can say to all people in libya and benghazi or from al qaeda. probably not. what is sure is that al qaeda will move, will try, will test. taking the opportunity of this question. al qaeda loves the space where there is no strong and democratic national power. >> why don't we go to the audience now for questions. i did not recognize at the beginning, we have some distinguished guests in the audience. the ambassador to jordan. and your excellent ambassador. welcome to all of you. let's take some questions. wait for the microphone.

identify yourself to the foreign minister. please make sure there is a question mark and the end of your -- yes, here. >> good morning, mr. fihri. i am a senior at georgetown. what role for morocco in the future? i like to believe we could be a model r the region. thank you. >> the answer is simple. express what you want to express do do what you want to and contribute to the debate. it is open. morocco nee all -- >> how would he participate in

the debate? >> there is a mechanism. you can send your contribution to the internet, articles. we have more in morocco, more internet, internet. >> internet. >> then vultures. true.it is it is true. we have this fresh -- the last elections, less than 40% of citizens participated in the elections. these elections were free,

totally free. but some people said, why go to vote? your voice is important. >> right up to back there. >> i am a graduate student. you talk about a multi-party system. with that include the islamic parties -- will that include the islamic parties? >> they have been banned. >> tee tee difficult -- it is difficult to say. islam is the radical spehre -- sphere of environment. they said, ok for constitutional

monarchy for many years. we have some -- in the parliament that if they want to be in the party, are welcome. if they want to say no, i will not participate, i am waiting for -- i do not know which element. but everyone is associated -- is invited to participate to this debate. and i love the conscription of a new constitution. >> ken? >> thank you, mr. foreign minister. we're honor to have you here. i assume it is not coincidental you decided to come to the united states to a library on the king's vision.

there is a desire for some kind of american role. americans looking at the region, we understand that changes need to be made in the region. people want ownership of those changes. what the king is proposing is exactly what some money americans wanted to see more of in the region. how can the united states help? we want to see the vision to succeed. what can the united stat do? >> i think the questn is maybe more larger. when we compare what is happening in the arab world of what happened in central and eastern europe between 1989 and 1992. it showed that the evolution or revolution changed from a problem to -- check slovakia --

czechoslovakia. i am impressed by nato the european bank. it was easy to do that. it was important. usa contributed. the european union and the g-8 members and mainly usa. the three together. and i hope they act together in a complementary effort, to help this transition. to respect the change --

including the condition -- you what progress? i can help you. the marshall plan, ok. don't forget that the marshall plan, there was some conditionality. i think it's logical if the u.s.a. and others say, ok, we're interested by your process. europe -- by the progress of tunisia. if there is this possibility, i am sure we can win together. it means that we need some new initiative. new speech by president obama. maybe. i am not taking notes of all this. new meeting for future.

the g-8 effort, and it will be now maybe more successful, because before the egyptians, the two nations and others were unisians andwo na others -- there is the possibility to create, to take note othis evolution. the transitions and to create a new arab world. everyone said in washington or in paris, we do not want to impose. we just want to -- i do not know

the difference. what is important -- to have ownership in the definitions of the global end in the implementations of the means. >> a question. >> thank you, minister. i would like to congratulate morocco's progress of reform on human rights. >> which you identify yourself -- would you identify yourself? >> i am from george washington university. >> it is important. the justice is the best -- the best for the society in progress. and the king said now five

years and ask the government to propose a real and deep reform system. some proposal, some projects are rated. there will be adopted during the next week or month. what is more iortant is not only code or new text is the spirit, and the spirit is tha there is a colorado -- there is a law. no more, but no less. >> it occurs to meet as you're talking that -- palestine has not come up yet. >> yet. >> i think that is interesting in itself. >> which palestine to prefer,

gaza or in the west bank? >> i am asking the questions. >> how is it likely to impact on the palestinian issue and the prospects for resolving it? >> many people talk about the capacity of the government of -- to create or to prepare the future of the independent state. and some people talk about justice, but i am sure that it will have an impact and we see the west bank, some protests expressed an strong desire to have a better life. i note also that -- they tried

to reach some new success. not in the political process, because -- but all around the world is the recognition of an independent palestinian state for us is important. but i hope globally that quickly and quicker will be better to create once again this negotiation process. it has to start again. and maybe including some new elements, some new elements. ok? at which independenttates. how to be sure we will go directly to this democratic palestinian state, with the

constitution, which won? it is important for palestinians to listen to what is happening and to talk also with the brothers in gaza. we heard about the renciliations and we know it is not an easy mission. but the arab conflict is still here. and if we forget it, unfortunate what happened this morning in jerusalem, here to talk to us together, to the arabs and two others -- and to otherrs. s. >> thank you.

mr. prime minister, i like to ask you for your views on how the new government will approach the existce of a national government in the market, and at the same time the regions to which referred and in terms of how these regions will be structured, because they will contain some of the several communities that comprise the nation. and as these committees will be distributed in different regions or may be concentrated in " art two of several reasons, how will a balance be maintained in the new government to represent all of the religious and ethnic populations? thank you.

>> first, we have to house -- we have the senate, and the senate will change. participation in the senate will be the results of the elections at the original level. in terms respect, the problem in morocco, we don't have this problem because we're all moroccans. moroccans first. after that, we're from the north, the east, and the sth. it is important question because we have a problem, and the name is the western sahara. we present a proposal to resol this dispute between us and

moroccan nigeria. it was welcomed by the internatiol community. with that, it negotiates -- the security council said we have to negotiate, taking intoccount the air force and the realiic approach. but we cannot wait for the final solution of this problem. that is why we think and we strongly believe that we have to move forward. then it will respect all the inhabitants of the beach area. the national rules protection of freedom of religions, we have no problem in morocco because we

have jews and muslims living together since many centuries. some jews are more -- not more but -- longer american than others. arabs came from morocco 14 centuries ago. jews are a reality. this is an interesting mix of people. each sensitivity will be protected in the complex of national law. >> he said last night -- you told the associated press last night that arab strength could end. this does not lead to rl democracy.

how long do you think the people in the street will be comfortable waiting? their expectations are high. they must be puffed up. how long the you think they can sustain this enthusiasm without a real change inovernance in those two countries? do you think it will come quickly? you do not expect this to happen in six months, do you? >> i think the transition is important and the time for this transition is also important. like you, we heard the for the best andair and fruitful elections in tunisia, general elections, we need time, citizen

time for the organization of the ne parties to be included. but not too much time to not give it to some islamic radicals to have more -- and i am sure that the elections have to be over night in tunisia and egypt after stember for egypt and after november 4 tunisia. -- for tunisia. if we ask the g-8 and some arab countries to help this transition, we need some appropriate time. because youth needs youth -- youth and others need political

change. at the same time, this society needs some concrete results in terms of employment, in terms of subsidies. the transition has to combine between the political refor and the economic and social needs. it is not easy. impact, investment. the comet has to continue to produce and distribe -- the economy has to continue to produce and distribute. >> i am a representative of the moroccan democrats. here is my question. what are the implications of this new reality in the arab

world on the u.s. policy in the middle east? thank you. frank.s be very the bushdministration asked for a revolution in the arab world. after 11 september. and there were largely -- to impose the change, to help or to continue to talk with this country, but let them organize. now, with the current administration, we continue this effort. but with different approach. less imposition, but more

ownership. the change happened in tunisia and egypt. it is more clear. the media will not know to what the outcome in yemen. the change will be quickly. and the u.s.a. has to realize that offer of the region -- i know that maybe it will be difficult. intel in accordance with others, the total complementary to others, including the government opinion. >> over here. back there. you. come back to

>> i am a photographer. i was encouraged when you made reference to the arab world and you kept making reference to it. there is a tendency here to divide the arab world up to say north africa to not see us as a unified group. with differences. arab nationalism is still very much alive, at least for the people in the region. i was wondering, given tha fact, i think wn bad things happen in the arab world, here we have a tendency to demonize all arabs. but when things are happening that are frightening to us, maybe in a positive direction, we want it divided up somewhat. prison as aco's

country that is seen as a positive country, not least of which hollywood has done a good job because people love to shoot film there and that is always a positive thing. what has happened as much as you can talk about it with the king speaking to some of these regional leaders behind the scenes? what kind of influence did you guys have in terms of -- not putting the screws, that is a negative thing to say -- to encourage them to be seen as a more positive force, rather than bringing about all the negative stuff, which think is also encouraged because people do not really respect a lot of the other arab countries of the way in morocco is perhaps respected. >> she is referring to leaders across the region.

>> i insist that each country will reach its own solution, if i can talk about a solution. that would ensure is that i remember myself -- that what is sures that i remember myself in 2002, 2003, the king made many speeches and participated in many summits and insisted on the necessity to not just talk politics between the -- about the israeli conflict. it is important for the stability. the arab citizen needs to see this cooperation and the production from the arab league.

have not -- a free-trade zone -- some investments are shared with private initiative rather than a global arab economic charter, and also human development, because many arab countries can help. once again, we cannot compare it cut dark with egypt in ter of human development. i think the most imptant cash think we can share among us as arabs -- the most imptant thing we can share is to concentrate more on the concrete operational issues, rather than to talk, talk, talk.

principals from time to time are a contradiction with some national decisions. >> the sultan of oman came out with a similar program after the king's speech. i think this will have to be the last question. >> i'm peter from brookings. many people were quite surprised at the arab league approved action against libya. what is the significance of that? does that portend a greater readiness, willingness, on the league and the member states to intervene domestically more than they have in the past, or how significant is this step? >> in 2009, i think, during a

summit, we adopted a new code for progress. and it was at this time not imposed. but the dialogue with the u.s.a. and with the european union, our partners asked us to fix a resolution or an annex of our charter this modern concepts. but nothing happened. nothing happened. how to modernize and how to be more liberal. now, we have the -- we have -- even from the ground, given to us as a member of the arab

league an opportunity to creates a new common house with common vision, which is more importance, e same and shared rules -- how to conduct some domestic issues in this country have to be the same then in other countries. and i hope that is -- in french we say -- [speaking french] >> springboard. >> springboard for arab world. and i hope that the next secretary of the arab league can work with the spirit. it will be a change.

>> i want to thank you not only for your presention today but for morocco's friendship with the united states and the leadership and role your country is playing now. hope that flowers will bloom across the arab world as a result of the role that you are playing. thank you very much. [applause]

>> the brookings institution will have another look of arab politics tomorrow when they turn their attention to egypt. the panel will discuss the role of civil society after house nate mou barrack. live coverage at 1:30 p.m. eastern on c-span2. next, the authors of a report arguing for a negotiated peace

with the taliban in afghanistan. congressman anthony wiener discusses the federal health care law on its one-year anniversary. later, morocco's foreign minister discusses his country's proposed political reforms. on "washington journal", a report on america's fiscal management. then a discussion on unrest in the arab world with the former u.s. ambassador to morocco. live at 7:00 a.m. eastern on c- span. >> this weekend on "book tv". a panel discussion on john failedey, jr.'s assassination attempt of ronald reagan. throughout the weekend, from the

virginia festival of the book, panels on madison and science, the vietnam war, the founding fathers, and religion. find the complete schedule at booktv.org. >> the century foundation released a report on the prospects for peace in afghanistan. the report's authors argue for a negotiated political settlement with the taliban. the century foundations international task force on afghanistan presented the report at the national press club. this is one hour. thank you for joining us today.

if all of you had time this morning to see an op-ed in "the new york times" entitled " selling the afghan war", our speakers make the case for what could be the next steps in thinking through a complex set of challenges. i am going to the state of play. we are striving this live on a number of blogs and web sites. i want to agree to those folks and say hello to c-span which is covering this morning and voice of america. we have the task force staff director for this and the head of foreign policy programs, and i will introduce our panel. we have with us to my left,

lawrence korb, former assistant secretary of defense and ambassador thomas pickering who served as this task force's co- chair and former undersecretary of state for political affairs and served as ambassador to six different affairs. he was our ambassador to the united nations. other co-orce's chair, special representative for afghanistan from 1977 through 1999 and 2001-2004 and finally, james dobbins. thank you. >> thank you and thank you for coming. two years ago as the new obama

administration confronted the imminent collapse of the neglected project to reconstruct and secure afghanistan, washington's think tank beehive was abuzz with excitement about counterinsurgency as the elixir to cure the deteriorating situation. from the century foundation perch in new york, out reflecting with our friends at the carnegie corporation, we were doubtful this would and what was already afghanistan's 30-year war. major troop reinforcements could recoup lost ground, but this has been a war with lots of foreign hands and perhaps too many foreign intelligence services involved to be set right by yet another military solution. the end game would not be shock and awe, but afghan regional and global politics. enlisting financial support from

the carnegie corporation, the rockefeller brothers fund, an active collaboration with the german foundation, we embarked on a project to look at afghanistan in its regional and multilateral dimensions, led by an exceptional international task force composed of distinguished people in these areas. bajardi international, a minority american. we were fortunate to recruit lakhdar brahimi a, and from late 2001-2004 was the un special representative in afghanistan and one of the few people walking the streets in the city today who has engaged directly with mullah omar. and thomas pickering, america's

most accomplished diplomat and an ambassador to anywhere that could have broken somebody's career, but who made it into an exceptional series of addressing problems for america on the world stage, culminating fortuitously for this project as ambassador to the un, ambassador to india, ambassador to russia, all places relevant to finding solutions to the afghan problem. he was undersecretary for political affairs at precisely the time the taliban was during into an embrace with al qaeda. americans on this panel spent administrations from reagan to the second bush's. international members span from western europe to turkey.

in the report, it spells out the input this panel had. fresh analysis and brilliant background papers that are listed and i would call your attention to one particular published on women in afghanistan from the perspective of someone who was undercover trying to maintain women's schools during taliban rule in her country. with background meetings in a dozen capitals including meeting with afghans on all sides from senior officials of the government to the political opposition within the political system, to civil society, too, yes, persons intimately linked to the insurgency. we at century, we provided the

kind of support that hand writing what was being told to us by these task force members. they set the course and it is to them we turn to outline to them our group's recommendations and findings. >> thank you. -- thank you for your kin d introduction and setting the stage. the prospectus were unanimous. of footnotes,ee disclaimers, and i think at this stage, any serious differences were remarkable and unusual and quite encouraging. many of the people who were concerned have had long and deep experience in afghanistan and

have the opportunity to join us in meetings around the world to know and understand how people were proceeding and understanding this issue. my job is a simple one. every man's or woman's guide to the report. to give you a sense of what we addressed and how we see it. there are three major questions that formed the backbone of the report and our recommendations. is it appropriate to have a negotiation, and if so, when? the second was what to negotiate about and how to get there. with each of these, we come forward with our analysis and carefully phrased and focused recommendations. to begin with the first one, it was not immediately apparent when we began and still is not to this day in this town and around the world that a negotiation has a place in all of this.

we think it does for a number of reasons. we detect with the help of many on both sides, including our military leaders, a sense of a military stalemate. progress may be being made on shoving back and forth across the 20 or 50 yard line, different ways of dealing with the problem, but we do not see any goals in sight and we see no crossing of a goal line. the second point i would make is that people are getting tired. the financial costs are increasing. our friends and allies are going home. we see some wariness among the taliban and some frustration things are not moving the way they wished to go. we see around the region including key players, a feeling that approaching a political settlement from their perspective makes sense. all of these have to encourage us to believe that a political

process needs to be included. i have a simple sense that all wars and with political implications. if you do not try to shape them, you undertake to accept what you get. and from my perspective, this is important. we believe for a much that an exploration has to take place and i will come to that when i give you the answer from the task force for the third question. the second question is a difficult one but it is clearly that the central focus of a negotiation will be at among afghans about the future governance of their country. we will have to involve afghans from the four parties that jeff set out for you. the present government led by hamid karzai, the loyal opposition, the northern alliance folks, civil society,

including those groups that have emerged in the last two or three years who are truly impressive in kabul in their dedication to the future of their country and their search for an equity and justice and getting their, and the taliban, a significant number of whom have indicated their sense the negotiation process has an important role to play in the future. the country from their own somewhat narrow perspective. it is also important to recognize that there are many other issues that have to be addressed in the course of governance and beyond. central to that, of course, are forms of governance. is a parliamentary system of any value? how and when do appointments take place? what is the structure of the future of the government regionally and centrally? is islam adequate and how can

one assure human rights and the of rights of women are maintained and prospered in the future of this country, and money other issues -- many other issues. the international community has its own thoughts about the negotiations and somewhat more prescriptive way. the non-return of al qaeda. the disappearance of foreign forces, for example. there are other questions that will need to be addressed. the question of how to get their was particularly interesting and taxing for us. there are many ways to go. we decided that we would try to not only illustrate but inform the international community, those who will pay attention to this report, and we hope it will be attended to widely. we thought there was one

approach to this that made more sense than perhaps any others. it was an approach built around a process of facilitation. the appointment of a facilitator, a person, a group, a state, perhaps a group of states or an international organization could fulfil this role. we thought you and blessing would be helpful for this kind of process -- un blessing would be helpful for this kind of process. the initial roll the facilitator would be to talk with all of the parties and explored extensively with them two questions. one was, was there a consensus building in favor of negotiations? secondly, on the basis of the development of that question, what did they want and how did they believe they could get it? as a result of the negotiation? those questions are critical. at the end of an exploration process, we thought that the

facilitation mechanism should consider next steps. we deigned to suggest that the next step if it was decided to go ahead, was to create something we like to call a steady international conference. a group that will bring together the key players. it will have in our view two important roles to play. one would be the center for an inter-afghan negotiation which should take precedence in our view to help to decide those critical questions that relate to afghanistan itself. around them should be clustered various circles of players. critical and very important our pakistan and the united states, for all the reasons you know better than i do. close in as another circle, countries like iran and india.

the central asian neighbors of afghanistan. and beyond but also closely related, china and russia. the european union or its key members. japan. turkey, a special and interesting possibility given its role in the region and its current involvement in afghanistan. perhaps saudi arabia and perhaps others. we are not prescriptive with respect to that. their role would be initially to work closely with the facilitator to help in fact cement ties and bring forward the kind of agreements that are absolutely necessary to see the inner afghan part of the process prosper. the their second role and it will evolve in our view over time to also consult together and negotiate to undertake

hollen what with the international community and particularly the region will support what is that the afghans can agree, support what the afghans would like with result -- respect to their future status in the region and the world, is it neutrality or something else? also make commitments themselves on critical questions regarding the future of afghanistan. centrally continued economic assistance and wherever required in the future of the government, security and assistance to help against any of surgeons -- resurgence of al qaeda. as well as a series of issues having to do with the international role in afghanistan, peacekeeping and here we are persuaded that needs to be monitoring and verification of the agreement.

the central part of the process of working things out. all of this is illustrative of the fact that a military and economic surge needs to be complemented by a diplomatic search to take advantage of all the progress that has been made. and to take advantage of what we see now clearly is the evolution of the situation. we are encouraged that we present this today at the right time. we are encouraged that not only among the aficionados huddled behind desks in academia has this idea struck a chord of interest. now even more importantly, up to and including the highest officials in many countries around the world, many of whom we have consulted in advance. we're not persuaded that presenting surprises get to

anywhere. presenting consensus is much more effective and that is what we have tried to achieve. now it is my great pleasure to ask lakhdar brahimi to share with you his perspective and the great contributions he made to the production of our report. >> you said everything. i do not know what you want me to add. just emphasize the point that tom made at the end of his presentation. that is although we were 15 people, not representing anybody

except ourselves, coming from various countries, i think we were from the beginning clear in our mind that our work is not academic. it is something we hope will be useful to the people that are concerned with people -- issues of war and peace. concerned with the problems of afghanistan. therefore as we worked a long to try and prepare the idea that you will see in this report and that tom has summed up well for you, in doing that, we needded to speak to as many people as possible to avoid surprising them, as tom said. not only in washington, the americans, the un in new york,

the government, and others in kabul and afghanistan. and elsewhere. because some of us went out of kabul. the neighbors, pakistan, many of us went to pakistan and talked to not only the government, the military, but also to members of parliament and civil society, former ambassadors that we have known in the past and who are still talking to their government. india, we did the same thing. we have not been able to go to tehran but we did talk to the government of iran and a few others from iran. a couple of academics here and elsewhere.

we made sure that people knew what kind of ideas we had started with, tried those ideas on them, listen to to their views and worked out this report that you are going to see. we think that there is not much new in the report but there are perhaps a new way of putting out these ideas and organizing them. -- organizing them to see how we will move from the situation that exists now to hopefully peace at long last in afghanistan, for afghanistan, for its neighbors, and for the rest of the world. i would like to add a few things. why, amongst other things, why this idea of negotiating.

-- negotiating a settlement that hopefully will be accepted by everybody in afghanistan and also accepted by the neighbors of afghanistan. tom has mentioned my personal experience. my personal experience in afghanistan, i had two incarnations. the first time i was the envoy of the un to try and put an end to the civil war that existed when the taliban was slowly taking over most of the country . by september 11, they controlled 95% of the country.

we feel completely. i myself -- the effort was continued by the un after i left and september 11 came and the conflict was finishing because the taliban have practically taken over the country. we were telling the taliban that ok, you control the territory. you are not going to have peace unless the other parties accept the kind of dispensation that will be in kabul and afghanistan. they thought that if they took control, it would be all right.

the second incarnation we had was after september 11. we, the un, tried to see if on the back of the military campaign of the americans against afghanistan, against the taliban, because the taliban were are bring the people who attacked the u.s., if following that military campaign of the americans, we could resume our efforts and help the afghans create a government and rebuild a state that was acceptable to all its people. i think that we have made considerable progress in doing that. afghanistan i think has an

elected president. they have a parliament. i think development has taken place over last 10 years as it never had in the history of afghanistan. all this is very good. we made a number of mistakes. it was impossible to have the taliban. i think if we had invited them come out they would not have come. it was impossible to have them there. the next best thing we fail to do. the next best thing should have been to start exploring the possibility of talking to the taliban, those of them who were willing to talk to us immediately after we returned it to afghanistan.

the bulk of the taliban was still there. where did they go? we did not ask this question. we did not go out and look for them. i am absolutely certain and have been for a long time that committee had made that effort, perhaps we would not be where we are now. the second question is that, isaf, formed at the recommendation of the conference was a noncombatant

force made almost exclusively from western countries. one of the reasons why the force was small was the great reputation of afghanistan. they do not accept foreigners . people were coming from

everywhere. can we please have some of these soldiers? we immediately asked for more soldiers. unfortunate, we were unsuccessful in getting more troops. these are two important mistakes we have made. a third one is a little bit personal. in 2003, i went around with what we called the bond to paper. surely, we have made mistakes.

because of the success, perhaps we need to revise a little bit and look back at what we have done and it just -- and just -- adjust what we are doing. that was rejected back in those days. we see that it was not perfect. this is a little bit of the background that has convinced me that a new approach is needed. what has been done is good. it has been successful in part. just like i personally did with james dobbins, we did very good things. but we also made mistakes. the same thing that is happening today. a lot of very good things are happening, but not everything is perfect. a new approach is needed. that new approach, we think,

quite a few interesting elements in this report. i will stop there. james dobbins will tell you the truth. >> you will have to speak for yourself about those early mistakes. [laughter] i agree with both of the mistakes that you mentioned. one of the things that struck us as we did our research for this report to was the overwhelming support within afghan society for some kind of process of negotiation, a combination.

-- accommodation. polling shows is strikingly strong majority that wants a peace settlement, that are prepared to make some unspecified accommodations to get a peace settlement. what is interesting is that there is strong support -- even in the segments of society that one would assume would be the most skeptical -- this support is not universally shared among the political representatives, all boat is important to recognize that the -- although it is important to recognize that the former number alliance president is the chairman of the high peace council in charge of creating a national consensus in support of this process. in the united states, i think there has been a debate over the last year or two between the concepts of reintegration and reconciliation.

reintegration is a bottom of process in which you detach elements of the insurgency on the iraq model of putting them on the west imperiled. -- western the payroll. it was successful in iraq. reckons the like -- reconciliation is considered a top-down process in which to negotiate with the leadership of the insurgencies in order to declare an end to the conflict. i think it is our view that

these are entirely compatible approaches and if you pursue them both simultaneously, you will be more successful doing both. that is if you are talking are trying to talk to the leadership. it is going to be easier to talk to the foot soldier and the captain and the field. a local settlement will be facilitated. to the extent you're having success, you are putting pressure on the upper levels to make a deal before they lose the support of their constituents. we do see these as mutually reinforcing processes. i sense that the debate in washington over this has diminished, if not ceased entirely. anyone that reads hillary clinton speech on february 18 will see an unambiguous endorsement. none of us can firmly predict that this will succeed, but we do believe there is a realistic chance and we believe there is nothing lost in trying.

there is a great deal to be gained. >> i will be very brief so we can get to the questions. this was a wonderful experience for me because the americans -- taught has been in a lot of task forces before. but never in a minority. given the fact that our visit was not dominated by the united states, we got a lot more frank discussions from the various members. everybody agrees there is no military solution. secretary clinton, secretary gates have said that. that is why it is important that we will have to move toward a diplomatic solution.

the other thing to keep in mind is that not only the afghans are tired, the americans are tired as well as our allies. the country is broke and for every soldier or other members of the armed forces we keep their, it costs us a million dollars. it is costing about $10 billion for our major allies to be there. they're also having economic problems. our military forces are overstressed and over strange. to continue this for a long period of time is only going to increase that. in terms of dealing with our budget deficits, the defense department is projecting to begin to reduce the size of the army and marine corps within a couple of years. that is going to make it more

difficult to keep up. we " secretary gates. this is not going to be a perfect solution. this idea that you were going to have this is not going to come about. finally, why now? from a military point of view, keep in mind that when president obama unveiled his so- called surge at west point, he talked about this summer as a point to begin withdrawing our troops. i think this will happen. i think it is a good time for the taliban to want to enter into the negotiations. our feeling was based upon the conversation we had of been there, the taliban did not want to look like they had been defeated.

once you begin to temper that down, i think they will be more willing to enter into these type of negotiations. i was reminded of somebody that the kennedys used to call -- if not us, though? if not now, when? [no audio] [applause] >> for those who are listening or watching, the report is available at the century foundation website. i would like to open it up for questions. if you could state your name and affiliation. there is a microphone that should be going around the room. >> thank you. david, the huffington post. the most recent assessment is negotiations are a great idea, but first we have to get a little bit of an edge over the taliban over the battlefield. the taliban has the same

approach. what is your assessment of whether those ideas are for public consumption? how much do you think the u.s. military and the taliban -- how do you get beyond that kind of assistance to negotiating? >> we addressed that question i extreme blanks. there is no question at all that it was very much in everybody's mind. when you are at the height of your power, the slope ahead is all down hard. -- downward. it takes to negotiate, obviously. -- you want to be careful to select your time. it takes two to negotiate,

obviously. with all of the fact that we have put on the table and with all the conversation that we had, the appropriate time to begin the exploration. on the american side, there are pending changes. we are not sure that even force reductions will mean a great deal of difference in terms of force capability. however, i would like to emphasize again the central thesis of our view is that this is a military stalemate and we do not see signs of that breaking soon. along very you wait to begin a process of seeing whether there is a political answer, the harder it becomes. >> it seems very much that you are pressing on an open door. a lot of what you propose have

already begun. the current u.n. representative in afghanistan has been organizing meetings of regional ambassadors. he spoke yesterday here in washington. he talked about organizing a meeting in istanbul this summer. we have the high peace council, which already mentioned. why propose more bureaucratic structure? [laughter] >> let me take a lap at that. -- whack at that rate 12 months ago, it was not that much of a slam dunk. it is now time to bring the threads together. a certain amount of cacophony and laudable objectives may be right, but over time, if he wants to take energy, you have to focus it and move it.

in fact, numerous channels, the endless numbers of individual conversations, are all taking into account to that we are on the cusp of needing a certain effort that will move ahead in phase is that we've set out and tried not to replicate what is essentially a series of isolated conversations and semi jamborees, and begin to put it into something that could actually lead somewhere. we feel this is a serious contribution of our report. >> i have a point on the facilitator.

there are a couple of factors that are featured in a recommendations. we think this is a full-time job. it is not something that can be an added function of somebody was already pretty busy. secondly, it cannot be done principally in cobble -- kabul. you also need to engage neighboring countries in ways that probably transcend the instructions of their local embassador and require consultations in a variety of forms. finally, it's a process is started, that process will not take place in kabul. those are some of the factors that led us to believe that something new was required in addition the soundings that the u.s., the u.k., the un, the afghan government have been taking on this subject.

>> thank you free report. let me put the question to the panel. you talked about a facilitator. it will be the initiator? how long will you get this thing under way? to is going to light the fuse? pakistan is clearly critical. just when you think relations cannot get worse, they manage to do so. what is your plan for improving u.s. relations and making sure that pakistan is part of the team, and not part of the opposition? >> we have not pointed -- we have no authority to appoint -- there is no question at all that this will have to mean as much to the u.s. as any other party. without the u.s., it will not work. the u.s. has the peculiar possibility -- working here with china to bring islamabad further along the path.

it has to come. the afghans are critical. it is that nexus, in my view. i cannot believe that given the american tradition of always wanting to solve every problem and seeing itself as the irreplaceable spark plug, that it will not start there. the proposal is not to improve pakistan-u.s. relations. by ellen view is that i cannot imagine anything -- my own view is that i cannot imagine anything that would make a greater positive difference in pakistan-u.s. relations was a process that led to some reasonable and acceptable solutions to afghanistan, as difficult as we all see that now.

nine months ago, we saw the process of being entirely improbable. we now see after conversations that it is probable. we see the negotiations and the agreements that have to be reached as entirely improbable, if not extremely difficult. over time, we had even begun to see signs that what we are preconditions to discussions on each side are now being moved into becoming their negotiating objectives in the process was underway. these are encouraging. they are helpful. in my sense, they can help make that difference that we all would like to see in pakistan- u.s. relations. >> let me take to questions. -- two questions. >> dennis coax from the woodrow wilson center. what sort of role do you see -- what is the role of u.s.

military going to be the day after you have an international accord? do you envision part of and a lot -- of an accord accepted by afghanistan? >> i will take one more. >> i represent a coalition of veterans for rethinking afghanistan. thank you for your due process. we have been advocating for two years to get this going. to get our troops out of there. i served in both battlefields. i am generally critical of counterinsurgency as a method of war.

it seems pretty limited to me. with regards to president obama and he had been lustration -- and the administration, does the current administration have the current to start this process and all it through to the end? if we do not, what will happen if there is a changeover in leadership? >> before we get too far down on this -- i could take a brief shot at those questions. thank you for calling all of my best friend here who are experts at torture. dennis, the question of u.s. bases is clearly an issue between the united states and afghanistan and certainly in the context of negotiations. my own personal view on this is that what be administration has

been saying about not seeking any base presence, but committing itself to long-term support of an afghan government in whatever way is necessary, and is probably as good an answer as anyone can find. it was not a central subject of the report because the reports only suggests ways ahead. it does not seem to prescribe points of agreement or specific ways to get there. maybe others will come along in the near future and begin to be helpful on the part. it was hard enough to get over the initial to hans -- two humps. this is a question between afghanistan and pakistan. you know better than anyone in this room, it is fraught with

difficulties. in the end, one could only hope that it does not become a central roadblocks. over a period of time, the two countries will find ways either bilaterally or using judicial process to see if they can find an answer to that question. thank you for your points. i would only emphasize that we have from the very early days of this report discussed with key officials of the administration. they will have to speak for themselves. on the record last night, they indicated that they welcome to the consultations. they welcome to the reports, that they thought it would be useful. my own feeling is that the central purpose behind this report, with all the players with him we spoke, we wanted to give them an inspiration and a way to gear up courage to move ahead. to do so, on the basis of facts and analysis, not on the basis of hype and hope.

i think we have tried, but it is up to you to decide whether this report is in the right ballpark. our consultations lead us to believe initially that for the obama administration, people with him we have spoken, it is in the ballpark. >> what the wake one comment. -- let me make one comment after you come to an agreement, you may need a u.n. peacekeeping force. we model but on other countries in which said this happened. -- we model that on other countries in which this has happened. >> humans and -- humans and there is a widespread agreement for a political end to the conflict. i wonder if what you laid out in the report is that close to the current u.s. policy. clinton said that -- hillary

clinton noted the goal of the reconciliation was to split the movement from its irreconcilable core. that is significantly different from what you are advocating in this report. first of all, you outlined the possible settlement -- take the constitution as a departure point. i think that addressing the taliban as a unified movement is a little different than trying to split it. i wonder if you could address that. >> maybe i could do the one piece on the u.s. policy. i think that everybody is free to give their own exegesis on the secretary's speech.

i would point out that it is the feeling of many that reintegration, which is bringing people in, is entirely compatible with reconciliation. it is finding it wait for word for the whole future of afghanistan. -- finding a way forward for the whole future of afghanistan. the secretary was here a careful to say that those to work looking previously at preconditions for discussion have not converted those preconditions into negotiating objectives. there is no internal

disagreement on these particular points. >> you are absolutely right. it is different. we do not represent them, they do not speak for us. i believe that the devastation is on record -- the administration is on record supporting. they have said that several times. they said it here. the thing is, how are you going to do it? i do not think there is anybody who says there is any solution, as it is a political solution. how are you going to do it? these contacts with the taliban, these ideas that are floating around, they're useful.

absolutely. at the end of the day, many of you have followed -- it was three years ago in kenya, having left the united nations, having to mitigate the terrible consequences. the most important thing was to demand from everybody that he be the only channel. everybody has his support. he did not say, only i can contribute and and work out the solution. he said, i need a lot of support. that support has got to come to

me and we've got to have one channel. this is what you need. that does not exist yet in afghanistan. that is what you need. you need that one channel for this political solutions that everybody is talking about. >> no negotiators specifies the concessions he is prepared to make at the beginning of the negotiation. [laughter] hillary clinton has said that accepting the constitutional line down their arms and cutting ties with al qaeda is the objective of the negotiation and. it is our opening position. nobody gets their entire opening position at the beginning of the negotiation. if you agree to it, you are

implicitly stating its willingness to compromise on some points. the united states government is going to have to prepare 400 futures traded one as a future where there is an agreement. one is a future where there is no agreement. things like talking about the base structure in afghanistan post 2014 clearly is appropriate in a world in which there is no agreement. the alternative obviates the requirement for much for all that and creates a different future. all the government can talk about at the moment is the default future. that is, there is not an agreement. they have indicated a willingness to go down the other path.

that is the most we can expect from them at the moment. >> will take one last question. >> -- we will take one last question. >> doug brooks. my question is how the west is going to accept this. there were a lot of real gains in terms of the electoral process, women's rights, and so on. there will have to be some sort of compromise to come up with an agreement. do you have enough assurances from western nations that they're willing to allow some of these advances to be pushed back a bit? >> you know, what we hear from western nations, europe and canada, what we hear is that -- that is the most important thing. yes, of course, they insist on protecting the gains in human

rights, women's rights. but their main concern is to get out. i am not sure how people view these gains that have been made in afghanistan. these gains are modest. they are the subject of debate amongst the afghans. what is very, very important is that you have now large afghan constituencies that are fighting for those rights. that is what is important. that is what is not going to go away. but we started to discuss human rights, i have very serious arguments with my colleagues in

geneva. i told them, what we need is support the afghans to set up their own organization. since to dozen to, -- 2002, you have a strong organization led by a woman that has offices in every single city in afghanistan. fighting for their rights. one day when, one day they liz. they're still a lot of programs -- one day they win, one day they lose. there are still a lot of women who still in themselves to death because they're forced to be married.

those problems are going to continue. that will continue whether you have peace or not. they will have a much better chance of moving forward, however slowly, in this environment than they have now. >> thank you very much for joining us today. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >

coming up next, congressman anthony wiener discusses the health care law on its first anniversary then the proposed political reforms. then further discussion on peace treaty in afghanistan. >> on c-span 3, special counsel to president nixon talks about the watergate break-in, the secret white house tapes, and his relationship with the 34th president. then slavery in academia. also, remembering the father of the constitution, the story and author who says that james madison who should be known as the father of american politics.

>> beginning april 1 and throughout the month, we will feature the winner of this year's c-span studentcam competition. and focus on events commission, are topics that helps them better understand the role of federal government. watch the winning videos on c- span and watch the people who created them. >> new york democratic congressman, anthony wiener, said today that the white house needs to do to -- need to do more to highlight the benefits of the federal health care law.

>> welcome. i'm the chief operating center for the american progress. i oversee it was enacted one year ago today. congressman wiener was talking about the -- talking at the center for american progress action fund. >> thank you all for coming today. i am mayor ed tanden. -- i am neera tanden. we are very honored to have you all here. prior to my time here, i served on the president's health care reform team at the white house and was an advisor to secretary sebelius. i am particularly honored to invite you here on the first anniversary of the affordable care act. it is actually a six-year anniversary for us here at cap. it was six years ago today that we put forward our own plan to provide coverage for all americans, reform the health care system through insurance regulation, provide tax subsidies, and subsidies for people to be able to afford it and to lower the cost of health care.

it sounds a little familiar. i hope it does. we believe it helped shaped the debate in the presidential cycle and ultimately the congressional passage. over the last six years, cap has worked very hard to push the idea of covering all americans and lower health care costs as well as working with our allies in and congress. ing all americans and lowering health care costs as well as working with our allies in congress in last year's debate to get the bill done. through that process, now six years later, i know that on this anniversary, there are those who are a little weary from the attacks a year later. people wonder why the bill is still so controversial and why we're still having to defend it. we have a congressional debate which, instead of moving forward to discuss how to make the bill work more effectively it's really about how to take all the

benefits away from people. a lot of us can grow a little tired. i find myself every once in awhile growing a little weary from talking about health care reform and defending its benefits. every time we grow weary, i hope we remember that people who are already benefiting from this law, the cancer patient, who no longer has to worry that she has to cut off her basic services from her doctor because she's reaching her life time limit, because of the affordable care act, those days are over. the parents who worry about being able to get health insurance for their child with asthma because she has a preexisting condition. because of the affordable care act, those days are over. on the affordable care act anniversary, i also hope we'll remember those public servants who underwent angry town halls, some of them under went death threats to defend this, during

the process of the deliberations and ultimately voted to have affordable health care for all americans. there were many public servants who knew it was a tough vote, knew it was a politically tough vote for them, but they did it for a simple reason, that it was the right thing to do. in the cynical age, it's important to remember that that was really the guiding principle for very many members of congress. so we're very honored today to have one of those fighters and true champions of health care reform, congressman anthony weiner. he's a western who never shies from a fight. often leads the fights on behalf of progressive values, whether it's 9/11 workers or health care reform or funding basic benefits for the american people. he's been a champion for these issues throughout his service and has been a champion for health care reform. for that, we're very grateful and very honored to have him. congressman weiner? [ applause ]

>> thank you. thank you very much and thank you for the center of american progress for hosting. it is indeed the one year anniversary of health care reform and i'm thrilled to be here. if you are busy or have time later, i'll also be doing a twitter town hall meeting at was 6'4", 220. this is all that is left of me after 22 town hall meetings, 70 hours of markups and hearings.

i think there has been this exaggerated sense that was frequently from -- that was expressed by rather inartfully by nancy pelosi in a widely misquoted thing she said. there was this presumption that after six months of pitch debate and back and forth, once the law became a reality and people could see it on a piece of paper and the policies would take shape and we would start to see people in our communities that benefitted from health care reform, it would be harder to make up stuff about the bill, harder to lie about the bill. that turned out surprisingly not to be the case. a year later, a year after pen to paper by the president of the united states, a year now that people can actually see what's in the bill and what's not in the bill, there's this widespread and sophisticated campaign by republicans and opponents of the bill, many of them sponsored by the health care industry to make up things about the bill to continue the

mistrust that goes into it. now, i think to some degree, we democrats and progressives, we sometimes have this fidelity to process and words and laws that we sometimes don't realize that it's not enough just to say here's this great bill. here's the good thing it's doing and we're off to the races. i think we haven't done a particularly skillful job in the last year of rebutting some of the basic thrusts of the republican opposition to the bill. thankfully, the republicans have given us another bite at the apple by coming to washington in 2010 with an agenda. they've come to washington to say let's repeal and replace this bill. every day we've had hearings on some other vote or element of defunding, eliminating the health care bill. they've put an enormous amount of stock to have portions of it ruled unconstitutional.

some of the hiding under the desk wing of the democratic party are chagrinned at this. i, on the other hand, i think the center for american progress has reviewed this as well. we welcome this. this is like a second opportunity for us to make the case and explain to people the separation between wheat and chaff here. there are a lot of opportunities where people are going to be doing summaries of the bill, i want to take some of those basic republican thrusts that i don't think we've done a good job of confronting head on, and just trying to take them down a notch and try to explain why at the end of the day, they are not only not valid, but in many cases deeply hypocritical. the thirst thing said abo first thing said about the bill, we who sponsored the bill was this notion that what we had done to health care was this giant transformative thing. in fact it wasn't.

in fact for many americans who have health care at their workplace, they're still going to get treated like crap by their health insurance company. they still have very few chances. that still is going to exist. i would like to have done more transformative things and made those things more difficult, but out of a deep sense going into this that we wanted to try to find a compromise between the people who were like me, who said let's double down on the employer-based model, double down on the single pair government model as medicare, which essentially takes money from taxpayers and gives it to doctors. doesn't take very much in overhead and nothing in profits and the employer based model. this effort was made to essentially double down on the employer-based model. there were great pains that were gone into by the sponsors and by those of us who supported the bill not to completely disrupt the marketplace of people that already have health care.

the one thing that is said that is most commonly said is that health care was completely transformed. for those that are uninsured, it is a dramatic improvement. they have a place to be able to go. for small businesses that want to do the right thing, provide health care for the workers, enormous benefits, but the notion that the entire health care infrastructure got turned on its head a year ago today simply is myth logical. there are things that were changed but not nearly as many as many people in america wanted. if you look at many of the polls that say what wound up happening? are you satisfied? if you drill into those dissatisfied, you find out many of them wanted bigger change because they found out that frankly, their benefits were not going to improve that much. the next thing is that there is big government takeover of health care. no, in fact this is the opposite. when people use words like socialization to describe what is happening, this is the polar

opposite. we are taking taxpayer dollars and giving them to private companies, private insurance companies, it's the opposite of socialization. and in fact, even if we would have done what i wanted which is expand medicare to more americans, that wouldn't have been a government takeover of anything. it's private doctor, private hospital and private clinics. the idea that socialization or something like that is happening, it's quite the opposite. we went to great length in this law to empower people to get private health insurance policies. the third we hear is, it's particularly interesting to have governors come to washington and complain about the plan, although they were governors with political interest like haley barbour. come to washington and say you're trampling on our rights as states. if you look at how the bill is structured, the exchanges, we gave the states every right to administer exchanges. i think even the most anti health care governor is going to

say yeah, we want our state to govern the exchanges. we hear republicans complaining that there's not tort reform. hi, huma. apparently there's peace in the world. she's able to stop by. we took -- should i start at the top? no. she'll be one of the people on read it asking questions later. the decision not to include a broader tort reform and limit on torts in the federal law, something the republicans bitterly complained about today was a hat tip to the idea that's the province of the state legislators. there's not a body of tort law that governs things like mal practice. the idea there's a big takeover of trumping state's rights is not the case. finally, we've heard many

governors complain about provisions of the law that expand medicaid eligibility between now and 2018, saying you're going to bankrupt the states. what they fail to point out is in that period of time, yes, more people are going to be covered under medicaid, but it's going to be paid for entirely with federal dollars, resulting in what should be a dramatic savings for the states. now, there is a scenario in 2019 that states have to pay a lot more, but that's only if you govern your state very poorly. because if you think about it, the expansion of medicaid still means you have to have an enormous amount of poor people for this not to be a good deal for your state. it's funny to list ton haley barbour come to washington sand say you're going to bankrupt my state. he's stipulating to the fact there's an enormous number of poor people in the future in his state. it's further ironic to hear the governor of mississippi which has the most generous reimbursement rate complaining about anything in the federal

government. they get close to an 80% reimbursement on their medicaid expenses compared to 50% in new york state. far be it for me to complain about haley barbour. i hate to punch down. still i believe that the kplamtss about trumping state's rights are simply not true. today, we saw an article in the "usa today" by congressman gaves, who is the chairman of the small business committee, talking about the burdens to state. that's not true. there's a 1099 provision is the only new regulation tax fee burden put on small businesses. on the other hand, we, in this law, are going to make it 30% cheaper for any small business to offer health insurance to its workers. in the future, we're going to allow those small businesses to go into this exchange where there's going to be competition to hold down prices. we're going to offer small

businesses for the first time ever the opportunity to get subsidies to purchase health insurance for their workers. if anything, we now have republicans complaining bitterly about one of the largest tax cuts for small business in american history. the idea that somehow small business is being burdened by this law, quite the opposite. we hope that small business takes these incentives to go out and buy insurance for their workers because it is simply unfair to be honest with you, to have a shoe store on one side of queen's boulevard to make a decision to offer health insurance competing on one on the other side that doesn't. the fact is those costs are getting passed along. the way we chose to solve that problem is to offer heavy incentives for all small businesses to offer insurance to their workers. another common cry that we've heard from the republicans is the notion that this is going to bankrupt the federal government. we could have a conversation that can dominate this forum on

how the cbo score was done, how it's ten year projection, 20 year projection, both of which show this is going to be a dramatic reduction in the national debt and deficits, i prefer we focus on is an element of this discussion that has not come up in this conversation about costs. the cost to the federal government is only one of the costs that we have to deal with when dealing with health care. we also have the cost to localities and local taxpayers. when uninsured people walk into hospital emergency rooms without care, in new york city, we pay $8 billion in taxes. $8 billion in taxes each and every year for the uninsured and the under insured. that doesn't even count to the social cost of the fact that we have 17 fewer hospitals in new york city since the year 2000. that shows up in no cbo score. it shows up in none of the debate that we've had in washington about the cost of this bill.

frankly, there is a transfer from local taxpayers, from state taxpayers to the federal government in this bill. even with that transfer, it winds up being a net savings of $1.2 trillion over 20 years. i want to point out when we have this conversation about cost and bankruptcy, one of the things the cbo gives zero credit for is a lot of the incentives built into the bill for preventive care. we know intuitively and we also know because our mothers told us an ounce of prevention is worth a pound of cure. the heads of cbo don't see it that way. they give us no credit for virtually everybody agrees is that if you do things like we do on the medicare side of the bill, where we cover preventive services 100% without a single co-payment, that you're going to insentivize people to get those preventive services, the

conversations we're going to be having about insentivizing in years to come to get more people in the front end of the health care structure than the later end, none of those savings are included in the bill. i think if anything, the cost is articulated by the cbo score are very, very conservative. that in fact, the savings are going to be much higher. if you start adding in the savings to state and local taxpayers, you're going to see the number increase even more. finally, there is this issue of the mandate. this is perhaps dominated in more conversation than it really deserves. first of all, the philosophy behind the mandate is one most americans understand, the idea that people have to bear responsibility in this transaction for their own care. people have to be, if we offer them incentives, if we offer them subsidies, ultimately they

have to accept responsibility for their own health care decisions inasmuch as they impact everybody else. there's a basic element of legal thinking that, you know, the right of my fist ends at your nose. i can do what i like. when i start to impact your rights as an american, as a steb, there's reasonable place for government to come in and set the rules of the road. when it comes to health care, people that choose not to get insurance, choose to be uninsured are making a decision that has only two branches on the decision tree. one is to be perpetually healthy and the other is to pass along expenses of health care to someone else. as much as we think we're ready, the shear expense of being hit by a bus is pretty high. when you can't pay it, it gets passed to hospitals and fellow citizens. the mandate is something that was included in romney care, included in the president that the signed a year ago.

in massachusetts, which again, it's a similar model. i'm going to enjoy watching governor romney debate himself during campaign 2012. it's a similar model. here's a subsidy. here's a system to shop for health care more efficiently. now you have to get it. a number of people that given that structure, which is the same in this bill, that chose not to get it in massachusetts was .067%. meaning virtually everybody. this should come as no surprise to anyone who takes a step back from the political debate and thinks the way most people think, people want health care. they want health insurance. they want their family to be protected. they want that peace of mind. if lightning strikes and it turns out that as many of us believe the supreme court turns out to be a third political branch of government and they strike down the mandate, big deal. big deal. first of all, i believe that as many of you know, not to get off

on a tangent, it's pretty clear that justice thomas should recuse himself from these decisions given the amount of money he's gotten from companyings overturning health care reform, putting that aside, we pretty much see the direction the supreme court is going, although i think it would be folly to strike it down, it's a relatively small number of people. by the way, the solution, if the mandate is struck down, is not that the bill falls like a house of cards. people aren't going to suddenly start cheering and say i'm going to sign up, now i'm not, the solution is going to be offering something that everyone agrees is constitutional. that's the public option in the exchange. clearly that is constitutional. no one denies that because it would be into medicare, social security where we do require people to withhold money from checks and go into those programs. if you think about that list

that i just read and the brief and i think i did each in a couple of minutes, the brief rebuttal, it donesn't change th fact that more millions and millions of americans, they saw this first year not be as much about back and forth as if they wanted it, if they were a senior citizen, they got coverage for the doughnut hole, if they were a young family, 23 or twour 24-year-old person in the family, they were able to go on their parents' health insurance plan. this next period is going to be very, very important. it's going to be the rule making that's going to go on, as with any big bill, it's going to go on here. you have enormous back and forth about the minimum standards in the bill. that's the next big fight. every advocate for an illness is going to want coverage. advocates for certain technologies want prejudice in the bill for their services.

that's going to be tough but necessary. the third stage of the bill is the implementation of the exchanges which is where the big stuff that we're trying to do in the bill, covering the uninsured, taking that burden off of states and individuals. that gets implemented and people get to shop on those exchanges just the way members of congress and federal employees shop for their benefits. the final stage of the bill is all the republicans who voted no going to ceremonies and going to town hall meetings where they're bragging about how great obamacare is. they have to bite their tongue for calling it obamacare for the next 50 years. i don't anticipate this fight will end. i think we're in this dynamic that synopsises are facing in a certain direction on this bill. we're going to continue to have debate. democrats have only a couple of choices. we can engage the debate or not engage the debate. i think it would be folly to believe it is going away. it would be folly to believe that i am either. thank you very much.

[ applause ] >> we'll take your questions. go right there. that's great. so i have a few questions and we'll take questions from the audience. first of all, you referenced the presidential debate, the upcoming presidential debate. as you might note, republican presidential candidates, possible republican presidential candidates are celebrating the anniversary differently than we are. you referenced this a little bit at the end, what specifically do you think advocates for the legislation should do over the next year as presidential candidates on the other side attack the bill with a lot? >> it depends on who we think is going to run against us. i think the one thing we have to do is make it pretty clear that

a lot of the values that these republican can indicates espouse are in the bill, are reflected in the legislation. look, this was basically a structure that republicans, for years, had advocated. the idea of taking tax benefits and incentivizing people to get health care. we took a couple of steps to codify it differently than they would have, but, you know, there's inherent inconsistencies in what they argue. there's a class act which is a voluntary long term care insurance program. what it does, it says if people sign up, they can sock away some money and they get a guaranteed cash benefit to provide long term care services in years to come. it's a medical savings account. it's exactly what many of them have been arguing repeatedly year after year, yet this is what they want to repeal. the other thing is i think we need to embrace this argument

about -- i think we need to engage and have some fun with the argument that the field is having with mitt romney because, if for no other reason, he to some degree deserves some credit. i mean i can do him his campaign by giving him credit, but for leading an adult conversation in massachusetts but also showing something else. the basic thing we learned from the romney care plan in massachusetts was that even a state isn't muscular enough to be able to force insurance companies to compete and hold down -- hold down rates. most of the rest of the field doesn't seem to know what's in the bill. either that or they're overtly lying about provisions of the bill. i think we should -- i mean, i don't think the president necessarily should engage every one of them, but i believe we as democrats have an obligation to the primary voters of iowa to have this debate.

>> also, we could demand they put their own plans forward. >> right. >> i want to shift a little bit to the budget debate. we're seeing there's two points emerging in the budget debate on the hill. there's a debate about how much money we spend. and then there's a debate about riders. obviously, repealing health care reform itself is a rider. so i wonder, there's been obviously a lot of back and forth. the white house seems to be signaling they have a real concern about the riders and trying to eliminate that. i think it could end up that we're in a place where a government shutdown is threatened over riders itself. how do you think we as advocates should respond? >> well, there's two things i think that fundamentally have to change here. for one, i think we need a competing narrative from two of

the basic thrusts of what the republicans have said. one is repeal and replace. i believe fundamentally americans offered the choice between repeal and replace and something like implement and improve believe basically in the idea of not rolling back things but trying to work them out and make them better as we go. yet we haven't offered them that narrative. it's been very defensive and reflexive up to now. the republicans have done a pretty good job of making this fight on their side, for lower deficit, smaller government, less debt, lower taxes. our side, it's just this general defense of the good things that government does. rather than us having our things, we should have, i don't know, medicare, social security, environment and education. those are our four things that we're not going to budge on. now let's negotiate, because i think the challenge we're having in this town legislatively and from public perception is we have not defined our side of the

argument particularly well. i think if the republicans want to shut down government ovary peeling the health care reform, i don't think we're that lucky. i mean, there is this tendency among republicans right now, but i think that it is insufficient as i said recently, to sit back and wait for the republicans to self imlate. i think we need to have an affirmative contrast. >> i now invite questions from the audience. if you could identify who you're with. over there. >> bob catcher. thanks from brookings and mckenzie. we're inspired. republicans keep saying, this bill doesn't cut deficits enough, yet they're against cutting medicare and medicaid. how do we score that argument? what's the right comeback? >> yes. for one thing, implicit in a lot

of their critique during health care is they can't possibly like medicare very much. you know, they're concerned. i mean, i asked a panel of witnesses at one of these mind numbingly boring hearings on health care, whether the panel considered medicare to be a single payer system that they derive so much. i think there is this notion, you just mentioned it, that it takes a great man to build a barn, but any jack ass can kick one down. we pretty much know the republican talking points against the solutions we've tried to come up with in this bill. we've yet to see very much public pressure put on them to come up with what their ideas are. i can tell you their ideas during the health care debate, not with standing their protestations were not serious, things like tort reform is a solution.

well, the cbo -- we asked cbo to score a 30% reduction of torts. what they found is it would save you $50 billion over ten years. we spend 2.7 trillion every year in health care. they have yet to be terribly serious about it. i think we haven't done a very artful job even with the thrust of this nonsensical question of double counting of the $500 billion of savings of medicare. article after article have unpacked that and explained it to my republican funs. they keep using it because it's fairly successful. we need to do a much better job pushing back. >> right there. >> my name is scott. i'm from gw. first of all, thank you for -- i don't think members of congress, i don't think y'all get enough

credit for this bill. you get a lot of crap for it. i'm diabetic, i have a preexisting condition. i'm able to stay on my parents' plan until i'm 26. the president said something about letting states opts out if they can come up with a better plan by, like, a few years from now. what's the whole consensus on that? what are they trying to do about that? >> what was your name? >> scott. >> before you put down the mike, there's a lot of talk about the free market governing health care. you chose to have diabetes, right? that was your free market decision? >> yeah, when i was 8, i said that would be cool. >> i think -- look, thank you for the kind words. i think the president articulated something that i was debating whether to bring this up in my remarks about things we're not pushing back upon enough. there have been well over -- i don't know what the exact number is, over 1,000 waivers given

over different provisions of the of the bill to states, labor unions and businesses. this notion of one size fits all, the federal government shoving the bill down the throats, hhs has administered this bill to be very sensitive to the idea we have common objectives. we want lower costs, more access. we want the system to work. the idea that somehow we would not want the law to work by driving health insurance companies out of business or by being inflexible in regulations. in fact the waivers, i would hope that the administration kind of understands, makes this argument more forcefully, is an argument, look a lot of the people who got waivers were organizations that didn't like the bill and had real problems with it. some of them are friends. i think when the president said if you've got better ideas that can accomplish the same thing, come do them. i'm in the process in my office of trying to see if we can take him up on it in the city of new york. i have a passing interest in the management of the city of new york. so i'ms

i think the president is right. if you can achieve the objectives of the bill, then all of us in congress would be flexible enough to say go to it. >> right here. thank you, congressman. i'm from americans for democratic action. you mentioned before we weren't doing a very good job at that narrative. i simply want to ask why, and what agents you think need to play a role in helping us craft

that, as a young progressive, where should i go and who should i be looking to for leadership on these issues. >> thank you from your organization does great things. i think it's more about who we are structurally as progressives to some degree. we have this idea that if you have a law and think it through carefully and you're trying to implement and you have regulations, we're all going in the same direction, that ultimately, that will weigh out for someone who still to this day is talking about death panels. i think to some degree, we have to play more skillful defense and offense at the same time. i think that today, you're going to see a lot of democrats. nancy pelosi is using her twitter feed to have another benefit of the bill every hour. it's important to do. it's important to realize that we have not done a good job disabusing americans of some of the things they've heard so many

times that we can't just say that's obviously not true. people can go to any website they want and look at it or pull out a fact and check it for themselves. no. we have to keep doing -- we have to keep at these fights. who does it? i think the white house has to understand at the same time they're trying to write these regulations this is going to be an issue in campaign 2012. i think whether they like it to or not, and i think they should make a virtue of it and should be out there doing it more. i think there are a lot of people in congress who are trying to do it, but we in congress still have within the democratic family do have disparate voices. there are some people who are cringing anytime health care comes up they don't want to go through that again. it's not going to get any better. we're going to have this discussion whether you want to or not so let's have it skillfully. >> there's a question in the back. sorry to make you walk around.

>> i'm deborah shumen with physicians for national health program. i've also been working in the state of maryland with the governors coordinating council to implement the affordable care act. one of the main things going on in anap list during this session is to try to create an exchange or at least set up the structure for an exchange. in maryland, we have two bully insurance companies care first and united health care who control 70% of the market. one of the things that they talk about in the committee meetings is who's going to pay for the exchange. they look at it as another layer of bureaucracy. i have to say i agree with them. i wonder how this is going to get paid for once we have the essential benefits package. these are all good things,

essential benefits package is a good thing. no lifetime limits a good thing. no preexisting condition limitations and recisions, those are all good things, but i really can't believe that an exchange is going to be able to control costs. it hasn't in massachusetts. i'd like to hear your comments. >> first, look, there is no doubt we are, to some degree, betting on the following premise, that if you give companies a playing field on which to compete, if you give consumers information that allows them to examine choices side by side, that the presence of that competition and the rules of the road being consistent, will lead to people making decisions that are driven by cost and price and that consumers will choose lower priced plans and that more choices that people have, the more likely costs will come down.

this, by the way, is not socialism. it's free market concept. it's the law of large groups of consumers shopping for a product. now, we are not entirely taking a shot in the dark here because putting aside the massachusetts experiment which had mixed results, we got the federal employees health benefit plan which covers 9 million americans and their families. that's a pretty big universe of people who use an exchange model that is very low cost, meaning the administration of the program costs less than .075%, less than one 0.1 of o1%. there's one other element that my republican friends talk about a lot but ignore in the bill. once you have regulations that are consistent across state

lines, that tennessee can no longer have very, very bare bones things, there's nothing stopping companies from offering services over state lines. this mantra we hear from republicans all the time. why don't you let companies sell their products over state lines. there's a simple economic reason. they have their own state insurance commission, but another is a fairness thing. if tennessee, just to take an example, offers a bare bone, low cost health care plan, it would serve to attract a lot of younger, healthier people and states like maryland and new york would be stuck with more, bigger families, more sick people. it wouldn't be fair. once you have these regulations in place, you may have more than two choices, but your argument, your question is why cbo said that having the public option would save a bunch of money, because then we would know that there would be an efficient, low cost option available to people

and with that knowledge, we know that competition would at least have some effect on lowering costs, but to some extent, it's an experiment with the rules of the free market, and unfortunately, the insurance industries have proven that the laws of economic gravity don't apply when it comes to insurance rates for a lot of reasons and hopefully, this model will work. >> we have time for one more question. someone in the front? right there. >> final question, congressman, ms. tanden. what's the verdict? is this a happy birthday or an unmerry birthday? >> i'll let you take that one. >> the way i look at it is what are we going to be saying about this in, let's say ten years? if you look at, as i did, you look at the debate on medicare, you look at the year after. there was still enormous amount

of questions about whether the system would work. what ultimately happened was a divided public opinion. ultimately, evolved to a near universal among 65 and older people, near universal support for medicare. among people 65 and below, a great deal of confusion. but i do think that if we're going to look back at this year and we're going to laugh at some of the things that the things that its critics said about the law. we're going to see that things like a day of armageddon or whatever boehner said the day that this passed, crazy. and still be tweaking it in ten years. that's what medicare -- we're tweaking it to this moment. so i think this is a day that testimonies and people who voted for this bill should be celebrating. and i hope it's a day that

americans renew an interest in it and don't look at, you know, two people shouting on tv and try to learn a little bit more about the law. and i believe that each successive year that goes by, if we handle this conversation right, i think it's going to be seen as a true success story. and i guess the question is going to be this. this time in 2012 or later in the fall of 2012, are you going to see ads by the republican saying, don't vote for president obama, because he passed obamacare, or are you going to see ads from president obama and all the people like some of in this room that are getting care going to be the latter. so i think this is a happy birthday. thank you. >> thank you.

>> >> you do not want the federal tort law to supersede state all

do you? >> if it is very beneficial. >> would you agree that you want state law to supersede federal law? >> i think in federal cases, i think there ought to be a federal law. >> if you go into federal court in mississippi, state law prevails. >> medical malpractice is a state law. >> that is correct. >> you do not want federal law to supersede state malpractice laws. >> not in state cases. >> do you think you have any additional cost alcohol -- costs at all? >> always try to say what the cost work. we are set back limited. >> do you anticipate that the

state of mississippi will have more or fewer poor people with you as governor? >> we will have more -- >> is it your policy to reduce the number of poor people in your state? >> our goal is to grow the economy and have more people working. >> is that a yes? it is a rhetorical question. that would make you a more successful governor. if you have fewer poor people, with your medicaid costs down? >> we added 60,000 employees might first three years as governor. we are better under control. >> by 2017, you have fewer poor people than today. your calls will go down will they not? >> they will actually go up. they will put all these people on medicaid under the affordable care at the or not want it now. >> let me put it out in terms of

the law. under the affordable kerouac's, -- affordable care at, at $30,000 will be the maximum coverage. in 2017 when the federal government starts absorbent one under% of that -- if your number of poor people goes down a sufficient amount, if you are a good governor, your medicaid costs will go down, will they not? >> the definition of poor eligible for medicaid are two different things. the number of people eligible for medicaid will go up. >> $30,000 for a family of fort will be the new limit. fewer for people -- fewer poor people work medicaid. >> the gentleman's time has expired. >> that is exactly the number i gave you.

>> we will discuss the one year anniversary of the affordable care act on this morning's washington journal." this is 45 minutes. host: rebecca adams is with us, the associate editor at cq healthbeat. we have a separate line for health care practitioners to call in on. 202-628-0184. we will get to the second bullet point in a little bit. but i want to stop on these health insurance exchanges. guest: in 2014, there will be new markets open for people who buy insurance on their own, who

do not have employer sponsored coverage. these are people who get their care through individual or small group markets now. these are going to be new insurance exchanges that have to meet federal guidelines. states can choose whether to run their own or the government can come in to create these marketplaces. people will be able to go to websites and see what is offered in their state, see what prices are. they will have pretty uniform benefits in the health care law. host: they are only allowed to participate in their own states exchange, unless there state says that there will be part of the federal exchange? guest: there is law that would allow regional compacts to be up and running. most states will probably just have it within their own. host: have you heard about other state performing a compact? would that be competitive for the buyer? guest: we have not heard much.

it is in the early planning stages. in the next year, state officials will be deciding, do we want to run this ourselves, do we want the federal government to come in, what do we want the exchange to look like? host: so people do not have access to these exchanges yet, even though funding is beginning. how are states reacting to this? guest: it is interesting. we have heard a lot of complaints from the 29 republican governors out there, but not all of them are saying they want the government to come in. some would want control over their exchanges. we want it to reflect our values and what we want. so we are going to run it ourselves, regardless of our opposition to the health care law. host: we got a phone call earlier from abramoff collar, -- from a vermont caller, saying

that they are going that way of single payer. guest: vermont has an interesting history. you remember there was quite an expansion of public programs in vermont any way through public programs. they want to build on that to have a state-run health care plan. host: let us talk about the cost. that has been critical. cbo came and with new numbers on how much this is going to cost. what did they say? guest: repealing the health care law would cost $210 billion, if the republicans were to succeed in that. that is something that republicans will disagree with. they say, cbo, we have to pay attention to what they say, but they are discounting the impacts because they do not believe all

the savings will accrue to medicare from the cuts in the law. they also say the costs will be higher than expected. so there is a little bit of disagreement on whether the scores that are put forward, but estimates put forth by the cbo, are simply reflecting what is on paper or reflecting what will really happen. host: cdo on friday said this, according to "the wall street journal" -- guest: the cost of coverage in everything, that is what is included. but we have reductions also. when i was talking about the

$210 billion cost, that is cuts to medicare, other programs, so that is when you end up with. host: so they did not take into consideration payments to doctors, everything else, that will be revised? guest: not to the increased costs. host: mary is a democrat. good morning. guest: most people -- caller: most people do not realize these health care companies are on the stock market. their goal is to raise the stock price, paid executives. they make these huge salaries that are beyond comprehension. they do not prioritize real health care. this is what i see amongst most of the people that i know. if they realized this, they would have a different attitude towards the affordable health care plan. guest: she is correct.

some of these insurers are publicly traded. aetna, humana, etc. this would allow states to take a closer look at a rate review. the federal government is not saying that rates have to stay under a certain amount, but they're providing money to states to take a closer look at whether insurance rates are too high. starting this year, one thing that is important, there is something called the medical loss ratio going forward. what that means, in simple english, insurance companies are not supposed to spend more than 80% of your premium dollar on anything such as medical cost in texas. that is for the individual market. for large group markets, 85%, who have spent a bit more on health benefits. if they do not meet that, then

next year, consumers will get a rebate. host: lee is a republican in springfield, missouri. one year later, what are your thoughts about health care? caller: i am on social security disability. i just got on last year. period a two-year waiting plut to get my medicare, but they want a $631 premium. there is no way i can afford it being on disability as i am. i am afraid of this health-care law, the premiums that i will have to pay, being on limited income. host: she wants to ask you a

question, so hold on. guest: have you been uninsured for at least six months? caller: yes. guest: you have an option that you may want to look into. the pre-existing condition plan. it started last july. you may want to check it out. it offers insurance to people who have been uninsured for six months and have pre-existing conditions. this is something that states are ripping up through the country. the rates are better than what you would typified through high risk pools or private insurance. they are still not terrific, but better than previously. the government is putting $500 billion to offer that insurance. host: for people with pre- existing conditions that prohibits them from getting private insurance and temporarily put them into a high risk pool.

robert is a democrat in atlanta, georgia. caller: good morning. i guess i am one of 140 million americans without health care. i have been living on my savings for several years. i would like to get health insurance. i have two questions. where do i go to find out -- can you recommend a government agency that can help me get started? and because things are changing because of the implementation of this, should i do this now or when things change? guest: let me just say, if you have been insured for six months, you might want to check into this program that i just talked about. but you have to be uninsured for six months. if you buy insurance and looking

to the pre-existing plan, then you are not eligible. host: what about that criteria, pre-existing condition? guest: if you are in a state running one of these high risk pools, then you have to have been denied by insurance companies for anything that is a chronic condition. states are a bit more flexible. some of them don't need to necessarily have gone through the entire process. let me mention a website, healthcare.gov. there is another, healthcarefinder.gov. you can enter your zip code, and it will give you some options for insurance. host: next phone call.

good morning. caller: i am calling in reference to the health care law that was passed. i am one american that does not have health care. people do not realize that 17% of our gdp was going to our health care. we cannot do that if we are going to be a leader in the world. host: what about those numbers? guest: he is right. we have one of the highest costs per capita around the world and our mortality rates are worse than some of those countries. we spend more than other people in the world and some would argue that we did not get as much for our money. host: the senior house policy analyst at consumer union has a piece in "usa today."

one of the first thing he read it -- recommends is to not demand unnecessary care for minor ailments and pains. things that will heal on their own. a large body of research shows that up to 25% of care that is delivered is useless, questionable pa or harmful. guest: that is something that we say with parents that have children with viral infections. an antibiotic will be issued, but that does not really help. there does seem to be a balance. you need to be getting appropriate care. host: some other recommendations that he makes --

share record with other doctorsk tv" what are your comments on that? host: we should note, it does bedight your privacy, but you may want to consider another doctor. here are some of the websites

they recommend. guest: there are all sorts of things out there to look at. you can also look at the medicare website which has hospitals, compared by quality measure. host: an independent caller in arcadia, florida. caller: if obamacare was such a good deal, why did they have to give out a thousand waivers and exemptions to companies and states? guest: he is referring to something that took place over the past year. on september 23, there were a lot of different consumer protections that kick in. we saw things like the coverage for young adults and other things kick in. one of the thing that took effect was a limit on how much

insurance companies can cap your insurance every year. the health care law says that has to phase out, and in the first year, the limit was $750,000. what hhs faced was a lot of complaints from employers that said, we offer these very limited health-care plans. we are either not going to be able to offer these plans at all, we will get rid of our coverage, or you have to give us a waiver. there is no way we can meet the limit this year. so it hhs complied. they did give out a thousand waivers. 90% of the applications were approved. a lot of those went to mini-med plans, very basic health plans. host: according to "the new york

times" -- seattle, steve on the republican line. earlier there was a story on "politico." he was supporting it initially but now says that it will put too much pressure on businesses. caller: i am a small businessman. he is absolutely right. since you are showing media accounts, the most misleading and inaccurate statement that rebecca made was the idea that states have the option under obamacare to have their own values and run it in their own

way. that is not true. i want to draw everyone's attention to a march article of "the national review." it is by michael kamen. keep in mind, obamacare does not allow states to decide policy. this article points out that the federal mandates, the only thing the states are allowed to do is have people or heavier mandates, equal or heavier price controls, or a single payer system. anyone -- and the states are a lot to do that even before obamacare was passed. you should go to the article as a resource. kathleen sebelius has made it clear, and the law has said, these can go towards mandates. it is heavy price controls

combined with the heavy mandates that will force insurance companies to be unable to compete in the free market. prices are going to go up, rationing is going to occur. any state that starts putting together their own -- you know, plan -- it is better to put the burden on the federal. you have to totally repeal and dismantle this. people should stop saying that states will have their own belt use through this bill. guest: he is right, that there are concrete things in the law that are not negotiable, that states do not have control over. the individual mandate, that is something that states cannot wave. the employer mandate, -- there are a lot of things in the law, especially related to benefits

that have to be in the plans. all of those things cannot be waived. he is right in that sense. what i was meaning -- republicans who are concerned about the law but still want to run the exchanges are thinking that they will test the limits of how much they can tailor the law to their benefit, how much influence they will have over that. host: cspanjunkie tweets -- chattanooga, tennessee. dorothy is a health care practitioner. what do you do in the industry? caller: i am a nurse. i had to retire because of arthritis and i had back surgery. what puzzles me, i went back to work but i could not work full- time. because i could not work full- time, i could not get insurance. my therapist said, why don't you

try for disability? because i was gainfully employed, i could not get disability. now i am training for a job that will let me do sit down work, but i cannot get health care. while i am working, nobody wants to employ somebody who is high risk. and i cannot afford -- any health care that i can get will not cover my back. he only way i can get high risk insurance is if i go without health care. that is a rationing. i have never seen anything more like rationing. it discriminates against people who try to work. i think that is decimating for our work ethic. everything is against the worker. host: hang on, dorothy. guest: if she has insurance, in

order to qualify for the temporary high-risk pool, she needs to be without insurance for six months. it is what is available. there are limits on when you can qualify for disability. congress, 10 years ago, tried to loosen those, but there are still restrictions that apply. it sounds like she is in a difficult spot. host: next phone call. larry on the democrat's line. caller: i am a single data with three kids. i was trying to get health insurance for them. what can we do about the deductibles? deductibles seemed to range from $1,000 to $3,500, depending on what you pay for a premium, and i could not afford to pay the deductible, so insurance companies would --

host: i think we have your point. you have to remember to turn down your television. i would recommend you see if you qualify for the children's health income program. it is a bit more than the medic medicaid income level. for deductibles, it is difficult. you need to shop around and do what you can. if you have access to a flexible spending account, you may want to look at that as well. host: when will medicaid be expanded? guest: 2014. 15 million people will be added to the rolls. right now, there are a lot of restrictions on who is eligible. you have to be in a certain category to qualify. one of those categories is people with children.

if you are a child less of adults, often times you do not qualify for medicaid. in 2014, that will change. anybody under 133% poverty will be covered, regardless of whether you fit into one of these categories. host: for all ages, all types of people? guest: yes, if you are over 65, you are eligible for medicaid. host: let's go to paris, illinois. donnie is an independent caller. caller: i was so happy that i just got on. i have been waiting for a while. the lady and fellow that was on before i called answered a lot

of questions that i had. i am basing my opinion just on today. medicare, medicaid, social security, disability. i started working when i was 13, picking strawberries over the summer. i have worked all my life. i am 58. 2003.e been crippled since i was lucky enough to have children although i have only started to collect medicaid in the past few years. my youngest is starting college this year. i lost my insurance december 1. between december 1 and february 2, i have already accredited about $4,000 in medical bills from my heart doctors and everywhere else i go. i do not understand how the situation is working.

how do people, who do not work, and have not worked, and i see people collecting medicare, they get paid, social security check us, they get disability every month, and i am still fighting for that. guest: medicare and medicaid, you have to qualify. it is income-related. one of the things the proponents of universal health care have said, they wish there was a public option in the health care law. they wish everyone would have had access to a government-run plan, which is not part of the law. host: we talk about what would happen in 2013, state-run the insurance exchanges. other aspects of this law that will be kicking in, phasing in of subsidies for medicare part

b coverage gaps. -- d coverage gaps. guest: last year, these people got a $250 check to cover this. this year, it is going to change a little bit. there will be a 50% discount when they are in that group, known as the don't hold. it will continue like that until the gap is completely eliminated. host: other things scheduled to kick in. guest: i need to make sure i am understanding exactly which provision you are referring to. there is an increase for primary-care doctors that starts. it is a two-year program. but it phases out after two years. that is something that congress

put in, try to attract people to the primary care field. they earn less than specialists. there has been a concern about a shortage of primary-care. that is what that refers to. host: bennington, vermont. peggy on the republican line. caller: you actually just started to touch on what i have called about. i was reacting to something that you read from the "usa today" article about people trying to take steps to improve their own care. it included rating doctors, providing medical providers, making choices and choosing different providers, if you found the quality of service lacking. i think the real problem for many people, increasingly, is that you are simply not able to find any provider that will

accept you, particularly for those people on one of the government programs, whether on medicare or medicaid. they are not really in a situation -- and it is not just those people -- but particularly if you are on a government program. guest: she has a point. some of the critics will say, you are adding 60 million people, can you handle that? right now, there are some anecdotal access problems. the argument is, are you just giving people a piece of paper that does not really allow them to get the access they need to health care? that is one of the criticisms of this law. host: san francisco. murray is in the health-care industry. caller: this country is run by

people selling drugs. our country is addicted to drugs. our country is one of the sickest countries in the world. in reference to health care, i feel president obama has done an outstanding job. he is looking up for the masses of the people. he is trying to uplift the people. i feel he is one of the true statement that i have ever observed in my 78 years. the increase in the insurance rate is due to the pressure being put on the people, in order for them -- based on fear. guest: it sounds like he is a gung-ho supporter of the a lot and president obama. he referred to prescription drugs. that accounts for 10% of spending. the increase in insurance rates, there is debate about what

causes that. insurers will say it is because of the underlying health care costs. there is a perception among critics that the health care law is contributing to that. however, there are others who say that is really not true because the provision that have taken effect so far would have a modest effect on premiums. host: several opinion pieces in the papers about this health care law. the editorial page of "usa today" -- sam graves, a republican from missouri, he writes the peace in "the washington times" -- small business is not celebrating. he says this is having an impact on the mandates. the new senator from wisconsin, a republican, he also writes in opposition, in "the wall street

journal." he is writing about his own daughter and a halter that she received as an infant. chris is in frederick, maryland. independent. caller: thank you for taking my call. my question is along the lines of unfunded mandates that come down to the states. there are already doctors not accepting medicaid, medicare. what is going to happen in the future if there are more and more doctors at opt out, and even states that opt out? 20 states have pending legal action against this. is there a tipping point, something that may not have been planned for, if enough doctors and states opt out of this, and what will that do to the concept? guest: he referred to the constitutional questions. the supreme court is likely to rule in june, july, 2012 on the

constitutionality of the individual mandate that most americans buy insurance. in terms of states opting out, if states have decided they did not want to run their exchanges, and the federal government would run those exchanges in those states. melo will continue to go forward, unless the supreme court rules, or congress acts to stop it. host: we saw a new poll that said that neither side, opposing or supporting, have broken 50%. guest: absolutely. it is amazing. the numbers, i think, were 46% opposed, 43% in favor. that is not much different from the time of passage. 50% of americans approve this. host: debbie is next, a

republican caller. caller: i think we are going about this the wrong way. it is not so much the insurance companies. they need to be capped. but there needs to be a standardized cost. when i was on personal insurance, medicare -- eventually i have to go on medicaid. who i see as the bookkeeper are the hospital charges. day stay.or a three-sta and that is just for the room. no doctors, tests, anything else. when it costs you $150,000 to see a doctor, when years ago in used to cost $25 -- the services have not changed. they have more inside with the ppo's. they have everything right there

now. it is not the insurance companies, the insurance company premiums. and there has always been injured for pre-existing conditions. you just have to pay more. -- insurance for pre-existing conditions. guest: the law does to do anything with standardization of medical costs. it tries to deal with insurance premiums. there have been concerns about transparency in pricing, but hospitals charge. it is hard for a consumer to find out what something is going to cost before they go in, especially in an emergency situation. that is something that has been a concern over the years. supporters of the law " that cost will come down -- hope that cost will come down, with the

inclusion of care. host: we are showing viewers what will be kicking in. restaurant chains must disclose additional content. what happens after this? guest: this will be an interesting year. last year, there were a lot of announcements. the announcement of young adults staying on their parents' insurance. those announcements about a temporary high risk pools, early retiree program which subsidizes companies that pay for retiree coverage. all of the limits on insurance no longer being an issue. this year is different. it is interesting. a lot of what is going to happen will be in the courts and states. in the states, we will see a lot of planning, preparation for 2014, which is when everything takes hold c