it was started by the republican president. this is a problem. we can put on. we stand together on this. as mayor, we do not have it. it is about the people of this great country. we stand together. >> thank you. >> president obama has proposed cutting community development. >> the issue of urgency is the resolution that is before us. that is a huge cut. if that money is cut, then the budget goes to that baseline. there is nothing lasletch. we need to fight this budget and a win this one. >> we are not going to get

distracted while we are living in 2011. that is the issue. this is something you have to pay attention to. we will deal if it -- we will deal with 2012 will make it to 2012. and it is difficult to focus on what you will have for breakfast tomorrow. we are focused this. as they indicated, at 62% we have to stay focused on where we are right now. >> this is the first time that there has been this to eliminate the funding >> this is not the

first time. i believe our officer can tell you how many times mayors have bought this fight. >> it is more serious. >> can you come to the microphone? >> it is important to look at every president since nixon. president bush would try to eliminate the program. with the help with his secretary, we did it. this is not the first time. this is more serious and more critical than ever. >> anyone else?

>> of one of the citizens is that it is typical -- one of the criticisms that is typical is that it is difficult to assess. >> it is a flexible program. we have asked the question. where do you start the measure? we can talk about the 3000 children under the bridge. that is today. what about next year war may have to look at something? it is organic. it is a flexible program. we need to make sure that we address these issues. >> we have to account for every dime. it is spending well -- it is

spent well. all our bridges and cities go somewhere. all this talk about this measure and that measure, go talk to a senior citizen who is living in a developed building. ask them what the outcome is. as in the outcome when the kids and a safe and secure environment. most and do not even know that the streets they drive on will probably funded with those dollars. it is tremendous flexibility. it is more than we know what to do it. we know what is going on. they do not even know that some of them are funded by then.

we know where every dollar in dime goes. congress needs to find it out. >> we know over a quarter of a million jobs have been retained were created by funding. we know that there have been over 14 million people that have have had their allies affected. we can talk about data. this allows for innovation. they can leverage in be created. >> this is probably the most transparent program there is.

it is not unlike most other cities where funds are subject to a very extensive public process. we have to counsel subcommittees that debate it. it is probably the most responsive and purely citizen driven program. there is transparency. you will surely note the impact when it is gone. >> we have forms that we have to fill out. they are extensive forms. they want to create measurements, bring in on. >> are they focused on it?

but right now we are focused the bazooka. that is another bite we have to address. -- another fight we have to address. >> island to give you a small example of the funds for development. the poor and elderly who are homeowners were in danger of losing their homes. they granted money. we have established the account at home improvement. we have volunteers come and go to the home improvement place, by the plywood and they have

renovated 87 homes and the elderly. it not only increase the homes of these elderly people, but leverage the money from $27,000 $2 million worth of profit. -- from $27,000 to $2 million worth of profit. when you start counting about accountability that keeps our communities striding. in this totally un-american. anyone else? flexagon three times. thank you so much. it is nice for years to come. have a good day.

>> that was a good job. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> and look at the standoff in wisconsin state house with scot ross.

then john felmy. then the result of a loophole showing fewer of voters and to define and democrat. we will talk with -- who define themselves as democrats. we will talk with charlie cook. >> this weekend, the governors will talk about how to grow their state's economy, education, and cyber security. we will have live coverage throughout the weekend. >> i think our government is breaking down. i think the system we have are not operating property. >> they have the military reform project. he is also written essays and a

black friend. >> there are -- he has also written essays in the project. >> we have written how to investigate it. it is meaningless if congress does not exercise powers to investigate. >> see the rest of the interviews sunday night. >> cbo director spoke that economic recovery is under way at a moderate pace in that reductions in spending had increased revenues and will help the un and roman -- the unemployment rate. it is hosted by the national economists club. >> good afternoon. can everyone hear me ok?

i am the president of the national economists club. i like to welcome you to this lunch. i would like to make an announcement of some upcoming events. on march 10, they will speak on social security. that event will be taking place on eight straight. a march 24, we will be spoken to on the aleconomic outlook. they will speak to us on a finance issues. the one to welcome those members and guests today. if you are not a current member and a light to become one, holly

is available to talk with you. we have different memberships available for residents and institutional memberships available. she can provide you the details. let me turn the program over. >> hello. i'm glad to have you here today. it is a great crowd. as an economist, i am from the business. i tend to spend a lot of time reading the collected writings of this gentleman. i always enjoy it. i always enjoy the blog and everything else. doug elmendorf has held the positions since

2009. he and various gadsby for that. better reserve board -- he has had various positions. the federal reserve board in princeton. let the speaker speak for himself. thank you for taking the time to come to see us as always. [applause] >> thank you. it is great to be back. i am going to talk about the economic and budget outlook. the u.s. faces daunting challenges. the economy has to look to recover. the pace of output has been anemic. the unemployment rate has remained quite high. the budget deficit has surged in

years, falling to a severe drop in economic activity. there is an underlying gap that predate the last few years. we think it is likely that a return will take years. even after the economy has fully recovered, they returned to budget conditions will require significant changing as -- will require significant changes. the cbo expects production and employment will span in the coming years. we projected gdp will increase 2% this year and next year, reflecting strong growth, and modest increases in consumer spending.

payroll employment has recovered by just over $1 million since then. the recovery has been slowed by structural changes in the labor market, such as a mismatch between jobs and the skills of job-seekers. it will add roughly 2.5 million jobs per year oover the next six years. we expect the unemployment rate to be in 9 and 1/4 percent this year. only by 2016 doesn't reach 5.2%. the cbo projects inflation will

remain fairly low in 2011 and 2012. it will average no more than 2% per year between 2013 and 2016. it does not include the effects of the events the past few weeks. it would not have made some of against factor on our production. economic developments have had a big impact on the budget. if current laws remain unchanged, the budget deficit this year will be close to $1.50 trillion or 9.8% of gdp. that is falling deficit of 8.9% of gdp in the past two fiscal

years. as a result, public would jump from 40% of gdp to nearly 70% at the end of fiscal year 2011. the current laws remain unchanged after that. budget deficits would drop largely. the visit would average about 3.5% of gdp from 2012 to 2021. as a result, it reached 77% of gdp. that projection is based on the assumption that it unfolds us testified in current law. it understates the budget deficit that would occur rather

than allowed to expire under current law. suppose that three major assets were continue during the coming decade. the higher exemption amount is extended and along with the of braque's -- along with the tax bracket of 2011. it affects individual income taxes and state taxes were extended. the payment rain were held constant. -- all of the payments were held constant. if they were extended currently, the this is through 2012 through 2021 would average about 6% of gdp rather than 6.5%. cumulative deficit would total

nearly $12 trillion. if those policies were to continue, the public would rise to nearly 100% of gdp. that is the highest level since 1946. it is not uncommon to have to draw pictures back to 1940 to find a comparable bearable level to present. this is a case we have to. further increases in federal debt almost certainly lie ahead. let's focus on 2021. assuming the continuation of the policies, the projected gap would be larger than almost anything in the budget category. -- theht hand barstow's

rights can bar shows the spending. under those -- the right hand bar shows the spending. under those, it shows about 1/3 of those afflicted. what would it mean to cut spending by a corridor? that is a bit more than total projected spending. it is almost as much as combined spending. it is much more than spending on defense. on the other side, what would it mean to raise revenue by 1/3? that would be more than a tripling of the corporate income tax.

i might ask how we dealt in the past few decades with the budgetary impact of rising social security and medicare spending? this slide it tries to answer that question. the principal factor has been a decline in defense spending relative to gdp. the columns are 4197 a and the end of our current 10-year production window. -- the columns on for 1978 and the end of our current 10-year production window. there was a very short changing composition. social security, medicare, and medicaid help turn subsidies and increased by a little over 4% of gdp in the past 40 years.

defense spending fell relative to gdp by a little over for a firm. -- 4%. the extra pressures imposed by increased spending was absorbed by reduced spending on defense relative to the size of the economy. that pattern cannot repeat itself exactly. there was a debate. it cannot fall by more than 4% of gdp. meanwhile, at these programs are continuing to rise very rapidly. it is almost relative gdp over the next 13 years. ok. you have it in front of you.

defense spending -- it is rising very rapidly both because of the aging population and the rise of health costs. if you show the next slide, you can try to imagine it. it compares that in the united states to debt and other developed countries. we did it compare debt -- it compares debt in the united states in to debt other developed countries. debt in other countries is also rising now. we should not take much comfort in the fiscal challenges. to prevent it from becoming unsupportable, congress will have to restrain the growth of spending to raise revenues

significantly above the historical share of gdp. the last light you can seen -- slide you can see, the greater will be the negative consequences of a mounting debt. mort -- and the more drastic the policies will be. changes of the magnitude that will be required could be disrupted. congress may wish to implement them gradually to avoid negative impact on the economy as it recovers from a severe recession. as to get families and businesses time to plan and it just -- and at just -- and adjust. major policies would need to be enacted soon. thank you. i will be happy to take your

questions. [applause] blacks to questions. -- >> two questions. they have made recommendations and interest [inaudible] >> it affects the health legislation last spring. there have been a number of points of criticism from people with different economic and political views. they have fallen into a few major categories. one is taking the law at face value. some people think we miss estimated -- wemisestimated the

cost or savings. something we have underestimated the savings. we worked very hard to try to put our projections in the middle of the distribution of possible outcomes. distribution. we are embarked on a course that goes in a direction we do not have much experience with. they are going to suffer from uncertainty. we are comfortable with having laid out projections that are in the middle of the distribution. a second sort of a critique are the people who say the law will not unfold as written. whether or not we are correct,

people who say the provisions are not the ones that will be in place when one gets to 2015 or beyond. our job is to estimate the backs that -- to estimate what congress has put in front of us. one area we emphasized that we think some of the changes in this legislation, especially in the slower growth of medicare spending, might be difficult to sustain for a long time. because of the uncertainty, we also shown estimates of things that have been if they are not sustained including some we sent to general paul ryan of the budget committee. the plan that have been put forth, we do not make

recommendations -- what strikes me as a new and important is that a number of groups of people have the lead out with some degree of specificity what they would do to remedy be nation's fiscal imbalance. there are also reports from a number of individuals. these recommendations covered a wide span of possible policy changes. the fact that these things have been laid out in black and white with numbers and some justification of the proposal, it creates a very important groundwork for at serious

discussions about what direction to proceed in. the fact that these various plans, there are more than one of them, the fact that they are specific and have tackled a large part of the budget and make fundamental changes is all very useful for the public debate. >> two quick questions. he mentions that it would be years before a recovery. i am curious what your ballpark is. in terms of unemployment, could about -- how us visualize that. what regions and solutions? >> my statement was that it would take a return to normal economic conditions. recovery is under way. it will continue. the unemployment rate will get

down to 5.25% by 2016. that is what i mean by a number of years. what are you thinking 2016 or 2020? >> recovery is underway now. it has been that way for some time. it will proceed at a moderate pace. we think the and upload it rate will be down to 5.25% five years from now. the economy will continue to of all after that. you asked some important questions about our view of the economy. as you probably guessed, we do a forecast of the economy as a whole. there is some insight that will be gained if you had the capacity to do that work as 1a does abrogated basis. -- to that on a disk abrogated

-- -disaggresgated basis. >> i agree it is certainly ovewt you look at. we are holding up a lot of debt. it is also retiree plans for government workers. anything over that is going to get into the publicly held debt. as a snapshot, it is supposed to be distinguished at some time. those numbers are superior. >> cbo has traditionally focused on debt held by the public. as a best simple measure of the government is a natural obligations.

-- government's financial obligations. we combine that with what will happen under current law going forward. it is that combination of the public and a snapshot of what has done up to now and projections of going forward. it is the most useful way to see the current and projected path of the government. we had a report in december about a debt interest payments. we talked about these issues. the government owes financial assets more now than it did a few years ago. they might want to shoot dead on the assets. we do show those numbers. it is complicated.

it is not clear what other assets should count. it is not clear how to value all the asset you may want. the trajectory of the financial assets is a substantially different thing than it debt held by the public over the next decade. -- than it is a debt held by the public over the next decade. some is in funds for government retirees and other places. we keep track of that. we report on that. we do not find that a useful measure. it captures some but not all of future government obligations. when we think about that, if there were no bonds at all but we had everything the same current law, what is in the

trust fund? would you feel better or worse about the government's future financial situation? my answer is neither. one thing we should be thinking about is gaps between spending and revenue and social security and other parts of the budget. some of the future obligations and social security can be met by turning bonds over to the government. there are parts they want to pay. it is not strike me as a first order issued. the bonn said they have have important legal meaning. they have real bonds. we do not think they have economic and budgetary needs. they can look at the outstanding

debt held by the public. >> there is a change where housing is less support of by the government. we have subsidies and tax benefits. is there going to be more infrastructure spending to keep up with the rest of the world? life those are mostly separate questions. i think there is already and will be a very important debate about how the government should or should not be subsidizing housing. we do nice things. we issued this a year or two ago. it is very important.

more subsidies go to homeowners but some goes to renters as well. economists have long noted that it is not obvious that that level of subsidy makes sense. no economic answer exists. they encourage home ownership. the interest as it is currently structured does that. that is an important debate. coming out of the experience, of and not guess how the debate turns out. -- i will not get out the debate turned out. and how the government should choose what specific people to undertake.

we had a cbo website. we did havit is importantly a mt the money is spent on. economic research shows that some infrastructure invested has had high returns. some have had quite low returns. it is a matter of picking ones that have high returns as a judge from a social perspective. dged byt judged -- as ju social perspectives. >> [inaudible] >> everybody in this room knows the fear of government spending

that goes to the title meant -- goes to entitlement programs. much more is going to that direction. much more is planned to congressional spending. the non-defense discretionary spending has a fair bid over time but shows little trend over my lifetime. and our projections going forward, we always assume that discretionary spending rises like inflation. it ends up with non-defense discretionary spending.

total defense and non-defense spending -- it did out of an outlay -- it is out of an outlay? it is not shows something you should be concerned about. as a share of the total budget and as parts of the budget battle growing, -- that are growing, it is a small part. >> if you could go back to your forecast. can you say more of your assumptions about the unemployment forecast that it looks like you are assuming the national rates -- forecast? the looks like you are assuming the national rate of about 5.5%.

there is a big structural employment. what do you assume about the labor force. what does it have on your projections for revenues? >> most of the current is due to a cyclical sharp fall in demand for goods and services relative to the capacity to provide them. we think there is a structural that we have not quantified. >> we think it will diminish over time.

we have not reported exactly what we think the structural rate is in the next few years. it is not binding. we have talked a number of the pieces we think are important. one is the extension of unemployment insurance benefits. one was some skills mismatch. it was very large. they've gotten very large. it is difficult for people to move. it shows the importance of that.

it is the overall national employment rate. there are a number of factors that are important. we see been diminishing. the revenue forecasts has affected not just the unemployment rate of participation. it matters to revenue growth. we in general think that the

democratic changes are leaving it on a downward trend of participation. it is a very distinct difference than the 1990's. moreover, the economic event of the past few years have had a further diminishing at that. there are people that will not get work back. they will stop looking for this. there is some of state we tried to quantify. -- some of the date we tried to quantify -- there is some update we tried to quantify. >> the reverse of that was the significant discretionary cuts.

>> our assessment is that increases in government spending provide a short-term boost to economic activity and employment. that is consistent with a large amount of literature. we said that since the passage of the recovery act. we now report cordially. -- cordially on the effects of the economy. we continue to read the effects. there is not any fundamental change. the implication is that reductions in government spending will reduce the level of output and employment in the

economy. for policymakers, the challenge is to balance that against the very large cost of continuing to growth. that tradeoff is something that we present. there are changes that seem large to normal standards. there are significant differences and the economy. it is what makes it challenging.

it is worth keeping that in time. >> just to follow up that question, if it was put into affect on that scale of change, do you have any estimate on the effects of economic growth? >> we have not estimated the effects of that proposal. we could do testimony that looks to extending the expiring tax cuts. will get the setbacks in the

short term. -- we look at the setbacks in the short term. we have none applied that a large deficit reduction. >> can you quantify the effects of the very high rate of people -- people that have the mortgage rates there? >> we think that is a factor.

we are not try to quantify that specifically. the picture the line i had here, most of that is typical. there is a structural peace. piece. -- there is a structural piece. we think there will be a considerable amount of cyclical employment. it is later important. we assume create -- correctly that it will come down to longer-term levels.

we are not explicitly reported what we have going on. it might be that vulnerability relates to total debt in the economy or the ex journal piece of debt in the economy. how do you see it relative to government debt? >> we do not make explicit productions.

the consumer spending incorporate our sense of the assets. by our nature, the projections do not incorporate these scenarios. there were some hits. and can be incinerated by the amount of total debt.

it is impossible to identify any particular tipping point that might be out there. we discuss them regularly. we know when they might occur. the capacity. >> de you expected increase in date next several years? -- do you expect an increase in

the next couple of years? [unintelligible] >> we think net interest payments will triple in nominal terms. it builds up over the next decade. whether we are right about that, it is hard to know.

the qualitative. interest. are about to come a much larger burden on the economy and federal budget. it is hard to avoid. >> what do you see as the great of stock -- the greatest source of employment in manufacturing services? what do you see having relative weakness? >> we have not done it in that sense. will get more from the demand side -- we look at it more from the demand side and not from the level it was. we will think there will be less instruction growth.

we have not been more specific. it is all equal. they have driven manufacturing employment in the past two decades. we do not see the fundamental dynamic changing it. >> we have a small depreciation of the dollar. it does play a role in boosting

exports. >> you mentioned the budget deficits. you were getting criticism in terms of the diet of the subsidy. this is the best estimate. we have several years before any real evidence begins to unfold. it change one of the dynamic assumptions.

they perform for some number of years before they came in. the essence we have developed are based on evidence of past changes in federal policy and the health system as a whole. those changes have limited relevance to the future given a more fundamental change. the research community is studying the effects of past changes. they continue to follow that evidence.

we still was seen a thing in the world that will be direct screening. when evidence arises to change our view, i think we should do that. until a couple of years ago, the view was that the resource literature on the effects of the reforms on health spending was not officially clear to allow was to incorporate that. we took that on board. it is consistent with our reading of it. we read new evidence. it has changed the distribution.

it is that and other topics. it is very important that we nuts get locked into these views. our job is to give the assessment on what is known. what the evidence was or why we read it a certain way. it is our job to put it on board. we will continue to do that. >> is this use in the upcoming debate? >> no. any other questions

>> before your time, cbo was doing questions before the economic problems several years ago. i was thinking the cbo did not predict or no one listened to it. based on that, did cbo do business differently in anyway? do you look at different things? had he gone back and assess how we do this, how we missed this? >> we did miss it. we report every year on our history of economic forecasts and key variables. in the last two years, the turn up -- it turned up stronger errors. we certainly have thought about how to not miss something like in the future.

the obvious lesson is the developments in the financial system, several developments may be just issues about who owns what and how they are related to each other, that those issues are more important than most forecasters had taken into account. i think the problem is that saying that in principle does not tell you exactly what numbers to look at to try to understand better what is going on. last spring, when the problems in greece and in europe were coming to a boil, one of the topics in our june meeting of the panel of economic advisers

was the situation in europe and how that might spill over to the united states. we had members of the panel and other guests speak about that. one of the things was exactly on the financial entanglements. the discussion was how vulnerable are u.s. institutions to mortgage markets in europe and, secondarily, how much were u.s. institutions tangled up in foreign institutions and a debt markets? in that situation, it brought in the right people and tried to take that on board. evidence at the time that it was not going to a trade balance. it was a connection through the financial system. we tried to focus hard on that. it has been hard to quantify it

will be harder still as an event in the newspapers as something subtle going on. we are properly chastened by that experience. we have a general sense that we should be watching it very closely. but i do not want to leave the impression that now the forecast will be right because i cannot make that claim. >> yes, what way would be giving in your analyses about the fiscal problems at the stately old? -- state level? >> we do give some weight -- again, i do not know any quantification of it. state and local government behavior is important in our modeling and in our forecast.

as a general matter, the states have localities are in a tough spot now. they also have a longer-term budget issue. we're looking at analysis of the panic -- of their pension situations. we're focused on what is happening in the near term. it plays a role, but i do not actually have a way of hand to tell you how important it is. >> congress passed a law that said that by, say, 2020 we required to balance the budget, what are your thoughts about that? >> i think i would have to see what the law says. [laughter] we need to make choices about what changes in tax and spending policy one might make to achieve any deficit or debt target.

i think it is those sorts of policies that we have set out to try to analyze. commandments like thou shall not achieve certain things, i really do not know how that would play out from our point of view. >> what happens if the continuing resolution is not resolved by march 4? what is the impact of that? [laughter] >> that depends partly on what the government continues to do and does not continue to do during the shutdown. and there are a lot of people around the government who are wrestling with that question now. it depends partly on how long the shutdown process for. it depends on what happens in

the wake of the shutdown. for example, it people are paid for what they did or did not do during that time, versus if they're not paid for what they did or did not do during that time, it would affect the economic implications. someone told mean that there is interesting work, looking at the past, what happened in the 1990's, but i do not know the results. yes. >> the cbo has been looking at the shift toward services, especially health care and the high proportion of gdp going to health care, how that might affect the weighted average productivity and, therefore, potential gdp going out 75 years.

>> we do give that some thought. we do give some projections. we try not to draw undue attention to them because we understand that there is greater uncertainty. social security generally analyze that perspective and medicare did as well to some extent. certainly in the 25 years before the first ticket, we find interesting how congress is focusing on that. that consideration and a whole slew of other considerations, it is hard to know. i think, health care in

particular, i think the health care system is undergoing a very dramatic changes. maybe you at the table would know better than nine. -- and i. i talk -- than i. the universal view is that everything will be did -- different than it was. rather than different, -- whether that defense leads to productivity or a temporary surge in the level sustained or an increase in the growth rate over a longer time, i think that is beyond our ability to really judge. it will be interesting to watch. >> were you doing any special

analysis? can you talk about the cost and benefits about tax reform? >> we participated in one of the committees in this effort. i do not talk about work we have underway for the congress. as a general matter, if one wants to raise more revenue for the tax system it is especially important to try to do so in a tax system that is more efficient, rather than one that is less efficient. a lot of analysts have, for long time, supported the view that a broader base and lower rates would be more efficient than our current tax system. it could be done in a way that would address a number of distributional objectives about who bears the burden in me tax

system. of course, there is a reason why broader base of lower rates to not happen very often. that is because the specific provisions are of some benefit to somebody and the idea that, do not work, it will be more efficient in the end is not really comforting. from my conversations with members, there is a great deal of interest on both sides of the aisle and both sides of the hill in redesigning our tax system. as some people have noticed, it is hardly a system even how much of it is on a temporary basis. i think that there is great interest in doing better than that. but how that will play out, i will not try to predict. thank you very much. [applause]

>> on c-span tonight, president clinton and madeleine albright talk about the 1995 dayton peace accords which ended the war in bosnia. health care providers and administrators to discuss the future of health care. and a group of mayors hold a press conference about federal budget cuts in cities.

>> on tomorrow's "washington journal, a look at to the standoff in the wisconsin state has. scott ross is the executive director of wisconsin now. and then oil prices with john fell me and then oil prices with john felmy. we will also talk with charlie cook of the cook political report. >> with congress in recess and a march 4 deadline, see what house members said about h.r. 1. spread over four days and 61 hours with 162 amendments considered, it is on line with complete time lines and transcripts of a recession. c-span.org/commerce. . >> we provide information about

public affairs and american history. it is available to you on television, radio, online, and on social networking media sites. find our content in our c-span video library. and we take c-span on the road with our local bus and video content vehicle. it is washington your way, the c-span network. it is now available in more than 100 million homes, created by cable and provided as a public- service. >> now, former president clinton and others look back at the 1995 dayton peace accords that ended the three and a half year war in bosnia. they discuss with the agreement is meant for global them -- global diplomacy. we will hear from madeleine albright and retired general wesley clark. he was the chief military negotiator. former national security adviser sandy berger introduces president clinton.

this was held at noon york university and hosted by the clinton foundation. it is an hour and 10 minutes. >> skeletal prisoners behind barbed wire. horse in europe we thought had been banished forever. yet at home, there was not much appetite. abroad, our european allies stayed fast and resisted tougher measures that might put

the humanitarian mission at risk. by mid-1995, bosnian serbs shelled innocent families in sarajevo. it took u.n. peacekeepers hostage. president clinton concluded that american leadership was the only hope for peace. that august we began an all-out diplomatic initiative. backed by the use of nato force, it shifted the balance of power. the early weeks were scarred by tragedy. first the death of three american diplomats and then a mortar attack on sarajevo. nato's relentless air strikes together with bosnian and croatian gains on the ground lead the party to a cease-fire and to dayton where for 21 days of our negotiating team led by our extraordinary ambassador, richard holbrooke, pushed,

prodded, pressed, persuaded, and finally prevail. -- prevailed. more than 2 million more displaced. the leaders of croatia, bosnia, and serbia it turned the page. for president clinton, another battle was just beginning. the president wanted to send 20,000 troops to help nato implement the agreement. most americans opposed the idea. many within the military were skeptical. much of congress was dubious at best. dick armey claimed that winning support of the house would be like pulling teeth from the back of your head.

in fact the house refused to take action in support of the mission. yet the president move forward because he knew it was right. it helped end the terrible war. it has been said that courage is not simply a virtue, but the form of every virtue. to be sure, president clinton showed political courage in seizing the initiative to stop the bloodshed and doing what needed to be done to enforce the peace that was so hard to secure. bosnia was also a reflection of his values. a belief that prosperity and progress must be rooted in unity, not division. he had a vision for europe and a transatlantic alliance at a

time of historic transformation. it was a vision of a peaceful, undivided europe. it has seen some of humankind's worst brutality taking place on that continent. the new a new europe will never be born with a fire raging in its heart. it is easy to forget how bullbat statement released was. nothing was preordained, especially not the peace agreement we live with today. the president also had a vision for u.s. leadership in the world. it was a belief in our power -- it in the power of our common humanity. it drove the administration's efforts from the balkans to the middle east, to northern ireland, to ethiopia, to peru

and ecuador, to south asia and south america. now in his post presidency, he continues to champion a world where defense works to everyone's advantage. as he says, the success of our work is measured by a single question -- are we better off now than when we started? 15 years after dayton we knew the answer to that question is "yes." i am proud to introduce president william jefferson clinton. [applause] >> thank you very much. please be seated. thank you.

thank you, ladies and gentlemen. thank you and thank you for the introduction. i would like to thank a number of people. i would like to thank the leaders from the region who have come here and will be represented on the second panel. i will introduce them later. i want to thank all those preserved in the administration during those early, turbulent days. some of them will be on the panel shortly.

i would like to thank warren christopher to played a pivotal role in the revolution of the bosnian crisis and could not be here today. i want to acknowledge those who are not here. first, richard holbrooke to look forward to dominating this whole proceeding today. [laughter]

the three brave public service we lost on august 19, 1995. ron brown and all of the people at the commerce department and the business community who were lost on the plane in croatia. their families are here. i hope that what we do today is a reminder of what could not have been done and without their loved ones. there are a lot of people for all of the fits and starts of that policy who are alive today because of their service.

i am internally grateful. i would like to thank john sexton, the president of nyu, and all the people here for hosting us again. i would like to thank the students who are here. many may be too young to remember what happened after the breakup of the former soviet union. the conflicts between the serbs and the bosnian muslims, the serbs and the croatians, the conflicts in bosnia and croatia. the killing in bosnia was as bad as the demonstrations in cairo and around the world today. i would like to put into some context what all this means before i introduced the panel. i will give just a little beyond what the film did. many people seem to think that the 1990's after the cold war and before 9/11 were peaceful, uneventful interludes between the cold war and the dawn of the struggle against terrorism. i think those of us who were there would beg to differ. first, in bosnia alone, it understates the sheer scale of the destruction and the killing.

in a small nation of two modern 50,000 people -- in a small nation, 250,000 people were killed and others became refugees. secondly, the dayton accords, the military action was really the first test of what the world would do to order itself in the aftermath of the cold war. the cold war dominated the organization of american foreign policy until about two years before i was inaugurated. the struggle between the united states and the soviet union created a architecture of diplomacy, military support, intervention or let their of around the world. during both republican and democratic in ministrations, our policy was driven by what was generally called containment. containment to meet met two things -- first of all that we would try to contain the spread of communism to the confine which existed at the time any given president took office and, secondly, we would try to contain the dimensions of the conflict so that the nuclear superpowers did not ever use nuclear weapons. it was a useful and often productive construct and we did not have another nuclear war.

i have often said only half in jest that on the nuclear issue, it may be that each country's spies were the other's best public servants. they did their jobs well enough that we knew enough to avoid the war. on the ground, when it came to geographical containment, it often lead to contortions of our values. when everything got pushed to a narrow funnel in terms of whether this, that, or the other conflict would or would not advance the interests of

the soviet union. it led the united states into supporting extremely repressive regimes in central america and to the iran-contra problem. it caused us to see the vietnam war to the eyes of the cold war struggle. there were all kinds of other issues which we are not here to discuss today. after it was over, there was a big issue of how the world would organize itself now that it was no longer bipolar and what role with the united states play? how would we manage the outbreak of ethnic, racial, and religious conflict represented by bosnia? what about russia? how would we relate to russia?

the russians had political, cultural, and historic ties to the serbs. is there any way they could be involved in the resolution of the problems in bosnia and later in kosovo? what did it mean for the dream of a europe united whole and free for the first time in history that the worst killing since world war ii was taking place on the european continent? what about nato? could nato had made nine cold war mission and should it have more members? how could the united states view its interest here? secretary jim baker, who i admire very much, once famously said that the europeans should handle the balkans.

"it is their problem and we do not have a dog in that hut." how should we view africa? how should we view latin america now that we no longer were conflicted and contorted by the cold war? having problems like what happened in the condo. all of these things had to be worked out and worked through. you could have all the theories in the world, but there had to be a specific example that informed us about what we could and could not do. in the balkans, and in bosnia- herzegovina particularly, there was a enormous humanitarian issue at stake. it was order to escape. now you know when we see twitter and facebook and youtube and 24-hour cnn coverage, it is hard to remember that the balkans may be the first conflict that was a long way away in a small place where we

actually knew what the heck was going on all the time. we did not have anything like the level of interactive communication, instantaneous information that we have now. when i took the oath of office, there were only 58 sites on the entire internet and the average cell phone weighed 5 pounds. [laughter] that is embarrassing. every time i say that it makes me feel ancient. [laughter] the things we take for granted now about how the world got swept up in what is happening in egypt, it was a new thing in the balkans. it meant that deniability was not an option. it is important to keep that in

mind. i thought we did have a dog in the hunt. i thought in the aftermath of the cold war, the united states had to redefine its relationship with europe and with nato and that all of our pretensions that the crumbling of communism would lead to a great start of the enlightenment, democracy, and freedom, it would look like a fraud it the rest of the world did nothing to help them. i thought, on its own merits, because we knew, we had an obligation to try to reduce the slaughter and reduced the flow of people from out of their homelands, restore decent conditions.

and we create the possibility that europe could find its way to a prosperous, secure, democratic unity. as you saw from the film, there were a lot of people that disagree with me on both sides of the aisle. there were a lot of people that thought that by doing this, getting involved, the united states was blowing a chance to claim the so-called long awaited peace dividend. if we just could get past this conflict with the russians, we could dramatically reduce our expenditures, invest in long- delayed infrastructure and other needs at home, deal with the problems in our cities and minorities, improve the performance of our schools. getting involved here was the beginning of a slippery slope that was, in the words of president eisenhower, "giving in to the imperative of the military industrial complex."

there were people who thought it would be another vietnam. there were a lot of people who believe that this whole thing was foolish. use all the film said 70% of the people were against sending troops there. it even after the whole peace accord was complete, the opposition was 58%. the first thing i did as president was try to put together an aid package for russia because they could not afford to bring their soldiers home from the balkan states. 74% of the american people were against that. three-quarters of the house of representatives voted against our aggressive early involvement in cuts above after we had gone through the agony of bosnia. -- involvement in kosovo after we had gone through the agony of bosnia. in foreign policy you have to

put your boat in the water towards what you believe is in the best interest of the country and the best interest in our values and the world and if you are right, it will come out right. if you are not, it does not matter what you did on day one. i will never forget when people thought i had lost my mind by helping mexico. 81% of the people were against it. we had just lost the congress. two years from now we have more illegal immigrants and everybody in latin america hates our guest and people ask me why i did that, i said that there was a poll that said 81% of the people did not want me to do that. that is a reminder for the young people here.

we were dealing with a lot of complex situations where we had limited control of some instruments and a lot of variables. the president has to do what he thinks is right. the people fundamentally expect us to do that. i am not saying you should ignore popular opinion, but if you know something that most people do not and you can see around a corner or two, if you have to do what is right for the nation and the world. that is the context in which this occurred. i should say one other thing, too -- i was rally criticized for not doing this sooner than i did.

warren christopher went to europe early in 1993 and try to build support from the europeans for being more aggressive when there were a lot of diplomatic efforts going on. i kept working at this because the objective was both to stop the killing in bosnia and give them a chance to make it, and to maximize the chances of a united, democratic europe. i did not believe we could do that if america acted unilaterally. just so you understand, and i am not criticizing other people in putting this thing in a totally rosy scenario, there was a lot of people who hit me day in and day out because they said, "the longer you take to act, the more people are dying." i thought the only way peace could endure is if we did it with europe, with our nato allies, with the support of the united nations.

what i think is it important to put out is that we were getting it from both sides. it from both sides. i asked you to think about that as i bring on the first panel. the panelists are secretary of state madeleine albright, who was ambassador to the united nations and was always an aggressive supporter of american intervention in thbalkans. general wesley clark wore many hats and became the supreme allied commander at nato. at this time he was our principal military negotiator in all of the peace talks with richard holbrooke when we lost

those fine people and was indispensable in this work. ambassador peter galbraith was ambassador to croatia in 1993. he miated the aeement in 1995 that ended the conflictn croatia and helped to end the muslim-croatian conflict within bosnia herzegovina. he also oversaw all iraq. i encourage peer to say this -- he was also at the center of a big controversy about what would happen while the conflict was stillaging before we could get the international community involved in terms of whether the croatians and the bosnians would

be what al because there was an international arms embargo. it seemed to make sense that an arms embargo would minimize conflict. the pblem is, it was a fraud because the arms embargo operated only in effect for one side. the europeans were unwilling to lift the arms embargo because it would look like we were supporting an arms race. we did not want people -- we d not want the battlefield to predetermine the outcome of negotiations. as you'll hear today, some reversals on the battlefield led to a balancing of interests which made the peace agreement possible. peter galbraith was at the center of all of that. it concluded a congressional

investigation as to whether we did the right thing by not vigorously enforcing the arms embargo. that is a euphemistic description of what we did. [laughter] i thank them all. i would like to thank ron brown's team. he is a columnist for the "los angeles times" and other outlets involved in this from the beginning. we began to raise all these issues in public debate. he is here to moderate the panel. let's welcome the panel and get on with it this evening. [applause]

>> mr. president, good morning everybody. i am ron brown. the president has introduced our distinguished panel. let me start with an issue that president clinton raised. the title of our panel is "the dayton accords and 21st century diplomacy." during the first two years of president clinton's administration, there was a great deal of uncertainty about how this was perceived. richard holbrooke wrote, " between 1991 and 1995, the actor national response to this tragedy was at best uncertain and it worse appalling." what it takes so long for the u.s. and europe to intervene? >> first of all, i i i think listening to president clinton,

you all know -- first of all, i think listening to president clinton, you all know how fascinating it was to work for him. it was an honor and a pleasure to work with you, mr. president. i think the hard part has to do with the fact that, as he says, we were so focused on the cold war and with the fighting in the soviet union. the other part is theulf war. there had been a war. we had won it, apparently at the time, in a way that tired the people out. at the same time, there were lot of things going on. one of the hard parts when you look back at history is that you forget a lot of the conflicts. we had a humanitarian operation in somalia. there had already begun to be the refugees coming out of haiti. something was happening all the

time. as the president said, the people were rdy for a peace dividend. they did not want to get involved. we had spent six years looking at the world to the soviet prison. i was not born in the united states. i was born in czechoslovakia. people used to say, "why should we do something about a country which cannot pronounced in a faraway place?" all of sudden, the same thing was going on ithe balkans. people did not know why they should do this. i think the president had talked about the economy and other issues. one part he said to motivate people is that you have to understand the context of so many things going on at the same time. >>eter galbraith, your perspective on things on the ground.

>> it strikes me. presidentlinton discussed the criticism on the ground i heard every day. "why are you not doing more?" at the beginning, there was disappoiment with president clinton who said he would do something during the campaign. the situation became more complex. that is because a war had broken out in bosnia betwe the croatians and the muslim forces -- the government. as long as that war continued, there was no practical way for assistance to get through to the bosnian government. when i arrived -- i was one of president clinton bawdry first appointee to arrive on the scene -- my job was to try to minimize

the violence, stop the atrocities that were being committed, the humanitarian supplies. i said the first week, i inuded a joke that was going around sarajevo. what -- the serbs had cut all the gas to sarajevo which meant there was no water and the way to boil the water. there is a cholera epidemic. "what is the difference between sarajevo and auschwitz?" in auschwitz they had gas. it was tasteless. that humanitarn crisis was defused. the next step to end the war between muslims and croats -- we

succeeded in doing that. there is a law of pressure on big relations. the president of croatia was -- changed course. then came a critical decision, which president clinton discussed. i would like to say a word about that. the president of croatia came to me and said, "the bosnian government has asked what would be the u.s. attitude if we permit arms to transit our territory and get to the bosnian government and some of them are coming from iran." most of them were coming from the black market. president clinton took the decision, which i thought was the right one, to tell the

president that we did not object. the ashley hope for the opposite decision. he still had territorial ambitions there. the arms began to flip. when i saw the president just beforee died, he said it was the single most important thing the united states did that lead to peace. it reversed a situation in which the serbs had all the arms and wo in danger of being exterminated. i think it was a very significant step that led to dayton. it is t something that happened all the sudden i in 1995. >> was the military primarily skeptical of greater involvement or were there key decision making processes that could play a role in bringing this to a close? >> it is a pleasure for me to be

here with madeleine albright, peter galbraith, and president clinton. when i think back on these years, there was unified leadership in the united states government. there is a man in charge of that vision. he took us where we needed to go. the military was not part of that vision. colin powell explained it that when he was the chairman of the joint chiefs of staff. he said he would go to the meetings and say tell us what you want us to do and i will tell you what it takes. the military was sort of in a reactive mode. in the spring of 1994, every weekend there was a crisis. it was north korea, it was haiti, it was a shootdown of aircraft in bosnia. from the outside you cannot see any of this.

i had no idea. we were still recovering from the war in iraq. we were doing precision strikes, high-technology -- if you could see the ground, you could control it. we were also wrestling with the bad memories of vietnam. there were two bad memories in particular. one was the so-called weinberger doctrine, which general powell could up in the early 1980's which said you had to emphasize your force. we call it overwhelming force at first. that was too much. we had a tendency to worst case with the opposition would do. there were se people saying it would take a couple hundred thousand of troops to solve this problem and that we should stay out of it. there was ao a sense that there was an idealistic strain in the american political scene. but when the going got tough and

you started to take casualties, the ideas would not be with you. we had to be very cautious. that was the military posture. they were by standing. >> it was not so much reactive as resistant. >> i have to say that colin powell and i a very close. what happened was, and i think peter was saying he was on the ground and people kept asking him what was going on -- i was known as multi-lateral madeleine. basically everyday people would say, "why are you not doing something?" i sold more diplomats than any other american diplomat. i would come to meetings and talk about this. it was at the end of the gulf war. colin powell came into our

meeting -- metals from here to here. i was a mere mortal female civilian arguing with them. i kept saying we had to do something. we would have these arguments. he had his little red a pointer. it would take a zillion troops and a zillion dollars. what would i say to the sergeant's mother whehe stepped on a land mine? i asked him what he was saving all e soldiers for? he got furious with me. he said i practically gave him an aneurism from this. his book came out. i call them up. i said, "patiently?" the sec, "i had to do it patiently."

>> let me ask you about one factor you did not mention. i think it goes from a comment the president made. the europeans should take the lead on the problem. that was the idea. warren christopher went over to europe in 1992 with a very unsatisfactory series of meetings. he left without a sense of direction. in the first months, the administration was struggling with what was the right balance in this first cold war period between consulting allies? >> that was something the first president bush hadeen working on. the europeans were ready to take some responsibility. but were doing pretty well

economically. nato was functioning. i think we had a sense this was in the heart of europe and why could they not do something about it. it was very frustrating. at the united natio it was very frustrating because the europeans fear -- i would go to a european ambassador and tell them i needed their help on a boat and they would say they could not help me. i would go to the same person a couple of days later and they would say they could not help cause the eu did have a common position. the comment the president made about jim baker saying they could handle it, it was not our fight. it was very hard. i think we did learn that we needed to know what we wanted to do before we went to consult -- that we needed to figure out how the system worked. what i think is so interesting about all of this is the president says this was a period

of institution buiing. i loved being ambassador of the un. we thought the u.n. could function in a way it could not during the cold war because it was paralyzed. peacekeeping operations could, in fact, supplement or makeover at the beginning military activities. it was a very exciting time in terms of looking at institution building that we thought was the beginning of the 21st century. i think we all heard more than anybody about building bridges to the 21st century. this is what the aspects we were looking at. it was very deliberate. it was delivered to use alliance structure and the un to be able to deal with the post cold war problem. >> pete fr your perspectives and the europeans taking the role on this?

were you dubious of that from early on? how did you come to assess that? >> there was a huge failure of institutions. richard holbrooke, he describes this as the greatest failure of collective security since the second world war. in the sense that the idea of the un was a security treaty. if there was a country that was the aggressor, we all ganged up on the aggressor until the aggression is deterred. it worked against iraq. was failing here. the europeans had said initially in '91 when the war bke and out in croatia, let's not forget the president of croatia is here -- that was our second gelinas war since the second --

its second deadliest war since the second world war. the europeans said they could handle it. luxembourg, portugal, and the netherlands -- in an environment of eastern europe, that was not a very impressive representation of europe. i do not mean to fault the individuals. it isust tell the european system worked at that time. certainly by 93, people in the region had given up. what gave the u.s. so much power was, first, the impression left from our spectacular military success in gulf war role in one. one of the things about having all this military technology is it is great when you actually use it. when you get bogged down in iraq

or afghanistan, it is not that impressive. second, we were the last resort. when i went to carry out my diplomatic assignment, i felt like the voice of god. people would never say, "no, we will not do it." they would say, "yes. you are exactly right. we would try to do better." when i came back a couple of days later, nothing had happened. we could not get done. we had enormous insolence in this particular situation which may well be unique. >> in 1995, we take a more assertive role and more of a leadership role. what is the reaction of the europeans and particularly the russia as we move from a confrontation to saying, "this

is what we what." >> first of all, the president had a good relationship with presidenltsin. we needed that. but there were different strains in the russian government that we came across. we had a russian ambassador to is the foreign minister. igor was a wonderful guy. i us to swim with them every morning. he spoke a little bit of english and i spoke a little bit of russian. he was wealthy. he would pass richard holbrooke memos and say, "take a look at this." he would quickly scanned at and, we think he understood it, but he would not be able to object. the russian military was very cynical about what we were doing.

i was on a trip. my western counterpart came up and said, "you americans -- we know what you are doing." "you are going into bosnia. that is our part of europe. you say you'll be gone in a year. we are russians. do not worry. we would do the same thing in your position." they saw it as part of the geostrategic chest that was going on. they did not like it, but they tolerated it because there were some who tried to make the retionship work. me -- it goest in need

to what you're saying before. you discussed the confrontation with direction versus confrontation while casting around for ideas. the old road to dayton -- was there a change in the administration's view about how america it would pursue its role in the world? >> he is the first one that said "indispensable nation." the bottom line here is that i believe that it is and evolution. i remember when i got interviewed for my job at the un. president clinton made very clear to me that he sell american leadership where we

work with other countries. that was t multiplier that the u.s. in conjunction with our allies could do much more than unilaterally telling everyone what we were supposed to do. it was an evolution. there was a way of figuring out that if the europeans and the others were kind of being -- dilly-dallying is the best word -- we would have to take the role. the first president bush did a good job on building the coalition in iraq. what president clinton did was take it to the next level. we did know when we wanted to do something how to do it. i enclose a vote - i teach a course on this -- we use every tool in the national security

toolbox. bilateral diplomacy, multilateral compliancy -- multilateral diplomacy. we used 82 countries if they decided to help with sanctions. we used both the threat of military force and we used military force and we used richard holbrooke. [laughter] it was an amazing way of using a set of tools that one has. mainly we had a president that directed it and believe in it and understood the role the united states had to take. >> peter, from where you stood, did the way the administration approached this show a change or an evolution? >> it is important that we have

a oad appreciation. it is a lot to talk about the bombing as a turning point. not at all. what it was was actually a croatian military offensive that took place in august. it involved some pretty tough moral choices. the croatians -- there was an enclave in bosnia which won an 60,000 people. in november of '94, the serbs surrounded it completely. the serbs or squeezing it. at that time, the croatians indicated by might want to be liberated. the instructions i got were very strong. tell them never. we do not want a wider war. then in july 95, there werthe murder of 7000 men and boys. the danger that the same thing would happen -- the same

question from the croatians. our concern was that instead of 7000, we might see 40,000 men and boys murdered somewhere else. we also knew that given the nationalist behavior that there would be consequences for the population in the serb held areas. it was a tough choice. we made the choices. we gave the croatians a no- flight, which they interpreted as a green light. it changed the military balance. the peace plan at dayton was based on a 521% for the federation and 49% for the serbs. when they all the sudden had 45%, by all the sudden had 49% interest. the nato bombing helped. there were a sies of steps that led to that. >> obviously bosnia is a turning point in the evolution of nato.

we see it move in other directions after that. talk about bosnia and the impact on nato's vision on its role in the way it operates. >> nato hadlready done some missions in the bosnia area. we had two exercises. we had air exercise and a seaborne exercise. we were just notn the ground as nato in the '94, '95 period. britain and france had their troops under u.n. control. the counter attack by the serbs had an impact. the new french predent decided he would reinforce and the british went along with this. they put out some military. the british and french rule became very muscular all the sudden.

these are not really military forces. they are there to provide assurance. the presence of artillery sadly made a more muscular. this was the beginning of talking about a real nato role. if you're going to talk about real forces, will command and control, will logistics', and reconnaissance and intelligence. in the summer of 1995 after the massacre, everyone got very serious. when negotiations started, we began also to dealith nato as the alliance and talk about a prospective nato role in the occupati. >> you talk about the time after the agreement -- there was some skepticism about whether it could hold. richard holbrooke described it as "rocky."

endured longer than anyone expected at the time. what allowed this to ultimately take root? >> first of all, i'd think the people wanted to have peace. the killing there was a dreadful. president clinton and i think that they were ready. there was also international suppor for it. it was rocky, but the europeans took part. the un took part. we obviously did an awful lot. it was not simple. i have to tell one story that exemplifies it. in 97, we tried to work out a way that out of bosnia and there could be a way out to a bridge. i ask permission to get this bridge open so that bosnia would not be totally landlocked. there was a big ceremony. there were three prime ministers at the dayton accords.

one of my pss assistants won a picture of us on the bridge. there were a lot of suits around nobody had on name tags. she asked anyone who was a prime minister to raise their hand. [laughter] 3 people raise their hands and another one left. it is an example of the problem. how is it that you could get this complicated system to work at it was still an issue? i hope in the next panel i can talk about it. it shows me that you cannot always check of the problem as done. it has to be managed. in many ways, the international community continues to be a part of this, but what we learned in bosnia and what we are trying to do it now is to bring serbia and this whole region into europe and go back to the original idea of a europe that is whole and free. that came out at dayton and all

the various evolutions. >> of like to say something about what it was that was accomplished. first, it is something very much in human terms. i saw this almost every day. there were refugees living in mind and houses on the frontline with babies dying from absence of medical care. never mind the massacres that occurred from time to time period that end. that ended. it was not a short think this was going to end. it was not a sure thing that dayton would be successful. richard holbrooke had a huge amount of accomplishment.

let's consider what the alternative might be. we might be discussing in 2011 year 20 of the bosnian-croatian wars. serbs occupy a part of cyprus. there is permanent hostility. bosnia as a source of ongoing conflict. it is a hotbed for terrorism. the impact that that might have had on europe -- it would be profouly demoralizing to europe. what would it have said about the un and the u.s. mission? it would have been a failure in its broader purposes. whe the constitution of

bosnia-herzegovina as a unified state is far from perfect, and from the stage year a lot of criticisms aut dayton -- we were not seeking to create a perfect country. we were seeking to e the war. we did. nobody has died in hostile action since 1995. 16 years. that is a markable achievement. >> our time is beginning to run down i want to ask two questions. let me start with you, madam secretary. this is a case where we used all the tools in our toolbox. military force, diplomatic pressure, consensus building -- is there anything that model can tell us that apply to the chlenges we face now in afghanistan, pakistan, and the unrest in the arab world?

is there a lesson in that integrated approach? >> i do think that, first of all, i have said that there are not a lot of tools in that tool box. what i thi we have learned is to try to use them together. i was asked to help on developing be made a strategic concept. what is interesting is that they took the lesson of the balkans to some extent and to afghanistan to talk about a "comprehensive approach." that is to use the military to bring activities together and where you learn lessons we cannot solve all the problems militarily. you have to have the civilian component in terms of reconstruction and polical work, in terms of getting the population to understand what is going on, and also to have all lances work. i think that is one of the ways

that the lessons could be learned about how you use which institution, but you need to mix and match on these tools. i think that is finally what is going on. but it is not easy. i think sandy berger can speak to this better than anybody. systemgot to keep the together in terms of getting the bureaucracy tmove the process afford. it is internal to the sometimes you actually call up an ally and say "would it to suggest that instead of me?" >> you have to havehe right conditions on the ground. that is one of the most important lessons. not only do we consult with

allies and friends and others in the region, but we set the conditions. i want to go back to richard holbrooke. when the croatian offensive was really grinding forward, richard and we were marched en on a sunday morning. the minister of defence said "wait a minute. we are in complete disarray. they are shooting disorders in the street. they sent a new general to take charge. if this is the opportunity. we will be there in a week. you want us to stop?" they stopped. after that, it never got going again. that was t 51-49 boundar the sbs did n know it got

going again. richard is all that and got the conditions set. the other thing about this, if you have to have the right personality and ability to put the pieces together. richard holbrooke was right. heid it at the dayton and with lot of help from a lot of people. it was his responsibility. he did it. we saw pieces and bit of it. i cannot tell you all of the eces. he cajoled and fttered and it did everything to bring those groups together. even when you use all of the tools and set the conditions on the ground, there is a certain amount of chemistry to bring the agreement to a cse. >> he had been close to the

current challenge and have been involved in the bosnian challenge. your thoughts about what they can tell us about afghanistan and pakistan? >> let me turn to that. i want to add something. i listened to t tape of the meeting that dick and i had. we met along. -- alone. one of four trials that i testified at -- it was not quite as unambiguous as that. what was extraordinary was the fact that at the outcome where the trials. every journalist said this was a cynical exercise because you are not prepared to do somethin all but two of the peopleho have bn indicted have gone and are dead or died in the process

and have gone through it. i have to tell you. there is nothing that gave me more pleasure than testifying. normally, you take abuse from terrible people. some of these were terrible people. all you can do is write your memoirs that no one will read. they are probably already dead. i got to people in jail, real justice. the second point i would make, because i have been involved and served. what are the lessons? one is do not try to apply to many lessons. what came out of bosnia was a sense that the elections were held too soon in bosnia. that lesson was then applied to iraq. it was a disastrous course of action. we would have been better off to have quick elections from my experience in afghanistan, i cannot see

anything that is applicable to bosnia except this. in croatia and bosnia we have partners. that is the key to excess -- that is the key to success. we have a strategy that requires a partner and that is why it is not working. >> we are down to our last few minutes. it was not -- the president talked about where it internet and cell phones were. it was not a long time ago in a galaxy far away. it was different ithe sense that people talk about the 1990's and the early part of the 21st century as a moment when the u.s. was unchallenged for world supremacy. it is the model of how we pursue our goals ithe world then still applicable today when we are talking about a much greater diffusion of power? is the vision of the u.s. as the

indispensable nation the way we should be leading the world today? >> there is nothing about the definition of "indispensable close code that says "alone." -- indispensable" that ss "alone." the things that happened in some far away place actually affected us at home. our engagement was very important. i believe that continues today. it needs to be done within a structure that respects other countries. americans do not like the word ulti literalism -- multilateralism." it has to many syllables and in an end ism. we are the most powerful country in the world. we are in a screw the situation,

but we are the most powerful country. that model comes in at the end. >> we need to know where we are going. we have to have a clear direction to drive that. >> when the issues in bosnia is "what is the national interest?" the question is whether it is geostrategic or whether it has a moral component. i believe american values and terms and not letting people be massacred and ethnic the cleansed is part of our interest. everybody defines it differently. it takes that kind of leadership to explain it. why we do want to pick people in harm's way because something is happening somewhere else? can explain it because it does affect us physically or affect our morals. >> is the way we exert leadership in the world today -- should it be different than it

was at the point of bosnia? >> it is going to be different. it the power relationships are different. i want to reinforce the idea of the indispensable nation. america is still the greatest power with the great his values and credibility. we deliver. we are still indispensable. others have more capacity to contribute. one of the things we have to do is find ways to engage them with us and get their contributions. >>ou have been up close at some of our greatest setbacks and successes. what is your thought about the nature of our leadership today? >> i think the day 10 period -- dayton period and leadership of president clinton was unique. america's relative position was going to decline.

the previous administration accelerated that decline with some very poor choices in terms of the places it pursued. one of the other lessons of bosnia and the war's in the balkans is just how interconnected we are as people on this planet. there was a hope on the part of policy makers -- the clinton administration wanted to focus on many -- that we could set this aside he was in egypt. i thought she end richard holbrooke my shared the nobel peace prize. she exemplifies that put what was happening in bosnia and our faces. we saw the people who are being

shot at by snipers were not faceless people. they were women in high heels, children. people who looked a lot like us. that is very important. we have this kind of immediacy with egypt right now on the square. i think that is another of the big lessons of bosnia. >>t is a milestone in recognizing our share. blacks this has just been an incredible -- >> this has just been an incredible tour. if you'll join me in thanking this terrific panel. [applaus

>> coming up next on c-span, health-care providers and administrators discuss the future of health care. a group of mayors hold a press conference about budget cuts. congressional budget office director gives an update on the economy. >> this weekend on "book tv," the former chief on the osama bin laden unit on the war with the u.s. an "after words," "never say die." >> it is critically important that the house move this to

avoid a government shutdown. >> we all have a responsibility to make sure there's no government shutdown. >> with concerns about the shutdown, see what was said when the government did shutdown in 1995, online, with the c-span video library. search, watch, click, share, any time. it is washington your way. >> health-care industry executives recently discussed health care policy at the university of miami. analyst include hospital administrators and officials in charge of medicare and medicaid. they focused on accountable care organizations which are new models for providing health care that combined physicians, insurance companies, and hospitals. this is an hour and a half.

>> this session w >> this will focus on accountable care organization which many are counting will be part of reform. year encourages the establishment of these bigalke -- aco's it does not gotten a lot of attention. i want to thank them for sponsoring this panel and extend a warm welcome to john kirsner he will leave the discussion. he is an advocate for insurance companies, plans, hospitals, and government organizations. we are delighted they will

monitor this. with that, i turn it over to john. [applause] >> thank you very much. i would like to say thank you to the university of miami for giving us the opportunity to be here today. be a sponsor.re happy to we are a large law firm. we have 37 offices in 17 countries. when we heard about the forum to be presented, it was a natural for the reach of our firm to match up the strengths. two of our strongest offices are located in south florida. our healthcare finance practice is among the strong this and

our firm, providing innovative solutions. with that little commercial, let me get to the meat of the introductions. the objective of our panel is to talk about a patient centered care and accountable care. the perspective of the leaders who have agreed to be here to talk with us on this panel included viewpoint of physicians, hospitals, medical centers, payers, and denied state government as well. they are a great panel of people. dr. toby cosgrove will speak first. steve jones is the president of the university hospital. john bigalke bigalke is head of the practice area. tony rodgers is deputy

administrator for strategic planner. with that said, i am going to introduce our panelist in reverse order. after i got done introducing them, toby is last and he will speak first. that seemed to make the most sense. rodgers money has over 30 years of experience. -- tony rodgers has 30 years of experience. he has worked in lansing, michigan. he was a past director of the arizona medicaid program providing health care coverage for over 1.3 million people from arizona. john bigalke has acted as vice

chair and industry leader for health sciences at deloitte. he had 20 years of public accounting practice. he is the partner. he provides service to many key players including health net, cigna, universal american and others. he also provides advisory services to many leading providers. the perspective that he will bring today will focus unaccountable care. steve jones as president and ceo of robert wood johnson hospitals. he is work in a variety of roles. the hospitals and health systems is a for hospital system, an

academic medical center that includes a children's hospital. he is a board member of the hospital association and a veteran of the united states air force were specialized in russian linguistics. hopefully, he will be able to help us weave through the acronyms of accountable care with that background. if [laughter] dr. cosgrove is president and ceo of the cleveland foundation. it is a $4.6 billion health-care system and is one of the most well-known health care systems in the world. he emphasizes patient care and experience. he has reorganized the model into a patient's centered institute model, a perfect person to talk about getting it across. he joined in 1975. he led the clinic's heart program on a 10-year run.

he was an air force surgeon. he served in vietnam. he earned a bronze star. yes performed over 22,000 surgery's, which is at numbers i have a hard time getting -- she has performed -- he has performed over 22,000 which is a number i have a hard time getting my head around. i would like to introduce you to mr. costs grow. >> i want to thank you for including me. this is an opportunity for a great discussion. art institution is unique in how it is a forms and organized. we are in not-for-profit

organization. we are the second-largest group practice in the united states. we have a physician leadership. we are all salaried. there are no financial incentives. we have an annual professional review which we take very seriously. lester, we spent 8000 man hours. there is no tenure. we have one-share -- one-year contracts. i hope for numbers 35. [laughter] we have had to the beginning growth. physicians have become interested in being part of the group practice. a number of employees has reached 40,000. we are scattered across the large area.

the organization of our group is quite different than most. most hospitals or organized -- are organized around professional groups like radiologist, etc. we took a different view. rather than organizing our hospital around doctors, we decided to organize it around patients, an awful -- a novel idea. we put them together, medical and surgical. we do them around as these systems. they had a single leadership and, and location for these physicians. take the vascular institute. it has cardiologists and vascular medicine. the neurological institute would have urologist and psychiatrists. the location this is coming --

this is a health care delivery system. you need to have the patients in the right facility at the right time for the right care. they go for the entire range of care. we have partnered with minute clinic and have outpatient facilities where you can get strep throat swabs. we have family health centers, there are currently 17 of them scattered around cleveland. these are associated with community hospitals. there are nine that surround the main campus. the commonfter

ailments of individuals. the main campus has become a high-tech facility, 1200. we no longer feared do psychiatrists. it has heart operations in complicated orthopedics. in florida, we have 170 doctors. it is growing rapidly. they are building it on the same plan. in las vegas, we have the center for brain help looking after neurologic disease. this is not the crash of a 747, it is a new building. in cleveland or canada, we have -- cleveland clinic's welna

wellness center. we are building one in of gadaffi -- in abu dhabi. we will have over 1100 beds in abu dhabi in the next few years. this enterprise is held together by electronic medical records that looks over 6 million patients. they are all tied together with medical records. we got a nice shot out from the president. -- shout out from the president. what holds us together is the transportation system. it includes land transportation,

three helicopters, and aircraft which can pick up patients from anywhere in the world and transfer them to our facility. this is part getting the right patients in the right place at the right time. it has gone progressively up as we have at the capabilities to the patient. we do not think that all hospitals can be all things to all people. it is important that we began to centralize our activities of patients have an adequate volume to develop quality which comes from having volume and from having the efficiency that goes with it. if you look at our health care system, we have of obstetrics

previously in a number of places. we have concentrated it. this will be reduced further. some hospitals only do 800 deliveries a year. we plan on continuing to consolidate. with the dead inpatient rehabilitation -- we've looked at inpatient rehabilitation. there are four cornerstones, quality, innovation, a team mark, and a service. the u.s. news. we are numbers 4 in that. we do not know that is a measure of quality. it is more important that you measure outcomes. these are our books that we published every year. it is good, bad, and different. i did not know what we can

measure. it is pretty easy in cardiac surgery to measure outcomes. to either walk out or get carried out. [laughter] i asked dermatologist to come up with their on metrics. we have asked of the dermatologist to not to say they are great determined colleges -- grated terminology a great to the metricsbut th to this. we believe in transparency around these outcomes is important. as far as innovation is concerned, we think it is baked into our legacy from our care delivery in and continue to increase with over 2000

projects. the number of publications coming out is over 1200 a year. the patent are shown here. there are 36 spin-off companies. teamwork is another one of our corners torrance. madison is no longer an individual sport. -- madison is no longer an individual sport. -- medicine is in no longer an individual sport. no longer will one individual be able to surround the amounts of knowledge that you need. it has grown enormously from the individuals who formed the teams back in the early 50's. they've also become more sophisticated.

each one of these represented a different country. the 13 to plastic surgery. the teams have become more sophisticated. this is a cornerstone for us. it is what we are all about. we recently said that patients should be seen when they want to see. they are given a in appointment. it is more than a clinical outcome. we pointed to individuals to be the chief experienced officers. one is a surgeon.

one is a head nurse. if we start by treating patients at the door. we help them find their way through our organization. we have art on the walls that acts as a locator and allows you to break up the monotony of the facility. we designed our rooms with large amounts of glass. families can spend the night there. we think dignity is important. they design a gown that no longer believes your cheek flapping in the breeze. [laughter] [applause] thank god i have a wife that directs me in the right direction.

you cannot tell the playj heirs without a scorecard. we have color-coded all the people who work in the hospital. the patient is given this card so when someone is green comes in and it is a clinical technician. a resident is a white coat with black lettering. patients know who is coming into the room and why they are there. patients visiting hours are now a thing of the past. he can come in anytime you want and stay as long as you want. it is no longer about taking care of a patient but a family. we have all the medical records. it is no longer the doctor's record. this is your record. you should have access one ever you want either electronically or in paper form. massage therapy is available on the floors of. there is that there be that comes into the hospital. nothing is better than a leak from a lab -- lick from a lab.

there are prayer rooms. it is important for our patients and for our employees that we began to discuss the major cause of premature death. obesity, sedentary lifestyle, and smoking. we started out by making the campus smoke-free. we decided not to hire smokers. we test them coming in. if they test positive for nicotine, we allowed them to have a smoking sensation opportunity and they can reapply. this applies to doctors and all caregivers. resulted in the county. but these are the incidence in ohio. it was 28%. it is now gone down to 15%.

you can make a difference of public health. we took trans that out of our food. we tip soda out of vending machines. we have a major wheat reduction program including free weight watchers, yoga, etc. we have lost 180,000 pounds so far. [applause] i would like to say that it is a start. we probably have 2 million more to go. a journey of 1,000 miles starts with a single step. we are in the service business. it is about putting patients first. we had done everything we can to putsnize our system so it co

patients at the center of the activity. thank you very much. >> thank you. i appreciate the chance to participate in this discussion about the development of aco's or that transformation, particulates from the academic medical center. let me see if i can advance this. there we are. we are the principal teaching hospital for the medical school. it is one of our state medical schools. we are the principal teaching facility.

we are the flagship of a four hospital system. there is a pediatric system. the center of excellence have a credit basilar institute. we are proud of what they do for our country. in cancer care, it is new jersey's only comprehensive cancer center. we have a cancer hospital connected by a sky bridge. we have the children's hospital. one of our system members is the children specialized hospital. it is the leading provider of children's specialty services. we are also a level one thomas

center in new jersey. -- level one trauma center in new jersey. we are co owners of a provider sponsored managed care organization. i believe that will pay an accountable care organizations. the role of an academic medical center is you need with patient care, education and discovery. the challenge is balancing that academic mission in a low-cost environment. that is clearly where we are going. two months ago, at the annual meeting they talked about the leadership role of academic medical centers in said that it

was very important that using the strings of the medical center that they need to become engaged in the transportation needed to improve the help of all. there are challenges to the developments while we await regulations so we understand what the requirements are. we know there are challenges they need. we also have four hospitals on the same information platform. there is a lot more to do to be fully integrated and to have the integration move among the ambulatory care facilities. access to the large enough supply, you read about the experience in massachusetts. they went their transformation.

-- true transformation. we are uniquely situated. they have been doing research for more than 20 years. we think that gives us a leg up. comprehensive case management is lacking. to most medical centers have not assumed responsibility. there are fundamental change in the revenue stream. position alignments will be more critical. they are challenging. they have the roles and irresponsibility of the chairs and the need for us to align with physicians and our community.

physician leadership is critical. physician alignment will be critical. how we mix those with the academic medical center with the changes we know are needed to engage in the physicians and our community. in new jersey's experience, five systems have a major teaching hospitals as their flag ship. this is the only one with a medical school on the campus. if each of the health systems are working to be ready. it happens that we are all co owners of the managed-care organization. we are working individually and as a group for what they can do with us. physician groups are mainly

fragmented. there are lots of them. there are very few large multi specialty groups. our practice is among the largest. they are positioning themselves .o develop, -- to develop aco's they will block hospitals out of the leadership. hospital services are a commodity they plan to buy. the strategy for development, we want to leverage the existing strong relationships with our medical school. the positions are broadly in our community. we give patients from all 21 counties.

we are enhancing position alignment strategies. we are developing accountable care organizations that we call robert wood johnson partners. it includes standard best performance measures. the department of health is releasing help. we received an embargoed one. we believe n. transparency. it is interesting, the development of partners. we find many organizations that are looking for staffs to provide the leadership. in our county, they provide

this. new jersey is a very highly unionized state. there are labeled -- there are labor unions. if they are looking to manage the cost and quality of their employees. they are interested in the developments of the care organization. there are other large employers. we just started those. it does come to lot of the pharmaceutical companies. there are opportunities there. in our state, medicaid want to transform its population which is just under a million.

we are talking about new brunswick. there are one of five systems that managed to do it. there is a strong business case for health care reform. there is a strong business case for transformation. i believe there is for academic medical centers to be involved in this development. the first is value. there is the economic engine. more important that, the economic engine is our responsibility to the small and midsize businesses.

in order to build all of our state's economy is common the more we can do to help manage health-care costs, the better. there is leisure about reduction from those organizations like the clinic. they have managed these populations. they are incorporating the next generation of professionals in what the best practices are. the need for transformation is clear. we are waiting the political change that might come in washington. the pressure to increase value will not change. in 1993, remember the clinton health plan? president clinton came to the robert wood johnson university hospital.

be ready for receive visited to talk about health care reform. what happens when they did not advance? employers stroke change. it is very clear and that we need health care reform. there is a need for this. they must help that change. thank you very much. i look forward to questions from the panel. [applause] >> i am glad to be here this afternoon. it is very rare that you have an opportunity to speak at the podium. there are a couple of points i live like to make.

in my job, i work with a lot of providers and health plans. i hear what each of you have to say about the redeeming qualities of the other. that will have to change. we are talking about today are the tip of the iceberg. it is a first step in trying to do some of the things that are described. when you look at the population, you talk about medicaid. medicaid follows medicare. what about large employer sells bonds? what about geography? what about things like workmen's comp? you have to realize it is a much bigger than a set of regulations on payments a defines medicare

population. at some point in the future, this is how we will have to manage the cost. i start with that to ask you to step back. think of this differently. i'm not talking about rationing. i'm talking about caring for a population before they become a patient. never have to see the inside of a patient room. creasing the incentive for them to be paid in a way that creates that kind of environment. that will require a different business model. i put out some of the attributes that you can argue. that you can argue.