the territorial integrity of libya and the physical integrity of libya. the arab group calls upon the liberty -- the libyan authorities to lift all restrictions on the media and to guarantee access to the means of communication, to telephone networks, and to ensure that the emergency medical assistance is provided to victims. we reject the serious allegation of participation of foreign nationals from other arab countries taking part in violence against the libyans. these allegations must be verified. call upon the libyan authorities to ensure protection to all nationals of arab countries and other foreigners

living in libya and to ensure that all those who wish to leave the country can do so safely. the arab group emphasizes the need to meet the aspirations of peoples to reform, democratic change, and social justice. this is a legitimate demand which must be respected. mr. president, the arab group invites the member states other international organizations and arab and international civil society to provide humanitarian assistance in an urgent way to the libyan people at this crucial stage of their history. and finally, we balance our heads in memory of the mortars,

the peaceful demonstrators, the innocent victims, the women didn't, not to mention -- the wounded, not to mention the enormous physical damage to public and private property. i think. >> the british house of commons is back in session this week. live coverage of the prime minister's question this wednesday at 7:00 a.m. eastern on c-span2. next, a conversation with former arkansas governor mike huckabee. then talk about the sustainability of medicaid. at 11:00 p.m., winslow wheeler of the straus military reform project. >> secretary of state hillary clinton addresses the human rights council on the situation in libya. our live coverage from geneva begins at 6:00 a.m. eastern on c-span2.

as the nation's governors meet here in washington, accused the c-span video library to learn more about the chief executives. watch their speeches and appearances, see in all boroughs of new governors, and your state of the state addresses all free online. search, watch, click, and share any time. former arkansas and governor and presidential candidate mike huckabee is the author of a new book entitled "a simple government." c-span had a chance to talk with them about his possible run in 2012, social and fiscal issues, and about growing up in hope, arkansas. this is 40 minutes. >> mike huckabee, the book is "a simple government."

>> allen born it is to take complex problems in the country, and even the world, and to back up and say, what common sense proposal could apply here that would make sense. i wanted this book to be a book that when a person ready, they did not have to have a phd in political science, or economist. this was written so that a person could come home from work, read the book, and say, i understand that. they may not agree with that but i wanted them to understand it and to be written in a conversational way. this is where i stand, it is what i believe, and i hope it makes sense to people. those ideas could work. >> you're right that can add that obama would find common ground. the president obama has shown themselves to be the most partisan president in my lifetime, hands down. >> he has surprised me. i anticipate he would govern like to campaign. all about a new day in washington, a new kind of

dynamic, but we saw through obamacare that he said to republicans, we are in charge. you're not invited. it was interesting to see that he did not have any meetings with house leadership for months into his presidency. when had the meeting on health care, and i remember vividly when paul ryan, the congressman from wisconsin, said, mr. president, we have some ideas. and he basically dismissed him with, look, we won, and you guys to nine. i saw some of the speeches that the head. i remember a labor day speech that was stunning for president. it did not have that type of credit tossup president's speech typically would have. it was the take your coat off and wiped of sweat from your brow type of speech. i saw him as a difference person as president than others

to understood that they had been elevated to a different position when they were a candidate. >> what changed? >> i think he was on a mission to get his agenda done. i think he misunderstood the voters of 2008. there was an unchecked mandate he thought that he go full throttle ahead. but that is not what the people were saying. they were angry and republicans for the way the republicans and mass some stuff up. -- have massed some stuff up. but i don't think that meant he had 100% of an opportunity to do to what everyone did it. >> let me ask you about one chapter. you write about one in three american kids lives in a home without the data on the premises. on the premises. allowing for exceptions as in all things, the typical portrait of these children is grim indeed. where did you get the figure,

and what does that say about american society? american society? >> 75% of american verse are out of wedlock. the reason that is important, what i am trying to do in the first chapter of this book is to quantify the economic cost of social breakdown. a lot of times, particularly, people will say this social stuff does not matter. we need to focus on the economy. i could not agree more. if you are serious about focusing on the economy and dealing with issues like poverty that calls a lot of government money to be spent, you cannot divorce that from the root cause of why we have so many government programs.

14% of our overall federal budget is safety net spending for things like wic, medicaid, a lot of which would not be spending if you had stable, solid, and financially capable families. >> you say that red states have more out-of-wedlock babies and blue states have perhaps you have already guessed it, more abortions. why did you identify that in terms of red and blue? >> i think sometimes people will look at the birth rates of states that are lower portion states and see that the out of wedlock states like arkansas and mississippi and even utah might be high. they say you do not have those kinds of numbers in states like new york and connecticut. what you have in new york is 33% of pregnancies end in abortion. that figure is more like 9% in arkansas.

excuse the figures if you don't interpret them to understand the reason that you don't see as many out of wedlock births is not because the rate has gone down, it is because those babies are aborted rather than born into a single parent homes. >> should roe vs. wade be overturned? >> that is not enough. all that would do, and maybe would be an improvement, but maybe not, because of this. it would then refer all abortion law to the states. if you live in arkansas and are pro-life, that would be very pro-life, that would be very good, because arkansas has an amendment that says that life begins at conception and it is the government's purpose to do everything possible to recognize the sanctity and worth of every human life and tillis natural conclusion. in other states you might have even more liberal abortion. we need to start recognizing this is not so much about

abortion, just that one aspect. the bigger issue is, do we believe that life has value and that every life has intrinsic worth? if we believe that, then we have to believe that it is our purpose as a culture and society to do all that we can to protect and enhance life. the next question is be irrefutable scientific question, when does life begin? we need to be more scientific, whether it is global warming our evolution. human life begins at conception. we can argue philosophically, but biologically, that is when human life begins. 23 chromosomes from a man and 23 from a woman come together and created the in a schedule that is unique to that individual. it is neither the father nor the mothers dna schedule. as of the elements in its genome at that very moment that it will ever have.

and it is life at that point, and it is human. it is not a puppy, it is not a stock of broccoli. it can only be human. if that is in fact him live, is it our responsibility to protect it and to treat it with dignity and worth? i say we should. that may require a constitutional protection for the lives of unborn children. >> so you are saying the government has a responsibility. >> in the same way the government has responsibility to protect people at the other end of life. if we come to the conclusion that it is ok to take human life because it represents a financial hardship. typically the argument is i cannot afford this baby, i don't want this baby, it is going to interrupt my college, or my boyfriend will not accept it. if we apply that logic at the beginning of life, then why can we not applied at the end of

life? by the same logic, when a person gets older and they become very expensive, because those nursing home bills are not cheap, and the family has to go out and visit grandma and take care of her and look out for her and lose their weekends because they have to go and visit her, they might decide that by the same logic that we can terminate the life at the beginning, we can terminate it at the end. that is where we end up at the logical conclusion of devaluing and human life. >> did you ever councilwoman who had an abortion? >> dozens of times. -- did you ever council a woman who had an abortion? >> there are lots of women who had an abortion, often because they were pressured by their mother, may be pressured by a boyfriend, had the abortion, and then later they married and had a child. they would no longer just a student who had made a crazy mistake, but as they had their

children, it started hitting them and hitting them hard. i saw a level of guilt and pain in the lives of women in their late 20's and early 30's, and i have never seen anything like it before or since. i realize that the people or counseling those young women to get abortions were not telling them the whole story. they were not being honest with them. they were just telling them this is just a block of tissue, don't worry about it. now we have sonograms, which we did not have a generation ago. i am going to be a grandfather this summer. my daughter-in-law showed me the dvd of a little bitty baby inside of her. it is stunning, and it is a 3 d version of this or you can see facial features. this is a chore of where in any state where abortion is legal

-- a child that could be terminated for any reason. you can see the heart beat, you know it is a boy. tests have already been done. these are technologies that did not exist before. the viability of a baby is much different than it was 20, 30, 40 years ago. i think that is why we are seeing for the first time in polls this last year that for the first time since 1973, more people identify as pro-life than not, and interesting thing is because younger women are actually more pro-life than their mothers and grandmothers were. it is an encouraging sign that we as a culture and society are beginning to more greatly value each human life as having intrinsic worth and value. >> you understand the politics on both sides of abortion. if you are the president, realistically what do you think

you as president could do on the issue of abortion. >> one thing you could do is reverse the obama decision on the mexico city policy. you could make sure that federal funds never get used to take the life of a child. the president has responsibility to try to explain to the to try to explain to the american people that this is not some extraneous issue that is peripheral, and not an issue that should solely rest just in the caretaker. it should rest with all of us with a deep sense of elevation of every human life. what a president get everything he wants in a pro-life way his first few months in office? probably not, but i think he ought to try. he ought to set the standard high for the value of human life. >> the book is called "a simple government."

>> one of the things i wanted to get across in the book is that the greatest gift a leader gives to his or her constituency is the power to be independent. if a mother and father raise children who never are able to go off on their own, and when they are in their 30's and 40's, they live at home, mom has to cook and clean for them and take care of their clothes, we don't look at that and say what a deal. we look at that and said what a tragedy that that child never grew out of being a child. the whole point of being a parent is to train our children to become a replacement, to take on responsibility. the same thing is true of a pastor. the same thing should be true of a political leader. it is to empower people so they can live independently with the full expression of their own personal liberty. >> you say sometimes i hear

president obama speak and i want to chant the mighty mouse theme. here i come to save the day, that means barack obama is on the way. >> i have been somewhat taken aback by so many references in his speeches to himself. i say that sometimes i think he is more interested in his story than history. i find that the speeches are often about what he thinks, what he believes. this is about the american narrative. in a specific reference to that phrase, here i come to save the day, i think political leaders are first and foremost servants of the people. it does not mean they don't have strong leadership capacities, but it is not to call attention to themselves nor is it to somehow make the american story all about their own commemorative story.

i just have been sometimes amazed listening to the president speak, it was as if it were more about him than it was about us. >> you are right about president reagan, this year marking the centennial of his birth. looking back at the media in particular, social networking, and the plethora of information out there. is that one of the inherent issues that any president today is now facing, that reagan and his predecessors did not face? there are so many different opinions. >> it has changed the internment completely. i am not sure ron reagan could get the nomination today. here was a guy who changed his position on abortion, he raised taxes, he granted blanket amnesty to illegals by the

millions. he pulled out of a conflict in lebanon almost overnight because of attack. leave me, i am speaking as a person who loves rating, voted in campaign for him, a strong supporter of him, then and now, and believe he was one of the greatest american president ever. ever. basically he was living in a world where there were three new sources and broadcast, plus radio and television. even radio was different because the fairness doctrine is still offer to. now, the end user of information has to become his or her own editor. in the old days, there was someone between reporter and the consumer who asked the consumer who asked the questions, were due to get this information? what is the veracity of this information? how do we know is true? we don't have an editor now.

somebody can block anything. the next thing you know, people are saying is true because i read it on the internet. that does not make it true at all. we have to be far more discriminating that what we read may not at all have any semblance of truth. unfortunately, not everybody is being the editor that he or she needs to be. a lot of people have been critical of fox without realizing that the fox news realizing that the fox news channel, when it does the news, i would put the people on the journalism side of fox news at next to anyone. function on the journalism side on fox news, i am on the program side. it is unapologetically -- i

guess you can use the word partisan. i don't pretend to be a journalist, but i know a lot of people who are in mainstream journalism whose roots are in partisan politics. at least i think fox was honest about that. when you have people in the news division, chris wallace, people who report receive any of our news folks, i think you find a level of professionalism that is second to none. they are not commentators. there is not this collusion or one division tells the other what is going to do our thing. there is a law there and i respect and appreciate that. >> with their is opinion journalism on fox and msnbc. i think fox is honest about saying if you watch bill reilly r mike huckabee are sean hannity, you are going to get an

opinion. we tell you this is an opinion show. if you watch shepard smith, you are going to see journalism. you are not going to know if they or liberal or conservative. shepard smith, i have no idea how he voted in the last election, and i watch his show. i cannot detect that he has a bias. sometimes i think he may lean a little more left than other people, but i don't know. i feel like the news guys do their job professionally and very well. we do not pretend to be journalists. we do commentary and we do opinionated programs. >> you share one thing in common with bill clinton. euro from hope, arkansas. describe the town.

>> when i grew up there it was a town of about 8000 people. i grew up in the old deep south culture, seeing jim crow laws and segregation. i remember -- it was a great time to grow up there. people knew each other and look after each other. i used to say that if i got in trouble eight blocks from home, before i could get my bicycle home, six people would call my parents and tell them what i had done. there was a sense in which the village was involved. it was a good community, good schools, teachers that inspired us. there was a sense of civic life there that was very admirable. i also saw that community grow and change. one of the things i am proud of

is seeing that in my lifetime, i have seen an african-american elected president. i said that right after the election. i write about it and make it very clear that my home town was a very good place to grow up. >> you refer to -- barack obama refer to the unprecedented economic crisis. you said that the word you are looking for is debt. >> i don't think he is listening. at some point you have to say, i got elected to the job and have taken command of the ship. it is my baby and i have to nurse it. the fact is, president obama has

increased the debt of the united states several times over. the greatest challenge facing our country is debt. i write about it extensively because it is important for americans to understand what 1 billion looks like and what one trillion looks like. frankly i think it is one of the most important parts of the book. if there was one thing i could say as why you should read this book, look at the pictures. a picture is worth a thousand words. my book has several telson words in it. it is staggering when people start grasping the sheer magnitude of one trillion dollars, and to think that this country is in debt between $14 trillion and $15 trillion, it is a stunning revelation. >> both parties are responsible. >> of course they are.

democrats have taken into an era -- inouye level in the past couple of years. believing that we can just continue to at entitlements. the obamacare bill will add another trillion dollars. that is not going to save us money. that never made sense to anybody. >> he pointed out the multiple tax increases. can you reduce the debt without raising taxes? >> first of all, you have to get spending under control and start cutting the spending before you even put any talk of taxes on the table. i don't think the problem in i don't think the problem in america is that we don't have enough taxes. our problem is that we have become addicted to spending and we use it as a political tool. i also think our tax system is

completely skewed, and the way we assessed taxes is fundamentally wrong. we penalize the productivity of our citizens. i write about the tax system in the book. my position has been that we need a consumption tax. we should be taxed on our consumption at the point of retail sales, not taxing people because they worked, earned, and saved. those are good things. those are the things that do stimulate the economy and create jobs and cause people to manufacture. we penalize productivity and then you subsidize irresponsibility, like we do is bail out, you do harm to the economy, you don't improve it. >> did you support the tarp bailout? >> i did not. >> and yet most of the money has been paid back. >> the government should never have been in the business of picking winners and losers in the marketplace. why did the government decide

that goldman sachs should live and lehman brothers should not? i look around at all these so- called conservatives who were supporting tarp. there is nothing conservative about the government bailing out poorly, recklessly manage companies to got in trouble because of their own mismanagement. the fact is, the role of the government is to be that of the referee. they are there to where the striped shirts and referee the game to make sure everyone is playing fairly. their game is not -- their job is not to put on a team jersey and determine the outcome by picking the team that is going to win to the exclusion of the others. when the government says we are going to let lehman brothers fail, but not goldman sachs, aig, we are going to bail them out. why? if the companies are in a position to fail because they were not run properly, i hate to say this, but maybe they need to fail.

maybe good companies and better run company should rise to the occasion in come to the top. i have heard all the arguments from republicans, the hand- wringing, the sweating about the economy collapsing. i think the economy will collapse in the future because we set a precedent that is impossible to keep, that if you fail, the government will bail you out. that is the equivalent of enabling a drug addict who continually messes up, but his family always rushes in and saves him and rescues him. there are some tough consequences of getting on drugs. you are going to hit bottom before you ever start climbing back to the top. what we have done as the government is decided we are going to bail these folks out without ever letting them experience the consequences of their own reckless actions. >> it was president bush and the

secretary of the treasury who pushed for part. how will historians view george w. bush? >> given the way that the prevailing view is, they may say it was a necessary thing to do. i will go to my grave saying it was an unconstitutional intrusion in the marketplace, and it was fundamentally wrong and it set a terrible precedent. i am a big fan of george the bush. i like him personally and i thought he managed the duties far better than people will ever give him credit for, until some were out in history. on that issue, i disagree with that then and i disagree with it now. >> how does a baptist minister become governor of arkansas? >> a lot of people would like to know how that happened. i first career was broadcasting and advertising, and by a circuitous route i ended up

pasturing a church, which was a magnificent experience. it gave me an opportunity to deal with people on every level. it was 25 or 30 years ago now, but part of my experience was, i saw every social pathology that can be described. it was not just that i sought in an abstract way. i could put a name and face to every issue we were facing, if it was homelessness, drug addiction, alcoholismand make tr eat or have madison, young couples, struggling with too couples, struggling with too much debt, it is nothing that a person could made that i cannot put a face to. over the course of that time, i became increasingly convinced that the people studying public policy did not have a clue about what the root causes of a lot of our social problems tunnel breakdowns of our culture were,

and i am not just talking about social. poverty, disease. i became convinced that in a representative form of government, we needed people who represented all kinds of people who lived in our culture and society. it did not see people like me involved, so three long process of conversations with my wife, i decided to step out of the stands and get down on the arena and i guess the rest is, as they say calm history. >> why did you ultimately decide to run? to run? >> i thought that i had the internal compass that pointed

north, and i understood why i believe what i did and could defend it and i believe in the greatness of america. having been a governor for years, i had more executive experience. when a person is a governor, they have actually run a microcosm of the federal government. every agency that you have of the federal level, you really have at the state level. millions and billions, more like millions and billions, more like trillions, ebut the premise of what you're governing is really what you have as a governor, and i understood that the job in that role, the executive branch, very different from the legislative branch, where you can specialize in two or three different things. it needed a person who had clarity of vision, and many people encouraged me to run, and i decided that was exactly what

i would do. >> during the campaign, did you learn anything new about yourself that you did not know? >> i learned that i was more resilient and i had anticipated. it was not as savidge running for president than it was running for anything i ran for at the arkansas state level, because arkansas is a tough political environment. political environment. it is sort of an old school kind of place, where it is down there at the retail level, and i think it is one of the reasons looking back, when i saw bill clinton go through so many different challenges, some of which were his own making, but he kept coming back after them, people were amazed, and i felt later on, after my own campaign, i kind of get it now, because once you have gone through the political sausage making an arkansas, you are going to take some real hits to the head. there are going to be some political concussions going on, but you learn to get up, dust yourself off, and fight another day.

>> let's talk about 2012. if you were to run, what questions would you ask yourself this time around? >> am i the best person prepared not just to run but to eat? and do my ideas really make sense to the american people, because ultimately, you have to have the consented to be able to govern effectively. i wrote this book largely because i wanted to lay it out there. here is what i believe. do not listen to what somebody says i am about, because political opponents will distort, contort your message and all different ways to make it look different than it is. i wanted to say," here is to i am." if you read that book, and you say, "you know, that guy's got to make sense to me," then that is good. if you read it and say, "none of that makes sense to me," then it is something that is true and

not something you read on the internet. >> i thoughtful, mature, and tempered leader, but that could be lost in a sea of gotcha games, while political hacks and media hit men look for the slightest change in a candid its history. >> we are less interested in where a candidate stands and what he stands there than we are interested in what i call the gotcha questions. some almost very rare, nuanced position that may have taken 30 years ago, and the show that in your face of a sudden, unexpectedly, almost as if to say, "ah-ha." it looks like a great "60 minutes" moment, but it does not give people of the country an

idea of who you are, and what i think we should be talking about is how you would deal with border security or terrorism, how would you deal with these? the deficit? social security? frankly, i think i take some risks in this book. i take on some of the sacred cows a politics that people do not talk about, social security, medicare. interestingly enough, a hot item over the past few weeks has been unions. unpaged 35 of the book, this was written back in last june, i talk about it, but this was a train wreck that i think any governor could see coming, and i talk about the relationship that unions have with states and the symbiotic relationship they have with the federal government. it made me feel good that the very week that the book came out, the front page everywhere was all of this issue about can we afford to continue to pay public employees disproportionately better than people in the private sector make?

>> so where is mike huckabee right now in terms of a presidential bid? >> right now, i am very seriously contemplating it, but i and taking my time in a methodical way. i am not going to rush into it because of a 24-hour news cycle. first of all, this is different than four years ago. the calendar itself as far as the primary is going to be elongated, so there is no sense for starting it up as early as last time, because very few people can sustain a campaign. one of the things i am gauging is how do people respond to the message, and the best way i know to present a message, other than being on radio every day and television every week, is to really codify it into a book form and say, "here is where i stand. this is it. it is in print. you can read it. you can underline it. you can read it twice."

you can go back and read the same page again. if people say, "i think this guy has the ideas that can help this country get back on its feet," that is going to go on long way. i said i sure hope i had something. in terms of what i be a different person, i hope not, because i tried to be as authentic as i can possibly be and not be duplicitous about what i believe or where i stood. i tried to answer the questions asked of me, and i would hope to be able to do that again. >> if elected, what kind of president would you like to be? >> i would like to be the kind of president that whether they liked me at the time, in retrospect, they would say, "they really gave his wholehearted to raise this country to the best it could be ." "he was a great american president pierre " --

president." there is still 40% of the people who did not vote for him, it is his job to serve them as much as the 60% that on the front and put him there in the first place. one benefit i have been a governor -- on the front anend. it reminded me every day pair that i cannot go in saying, "this is how we are going to get it done, fellows, and we are going to do it my way. i am proud of the job creation, educational excellence, et changing the tax structures so that we actually lower taxes on working families and couples who are married. there are many things i could point to, but i also believe

that is how you govern. it is not from some sense of ideological idea. i am an ideological person. my convictions are pretty doggone clear. i have been about as plainspoken as i think a person can be, but as i think a person can be, but i also recognize that when you govern, and you have to govern within the context of the consent of the governed, and i always remind myself that if the voters had sent other people to the legislative body, i may not have voted for those guys, but their constituents back home did. they may not have voted for me, some of their constituents did. somehow, the constituents, the people we all work for, our employers, expect us to be able to work together to solve their problems, not create our own. >> two final points. what do you like about campaigning, and what do you not like? >> what i love about campaigning

is getting out to talk to people, looking them in the eye, learning from them, and get a the energy that comes from the with some of the campaign. you know, i love the campaign. some people have said that i do not like this. no, i loved it. i wake up every morning, and i cannot wait to get out there. what i do not like about it is you get distracted from the actual campaign of substance of louis saying, "this is what we need to do," -- substantively saying. that is frustrating, because it takes the meeting away from the reason iran. it was not to play defense all day long. -- the reason you ran. "i think you are right. those are the important issues, and i will give you the

opportunity to lead us. >> and finally, whether you run or not, what will the republican field look like in 2012 >> i hope there will be more governors. i think governors made better presidents because they have actually run something. i like the fact that there are a number of governors who are talking about running or are taking steps about running. i will be a lot more comfortable when somebody is sitting there making decisions who has a history and a track record of governing from the executive branch. >> a former governor, 2008 >> two house committees hold a joint hearing on the mission in future of u.s. presidential libraries. that will hear from the directors of the john f. kennedy and ronald reagan presidential libraries and other residential,

the presidential historians. the national governors' association winter meeting in washington d.c. continue today. over 50 governors from across the country and territories met to discuss the issues facing the states. now, discussion of that sustainability of the medicaid program. this portion is about 40 minutes. i would like to offer the first to governor walker. are you still with us? >> yes, thank you. thank you to both glenn and dog. i appreciate your comments. they were very helpful. dr. nichols, you mentioned two things. he talked about systemwide cost

growth and enrollment growth, which is right on the money. first, and system growth and know that many governors have experienced this, but i have spoken to our health care providers where they're interested in the radical home concept. where they could focus more on being reimbursed for outcomes, not just procedures. while there are a lot of things to go on with that, medicaid reimbursement is obviously a key factor. the other part, on the involvement growth, clearly the economy has some impact and i do think that many of us assume that as the economy improves we are likely to see increased enrollment growth. one of the things we are concerned on is the vote between those that will receive the federal subsidies on the health care mandate as well as those going into medicaid.

our estimates are that 46% of those people currently already have private coverage. i think it goes to the heart of your comments about governor is getting more flexibility. otherwise we are stuck with shortened provider payment rates with many adverse effects. i would be interested to hear your comments on both of those. >> first of all, governor, great question. as you noted, you have got some really stellar examples of their. what they're talking about with you is exactly right. moving from a system where we pay to a system where we received value. the best way to think about that is the grand bargain to where you can actually cover costs and essentially having providers incentivize delivered value to manage patients far better than

they are today. i think that many of us believe that if we do that right, you can actually lower the cost over time. looking at the people that run the system like you have in other places around the country, they will tell you that one- third of what we are spending now is not adding value. it is hard to go to the point, but the people in those consistencies are the structure that holds them back. we cannot write down the left this afternoon, but we can write down good ideas. on the game point of enrollment, i would definitely concur. i got to be somewhat involved in the commonwealth of virginia liberation going forward. one of the first issues to hit us between the eyes was -- what

about this population that is counting back and forth? i would encourage you to look at managed-care plans that are set up, seeing that behind the door, there is also an impact along the way. clearly, over time you will want to make sure. >> we did actually agree on a few things. let's keep it loose. [laughter] you cannot emphasize how important it is going to be in the long-term care problem, which is a big part of the study. by necessity i would like to see greater use of managed plans in the medicare and long-term care services. these vehicles will have to be

involved overtime in the cost program. the sad reality is that it is going to fall to governors to lead the way on that and try different experiments in your state. no question. the only thing that i want to get on the record as fundamentally disagree with is the notion that somehow we need to just talk about spending more money right now. that is wrong. this nation has been growing for nearly two years. it is growing poorly. we need to fundamentally emphasize growth strategies that raise the long-term rate of growth for the americans out of work. these of the burdens placed on the economy at the state and federal level. the obligation is to be to our children a better standard of living. federal spending is number one. i could not possibly endorse

anything that said spend more now. time to go in the other direction. >> in florida we have got medicaid holding 3% of the budget. what do you think about block grants? but you think of the chances of getting block grants democrats -- what do you think of the chances of getting block grants? >> one of the fundamental problems that we face in this area is programs brought upon by medicare and medicaid, where you might have the finest quality medical science that you want add little to no cost, and it is expensive. then we go to providers and state -- stop that. cutting reimbursement rates and tell them not to cover particular services. constituents come back and say

-- you promised. until you put a budget on it and until we get serious, this is the budget for this activity. the block grant is a great way to provide the federal taxpayer with no budgetary exposures. lord knows that we need one. allowing states to know the deal. in exchange you should not get a little flexibility. you should get big flexibility to cover your population on the exchange. however this works out. that would be a good signal to everyone involved, solving many of our problems. >> i assume that the block grant philosophy would require states to meet a certain public forced metric.

let's you do not satisfy your populations metrics for social care access, you will not be able to [unintelligible] >> is there a director? >> certainly the way you pay should be changed. >> absolutely. >> i think that the block grant idea has a lot of merit. it is seductive in many ways, but risky for states. go forth, do good. i would certainly endorse the concept of giving you a lot more flexibility than right now. this population is going to bounce back and forth.

block grant is not a bad concept. but it is second best. far best is performance across the board. i would start with local level transparency and build my way up. be wary of what you wish for. ->> first of all, looking at the chart there is an interesting observation and a real compliment to the state of wisconsin. between 1990 and 2000, the governor released focused on welfare reform. my analysis was upset it would move people want real jobs from the medicaid rolls. i think it is more effective to stabilize reform.

i have been gone for clothiers and now back. almost double. i had to come back with $540 million because of the one time stimulus mcveigh -- stimulus money that was used. higher education provided zero growth. i believe that the federal government with maintenance and effort has really tied our hands and not given us the flexibility to do what we do. i would like to be able to set my own eligibility requirements. i think that people need to have scanned in the game. my experience of medical school with trained professionals, we

did assessments of everyone. everyone contributed towards their health care. and we then rewarded people that did things to reduce their risk factors. unless we get a system where people take ownership of their own health and are actively involved in that decision, i do not care if they are on medicaid or what, if they have that in the general population there is not going to be a way to solve this problem. i would like to give flexibility and the opportunity to succeed or fail based on our own policy.

[unintelligible] >> if i could read to put points on block grant issues for states, it means the risk for constituents. the main level of the man's increasing, one option is cutting services and i think we need to be cognizant of that. there has been a lot of talk about flexibility. recently said recent -- recently the secretary expressed interest in working with states to give that flexibility. i know that we had a

conversation earlier about what exist within the current law. that is one way from my perspective that the administration has shown participation in having a conversation. finally, the incentive system. i would like to see some real examples. a couple of weeks ago they introduced a way of doing away with fee-for-service. in my view that will be critically important. so that they're not just talking about 30,000 feet. i do look forward to hearing more on that. >> i would like to thank the

participants and speakers today for convening. our medicaid budgets has grown over the last 10 years. even with the downturn. we are doing precisely what was the intended strategy. right now medicaid is the only flexibility that we have. but how do we get that away from fee-for-service? the number one concern that i hear from small businesses is that when they get that payment increase, they cannot add a few jobs.

if they do not start retiring, they do not get to retire. it seems to me that everything around affordable care is a different question as opposed to having to get control of health- care costs in the economy, trying to move things away from fee-for-service, for example. as well as suggestions on how people pay for the services we need. i cannot tell you how would warms my heart, but not

necessarily being the same model in your mind's but what a powerful thing to come up around that strategy. >> thank you. i think the deeper and more fundamental question -- is medicaid of a wild and rapidly raising cost in the system? as governor patrick pointed out, we all agree, those are dollars that they cannot invest in your business or used to hire people. sharing the best practices. this is a time when governors need to manage and use

performance measurements and management to put people together to bend down cost curves. in our state to regulate hospitals. our rates have not gone up. just like you have seen in other

states. we believe that there is flexibility here. we believe that with the ability to use this technology to mapping where our thoughts are, or the costs are, where there are now -- anomalies, using an open transparency, we have the tools to bring down the costs of health care. as well as flexibility in the affordable care act. getting these unsustainable costs off the backs of businesses in our state. >> it is important to be honest about the affordable care at being a step in the wrong direction.

there has been no non-partisan entity to look at it. in fact it will probably go in the wrong direction. i do not think the two should be looking for the flexibility that you would like in the context of that. bankruptcy, flexibility is like waivers. doctors, hospitals, insurance patients with fragmented service care. one that lack of flexibility

will put us in trouble. >> the average annual bonus increase of 4% to 5% over the next 10 years with an average rate of 8.3%, 83% over enrollment. not only imperative, but there is an opportunity with these costs. it seems simplistic to say that that is the fault of the act. with the population aging, they will get older and need more expensive medical procedures. focusing on the context of how

are we, as a society, going to provide for all of our citizens. how do we holistic play it the businesses? that is a much larger issue. -- get business -- holisticly get those businesses? that is the much larger issue. >> i would actually say that there are tools available. they point the way towards precisely what we are talking about. let me tell you a secret. if all that we do is public sector reform, we will fail. which is your point. this has got to be multi-payer. what is going on right now, how do you get real multi-payer conversations to complement, if you will, and improved?

i am totally in favor, but not of starting over unless it is with the same commitment. i hope that we start there when we start over. >> i was pleased to hear about the ability to get flexibility, as it is contrary to our experience. in 2009 be tried not to get a waiver, but a state plan amendment. it was approved in february of last year. we submitted a contract subject to that and it took until this february for them to act on the contract. saying that this was a plan for coordinated care. cms said ok, you can have a contract, but she cannot do the

things to save the money. sabin's were essentially taken out of the cut -- savings were essentially taken out one year later. the idea that the federal government knows better than we do want pre-existing conditions, i deserve no credit. 3600 people in our risk groups, about 160% of what standard premiums would pay. they will not let us use that risk pool to meet the requirements of the new act. so, they set up their own risk pool. they cut the premiums to get more people in that and is still only has 58 people. it might grow later, but the idea that the federal government has to create their own, or forced us to create a new risk school, that is not the kind of flexibility we are looking for. i am glad for the state that get

it, but it is not my experience. >> my experience is similar to the governor's. we cannot get a response or did anything done. we will not get control health- care costs until we change how we deal with providers. we need to not restrict competition. two, we have to allow individuals to purchase wherever they want. four, give people the same tax breaks as employers when they purchase their insurance at 25. you have got to allow people to be rewarded for doing the right things.

my state is different from every other state. if you give me a block grant, i will cover the right people and spend the money better. if not, i do not get reelected. >> let me expand on something that was said. the affordable care act does not contain the elements for significant cost, and expiring -- expanding is good. we wind up paying for the scope of managing hypertension. i think that the challenge and opportunity for states is to figure out how to change the way that those dollars are spent. unless we wake up medicare and medicaid, we will not solve this problem.

whoever the candidates are, if it is not on the table we will be in trouble. if you are admitted to hospital with congestive heart failure, there is no incentive for any care to make sure that person does not come back in. 80% of the costs in the system come from treating chronic illnesses. suppose that you had a 90-year- old woman somewhere in washington, d.c., without an air conditioning apartment. there was a heat wave and the temperature but up to 100 degrees. that is enough stress for full- blown congestive heart failure. in the current system you would not even know about her until she shows up. medicare pays for the ambulance but we cannot purchaser a $200 air-conditioner, which is all she needs to stay at home.

the difference is $48,800. but what we really need to do is get the flexibility to use those resources as they come in. not just to expand coverage, but to change the incentive in the community-based chronic conditions. >> may i build on your example? the work that it takes to manage the front end of that example is not reimbursed today. it has to get precisely that kind of flexibility. they have so the most detailed percentages on the cost of care.

that is the other issue, how do you create the incentive i feel that there is a tremendous amount of incentive. my last point, i am trying to do very different incentives, this has got to go beyond the public care and a scene that that is what we should be working on to come together. >> the first need is getting health care system broadly more competitive. it seems to be 20% of the economy and if we continue to allow the change dramatically, as an economic policy.

there are many ways by which to judge the affordable care act. if you think about the example the to gave, there are no longer twisting insurance into a pretzel. they are willing to pay for the things now that keep them healthy in the future. there is no financial incentive to do it. changing the private-sector payments system. i think that that is something that really needs to come back into play. >> you talk about the private and public health machines. this last year they averaged

15.1 million people were 62.9 people enrolled. what can the states do to reduce that turned? >> the research that i am online with was done in february of 2011. it is informative. if you have eligibility rules, people are going to bounce between eligibility and medicare. it is the nature of their income bouncing up and down to change eligibility. they disappear and sign up again and disappeared. you want to take your medicare money and stay in private insurance -- private insurance.

i do not understand that fire wall. it makes no sense. >> the accord will care has a requirement that the states come up with a window for -- the affordable care act has a requirement that the states come up with a window for eligibility. a human being comes in one time. you cannot stop the economics of people getting and losing jobs. you can maintain a proper care and keep it -- keep it as cheap as possible. you can save a lot of money if you can make that change seem less for people. >> if you want to have a preventive system, every state has a department of public health. in all this discussion about

health care, it gets messed a lot of time. the increase in the american life expectancy comes from public health changes. whether it is using seat belts, cleaner air, said her -- safer food. when we talk about health care, we have to look at our public health departments and how they interact with big populations of people. in our state, we have 50 million people. the public health department educates the public on everything that has been said about being healthy. if you do not have a director of public health that can engage the public in this mission, we will come up short. in the next century, we want people to live it a moderate than they live now. that is what better outcomes

are, especially healthy outcomes. i think all love us need to keep an eye on public health as well as all the things we have talked about today. >> there are factors that impact people's lives. 40% of them are lifestyle and the haiti. 10% are genetics. -- 40% of them are lifetime -- lifestyle an. 10% are genetics. if you work spending to% on an outcome that =-- 10% on an outcome that provided no value,

would you do that? we need to endorse community- based delivery models and allow people with chronic conditions to be in the health-care system. this debate is not about health care, but health. it makes a difference. at the end of the dead, people do not want health care. -- at the end of the day, people do not want health care. there is no intrinsic value outside a outcomes instead -- other than the economic model. we need flexibility to get our arms around this problem. >> one of the issues we are dealing with is we have 12% unemployment. whether we are talking about private insurance or the cost of medicaid for taxpayers, if we do not solve this, we are going to

continue to lose jobs. we are competing with companies with headquarters here that are moving out of the country. health care costs are less expensive. if we do not solve this issue, we will never get our unemployment where we need it. >> governor walker, do you have a question? >> i have been listening. i have been watching and listening on c-span all at the same time. [laughter] i have one comment. is perfect after governor scott's comments. secretary sebelius commented on

questions i had about the affordable care at. she says the affordable care act is based on the belief that the states understand their health care system better than anyone else. i believe that is true. what we are a democrat or republican governors, we know our states better than anyone at the federal level. i would echo what rick scott has been saying. we would love to have a block make so that we could allocations the way we see fit. i have a comment on the procedure here. one of the things we are willing to do? i followed up with the number of governors. after the discussion, i am willing to follow up with each of the governors on this panel

individually collect a list of specific flexibility and try to figure out if there is any sort of consensus on that. the question is, what is our next step? what do we ask the pharaoh government for? for us right -- what do we ask the federal government for? there are provider pay rate changes. many of us would like to have the stability, if not a block grant, then some flexibility. >> i want to stress something that i think gets lost in this debate a lot. number one, if you look at this in the point of view of jobs and growth, the way the federal budget is set up, these large federal spending programs --

many of them are legacies of our past. they questioned the ability of government to spend on anything else, including things that our core functions of government, national defense, education, infrastructure. that is the future. i have these questions on the future in a fundamental way. to get it under control means dialing the clock back a week. we can say there was a bipartisan consensus about the delivery system in the way there was not about the coverage expansion. that shows the importance and the willingness of both sides. we would all be well served. >> the important thing a lot

with flexibility is that there are examples where we are moving toward paying for wellness. they are doing things with their frequent-flier who come to the hospitals with diabetes. -- frequent flyers will come to the hospital with liabilities -- diabetes. they are bringing down because of health care, that small percentage that is driving the cost. they have a financial incentive because they are able to share in the profits from reducing those costs. that is 10 hospitals. we gave them the ability to do what we need to do, which is to

get better care results and to bring down the costs. i cannot want to go back. i understand your point. i do not want to go back. the states that do it best and embrace these reforms are going to be more competitive places for businesses. they will have better care results. >> i would pick up on that. i would recite a similar example. it makes a larger point. we are only going to make our health-care system better if we find the best examples from around the country, highlight with or without the federal government. there is a company that offers their largest customers 0 park = price inflation if you

bring the same number of patients as last year. they cannot get that deal from the federal government. private sectort incentives. only the private sector understands incentives. the government has realigned banks. this is not impossible. -- the government has realigned things. >> we had a meeting of governors in florida. we came to an agreement with democrat dicks and republicans. we want to put together our thoughts and work it out with the federal government. that is important. governor should not be focused

on one wall and disagree or agree with that law. we have a basic idea of better health. that is the outcome we want. there are things the states are doing and it is doing -- entities are doing in the states and we can share them together. we should not get distracted by this one lot. there is a common agenda of governors who are making health care work. wrap this up. there is no reason for us to hang out just to hang out. as governor patrick said, we cannot solve this problem by dealing with medicaid itself. it is closely related to

medicare and private health care itself. we need to deal with it in a way that is comprehensive and moves us will work. we can come together around a set of parameters that would allow us to do some brought demonstration projects that can inform the national debate. it has to happen sooner rather than later. i want to thank our distinguished guests. thank you, governor walker. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011]

>> the national governors' association winter meeting concludes with bill gates. he talks about the william n. mullin the daetz foundation and how to remain competitive in a global economy. live coverage beg