you can either go on the export.gov. not all of us can come, but the department of commerce, the import-export bank, the small business administration is working collaborative lead with the export initiative to try to make this as simple as we can. nothing helps us do that better than a partnership with you. thank you for your time and attention, thank you for your great leadership of the nation's cities. [applause] >> thank you, mr. ambassador and for being a great friend. >> housing secretary donvan spoke today. he talked about how the package would benefit cities.

and cutting funding for community block grants. this is about 45 minutes. >> it is a real pleasure to be here with all of you and introduce the secretary. before i do, i just want to mention a couple of things. first of all, thank you for leading the effort on protecting cdbg funding. we all have the opportunity to hear the president speak. his steadfast support for cdbg funding has been critical for the last couple of years. it will be up to us as mayors to take the lead on telling the story of how important cedbg

funding is. it benefits republicans and democrats on the ground. it really touches the most vulnerable. we will be engaging members of congress and senators over the next couple of weeks. i just want to mention, very pleased with working with the secretary's staff. we must take the lead on this. i am very pleased to introduce the secretary this afternoon.

the secretary has attended several conference of mayors events including the seattle leadership meeting and the press conference releasing. under his leadership, we have seen the strengthening of many housing and community programs and the homeless as programs. we look forward to continuing our work. please welcome the secretary. [applause] >> thank you. thank you for all of the fantastic work that you're

doing. it has been great to work with you so closely. and for your leadership. and it has always been important. it will be particularly important in the years ahead of us. i want to recognize conference president, mayor elizabeth kautz, for her leadership. it has been such a wonderful partnership that we have formed over the last year to work so closely with you. on behalf of myself, thank you for a leadership. it has been remarkable. [applause] it is such a great honor to be back with all of you. i came in the midst of the transition to have the

inauguration the day before to join you at the national building museum. one of the things that i have said there, i have been working for one of the nation's great mayors and i was looking forward to taking on my new role working for all of the mayors across the country. it is such a pleasure to join and echo the president's words earlier today. the men and women across the country who understand the importance of putting aside our differences to solve real problems on the ground had make a difference in people's's lives. i often like to quote: "there is no democratic or republican way to take out the trash >" -- trash."

i will tell you that my commitment to what you do in local government stands true. i am wearing my cufflinks that are manhole covers. they reminded me that what i do every day is to help you deliver the desperately needed services and make your cities worked each and every day. i want to talk today about the partnerships at tools that we have been developing to make sure that you can do exactly that. let me say a few words before i start about where we are in this moment in the economy. the president said this morning that we have seen a difficult couple of years. you are the people that your

constituents will find. not me or the president. you are the ones that they will find. what we have experienced the last couple of years has been nothing short of the consequences of the greatest held down this country has experienced since the great depression. i think we often forget how far we have come. 753,000 jobs were lost each month in the first quarter that the president came into office. 22 straight months of job declines. 30 straight months of home price declines. and so we took the dramatic and urgently needed steps that we needed to at that time to keep families in their homes, to keep

the housing market afloat, and to provide the critical assistance you needed through the recovery act. today, nearly 4 million borrowers have had their mortgages modified to be able to stay in their homes. more than twice as many foreclosures as we have seen in that time. we have stopped the slide of home prices and every single month, we have seen private sector job growth. i also don't need to tell you that we have a ways to go. that is our job. that is why this tax package that was signed into law is

critically important. 159 million americans will get tax cut worth $1,000 for the typical family making $50,000 a year. 12 million families will benefit from a $1,000 child tax credit. 8 million students and their families will benefit from a yearly $2,500 tuition tax credit to make college more affordable. and 6.5 million families which include 15 million children will benefit from an expanded earned income tax credit. the council of economic advisers estimates that just the full year extension of emergency unemployment benefits will create 600,000 jobs this year alone.

and an enormous amount of pressure, we were able to deliver a package that was focused on high impact job creation tax cuts that will have real repercussions and which has traditionally been such important pieces of our economic recovery. businesses in your communities now have tax incentives to buy equipment and make the investments that help them higher and grow. and create good paying jobs in your communities. the package also extends the tax

credit of up to $2,000 for builders of residential homes that are more energy-efficient and it extends the gulf opportunity zone tax credits which will ensure that more than 6000 affordable housing units are able to be completed in support 13,000 construction related jobs in communities still recovering from hurricane katrina andrea -- and rita. and because of them, independent experts now expect another 1.5 million jobs and more will be created in 2011. i never forget on the day that the tax cut passed, i ran into jean just leaving the ceremony to celebrate the passage.

he said there are not many days you can say that you got something done that day that will raise the growth of the entire american economy by a full percentage point next year. when 0.5 million jobs, independent economists are expecting next year. remarkably important for all of us. of course, you have been hard at work helping our economy and our economy recover these years. many of the tools you have been using were provided through the recovery act. i want to particularly shanghai -- thank all of you for getting back to work in your communities. indeed, we provided almost 75%

of hud's $13.6 billion in recovery funds directly to localities because we believed you best understood the needs of your communities and that you knew how to ensure these dollars benefited the people and the neighborhoods who needed them most. and you have delivered. beyond even our high expectations. with your leadership, hud's recovery programs have helped renovate over 358,000 homes and -- of around this country. give yourselves a round of applause. [applause] be additional homes the you help to build our to green standards

and energy efficiency improvements that save money for residents, owners, and for the taxpayers because they typically pay back our investment whether it is public housing or other affordable housing. they pay back the original investment in three or five years through lower utility costs you have helped us and homelessness for more than three-quarters of a million people. it might not have been for the homeless prevention program. as you said, it is fundamentally changing the way that community's response to homelessness.

we were able to do the release of this year of the homeless this -- we have seen an increase. our recovery act programs has seen an increase. when most people thought the effects of the recovery act would be declining, just in the third quarter, he created 27,000 jobs with programs from the recovery act. none of this would have been possible without your leadership. i want to congratulate you for obligating a full month ahead of schedule.

putting that money to work creating jobs, more quickly than anyone had expected. beyond the recovery act funds, for the neighborhood stabilization program. $4 billion critical to help renovate despite a very tight deadline. 99% of the money was put to work on time and met the deadline set by congress. our wonderful assistant secretary for planning and development is here. she joined me in thanking you for the remarkable work you have done. it has become an essential tool in your tool box helping you to rebuild any of the communities

that have been devastated by this crisis. that is why we work closely with congress to provide additional money for neighborhood stabilization in the reform bill. and that built on an additional $2 billion in the recovery act. but we know that the extraordinary challenges that your community is facing using these funds from staff shortages and during a time of enormous budget cutbacks to having to establish individual relationships with financial institutions to having to negotiate the best price on homes one house at a time. that is why it was not just enough to provide you $7 billion of stabilization funding, we went out with private sector partners and created the first look partnership to give you and your brand -- grantees 2 weeks

before anyone else could bid on them and allow you to get discounted prices that would help you stretch those dollars even further. because of this, we expect neighborhood stabilization to be able to reach more than 100,000 homes are around this country. if you look at the areas we have targeted, it is a huge impact. we estimate 20% of all the foreclosures in the neighborhoods targeted can be purchased or renovated with the funding we have provided. and because we have been able to set up this first look partnership, 188 communities have been able to save over $26 million, an average discount of 13% over the market price coming to foreclosure.

this has been a tremendous partnership. with projects continuing to get under way at neighborhood stabilization hitting the ground in march, and with the fragile but growing stability in the housing market, we expect a big jump in the impact of this first look has in the number of homes you could acquire in 2011. at the same time that these tools are helping repair our economy, we face an uncertain budget situation for the foreseeable future. i heard your truckles this morning with the president talked about this. we need to work together to be closer partners then we have become over the past couple of years as we face the difficult budget ahead of us. i mentioned earlier that you

have done a remarkable job with the recovery fund. you are creating jobs and opportunities in your communities, and one of the things that has been the most important is the funding that was provided during the recovery act. [applause] 300 mayors around the country, and 300 u.s. conference of mayors have already drawn down and spent every single dollar that they had in cdbg funds. dozens more are about to reach that threshold. having led the housing department in new york city, i know how critical the fund is to you and the work that you do on the ground. i know that this has been a primary focus.

you heard the president talked about it this morning. i also want you to know that i was the largest user of the home program in the country and that we will be reaching a remarkable milestone in the history of the program. the twentieth anniversary, we will reach right about that time of having renovated the million tom in this country. a remarkable record of achievement. in fact, when you take my experience and mercedez's experience, we have the third largest in the country. you don't have to tell us the importance that cdgb has. those dollars can leverage what

you need for infrastructure and to help your community thrive. still, while president obama has not released in the 2012 budget proposal, some are suggesting that we cut $100 billion this year from domestic programs. let me be clear. this administration is serious about training and our budget deficits, and you will see that in the president's budget. there are tough decisions that need to be made. but we are absolutely committed to making the strategic investments we need to ensure the economic future of this country. cdbg is one of those critical investments. it is a critical catalyst. [applause] it is a critical catalyst for economic growth, helping you

everywhere across this country bring retail businesses to your communities, forge innovative partnerships are around child care and rebuild your economies in some any different ways. our data from the recovery act shows that cdbg has created the most -- [unintelligible] at about twice the average. about twice the average of our programs overall. let me be perfectly clear. when it cdbg funding -- comes to cdbg funding, we hear yo ulaou -- you loud and clear. we need your help to get us the stories, to get out the real

story on how it creates jobs in your communities. that will be critical to winning the battle to ensure that it remains a proud and strong investment in every community around the country. you have rightly focused on how important it is. i also want to say it is not the only area where you need to make your voice is heard. programs provide a decent and safe housing to 4.5 million people. more than half of them are elderly or disabled. these are programs where just finding the same number of people costs more money. as rental costs rise, just to serve those same people, because that make up a larger share of the budget, that is a growing costs that is critical

to meet. insuring we continue to support those residents, it will be a priority. that is why you and i have a big case to make on other innovative initiatives that we have put in place together to follow the innovative things that you have been doing in your communities and support the work you are already doing to prepare your communities and economies for the future. the first is the sustainability in green jobs. i don't have to tell you how important this is for the economy. it already supports 2 million jobs and generate more than $100 billion in gp and wages. it will support nearly 8 million jobs and generate more than $0.50 trillion. i join mares on tuesday to

promote green cities and green jobs. what i heard was crystal clear. sustainability is not just about energy-efficient building. it is about where those buildings are located with respect to transportation and the rest of how we build our communities. america must find a way to connect housing to jobs. for every dollar that the average american family earns, we now spend 52 cents on housing and transportation combined. they have become the biggest expense is by far. that is why i was proud to announce $140 million in funding to support local and regional sustainable community

initiatives in over 100 of your communities around the country. demand for the sustainable communities program was remarkable. 78 million americans lived in the 45 regions that one those competitions. we were only able to fund 25% of the applications we received. we administered it jointly with the department of transportation. the funds awarded will leverage over $50 million in additional state, local, and private funding. these grants represent the most significant of federal investment in generations. planning our communities smarter means that parents will spend less time driving into more time with their children. more families will live in stable communities with jobs. more kids will be healthy and fit.

more businesses will have access to the capital and palestinian and -- a talent that they need. they will have a built-in competitive edge in attracting jobs and private investment. more than half of the applicants came from small towns or rural regions. this commitment extends to rural america with the $25 million renovation fund that supports -- [unintelligible] and bolstering our capacity to really change the game.

one of the things that is so important is that we don't take the old federal one-size-fits- all approach. you know better than anyone that they need in your communities vary dramatically. when we think about the threats we have to the sustainability, this is not about the federal government telling you or created an unfunded mandate for you. this is about us supporting the vision you have for your community. rural, urban, or otherwise. i was pleased this morning as the time with you at the white house to hear how excited you are from georgia, to sell lake city, and other places excited about the sustainable community agenda. it is long past time that the government understood that we need to speak with one voice and

finally, we are beginning to. help us continue that momentum. another place we have to make our case is transforming public housing. i talked with many of you earlier this morning about the enormous challenges you feel in creating make use, mixed income communities. and being innovative with public housing. despite that enormous desire, our rules half a century old prevent you from doing what you need to do. it stops any of you from being able to finance the needs you have in public housing. my own experience in new york, trying to bring grocery stores,

schools and services, was like banging my head against the wall. our transforming rental assistance proposal will change that by providing you the power and the tools to bring in private financing, bring in low- income housing tax credits, and create the kind of vitality and a market discipline we have seen elsewhere in the affordable housing sector. indeed of this is not just theory because you have seen it. i talked to mayor anthony fox that lives in a redevelopment. you have seen the remarkable transformation that they have been able to provide some many communities around the country. let's be honest.

we are not going to transform public housing with a half-dozen grants a year. we have to change the system more broadly. otherwise, we are going to keep losing public housing. during the time that i am talking to you today, we will lose another unit of public housing because there is a need for 20 or $30 billion of capital around this country. we think the transforming rental assistance initiative alone could bring him $25 billion of private capital into public housing. most importantly, it would create 300,000 construction jobs around the country. renovating public housing. building the communities that your cities' need. and i want to say this is one of the most important bipartisan

issues we can have. the secretary that created hope 6 neknew that. we have legislation that was introduced by the revitalization act that would bring that kind of transportation to all public housing. we need your support. you know the results they can have on the ground. lastly, let me say there is no greater opportunity for bipartisanship and getting real results that on the issue of homelessness. when i was the housing commissioner in new york city, the mayor and i worked with the republican governor. i often like to joke that i know by partisanship and i worked for all three parties. that was just under one mayor in new york.

we worked closely to enter into a billion dollar investment to create 9000 housing for the loan -- the homeless. it was because mayor bloomberg is a businessman, george is a fiscally conservative governor, they knew that this is not only the right thing to do for the homeless, it was the right thing to do for the taxpayer. they knew that the real cost wasn't just the cost of housing in the services that support of housing provided, but the real cost with the revolving door of emergency rooms, shelters, jails that would result if we did not do anything. we have learned it is more expensive to put a band-aid on homelessness than it is to solve

it. the bush administration realized that as well. thanks to its leadership, key members of congress and countless local leaders, the model has helped communities around the country reduce chronic homelessness. people we thought would always be home less, by 1/3. in fact, that progress, your work at the local level, and opened the door to a federal plan that president obama announced last year that will finish the job of ending homelessness. it is the culmination of a decade of work and commits the federal government to ending chronic and a veteran homelessness in five years, family and children homelessness in a decade.

this fight was not started in washington. it was started by you and your partners around the country. you were the ones that said we could end homelessness. you set out to prove it. with this plan, we are not only taking on this fight, with the federal government, we are going to win this fight. [applause] next wednesday, i will be joining thousands of volunteers to conduct a national one-night count of homeless persons and families. this count is essential to having the clearest possible understanding of the scope and breadth of homelessness and measuring our progress toward ending it. you can find out more how to volunteered hud.gov/homelesscount. good data is essential to

measure what we need to do better. you heard the president say that the key guiding principle in these budget fights is that we need to demonstrate what works and stop doing what doesn't. and we need the data to show what works. we are urging everyone of you to join this count. i will be on the streets and i urge all of you to get your communities to help us. some wonder whether we can make progress in a country that is divided. whether the issue is tax cuts, putting people to work, rebuilding our public housing, and proven strategies that prevent homelessness or new tools to help communities care problems and finally start sharing solutions, i am confident we can not only make

progress, but history. insuring we do starts with the men and women on the front lines of the communities. it starts with the leaders here today in this room. it starts with you. thank you for the opportunity to be your partner. thank you for everything that you do across this nation every day. i look forward to continuing our work together. [applause] >> mr. secretary. we thank you for being here, and one of the things that the mayor would like is to take a questioner to. there is a very pressing question on the minds of all the mayors. if you could address that, we will go to the floor because we have other members that are going to be speaking. the document that i hold here is

going to be up there. the republican study committee issued their reduction act. can you tell us, what is the process? and what does this mean? we see reductions in the community development block grant. could you talk to us about that mr. secretary? this was out yesterday and everybody has gotten a copy and they are of great concern. >> elizabeth, thank you. we have been talking a lot about what the president's budget proposal will look like. you have made your voice is heard and i want to thank you, mayor warren and congressman

frank. your voices are being heard, make sure that they continue to be heard. this is an immediate question about the 2011 budget. because of the continuing resolution that ends in march, will have the debate about whether it continues to be funded for the remaining six months this year. this will be a critical discussion. as i said, i was running the largest program in the country when it was proposed that it be eliminated. there were proposed cuts of up to 2/3 of the budget. this is an immediate question

that we need to work on. the process here is that the current year's but it needs to be passed in march. it might be a continuing resolution, it could be something that cut substantially. you have heard a proposal of $100 billion of production this year. that is really what we need to make sure of, as we're looking at 2012, we're looking at protecting cdbg this year and the other critical resources we have provided. >> i know that your time is very precious and limited, we appreciate you being here. >> i can take one question. >> you would think that beverly

hills should not have many problems. but that is not the case. we have the same problems like any other city. something that might be a challenge, what you can do for the rest of the cities. it goes way beyond sustainability. i started with 10 initiatives and we are now at 175. now we have solving problems [unintelligible] because it would really make the government smaller and payback in the long term. >> thank you.

let me go back to something and amplify it a bit that i said earlier. one of the misperceptions, i think, about a lot of the work we are doing on sustainability, linking housing transportation is trying to make our communities more sustainable. and this is a big city issue. an issue that n.y., chicago, and l.a. is dealing with. i have dealt with it with ray lahood and miss jackson. urban, rural, suburban. every geography. what is heard is that we are supporting your vision. we learned with urban renewal

and many of the historical just as, you can't have one-size-fits-all policy. you can't think of new york communities having the same needs. what was so different about this process is we are asking you to tell us what the communities should look like. if it is a small city vision, we will find that. if it is focused on art space that we have seen in many communities, we want to fund that. we want your ideas. we don't want to dictate to you what the community should look like. but that is something that the mayor and i were having that exact discussion earlier. there are still too many that think of federal planning support as modeled on the urban renewal approach.

this is a very different approach based on your vision. we need to make sure that the newest members of congress here that. and understand that this is reaching every region, every size community. it is about your vision, not about a federal government dictating. thank you will so much. i look forward to seeing you very soon. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> here is what is coming up tonight on c-span. an update on the medical condition of gabrielle gi ffords. and the director during the president bush administration. that is followed by a news

conference with democratic leaders that are holding a party retreat on the eastern shore of maryland. >> this weekend on c-span 3, domestic terrorism of the late nineteenth and early twentieth centuries. learn of the century old traditions of preparing for horse-drawn a funeral. and how slaves escaped and started new lives. all weekend, every weekend. see the schedule on line where you can also press the cspan alert button and have the schedules emailed to you. >> cspan. bring public affairs to you. it is washington your way.

>> a medical briefing on the condition of the gabrielle gifford. she was successfully rehearse -- transported to a hospital in texas for therapy. this is about half an hour. >> good afternoon. i am the head of corporate communications. i am very happy that all of you are here today. we have enjoyed working with you the last few days though they have been a whirlwind of activity. this is our first news conference, and we anticipate holding additional briefings when we have additional information to report. with that, i know you are anxious to hear from the doctors and i will get the press

conference underway. it is my pleasure to introduce the president and ceo of the memorial hermann health care system. >> welcome, the afternoon. thank you for being here. shortly before 2:00 p.m. today, congresswoman difference and her husband, her family, and the staff arrived here. we completed the successful transfer ha. i had the privilege of reading them and i can tell you they have looked forward to this day. she takes the next step on the road to recovery. we are honored to have hermann play such an important role in

this next step. before i introduce the positions, i would like to recognize the ceo of our memorial hermann texas medical center operations. stand and be recognized? thank you. i would also like to introduce the ceo of the memorial hermann hospital. also seated next to them is my colleague and good friend, dr. larry kaiser, president of the university of north texas health science center at houston. or as we call, ut health. all of the positions that will be treating congressman difference are members of the university of texas and that the

school out there. i missed one other that is not on my list. i want to introduce tj. i believe -- cj, i apologize for that. that is the staff person that has the relationship with the media. our first speaker here is from arizona. the associate medical director at the drama -- trauma center. i will turn it over to you.

i am pleased to tell you that it went flawlessly. there were several times we could hear applause. she responded very well. it was very emotional and very special. there was absolutely no difficulties. i am pleased at the entire process and i am very happy to turn the care over to the new team of physicians.

>> we will introduce them here in the second. before we get to the physicians and the question and answer, let me call out dr. john [unintelligible] he is the trauma surgeon here. he is also the chief of the division of the surgery at duty health medical school. -- ut health medical school. >> this transition, as we discussed, transfers are already a little shaky.

the aircraft loaded up, landed here in houston. we were very concerned about that, actually. it is a real testament from the team from tucson that got her safely to the i see you. -- to the icu. to the nurses and doctors at the bedside, there was a good exam. she is doing great. she has done very well. that is one of the main things that we want to emphasize. she is going to start rehabilitation at 4:30 this afternoon with physical therapists. we will start the rehabilitation, which is one of the main goals that everyone has. i am impressed.

i see a lot of logistics and a movement over the world. it could not have gone better. week that the doctor from tucson already. this is the team that will be taking care of the congresswoman. >> how unusual is it? [inaudible] >> we discussed that upstairs. nobody knows the trajectory of the bullet for real.

it certainly could have been a lot worse. this was a tangential gunshot wound that did not go crosswise or write down to the center. it could have been a lot worse. it did not damage large portions of her brain but some portions. >> [inaudible] >> it was very heart wrenching. it was just so wonderful to see the support that they have for gabi. >> [inaudible]

>> it could not have gone more smoothly. from the minute we took off to the minute we landed, she was napping. she was interacting with her mother and her husband. her monitors registered no abnormalities' whatsoever. it was a flawless transfer. >> [inaudible] >> we have had a great assessment. i would seay that the care in tucson has been great. everything we have heard in the last couple of days and did a great job.

up to the operating room within minutes. i think it is really an exemplary and an important part of her status today. >> i would like to say that she looks spectacular. from a neurological point of view, she was alert and awake, calm, comfortable. we were already feeling some interaction which was important. she has movement on the left side of her body and very purposeful. we were testing her vision and he did not like us fighting the light in her eye. she wanted to keep them closed. these are all very good signs.

it is often a precursor to a much more functional recovery. as i said, she looks spectacular. >> [inaudible] >> there are varying stages of paralysis or weakness. she has maybe some movement of her legs. there istone. -- is tone. she might be able to support herself but not move it when she wants. we are not seeing much in her arm. but that is only about 30 minutes. >> [inaudible]

>> let me say that she has great rehabilitation potential. we will keep her busy as well. the press conference, i will be joined by a couple of members of my team. we will do the range of motion exercises. we will look to get her up. >> [inaudible] >> on the assessment, she is ready to start rehabing in the icu. after discussing back and forth on tuesday, there was fluid collection.

it is still in place. you cannot lead the -- leave teh i -- the icu . she is going to stay in the hospital for a little bit longer. we sort out this business, worry about infection. and continue we will make sure that all the other ones are addressed. it has to be the most optimal thing we consider. it is a little early to tell when we will do it. >> you said it moved in.

>> have they been replaced? >> she still has a crane yet to me. portions upper school are not -- skull are not there. >> patty transfer portions of her skull? >> it is not that important it can be manufactured. >> it is taken up steadily and frozen. andaken out sterile ley frozen. >> we measured them for a helmet

to protect their brain. it is exposed. we had when it did for her. the assets to make loan with an arizona flight because that is what she would what -- they asked us to make her one with the arizona flight because that is what she would want. >> we have started that process. she is clearly aware of her surroundings. she is interacting with us and your families. there are many ways we interact with gestures. that is already happening. we also reviewed the ct scans today. there are really minimal injuries from what it could have been.

we think she will do remarkably well over the next few months. >> when she squeezed my hand a thursday, the most encouraging thing i could have seen. when i saw her reaction to the cheering in the street, it confirmed to me that she knows what is stalling -- going on. >> [inaudible] her husband relayed to me that there are times when she is kind of rubbing his shoulder and neck to calm him down. that is a very clear interaction. today we are trying to do parts of the exam, she was pushing us away are directing us to do something different.

there is no question that she is aware of what is happening. this can a very difficult to say. she is clearly moving her lips. i think she may be trying to form words. >> is there anything else? cracks in the i see you, we try to keep people from having problems that we anticipate. icu, we tried to keep people from having problems that we anticipate. everything looks pretty good.

we are ira -- we are happy with our assessment of her right now. they did a great job. >> i'm going to put you to work. there are an ammonia comment exceptions, those of the things that happened to people that have been in the ic for to work for weeks. >> [inaudible] >> it is amazing and emotional to see. she smiled and began to tear a little bit. i think she understood the

immense support that our city has for her. >> if i could add a story for when she was initially here her nurse from arizona was interacting and helping us with the system. she had some familiarity. she has awareness of the situation in the family amity -- and the familiarity. she gave it to her.

i gave it to her. she was looking at it. >> she was taking it off my hands. she took it into her hand. issue is looking to put it on her finger. do you want me to cry? it is very emotional. she is a very gentle person. her personality is coming out. i am very lucky to know her and

her family. what is your name? >> tracy culbert. i'm sorry? we are leaving today to go back to tucson. i know she is generally good hands. we've had a good transition. they are going to keep in touch with us. i have a lot of hope for her. she is going to do great. we yardy said our goodbyes. -- we already said our goodbyes. it is personal. i have a big bond with her.

it is difficult for everyone to see her leave. >> i was proud to vote for her before and i will vote for her again. >> she smiled really big that time for them. >> there you are. i think the goal for the next two days is twofold. she will be going with the rehab right away. some of the housekeeping issues major she does that have any of the infections you talk about.

this has helped to reduce the well, his optimism. >> her husband is going to spend a lot of time with her. he has a lot of options. >> there is an area where a family member can stay over night. they are with them right now. it is still really early to tell. it is how things go with managing the drain.

holley, not many complications will arrive. -- hopefully, not many complications will rise. it is tough to say how long. we will be reassessing the neck steps. we will take it from here. >> it depends on how much it is going to tolerate. we will have the least three hours of therapy. after the overall condition improves, we will upgrade nudges the hours of therapy but the time of therapies that we will provide. >> and cannot tell you what

specific ones there will be. they will be tailored. they will develop this over the next few days. >> are there any last minute burning questions? >> d.c. a vision? -- do you see a vision? [inaudible] i am curious about what you expect based on what you have seen? she will continue to make dramatic progress. there are still issues over the next week or two that we will be interesting.

overall, we are looking at months. it may not be that long in the hospital. at some point, they can continue their rehab. >> thank you very much. we really appreciate it. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> tomorrow no, a look at the white house economic team as long as the president's newly created council on jobs and competitiveness with a reporter from politico. after that, a director from the national league of cities.

they will prosecute detainees. it is like everything it 7:00 a.m. eastern. >> david, and republican from california's 29th district. what it sunday at 10:00 a.m. eastern. >> i have to practice staying alive and preparing to die at the same time. >> our guest is author christopher hitchens.

but it is a tantalizing time to have cancer. there are treatments i can see that are just out of my reach. it is both encouraging and annoying. >> the president of the united states. they reflect on the previous an annual state of the union. >> earlier this week amid the house of representatives voted to repeal the health care law voted last month. harry reid has said the senate has no plans to vote on the repeal. there are 10 proposed changes. they discuss why it should be repealed.

this is one hour and 10 minutes but the of >> i am president of the policy for analysis. one to welcome you here today. we are doing it by the representatives of the heritage foundation. they cannot be here physically. our interest in the bill that was passed is a major defect in the bill. we think it is so serious and so severe that the congress will have to reopen a health-care law and make major changes to it even if there are no critics around.

i want to go over 10 of this major problems. number one is an impossible mandate. they will be required to have a health insurance plan. you do not have to be a mathematician to know that if you are forced to buy something it to a potentially crowd out everything else that you are buying. bombload not create this problem. health-care costs have been growing for the last 40 years. the united states is not the worst case. we are just und the european average. so this is a problem for the entire developed world.

but even though barack obama did not create the problem, the bill that we passed makes it worse because what it will do islock us into that very a sustainable path. if we continue on the path indefinitely into the future, by about mid century, today's young folks will reach retirement age and health care will have crowded out everything else that they consume. i suppose that that is not the goal that we want to reach. the problem with the bill is that it takes away from the private-sector many of the tools that are now there that allow you to control the health insurance cost, and letting the package of benefits, more cost sharing, all of that goes away and walks into a path that is unsustainable and undesirable. then we have is our system of subsidies.

the hotel down the street has a lot of workers that are making only $15 per hour. they are theaids, busboys, the custodial folks, the garden folks. according to the congressional budget office, if these people make it over to the health insurance exchange that will be set up under the new health law, there will be able to acquire a health-insurance plan for a family that costs $15,000 and the government will pay almost all the premiums. then if they have a lot of out- of-pocket costs, the government will reimburse them for those and the cbo projects that the total benefit they will get is about $19,000. on the other hand, if these employees stay with the hotel and get their health insurance from that hotel, the only subsidy they get is the subsidy that is currently in the tax law, which means the ability of the hotel to pay premiums with untaxed dollars. but since people at this way is little to not pay income taxes,

we are only avoiding the payroll tax. the ability to do that is only a little more than $2,000. they could have something for free worth $19,000. where do you think people will end up? economy tells me that they will find their way into the exchange. if the marriott employees do not do it, but the others do, marriott will find it very hard to compete in the marketplace with labor costs that it% higher than all its competitors. i do not know what firms will do, but i can conceive of a wod in which firms completely reorganized to take advantage of these new subsidies. the strange thing is that, if marriott has an employee that makes 9000 that -- $90,000 or $100,000, that employee gets no subsidy if he goes into the exchange. if he gets his and assurance from the marriott, however,

marriott gets the subsidy with the rrent tax w,he ability to pay prelims with pre-tax dollars, avoiding the payroll tax. but for the higher income, also state and local income taxes. those subsidies are about equal to half the cost of the insurance. so a higher-income employees once his intered -- once his insurance from -- once his insurance from the hotel. what will employers do? end entirely independent contractors and such? there will be decisions that will not be good for the job market, not the kind of labor market situation that gives employers conference and lets them know what will happen. we have health insurance

exchange that creates perverse incentives for the insurers. you charge everybody the same premium, regardless of health care costs, everybody's incentives are distorted. the person that has health problems and will look at the premiums and say that health insurance looks cheap to me and they will tend to over insure. the person who is healthy will lo at the premiums and think that it is way too high and some will decide to under- insured. incentives for the plans are to avoid the sick and attract the healthy. here in washington, at open season time in the late fall, what kinds of ads do you see in newspapers? you see as a young healthy people with children and the implicit message is that temecula put the people in these ads, we want you in our plan. -- the implicit message is that, if you look like the pple in these ads, we want you in our

plan. if you have aids or some other difficult-to-treat condition, consider us. remember the phrase "you are in good hands with all state?" they have a catastrophic seen and they say, we know that you do not care about health insurance until you have an accident. but when the really bad thing happens, they say, we wil take care of you. in health care, however, it is the other way around. we give health insurance companies an incentive to attract the healthy and tell the sick or potentially set that we hope you do not get sick at all and we wanted to go someplace else. you do not want to erect a health care sense of -- a health care system that avoids people who s problems. one that is better is the medicare advantage

programs where they tried to recruit senior citizens with high health care costs because they know they will get a premium that is much higher than the premium paid by everyone else. we have in this loppers incentives for individuals. we have a fine for being uninsured, wch is, quite frankly, not great enough if you want to make the premium mpletely independent of people's expected health care costs. in massachusetts today, people are going bare when they are healthy. they are signing up for health insurance after they get sick. the number of people who do that is increasing each year. it is a small problem for massachusetts right now, but it will be a huge problem for dallas were coming in dallas, they find that medicaid patients end up in the emergency room. it does not matter so much to medicaid because it is taxed pair -- it is taxpayer-funded anyway. bluecross will not survive very

long in the health-insurance marketplace. we have made promises that we cannot possibly keep. according to the congressional budget office estimates, we will ensure about 32 million people who would otherwise be uninsured. if the economic estimates are correct, those people go out and try to double the amount of health care that they have been consuming. we have millions of people, 90 million in the last estimate, that will have access to preventive care with no deductible and no copayment, benefits that they did not previously have. let me give you some idea how bad that is. economists at duke university estimated if everybody in america went out and got the preventive care that is prevented -- that is recommended by the preventive care task force that will set the standard for the new health plans. the estimate was that the average primary care physician in the united states would have

to work me than seven hours every working day to ride these services, essentially providing services to help the people, leaving little time left over to take care of the sick. what i'm describing is a huge increase in the demand for care. in this legislation, we did little or nothing about the supply. early on, there were versions of the bill that had line-item expenditures to produce more doctors and nurses and so forth. but all of that was zero out on the final passage, probably to keep the cost of the legislation down. the cbo that probably figured, if we do not have many more doctors, they cannot deliver more care, and we cannot spend more money. but what we will have is a large increase in demand, no change in supply, and a huge rationing problem. in this country and other countries, we do not primarily care -- we do not primarily pay

for care with money. we pay it with time. please stand by they are going to crowd out the poor and the elderly.

they will have an increase of problem of access to care. they will have the requirement of doctors and hospitals. this gap grows over time. medicare will be paying lower rates. all too often they will go to committee centers for their care. the elderly may be there as well. the elderly may be behind. there are large burdens here for the state.

it to be difficult for them to meet. this legislation does nothing to solve the problem of portability. this is the biggest problem the most people have. portability, which is the biggest problem that most people have. there is no legislation that produces affordable health insurance. it regulates both the patients and doctors. if we really want to solve health care problems, we want to get rid of waste in the system and higher-quality care. many patients and doctors who will do it. but there will lead to a gifted and had incentives to do so. -- but there will be no incentives to do so.

every patient, every doctor, every nurse, and every hospital the administrator will have to do just that, lower costs and raise quality. i want to turn the program over to my colleagues. this program is co-sponsored by the heritage foundation. robert moffitt who is here today was very kind to put this program together. >> thank you for the chance to be here during the since -- during this event. obviously, this is a central piece of legislation and one that ought to be examined very closely. i want to echo the remarks that the john made about the impacts of the law from the perspective of health policy. but i was taught that, when one looks at legislation, it must look at it in the context of the nation's problems.

the top two problems in the nation today is an economy that is badly underperforming and the need to generate jobs for americans and a federal budget outlook which is coming in and of itself, so threatening as to really cast in doubt the future prosperity and freedom of americans. this legislation is quite damaging from the perspeives. first of all, the health care sector is now moving to one- fifth of the economy. evything john set about improving incentives in that sector would constitute improve economic policy, and getting higher quality in care and less cost and improvements in efficiency. those are things that we ought to support as a matter of economic policy in the united states. on top of that, there is sspill over to the rest of the economy. you ca save $500 billion in taxes over the next 10 years. i do nothing that anybody in the room would say, if you want

to create jobs, should we raise $500 billion in taxes over the next 10 years? some of those taxes will show up in the form of reduced incentives. there is a so-called medicare tax, a surtax on investment incomes for high-income americans. that is a pure trackincrease inx on marginal tax rate. it will have the same kinds of entities that were the subject of so much discussion and recent debate over extending the 2001- 2003 tax laws. small businesses and entrepreneurs in america will create new firms and generate job growth. indebted in this bill is damaging incentives for those individuals. there are all sorts of inputs into health services that will lead to higher costs to those services when held some -- to

those services. when health services are more mix and sift -- more expensive, there will be higher premiums you will see the bottom line show up in every small business in america. every businessman wl have to do the calculation that says i have to pay my workers less to cover the cost of the premium increases i am seeing. there will be some workers, those in particular with minimum wages, where you cannot lower their cash to offset the premiums. we will see those jobs go away. again, it will be the low-income workers were primarily damaged by this bill and the economics at -- economic incentives that are in it. this is a recipe for less less jobs in america. it is a recipe for slower economic growth. that is just putting the $500 billioin taxes in.

there is nothing about sending out checks for $1 trillion worth of seven cities that will generate job growth in the united states. nothing about that has ever been a successful path to economic performance. i believe that the nature of the subsidies -- i want to echo what john said -- in addition to the real efficiency costs and the growth impacts of this bill, there is some deep and fairness associated with how these subsidies are distributed. the example he gave was a rare one. there are two people who are otherwise identical. you have one woman making $70,000 and gets her entrance from air her employer and gets the tax benefit from the employer-sponsored insurance. another woman making $70,000 goes to the ehanges and get $7,000 in federal subsidies. that is an industry that is so profound that it will not be allowed to persist. one that i am deeply nervous about is that a future congress will fix that in every by giving everybody $7,000 and making the

bottom line cost so much more expensive than it already is. i want to turn to the budgetary implications. they' very closely related to the economic incentives. there are many ways to look at the budgetary implications. the first one i would ask you to begin with is the last one. set up two new open-ended income of programs that will grow at 8% per year as far as the eye can see. that is faster than the economy will grow. it is faster than any notion of revenues will grow. we will set two new programs that will grow faster than the economy for as far as the eye can see and we're supposed to believe that it reduces the deficit. it is impossible to make that claim with a straight face. we have cbo estimates of budgetary impact which showed a deficit reduction from the bill. but i do not think it is widely understood that this particular estimates and the nature and that thoserules -- t

particular estimates are forced by the nature under which the cbo has to follow the rul. if you take away those rules and look at this in any realistic fashion, our estimate is that the bill would reduce the estimates by $500 billion the first 10 years and $1.50 trillion in the next 10 years. that is an important thing from the future the economy to the fairness perspective. the rules are so offensive and it has to do every young person in the audience. this bill is the biggest generational money grab in history. it forces every young american

to buy insurance, thereby pay for the cost of those who are older and sicker than them, and then, having done that, when they get to the end of their working careers, they will inherit the trillions of dollars in debt that this bill will produce and will be saddled with paying that off well. from any perspective of fairness, that is simply wrong. it comes at a time when it is also dangerous. everyone has heard a lot about the budget outok. regardless of which one of the particular forecasts you look at, the united states is in the fiscal situation that is unprecedented in its history. over the next 10 years, we are likely to run deficits that averaged nearly $1 trillion by the end and zero of -- an average ove$600 billion each year. at the end of six years, we will have over a dollar trillion in deficit. we will be borrowing just to pay for the interest. that is a recipe for financial

disaster. all along that path, we will meet the technical criteria for downgrade. that is the fiscal outlook before they passed this legislation. this legislation will make it worse. i stipulate that introducing a damaging bill to a stiffest -- to a dangers fiscal situation will not generate jobs. thank you. [applause] >> thomas miller is a former senior health economist and is now with the enterprise institute. if you're interested in health policy and you loo at the journals, it is hard not to find tom miller everywhere you look. let's give him a warm hand. [applause] >> thank you very much, john. there is a lot of repeal-and- replace work to be done.

you can also find them at our website. coming soon also, with my co- author and others, "y obamacare is wrong for america." look for it. today,ohn asked me to focus on something else -- how to improve the health care delivery system and health care quality through u.s., political, and other ways and means. we have to give chase the way we think about the issue. there should be health outcomes and value. helter quality is too often viewed in process terms, -- health care quality is too often viewed in process terms.

there is no single setting. it does not mean there are not institutional process no- brainers that is just not the big story on how to get better value. we also need to reach beyond the conventional health care delivery system. a wide range of actors shape it. two different individuals should have exactly the same health insurance and differences in health, both initially and after getting the same diagnosis and it can be vastly different depending on where and how they go to for treatment, how to make decisions as patients, and a host of other factors earlier in

their life that brought them to thatarticular point. " we always forget to look for the health outcome keys that e lost from the health care funding lampposts. let's be more humble about providing simple guarantee answers. the patient protection and care act is promising what is unbelievable and what is all too predictable. in the flyover land of the law, the unicorns and health care delivery reform miracles, or science fair projects that never got out of the exhibition hall, we have various 3 iterations of repackaged centralized command and control edicts from the usual sources who issued the previous ones that failed outright or aggravated the systems pre-existing chronic conditions. the latest cliche is tt every

idea for dealing with health care is -- they managed to leave out a few important ideas, like choice, competition, personal responsibility, truth in labeling, market pricing, respect for personal preferences, inctives for better performance and decision making, double entry bookkeeping, and even arithmetic. most of the quality of experts who tried to sell the message bore over that most americans do not hear or believe, yes we believe the health care costs are too much, even though you only see a fraction of the full expense directly or there are too many barriers of getting more of what we want when we wanted, but a vast majority actually think that the health care they receive is excellent or good. that is partly why you will hear

politicians talk a lot more in public about high health care costs or spending on the uninjured and the patient protection affordable care act provisions. the reality is that our health care system, although excellent in many important ways, is not perfect. different approaches could increase its value. with some more on his choices, it could push forward in a more competitive and transportranspat marketplace. the meter is running on my time. first, throttle back a good bit of the overbearing regulation. two, guarantee a socially acceptable floor of health care services for the less fortunate, but stopped attending to subsidize some much of everyone else's bill when it mostly becomes more wasteful rounds of

dollar trading. 3, stop pretending that all care must be high quality and can be high quality and avaable to everyone all the time. instead, let's encourage more competition in seeking and delivering care whose value continues to improve from whatever it is in the moment. you cannot just imagine the merkel of a totally unfettered free market -- the miracle of a totally unfettered free market. policy changes can help private parties compete in measuring and reporting better have different parties in the health care system performs so they can be rewarded. i have written about this in greater length elsewhere. the new law is not tally barack -- not totally moronic. but it is on a consensus

standards that, by the time they are derived, they're too weak, too unrealistic, or to outdated, and perhaps all three of the same time. while other provisions drive to a more concentrated health care marketplace, it is less competitive andore politically dependent. we cannot expected to be perfect. we cannot measure everything or even most things. but we should use what is best available within limits of current data and measures while acknowledging those limitations. we should also shut up about ality when we do not know one way or the other. decide what you really want to waste your money on. we need information much more about provider performance and about insurers and the insurance they offer. and about physicians, not always that the group level, the

information needs to be a combination of measurable health outcomes or intermediate markers for them. it is the value combination that matters, not just quality, cost, or price alone. this whole area is complicated, contentious, a evolutionary, and full of caution and caveat. but we ignore it at our pil without beginning to engage. basic sweeney are to do aggregate data and -- there are basics we need to do to aggregate data and assess it. thank you. [applause] >> thank you, tom. michael cannon is at the cato institute. some months back, he recruited a

university of chicago professor to show us how we really ought to be handling the problem of pre-existing conditions. we had a lively discussion of it at my blog. i have asked him to tell you about it today. please welcome michael cannon. [alause] >> thank you, john. thank you all for coming. i may have to leave before the question and answer period. if you have any further questions about my remarks, i encourage yoto visit the cato institute web site. you may have heard today that th department of health and human services released a study that says that about half of non-elderly americans have a pre-existing condition and repealing the health care law known as obamacare would mean that those folks who have trouble getting coverage. but, in obamacare, it guarantees that those folks would get coverage and the care that they need. there is problem with that.

a government survey conducted just a few years ago found that only 1% of americans had ever been turned down for health insurance. that is consistent with other research. research by the rand corporation looked at lightly regulated individual insurance markets, such as california's, and found that lots of people with pre- existing conditions get injured even when the insurance company has the ability to deny them coverage or to charge them higher premiums. it is a tricky thing, really, to get people to keep the promises that they make too sick people. this is true whether you are talking about pollock health let's look at the record. there was a long- term promise to sick people. employer-sponsored health insurance. if you know that history come

you know that this market is a creation of government. in the 1940's, the government through a series of accidents decided that employer-sponsored health insance would be exempt from payroll taxes and income taxes, which created a huge tax break. have a corresponding penalty -- purchasing on your own -- if you want to purchase it on your own, it can cause peopltwice as much for the same or less coverage compared to getting that throughn employer. this is the horse the government decided to back. but if you think about it, your insurance plan for your employer does not provide you a long-term promise to take care of you when you're sick. they only provide medical care so long as you are still connecd to that employer. if you get sick and cannot work, you lose that health insurance and you run your own.

the individual market, researchers have found, even with various regulations, fines or secure health insurance than employer-sponsored health insurance. for people with high costs illnesses, they are likely to keep their insurance than that they had it through an employer. that is the situation the vernment created when it decided it would increase access to health insurance. nine out of 10 people with health insurance or in this employer-sponsored health market where you not get a guarantee that you'll be taken care of over the course of a long-term illness. how about another ker -- governnt solution and? we heard about the medicare program 20 years later. we're going to provide secure health insurce for people in old days so they created the medicare program for people over

age 65. yes, medicare provides secure access to health insurance for the time being. they do it in part by being completely fiscally unsustainable. we cannot continue to provide access to the medicare that seniors had been accessing in medicare for the past dade. in addition to that, one of the ways that medicare is so financially unsustainable is that 33% of medicare spending does not provide any value, does not make patients healthier or happier. that is where research shows as. and it causes most of

the same sort of price control as obama -- obamacare. lf is the americans who would be heard immediately. 100% is the share who would be over time. how to keep the commitments that we have made? pyridine a better job of providing in her -- they are doing a better job of providing it as a low-cost. you will have the freedom to

switch insurers. it does not keep its promises to you need it said the. >> robert mcpherson. moffett is a senior fellow at the heritage foundation. >> thank you very much.

there is a lot of work. we are now entering the second phase of the gray matter of the health care debate. but me focus on a couple of items. this is part of the challenge of entitlement. traherne -- this is january. this is the first. wade -- first great wave. it to experience the largest single demand.

not on the primary care physicians. the gravity of this is greater than most member of congress really appreciate. one of the striking facts has been the hostility of the medical profession. the medical profession itself is holbrooke energy is held to this

law. they are demoralized. they do not have control over their professional life. they are faced with an expansion of government payment including medical malpractice. there the sun the house that is remarkable here. -- there is something else that is remarkable here. this will result in a savings.

what does this actually mean? they have never been here before with the aging population. medicare reform will threaten the access to care. this is not my point of view. it further legislative intervention will not enhance the solvency of the program purdah -- program. he said the unified budget shows that this would be used to

pay for other things. it will not enhance the ability of the government. they will guarantee that we will see greater access problems. they do not think these massive record-breaking reductions will actually comply purd. they will have access to private section options that many do not have. they will maintain the existing limitation on the ability to go outside this.

we have to go in a different direction congress has direct responsibility

that is not a bad option. they will have to depend upon us to make good decisions. thank-you note very much. >> thank you. that was very informative. up. well let me just begin by asking this question. to the panelists believe that senior citizens realize what has

happened to them under this legislation, and what do you think will happen what the medicare provision? will we go forward? we carry out the way law was written or will it have to be changed? who wants to take this? >> i bet it was very interesting that both the actuary at cms and the director of the congressional budget office both publicly stated and formal, official correspondence to the congressional leadership that they did not think that the medicare payment deductions were sustainable over time. but the cbo and the cms actuary. we have never quite gone here before at this level of payment reductions. i think that whether the survivor not, it is highly unlikely that these kinds of

reductions will survive. >> let me address this question to doug holtz-eakin. what happens when you have a bill with a huge expense and the way you thought you were going to pay for it does not pan out? >> nothing good. [laughter] this is been the history of entitlement programs in the united states. they are launched with fanfare, that includes their budgetary soundness over time, enrollments expand, benefits are added to what was originally envisioned, the incentives are such that no one is ever going to impose things on programs that cause the beneficiaries to scrap or say. so we get this enormously bloated title -- entitlement program. that is in the history and medicare, medicaid, and likely to be the future of this law

unless we change course. we end up where we are today, with enormous structural deficits that are so large and so troubling that they literally threatened to cut acid -- the capacity of the u.s. economy to provide a high roll standard of living than we have now and that is something we simply cannot do. >> we value currency with economic balances. we can also the value health care -- devalue health care, either explicitly or directed. >> you mentioned the department report that suggest that about 30% of the spending in medicare is wasteful and goes to -- is spent on care that provides no particular good for people, so my first question is -- doesn't that suggest that there is in fact allow that to be pulled out of medicare? and if so, how do we do that? steady path -- published

last month looking at mcallen texas, and looking at variations in medicare spending and they found that the variations and private spending. this does not seem to exist in private spending, at least in these two locations. my understanding it that the administration, a lot of plans for obamacare were base on the idea that this same sort of problems existed in private and public health insurance. what does th say about the reform and how will play out? >> the fat is measured crudely as an aggregate. 15 years ago, people are rediscovering that there is much variation in private-sector health care then there is and medicare. there was another program or managed care plans or there was

a variation on a regional basis. the tendency of research is that there is a bias in the field. you go where the data is. we had medicare data and you could show this type of crude variants and band you prop up a lot of theories around it. it could be true that the nature of the medicare program lends itself to more of that waste and variation without -- there are two principles in dealing with this. we're not ready to go there. putting money in the hands of the patients and the consumers? we have that that much. we do need some type of -- even though they are imperfect -- markers as to what is better or worse, not perfect, something in that regard. we're building a lot of matters which may not tell us that, but that is the general direction to go. you can always find it right here on the map in this particular area and pinpointing

get that passed politically? probably not for you would probably have to decentralize that. >> let me add one thing to that. tom's answer was very good. there probably is 30% waste in medicare. maybe there is more, but when he get the bill, you do not get an item that says these items are waste. then it would be easy to get rid of the ways. you do not know where the waste is. what we mean when they say say there is ways, there is inefficient hospital and minister are an efficient group doctors that could have done this for 70% of the cost of was suspended. unless they have an incentive to do that, they are not going to do it. we have to get -- we cannot get rid of the waste unless it is in someone self-interest to do it. >> should congress even attempt to fix this legislation? is it possible that thinks this law or you think that tweaks as a whole cannot make it difference? the whole thing has to go?

>> take your shot at it. >> the issue here is what is your vision for the future of health care in america. what i think the law represents is a very specific vision of health care policy. we know our colleagues very well who disagree with us. frankly this is their vision of what health care system should look like. they believe, many of them very strongly, that health insurance plans should the public utilities and should be heavily regulated by the federal government, and the federal government should make the key decisions allocating resources in the health care system,-and making decisions about what will be covered and how will be financed. that is not my view and i think my colleagues here share my view. . but the bill does represent that point of view. having said that, i would say that in answer to your question that you actually cannot build a

system bed on free-market principles of consumer choice, and competition on a foundation which is fundamentally incompatible with thatision. a foundation which is built primarily on centrallanning and bureaucratic regulations. again, that is not the personal opinion. that is what the law does. i understand that our friends on the other side, they he the very different vision on this. let me make one observation before i stop. in the early 2000's, the idea of the health insurance exchange became very popular among health policy analyst. the idea behind that was competition among private health-care plans. there had been riding on this issue. but at the university of california, a number of analysts got together and said, look, this is a great idea. if we should do is have a health

insuranc exchange with a taxpayer-financed public option. what was the purpose of it? it was very open and very publicly celebrated. it was a way to get to a single payer health care system by basically undercutting private health insurce. that is the image, that is the vision. we have a different one. >> this was a package deal. it was not all you can eat, it was all you could stomach before regurgitating. you can also talk about a few appetizers. we have seen patients that probably need the entire meal. pulling one part that meanshe restas to go, it's like saying i'll have one of column may, one of column b, and do not worry about the rest in that regard. we're pulling apart the most obnoxious features and playing for time. if the designers of this legislation want to institutionalize and make inevitable the early parts.

this is something that can be pulled up quickly and need to get on to what we need in its place. it does not mean that nothing remains. we have to be in front of things that make sense. >> after the repeal vote in the house, voting on a resolution, are you confident that with a goals to come up with replacement regulation will make the serious structural changes you're talking about on how health care is paid for? >> i think there is good reason to be optimistic on that front. what people not forget, given the events of the past few years, that is that if you dial back to the beginning of the roof health care reform debate in the united states, there was a tremendous amount of bipartisan consensus about the need for reform. if there was a tremendous amount

of a consensus about what reform should look like, how much should provide incentives to root out low-valued care, to centralize, and equalized across states, the cost differences we have seen, provide better insurance options. none of that was in dispute. so there is no reason to be at all skeptical about the notion that you could go out and find a common objective. it is also the case that there was a tremendous amount of bipartisan agreement on a whole lot of the delivery system reforms that would improve the quality of care in the united states. where there was great disagreement was in the nature of the insurance reforms and how doing -- how to cover more people. this legislation is by and large about ladder at e expense of the former. so we could go back and do better on a bipartisan basis by concentrating on the real problem, which is the u. delivery system, and not on massive expansion of check writing will power at the

federal level. >> there is going to be a political gridlock in terms of repealed for over the next two years. there will be a lot of forward movement at the state level with the exchanges as they look forward to 2014. does it make sense for one state or multiple states to try experimenting with some of the models who have outlined here? resistance, one model, not just private insurers but also medicare to participate? >> a lot does not allow enough of that experimentation. the states will have to be more aggressive than what are going to be the rule sent down from hhs. there is some leeway but you get into this plea-bargain game where you think, give me more slight, can i have a few more? it does not actually turn it

around. i will be speaking tomorrow at the national congress on health insurance reform. there is a different way to do exchanges. to some extent, states have to put something on the ground which is not going to get that within the parameters of what they're told in washington to do. they need to get examples the work in the next two years and see what we actually prefer. dobie things that make sense to the people that live there or an entirely different regulatory scheme which is not where we need to go. >> the only thing i would add to that is that the administration seems very desperate to me to get something to work. i think that is why they gave waivers to 1 million workers, including 30,000 mcdonnell's workers. they do not want to be embarrassed by bad things happening. they want to see some good things happening. that makes me think that they might be willing to be flexible. yes? >> what doctors, the physician

payment cut, they are not going to get paid anything, who would want to be a doctor anymore, and how are we supposed to fix that? >> anybody want to take that one? >> let me take a shot at it. no, i honestly think that one of the most serious problems facing the country is the demoralization of the medical profession. physicians are dispirited. many of us have an opportunity and it is a great pvilege for me to have an opportunity to address and talk at professional medical meetings were members of the medical profession are gathered, and the talk among themselves a lot about the profession and how they can function in this environment. the environment for independent medical professionals is becoming increasingly hostile. you are expected now to go to work for hospital. you are expected to join a large

practice. at the same time, you are expected to absorb a massive number of people who are going to be getting care under medicaid. medicaid, really, if you want to talk about the big change in this bill in terms of insurance coverage, if what we have with all the people getting hlth insurance will get it through medicaid. talk to decisions about what that means. it means that every single time, the patient walks into the room, the patient is going to incur a financial loss. it also means that more and more people, are going to end up in hospital emergency rooms. this is been completel overlooked in the past health care debate. the degree to which medicaid is a driver of hospital room overcrowding, i think the situation is very serious. the only way to change that, it seems to me, is to change the

fundamental underlying financial structure of our health surance system. where we basically have an opportunity for people to buy the health insurance which is best for them, and enter into the kind of relationship with the doctor that used to be the norm. what i am saying and it is prty radical here, what we ought to do is make one of the goals of health care reform the restoration of the traditional doctor-patient relationship for those who wanted. not all people wanted. but many of us do. that is why the president has spent so much time saying, in form after form, if you like your relationship with your doctor, you will be able to keep it. the problem that you and i are struck with it that you may want to keep your relationship with your doctor but your doctor may not be able to keep his relationship with you. >> i think that goal of one-to-

one relationships, you can just be around doctor now. >> dr. burgess is with us here. doug holtz-eakin tells me that there are 20 doctors in the house of representatives with a margin 80 new mbers and the house, 20 or doctors. ted and i hope we will hear from all of you in the debate that starts later today. >> it tells you how hostile the medical profession has become at we seek refuge in congress. [laughter] >> we are glad to see you there. >> there no requirements for reserves, class is that only have to pay $5 increments while others have to pay to under $40. can you talk of the sustainability of a program like that chris mark >> the class act

is a new long-term care insurance program whose basic structure on paper is, pay premiums in what you were, it looks like a payroll tax, and once you're in for five years, you're eligible for benefits. we've seen the structure before for social security, medicare, and they are in deep trouble, given the way that they are structured. just to quote someone who would know a lot about this, kent conrad called upon the scheme. i think that as an optimistic. because the way the program is set up, it looks like an enormous amount of adverse selection so that the people who want to claim benefits will have well above average costs. the premiums will become the were close to paying -- no where close to paying the full cost. they could get into a death spiral, but it would just be shoveling much more general

revenue into it. on the quality of the policy, one the worst parts of the bill, and not any way i see to redeem. the fix this or repealed? you that just got to repeal the class act. it is underlay unworkable and dangerous. >> and we have this commission set up telling us what to do about on funded entitlement programs, d then we pass a bill that creates another one. >> the president's on commission and its final report recommended repealing the class act. that is a very telling recommendation coming quickly after the bill became law. >> one of the debates that congress has had is about earmarked for it lobbyists come up and get special treatment and now we have hundreds of waivers being sought for the department

of health and human services. is this another prescription for political foritism in the granting of waivers, much like we've seen in the corrupt practices earmarked. >> it is incredibly troubling. the waivers we have seen already up and that they see evidence of the andorkability of the law. -- are primaacie prima evidence of the un workability of the law. there appears to be no particular transparent process by large kurds -- by which large groups could get a waiver to keep the competition fair. it is a really troubling aspect of the implementation of blog. >> i would like to so that. if we have time for one last estion. anyone want to ask it? >> the delivery reform aspects

of the bill. they're a been a lot of f coordinated care and i was curious what you think that focuses good, and if so, that consumer-directed approach, can deal with these issues? >> coordinated care, managed care, evidence-based medicine, pilot programs, do you think that the workers are more >> randomly, yes. in an organized, political fashion, and a. if you throw enough money at something, a few things will seep out. but it is organized in a way that seems to stop innovation could you do not have that up -- the feedback that determines what works and what does not. you're trying to manage from on high and thinking that you are calling it innovation. you get no incremental gains. we will also have markets with inntives with people spending their own money, the fastest route to innovation. >> the fundamental probl with

our government health programs is that we send a message to consumers that they can have all the highest quality -- quality care that the one at no cost. and then we tell the providers, cut it out. stop charging so much. we do not pay them and that is why they are discouraged. you can put everything you want in the mill that. until you address the mismatch between the promise and the capability, it will not work. and we have been doing pilot programs and experimental programs trying to finout what works of that everne can copy it. for 25 years, it has not worked in education. it probably will not work in health care. thank you all for coming. [applause]

>> this new law is a fiscal house of cards and a health care house of cards. >> has any family in america, any single mother, annie spouse, any child, and the grandparent met a more bureaucratic system than the american health insurance system? >> watched his health care debate from the child -- from the house floor any time. see what your representative said, read time lines of every session. congressional chronicle, at c- span.org 4slash. >> today "washington journal:" reporter from politico. the discussion on how the economy has forced cities to reduce police and fire and rescue jobs. then, a discussion on the

obama's administration use of military tribunal to prosecute detainees. from "washington journal," live every day on c-span. >> tuesday, president obama delivers the state of the union address to a joint session of congress. the coverage begins at 8:00 p.m. eastern. then the republican response from the house budget committee chairman paul ryan of wisconsin. plus your phone calls and reaction. you can watch the address on c- span-2 followed by reaction from members of congress, from statuary hall. >> coming up next, a look at the day's events beginning with president obama's remarks to a general electric plant in new york. then house democratic leaders who are holding a party retreat.

then remarks from the vice president at the symmetry. then, ron kirk and the housing secretary talked about the economy and jobs. >> president obama traveled into new york or he visited a general electric plant. the president's appearance include a tour of the facility with the ceo who helped the new council on jobs. this replaces the president's advisory board headed by paul volcker. he spoke to workers and officially announced the appointment.

>> i know that is not for me. that is for our special guest. i know we have any number of members from the congressional delegation. i would like to thank our representatives. thank you for your help. welcome to the other guests. welcome to the birthplace of ge more than 100 years ago. [applause] i like to think that this is where capitalism and innovation was born. we are proud of this site and we are proud of all of you. this was one of the few businesses in the world to have positive earnings every year during the crisis. we did this because we are an

exporter and we are a high-tech story. we have 4000 employees that work on power generation, water, renewable energy. in the capital region, we are big with 7000 employees. we in a state with a global research center, we build things here, we are a big exporter. 90% of exported outside of the united states. this is an example of what we want to do to renew this country and company. we now that the futures are given to no one, we have to compete and we have to win. i know that this team can compete with anyone in the world because we can absolutely do what it takes. in the same of competitiveness and exports and manufacturing

and innovation, it is wonderful to energies president obama. i have had the opportunity to work on the advisory board as we have gone to the economic crisis. i am proud to lead your council on competitiveness and jobs. [applause] and 60% of our revenue come from outside of the u.s. but we share in the accountability to make sure that this is the most competitive country in the world. president obama, it is glad to have you with us here today. [applause]

>> hello. it is good to be in new york. if i am not mistaken, governor cuomo, who will be an outstanding governor, he tried to give me a jet pack. i had to refuse it. i had the secret service confiscate it. and i will say both the jets and the bears are slight underdogs. in addition to governor cuomo, i would like to acknowledge the lieutenant governor can tell -- and lieutenant governor. chuck schumer and senator

gillibrand are here. members of the congressional delegation are up this way. the attorney general is here. the outstanding mayor who flew up with me because we had an event in the white house for mares and he was on marine one and air force one and he looked like he was having a pretty good time. and from albany, mayor jerry jenningses here. thank you. thank you for the outstanding introduction and thank you, ge.

it is great to be her. i just had a chance to see some of the high-tech turbines and all kinds of fancy stuff that is being made here and manufactured here at this plant this is unbelievably impressive and part of a proud tradition. ge has been producing turbines and generators here for more than a century. a lot has changed since those early days. we have seen technologies transformed the way we work, the way we communicate with each other. we have seen our economy is transformed by rising transportation tough competition from around the globe. upstate new york and places like it have seen more than their fair share of hard times. what has never changed, we see it right here at this plant, at

ge, is that america is still home to the most creative and innovative businesses in the world and we have the most productive workers and the world. america is a land of builders and creators. all of you represent people who each and every day our pioneering the technologies and discoveries that not only improve our lives but they drive our economy. across the country, there are entrepreneurs opening businesses, there are researchers testing new medical treatments. there are engineers pushing the limits of design and programs and poring over lines of code. there are workers like you on assembly lines all across the country eager to create some of the best products the world has

ever seen. there are students training to take new jobs by their side. in this community, ge is building one of the most sophisticated manufacturing facilities to produce state of the art batteries. o[applause] last year, you opened the headquarters of your renewable energy operations and you created 650 jobs on this campus. [applause] so, our challenge, especially as we continue to fight back from the worst recession in our lifetime, is to harness the spirit and potential, the potential that all of you represent. our challenge is to do everything we can to make easier for people to bring the products

to market and start and expand new businesses and to grow and hire new workers. i would like plants like this all across america. you are a model of what is popular. that is why as part of the tax- cut compromise that i signed at the end of the year, we provided incentives for businesses to make new capital investments. ge is investing $13 million in advance manufacturing at this plant taking advantage of some of these tax breaks. we also extended program that she says that its customers have used to allow $6 billion in clean energy production across this and driving demand for the wind turbine. i saw one of those on the way in. we know that we can compete, not just in the industries of the past but also is in the industries of the future.

in an ever-shrinking world, our success in these efforts will be determined not only by what we build here but also by what we can sesell in shanghai. for america to compete, we need to export more goods around the world. that is where the customers are. as i was walking to the plants, you have at some handy signs so i knew what i was looking at and i noticed that they all said, this is going to kuwait, this is going to india, this is going to saudi arabia, that is where the customers are and we want to sell them products and america. that is why i met with chinese leaders this week. during these meetings, we struck a deal to open chinese markets

to our products. we want to open up their market said that we have two ways to trade and not just one way. [applause] the deals we struck will mean more than $45 billion in new business for american companies, $45 billion. that translates into 235,000 new jobs for american workers. that is why i hope fought hard to negotiate a new trade dizzy it -- up new trade deals. we were able to export $10 billion in goods and services. this will lead to another 50,000

jobs in the u.s.. part of the reason i want to become part of this plant is because what that trip was all about. ge will sell advanced turbines. once you generate power at a plant in india, most of you have not heard of this. now you need to know about this. that new business will help support more than 1200 manufacturing jobs at more than 400 engineering jobs in this community. [applause] this is a perfect example of

what promoting exports is so important. that is why set a goal of doubling american exports within five years. we are already up 18% and we will keep on going because we will sell more and more stuff around the world. when the company sells products overseas, there is firing on our shores. this is how we create opportunities for our people. this is how we go from an economy that was powered by what we borrow and consume. that is what has happened over the past 10 years. we were spending a lot on credit-card. everyone was borrowing a lot. the chinese or selling a lot to us. we have to reverse that. we want an economy that is fueled by what we in sent and

what we build. we're going back to thomas edison's principles. [applause] >> no one understands this better than jeffrey immelt. i appreciate his wisdom during the past two years. it is a few days after i took office. there are a ripple effect all of the world. the entire world economy was contracting. this was at such a dangerous moment that it was essential that we heard voices and ideas from business leaders and from experts who were not part of the usual washington crowd.

but there is helped to steer our nation from a deep recession into recovery. of the past two years. it was six months ago that i signed into law a set of financial reforms to prevent future crisis and put an end to taxpayer funded bailout and that was an achievement which paul volcker was instrumental. we are very proud of him for that work. [applause] two years later, we are in a

different place. because of the plant that might -- because of the plans that mine administration helped shape, the growth is picking up. that is encouraging news. millions of people are out looking for work. i know everyone knows a friend, and neighbor, or relative who was still out of work. it is a great thing that the economy is growing but this is not growing fast enough yet to make up for the damage that was done by the recession. the past 8 years were about pulling our economy back from the brink. the next two years, our job now is putting our economy into overdrive. -- the past two years was pooling our economy back from

the brink. we want people to find good jobs. people determine our success the 21st century. now, to help fulfill the mission, i am assembling a new group of business leaders and outside in advisers. i'm so proud and pleased that jeff has agreed to chair this panel, my counsel on jobs and competitiveness, because we think that ge has something to teach businesses all across america. [applause] i hope you don't mind, i will brag about your boss for a second. he is bringing in a wealth of experience to the table. he is one of the most expected admired business leaders. that is a reputation he earned over 10 years at the helm of this company. in the coming days to the announcing the labor leaders, economists, and others who will join with just to help guide us

into that overdrive. i know that council had an important aspect. this means spurring innovation and in clean energy innovation. this is showing that our economy is not held back by crumbling roads and broken down infrastructure. this means of educating and training our people. i just had a chance to meet one of the guys at the plant who was trained at hudson valley. that is the kind of thing we need to duplicate all across the country. hudson valley community college credit program where people can

get credit for training for jobs at its plant. that is helping ge billed high skilled physicians and is making this whole region more competitive. but ultimately, when in this global competition comes down to living up to the promise of places like this. you are connected to a great tradition of innovation and enterprise. the pioneering work of medicine that made the entire modern is possible. the tungsten filament that still like our homes, the x-rays that ims disease. now, the advanced batteries and renewable better resources but also much promise for the future. in these pioneering efforts, we see what america's all about. we see what his it in our past allowed us to not only whether rough storms but reach brighter

days. this has to remind us that we have those same strengths. this is america. we still have that spirit of innovation and incentive optimism. the belief that if we work hard and get it our all, that anything is possible in our country. the future belongs to us. you at this plant, you are showing us the way forward. thank you very much, everyone. god bless you, god bless the united states of america. [applause] ["stars and stripes forever" playing] ♪

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host: callec-span3 c-spa >> speakers will include representatives from u.s. and can get at the town hall event from newsuem. >> by congressional invitation, the president outlines his agenda. watch every addresses since 1984 on line at the c-span video library. all searchable on your computer any time. this weekend, bill kristol

discusses his late father's essays on the history of the neo conservative movement. also, 52 women look back on their work in the civil rights movement. then gordon brown on coming back from the downturn. sign up to get our e-mail directly to your in box >> house democratic leaders said they are ready to work with their republican colleagues but they also criticized the first two weeks of republican house rule. nancy pelosi spoke with reporters at a democratic caucus at the eastern shore. this was about 25 minutes.

>> what an enthusiastic start to our annual issues conference. to be there yesterday in the rotunda and to see two of our leaders who are actually at an inauguration of john f. kennedy. >> with a minute, i was not their. [laughter] and to know that a torch has been passed to another generation. we will have the president will talk to our members later this evening. we have a great start because

our theme is about the economy and jobs. our theme is make it in america," because we know that when you have jobs, everyone can make it. people have come here with ideas. this has been a great opportunity to us, especially after what has transpired. not only are inspired by president kennedy. but also by the progress of gabrielle. she is being transported to houston. we will be sending a message from everyone in our caucus to her. we think that this is a great way to start our caucus, inspired by president kennedy in

the 50th anniversary. do have the president and the vice-president to emphasize the need to focus on jobs and the economy and to make it in america. with that, i'm going back to our caucuses. we are running behind. i would gladly turn this over to our vice chair. >> thank you very much. we are looking forward to the lunch that was made for us. i have to tell you, i came to work some 30 this morning and members were at it already. that was a very sociable night yesterday evening. members are ready to get to work. at the end of the day, we know what our job is. our job is jobs in america. we just finished a fabulous session headed by our whip, steny hoyer, dealing with making it in america.

what we heard was representatives from ford. were it not for the efforts of barack obama and the democratic congress, we might not have had anything to talk about. when they tell us that they will hire new workers, we know that we are making it in america. we're very pleased that this issues conference is very focused. we're very prepared to tell america what our plan and agenda to move this country forward and make it in america. i would like to turn to our leader, nancy pelosi. >> thank you very much. thank you for been in the members -- how we create jobs and how we reduce the deficit and how we strengthen the middle class. strengthen the middle class.