure you are. thank you for the opportunity to speak to all of you today. [applause] >> thank you, bonnie. again, we turn to the social media world. >> we have another one. this is from matthew in oberlin, ohio "our politicians take students for granted.

democrats assume that we will support them no matter what. we are a dynamic force in politics that is just as sick of the hyper-partisan rhetoric as any other group. we are looking for real leaders with the bravery to work with the other side to solve the huge problems we face. we are as open-minded as anyone and are waiting for politicians to show that they can lead." [applause] >> thank you, kiki. our next speaker hails from the hawkeye state, congressman bruce really who has been in the house of representatives. please welcome congressman bruce bareilly. [applause] >> i am delighted to be here. i am proud to be a democrat from waterloo, iowa. but i am also proud that i grew up in a no labels house in a

small low levels town called brooklyn, iowa. my father was a republican. my mother was a democrat. somehow, they made that work. and people had a problem in the small town i grew up in, they did not ask you if you were a republican or democrat. they asked for your help and they got it. that is what public service is supposed to be about. i am proud to call bob english, who just walked off the stage, a conservative republican, a good friend of mine. i think it is a tragedy that we're losing bob from the house of representatives. [applause] i want to tell all of these young people sitting behind me that i do not take college students for granted because i have three children who are currently in college and, believe me, i listen to them every day. [applause] a the most important place i go

every day is the house gym. why? because there are no labels in the house gym. i get to meet people like bob english and i got to learn about them, what they did before they came to congress, what their family are doing, and i find it is much more difficult to demonize someone when you actually know them and have a personal relationship with them. one of the things that this movement should be about is bringing people together to solve problems and help people. that is why i ran for congress and i believe that is why most of my colleagues ran for congress. i am proud of the fact that the very first bill that i introduced in congress, the new era at, to create opportunities for young people and renewable energy through partnerships with community colleges, came about and was signed into law by a republican president because i had a great bill and i reached out across the aisle to congressman joe bonner, a

republican from alabama, who have the same problems in his district that i had in mind. we worked together and got that bill passed and into the farm bill and signed into law by president bush. i was proud of that fact. just recently, before the last election, i had a very important piece of legislation called the plain language act requiring every federal agency to communicate with constituents in language that they can understand, passed overwhelmingly in the house of representatives, and was held up by one republican senator, senator bennett from utah. i could have gotten frustrated and given up. he served in a different chamber and sometimes the distance between the house and senate seems like a distance between new york and los angeles. instead of getting frustrated, i scheduled an appointment with him and i met with him and his staff for nearly an hour. we worked out his problems and got that bill passed in the

senate by unanimous consent, passed by the house with overwhelming bipartisan support, and signed into law by president obama. i do not feel i gave up any of my values or the reasons why i ran for congress to make both of those bills happen. yet, it seems that, in this partisan environment that we all live in, working together to solve the problems is somehow become a liability for any elected official. the purpose of this conference is to start a spark a conversation. we have to work to spread that sparked around the country until we realize that we are most effective as a nation when we help people not by abandoning our principles, but by coming together and having a rational, adult conversation about how we solve complex problems. that is my challenge to all of you here. people who came together in

goodwill from all of the country, from divergent political philosophies, very different regions with different problems, but came here because they care about their country, they want to see us move forward and be able to hold our heads proud as a nation that respects different opinions and yet can come together in an intelligent way to solve tough problems. the challenge is not getting any easier. i can tell you that from firsthand experience. as someone who has two $0.5 million of secret outside money spent against me in the last campaign. we know that this is a tough challenge. but we also know that this country has never shied away from tough challenges. that is why your presence here today is a strong message that america can still do things the right way, bring people together, and saw all the challenges we face. thank you for having me here and i hope you have a great time at the conference.

[applause] >> thank you, congressman bareilly. thank you very much. now we will hear from another of our citizen leaders, having traveled here from south carolina, mr. can subs -- mr. ken suggs. >> there is a country song that says "i love the country, but i can stand the scene." -- but i cannot stand the scene. i am an attorney. let me bring something to your attention that man not -- that is important in this partisan world and that is the federal judiciary. i live in south carolina. there would not have been a civil rights movement in south

carolina without the federal judiciary taking or the schools. these were people living in the community and had tremendous courage. because of the tremendous bipartisanship we have now, our federal judiciary is being depleted. good people cannot get appointed because of the partisanship in this country. we have to overcome that. we have to overcome this "me versus you" mentality that has led us down this path to long. thank you. >> thank you. kiki has more reaction from the social media world. >> we hear from sun prairie, wisconsin. she says, "i believe that we must ask our politicians to look forward degeneration, ask them "what have you done in your term in office to move america forward? have you made america a better

place to live, safer, provided opportunities, created a healthier in burma for all americans, young and old?" thank you. [applause] >> our next speaker is currently serving in his next term representing and advocate for just about 4 million californians, the second most populated state in the united states. we are so honored to have the mayor on hand. we please welcome mayor antonio villaraigosa? [applause] >> first of all, let me say how excited and proud i am to see so many young people here. i had a chance to meet a lot of them last night. america will be on the right track, will go forward with young people getting involved with the way that you have. there has been a lot of talk

about the need for bipartisanship, the need to move away from the polarization, the vitriol, the screaming that you see on tv and in the halls of congress and state capitals around the nation. and there is no question that we need to do that. i remember when i was speaker of the california state assembly. the first thing i did as speaker, democrats used to sit on one side of the aisle and republicans on the other. i said, why do we not to them together? i colleagues were very upset. they said, we won the election. what we have to sit with them? the republicans said, of course, why do you want to sit with us? are you trying to get information about our strategy? and i said, no. i want us to sit together because i want us to work together. i want us to figure out this week and how we all face the many of the same challenges.

we have to take our kids to soccer game wore a baseball practice. we have challenges with their constituents. and maybe once you start talking and getting to know one another, maybe you will realize that you have something in common. when i left the speakership, i said to both parties in the assembly hall there, in the chamber, i said, "you know, i learned a lot in the six years that i have been in the legislature. i learned that there are democrats that i vote with everyday who would not invite to my home to dinner. and the republicans who i never would."vote who i we know that the problems the people face every single day are not a democrat or republican. they are real problems. as mayor, i am very fortunate that i do not have to be in

sacramento or washington, d.c. fixing it pot hole or making the city safe is not a democrat or republican. it is not partisan. it is something you have to get done. and our city, people expect you to roll up your sleeves and get things done. unfortunately, what we have in congress today and what we have in state capitals around the world is so much partisanship and not enough getting things done. and so, yes, i want to speak to the bipartisanship, but i also want to speak to the idea that part of why we want to move to bipartisanship and to talking to one another's because we want to give california and america back on track. we want to take on the challenges that we face in the united states of america today. but the other reason, i think, within the space of no labels that we ought to be able to talk about is the idea to challenge

our own orthodoxy. i am a democrat and a progressive democrat. i come out of the teachers' union and was an organizer with seiu for 25 years before i came out. i am absolutely committed to our teachers and the union. but when the most powerful defenders of the status quo are the teachers union. you see the cities crumbling under financial pressure and tensions and benefit structures unsustainable, democrats have to be able to challenge those orthodoxies, just let republicans have to be able to challenge their own orthodoxy. you see 20 little of that going on in america today -- too little of that going on in america today. [applause] i joked the other day, much as

mayor bloomberg has tried to take over the schools, i tried to partner with our teachers' unions, with parents, with teachers to turn around our schools, to set a high borrower for our schools, to change the paradigm of the school system where 50% of our kids are dropping out and 80% of our kids are scoring at the bottom 20 percentile. when you challenge in orthodoxy like seniority -- i am not saying we should throw it out completely -- but absolute security for transfers, for layoffs, for assignments cannot be the only thing we look at when we evaluated teacher. performance ought to be important, too. [applause] when in my schools, and i have taken on the lowest performing schools in l.a., when i am losing 55% of my teachers

because the least senior teachers are the only ones that go to these schools, that we ought to be able to fix the problem. we ought to be able to not call each other names, you're anti- union, but figure out how we fix the problem. when cities like mine have had to face $1 billion deficit over the last three years, when they make a clarion call and i start with myself and say, for the last three years, i have taken a cut of 16%. what about the rest of us? what about we all share and a sacrifice right now, tighten our belts together so we can provide police and fire services, that we can keep our libraries open. so these are the kinds of challenges that we face in our party, as a democrat, but the republicans face the same challenges. they say on the one hand they want to cut deficits and debt, and then pushed as hard to

extend income tax to the rich and powerful, to reduce the estate tax. i supported president obama in the compromise, but it is important for us to recognize that you cannot do both at the same time, that you cannot go into three wars as we have and tell our children to pay for them, because that is what we have done. no matter what you think about those wars -- [applause] in the history of our country, when we have gone to war, we said to the american people they have to sacrifice. i'd like to argue that while, yes, we do need to work together, we need to reach out, a democrat and republican, independent, and take on the challenges facing america. we have also got to talk straight to our own

constituencies. we have to talk straight to the interests that tie our hands when we want to address the difficult problems that we face. these problems are the great magnitude, make the mistake. in the history of our great country, we have always been able to take those great challenges on when we are working together. i want to thank the young people here today. i want to thank all of you for getting behind this effort. this is a conversation that cannot just have been in york. as to have been around the countries, in state capitals, in the caucuses, both democrat and republican, an independent and socialist, and the congress. we have to start having this conversation about what we are all prepared to do to roll up our sleeves, to get things done, to reach across the aisle, to move america forward. thank you so much. [applause] >> thank you, mayor.

thanks, mayor. now we have another of our citizens and leaders from new york city, please welcome benta brown. >> good morning. i am like so many of you tired of bickering and destructive, always hostile, rhetoric. the rhetoric that keeps us from getting anything done. i grew up outside of washington, d.c., during a time when it did not matter if he were a democrat or republican. what matters is that you were american, country first. not country first is something that we used to exclude or to separate ourselves off from our fellow americans. the country first met a

commitment to public service, it meant learning, it meant being a citizen of the united states and all of the rights and responsibilities that come with that. country first really truly meant something. it meant to a certain degree a dying to self in order to put the values of america for. i am one of those people that is a a little bit on the fence politically these days. this is a movement that can remind us once again what it means truly to be an american, to solve problems, to move forward, then i am in. [applause] >> thank you. kiki mclean has more reaction from the world of social media. >> this time we hear from brenda from little rock. she says, "the energy and money we spend fighting against one another causes damage to the

people within our country and limits our ability to help on all issues. let us find common ground, stop the stagnation and build momentum towards the betterment of our country and the world." [applause] >> please welcome our next speaker, a tireless advocate for the empire state, united states senator kirsten gillbrand. senator? [applause] >> well, as a senator from new york, i welcome you to our great city, our great university. i welcome all of the students. i cannot thank you enough for the efforts you are undertaking with this conference. it could not come any more important time in our nation's history, and at a time of extraordinary crisis. not only do we have an unemployment rate touching 10%, we have a massive deficit, a two

wars, on national security crisis at every border. it is a huge time of enormous discordance in washington as well. we have seen time and time again that people on both sides are measuring success by the amount of bills they block as opposed to the amount of solutions they find it. we should be measuring our success on how many jobs we are creating and how many problems we are addressing. and it is really a time when we need leaders, leaders from the private sector such as yourself to have this call to action, to demand by partisanship, a coming together and working on solutions and not the partisan bickering that has become a staple of every political talk show on every evening news. i really appreciate your dedication to this. and there really is a vision for success here. there are opportunities in every way to have bipartisan efforts in the senate and in congress

and in state governments all across this country. i am reminded even in my very few short years in washington that it is possible, on an issue like earmarked reform, where there are votes on both sides of the spectrum, even tom coburn and i can come together. if he wants to ban all earmarks. one thing we agree on is on transparency, what we need to do when it comes to federal investment, we need accountability. we need to make sure the american people have the information they need to hold members of congress accountable, and that is why we are on a bill to have a searchable database, and we are doing it with john mccain. the lesson i want to leave you with is that your advocacy will really make a difference, because being able to hold public servants accountable for their behavior, for their discord, for the work they are trying to do in washington to solve problems could not be more important. like every advocacy group in this country, the ability to hold members of congress accountable is so important and

it is really missing when it comes to the quality of working towards solutions, this quality of working together on what this country needs. so i just want to leave you with a greater appreciation for what you're doing, and a great word of hope that this is exactly what we need for america. [applause] >> thank you, senator, gillibrand. let's welcome another of our citizens leaders, having traveled all the way from golden state, from san francisco. martha? [applause] >> good morning. well, i am from california now. in fact, i live in marin county, and the politics there are about as blue as they can be. i have to say it suited me. however, after the last election and the hyper

partisanship, it scared me. and i see no labelss an opportunity to get beyond that and move on and get real and face our very serious economic and environmental and health care challenges to find solutions. and i think we are on the crest of a wave, and we like waves in california, to make a difference and support leaders who will collaborate, who will work together, and who will help the vast middle to solve these challenges. thank you. >> thank you, m artha. kik mclean has more comment from the world of social media. >> we hear from mary from yhuri, pennsylvania. of voter who is tired of extremist views on both sides.

our problems are not insurmountable if we find middle ground. we used to your extremist views only during election cycles. now that campaigning seems to be a never ending, the posturing is never ending. it cannot continue like this." >> thank you, kiki. our next speaker has battle longtime fixture in the world of virginia politics having represented the 11th district for many, many terms. today, he is the president and ceo of the republican main street partnership which gives a voice to pragmatic republicans who are seeking to put aside labels and work together. would you please welcome congressman tom davis? [applause] >> thank you, all, for being here today. i retired from congress undefeated and unindicted two years ago. i'm very proud i have been a

committee chairman of the government reform committee. i am proud of our record, but we see where labels are getting in the way of getting things done. members terrified to move, knowing better, but terrified to move because of strong individual constituency groups. just to address, the last comments, what we have seen over the last decade is that the parties have sorted ideologically. we have seen a new media coming out where there is little vetting over the internet. we call it cognitive dissonance. this is added to polarization. the campaign finance reform bill and the citizens united case, the money has moved away from political parties and out to the political streams. the money did not disappear. it has gone up. what you saw this year for the first time is more money spent by interest groups in a

political campaign and the parties and candidates combined. this sent chills down the number of political leaders who are not afraid to but these interest -- buck these interests. for the last decade, we had no good news coming from the federal government. you had 9/11, two wars that have not gone as planned, you've had katrina, you of had the economic meltdown over the last couple years, the longest period of sustained unemployment since world war ii. real wages have not moved in 20 years. that is what this political system has delivered. and then you have to think -- take a look at the deficit and what this means for the future. we are borrowing this year in washington 41 cents for every dollar that we are spending. that is just unsustainable. it cannot last. but when you have one side lighting up, saying, we will never rain se revenue.

and the other side saying it will not cut benefits. it makes it difficult to get to the bargaining table and do anything but read your own statements. it is not solving problems. let's take a look at how that money is being spent. when you take a look of the federal budget, you have medicare, medicaid, the bulk of which is for hospital beds for seniors, social security, federal pensions, debt service, which is artificially low because interest rates are so low. total that up, that is 60% spent on retirees. that means we are not spending a education. we are not spending on infrastructure, on research and development, the kinds of things that will get america's strong for the future, that will keep us competitive in the global economy. our global competitors are not doing the same thing. they are investing in the future. making thesemaare not

tough decisions. there are litmus tests, there are ideological persuasion is that people who come to washington wanting to do the right thing do not feel they can do it. that is where you come in. we will add a voice to the middle. we call ourselves the radical center. people that look at these issues and care about results. we care about results, not the rhetoric. we do not care about the ideological purity, about caving in. i have been through all of that in my political career. our political leadership has smart, dedicated people, but they are not being propped up by people like us. they are being propped up by people on the right or left. what we are starting here today is so important for building for the future, to give our leaders occurs they need in the future. i cannot thank you enough for being here. i think this is the start of something big. when you look back in the future, you'll be proud you were here today to kick this off. god bless you all three thank

you very . thank you. [applause] >> thank you. we hear now from another of our citizens leaders. nate garvis from minnesota. mr. garvis, the floor is yours. >> thank you. i am here from minnesota with my family, my wife and daughters. we come from minnesota were purple is not only the color of our home town rocker prince and the vikings, but where purple informs out political conversation, the inclusiveness when read it mixes with blue. i'm here to pass on with your mother, a civic legacy that is not defined by the shrill voices of the far left or the far right. we want to give you a legacy of moving a much more important erection of fordward

together with no labels. these are the folks, my daughters, who you'll be working with. i want to thank you for what you will do in the future as well. [applause] >> mr. garvis, you are our first no labels family. kiki, more from the work of social media? >> we hear from chris from wichita. frustrated by our countries shift to polarized politics. we have lost sight of the issues that matter. now more than ever it is time to apply common sense to the problems of today and generate real solutions to move this country forward." [applause] >> ladies and gentlemen, we have heard from some terrific speakers already. after this next great part of the program, there will be time for all legs stretched, but this is most important of all.

we have over 300 students traveled here from 90 colleges across the country to be part of this movement. [applause] you could aruggue that real change begins with all of them. would you please welcome some of the representatives from our no labels generation leaders? [applause] >> hi there. i look forward to the day that this is as easy as the seasoned professionals make it look. until then, my name is matt sextant. i am a political communication senior at uni, also known as the basketball team that beat kansas cured i'm serving as the chairman of the iowa federation

of college republicans, but i am here today amidst finals and snowstorms in an an effort to avoid the hyper partisanship that's been bred by past generations and give my generation a chance to pursue american solutions ahead of tests.n but missed litmus >> my name is alexandria increase. i am a sophomore at the university of new hampshire. i am president of the college democrats. [applause] >> i am a doing here at the university of new hampshire. i'm a leader with the campus conservatives. i founded unh normal, the first drug policy group for the reform of marijuana laws. like our founders, we understand that compromise is the fuel that

drives the engine of american governance. it is renewable. [applause] >> hi, i am a sophomore at emerson college. i am a member of our communications, politics and law association and i am part of the association running start to get young women interested in politics. [applause] and i joined no labels so we can afford instead of backrest -- move forward. >> i am a a senior at dartmouth. i am the editor for "dartmouth review,"a publication that is celebrating its 30th anniversary this year. i am god to blad to be here. > i am a freshman aat ohio university. i weakest -- i was considering the point -- a traditional

avenues such as college democrats or republicans, but i wanted to have a greater impact and enjoy the challenge of dealing with different ideas and working with different ideas. i have committed myself tips no for the next four years and beyond. [applause] >> we begin our pledge by acknowledging that we are facing the worst job crisis since the great depression, and the hyper partisan gridlock in washington threatens to leave us a week or america -- a weaker america. >> i am here because i want to make my party stronger, to address the tough challenges our nation faces. a win for one party is not necessarily all loss for the other party. as history has shown, are parties can work together in our

common interest -- our parties can work together in a common interest. we are here to take an oath. i pledge to speak out against the hyper partisanship that prevents america from solving problems critical to our nation's future. >> i pledge to work with people whose principles are different than my own, and i will treat my tears with respect. -- my peers with respect. i will listen to them. as i listen, i will think about advancing my own ideas. i pledge not to despair to another person because of his or her political beliefs, because i believe that human beings are political -- bigger than their political ideas. >> i pledge to demand solutions for my elected officials. i will call my congressperson, write to my senators, and email my mayor, governor, and state

legislators until the lesson. -- until they listen. >> i place to do what is best for america. our allegiance lies first and foremost with the united states and not a political party. our future depends on it. we ask you to stand and join as in siding that -- reciting the pledge of allegiance. >> i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation under god, indivisible with liberty and justice for all. thank you. >> may we have a round of applause for all of the young leaders is seated on stage? thank you all very much. [applause] it's 10:

that is fussy and hard, that