fraud, abuse, or criminal conduct, you can take that information up -- and in the intelligence community, you can take that up to congress. the argument that you need to have press leaks is not the case. >> national security leaks and the press. possible avenues of investigation and prosecution -- topics for this subcommittee. watch online at disease and video library. -- c-span video library. >> the director of the national security agency said sapper attacks are on the rise, and it is time for comprehensive legislation. general keith alexander admitted that, politically, it is tough to get friends through congress now, but he emphasized that lawmakers on both parties know the urgency and agree that it needs to be addressed. this is one hour.

>> i suppose i should say something. first of all, thank you for coming and raising -- braving this cold wave that struck washington. judging from the size of the crowd and the number of cameras, i do not think that anybody needs to underscore the importance of this subject. it testifies to the statute of our speaker. -- stature of our speaker. let's take a few minutes to provide some useful historical context. to think back to the beginning not only of -- not of this century, but the last. the world today is transfixed by the phenomenon of rapid economic growth in a number of countries that are rapidly treating major powers in the world. of course, the biggest are china and india. some others that would look

fairly large in comparison to greet carter -- powers in the past, such as vietnam, russia, indonesia, and brazil. they are becoming much bigger players in the world. 100 years ago, the rise of germany as a great power led to two at catastrophically destructive wars. that also spawned a number of other tragedies, such as nazism and bolshevism, which turned the 20th century, which had begun with a decade of great promise, into the bloodiest in history. we cannot afford to repeat that history with even more terrible weapons of the 21st century. the challenge of managing a merging towers has become, arguably, the major challenge of our time. not that we are short on challenges. success depends on many factors, of which the military is only one, and perhaps, not even the

most important. but it is important. and it is worth recalling something else about the history of that last bloody century. what made it germany a country that almost conquered the world in the last country was not only its economic strength, but also the way it succeeded twice in transforming the economic power into military power, particularly with the mastery of armored warfare in the 1930's. germans did not invent the tank. german were not the first two field tanks. the british and french did at the beach -- beginning of world war rahman one. when the battle took place that led to a catastrophic defeat, the british and french fielded as many tanks as germany. it was not superiority in numbers that led to german victory, but rather superiority

and understanding of how that new technology could be exploited for military advantage. when we think about a technology that could have similar multiplier effects in our time, cyber technology stands out as an obvious -- the most obvious candidate. unfortunately, it is not only a potentially dangerous tool in the hands of states, but in the hands of non-state actors as well. famous recents book "confront and concealed," he describes an incident where senators this march came into a secure briefing room for a demonstration designed to scare the hell out of them. for half an hour, the senators got a vivid demonstration of what it might look like if a dedicated hacker or enemy state decided to turn off the lights in your city.

among those who came to make the case was general keith alexander, who runs the national security agency and the new u.s. cyber command. he goes on to say that general alexander is one of the "most important figures in washington that nobody ever heard of." i guess that is not true anymore, judging from this room. he also says that in rare moments when he talks to the public, general alexander is pretty open about america possible ability to such attacks. in a classified setting like the one the other day, it is very different. i do not know what that means about what to expect today, but we could not have a better speaker to address the subject. general alexander enrolled in the u.s. military academy in the class of 1974. it was maybe the first post- vietnam class.

members of that class or joining an institution whose future was very much in doubt. they made jokes sometimes about themselves. general david petraeus was one of the graduates of the class. they called themselves the class of 1974, pride of the court. -- core./ the class produced general petraeus and general dempsey, not bad for an institution. general alexander came into a career in military intelligence. it has been an outstanding career, including a tour in the first armored division in a desert storm. i worked with him closely when i was deputy secretary of defense, when he headed the army intelligence command from 2001 to 2003, and when he was deputy chief of staff for the army for intelligence from two dozen to to 2005.

2002 to 2005. after working with him for four years, i can confirm that he is an outstanding officer. he has since gone out to be the director of the national security agency, serving in that position since august 1 of 2005. that is seven years -- it almost sounds like a life sentence, but we are lucky he has served that long in two different administrations. 40 last two years, he has given -- been given the additional duty of the united states cyber commander. to those positions, he brings uniquely suitable qualities. he is an innovator and leader, but not a self-promoter. he is focused, but also deceptively low-key. he is a risk taker, but also very careful.

i might add, he is very smart. one other thing -- he does not like publicity. i am not sure we should expect -- what we should expect today, but we are lucky to have him with us. please welcome us in joining keith alexander -- join us in welcoming general keith alexander. [applause] >> i will -- part of the reason i do not like the publicity is that my mother used to say that i had a face made for radio. i am sure you have all heard that before. [laughter] another comment you could probably add to it is, behind every successful army officer is a stunned father-in-law. we have that as well. a few things i would like to talk about today. i know we will have a group of about 25 to 30 people to do that

with. i see that that has grown slightly. i am not a mathematician. there are some things i want to do -- put on the table for us to discuss. i know we will have a panel that will talk about what we talked about here later in more detail. first, what secretary wolfowitz brought up is absolutely important. cyber legislation. it is important we talk about this. i am not here to talk about any specific piece of legislation, but i do think it is important that we as a nation look at this and say, what do we need for our country? how do we do that? let's put all the facts on the table as we talk about this. i think it is important to protect this country from cyber attack. how will we do that? we just finished up the fourth

of july. i had the privilege and honor of hosting 14 young children at my house -- my grandchildren. when you look at these kids between the age of 1 and 10, the average age, i guess, would be about three. they are have ipod s -- all tremendously smart. they can run these things down to a battery and wilt is plugged in and keep on going. it is amazing what is going on in this world. think about the opportunities that we have. in the year 2000, there were 360 million people on the internet. today, in the first quarter of 2012, 2.3 billion. there are today over 200 million

u.s. e-mail users. in 2011, there were about 107 trillion e-mail's cent. -- sent. that averages out to 293 billion a day. a large portion of that was spam. the united states hosts 43% of the top 1 million websites in the world. by august of this year, facebook is expected to go over 1 billion users. that would make it to the third- largest country in the world. incredible changes. the united states would have -- 24% of websites have facebook

integrated into them. last year, -- traffic will evolve and grow 18 times between now and 2016. u.s. cell phone users -- 165 million. 90 million a check their e-mail every day. my daughter's check their e-mail every half hour. many of you do the same. how many of you, you get a conversation, then an e-mail. he said, i thought we were talking. there are 500,000 apps for the iphone. about 280,000 apps for andrews. by 2016, the world population is expected to be 7.3 billion. the world's mobile device population, 10 billion. some of you already know who you are -- you have two of them and

and ipad. it is growing. it is incredible what we will be able to do with this technology. think about what we can do for medicine. for genetic research. what hospitals will be able to do by 2015 that we could not do one decade ago. this is an incredible opportunity. stuff that we have to take the next step. think about it -- we are the country that made much of this technology. we ought to be the first ones to secure it. let's talk about the vulnerabilities and those things coming in. that is the real problem. you cannot hear me? can you hear me now? a little louder. i probably move this too far away. can you shoot me in the back? do not worry. you did not miss anything. [laughter] if you need some quotes, get some good ones from somebody.

there was nothing worth quoting there. look at the number of pieces of malware. all the statistics i am giving you are publicly available. you can pull these down from zd net, pew, gartner, they had some great statistics about where we are today. if you go to sofftpedia.com, they will tell you they have 75 million each pieces of malware in their inventory. 89.5 billion unsolicited denials are sent each state. that is roughly 1/3 of the e not going out on networks today. over 100 countries have network

explication capabilities. in 2011, the number of the cyber attacks rose 44%. malware increased 60%. the number of attacks on critical infrastructure when from nine in 2009 to over 160 in 2011. from january of 2011 to june of 2011, 19,000 malicious addresses appeared. 80% of websites have been hacked or compromise. it is interesting -- when you go out to companies in the fortune 500, the 160 companies queried in this, 162 had been packed. i will give you insight about some of those. some unique statistics. in june of 2011, google was packed.

in july, booz allen. mitsubishi, heavy industries in september. sony in october. at&t in november. chamber of commerce in december. semantec in january. nissan in april of 2012. visa and mastercard in april of 2012. when you look at this, these companies, you have to say, these are some good companies. what is going on? these and some of the best of our nation. why are they being hacked? let me explain. they are the ones who know they are being hacked. our experience is that when we look into it, when fbi and others look into it, there are more than 100 companies for each one that know they have been hacked to that is not know they have been hacked.

that is significant. in my opinion, it is the greatest transfer of wealth in history. semantec placed the cost of i.p. theft to united states companies at $250 billion a year. global cyber crime is 114 billion -- a billion dollars annually. -- $114 billion annually. $1 trillion was so bent on remediation. that is our future disappearing in front of us. let me put this in context. we have this tremendous opportunity with the devices we are using. we are going mobil, but they are not secure. tremendous vulnerabilities. our companies use these, our kids use these, we use these devices. they are not secure. when you look at what is happening in estonia, in 2007,

the monument issue. look at what happened in latvia, lithuania, georgia, as azerbaijan, turkistan, countries hit with cyber attacks. we have gone from exploiting networks for intellectual property to a tax. these attacks have been disruptive in nature. this is like the kids screaming at once at suppertime -- it happens every night. that was a joke. i can go slower. [laughter] no jokes. ok. the kids screaming every night when you are trying to have a conversation. you cannot communicate. as soon as they then are quiet, you can communicate. it distributed a denial of service attack is like that. the communications types are

filled up with spam or botnet email, denial of service. there are different versions of this that can block the communications channels or use up the computer capability of your systems. either way, you cannot communicate. but as soon as that stops and that is cleared out, you can go back to communications. but what i am concerned about, what i think we really need to be concerned about, is when these transition from disruptive to destructive attacks. i think those are coming. in a destructive attack -- destructive attack, your computer would simply not work anymore. if the bios or some version of the firmer, your system would have to be replaced. those are coming up. we have to be ready for that.

what do we talked about here? this makes this more difficult than the nuclear deterrent strategies and theories we have talked about in the past. when you think about cyber actors, let's put them into five groups. nation states, cyber criminals, hackers, hacktivists, and terrorists. not all of them are nation states. when you think about deterrence theory, it is not just nation on nation deterrence, you have other non-asian actors you have to consider. -- non-nation actors you have to consider. either way, the outcome could be the same. you lose the financial sector or the power grid. or your system's capabilities for a period of time. it does not matter who did it. you still lose it.

you have to come up with a defensive strategy that solves that. talk about that in a couple of different venues. first, a closer look at some of the international programs. i want to use some quotes here. this is a team sport. one of the things that people look to us and say, are you going to handle all of this? i come from the tom sawyer huckleberry finn approach. we want to get as many people as we can working together to solve this problem. that is what retakes. i think the white house has led a great effort in bringing that team together, bring in dhs in their role, the private sector, the fbi, and dod and the intel community. bring us in as a team.

our responsibility as foreign intelligence and defending the nation from an attack. there is another area. let me give some quotes. secretary clinton has noted that the growing threat to security posed by cyber intrusions, the threat of intellectual property, and commercial data by cyber means. this past month, secretary panetta, while testifying before the subcommittee on defense, said that america faces the potential threat for another pearl harbor, and that technologically, the capability to paralyze this country is there now. the more this technology develops, who is not to say that the world's potential to use it increases. in response to these risks, with many countries on these issues, we are working with many countries to respond to these

types of risks. at the 2012 u.s.-china strategic and economic dialogue, secretary clinton stated that, as two of the world's largest cyber actors, it is vital to the united states and china to have a sustained and meaningful dialogue on cyberspace issues and work together to develop a shared understanding of the acceptable norms of behavior, establishing clear and except or practices in cyberspace. what are we doing to address this? let's set an initial framework. i am not sure how familiar you all are with penetration test and hacking. let me give you a quick understanding of that. some of you -- how many of you are familiar with backtrack? one. that is good. two.

please do not correct me. [laughter] there is a great book out there on the basics of hacking and penetration testing. the reason i bring this up is that we are looking at this -- here is an army officer who has learned to read. actually reading a book. there are pictures in that. [laughter] but the reason that this is important is that i think we have to understand the issue of what is coming at us. we have to understand that issue to train our people. we at the defense department and the intelligence community have to know what it is we are treating people for. -- training people for. we should have a way of discussing that with industry. we will ask them to do many things we are doing today.

if you look at this book, what the book does is refer you to a program called backtrack. backtrack is a penetration testing toolkit. it is great. you can get back track, you can down the it off the internet for free. the price is great. you can get a virtual machine capability, download that, and you can uplift two systems. your system and the system you want to do penetration testing on. this is to train yourself and others on how to test your system to see if it is secure. this is what people are doing to our systems today. what the book teaches you is how to do reconnaissance. if you think about 2.3 billion

systems out there, it is not like hugh jackman drinking champagne, typing on the computer, and launching out tubes. i'm just kidding. [laughter] it is different. it is much more difficult than that. this book walks you through it. in this case, how to do reconnaissance. how, when you find a system, to standard and determine vulnerability. for example, one of the faults in our office uses this to test his system at home to see if he has portability's that others could be exporting. and to patch those. just like if you had mcaffee capabilities on your home system. why do i bring this up? my time on this -- and i am not

the of the computer operator that we have in our young of folks today. i was able to take one of my machines against the other over a 10-min. i broke into the other machine. down the files, took control of it and did with that machine anything i wanted to do. what that does is it says, what are the training requirements we have to have to defend against that? how do we help explain that? if we cannot explain that to the american people, how do they know what we are talking about is true? my concern is what happens is we throw out these words without having any context for them. that context is civil liberties and privacy. that context is, you can break the machines.

you are doing something illegal. the reality is that we can protect little -- civil liberties and privacy and cyber security. as a nation. not only we can, but i believe that that is something we must do. so this cyber legislation that is coming up will be absolutely vital to the future of our country. so what are we doing within the department of defense on this? we have set up five key areas. i want to talk about these. what does it take from the defense department perspective -- i will focus on the defense department initially. then we can use that as an analogy to look at what we have to do for the country. the first thing, building a defense of architecture. we have talked about that within dod. when we talk about building a defense of architecture, there are things that we can and, i

think, must do. one of those is, in my opinion, going to the cloud, a virtual i.t. infrastructure that is much more defensible than what we have today. many of you know from reading that the cloud is not perfectly secure either. we know that the system we are on today is not secure. 15,000 enclaves -- you have seen that. these are enclaves who can catch those at their frequency, which insures that, if humans are involved, the probability that somebody makes a mistake and hence there is a vulnerability is almost one. we should reduce the vulnerability by going to a virtual cloud. what we can do is have the computer update those patches and mitigate those vulnerabilities at network speed. that is a huge step from where we are today.

it is something we should take on right away. we need to build a trained and ready cyber force with the right number in the right capacity. one of the things -- the reasons i am reading that book is, knowing what the national security agency does and what cyber command does, and what our services are doing, what are the future standards we have to have for our military and civilians to defend this country in cyberspace? how do we know we are training the right? the answer is, lake that program out and get the right people. we have over 100 universities during cyber security-related stuff. put that on the table. we need to do that. we are taking that on. situational awareness. how you see cyberspace? think about that. if you got a group of folks

together and said, from a picture of cyberspace. what does that mean? show me what you are talking about. you are saying that you have got this different type of and vulnerability -- what does that mean? how you see that? how does your system defend it? how you know, how do we share information between government departments? how do we share information between the government and industry? how do we do that in such a way that the american people know that we are protecting their civil liberties and privacy? this is a great case in point. when macaffee and others look at the malware getting into the

system, they have a number of ways of doing it. they are not reading your e-mail per se. they're looking at the stream of data in hexadecimal format, looking for signatures or different types of activity. if they see that activity, they alert you. jump forward to our cyber legislation. one of the things we have to have is, if the critical infrastructure community is being attacked by something, we need them to tell us at network speed. it does not require the government to read their mail. or your mail. it requires them, the internet service provider of that company, to tell us that that type of of that is going on at this time. it has to be at network speed if you will stop it. it is like a missile coming into the united states. if you think about a missile coming into the united states,

there are two things you could do. you could take the snail mail approach and city saw a missile going overhead, looks like it is headed your way. put a letter in the mail and say, how did that turn out? cyber is at the speed of light. i am just saying that we perhaps ought to go faster. we probably do not want to use snail mail. maybe we could do this in real time and come up with a construct that you and the american people know that we are not looking at civil liberties and privacy. we are trying to figure out when the nation is under attack and what we can do about it. the nice thing about cyber -- everything we do in the cyber the canonchet with 100% reliability. it seems to me -- you can audit with 100% reliability. for situational awareness, we need to see what is going on. i do not mean that the

government needs to be in the networks. i mean, how you see what is going on and, like the police force, like the fire department, they do not sit around every building waiting for a fire to go off. you call them when there is fire. they come down and help put it out. in cyberspace, i see very much the same thing in our partnership with industry as an approach. another part. secretary wolfowitz talked about this a little bit -- transforming the way the government works, especially within the department of defense. some of the things we are working on -- how we work with other commands? how do we work with the department of homeland security, the fbi? what are the command and control relationships? how do we set them up? first and foremost, in my opinion it takes a team. no one agency or department can

do this by themselves. we have to have a command and control that leverage is the best of what each of us can do. the fbi has tremendous capabilities in this area. we have got to leverage them. dhs, the public space for private industry and state and other governments. we provide and technical support. we ought to do that. if the nation is attacked, finding out foreign intelligence is our job. finally, perhaps most importantly, obtaining the authorities, policies, and rolls. we are working through that. i think we are making great progress. the white house has taken a lead on that. you can see this in cyber legislation, in actions of the defense department, the intel community. there's a lot going on in these

areas. what i would like to do is give you a few thoughts on cyber legislation and then open it up for questions. i do not want to take all the time. i know there is maybe one question. and when we talk about cyber legislation, there are a couple things we need. we talked about information sharing. depuyt now there are vulnerabilities out there, we have got to have a way of sharing those former abilities with the private sector. or whoever is going to defend critical infrastructure -- so that they know what it looks like. we need to be told that when that threat hits part of an industry, what is going on, so that we can help stop it if it is our responsibility to do so. we have to take the information sharing -- there is a lot of information sharing going out there. the key thing in information

sharing that gets, i think, misunderstood -- when we talk about information sharing, we are not talking about taking personal e-mail's and giving them to the government. as a consequence, i believe that we are -- where we can all help is by educating our peoe on what does it mean to share information and to tell the government when we have a problem so that we can respond to its? that is a straightforward thing. we need to do that. if we do not, my concern is that we will argue about this and never get into a solution until something that happens. when something bad happens, we will jump way over here where we do not want to be. so while we have the time, the patients, and the understanding, let's get this right. let's do this now.

the second part -- i will quote the sans institute. they have a great website. i am not on their peril. i do not know if they have a payroll, actually. i might find out later. [laughter] the top 20 things you ought to fix if you are an industry. what are the top 20 things you would fix on your network? they then laid out those top 20. they our rules of the road. we talk about those rules of the road when we think about -- a they will fix those right now. [laughter] think about this like driving. if we had no rules of the road for driving, you could drive on the left side, the right side, there might be some problems. after a while, we would say, should we set up rules of the

road, like a drive on the right side? that will stop collisions. we start the right side. we got it right. the brits, we have to work with them. [laughter] this will be an international problem. but what are the standards we need now to protect our systems? he will have to set up some. how we will protect and ensure the systems? those are the problems we will face in the future. i think there are two things we need -- information sharing, from my perspective we need to think about that from the perspective of situational awareness. can we get that in time at network speed? we can do this and protect civil liberties from privacy. two, what are the set of standards we need out there for operating in cyberspace? so a couple of things.

as we looked at what is going on in this area, it is the greatest growth in our nation. it is tremendous what is going on. a tremendous opportunities for our country's -- country, and tremendous boehner abilities. other countries are using this -- tremendous opportunities. other countries are using the space. the possibility for crisis is mounting. well we have the time, we should think about and enact the things we need to ensure our security, and to it now before a crisis so we do not have to jump to this after a crisis. so you do not have me call down there to explain why it happened and what we did not stop it. i would prefer not to do that, as you know. those things are not fun. i think that is coming our way. you can see it's statistically, the number of attacks are growing. you can see that they then are

growing from destructive to destructive, and that our country has the bulk of the most of this network. it is the part that started it. as a consequence, i think we are the most vulnerable and we need to do something about it. now is the time to do that. with this, i opened it up for questions. [applause] >> waiting for a microphone. >> you do not need one. >> i will pass on the privilege to ask questions because there are some the out there. three roles -- state your name, your affiliation, and make a question, not a long speech. we will try to get as many as we

can. wait for the microphone, sir. >> i write for the epoch times. could you please talk about the cyber threat china poses to the united states? >> yes. did you want a long track at -- answer? -- longer answer? [laughter] if you look at the networks, the hardest part is to go into the details of your question. viewed statistically, the united states and china, as secretary clinton pointed out, we have the two biggest numbers of computers and related devices. from my perspective, there are

two issues. one, the greatest probability is that those devices will be used for disruptive, destructive, and other forms. we both have to get together and figure out a way forward. i believe that as we -- as it has been quoted, the threat of -- theft of intellectual property is astounding. we have got to figure out how to stop that. part of that is not having a viable defense. the defense is something that we can put together. that is where the cyber legislation comes in. i cannot go into the details of the threat in an unclassified venue. and keep my job. [laughter] >> sydney friedberg, aol defense. stuxnet and offensive capabilities in general get a lot of attention. a lot of people think the united

states is in the position of being the most-skilled rock thrower in a city full of glass houses. we have a glass house. it is a two-edged or -- soared. -- sword. what former belize to recreate for ourselves we work on offensive cyber? >> -- what of vulnerability to retreat for ourselves when we work on offensive cyber? >> that is a great question. i think that the issues that we face in cyberspace are different than the physical world. if you think about the two -- in cyberspace, this is an area where we have to look at, and other countries are looking at, what are the alternatives? what are the means of potentially getting other countries to do something that

they may or may not want to do? in the physical domain, that would have been a war. secretary wolfowitz talked about world war ii as an example. what are the things you can do that are short of a war? what things should we do that are diplomatic, economic, informational, and not just military? how you put those on the table? those are policy decisions, not our decisions. the consequence, in my experience, has been that people way those considerations -- weigh those considerations deliberately, and as a consequence the policies they come up with use of that. i cannot go more into detail than that general statement, being a general. [laughter] >> tony with bloomberg news.

to what extent has al qaeda or non-state actors acquire the expertise to move into destructive cyber attacks against united states or the last -- the west in general. what would be some of the ingredients they need for it becoming a viable threat in their ron? >> i do not personally believe they are a viable threat in that from now. let me qualify that. the reason i think that is so important to get to is that, when you look at that, you say, well, this is pretty easy to actually conduct some of these exports. the ability to get on a machine -- it is that easy. we look at the bar of entrants into our networks, the dod networks. we had a tough thing with critical infrastructure.

they are all different. when you look at the capabilities that are out there publicly to do this, those would be available to anybody who has access to the web and a semi- literate. from my perspective, because of the internet itself, that gap has decreased. you look at some of those -- you give somebody who has a computer science background, maybe even just at the bachelor's level, they could probably conduct this. i am concerned that, while i do not cedric today, they could very quickly get to that. they and others. that does concern me. >> i am an old auditing person.

the automatic digital network. it controlled the internet before. i have seen in recent times, going to a lot of cyber security fence recently, there does not seem to be an urgency to this legislation. a lot of people are talking about it. but nothing is being done. in the meantime, putin is president of russia again and he is not sitting by and letting cyber attacks go by. china has guidance. when are we going to get serious about it? will we have to have a cyber summit where we get them

together and say, look, pass this bill? >> well, there are so many things i could say. i will try not to get in trouble. i think that this time of year, it is politically difficult to move things through congress. my experience in working with both sides, republicans and democrats, both see this as a key issue. the key problem that i see is how do we help articulate what is in that legislation? i am getting a lot of calls from both sides. from my perspective, they then do want to push this. i think it is hard, because there are fundamental disagreements. we are solving those and helping people understand those, helping people get to the right middle ground -- that is a step in the right direction. we may not get everything i would personally want, but i think the legislation and

different forms -- generally speaking, they have the key issues and understand this. as the secretary pointed out, we have had a chance to talk to a lot of members, both in a classified and unclassified setting. they take this very seriously. there is no doubt in my mind. but it is also a difficult piece of legislation, because there are different views. d.c. those in the different versions of the bills out there. what we -- you see those in the different versions of the bills out there. we can help educate everyone on the civil liberties and privacy. i think that we need to do that. i think that we need to address that had-on. we need to show the american people we can do both. i think we do a good job of protecting our civil liberties and privacy. the information sharing is something everyone agrees that we have got to set up.

the hard part will be, what do you mean by setting standards? how you do that? how you get that right? that is a tough part. industry and everybody has got something -- thoughts on that. that is the party will have to work our way through. i see a need for that. -- that is the part everybody will have to work through. what is the right starting point? does that make sense? >> kathrin, folks news. thank you for taking my question. -- fox news. does the data center hold the debt of american citizens? >> node. i cannot get into all the details of the u.s. debt -- utah data center. we do not hold data on u.s. citizens.

one thing that everybody says that is grossly misreported -- you will take all the nails and put them somewhere in the united states. -- all the e-mail's and put them somewhere in the united states. we will not do that. think statistically for one minute. we are talking about probably 30 trillion e-mail's a year or more. does anybody read and 30 trillion emails? think about how that is. the mission that nsa does -- foreign intelligence with a focus on countering -- counter- terrorism. looking at what happened in world war ii -- enigma. red and purple. that is what nsa does. it has been the greatest

privilege and honor to work with them. they take protecting your civil liberties and privacy as the most important thing they do in kasich during this nation. so when people think, but they will have all this stuff at the utah data center, that is baloney. [laughter] i think that we need the american people to know that that is not true. i cannot and i do not -- i try not to go up publicly every time somebody says something bad about the agency, but from my perspective that is ludicrous. i will not come out and say, here is what we are doing at utah. that would be ridiculous as well, because it would give our adversaries a tremendous advantage. we are not going to do that. >> i am from china central

television. according to american newspapers last month, there were six specially-trained chairmen in cyber warfare who graduated. is this another evidence of showing that america is achieving priority from the general battlefield? what are your comments? fenty. >> defending our country in cyberspace is one of our most important missions. to insure that we are secure. the president and the secretary of state have laid out that. in the 2009 speech -- there comment was that we will respond to those attacks in different forms. from our perspective, we need a trained and ready force to

defend this country. we are getting -- doing that. it is not just military. it is a military and civilian. we have great technical capabilities. we have got to stop the theft of intellectual property and other things that are going on. part of that is setting the defense. we can do that. part of that is the cyber legislation we just talked about. i think we can fix that. i have time for one more question. >> you look familiar. >> elena nakashima with the washington post. you say that you are not interested in reading the e- mail of americans. what kind of data would you like from the private sector in real time? if you got rid, what would you do to block an attack or prevent

an attack? do you have the authority you need right now and terre thank you for that question. billing into the deeper is absolutely important. in the interest of making this understandable, i will use signature a, b, and see. those are pieces of malware. the bank of the ports they come in on. they could be the ip address they come from or the website. in some combination thereof. what the anti-virus world does is that they map that up and create what is called a signature. let's call it signature a. so you are the power grid. if signature a were to try to get into the power grid, we need to know that signature a was trying to get into the power

grid and came from ip address acts, going to ip address why. we do not need to know what was in that e-mail, just that it contains signature a and came from there at this time. the answer is, if we know it @ network speed, we can respond to it. those are the authorities and roles we are working our way towards. you have and amend its ability to help inform the american people. i would offer that many of you could get with companies and say, how you do that? what is it that you should do -- we should do if the power grid, the financial sector, or our government that works and, if it were attacked, what do we do? you see, we are not sitting in the power grid? we are not sitting in the financial sectors. we have parts of the government covered. the fbi does not see what is

hitting them. somebody has to tell us. that information-sharing portion of the legislation is what the internet service providers and those companies would be authorized to share back-and- forth with us at network speed. it only says signature a, ip address, ip address. that is far different than that e-mail that was coming. it is interesting to note -- i am not a lawyer, but you could almost see this. a bad guy said that attack in their. the issue is, what about the good people sending their information? are you reading all those? the answer is that we do not need to see any of those, only the ones that had the malware. only the fact that it was there. you do not have to see any of the original e-mail. only did you need to know what

was going on. >does that make sense? >> [inaudible] >> the question is, what is the of that occurring? is this an attack on the country? if it is an attack on the country, what you do not want to do is say oops, there goes the power grid, there goes the financial sector, wake up, it is time to go to work. the only work they will have for me is going down to the hill to explain why we did not stop it. that will be a full-time job. the reality is -- defending the country in this area will take real-time capabilities and sharing. it will take institution's working together to make that happen. the intent would be with that occurring and that occurring -- and now we have a problem. the defense department has to act. dhs has a part in that.

fbi has a part in that. those are the things, those are the rules, those are the authorities we are working our way through. the key part of that is the legislation. from my perspective, up and people understand technically, exactly what we are doing their is absolutely vital. one thing -- you can all help us get that right. thank you for taking the time today. thank you very much. [applause] >> the green party nominates its presidential and vice- presidential candidates. then, a historical dinner. after that, a national governors' association panel on controlling medicaid costs. >> the green party is holding the vice-presidential nominating convention in maryland.

delegates selected joe stein as the nominee. we will hear from a spokesperson for roseanne barr, who was a candidate. later, we will surely the nomination process and speeches by the presidential and vice- presidential nominees. >> i am not trying to be a jerk. ok. [laughter] i am the delegate coordinator for the roseanne barr campaign. [applause]

roseanne send me a speech that i would like to read. it is right here. thank god for technology. before we start, if i read off things -- they are not my words. i swear to god i am reading them. and do not get angry at me. here i go. i thank my delegates who bravely support me in my campaign despite a michael feinstein- lettuce mere campaign that began as soon as i was allowed on the ballot. -- senior campaign that began as soon as i was allowed on the ballot. how the hell can the green party expect to face down in the u.s. government to make the same demands? it is not possible to violate key values during this election cycle and still claim to represent the high road. iran as a representative of the black caucus of the green party,

not as a celebrity. jules stein has never met with the black caucus, and is still unaware that they exist. to smear me as a rich celebrity instead of an activist who has pasted down power -- faced down power and brought issues into america week after week in a groundbreaking television show about working-class families and values is not repulsive to me. if i were a man, nobody would dare to say that. i will work these four years to remove michael feinstein from power. i will oppose the floodgates -- to the 99% of americans who deserve better representation than what this party currently offers.

thanks. i think there might be a part two. maybe not. there is. i will tell you what was on that piece of paper over there that she asked me to read. part of the things that roseanne had told me she wanted me to say was that she wanted -- she thought that she was carrying weight for working-class people, people of color in this party. one of the reasons why i support her was because i am a big activist and i felt she had my back, my community's back. i felt that i could take her to a mosque, to a place where people of color -- she was comfortable, welcomed, it would work. i am not ashamed for the fact

that i supported roseanne barr. i am proud that i did. [applause] i want people to know that it is not ok to treat delegates like they are outsiders or they are wrong. people came to me -- i got a lot of flak for supporting roseanne. when i was passing out signs, people in my own state told me i was a distraction. you know what is a distraction? poverty is a distraction. hatred is a distraction. discrimination is a distraction. she went out there and she thought that. that is why i feel that roseanne barr was the best representative we had. i do not care if you all still hate her or some of you still despise her. that is fine. that is your opinion. but i will say, i will encourage her to run in 2016. [applause] no matter how horrible, no

matter how many people like you accuse us, people who told us to deny the black caucus votes, you need to change your attitude. more people of color are coming to this party. no matter how racist some of you choose to be, or attack me for even supporting them by asking me to resign -- no. not ok, not happening anymore. [applause] fenty so much. -- thank oyu so much. >> just a few details we need to go over before we get this session started. the council be announced on the laptop over here.

when you announce your results, please hold up your sign. come out to this middle aisle -- there is a microphone here. hillary has that. please talk into the microphone. the people who will walk us through this next section are holly and colin. [applause] >> so this is what we are finally here for, right? we are finally at the final stage, the conclusion of the first step of what we know will be a groundbreaking, innovative, unique presidential adventure. it will spread our key values throughout the country and help state parties grow and give a boost to local and state-wide

candidates. this process began about one year ago at the national meeting, where delegates discussed whether we wanted to run and the benefits of running a campaign, what kind of a campaign wanted, what kind of a candid, and how to benefit and grow the green party. we will learn more tomorrow. there was no question we will run. we will continue to run. during the past year, state parties, in keeping with our commitment to decentralization and accountability, we got together across the country and the purpose stated, voting to support their choice of candidate for president of the united states. presidents and green parties unlike in california -- like in california, recognized by the state, had a state-run primary. for the first time ever, a group

of people came together to organize in south dakota. [applause] pursuant to the election loss of their respective states, and their party's rules for delegations and choosing delegations to the convention and establishing preferences for a choice of candidate -- or, if they are not organized, they have to call for a state convention and go through several motions. all states must provide a ballot line for the corrine candidate for work to find a green ballot line. what we are going to do here is go to the rules and explain what will be happening. you will see a tally of votes over there. we will ask you to make sure, when hillary comes around with the microphone, to make sure to lean and, to go to the center if you can.

we want to particularly thank david on the credentials committee for coming up with a handy list. [applause] for giving us the critical information we need to know. what happens? each state -- raise your side when called upon. each state may cast a proxy vote of not more than one absent predict -- delegate, the total not to exceed the elevate -- allocation of delegates for that state. each state may call when called upon. you do not have to include all of your votes, but you may not only a portion and then come back later. if you have to vote the mall or not. you may pass to be called upon a second time. you may not be passed twice. keep that in mind. when your state is called, your state reporter, one individual, will announce the number of delegates and proxy voting.

you have to bang minutes to make your statement about how wonderful your state is and your support. two minutes. he has lived a rugged lifestyle and can take you down if you go over. he will do it. [applause] please be nice about your state. say something nice about what the green party is doing or something good. the way this works -- it takes a simple majority, 50%, to win it the first round, some rules to be aware of. the nine of the above options -- none of the above options remain in voting. you must vote -- delegates must vote the way they have been instructed by the state party in the first round. singapore the second round, if there is one. -- same for the second round, if

there is one. half the votes are counted in the first round only. after the first round, if there is a winner, the candidate must formally accept the nomination. if not, they are eliminated and we go to the second round. after the second round, all candidates must declare in writing the declaration that they will accept the nomination and cooperate with each member state party to be placed on each available greenbelt live or work towards getting one. if we go to a second round, the threshold will be a whole number. if you understood that, you probably understood the electoral caucused in this morning. [applause] for vice-presidential candidates, they must also declare in writing their intention to except in nomination. same as above works also. what will happen is that the nominee or the speaker for the nominee will propose.

they then will call for a short -- show of hands to show a simple majority and that wins. that is it. do not forget to bring your paperwork tonight at 8:00. we will start -- collin, read the first one. >> to add, at a certain stage, it may become clear who will win the nomination, but we will ask you to hold your explosive enthusiasm until the last date has declared their votes. could we hear from the great state of arkansas? [applause] >> the great green state of arkansas is happy to be here and see you all today. i want to tell you briefly that the green party is alive and kicking in at arkansas. [applause]

we recently completed our fourth successful ballot access drive. i do not know how we did it, but we did. we also nominated a record number of candidates for the green party this year in arkansas, 16 candidates will appear on the ballot. in addition to that, we have the green party candidate for the first time in each of the four congressional district. [applause] we wanted -- we have achieved that now. one of those district races is very interesting. some of you may have heard about rebecca kennedy. she is a great green tent it from arkansas. she is running in the third congressional district. a very interesting happened. the democratic candidate in that race self-destruction. there is no spoiler issue in that race. and we are looking forward to

having fun with that. i wanted to let you know that we are alive and kicking and fighting hard in arkansas. arkansas has three delegates present. each is toting a proxy. all of us are casting their votes for jill sign. [applause] >> next up, the great state of arizona. [applause] >> good afternoon. arizona has five delegates. buenos tardes. i am still chairman and delegate to the national committee. the grand canyon state, arizona is celebrating its centennial, 100 years of history.

the arizona green party, founded in may of 1990, this year achieved ballot status for the fifth time. they are celebrating 20 years of history. arizona awards won a delegate to dr. ken, and four two dr. joe stein. -- jill stein. [applause] >> now we will hear from the black caucus. >> thank you. the black caucus casts two votes for roseanne barr. thank you. [applause] >> california.

>> good afternoon. i serve as co-share for the green party of california. recently, we have seen a growing number of youth and students at joining the green party. they are sending into leadership positions. the president of the associated students of santa monica college ran against the college's efforts to privatize the system. [applause] he successfully halted those efforts. half of all students that graduate from four-year universities in california graduate with an average of $18,000 of debt. as jill stein says, we need to forgive student debt and establish tuition-free education

throughout california and across the country, so that you also to economic backgrounds have access to education. thank you. -- use of all backgrounds have access to education. [applause] >> as a male to female transsexual i'm honored to be here in the green party and as part of the california delegation. in our ongoing struggle for the right to marry who we love, for the right to have the families of our choice, for the right to use the bathrooms that best accommodate the gender identity for our medical needs to be able to matt without radical and discrimination. -- be met without radical and discrimination. >> if you would not mind telling us your vote?

our time is up. >> maxine daniel for california. on behalf of the more than 100,000 california greens, i like to cast our vote of 56 delegates in proportion to our primary election. we cast six votes for dr. ken mesplay, 22 votes for roseanne barr, and 28 votes for dr. joe stein. -- dr. jill sign. -- stein. [applause] >> if we could hear, please, from the state of colorado. >> is the state of colorado has seven votes. we have 7000 registered greens in colorado we have 37,500 votes

in the senatorial election of 2010, which was 2.4%. we have two new chapters that started in the last year. one in el paso county, and one in douglas county. our seven votes are cast from the operation of our convention in may. we cast one vote for dr. ken one vote for roseanne barr, and five votes for jill stein. [applause] >> united states over from here, conn. >> my name is tim mikki, one of the long time the green party members. i would like to introduce our senate canada, jeff russell,

running for senate. the green party of connecticut has 27 appointed or elected officeholders in our state. [applause] in an election in the 1980's, we ran a green candid in one of the first elections for greens. one candidate came early and often to campaign. we still support all the other candidates out there. we have four canada's present and four proxies. we are proud to cast eight votes for dr. jill stein. [applause] >> the district of columbia, please.

>> the state to the green party , -- statehood green party has four delegates. three for jill and one for roseanne. three delegates and one proxy. i am proud to say that on february 2, 2012 on the 120 anniversary of the adoption of the second session of the 14th amendment penalty for democratizing the electra college. -- the electoral college. we want to redressed state initiatives to institutionalize monarchical situations by the

enactment of a voter i.d. loss and winner take all politics. a majority of greens may not have known that they supported this proclamation. unfortunately, too many greens, probably because you are in ignorance of that, you supported the national initiative over this, which relies on endorsing the bush vs. gore ruling. you do not have a constitutional right to vote. that relies on another case which overturned reconstruction and establish white supremacy in the south. that is now your platform, unfortunately we will resurrect

your intelligence on this -- we know you will correct it. [applause] >> my geography was bad. i know the next state is not next door to hear -- a florida. delaware -- we will put it on there. >> delaware is ok. >> here i am. the first state and the second- smallest state, the state that has given you some of the worst banking regulations in the country. i apologize for that. i tried my hardest to stop it. but one man is no army. i am very glad to have been involved in the last nine

months. delaware has grown -- the only occupation that has not been evicted. we are nine months in. we were there. anyway, delaware has four votes. they are going to dr. jill stein. [applause] i need a little help with this one. we are -- the 99% [chanting] thank you. [applause] >> now, the state of florida,

please. >> what an introduction. as co-chairs of the state of florida, we say that we need to redistribute our priorities. we are soon to be an even greater state when we become a state with the first green party state legislator, karen. [applause] we already have a couple of other greens running in the state. we do also have an elected official. we have seven delegates, one proxy. we use one for ken mesplay, two forroseanne barr, and 54 jill stein.

>> the next up is georgia. >> from the wonderful state of georgia, the home of martin luther king jr., a man of nonviolence and peace. we are glad to be here. i am representing folks who could not be here because they are working on a campaign. check us -- czech art said, kick us any help. in 2004, we have a -- check us out, give us any help. we had a full slate of candidates in 2004. we are working for that again. [applause] i want to recognize a special georgian who has moved to tennessee, nan garrett is helping us tirelessly. from the great state of georgia, a place where people with a spirit of democracy and social justice will prevail, we give our two vote to roseanne barr. [applause]

>> all the way from hawaii. [applause] >> aloha. greetings from the independent sovereign nation of hawaii. [applause] currently occupied as the 50th state of the united states. we look forward to the day -- this is my fourth out of five presidential nominating conventions. it is nice to be here. i am waiting for the time when we have our convention in hawaii. [applause] from santa fe to los angeles to

denver to chicago, i missed milwaukee, i was not there, and then to 2012 here in baltimore. as a young person, i lived in maryland, outside of washington d.c.. we are the state that presented this nation with the first part to send a victory of the green party against the democrat and bond, cans, 1992, keiko who this year is coming back and reporting -- running against the current speaker of the house in hawaii. she is challenging him in oahu, the 20th district. >> 30 seconds please. >> ok. aloha to everybody.

hawaii would like to give two votes. we have to send delegates and two proxies'. we would give two votes to bar -- a favorite daughter, roseanne barr, and our other two of votes for jill stein. [applause] aloha. >> somebody with a resents and keeps holding it up upside-down. -- eight roseanne at sign keeps holding it upside down. -- a roseanne sign is holding iy upside down,. up next, ill.. -- illinois.

>> i was on at the illinois women's caucus. i national committee delegate and a member of the national women's caucus and the national youth caucus. [applause] from the land of lincoln. as you know, lincoln was the most successful third-party candidate ever. we are home to the first black president ever. although you are not applauding him because he has not lived up to our expectations, it is still incredibly important that he was a man of color that was elected. [applause] state that is proud to announce that we have achieved ballot access for the green party of the united states. [applause] we turned it over 29,000

petitions. we're proud to cast our delegates. we have 49 delegates and five proxies. 12 votes for jill stein. four votes for roseanne barr. ken mesplay. two non committed votes. thank you. >> if we could hear from indiana. >> i am andrew struck, the delegate from indiana. -- andrew straw, the delegate from indiana. i am also the congressional candidate for district two, in the south bend area. indiana has a lot of work to do. we got right to work this year. mitch daniels, thanks a lot. we have an ongoing problem.

with a hog farms. i'm fighting that. that is kind of symbolic of our situation. we got 30,000 signatures to get on the ballot in 2006 for secretary of state. guess what? it was not enough. obama, in the second district, they forged signatures to get him on the ballot. it seems that we would fall short -- unfair that we would fall short, but it was a technicality. they let mccain and obama run. indiana is proud to support jill stein. she came to set and into march. she was on tv and just did a great job representing our positions and party.

we are proud to give our one vote to jill. [applause] >> you get two votes because you can count your proxy. >> indiana? >> you get to represent your delegate who is not here. two for jill. >> next is iowa. >> i'm from iowa, a state where you can marry whom you love. [applause] thank you. i wanted to give you all this idea that i thought was profound. unrestricted growth is the ideology of a cancer cell. [applause] iowa gets four votes this year.

we cast two of votes for roseanne barr and two votes for jill stein. [applause] >> thank you. kentucky. >> my name is josh robinson. i am the delegate from the commonwealth of kentucky. we have just gotten organized as a green party. we are happy. [applause] we are happy to have joined the movement. we look forward to work with all of you in the future. we have to 10 votes. one delegate and one proxy. one is for roseanne barr and one is for the next president of the united states, dr. jill stein. >> up next is the lavender caucus.

>> i am a representative of the lavender caucus, a caucus made up of activists and organizers that are out front on the issues of lgbt issues. we will cast our two votes to dr. jill stein. [applause] >> from the state of maine, please. >> i am and occupier who is occupying a wall street and now running for state senate in the state of maine. [applause] i have also become chair of the maine green party. the state of maine, where the green party was founded in 1984 under a tree in augusta, where

we got recent -- instant runoff voting for the city of portland. i have more stuff to brag about. we have had continuous ballot access since 1998. we had the first l.e.e.d. gold airport in the nation. we split our delegates. jill barr, and seven for stein. [applause] >> are gracious hosts, maryland. -- our gracious hosts, maryland. [applause] >> greetings, we are continuously fighting for the life of our chesapeake bay, which is mostly dead zones these days. we are fighting for the light of our cities and the civil-rights

of all of our residents here in the great state of maryland. we are also fighting to stay on the ballot here in maryland. after 10 years of continuous ballot access, we are struggling to get back on the ballot. all of you who are watching from home, if you are a maryland registered green, please go online and sign our petition. help us get back on the ballot so we can provide a diversity of political opinions in the state. the website -- bit.ly/mgp/betition/central -- bit.ly/mgp/ petition/central. we have to bang canada is running for congress this year,

including mr. -- two candidates running this year. george luck will run in the eighth district. also, bob will be running in the fifth congressional district. please help us get on the ballot so we can continue to provide a diversity of political voices here in maryland. the maryland green party delegation -- we proudly cast our votes. we have six delegates. one vote goes to roseanne barr. five of those go to jill stein. [applause] >> the home state of dr. jill stein, massachusetts. >> the great state of massachusetts would like to pass at this time.

>> next up, michigan. suspense. >> i am from the great state of michigan, also known as the great lake states. i am a proud member of the detroit green party. we have had access since 2000. we are pleased to be here at this historic moment. we have 10 delegates and six proxy votes. we would like to cast two votes for our current senate cana didate, two votes for ken mespaly, three votes for roseanne barr, and nine votes for jill stein.

>> in the state of minnesota, please. >> greetings from the great state of minnesota, home of the twin cities of minneapolis and st. paul, where the founding members of the green party of the united states first came together to draft our canned key values. the state of minnesota has seven delegates. we cast four of votes for dr. jill stein and three for roseanne barr. [applause] >> >>, mississippi. -- next, mississippi. >> we are from the great state of mississippi. [applause] fenty. -- thank you..

the magnolia state, home of many civil-rights luminarias. it still bears the strange fruit in any form of six executions and limits on the right to vote, but fortunately rejected the personhood amendment. we are also the home of the authors of the -- we have two delegates and two proxies'. we cast of four votes for jill stein. [applause] >> thank you. next is new jersey. the national women's caucus. [applause]

>> the national women's caucus is proud that our race for the nomination gave us strong green women. [applause] they demonstrated the spirit of cooperative competition. that is why green party politics are better than business as usual. slash and burn up winner-take- all contest. to our great sister, rose and bar, who brought us new contacts and our first endorsement from the national organization for the reform of marijuana laws. who brought us a beautiful planes began honesty and humor. we thank you and are you by casting one vote for roseanne barr. to our sister jill stein, who brought us new and renewed outlines, who showed us a great

example of team building, who has qualified for federal matching funds. [applause] who earned our nomination by working. we thank you and honor you by casting one vote for dr. jill stein. [applause] >> now, new jersey, please. >> greetings. my name is bill writer. i served as chair of the green party of new jersey. i am proud to be here with my fellow representatives today. let's start off by honoring what do you guthriee. this is his 100th anniversary. he was a fighter for workers. let me hear everybody say, this

land is your land. >> this land is your land. >> new jersey is called the garden state. it is a beautiful name, but we would rather it the call the green state. someday soon, we want to see green state popping up on that red and blue mat. [applause] we want new jersey to be the first green state, or any of our states here today. soon, someday, maybe the whole map will be green. [applause] new jersey is one of 17 states to approve and authorize medical marijuana. [applause] we have with us today our future senator from new jersey, who is a fighter for medical marijuana and is one of the directors of the american cannabis nurses association. stand up. [applause]

>> 30 seconds, please. >> new jersey is one of the states that ended the death penalty. now, we want to end life without parole. we want new jersey to be known as a single-payer state. we have five votes. we are casting 14 roseanne barr, and four for the doctor who visited our convention in march and the next president of the united states, jill stein. [applause] >> now, from my home state, the state i hope to represent in the united states house of representatives, new york. [applause] >> i am proud to report from the beatable state of new york, where we have 13 delegates and three proxies. new york state was the

birthplace of occupy wall street. [applause] we are holding the line against fracking. we of the state where a green mayor performed 25 same-sex marriages as an act of civil disobedience seven years before marriage equality passed in our state. a state that is ground zero for civil resistance to the u.s. drug wars, a state where what do you guthrie wrote this land is your land in 1940. -- what do you guthrie wrote this land is your land in 1940. a state where are governor received more money from the koch brothers then scott walker. the land of the iroquois confederacy, strong women, the women's empowerment movement. new york state, where a lifeline civil-rights activist is running for u.s. senate, and where i am

proud to be running as a representative to the u.s. house of representatives. [applause] new york podcasts two of votes for roseanne barr and 14 -- new york votes two of votes for roseanne barr and 14 for jill stein. >> next up is north carolina. >> the green party of north carolina. is it working? thank you. i am wayne turner from the green party of north carolina. the green party of north carolina -- the delegation is

proud to represent our state at this historic event. despite the repeated attempts of the democratic party, they have not been able to extinguish us in north carolina. we're still alive and kicking down there. [applause] recently, the democrats passed -- lost in the legislation to the republicans. they proceeded to address global warming. unfortunately, they addressed it by passing a law saying that the level of you see cannot rise faster than is prescribed by the state legislature -- the level of the sea cannot rise faster than is prescribed by the state legislator. in order to undo this nonsense, the delegation of north carolina casts 1/2 of one vote for ken mesplay, one vote for roseanne barr, and 2.5 votes of

four jill stein. [applause] >> the state of ohio, please. >> we fought harder for ballot access and one it in 2010. -- won it in 2010. being an official party has given us standing to do election protection activities so we can fight for the right to vote for african americans, students, and other disenfranchised voters. [applause] in ohio, we are fighting against fracking, and we defeated seante bill 5, anti-worker legislation.

we do proportional voting. we have six delegates and three proxies'. just i got -- jill stein got 90% of the vote. i would like to thank all of the candidates before making this a vibrant election and convention. and thank you. [applause] >> the next stage is oregon. it is next in the alphabet. [laughter] it is either oregon or pennsylvania. oregon, thank you.

>> from the beaver state, the pacific green party of oregon represents sustainability, economic justice, and nonviolence. we are fighting against the drug war by legalizing marijuana on a vote in november. fighting to save our public forests from clear-cutting, fighting for single-payer health care, fighting for renewable energy and proportional representation. that, passedg for in 1908, to be read implemented. we are fighting to enforce a comprehensive election finance reforms that democrats have refused to enforce. one of the birthdays in the green party -- of the green party. i am running for secretary of state and a slate of green peace

candidates for congress. oregon has four present delegates, four proxy's. we cast four votes for dr. jill stein and. >> four votes for roseanne barr. we lost one delegate, so we cannot cast that vote. [applause] >> now, the state of pennsylvania, please. >> hello, everyone. i am steve baker from the commonwealth of pennsylvania, home of the liberty bell and the constitution and the next vice president of the united states. [applause]

we are a very abused state. we have not had ballot access for many years. we are tired of it. but we struggle on. we are in a ballot access struggle presently. i will be here tomorrow morning at 9:00 to talk about help. we need help in pennsylvania. we have to 10 weeks left. we need to collect about 20,000 signatures. whether we make it or not, the party in pennsylvania is strong. we will continue on. a vote like to pass on to david, who will tell us how the caucus results came out. >> thank you. i am proud to let everybody know that in pennsylvania, through the way we voted, the local caucuses split their votes in a

very marginal split of four to three in favor of jill stein. the three votes were for roseanne barr. [applause] >> the next state is rhode island. >> buenos tardes, amigos y amigas. i and the chair-elect of the green party of rhode island, the ocean state. the green party of rhode island is the fifth-oldest green party in the united states, and we are in the ocean state of rhode island, which was the first state to declare its independence from great britain in 1772, when my forebears' set fire to the tax-collecting british ship in narragansett

bay. we were the last state to ratify the constitution, holding out until the bill of rights had been approved. [applause] we were the first state of the industrial revolution in the americas, with the first factory. by consequence, we are the birthplace of the industrial working class in the united states. we are proud of that. [applause] we hope to be participants in the next great american revolution, the green revolution. the green party of rhode island was one of the original 12 green parties to form the association of state green parties. we were one of the original 26 parties to form the green party of the united states. we have placed a green candid on at the ballot in every election. 1996, 2000, 2004, 2008.

we will do it again in 2012. >> 30 seconds, please. >> you might know that rhode island is the bluest of blue states. there is a 100% probability that mitt romney will not win the state of rhode island. they think barack obama will. we like to think that the green candidate will win rhode island. we cast our four delegates in this way. one vote for roseanne barr. we appreciate her outreach to working-class americans of all cars. we appreciate her contact to communities of color. we appreciate her outreach to women in america. our three votes remaining we pledged to dr. jill stein, the next president of the united states. [applause] on august 18 and 19, jill will be in rhode island.

any of you in the northeast, please join us for a rally for jobs, peace, and planet. the national parks service is gleefully helping us to host a rally in honor of jill and the green party at a memorial that recognizes the separation of church and state. [applause] on august 19, we invite you to north scarborough beach. come and join us in rhode island. thank you very much. [applause] >> the state of south carolina, please. >> i am the candidate to oppose the nation's worst house speaker, bobby harris.

www.hirelarryfirebobby.com the state of south carolina is the leading exporter of automobiles and the repository of the most toxic waste. the state of south carolina, where it is ground zero for the war on women. where our governor just vetoed funding for rape victims' medical treatment. [boos] she calls them a distraction. the state of south carolina, where we were honorably led by the great candidate for united states the southeast regional director for the abolition of this

deadly technology of boiling of water to make electricity. he got 10% of the vote. south carolina has three delegates presence and three proxies. this tuesday there is a special election for the first woman and only woman who could possibly serve in this state's senate. sue edwards. everybody listening in senate district 41 vote tuesday on july 17, vote green. we cast one vote for the honorable roseanne barr and five votes for the next president of the united states , dr. jill stein.

>> the state of tennessee. >> the great volunteer state of tennessee, home of the king of rock and roll and memphis blues and nashville country and smokey mountain bluegrass and the home of the highlander center that empowered rosa parks to sit in the front of the bus. and we have a green party that sued the state of tennessee for their unconstitutional ballot access and won in federal court. it was sent back to the state to revise those laws. they did not. we sued again and won again. this time the state was chewed up by the judge for not providing a case.

they appealed to the sixth circuit court and later this month we will find out that we have our ballot line because the state has no case, as i said. we have 12 candidates this year. first time we had such a large slate in tennessee. we are very happy and proud about that. and for the working class hero, roseanne bar the state of tennessee casts one 1/2 votes and two and a half votes for the next president of the united states , dr. jill stein. >> the state of texas, please. >> the state of texas has 12 delegates in the house, all voting. all living proof that not all

of our progressives live in austin. we would like to announce to the world after a wildly successful petition drive in 2010 we got ballot access and one of our candidates won more than 5% of the vote state wide. that assured us ballot access again in 2012 and we have had nearly as many candidates for all levels of office, county, state and federal as the rest of the united states combined. and because the democratic party hasn't fielded candidates for state wide office a good chance of resuming that for 2014 and beyond. we would like to remind the rest of the nation that friends do not let friends vote straight democrat.

the green party of the lone star state of texas would like to cast nine vote it is for jill stein of massachusetts. two for roseanne bar of hawaii and one for rhett smith from texas. >> next the commonwealth of virginia. >> the commonwealth of virginia, not just the home of the so called national governors association. we are proud to be the home of a number of elected soil and water commissioners who educate residents throughout the state

about the importantance of soil and water conservation and our storm water. we are also to be the state with a number of appointed green office holders, including myself. 60% in arlington county are tenants. joe galdo, stand up. for the eighth consecutive year the arlington green party has a candidate for local office. this time it is long time activist and petition gathers, audrey clements. running for county board. the commonwealth of virginia will cast .5 for kent massclay.

.5 for harley mickelson. .5 for roseanne bar. 3.5 for dr. jill stein. >> the state of washington is known as the evergreen state. yes it rains, not as much as you think. but unless you are greens and then we will let you move in. state of washington has the most diverse area in the entire united states. we are very proud of that. we are also proud of the fact that if you ever checked out the matching funds in jill stein's campaigns, first is

massachusetts. she lives there. second is new york. big state. third is california. fourth is washington. so, we hope you feel a little bit guilty about that. and will open your wallets and checkbooks than you thought you would before. we want to announce that on the 17th of august jill stein will be the featured speaker at hemp fest. largest camp fest in the entire united states. and we have four votes and four delegates here. we are casting all four votes for jill stein. thank you. >> we have just a couple more states left to report.

we will ask them to really compress it. just say hello. i know. it is not fair. the women's caucus out to be glad. unusually we were not last. but if you could be forebearing and just do that and let us have your votes we can continue. there is more to come after this i am informed. next up is west virginia. >> hi everybody. i am the vice chairman of the mountain party which holds the ballot access for the green party. national green party in west virginia. i have with you here today jesse johnson who ran for president in 2008. west virginia.

west virginia is ground zero for mountain top removal and corrupt politicians. and hydro tracking. a lot of people saw the movie running for the mountains produced by these fine young ladies here and jesse about his work in the mountains in west virginia. we will show that again today 5:00 right here in this theatre. please come. and our great state of west virginia casts its votes for two for kent, one for roseanne barr and one for jill stein. >> wisconsin, please.

>> you guys figure out how to cast your votes. >> we will not make it snappy, but we will go. all the other states have implied with their boasts. wisconsin is the best state. but only in certain areas. other states are better in other areas. we have more greens elected percapitala at the local level. we have the longest serving green. we have the youngest elected green who you saw earlier. i want to give a shot out to the twitter feed. it is the only major media outlet here. thank you for covering that. i'm sorry more people are

signed up on your twitter feed than watch your show. i also want to say wisconsin is the heart of the fight back. we started the mover. we are still fighting. and i want to thank everybody for supporting wisconsin and what we have been going through. wisconsin is the home of ask me. social security. and the republican party. we all have our flaws. but we are also the home of the campaign for jill stein for president and very proud to say that. with that i want to announce we are casting one vote for kent mesplay, one for roseanne barr and the rest of the votes for dr. jill stein. >> i have ayodele gat for west virginia back to figure out the

little issue. >> i believe the objection is not all of the delegates were registered. >> i was in a hurry to get in. i am more than happy to do that. >> can we accept jesse as a delegate from the floor for their two delegates? and i think their previous count stands and we can move on. all right. >> now we return to the state of massachusetts. >> we the people of the great

commonwealth of massachusetts, the home of the original tea party revolt against the power of corporate monopolies. the home of shea's rebellion. the first revolt against bank foreclosures and farmers and veterans defrauded of their pensions. the home of an exslave, abolitionist. women's right activist. the state where 10 years ago the greens merged with the rainbow coalition to form the green rainbow party of massachusetts. massachusetts, first in the nation in marriage equality.

home of our favorite daughter, dr. jill stein and the next president of the united states. we cast one vote for kent mesplay, one for harley mickelson and nine votes for dr. jill stein. >> our first round of voting is concluded. if we have more than 50%, a simple majority, we will have a winner. what does our tally say? we have a winner. 193.5.

we have a simple majority. jill stein is our next -- i am anticipating. stay seated. there is more to come. jill stein will be the next president of the united states of america. ladies and gentlemen, thank

you. a quick reminder that chant began when ralph heard go ralph go and to his credit leaned into the microphone and say go we go. that is what is happening with this party at this point. it is my incredible privilege to reintroduce one of our good friends, somebody that we have worked long with in building the green party and building the movement. anita. >> you know when i think of ben, i think of all of the hard work done behind the scenes. people don't understand how much work ben has done in his short lifetime because he is a very young man to help to bring us to this point and to build this party and help us win ballot access in every state. >> ladies and gentlemen, the campaign manager of the jill stein campaign.

>> that is quite an honor. i love the green party. you are not supposed to be here. you are not supposed to be here. it is supposed to be too hard to build an independent party. when i was co-chair i traveled to 37 states in just two and a half years. i have seen this party grow. i joined when i was just a little younger. i have been a member of the party for 22 years. today in wisconsin there is a young woman who is the child of d.c. greens, up and coming activist. we are a multigenerational party and we are growing. we stick with it. there is a job to be done.

now i want to say this is an election year, isn't it. one of these candidates reminds me of a school yard bully. the guy who would do something like chase a kid down and cut his hair or shove him into a locker or steal your lunch money. steal your lunch money. there is another candidate that reminds me of the guy standing there and egging on. he is not at your side. i don't care. i don't care. i know this is going on my entire life. for 30 years. year after year. the rich have been gorging on the spoils. after jacking up tuition.

they are taxing the working class. occupying every nation on earth. woe are still in germany. i think the germans have a pretty democratic system. they are doing pretty well. i say that as a -- never mind. they have been doing it for 30 years. finally what happened is that people have risen up like never before. we said enough. you had the occupation of the state capitol and the general strike in wisconsin. all of the students and teachers went out. you have occupy wall street and freedom plaza and spread around the world and the revolutions going on in the middle east and the greens came to power in iceland.

we are still hearing the same thing. they are still trying to scare us. they are trying to say if you vote for what you believe in you will get what you don't believe in. right? but there is a line to that line. they deliver that line in texas. they deliver that line in california. they deliver that line in vermont. there is the electoral college. it is still there. the reason why they deliver the line of fear is because they know that the greens represent challenge and that we are competition and they do not want us to take it anywhere in the country. they don't want competition. they are not afraid of the republicans or losing. they lose all the time. they made it an industry,

losing. they won all the time they would not have a job. so, i am going to conclude in a few moments. we have a little bit of dirty work to do here. it is the type of dirty work i like to do. i would like to make it a formality a reality. please welcome holly hart of iowa. the state that al gore walled wisconsin in 2000. wrong side of the river, al. >> so the grass roots rules. we have a vice presidential candidate, and when this person is announced, we need from you at least 50% majority approval. we want you to register it by a show of hands and whatever noise that you wish to make.

>> i move -- i will play by the rules here. >> we move that sherry -- ok with you guys? 50%? >> ladies and gentlemen, brothers and sisters, the vice president for the 99%. the woman who has been leading the fight against forecloseures and leading the fight against the banks. the woman who has been fighting for working people since before it was fashionable. this is a woman known to ride a horse into electer toal combat. she is the sheriff for working people in philadelphia, pennsylvania. deadon -- please welcome her

and her son and a lot of the next generations of greens that are go to lead this fight. >> wow. let's have another round of applause for those next leaders of this country.

nothing ever goes easy for us from the neighborhood and very few people know, but these guys traveled, they got ready to leave at 4:00 in the morning to come up to be here today. the story gets even better. of course nothing goes easy for poor folks. they get a flat tire on their way here. but they are here right now and they are not going anywhere. i bring you greetings from poor and working people in the us of america. i stand here today as a formally homeless mother. a sine mother of two children

mark and guillermo santos. i accept the green party's nomination for vice president of the united states. this journey began many years ago for me. watching my poor mother struggle to survive and provide for five hungry children. i never knew why we had to go hungry, specially when i saw so much food in my home state of minnesota. i did not understand. i grew up watching my mom cry

night after night about the bills. i grew up watching farmers lose their farms. and i grew up watching families struggle for something as basic as their land. something just did not seem right to me. especially that day when i had to tell my 9-year-old son, mark, that we were no longer going to be living in an apartment. instead we would have to move into our car. but on a cold winter night in minnesota, i lost my home, the car. when i parked my car in a drunk driver hit and totaled it. unable to find shelter in the

dead of the winter in minnesota i faced an important decision. occupy a heated abandoned house or risk freezing to death on the streets of america. i chose to live and i chose to keep my son alive. so we moved into that abandoned house. and we moved thousands of families into abandoned houses for the last 25 years. but something changed way deep down inside me that night. my hunger for justice was born.

i figured that if me and my son, mark, were just left to die on the streets of the united states of america this had to have been happening to other families across my wealthy country. here i stand today 25 years later. now i have a burning flame for justice. we now suffer from the worst economic equality ever. the new movie "the hunger games" makes the fight for the basic necessities of life look like a cakewalk when we look at what is happening in our country. 1 in 2 people are in poverty.

6 million families lost their homes. we spend more on building prisons than educating our children. the disabled and immigrants, youth and our elders have been told loud and clear from our elected officials that they just don't matter. but you see they do matter. every day around the world. they matter. and we, the green party of the united states of america are here to stand up and take on our historic role in history. we will refuse to proceed from

the politics of fear and scarcity. we will no longer sit down with rhonda, glen and ms. fran lose their homes to the banks we will no longer sit by as the united states of america continues to have politicians in the u.s. house of representatives that's proposing cutting 300,000 children from free school lunch programs. we will no longer sit by and watch as family members are deported.

we are the new and unsettling force that doctor martin luther king spoke of. and the daughter and the woman and the doctor that will help lead this new and unsettling force to create another country and another world that values the human rights of all human beings. it is my distinct honor to introduce my running mate and green party nominee for president of the united states of america, dr. jill stein. [cheers and applause]

[crowd chants "jill"] >> love you back, all of you! it has been such an honor and an inspiration to get to know all of you or at least nearly all of you over this past year. and together we are unstoppable. [applause] i am so very honored to be your

nominee and to be running on the ticket with sherry hunkala. thank you, sherrifment -- sherry. because together we are the 99% and this is the year we take our country back. [cheers and applause] something incredibly wonderful is happening across america and i have seen it firsthand traveling across the country this past year. in the face of severe, hard times, oppression and intimidation, people are standing up and speaking out. we are occupying our city squares, our impearled schools and workplaces, our threatened homes and now with this election, we are preparing to occupy the voting booth.

[applause] the need could not be more urgent as so many people know who are in this room. we are at the breaking point for people, for our economy, for our homes, for our democracy and for our planet. the heat is rising. the ranks of the poor are swelling. our young people are drowning in debt. there aren't enough jobs and wages are shrinking while the rich keep getting richer and the rest of america gets poorer year by year. an entire generation has grown to adulthood knowing nothing but social decline. the two establishment parties have taken turns leading the

way. bush and clinton, then bush, now obama while the party labels change, the policies have stayed largely the same. in fact, on most key issues, obama has embraced the policies of george bush and even gone further with more massive bailouts for wall street, more free trade agreements that send our jobs overseas and depress wages at home, more threats to medicare and social security, more skyrocketing foreclosures and student dead, more attacks on our impearl civil liberties, immigrant rights, medical marijuana, more plundering of the environment and wrecking of the climate and endless illegal wars.

have we had enough? [cheers and applause] we have had enough. and that's why people like you and me are standing up in a way the world hasn't seen in generations. we are a movement that is alive and well across america and we are here to stay. [cheers and applause] so let me tell you why i am standing up and how i come to be standing here today before you. 30 years ago, i was a new doctor starting off in medical practice but even then it was easy to see that our broken health care system was failing the people who desperately need it.

as a mother, i was especially deeply disturbed by the new epidemic of disease descending on our children, the rising tide of obesity and diabetes and asthma and cancer and learning disabilities and autism and more, these were new. i became impatient with just dispensing pills and sending people back to the very things that are making us sick to start with. everything from pollution to poverty to industrial nutrition, racism and violence. i thought if only our elected officials knew all the amazing solutions that save lives and save money and create jobs while saving the environment.

surely they would do something. like supporting healthy, sustainable local farms. instead of pouring our tax dollars into agriculture and poisonous fossil fuels. [applause] but slowly i realize that if you want to persuade elected officials forget all that cost-saving, life-saving, job-creating stuff. that doesn't really count. what you need is giant bundles of big campaign checks and that was my wake-up call that if we want to protect children's health or want anything for that matter, the health care we need or the education or the jobs, we need to first stick to broken

political systems. [applause] that's why -- that's why i now say that i'm practicing political medicine because it's the mother of all illnesses and we've got to fix this one to fix everything else that ails us. [applause] so i went to work to try to fix that problem and i joined a broad coalition in massachusetts to get big money out of politics and you know what, we won or so we thought we did. we passed a referendum to provide public financing for

political campaigns and we passed it by a huge 2-1 margin. but our state legislature which was about 85% democratic, they repealed the law as soon as it was passed on an unrecorded voice vote so no one could be held accountable for defying the will of the people. audience: boo! >> and that was my real wake-up call, that if we want to change the broken political system, what we need is not just a new law or a new lobbying effort or a fresh face in the same old corrupt system, we need a new, unbought political party that can put people of integrity into office. [cheers and applause]

we need real public servants who listen to the people, not to the corporate lobbyists that funnel campaign checks into the big war chest. that's what brought me to the green party, the only national party that is not bought and paid for by corporate money. [applause] and here's why my resolve has only grown stronger over the years. as a mother and a doctor, the concerns that activated me 30 years ago have only intensified. i like you see that our young

people are still struggling in every aspect of life, struggling for good health, for decent schools, struggling to stay safe on the streets. struggling to afford a college education, struggling to get a job, to get out of debt, struggling to have a climate that can actually live in for the future and they are losing the battle on every front. so when people ask me why i keep fighting political battles in a rigged system, the answer is simple -- i keep fighting because when it comes to our children, mothers don't give up. [cheers and applause]

and you know what, neither do fathers. [applause] or sisters and brothers and sons and daughters. and young people haven't given up. and they are the ones really carrying the burden of this rigged system. if they're not giving up, we're not giving up. we are not only not giving up, we are doubling down and rising up. we are a movement for democracy

and justice that is alive and well across the country. we are in eviction blockades and bank of america protests, in student strikes to stop tuition hikes, in protest against stop and press and shoot first and sp-1070 in mass arrest that nuclear power plants an civil disobedience to stop fracking and stop mountain top removal and stop the keystone pipeline. [cheers and applause] because they are mark game over for climate. and we're not going to settle for that. to quote alice walker, the biggest way people give up power is by not knowing they have it

in the first place. [applause] well, we know we've got it. and we're going to use it. and one of the ways we're going to use it is by having a voice in this election and a choice at the polls that's not bought and paid for by wall street. [cheers and applause] because voting for either wall street candidate for mitt romney or for barack obama gives a mandate for four more years of corporate rule. every vote they receive is an endorsement of the deadly trajectory that we are on for the american people and the planet.

it's time to change that plunge into catastrophe and that change starts with voting for real change. [applause] every vote we receive is a vote for democracy for the 99% and survival for the planet. to achieve that future as president, i will work to deliver a green new deal for america. a package of emergency reform to put 25 million people back to work and jump start the green economy and that economy will put a halt to climate change, a halt to unemployment and make

wars for oil obsolete. [cheers and applause] the green new deal reforms not only our economy but our financial system and our democracy. and it's not just an academic idea. it's based on a program that actually worked, the new deal that got us out of the great depression of the 1930's. it's time to bring it back and put it to work. these reforms create living wage, community-based jobs and communities decide what kind of jobs they need to be sustainable, not just eck logically, but socially. that mean first starters jobs in the green area of the economy,

clean manufacturing, local organic agriculture, public transportation and clean renewable energy. i want to tell you about a young man whose life was transformed by this kind of job. his name was ricardo and i met him in holio, massachusetts, touring some of the green small businesss that are thriving there. ricardo had dropped out of school after being held back three times in the ninth grade. like most kids in poverty his classes were too big, too underfunded and too dominated by less than inspiring test prep. but he found a training program in an efficient, an intall lation program offered by a, koa

power in western mass. ricardo was then hired by a small green energy business where he became a crew leader within one year and while doing all that, this high school dropout held back three times in ninth grade entered a g.e.d. program and graduated even before his own high school class received their diplomas. [cheers and applause] at age 20, he's now been leader of his crew for three years supporting his family and his young child. this is a triple win. ricardo pulled his life together. the community gets lower energy cost and cleaner air and the climate gets a little more stable for us all.

under the green new deal, this win-win jobs will be the rule and not the exception and they're coming to your community. [cheers and applause] so the green new deal not only creates jobs like ricardos like make us eck logically sustain b. it also creates jobs that meet our social needs. let's hire back those 300,000 teachers who have lost their jobs in this great recession. [applause] and let's hire on the nurses we need and the childcare and the after school and the home care and senior care and violence and drug abuse prevention and rehabilitation and affording housing construction. these jobs, yes, these jobs --

these jobs will be nationally funded and locally and democratically controlled. they are community based small businesses, not big multinational corporations. and they are worker-owned cooperatives and public works, in public services. so instead of going down to the unemployment office, you can just go down to the employment office and get the job you need. [cheers and applause] so to be clear, the green new deal ends unemployment in america. this would never occur to washington politicians and you can imagine why.

their corporate backers depend on the threat of unemployment to hold wages down and their profits up. but ending unemployment and war is front and center for americans who need jobs. so it's front and center on the green agenda. as green, we are committed not only to jobs but also to improving social conditions for everyone in america. that's why the green new deal will create an immediate moratorium on foreclosures and evictions.

[applause] we cannot afford to have even one more rhonda thrown out of her home. we're going to put an end to that. and that's why we want medicare for all. this, not only provides quality, comprehensive care for everyone. it will restore your choice of provider and put you back on control in your health care decision instead of having them made for you by a

profiteering-sharing c.e.o. and it will save trillion yons. -- trillions over the next decade by streamlining the health insurance bureaucracy and putting away to runaway medical inflation. [applause] we will forget the crushing student debt burden. and we will liberate an entire generation of young people who have been turned into indentured servants.

and we will provide tuition-free public education from prekindergarten through college. this is an investment in our future. and it pays off enormously. we know that from the g.i. bill, after world war ii that provided $7 in increased economic benefits for every dollar that we the taxpayers invested. in order to create an economy that works for people, we need not only jobs in secure working conditions, we need a financial system that is free from domination by big banks and

well-connected financiers who hijack our economy and our democracy. [applause] instead we will create a system that is open, honest, stable and serves the real economy, not the phony economy of high finance. [applause] we will end the bailouts and the corporate giveaways and ensure that the resources are available for investments in our communities, for consumers and small businesses and cooperatives. through these reforms, we will break up the big banks that are too big to fail. [applause] we will restore the glass stea

gallon separation -- steagall of separation of commercial banks. [applause] we will regulate all financial derivatives and require them to be open on exchanges. we will demock -- democratize the money to -- for credit creation. and we will tax capital gains as income, tax wall street transactions to stop reckless speculation and put a 90% tax on bonuses for bailed out bankers. [cheers and applause]

in order to secure these reforms, we must also enact political reforms to give us a real functioning democracy because as you know we don't have that yet. so to start with, we must end the domination of our election by corporations and big money which makes government of, by and for the people impossible. for this reason, we urgently need to amend our cons constitutions to make clear that corporations are not persons and money is not speech. [cheers and applause]

those rights belong to living, breathing human beings like you and me, not to business entities controlled by the very wealthy. the green new deal will also undercut the power of lobbyists and billionaires to control elections. and we will do that by enacting a voter bill of rights. [applause] in so doing, we will guarantee, a voter-marked paper ballot for all voting and require all votes are counted. [cheers and applause]

we will bring simplified, same-day voter registration to the nation so no qualified voter is barred from the polls. [cheers and applause] we will replace partisan oversight of elections with non- partisan election commission's and we will restore the vote of 1.4 million african-american men who are barred from voting because they are ex-felons. [applause] and we will implement election reforms like instant offloading and proportional representation

that can truly reflect voter sentiment. [applause] and we will take money out of politics and replace it with full public financing and free and equal access to the public airways. [applause] and we will guarantee equal access to the ballot and to the debates for all qualified candidates.

[cheers and applause] >> occupy the debates, exactly. they don't know what they are in for, but they are going to find out. [applause] so in summary, the green in new deal is a comprehensive program to pull us back from the brink and move beyond the current state of emergency for our economy, our environment, and our democracy. there is much more to it. i won't hold you here for the next three hours about that but

you can go to our website and find out more about it. but there is more to be done beyond the universe of the green new deal. that is why i am committed to emergency action in other areas as well. so first, i will bring the troops and the war dollars home. we need to bring them home from

these illegal and immoral what words, including the wars and theg drone morri soldiers in bases around the world where we do not need to be. [applause] foreign-policy and based on militarism and the protection of oil resources will be replaced. by diplomacy, diplomacy based on respect for international law and human rights. [applause] i will restore our imperiled civil liberties by repealing the un-american provisions of the

patriot act, the national defence, and it is not only the patriot act, as you know. it is also the national defense authorization act. and the antitrust pass an anti- terrorism act which criminalize protest and directs our protest to spy on nonviolent dissenters. i will prohibit the department of homeland security and fbi from conspiring with local police to suppress our freedoms of assembly and speech. [applause]

i will also work to legalize marijuana. and put it into a safe, regulatory framework, because marijuana is a substance which is dangerous because it is illegal. it is not illegal because it is dangerous. [applause] and finally, i will end the bipartisan more on immigrants.

i will stand up against discriminatory republican laws like the remnants of arizona's sb-1070. and i will stand up to the racist demagoguery that wrongly blames immigrants for the unemployment brought on by wall street's abuse of the economy. applause]nd a mosque the program has deported more than 1 million immigrants, heartlessly splitting families

and taking thousands of children away from their parents. this issue also gets my blood boiling. with that track record, the obama white house has been the most anti-immigrant administration in a century. it is true, obama did a pre- election about-face last month and gave temporary work permits to a limited number of immigrant youth, and even this fortunate group will still face deportation at age 30. it is not a solution. i am -- on taking office, i will

immediately issued an executive order to end the deportations now. [applause] and i will vigorously support passage of the dream act, and i will work to provide a welcoming pat to full, equal citizenship for undocumented americans who are vital members of our economy and our communities. [applause] and i will work to replace the corporate so-called free-trade agreement which generates

economic refugees in the first place. these will be replaced with a rare trade agreements that respect workers in this country and in latin america. now, we need these solutions, and the public supports them by substantial majorities in poll after poll. so why have we not gotten them? and there are big fear campaigns that have been waged over the past decade that have been telling us to just be quiet and vote your fears. but we have done that long enough now to see that silence

is not an effective political strategy. [applause] in fact, the politics of fear have brought us everything we were afraid of. what democracy needs is not fear and silence, but voices and value. it is time to answer the politics of fear with the politics of courage. [applause] as those massachusetts radicals did when they took on the british east india company and

dumped the tea in the harbor and declared themselves free of king's law and corporal rule, by the way, like the abolitionists did with the liberty party, and women suffer just did with the women's party, and working people did with the people's party and the socialist party and fighting the progressive party. in each of these cases, independent politics was critical to formulate the political demand which as frederick douglass said so famously, it is essential, because power concedes nothing without a demand. never did, and it never will. [applause]

by bringing that demand into the presidential elections, we can advance the movement for democracy and justice and drive these solutions into the political agenda. the history of progressive politics is filled with social movements allied with independent political parties that made history together. abolishing slavery, securing women's right to vote, the right to form unions, the 40-hour work week, campaign finance laws, child labor laws, social security, the new deal, and more, and that is what this campaign is all about. standing up and reclaiming our

political voice and our political courage, because the moment we do, the real aspirations of the american people can no longer be denied. we will have a base from which we can deabuild, and we can stat to drive for those critical solutions that people broadly support and which wall street politicians have kept off the table and which we are the only vehicle forward in this election and the foreseeable future. [applause] we will give people a choice and a voice in the voting booth and enable them to go to the polls and vote for the green new deal

and vote for the reforms that will improve our lives right now. so i ask for your vote, but i ask for something much more. help our ballot access drive. help us raise money. help form new green party locals all over the country. help support our local candidates. insure that the voice of principled opposition will be heard. now, and into the future, by standing up and pushing forward with this campaign for economic and political democracy, we signal to the world that we, the people, the 99%, have taken the stage political stage, once again in the united states of america. we will take the lead in our campaign as an our democracy. we will create an unstoppable

movement and we will not rest until we have turned the white house into a green house. [cheers and applause] and together, we will take back the promise of our democracy and the peaceful, just, green future we deserve. thank you so much. [cheers and applause] ♪ [captioning performed by

national captioning institute] [captions copyright national cable satellite corp. 2012] [applause] >> next, the u.s. capitol historical society dinner honoring the senate foreign relations committee. then the national governors' association panel on holding down medicaid costs.

then an nga discussion on providing assistance to military veterans and their families. tomorrow on "washington journal ," i would governor terry branstad discusses his state's economy and his opposition to the medicaid expansion included in health-care law. then it until stein take calls and questions and an update on the physical conditions of the u.s. postal service. "washington journal," live at 7:00 a.m. eastern on c-span. >> hitler by then had virtually no plan. when you realize that these remnants are armies are not coming to his aid and trying to escape into the west, that is when he collapsed, when he realized finally it was coming to an end and only a question of suicide. >> a new look at the end of the

second world war. >> his main objective simply is not to be captured alive by the russians. he was afraid of being paraded through moscow in a cage in being spat at and ridiculed. he was determined to die. eva braun was determined to die with him. >> more on sunday at 8:00 on "q&a" on c-span. >> we have leaks that have occurred throughout every administration that has served in america. is there in particular reason why we should be so dramatically concerned about the recent spate of leaks that have occurred? >> if i could, congressman, you put your finger on an interesting point. whether they are good or bad leaks. some people would say we have to allow some leaks because that is the only way about information

about wrongdoing within the government will get surfaced, and that is not the case. congress in its wisdom has passed a series of whistle- blower protection laws would say that if you are a whistle- blower, if you see something that looks like waste, fraud, abuse, are criminal conduct, it can take that information clearing the point being there is an avenue for surfacing that information other than going to the press. the need to have press leaks to allow that is not really the case. >> possible avenues of investigation and prosecution, topics for the house judiciary subcommittee. watch online at the c-span video library. >> the u.s. capitol historical society hosted an event tuesday night honoring that anniversary of the senate foreign relations

committee. senator chuck haggle of nebraska gave the address. the u.s. capitol historical society has sponsored an evening tribute to a senate or house committee annually for the past 17 years. this is an hour and 15 minutes. >> ladies and gentlemen, if i could have your attention. we will start our program. i think it is great but we can have an event when everybody is so interested in visiting with each other that is a great success when that happens, and i hate to put a damper on that, but we do want to get going. i do appreciate your attention and i am sure the gentleman i introduce will also appreciate that.

i am tom coleman, chair of the u.s. capitol historical society and a former member of congress from the state of missouri. i have the honor of introducing three gentlemen who actually need no introduction. i know you people are very much aware of the highlights of their career and quite knowledgeable about the senate and the congress. i will dispense with that, and of course each one of them has had some leadership positions in our nation's foreign policy as members of the senate foreign relations committee. those contributions we will probably hear about tonight. i also did a little history research myself and found that all of them have also written books. some have written more than one book. instead of me giving you the usual can introduction, i thought i would let their own words from their own riding serve to introduce them to you tonight.

-- from a wrongwriting. -- from their own writing. in his book "a call to service," senator kerry rights, i was a foreign service brat, which is a lot like growing up as an army or navy brat. the experience was valuable in two important respects. spending a good part of your childhood overseas expose you to a lot of other cultures, languages, political traditions, and histories, and teaches you a lot about what america stands for and what much of the world depends on us to stand for. he noted that his father was often transferred, not only overseas, but also back into the united states. he wrote, "one assignment that

had an especially strong impression on me was when he was briefly detailed to the staff of the senate foreign relations committee. it was with a sense of continuity in continuing a family tradition that i appear before the same committee in 1971 after my service in vietnam, testifying on behalf of the vietnam veterans against the war. when i was elected to the u.s. senate in 1984, i'd call with my staff for three solid days over my wish to serve on the foreign relations committee. they had gotten some assurances in washington that i had a chance to get a seat on appropriations, that great war aplenty from state projects and reelection politics, and i was determined to get on the foreign relations committee. i have been a member ever since. as they say, the rest is history. ladies and gentlemen, chairman john kerry. [applause]

>> thank you very much. i had totally forgotten that i was actually that candid. nowadays, the way it works without in the year mark, i made a very wise decision. everybody on the appropriations committee are pulling their how out, saying we don't do anything anymore. i am very honored to be here with the number of my colleagues, beginning with the ranking member, our good friend and respected colleague, and dick lugar ar. everybody here just want to say thank you for everything you stand for.

[applause] dick is absolutely a statesman. harry truman once said that a politician is a man who understands government. a statesman is a politician who has been dead for 10 years. [laughter] the truth is, as we all know, dick lugar has managed to champion that and others on our committee are all here, bob corker, i am delighted you are here. earlier we had a number of members who dropped by. i want to thank each of the members i just named that are

enteral, all four members of the best tradition of our committee. i will say a few words about that in a moment. for the diligence with which they approach every issue and for their personal ability to put aside, which is in the great tradition of the foreign relations committee, to put aside the rancor and divisiveness of this city and to find common ground which is what we need to do above all. i want to thank the historical society for bringing us together tonight. we are really a privilege. we share in a sense of privilege tonight and we are grateful for what the society does. it is just an invaluable source for bringing our nation's

history and the capital history alive and for creating all kinds of exhibits and events in helping young kids come to this place and understand their own history. it helps to put the business of the country ahead of politics. i think all my colleagues would agree with me at think each of them are working to find ways of this current predicament, but the country is obviously as divided as i can remember it at any time in public life, certainly since the rancor of the 1960's and early 1970's about a war. and at a time when the foreign relations committee played a critical role. we are now divided between red and blue coast some -- so much

more. i am reminded of william faulkner's words about full of sound and fury in signifying nothing. the full " was the shakespeare ", which was a tale told by an idiot, full of sound and fury. i am not going to go there because we are trying to get away from partisanship. i think it is safe to say that we are a long way away, except that these great moments where our committee kind of comes together from one of our great distinguished predecessors, arthur vandenberg, who famously reminded us that politics stops at the water's edge. when he passed away, the

chaplain in 1951 marked his passing by saying the following. he said we thank you that in the gathering storm of aggression which now rages, your server, arthur h. vandenberg, and a time that called for so i think it's safe to say and i think most of you would agree, and i'm very grateful for all the ambassadors who are here this evening because they understand this as well as any people in the world how much the world is changing, how complicated relationships are today, and how important it is for all of us in our countries to find a way to summon our people to something bigger than ourselves or tot partisanship which divides us, how critical it is to find greatness. now, we've been blessed to have a guy like dig lugor who whether he has served as chairman or whether he has

served as ranking member has always been a serious student of public affairs and of foreign affairs and tried to find that commonground and joe biden's letter earlier today is a tribute to that. i have seen him work on the nun-lugor threat reduction as we all have and the world has been fitted from that vision. and it is a vision. sometimes engaged in at the peril of some members of his own party or of other parts of the political spectrum who somehow don't believe that a nation like ours ought to be engaged with the rest of the world or reaching out and taking some of those kinds of risks. but even with the great satan of the former soviet union richard lugar was able to reach out and make things happen.

and i remember as a young senator i just arrived in 1985 and actually a member of my family -- this is not something i talk about in this city or ever, was the governor of the phil pins back in early 1900s. and so i had a fascination with the phil pins because of family involvement there for some period of time. and on my first trip as a young senator was the fill pins. i met with ferdinand marcos and came away that this had to change, this relationship with him and his people and us and them. so i came back and the first thing i did was put in a resolution to link our aid to certain reforms, et cetera. and mark coss responded to that, young brash senator by calling an election and saying i'm going to prove tot united

states who is in charge here. and dick lugar who was in charge and we worked together with people in the philippines. i remember steven bozz worth put together a thing called national movement for free fill means, this oversight of their elecks and ultimately it was 13 women in the same cathedral where akeeno lay in state after his asass nation. i attended an extraordinary mass. that was the place where we saw these 13 women come out and midnight with this halo of light shining over them because the only lights were the television cameras filming them. they each told of the numbers they were putting in were different -- the numbers they were putting in were not the numbers coming out on the board and the election was being

stolen. and dick seized the reins and he was chairman of the oversight group and said we've got to call this the way we see it. we rushed back, met with president reagan and dick lugar and others changed history with that event. it was remarkable. that's what the foreign relations committee membership can do. in any place in the world i think. chuck hagel is another guy who understands that and who has done an extraordinary job when he was here and continues to do it. and i respect so much his willingness to just speak out directly, his constancey when he was here at being willing to take on his own party at times. but just speaking to use the horrible cliche of truth to power. but he did it again and again. and i miss his good humor. he and i and joe biden took a

trip to afghanistan and we were up. and on the flight back we got engulfed in a sudden snow storm in the helicopters and i will never forget as this chopper pilot suddenly in panic diving. we had a chopper behind us. nobody knew and we kind of went down into an emergency landing on the top of this mountain in massive snow and it was blowing and cold. and the whole time the general is briefing us and he never stopped briefing us. and so i think -- and we were in this semi-crash mode and so chuck and i we just said why don't the three of us give a speech and we'll be air bjorn again with the hot air. lit work. so we landed. we saw these figures moving around the mountains and we tried to figure out what we were going to do when the

taliban came after us. so we first of all thought we would assign one of us to give a speech and talk them down. then we decided to set up a snowball squadron and take them on. finally we were rescued by a bunch of humvees that had to come all the way out of bagram and drive down off the mountain with this long corden of escort and so forth. so there are these wonderful kinds of memories that come with these sort of journeys sitting on a plane late in the night and talking about the problems of the world. and i just say to all of you this quickly. i don't want to abuse my privilege here tonight but it's a great privilege for me to be able to serve right now for some period of time obviously subject to the decision of the american people as to what happens tot senate and to chairs and nonchairs and so forth. so i always view this with a great sense of temporaryness.

and as an opportunity to try to make the most out of that. but this is a critical moment. i did cut my teeth testifying before a guy named jay william if you will briggete in a committee that had names like jabites and pellington serving on it and it was a very different time in the senate where you could find relationships on the other side, build them, trust each other and make things happen. i want that snat to come back. it's what the american people need and certainly what the founding fathers intended. but we are facing now a world that is obviously profoundly changing. and nobody can put the genie of globalism back into the bottle. nobody can do that as much as you want to or might feel rankled by it. there is only one way to respond to this world and that's to try to tame the worst forces of globalization and i

believe that can be done. the foreign relations committee is probably one of the world's greatest forium for doing that. it is extraordinarily unbelievable platform to shine light on things. in a week we will have a hearing on human trafficking, pandemic around the planet. there are many other things we obviously are working on. we will soon talk about people with disabilities and rights and needless to say historically the new start treaty, the cfe treaty, the original start treaty, the chemical weapons convegas vention. so much has happened through this committee and in some of the earliest times i think it was mentioned in the beginning, ron mentioned it but what happened with respect to the early times that the committee the alaska purchase in 1867,

the accomplishment of the united nations. the passage of the truman doctrine. and of course not least the rebuilding of europe and japan after a war where the united states against the will of the american people -- they weren't in support of the marshall plan but today no one could argue that it wasn't essential tot ultimate transformation of the former soviet union and to the freedom of people in eastern europe and to a remarkable sense of possibilities for people who had lived under the yolk of totalitarianism for too long. those things come out of this committee. those are the possibilities. i was excited to come into politics during the years of several sons of massachusetts

in 1962. i worked for teddy kennedy in his first election. and before that, and after that, we -- many of us were greatly changed by the asass nation of president kennedy and robert kennedy. and i will never forget the words of robert kennedy. and i think that we have an ability here in public life to do these things. this evening therefore to me is special not only because it brings all of us together to celebrate the foreign relations committee and its past accomplishments but to reminder of the debt that we owe to those who preceded us on this committee and set an example for what it can achieve and those who set an example tot country for what we can be. so i think we can learn from the way they conducted business

. i also think that we all need to remember, you know, what's happening in the middle east is the most significant change since the end of the oto mon empire certainly and it's up for grabs. today i talked with secretary sherman and secretary clinton is in hanoi tonight as we talk but will be in the middle east in a day or two and we need to do things to help egypt move forward as difficult as that may be in terms of politics. one quarter of the world's arab population doesn't have the sectarian challenge of shia and sunni but it has challenges. and it may in the end define the possibilities for peace in the middle east as well as what our national security picture is going to look like for some

time to come. so we have to have the vision to understand that even in this difficult economic time we're connected. we also need to understand that our economy is not something over here separate from all of our aspirations in terms of public foreign policy. to do things we want to do, to be the indispensible nation and it is impertive for us to make better choices about our economy because they go hand in hand. if we don't have the economic strength, the economic power or the economic stability, we will have a much harder time projecting the power that is in our interest in order to advance our interests and our values together. that is what foreign policy is. a balance between interest and values. sometimes your rests superseed your values and sometimes your

values super seed your interests but i am convinced that we are an exceptional nation. we talk about american exceptionalism to the point that it grates on other countries and probably should. but there is something exceptional i would say to you but it is not a birthright. it is not on automatic pilot. we have only been exceptional when we make the choices that make us exceptional. and we need to remember that it is not a slogan or a sound byte. it is when we embrace our values and our interests in the best way that advance the cause of our nation but also advance the cause of our fellow human beings on this planet. that is the way the foreign relations committee should define itself, in my judgment. thank you for honoring it

tonight. [applause] >> senator kerry thank you for your current, past and future leadership on the foreign affairs committee. and let's hope that your wish comes true tonight, that we can go back sometimes to old ways of working tot both side of the aisle. i know as a house member there's a lot of challenges in that body and we all have them tonight. richard lugar is the ranking member and former chairman of the foreign relations committee. a true gentleman. he is a universally respected voice for the development and implementation of the bipartisan foreign policy. as gracious in political defeat as he has always been in victory, dick luker is one of the giants in our establishment

and can take a great deal of pride in his decades of service to america, his presence in the senate and on this committee will be sorely missed. and as chairman kerry said his accomplishments while they have been many probably and perhaps his lasting legacy will be the reduction of nuclear war and nuclear weapons in the world. dick's passion for seeking long-term solutions to complex foreign policy problems instead of opting for the slogans and short-term political advantages is best summed up in his book, letters to the next president that he wrote to president bush and to senator kerry at the time in 2004. dick, i don't know if you ever get any of the money but i read your book on a kindle so that five bucks ought to somehow wind its way to you some day. and this is what dick lugar wrote in 2004. the consensus on foreign policy that once was prevalent in the

u.s. political discourse has been badly eroded. too often the motivation for important national security positions of both parties is driven by politics that are disconnected from any credible analysis. a consensus foreign policy cannot be wished back into being nor can it be manufactured overnight in response to an immediate crisis. it can only be restored gradually over time through presidential attention and the development of mutual trust between congress and the executive branch. dick lugar, we're going to miss you. we feel that we have lost part of the institution and we do very much love you. thank you for being with us tonight. [applause]

>> i'm so indebted to you for your thoughtfulness and your friendship. we are so pleased that you have chosen to honor the foreign relations committee. and i've been overwhelmed by the tributes to my dear friend john kerry. we've had a wonderful time together on the committee and john has cite it had fill peens adventure but so many others throughout the years. and chuck hagel was by my side throughout his tenure on the foreign relations committee. so important in terms of his judgment and stability. i just appreciate all of our colleagues on the committee being here tonight and the distinguished ambassadors and we're grateful to each one of you for honoring the committee

and honoring the historicle society on its 50th anniversary. i did simply want to thank once again the capital historicle society for offering some personal -- offering me the opportunity for some personal thoughts on a subject that has been a central part of my professional life. with the comprehensive research efforts of very friendly and diligent staff members, and i hope you will forgive the personal indulgences of their findings. i want to make a few comments about the history of the committee. by my count and the history of the senate, only five members have served 30 years or more on the committee. all five began their service in the second half of the 20th century. this is partially attributable to increasing life expectancy

and tot fact that many members of the committee during the 19th and early 20th centuries did not begin their foreign relations committee service until six, eight, or even ten years into their senate tenure. unlike my colleague john kerry who had the foresight to join immediately. there's been far more common in recent decades refreshment our good friends paul sarbanes and chris dodd each gained a seat on the committee as newly elected senators and held it throughout their 30-year senate careers. senator clay bjorn pell served 32 years on the committee. having gained a seat in his fourth year as a senator. at the end of this year, i will have served 34 years on the committee, joining vice

president biden who reached that tenure before he was elected to his current position. both of us gained a seat on the committee after two years in the senate. vice president biden also holds the distinction of being the third foreign relations committee chairman to become vice president of the united states. it is an understatement to say that he is having much more success in his role than his two predecessors. the first chairman to become vice president, william r. king had tuberculosis when he was elected and died only 25 days into his vice presidential tenure. he holds the record for the fewest days served in an elected u.s. executive office. even president william henry harrison who famously became sick after exposing himself to a rain storm on his

inauguration day managed to last a full month in office. the other vice president who chaired the foreign relations committee was han ball hamlin lincoln's first vice president. he was a nonfactor unfortunately in the lincoln administration and he spent much of his vice presidency in his home state of maine, a difficult platform from which to influence policy in washington, d.c. in the 1860s. he was more fortunate than william king in that he survived his term. but he was robbed from the ticket in 1864 in favor of andrew johnson. now like senator kerry my first intersection with the committee occurred even before i became senator. after graduating from university in ohio i was awarded a rhodes scholarship and soon after i arrived at oxford, my tutor in politics

told me about his tuetorle work with senator william if you will briggete of arkansas. and my first year of rezz dense emboldened by the stories, i decided to write to the senator who was a member of the senate foreign relations committee but not yet as chairman. he was in the midst of an embattled relationship with senator joseph mccarthy of wisconsin and he shared with me his thoughts about mccarthy. and there were a series of letters as our correspondance expanded i was deeply moved that he took the time to write to me and continue to answer my letters even more astonished to learn years later that he kept my letters. the senator and i shared a remarkable number of common experiences though generally

these came apart. we both won scholarships and both of us chose to study at pembroke college. both focused much attention on government as well as economics. and both of us were blessed with the same tutor. both of us were elected to the senate from states in the interior of the united states that were not typically associated with international interests. but both of us sought a seat on the foreign relations committee and asquended to the chairmanship. senator if you will briggete in fact holds the record as the longest serving chairman of the foreign relations committee, a tenure stretching from 1959 to 1974. my tenure as chairman was only six years but i hold the less notable record of the most times he left between my first

and second chairmanships namely 16 years. i did not have the pleasure of serving with senator if you will briggete in the senate he left office before i was elected but his influence on my career was profound and permanent. he was essentially generous to me when i became chairman of the committee in 19 785 for the first time. -- 1985 for the first time. what he understand as well the main function is oversight of the administration's foreign policy. the committee is responsible for some substantial areas of legislation including the state department budget, foreign assistance, and of course approval prove of trees but in most years its biggest impact comes from its role as both partner and counter weight in the administration's action on the global scale. the role of the committee is to

constantly question the president's foreign policy activities and decisions. reinforcing some and redirecting or opposing others. to some degree every committee exercises oversight. so in my experience nobody has such a broad expanse of activities to monitor. this is reflected in the fact that in many years we hold more hearings than any other senate committee. we also ascend more nominees tot the full senate with the possible exception of the judiciary committee. confirmation hearings on hundreds were served to both vet the nominee and to review our policy toward the individual countries that lsh represented. partly because of this vast oversight role the chairman and

ranking member i have attempted to encourage members with a few years of experience to stay on the committee, to build continuity and expertise. i believe that the senate and the united states foreign policy in general benefit from having experienced members who are willing to commit to long term service on the foreign relations committee through many presidential administrations. but returning members has become an increasing challenge in recent years. on the republican side our conference rule prohibitting simultaneous service on any two of the so-called super eight kess. appropriations, armed services finance and foreign relations has led to many short tern yurs on our committee. conference rules are more lean ypt but democrats also have seen turnover.

beyond conference dynamics, most members of the committee must deal with the reality that few political benefits come from devoting one's self-in the senate to formal policy on the foreign relations committee. on the flip side our members are invited to prepare on sunday morning talk shows more often than most. and service on this committee however brief is sometimes seen as a useful credential. but the foreign relations has a difficult platform from which to appeal for appeal for campaign funds. and there is very little public spending that flows through this committee to constituents. more tot point absent a serious global crisis foreign policy rarely tops the list of concerns of many voters. the committee depends heavily on members who want to devote a

substantial portion of their service to foreign policy and national security regardless of other roles they may play in the senate. my hope is that many more good senators will continue to come forward to embrace this role. i thank each one of you tonight for your contributions tot committee, for recognizing its importance and its members. for recognizing historicle importance of the committee tot senate and to our country. may god continue to bless the united states senate, the foreign relations committee, and especially may god bless america, the country that we love to serve. thank you very much. [applause] .

>> chuck hagel served as an influential member. today, as well as being a member of the secretary of defense's policy board senator hagel continues to play a leading role. in 2008, his last year in the senate, chuck wrote a book he titled america our next chapter. at the time he was kind enough to give me a signed copy which i immediately read. i reread it for this occasion

hoping to find a passage that would serve as his introduction. i wound up identifying 13. don't worry, i know the hour is getting late. i reduced it down to two. the first passage actually happens in the first paragraph of the book. and i quote above all i think of myself as an americans. if you would have asked my dad he would have said the same thing. that's how we thought out in the foothills of nebraska and ains worth when i grew up in the 1950s. there are's a hundred other towns. a couple of churches, a hard ware store, a movie theater. two gas stations and an american legion post. it's the kind of town when you rolled down your car windows you could hear buddy holly singing peggy sue from one end of main street to the other. just down the road in rushville

my great great grand father and great grand mother lied in an apartment above the bakery and the drug store. they shared their small apartment with two grown sons. one who got by on small disability pensions. eventually chuck and his brother tom would leave that small town and find themselves in the dark jungles of vietnam serving side by side they were both severely wound bdty viet cong in a land mine explosion. able to survive through the night they were medivaced out of the area. of that experience, senator hagel wrote, from that day on, i was a changed person. i remember strong resolve coming over me as our chapper climbed over the glistening canopy of the jungle and i watched the steam rise above it in the morning light.

i made myself a promise then that if i ever get out of this place and was ever in a position to do something about it, i would make sure that the world so filled with suffering that i would do whatever i could to stop it. i have never forgotten that promise. i made it to myself but also to everyone who answers the call to serve their country. i think of it every day because once you set a war in motion its consequences are often the ones least intended and they are always uncontrollable. chuck hagel. [applause] thank you. i am grateful for an opportunity to be here. for many reasons. to my not old but long time friend ron who when dinosaurs

roomed the earth we got acquainted on the fifth floor of the cannon building if you've ever been up there. but the office was right next tot closet and he performed admirably. i might add. his ward robe consisted and not unlike congressman coleman's of the wide lapel jacket much like a horse blanket if you remember those days. but to have two gentlemen of the caliber and the kind of public servants they were and continue to be lead the u.s. historicle society. thank you. it's an honor to be here. and congratulations on your 50th anniversary and what you're doing with this

institution. i don't know of anything more important than to preserve history, to apply that history, to our future generations. jan is here tonight who i think you all know. here sat man who like everyone in this room has made some contribution to that effort. a memorial that he was responsible for leading would not have been done without him. was -- [applause] was testimony yes to those who served and those who made the ultimate sacrifice. but memorials are built for the future. memorials are built for the next generation and the next genetion. they are built to remind us and to recognize the great virtues

of mannedkind, the nobleness of man. and each of you here in what the society is doing is all about that. of course, it's a high, high privilege to be here with two foreign relations chairmen. between them i believe 62 years of service on the foreign relations committee. and you add to that vice president biden's service. the three of them represent about 100 years of service on the foreign relations committee. that's a rather significant amount of time and a rather significant contribution to this country. and for all the reasons that you have heard tonight from these two gentlemen. my former colleagues, some were here tonight who new members of the foreign relations committees that i had did not

have the privilege to serve with. thank you for what you continue to do with our country. one of the i think most important parts of this job, one of the greatest pri ledges of this job is to recognize first of all who we are. we're not republicans, we're not democrats. we're americans. and when i was often asked but senator, you opposed your party. or you questioned your party, you challenged your president. , i would as cheerfully as i knew how respond, i'm a united states senator. i'm a united states senator. i'm a united states senator representing nebraska. i have a philosophy about government which happens to fit the republic party at least my interpretation. but i'm not a republican senator.

i'm a united states senator who happens to be a republican. and i think the foreign relations committee has been eloquently noted here tonight by two of the very best that ever served in this business has clearly articulated that there's no one in this room that doesn't understand what they said or has not witnessed it. and again the colleagues on that committee here tonight -- and the staff -- see it up close every day. i also want to recognize shar lugar for her service. thank you. for what you have meant. and the contributions you have made. [applause] and to the supporters. the reality is this society, no

institution can exist without the financial support and the recognition of the worthiness of the institutions. so all of you who have faithfully contributed, continue to contribute, continue to write your checks. is that correct mr. chairman? >> that's a big part of this and so thank you. my remarks are going to build on what our two chairmen have talked about. and that is the framing of the foreign relations committee. like john kerry and others as the vice president noted in his letter, like every senator here. when you get here, you have to make some choices if you're a

freshman you have limited choice bus nevertheless you make choices about committee assignments. and in the senate you have more of a men uff and more of an agenda, a variety. and i recall the day after i was elected to the senate in november of 1996, the world herd sat down and we did an interview and the first question i was asked was, is there any member of the senate that you would like to emulate? is there any member of the senate who you would like to model your career after? i responded by saying not being yet a wise senator but hopefully a wise senator. well, all the senators are smart. all have made great

contributions. all have something to say and it's important for our country and i said yes there isn't one senator who i very much would like to model my service after, and that's dick lugar from indiana. that appeared on the front page of the evening edition of the omaha world herald my noting that it was dick lugar who i had most admired. the second question was what committee assignments do you think you would like to see? and without hesitation i said the foreign relations committee. and i don't think that was particularly surprising to the reporter who was doing the interview who was the political reporter for the world herd and had been around for 40 years and probably the best politico reporter because as he had noted to me in august of that year i gave a major -- not quality of the lugar and kerry

and biden before. but a major speech in yaug of course when everybody was gone. and the reporters were all a bit surprised probably by the content. but they were generous to me and gave me some considerable noteation but the question that they posed to me was why would you give a foreign relations speech in nebraska? we have never followed a senate canned dated who no one knows, who has not held public office and you gave a major foreign policy address. well, when that same reporter asked me the question what committees are you going to try to get seats on i said immediately the foreign relations committee and he said

well why? and of course not unlike what john kerry and dick lugar have noted and everyone in this room knows it especially the members on the committee today. you can't raise money on that committee. it's kind of a dead end committee. what does it do? nobody cares. i said no, no. you're wrong. the foreign relations committee of all the committees in the senate frames america's interests more than any committee. when you think about it, it does. it isn't just the thing that is john and dick talked about. the oversight. and all the thing that is dick talked about in his itemization, in his agenda of thing that is the committee does and has done. but it's the 19 additional responsibilities that most people don't have any idea that

come under the jurisdiction of the foreign relations committee. many will remember, i know my most learn ed colleagues do, 19 97, 98, there was an asian currency crisis that began with the russian ruble. then the tilen bought. and it affected markets, it affected everything. i was also on the banking committee which bob corker and i both served on that committee together. and i remember dick the motto who was chairman at the time saying well the banking committee will take control of that. jessie hems was chairman and jesse and his staff and some staff members here might recall this said no the banking committee does not have jurs diagnose. the foreign relations committee

has jurisdiction. i happen to be a very junior chairman of the subcommittee, the international monetary policy and i got that chairmanship because no one else wanted it. and that was fine with me. i was a chairman of something. and i knew it was important but nothing really had happened. well, when this happened, i became very popular president clinton and the fact was thaw the moto and then later to be chairman of the banking committee, chairman graham were quite outraged by it and said you're wrong. and jesse said no read the jurisdictions. and sure enough jesse hems was right. i you that as one example. when i say framing americas i want rests, again, this has been noted tonight as john kerry talked about it.

comics, trade, relationships, stablet, security diplomacy. everything. everything revolves around the foreign relations committee. and most of it resides inside the foreign relations committee. and as noted here too, the up and down of committees not unlike markets, not unlike personal lives, not unlike nations which are clearly recounted in history. you work through those ways of different committees and different times. but up when john kerry talked tonight about arthur's comments which is very famous and everybody on the committee knows it. most people in this room know it. let me take that a little further. that comment was made by a republican senator who had

essentially been a bit of an isolationist. going into world war ii. in 1946, most of you know truman was the president and he was facing a republican congress, snat. and arthur became chairman of the senate foreign relations committee in 1947. that's when he said that. now, the significance of that statement at that time because events are always capped to timing and to spherics and to the environment. because those are the pressure ors that dictate and dominate always. votes, outcomes. he said that because he recognized that that was the beginning of the cold war after

world war ii. and if america was to succeed and lead then what there was of the free world on to some higher ground which later as we all know through history produced the marshall plan and other such events which helped stabilize a very unstable and unsure world especially europe. there was no guarantee that europe was going to turn out in any way the way it did turn out. but the responsible thing to do which vandenberg understand was to say what he said and work with the administration by that committee led by that republicen. which i might also note i know the members on the foreign relations committee who authored the nato resolution which set nato. now, i offer those two examples

as further testimony of what we have been talking about tonight, what dick's talked about what john's talked about what biden was referring to. i think to take this a little further because i think you've got the point about foreign relations to committees. everything that john kerry said and dick lugar about our current political environment is right. and i would suspect that no one in this room would question that america is not very happy. our congress is not happy. we're off balance and churchill's great words the jarring gong of probably 9/11 knocked us off balance and we haven't gotten back since. but i think to go back would probably be 1989 when the soviet union imploded.

what that did was set in motion a dynamic of global proportion that is no one had ever to deal with before and we're still working our way through it. nato. why do we need nato? our senior members here tonight recall viveledly the debate about nato. what was his role? we didn't need nato. where is the enemy? what's the problem? and essentially we put that aside and never answered that dwe. we are now back at it. and in its place we put nato enlargement. now, i happy to support it and i think john kerry and dike lugar were strong supporters. but the other change of that was nato enlargement, which again was housed in the foreign relations committee and all the hearings were in the foreign relations committee and the decisions made in the foreign relations committee that were brought out.

it was not so much now about what nato was 50 years before. collective security. this was as much about and maybe more about economic security for those eastern european nations that were just untethered. what do we do now? that nato alliance, they membership made a tremendous valdation to those new democracies because yes it gave them the imprim tour of nato and security selection. but far more important is every business person or associated with every business person. >> it gave investors some companies. some liability in their investment in one of those countries. and so this was now a whole different dynamic that has been introduced into the world and to nato specifically than we

hadr seen before. it was a verified economic dynamic. again i use that as just one example. that was contained in foreign relations. the 12 years that i served in the senate, greatest 12 years in my life -- no privilege like it, i offense have thought about those 12 years having nothing to do with me. i was a fleeting stewart as what we all are. but you think about what john kerry talked about, what dick was talking about, what's happening in the world. what is the problem today? why can't we bring ourselves back together and find a new grounding or a purpose. we don't have a common enemy and yeah we're kind of been struggling terrorism. we're going to have a war on terrorism. well, what's tearrix? it's a tactic, not a philosophy, not a form of

government. it's a tactic has gotten around since man got up on all fours. but there's no common purpose of anything and the greatest in the history of man has confused everybody. it's changed everything. these are just some of the factors that are playing out. the committees in the congress, they all want to go a little wider here in my concluding remarks. committees are damn important. they are so very important. i recognized that whedge i first got to the senate. everyone of my colleagues recognized it. i didn't appreciate it as much as i did at tend of 12 years or as do today. because what resides in that effort in the process -- and process is important in anything. i know we get kicked around all the time. well, process, process, process.

what does process do? it doesn't do anything. it prolongs the problem. imperfect? yes. but here is what process does. why it's important. it absorbs shocks. if you don't have a process you can't absorb shock. and when something happens and it always does. look at our world the last few years. shock shock shock. we've had institutions that have been able to absorb the shock. now, our greatest challenge ahead of us and they have to be done through the committee work because the committee work is the only forum, the only process that allows intelligence and intelligent understanding, knowledge, discourse, about identifying the problem, short term long term and then how do we fix it? that takes consensus. rarely did i ever see unless it was a mother's day resolution which i voted for all of them,

come out on the senate floor that was a controversial issue if it had not gone through a committee first. to sand down the rough edges and try to work through the compromises of the democratic and republican amendments and then come to a consensus and you vote it out of the committee. there's no other way it can work. these issues are too big, too complex. you've got to rely on the committee system. the committee structure. it's more so today i believe than ever before and will continue to be that way. and so the emphasis on committees i don't think it can be overstated on anything. the other part of that is again something that john mentioned, the interconnectedness of committees. not jurisdiction of committee oversight but how it's all interconnected. there isn't one part of our security, the future of mab, the future of 7 billion people soon to be 9 billion that is

not connected to everything else. energy, environment, security, economy, trade, education, jobs, religion, you name any element that drives society, it has always dictated the outcome of civilizations. it is now all wrapped in woven into one fiber, into one fiber. you're not going to fix that on the floor of the senate or the floor of the house or to my distinguished friends who are here from other countries who serve as ambassadors as good as their parliaments are you're not going to fix it even in their parliaments on the floor. it's got to be done through a process and a system. and that's why these systems, these committees are so important. i will end my comments this way. i don't know of anyone who has

lived and recognized and worked on these issues as well. and as honestly as dick lugar has over the years. i know dick has been noted for tonight for those effort but you will be seriously missed. but i would say that with the members of the senate who are coming behind you, dick, and john -- i know you're not ready to leave yet -- but who are coming behind you, the greatest advantage you have given, dick and to you john, your younger colleagues is the role modeling that i began with my comments on tonight. because every one of these colleagues sitting here tonight have watched the two of you how

you have done it and i would add joe biden to that by the way. and you've done it right. that's the greatest legacy you will leave. all the pieces of legislation with members' names on it having leadership which frenses in buildings named after you, that's not real. first of all it's not your money. it's the taxpayers money. but what you do leave is you leave that legacy of leadership and how you did it and you did it the right way. and i have great confidence in this country because as imperfect as our process is, as imperfect as our public servants are -- and we all are. we all learn -- i don't know of a group of men and women who are more committed to make a better world than those who offer themselves for public office. and if we're just wise enough to understand that and then build a consensus around that.

we will have differences but it has to start in committees and the strength is not just the academic part but get to know each other. when john kerry talked about dick, others when we travel together, when we sit in planes together, i sat in an suv with joe biden for eight hours. going to the turkish border into kurds stan. i learned a lot. but i finally had to give up. and say joe i can't do it any more. i had my mother on the phone with him. i had everybody. but you get to know the humanity. and that's what we're missing i think more than anything else. the humanity of the service of this noble noble cause. committees do that better than anything and any way and committees are important probably as much for that

reason as anything else. thank you all very much. [applause] >> chuck thank you very much and ladies and gentlemen thank you as well. senator, for your very, very thoughtful remarks and we're really very appreciative i want to present you with this book of architecture and decoration of the capital by henry hope reed. [applause] senator kerry and senator -- that's so you can find your way around. chuck hagel and i go back to as he mentioned to the fifth floor of the cannon building. when i was elected to office i

couldn't get an office because i had to wait for them to leave 511 cannon so i could move into it. 511 cannon is in the atic of the cannon building. it's a piece of real estate no one wants and only those of us who are unlucky get. only one elevator goes there. fortunately no one can find you there so it was very peaceful on the fifth floor of the cannon building. but that's where i met chuck and we've been friends for 40 years and i appreciate that friendship. senator kerry and lugar we also have mementos for you. these prints of the view of washington city, we are very happy to give to you. [applause]

i want to thank everyone for being here today. i have to give you some instructions on how to leave this room. because after 8:00 -- and it's after 8:00, the main door is locked so you may not be able to get home tonight. at any rate i will give you instructions in a moment. first, i want you to look around this great room. this is the room the titanic hearings were held in, the water gate hearings, the mccarthy hearings. this is a very, very historic room in the complex of the united states capitol. and we are very grateful for the opportunity to be here. i want to thank the donors who did so much to make this evening possible. wal-mart, cat pillar incorporated exxon mobile corporation and eye vess co. now the instructions on how to get out of here. guests should exit down the right corridor from the rotunda right outside, take another

right at the end of the corridor take the elevator to the basement. a guard there will direct you from there. what you're really trying to do is get out of the dirk sen building next door. you cannot get out of the building at this point, the doors are locked. so you've got to go to the exit door. a couple of rights into the basement you will find somebody who will direct you from there. thank you all for coming. this has been a wonderful wonderful evening. great comments. thank you very, very much.

>> next national governors association panel on holding down medicaid costs then providing assistance to military veterans an their families. another chance to see the u.s. capitol historicle society dinner honoring the senate foreign relations committee.

>> good morning and welcome. i would like to call the meeting of the health and human services committee to order at this time. i am pleased to be join by my friend and neighbor governor quinn who is cochair of this committee. i want to thank heather and william, the other nga staff for their work in preparing for this meeting. proceeding to this meeting are open tot press and to all meeting attendees. since taking office again last year, my administration has been working to improve health

outcomes for iowans and i know my fellow governors are striving to do the same for their citizens in their states. at the last meeting of this committee, we heard about iowa's healthiest state in the nation initiative which is a privately led publicly endorsed initiative to improve the health of all iowans and we also heard from some of the federal wellness initiatives. today we're going to focus our attention on the ways to better leverage data for focusing on bringing down the quost of care for high-cost medicaid beneficiaries. this is something that governors have identified to be a problem in just about every state. and as you may have heard, health care and medicaid have received quite a bit of news here as of late. regardless of party, i believe that every governor is interested in improving the

service delivery which is provided -- providing ways to control the costs within the medicaid program, a program that has been demanding an increasing share of our overall state budget over the last dozen years or so. the following four speakers will present today. dr. jeffery brener, founder and executive director of the camden coalition for health care providers. mr. david bellingga president and c.e.o. of mercy medical center in des moines, iowa. and jennifer deck bell luss, health director for the hen pin county minnesota and dan our executive director for the national governors association. we willhold questions until the end of the presentation. but before we get on to our speakers i would like to yield to our committee vice chair governor pat quinn of illinois for opening remarks.

>> ok. well, thank you very much terry. i think it's a very timely discussion. the concept of innovations cost reductions improvements and our health care system i think all of us understand this is one of the challenges of our time both in our state and our country. our own state of illinois we had to make some very tough choices this year in restructuring our medicaid system. we had to reduce liabilities by 2.7 billion out of about a $15 billion system. we did that through efficiencies in reductions as well as some new revenues to repair the programs long term deficit. we reduce it had medicaid spending through reductions by $1.6 billion and then we raised our cigarette tax by $1 a pack. that will allow us also to match our cigarette money with more money from washington for our medicaid. a part of our reform, our

restructuring in illinois involved the modernizing our system through medical records and innovative coordinative care models that focus not only o traditional medical care but integrating our mental health and human services as well. so in the coming time we're committed to enrolling at least 50% of our clients into some sort of coordinated care. the medical innovations project goal is to redesign our health care delivery system to be more pashte centered with a focus on improving health outcomes. we want a wellness system. we want to enhance patient access and patient safety. we plan to achieve this goal by testing community interests and capacity to provide alternative models of delivering care that we may not have today but we would like to see for tomorrow. i also joined with terry we had

an interesting discussion in washington on the importance of really a statewide effort for wellness. i was showing us a very good model led by their leading health insurer. we're interested in trying to do some similar things in illinois. i walked across illinois 11 years ago started on the centennial bridge at rock island at the border of iowa and illinois i walked across our state all the way to lake michigan in chicago on behalf of decrept health care for everybody. and i'm very happy to say that since then we've had some great reforms at the federal level where to allow our state to carry out the mission of getting more people health coverage decent health coverage. so we intend to work hard on that. i think it is important that we hear today from some experts that can help us reach that very important policy goal for everybody.

and so i will yield back to you terry and we'll take it from there. >> thank you very much governor quinn. now i'm pleased to introduce our first speaker dr. jeffery brener. dr. jeffery brener is a family physician who has worked in camden, new jersey for the past 12 years before establishing the camden coalition for health care providers dr. beaner owned and operated a solo practice urban family medicine office and provided a full spectrum of family health services to a largely hispanic medicaid population including delivering babies, caring for children and adults and doing home visits, recognizing the need for a new way for hospitals providers and residents to collaborate dr. brener founded and has run the camden coalition for health care providers since 2003. the camden coalition is a nonprofit organization committed to providing quality

capacity and accessibility to health care delivery within the city of camden. through the camden coalition, local stakeholders are working to build an integrated health delivery model to better provide care for city rezzdepts. dr. brener, the floor is yours and we look forward to your comments. >> thank you very much. thank you governor quinn. i'm a family doctor and i'm here today because i spent my career taking care of medicaid recipients and i don't think we're getting our money's worth. so i want to show you some evidence of that and talk about ways that i think we can do it better. about ten years ago as a medical student project i had a young person work with me for summer to collect patient level data from three local hospitals. this is very hard data to get. this is essentially the billing data that they use to bill the state or insurance companies and we got raw patient data the

name address date of birth date of admission charges receipts and insurance status and diagnosis codes. the word for this is an all payer data base. people like me never get ahold of data like this. this is u locked behind walls or with an insurance company. what i learned from the data was really stunning about how our health care system works. half the population in camden goes to an e e.r. hospital in one year. someone actually went 324 times in five years, someone went 113 times if one year. in the city of trenton where we have a sister organization they found someone who had been 450 times in one year. the total amount of money for camden residents in per year is $100 million just for hospital and emergency room care. we spend $2.8 trillion in the country.

i sure know what $1500 million buys and it could buy a lot more than what we're doing now. we spend probably twice as much on all health care services so this is just for emergency room and hospital care. we're the first second or third poorest country in the country. really dramatically dincht system. the most expensive patient had $3.5 million in payments and 30% of the cost go to 1% of the patients so spending and health care is highly concentrated. 80% of the cost go to 13% of the patients. i have looked at an employee data set, i've looked at labor union data set. and that basic rule holds up everywhere you look in health care that a small deliver of people are driving much of the cost. the problem is that we ignore

those patient force the most part and the system isn't really set up to deal with their needs. we're good with the average patient. we're not really good with the very sick patients. we can do amazing things. we can transplant and we can put them in the icu. but beyond that we deliver very unorganized care. right now about 20% of seniors are readmitted within 30 days to a hospital. and that's spending about 10, 15, $20,000 for that unit of service where it was essentially a defective service because they had to come back and get another unit of service. it speaks volumes about the disorganized system that we've created. the number one reason to go to an emergency room is head colds. there were 12,000 visits for head colds. viral infections, sore throat.

these are all problems i've dealt with in my primary care office. my primary care office is boarded up because my payment rates in medicaid kept dropping while i had the billing data and can tell you that the hospitals bill and receive hundreds of dollars for these visits. in the time that i've been in camden we've built new hospital wings, expanded emergency rooms and offices like mine continue to be boarded up and closed and have no value. so the problem in health care is that we pay a whole lot of money if you cut, scan, zap or hospitalize someone but we pay very little money if you talk to them. and ironically in my office i make more money when i treat head colds than i do treating a really sick patient. i can bill slightly more for a complex patient but if i run

from room to room i can see a lot of patients in an hour. if i get stuck in a room talking to a complex patient, that could take me half an hour, 45 minutes and i may as well send that patient out of the door with a $50 bill because i've jist wait add lot of time and money. that's wrong and doesn't make any fence. the other side if they can amputate that person's foot and keep them in icu makes an enormous amount of money. so we have a distortion in the marketplace of health care in how we set prices and pay for services. one of the segmentations of the data we found very useful is the geographic segmentation. this is a map of the city. this is 5 years of date oo for three hospitals combined in with the mapping out the payments to all three hospitals. so this is a small city, nine square miles, very small geography that we're talking

about. the red areas are 6% of the census blocks, 10% of the land mass, 18% of the patients. but 27% of the visits to the hospitals and 37% to the payments to the hospitals. it turns out that the way we house people in america, as you get older and disabled you can't live in normal housing. you get congregated so the two most expensive buildings are beautiful build wgs great management. the building at the top north gate ii. these are older and disabled people. 600 patients in the building had 12 million in payments just for their hospital and er care. that doesn't include all the other costs. the building at the bottom is a nursing home. the stories that we've collected from these patients are tragic and we should -- i'm

deeply ashamed of the health care provider how difficult our system is to use. these are people that have complex issues. we've taken this basic framework and begun to explore data sets from other communities. we have a nonprofit that's been formed that does similar work that has outreach teams in the community that does primary care redesign that pulls stakeholders together. and we found data very important to start conversations and get people pointed in the right direction. we found similar patterns looking at their hospital data of specific geographies and collecting these patients. if you ask the ems service which buildings they go to or the emergency room doctors they can tell you tse buildings. this is new work. similar patterns of specific buildings where they're being collected. this is maine.

we got data from the state of maine and wanted to find out the basic premise held up and we mapped graphed and chartered and found out that in fact they collect into town centers even sometimes very small towns that it is hard to live in the middle of nowhere as you get more and more disabled. this makes the problem easier to deal with that an outreach team wouldn't need to drive 50 miles. they're actually collected right into towns. believe it or not all of this analysis we've had very little funding to do there. i have 15 hospital data three counties in maine. i've got a 23-year-old kid getting a master's degree at pen doing all this.

this is not that difficult to do. the problem is actually getting the data. so our organization is a nonprofit. my board members are local primary care providers, hospitals, behavior health providers and i've got community residents on the board as well. our broad goal is to make the city of camden the first city of the country to dramatically bend the cost curve and improve quality. there's no city or state in the country that has actually ever managed to reduce the trend line. and we think if the poorest city in the country does this that it makes a powerful statement that this is not a technical problem waiting for a vender. that this is a complex political spiritual and moral problem that we're wasting public dollars and need to spend them and we have misaligned incentives where people are paid more for

sickness for cutting, scanning, zapping and hospitalizing than they are for taking good care of patients. our organization is trying to take basic ideas in business. the last hundred years our country has become very wealthy because we've become very productive. health care doesn't innovate in the same way that other parts of our economy have innovated. we've invented new pills and devices but the basic process of how we deliver care and how we organize our child hasn't changed in the 100 years. and that's what needs to change. we have a gap where we're spending more and more money but not getting value for that money. our organization spends a lot of time in primary care offices helping them to redesign. between hospitals and doctors, trying to get them to share data. and deeply involved with patients. i'm going to go quickly through

some slides but i want to make an essential point in our model. all of our care starts with data. we get realtime data every day from the local hospitals and we sit down and look at who has been admit and go up to the bedside within 24 hours. this is not case management there are nozz gizmos. we're not hooking people up to remote devices. we're going to visit them in the hospital and going to their house. opening up every medicine cabinet to pull out all the 50 different old medicines they have to sort them out and throw them away and organize their care. then we're going with them to their primary care office, sitting in the exam room sometimes 60 minutes, 90 minutes. and sitting there and helping them learn how to talk to their doctor and thou to advocate for them. so this is very hard work. it's not something you can solve with telefonic case

management which is primarily the model used all over the country we pulled data and looked at the top 1% of how ute liesers in each of these communities. and in camden it's 386,000 patients and 80% visit more than one hospital in a single year. the same thing in trenton and newark. and the point is wup hospital can't solve this problem. that this is a community level problem that the community has got to get engaged and solve and local stake holders have to work together. we embodied that in a piece of legislation that had bipartisan support and was signed by governor christie back in october to create a medicaid account yabbling care organization project. the basic premise is that if we save money, we get our act together and learn how to play nice and actually reduce cost for the state that the state

will share some of those savings back with us. to create a cycle to lower cost soss we can share in the savings. so this bill is better care with lower costs with no up front funding. so my fear about amp cos is generally speaking it's an integrated delivery model so i would end up with competing acos fighting over poor people trying to align with the homeless shelter. it wouldn't make any sense. and that our model is a sclabtive model in which working under the roof of one nonprofit in a collaborative way three local hospitals local church groups, primary care providers behavior health providers can work together and that's what we've been working for the last ten years to figure out and are slowly making progress in that. so thank you very much for the chance to speak with you.

>> we'll come back for some questions in a little bit. next i'm pleased to introduce mr. david h vellinga president and c.e.o. of the mercy medical center which is in 80 the bed accute care not for profit catholic hospital situated in three campuses in the des moines, iowa metropolitan area. i've known dave for many years and i've been a patient in the hospital in his hospital when he was in mason city, actually, when i was hit by a truck. but that's another story. with more than 7,000 employees, and a medical staff of more than 1,000 physicians and allied health providers including 380 employed physicians and 130 allied health professionals, mercy provides support to health care facilities in 18 central iowa

communities and has ten wholly owned subsidrizz. in digs to his responsibilities, he serves as senior vice president for operations for catholic operations. the floor is yours. >> governor thank you very much. whenever i'm reminded of doing these types of talks it's really engaging providers, payers, patients, government i'm reminded of my daughter who went to the university of iowa but went to the university of southern california for a master's degree in social medical social work. my mother who is now 90 years old could never figure out why my daughters and sons leave and don't settle back in orange city, iowa, dutchtown of about 3,000 people.

and last thanks giving my mother said why don't you come back to orange city? orange city, they have a nice critical access hospital. they need social workers. leave santa monica come back to orange city. so mageb would say to my mom and say, well, grandma, you know i've got this great little condominium that's close to the ocean which i'm paying for, i've got this nice car, used car but it's nice that i can get around in very well which i'm paying for. and i've got this graduate program that i'm in at usc that i'm paying for. she said i just love being on my own. and it's that idea that i think historically doctors and hospitals and systems and social and government comes to this issue of health care and that is we come together as we all have our own issues. my message to you is that it is

time to engage all of us. that we are receptive to the changes that are going on. that we are tired of the fee for service system that has diminished our health care system and we are ready for a new system. what i'm going to do, the governor talked about mercy des moines. it's a big place. we also are responsible for lots of other hospitals. we have about 13,000 employees. 625 or 50, 650 employees positions across the state of iowa and there are multiple good systems in iowa. but integration is occurring. the market is driving much of this already. our point is that patients providers payers and in this case the payer of medicaid is government also. and government need to be engaged together to achieve the triple aim of better case lower costs healthier communities. we have to all be engaged.

and i think our governor is providing leadership engaging all of us in the state of iowa as to how do we address this issue as opposed to let's address the patients, providers. our engagement, providers must demonstrate quality and efficiency. they need to use data. i think the comments are so pertinent that we've been absent hospitals and providers and government have not had the data to make good decisions. we've been driven by a fee for service system and it's time to get rid of that.

>> and physicians and hospitals are ready for this. they're tired of continually feeling we need to crank out more volume in order to meet the population's needs. so what we need are payments systems that allow us to be rewarded economically for the value that we create and there is huge value to be created with the money that we have. mercy is all in. we've made this commitment. we've said that this is our strategy going forward. we believe that it is relentless, regardless of what happens legislatively,

the market is driving us, and we're all in. the tool that we use is clinical integration. there are four or five points. one is primary medical homes. we've been using this for 11 -- 14, 15 years, primary care, patient in home and erit systems. at dr. brenner said, this is not the za jillion drr i.t. systems that we hear about all the time. these can be very simple things. we've had disease registries at mercy for 14 years developed by dr. david swiskowski's college-age son who said dave came one home as a primary care doctor, said it would be great if i had the disease registry for this and in a weekend, he developed it. so it's not sophisticated, easy -- stuff, it's easy stuff and it can provide us enormous amounts of data to do enormously great work. third is coordination of care. we've invested in health

coaches on the primary care side so each of our primary care clinics have multiple help coaches to insist in interpreting the disease registries for the family physicians, we have transition coaches in the hospital, to make sure the transition goes quickly and easily, right to the primary care physician, we have intensive a.m. blahtory care clinics, when you have a very sick patient, rather than going immediately to the hospital they go the intensive ambulatory care kiln toik make sure they get the care they need, maybe, and avoid hospitalizations, standardized care processes, we have actual agreements between specialists and primary care doctors that says we do this, you do that, so we avoid the redundancy between primary and specialist physicians, and then the data management. and what dr. brenner said, top 1 percent of patients, top 5 percent, 50 percent of costs. we don't need to do everything, we just need to do everything for a small segment of patients and focus

on those patients and we will have dramatically reduced costs. the drivers of cost reductions are pretty simple. they're intuitive to you, decreasing demand for medical services, again, counter to how we have worked for 35 years in this world where we've been paid on a fee for service business, the more we do, the more we get paid, what we want to do is reverse those so we can provide value instead of just volume. second is decrease in the episodic cost of medical services, so we get primary -- increase primary care offices, as dr. brenner said, eliminating nonemergency e.r. use, improve primary care, and then the decrease in administrative cost structure improve self-service capabilities. this kind of gives you the same idea that dr. brenner said. this is actual data that we have. so everything must change, so we need to change the system, but we don't have to change it for every patient. what we need to do is focus

on the highest costs, chronic patients. so if you look at this dat yarks you've got distinct members, you look at this triple number 70 over there, trippably, mumple dominant chronic diagnosis, there are 399 patients but it's $2284 per member, per month, then you look at the payor, multiple dominant, 4754 patients, 14 percent, $955. so you start to say where can we have the biggest bang for our buck, where with ce make the most impact in the work we do and we now have this data, first time ever, where insurance companies are actually providing us some data as physicians and hospitals. otherwise, we've had shall very isolated -- i know my hospital data, jeff knows what his physician data is. we've not had a cross section data list and this is not expensive stuff. it's there. what we need to do is find ways, the data, so we can analyze that dat yavment

results are pretty remarkable. and we've had this for multiple years. we've had 20 thousands patients, using disease registries, health coaches, primary center, provider, medical homes, patients with ha1c, a diabetic test, 24 percent compared to 30, ldl cholesterol, 69 percent compared to 46 percent, patients on couple din, 75 percent, compared to 55, 60 percent. so it's significant improvements as a result of this. and congestive heart failure, what we had before was patients with congestive heart failure would come into the hospital, get worked up, big expensive bill, go back home, get sick, and doctors would say do this, this, this, the reality is they'd go to the home, nobody would follow up, they'd get sick, come back into the e.d. and come back into the hospital. onomically it helped us because they came back to the emergency room, to the

hospital, so we actually improved ourselves economically but worsened the care of the patient and increased the cost. what we did was simple three steps, again, not high tech stuff, using case managers and computers and telephones, calling the patient, saying how's your weight today and if it was changing, the case manager would say do this. what happened is 85 percent reduction in in patient admissions, 80 percent reduction in e.d. visits. now, economically, in a fee for service world, that hampered our economic performance, but look at what the cost savings did, and this was done through no additional payment, through no additional steps other than just the right thing to do. this shows you mercy clinic's performance in blood pressure control in sending physicians at the place setting, doing the right thing, results in significant performance. the benefits, it's real, so you think of that one test, but look at this, the

results. 35 percent-40 percent decrease in strokes, 20-25 percent decrease in m.i.s, 50 percent decrease in heart failure, 12-point decrease in systolic blood pressure over ten years, prevents one death for every 11 treated. so those tests actually result in very real outcomes. and then mercy applied these same benefits or the same design -- benefit design and incentives to our own employee health populations so mercy demoines premium cost per employee increased less and less each year, 2008-2010, increase, we implemented it in 2010, you can see the actual decline in our employee cost, reduction in the increase and actual decline last year. we attributed it to very basic benefit design, risk assessment, doing our patient-centered medical home for our own employees. and again, it's amazing to

me, after doing this work for 35 years, it's not the sophisticated stuff. it's basic data, getting back and using it. lessons learned are this. engage everybody. don't focus on one or the other. governor branstad is doing that in our state, bringing people together, and my message to you as provider, physicians, hospitals, are ready for that engagement. top four things the state government should do we think, support i.t. systems. not the high -- the million, million dollar evident, the data warehouse, get basic health information changes, get basic information to the providers at the site, support clinical integration and remove the legal and regulatory barriers so doctors and hospitals can work together and actually provide better care. don't create barriers. knock down the ones that exist. strengthen primary care. over and over again. that's a backbone of the

population of health management. hospitals and specialists have rejected that. the message is they should be supporting it. the better they are at population health the better they will be at providing in patient care, reward value, not volume. remember value, not volume. state of mercy is participating in three key initiatives, the iowa medicaid home health program, again, led by -- it's a step in the direction to say we've got to provide these types of patients at medical homes and home care at every site across the state and we're going to participate in it. there's a work group led by governor branstad and governor reynolds redesigning iowa's health care delivery system, engaging competing hospitals and doctors and saying how do they do this work better and that's going to be i think tremendously successful and then as governor branstad, help the state initiatives, and so

what we've done, we're 10 percent of the way. we have a long way to go but we're on the track and my message to you is try and engage your physicians and your -- in your state, in hospitals, in the state, inra collaborative fashion to say let's go in that direction. >> mr. vellinga, thank you for your fine presentation and i also want to say in my previous position as demoines university which is a private nonprofit medical school in demoines, we worked very closely with mercy and the other providers in the chronic care coalition and working on congestive heart failure an diabetes patients and so you've been working on this for a long time and we appreciate your leadership and now i want to turn it over -- and we'll come back for questions to you as the other panel members. i'm going to turn it over to governor quinn to introduce our next speaker. >> okay, thank you terry. i'm pleased to introduce jennifer decubellis, with the

hennepin health -- she is the hennepin health director for hennepin county in minnesota. jennifer is the area director in human services and public health, with the responsibility for health care reform, and before joining hennepin county in february of last year, she worked in houston, texas as the assistant deputy director for the mental health and retardation authority of harris county. while working there she led an initiative to improve system efficiencies between multiple public sector agencies as a means to improve patient experience and reduce costs, and hennepin county, jennifer has taken on a similar role in bringing together the county hospital, hennepin county medical center, the county operated health plan, metropolitan health plan, the county federally qualified health care center, that's northpoint health and wellness, the social service arm of hennepin county, that's human services and public health department of the county.

the whole idea is to make a streamline model for health care recommend. jennifer, the floor is yours. we look forward to your comments. >> thank you. i appreciate the opportunity to be here. hennepin county has newly embarked on health care initiatives which is trying to look at things differently imagine not knowing where you're going to sleep tonight. not knowing where your next meal was coming from. this is the very reason why oftentimes we find patient that is are not taking medications, not managing blood pressure and it's the biggest failure of health care, is that we're not paying attention to bringing together health care services with social services and basic needs, and that's the exact opportunity that hennepin county is working to resolve. what was identified is that we were in crisis. about two years back, as the economy took a turn for the worse, we started as a county provider, seeing more people accessing services, due to

unemployment or underemployment, more people were coming to safety net providers, but revenues were down, so with revenues down, demands up, the system was in crisis around health care, and with every crisis is opportunity and that's what we're looking to maximize. looking into the problem, we looked at where are we spending our greatest dollars, an you've already heard my copresenters mention that the top 5 percent in hennepin county are utilizing 64 percent of our dollars, and it was an approach to see what were they utilizing and what we found was it was crisis-driven care. crisis-driven care is our most expensive venue and most of the dollars right now are going to crisis services, not to preventative care. we also noticed system fragmentation. systems that weren't working well together oftentimes with our payment models, systems provide specific services but they don't look across the span of holistic needs that these individuals need and ensure that folks don't fall

between the gaps. as a safety net provider we were also looking at cost shifting so we had the opportunity to look at what health care fails what happens in our corrections, what happens in the jails, what happens in the shelters, and where are there other downstream costs that again we're funneling a lot of dollars into these services nfd of ensuring health and wellness up front. hennepin health is one initiative in the state of minnesota of many. the state of minnesota is working on integrating and coordinating across continuums of care. they're working directly with providers and counties on initiatives where those providers and counties best know the needs of the populations they serve. they're also encouraging multiple models. not a one size fits all approach. so what i'm sharing with you today is the hennepin health model which is just one of many in the state of minnesota. as the governor mentioned, we have our hospital, our federally qualified community

clinics, our social services arm and our health plan all working together to try and define a service system that works well. we also have extended community partners, and really talking to partners and providers in the community to say we've got to stop competing and we've got to start collaborating, because when we compete and don't share our learnings, our successes, as well as our failures, we don't maximize the opportunity to improve the system across the span of care. the premise of hennepin health is if we don't meet individuals' basic needs we're not going to get their attention on health care, and what we found as i started looking at that top 5 percent is we found individuals labeled noncompliant and health care system had felt like they had done everything they possibly could to work with the population. in looking in the details of those individuals' lives, what we quickly found was there were reasons for that. it was transportation, it was lack of resources.

talking to patients about why they're going to emergency departments in large volume. we didn't find it's because they prefer that's where they want to get their care. what we found is transportation was a challenge, if they had a neighbor that was able to drive them at some point, they needed to go and they needed to go today, they didn't have the funding for preventative services or didn't know how to access those services. what they did know is they knew to call 911 and have an ambulance take them to the hospital. those are huge opportunities in our system to reduce costs and -- and chong how services are delivered. the population that hennepin health is working with can the medicaid expansion population. that is where we found the biggest bulk of our dollars going to is the population who typically are not connected into care and into services. we started january of 2012, and i continue to say, though, we have great learnings that i will share with you, we only have built about 30 percent of what we know needs to change in this system in order to provide better outcomes. the population

characteristics are very telling on where we have gaps in service. 68 percent of our population are minority status, chemical health and mental health needs make up 60 percent of the population having one or both of those conditions. chronic pain at 30 percent, unstable housing at 30 percent. 30 percent of these folks are very transient, often in our shelters, often in our corrections department, often in our emergency departments, because they don't have another place to go. and 30 percent have one or more chronic diseases. what we've taken is the opportunity to work with what we call tear three members, and it is those highest cost individuals who the system is working the least for. so it's not just a cost-driven model. clearly the system is not work and that why they're in those defense services and the approach we've taken is for every one of those individuals who we can turn care around for and get our arms better around, we free up amazing dollars to get to that next tear and to

continue to recycle those dollars through the service system. objectives are to improve the outcomes for patients. we've also added in improving the experience for our providers. if we do this on the backs of providers by constantly reducing rates and reducing opportunities, we're not going to have more providers coming into the system of health care, and that's absolutely what we need. so we are watching for provider satisfaction, and what we've heard is providers want this as much as the system wants it, as much as the payors want it, because providers got into this business to provide good outcomes and good health care. they need the tools to do so. core elements of hennepin health, it's a patient-centered approach so we have patients at the table, not in advisory but in work groups, helping us design the system, utilizing a health care home approach to get as many people engaged in preventative services as possible and integrating providers across the system. this integration of cross systems is critical and though hennepin county has a unique opportunity because we

operate several of the pieces of the system today, this is replicable in any system where providers need to be incentivized to work together and not just focus on their programs, because the costs and duplication of services are incredible. i met with one individual in a shelter who was confused about what was happening, and he said gosh, i've got a lot of people working really hard to get me where i need to be but i don't really understand where i should be going going, and what i found in looking into it is he had a caseworker from the health plan assigned to him because he was a high utilizer, he had a caseworker at the clinic that was in the shelter where he was living, assigned to him to help him get better. he had a social worker assigned from the hospital because he was frequently at the hospital and they were trying to reduce admissions and he had a social services social worker assigned to him trying to help him meet his needs. none of these social workers, caseworkers, case coordinator, whatever term you used, knew the other existed. huge failure in the system.

what was happening was folks were often running in separate directions and sometimes even running in the same direction but a waste of resources and an individual who couldn't get the care he needed because he didn't get that they all worked for different entities. he just knew he needed help. what we've done to try and solve that is we're looking at a one core patient record and i say core patient record because unfortunately with statutes a lot of different social services enter into different systems, health care providers are, so there's a lot of different systems, but the one core patient record is the place to bring all of those systems together, and what we've created is dashboards that can quickly -- if i'm a provider, the last thing i want to do is wade through caseworker notes and social service notes and who's doing what at the shelter and who's doing something in specialty care, i need a dashboard that tells me for the specialist i'm at what are the key things i need to know and it bubbles up from the record to give them those key indicators, so the dashboard for a community health worker who's looking to see who

failed an appointment, who didn't come in and who do we need to go out and see, who hasn't picked up medication refills is very different than what our nurse practitioners or physicians need to see but it's an ability to have one system that helps flag gosh, there's another caseworker that's recently been assigned over here with own of our community partners in social services that you need to know about, and what we're doing is pulling those folks into virtual treatment teams. don't need to be on site, we don't need to all work for the same place. what we do need to do is coordinate care and understand who's on point to help get to the outcomes that we want to have for individuals. goals, year one and two are similar to a lot of things happening across the nation. it's reducing admissions, readmissions, emergency departments, it's reducing those crisis services and hopefully reducing our corrections services and our shelter services as well. and working to increase getting folks into those preventative care, so getting upstream and spending more dollars upstream to prevent

the higher costs downstream services. we're also working a lot on reducing churn and by churn i mean folkies dropping in and out of benefits. by a -- every eight months, individuals are falling off of medicaid benefits because of the renewal process and the paperwork. not that they sud beenly got this wonderful job and they no longer need the care. it's that they are transeent, moving from place to place and don't always know they have a renewal date coming up or how to compete the paperwork. it's a system failure to meet their needs. our financial model, for this project, hennepin county is 100 percent at risk. basically, what they've done is given us the same per member, per month amount that goes to the insurance companies and we do have an insurance company within the project who gets that, but the difference that is been this gear shifting. we have the dollars, we have to provide the medicaid benefits, but we have the opportunity to make other decisions and spend dollars in other ways. an example i would give is somebody who has diabetes and is in the hospital greater

than six times in a year for insulin issues. what we're finding is that it's simple things like my refrigerator isn't working, i don't have a place to keep my medicine. an $800 refrigerator being purchased by hennepin health can reduce a $12,000 hospitalization. huge cost savings, and some easy answers. what we found is with the partners is that tearing model is for everyone we take care of at the higher level, we're able to fund social services to others who weren't getting them before or were able -- or we're able to fund preventative care, community health workers and it's constantly release thank funding back into the system to take care of a larger population. the other interesting part about the approach has been in the past, when funds are not shared across systems, you find that folks don't take care of each other, so we have individuals who are, for lack of a better word, stuck in a hospital bed, medically stable, but have high needs, traumatic brain

injury, behavior issues, high needs and nobody wants to take them. while at the point that the system doesn't work together, the hospital is on the hook for that. they're medically stable. there's no reason to be able to get payment at that point. in the past, systems weren't motivated. now what you'll see is we wave a red flag in social services at the table saying let me help you, let me get creative on how to tap into resources, we have nursing homes saying we're will to go partner with you, we're tired of you discharging and ditching us but now that we're in it together, the hospital is motivated to support the nursing homes and when we talked to them the nursing home said we'll take those disk patients but what we need is when that patient is disk we need your behavioral health team in our doors helping us manage them because when you're not there, which is the traditional model, if you're not there providing that support the tendency is to call 911, call an ambulance, send them to the hospital and as soon as they're stabilized, that same place

doesn't want them back. so it's provided us an opportunity to incentivize folks to say wee all need to support each other in working in the wellness of individuals and it has had great successes. early learnings, to go through a couple quickly, dental and our emergency department was one on day three, it was identified as a high population of our folks were going to the e. -- to the e.d. for dental care. you think of the traditional model, you get an e.d. charge, they prescribe pain medications and refer you to the dentist, for our low income population, what happens is they don't have a way to get to that dentist or that dentist isn't available so in three days we see them in the e.d. for pain medications, we have a high chemical dependency in this population. we've probably made that case worse. what we did is as soon as we identified that and we identified it through data is made same day access to dental in the e.d. and said e.d., we don't want you seeing this individual anymore, stop giving them the bandaid and in many cases making it worse and let's get them into the dental care,

same day, provide the care they need and solve the problem. and those are the constant opportunities we keep finding of where systems, when motivated to work together, can make huge improvements. another example, pharmacy consults has been deployed. what we found in this top tear is that it was not -- top tier, it was not uncommon in the past 12 month toss have 11 different providers and greater than seven different pharmacies. dangerous health care is what happened is that providers, those 11 different providers, were all duplicating services, they were duplicating tests that had been somewhere else because the payment system doesn't motivate them to find out from the previous provider what happened or the data technology doesn't allow them to know that that provider existed. what we're looking at is to change that. our pharmacy consults have been able to do outreach, do medication therapy management with folks to bring medication costs often down by about 50 percent. medication delivery is another initiative.

what we found was that folks weren't picking up their medications. the health plans are providing transportation to go get them, but with the low income populations, they often, their priority wasn't going to the pharmacy. so we're testing, delivering medications to them. it gives us an opportunity to make sure they get the medications, they understand how to take them and that we can successfully deploy those resources. our top 40 and top 80 tiers, i've already mentioned, which is gradually working our way through that list, to say where is the health care system failing, how do we change it for this individual, how do we take those learnings and expand it across the entire population, where we find system issues that aren't working well together. those are some of the care initiatives we have, and it's a small sampling of the many things that are moving as we learn more an more about what's broken in the system. some large system enhancements, is the health plan and the providers, typically health plan and providers don't share information. we are taking our health plan

and merging it in with the providers and saying you know what, we don't want two nurse lines the health plans often run one, providers often have one, duplication of costs, and you know who needs that information? the health plan doesn't necessarily need that nurse line information about what was the crisis. the providers are the ones that need to act on it. so bringing those systems together is huge. same with disease management, same with outreach calls. there's a volume of information at the health plan that often doesn't get to the provider and the provider is the one that can impact that care. we're looking at a continuum of care length, behavioral health program. we have fabulous programs in our community. unfortunately, they're levels of care and when one level of care is done what they've done and they've improved the life, they've improved the outcome, the patient gets referred to another level of care. but there isn't that linkage of us having a system that works well between those transitions. challenges to resolve.

we have several challenges that were faced and are looking for solutions for with this population specifically. i mentioned the eligibility churn. what happens is members that lose their benefits, if we don't help develop a system that can help them stay on benefits, and stay active and engaged in care, what happens is they go to fill that prescription and they're told they no longer have benefits and they need to pay out of pocket. they can't pay out of pocket. this is a population that has less than $700 a month in their pocket. if they can't pay for it, what happens is they stop their medication, they end up back in the emergency department, they end up back taking ambulances and we've cycled them back through the system again. so we've got to find a way to keep folks engaged. our other challenges, you heard all of us talking a lot about data and the power of having data in folks' hands. as we talk in hennepin health about bringing health care together with public health and together with social services, one of the big fran men -- fragmentations is our statutes don't support it. we have health care statutes

that define what data can be shared. we have welfare statutes that define on the social services we don't have statutes that clearly define how do those worlds work together within the regulations that are in front of us. so that's been a real challenge for us of getting information in the right peoples' hands at the right time. informed consent for patients are the ideal way to be able to share information, however, there are folks jumping between crisis services and in pretty dire situations where we need to be able to very quickly deploy the resources to improve their lives to get them better care, and we need to figure out how to do that in a cost-effective way. thank you. >> well, thank you, ms. ms. decubellis. we appreciate your presentation and the presentation and perspective of each of the speakers, and now we would open it up for questions. >> yes. dr. herbert. -- or governor.

>> i just got promoted! that's pretty good. thanks to everyone for their presentations. very informative and i think gives us pause for thought at what we can do at the state level. dr. brenner, i was fascinated with a comment you made that said health care has not innovated. and as i was just thinking about that, in my own lifetime, over the last 50 years, it seems like we've seen a lot of innovation in medical care. with new surgeries and processes and procedures, transplant of organs, you know, knee surgery replacements. it's been remarkable, the advancement of drugs. it's not often given us -- only given us better quality of life but improvement of life in the surgery room and better outcomes and quicker recoveries, less invasiveness in the surgery. so it seems like to me we've had some significant innovation. i know in the united states,

our health care is expensive, but it looks like to me our quality is very good, and particularly for those kinds of problems that would be life threatening, whether it be heart problems, cancers, if you're going to have treatment, being treated in america is probably the best place in the world for having better outcomes for the life threatening diseases and problems. so my question to you is what do you mean by lack of innovation, and -- in health care, and if, in fact, there is a lack of innovation, why? >> it's a wonderful question, thank you for picking up on the comment. the product that we're delivering has seen incredible innovation, so the surgeries we're able to do, the medications we're able to deliver. so it would be as though we were an apple -- we were apple and we had invented an amazing iphone but every time we did a redesign of the

iphone it took ten years to come out of the labratory. so what makes i.t. in our country so innovative is something called just in time manufacturing. so it's a plant -- at the plant where they make the i phone the ran materials come into the plant almost the same day that the product comes out the other end of it so that there's very little product on the shelves, and every time they cycle through a new version of the iphone, this just in time manufacturing system is finally -- finely tuned to make the product come out. that's a process reengineering. the cars that come off the end of the assembly lines now, anyone on the assembly line can hit the button and stop the assembly line if there's a flaw or an error, so as a result, cars are -- it's not just that we have a new and different kind of car but the way we make the car has been processed, reengineered. so in health care we do incredible things to people every day but the sum total of all of the parts is often a failure. let me give you a clear

example of that, a 70-year-old patient in camden who was flagged because he was frequently going to the emergency rooms and hospitals, a poorly controlled diabetic with terrible sugars in the 500s, our team went up to see him and he set the insulin bottle down, he put a syringe in the bottle, drew out 50ccs of air and went to inject it into his arm and he was sight-impaired and he couldn't see the -- what he was doing with the syringe. he went to the refrigerator and pulled out two bags of insulin and the pharmacy kept bringing the medication and he said i use insulin every day but i can't seem to empty the bottles. that's a process failure. the medication in that bottle is brilliant, we should be proud that we're able to produce that, but there are so many process failures built into what actually happened for that patient. many of us don't realize how broken it is until we ourselves, we have a relative sick, lying in a hospital bed, and ten ormo, 15, 20 different doctors come into the room every day and slowly start to realize that none of

the doctors are talking to one another and that you actually know more about the care delivery process. we have incredible quality in certain areas and abysmal quality in other areas. we think that probably 100,000 people a year die inside of hospitals for preventable errors and failures. now, you know, we do amazing things, we transplant their hearts, then we throw them out into the community and they're bee wildered at home, they're lost and they call primary care offices, this get put on hold, can't get an appointment, they come in, and so i agree with what you're saying, the product that we do, it's very innovative, but how all the pieces of the system add up is often a failure. >> and why is that? what is causing us to have this kind of stifling of better process? you would think -- i mean, you mentioned the iphone and the technology advances we've had. they find ways to do it and they either find ways to do it or they don't survive and somebody comes along with a

better widget or product and makes a gazillion dollars. what is it about the medical processes that we're not finding innovative ways to streamline the process, commensurate with the product we're make something. >> there's no financial incentive to do it. if we get it working together, you'll close hospitals, so there's a wonderful example in the guise inger health system, a closed health care system, in which they're the insurer, own the hospital and they employ the doctors, and they did a complete redesign of their product, of all the processes of care and for the average primary care office they lowered the number of patients so the average primary care doc has 2500 patients. that's why when you go to the waiting room there's too many people there, that's when you call it's busy, that's why when you get in the room you're waiting there for an hour for the doc to come in and spend ten minutes with you. so they cut down the number of patients the average doc has, they put nurses back in

the office and gave the doc big chunks of time to answer the phone so if you were a patient you could actually make a telephone appointment or e-mail the doc and get things done. they reengineered all the processes of care so that every patient hospitalized got some tlc and special attention. and they dropped e.r. and hospital use by on the order of 30 percent. now, if all we did right now in every one of your states is drop the bed days for the hospitals by 5 percent, you would close them all. hospitals are in the same business that hotels and airlines are. it's about occupancy rates. every day, every hospital in the country looks at the occupancy rate that day. so they are paid in volume. they are paid to hospitalize. they are very good at building service lines anding service lines because of how we pay for health care, in employee plans, private insurance models, medicare and medicaid, it is by in large a volume-based model,

where there's no incentive. you are actually put yourself out of business and there are wonderful examples of innovation being shut down because it reduced volume of service. >> thank you. >> from a hospital person, the issue is deeper. the reason we don't see tremendous innovation in the areas dr. brenner mentioned and we don't see the innovation in the primary care side is our system is built on a system of paying hospitals and doctors on a fee for service basis, meaning the more volume you do, the more you get paid. and on the primary care side, so that means seeing more patients and seeing more patients. it doesn't mean hiring mid-level practitioners to do other work to keep patients out of your hospital or keep patients out of your clinic. your state has done a great job, probably one of the

states that would lower costs than iowa, and we're second or third, but your system in the state -- you have systems in the state that have really taken this to integrate the care and the financing, so they assume risk, and now, they have a risk advantage, an economic advantage, to say we're going to try to keep our population healthy. that is a fundamental shift that this whole world is going on in health care, going from fee for service or volume to value. i think your state, where iowa is going, has really led many of those in that direction with the integrated systems working together across the continuum. >> i would echo that to say what we're seeing with consults, you heard me talk about provider groups where we're duplicating procedures. fee for service today incentivizes me as a practitioner to do more and

it doesn't pay me if i go and look at what david did three weeks ago for the same patient. so we've got to turn those incentives around. so now what hennepin health is work to go do is saying we're all in this together and if we can bring costs down and improve outcomes, we all gain. so providers are starting to look at it differently to say it's not about me doing more, it's actually about me doing less, but better with what i'm doing. so if not giving extra radiation to a patient is better for the patient and i can still make myself whole by talking to him and looking at the radiology that he did, then we can turn this system around. it is merging that clinical prac, practitioners know what they need to do. it's merging the payment system to match it. >> governor heinman is next. >> i'd just like to follow up the conversation and ask a big picture issue. i understand what all of you are saying, and the manner in which you think we can reduce

cost, and that is, are you suggesting the current system has more than sufficient funding, we just don't use the money that we have efficiently? >> we spend twice as much as any other industrialize dollars country and cover far fewer people. you know, i don't think the french are dying in the streets, i don't think the germans, i don't think the swiss, i don't think the canadians. i realize each system has good points and bad points. our system actually has good points and bad points as well. we're a country that doesn't like to look around the world and take best practices from other places, and i think that's a shame. but there is absolutely enough money in the system right now. the problem is that any business that's ever done change management, sometimes you have to spend a little money up front in order to reengineer everything, in order to save money in the back end. so we're going to need to make some investment right now in people, in reof courses -- in resources, in resume capital and states have an incredible role to

play. the states at the leading edge of this are the places where the governor and governor's staff or someone at the state level that is banged their fist on the table and brought people together an been catalytic in this. >> i think the issue is we think there is. i mean, that's my answer to your question. we think there's enough money in the system, if the -- if it's restructured. we know that now that we're getting data, seeing it across the board, we're starting to realize how we're infectively using the resources we have. so i think the answer is yes. i'm not quite sure if we can the -- if we have the data to really say that, but we're close to being able to -- i'll be close to saying yeah, i think we are. >> and i would agree with that. i would caution, it's not pulling the rug out from underneath providers. it's that gear diagram that we shared where you need to improve systems, release funding that can be used, and

if that gradual process happens, that's what will keep providers whole and not shut people out of business. if somebody takes an approach to say tomorrow, there's a new payment reform happening and we're exanging -- changing it, systems won't be ready to switch with that and we're going to lose quality providers, so i would take a cautious approach but agree that as we make those system changes, it should be cost-neutral. >> governor o'malley. >> mr. chairman, thank you. thank you for an outstanding panel. i mean, this is -- eachor you -- each of you is so insightful and obviously have proven your theory and you're doing it every day and it works. and so mr. chairman, i was reminded, as i was listening to this great panel, about probably 15, 20 years ago, many big city mayors thought we would never, ever be able to get a handle on violent crime, it was just going to continue to go up, the costs were going to continue to go up, arrests were going to

continue to go up, and then, bill bratton, jack maple, ny nypd applied com stat measuring performance, putting cops on the dots where you had the opportunity to arrest the most resid obvious violent offenders and what i'm hearing are the same principles. dr. brenner i've been following your work for many, many years, and as my second health secretary will tell you i bang my fist on the table often, in fact my fist is damn near broken over this issue because i've seen that you all are doing it. it sounds like what we need is the common platform that takes a system that is discoordinated and disconnected and makes it better coordinated and better connected and then the third thing that you sort of had to go through quickly was this notion of the -- you call it

the patient dashboard, the ability to let the patient see that they too are coordinates on this cost cutting. so i'm wondering if you might elaborate further on the patient dashboard and a role that a better informed patient, one that you actually speak with, plays in helping us to reduce these costs. and i agree with you, i think there's plenty of money in the system. i think it's not being deployed properly. >> i think what you caught on to was an opportunity we have with public health. we can't solve health care issues -- take the obesity issue we have in the united states as an example. we can't solve that in a ten minute or 20 minute physician visit. it needs to be getting word out to the general public, infusing it in communities, engaging and owning their own health care and individuals owning their own health care, and how can we employ folks to do behavior changes that

will ultimately help. so it's using all of our parts of the system. right now, public health often operates very separate from social services and very separate from health care communities. what we're pulling together in hennepin county a strategy to say we need that, front end education, we need the food resources available in communities to make the healthy choices that we want them to make, and it is taking a system wide approach to say we can't work in isolation, we've got to bring all the resources to the table in order to give patients the tools they need to make those healthy choices. >> but what is the dashboard, is that something that i.t. or the internet allows to you do, is it on the iphone on something? i've seen, united health care is doing some good stuff for us in map thank decknology. what is that patient dashboard that is on your -- >> what the dashboard that we've already employed is a provider dashboard. it is a way to take the information that's in a patient record and bubble up what folks need to see in order to meet their

individual specialization. there are a lot of models, however, across the country where there's a patient dashboard, so our i.t. system does have a patient portal. >> for individuals? >> for individuals, where they can go in and see their own labs, this he can see their own recommendations, and part of the thing that's being encouraged is charting. so if we can get smarter about charting somebody's blood pressure checks and they can see improvements over time based on interventions, if we can chart weights, there's a lot of tools that individuals, if they have computer access can be brought into. again, working with the low income population, we're finding we need to get them into our public libraries where they have access to computers to have some of those tools using the cell phones, like you said, deploying cell phones that remind people to take medications, that remind folks to, gosh, you haven't sent in your weight or your blood pressure. what we find in health care today is, again, because of the payment mechanisms, physicians are bringing

individuals in to check blood pressure. well, that's a huge waste in the system where we don't have enough physicians to treat providers, and there are a lot of patient tools that can be deployed at low cost. >> we're running out of time. i want to give governor markell a chance to ask the last question. >> okay thanks, and i agree with governor o'malley, this was a terrific presentation. if i could drill in for a second to the issue you all were talking about a moment ago, dr. brennan, you talked about, i think you said if we reduce by 5 percent the admission rates to hospitals and all the hospitals would go out of business, and perform vel eveninga, you jumped in -- vel eveninga, you jumped in, i think this is probably the biggest challenge we have because it's the reorientation of an entire industry, and it's easier for me to understand how, with providers, we can start to try to make them whole by moving away from what has become a sick care system to a health care system, rewarding quality as

opposed to paying on the fee for service model. can you explain, though, how it could work, and maybe a little more of how it does work for hospitals? and you know, maybe for providers, some kind of capitation, putting groups together. i don't know if that's the right model or not. but i can sort of see how you do it with doctors and health dare providers, but -- health care providers, but given your analogy to hotels, which seems to be a very good analogy, how do we get there on actual institutions? >> i think that core states have an important role to play. we've essentially inflated the largest economic bubble in the history of mankind. so health care is a $2.8 trillion industry, it's 18 percent of our economy, and the hospitals are a significant portion of that, as are the kind of high tech specialty portion as well. we've done that through bonds. so we have a mountain of debt underlying, and you the states have underwritten a lot of that debt.

those hospital bonds and guaranteed those bonds. so one approach would be to sell -- the big short is to sell short hospital bonds, because if you look at the cost of all what's in this, half of the costs are hospitals and doctors. the bulk of the federal debt going forward is health care. health care will be larger than the entire rest of spend in government. the only way to bend the federal debt is going to be drawing a lot of money out of medicare and cutting payments and rearranging payments to doctors and hospitals. and hospitals being the biggest chunk of that. so you know, we're looking at really a cataclasmic change in an industry that's just like other industries, like the steel industry, where we had too much capacity, where the underpinnings of what was going on in that economic system changed rapidly. the other analogy is psychiatric hospitals. at one point, where one third

of your state -- it was one third of your state budgets and in the '70s they closed and we de institutionalize dollars care and with medical care we're going to move it out into the community and the question is are we going to build a system on the other side. health care is 18 percent of the economy, finance is -- housing is about 11 percent, finance is about 7 percent. so think about what it's going to do to the eds and meds model of urban redevelopment, and of the, you know, the major employment gains that we've had in health. it's being built on a mountain of debt. so we have a really wrenching problem in this, and the best way to do this is going to be buydown capacity. all over the country, hospitals are closing down and private equity is going in and buying them up and that's going to be propped up by unnecessary occupancy paying for medicare. so when you have a capacity problem, states have a really important role of coming in and figuring out what's the

transition model so that we don't have massive unemployment and other problems. you know, sequestration could be going off the cliff for a lot of hospitals. >> a couple of comments. one is hospitals are rapidly becoming just not hospitals and doctors are not just becoming hospitals, but in all of your states, you see rapid development of the integrated systems, hospitals, doctors, payors, coming together to provide a better product, so this era of a file of hospitals, a silo of doctors and insurance companies is rapidly changing i support that. i think you should support that. i think that makes sense. but right now, we have a foot in two boats. we have a foot over here in a boat and a foot over here so it's a delicate dance. but my lens says physicians, hospitals, payors, are ready for this conversation. in fact, the market is driving this conversation and

government needs to do everything it can to advocate and support the further development of that. and then to reward those individuals, physicians, hospitals, systems, for doing the right thing. the reality is our payment system has -- we have the system exactly that we designed. we pay on a fee for service base. what do you get? we get more volume. and that's what we have. so now what we have to do is pay for and reward those that create the value. not just micromanage everything but create a system that rewards the value created. >> since we're running out of time, and before we leave today i'd like to provide the governors with an update on the activities and opportunities within the health division of the nga, center for best practices. as you know the health division provides governors and our staffs with information, technical assistance, policy analysis, and periodic national meetings facilitating pure

exchange. through 2012 the health division will focus on medicaid cost containment, health system transformation, prescription drug abuse prevention, and health work force planning and i'd like to at this time turn it over to dr. dan crippin, nga's executive director to highlight some of the actives and new tissue tiffs from the center for best practices. dr. crippin. >> dr. brennan, thank you for inviting me today. i want to take the time to tell you about the things we're doing now, an initiative we're in the process of launching that ties back to the presentings today. and to in part tell you what we think we'll have available for you but also to invite you to tell us what else we can be doing to help you, particularly medicaid, and the health care costs in general. most of you know and have met kristin drobak behind me here, runs the center for health care practices. she is driving much of this agenda. she just lets me speak for her occasionally.

so quickly, we currently have underway an initiative to try and get states together, compare notes and best practices on the abuse of prescription drugs. something important to virtually every state. it's worse in some places than others. but with that, we'll have six or seven states that will be funded to do the meetings for a year and to -- we'll have about $50,000 per state for your own expenses so we'll be making direct transfers to you as well. we'll be putting on leadership retreats for systems transformation, some of what was talked about today, how do you change a whole system within a state, and we'll have technical assistance teams going out to states as well to work on child health care and how we limit pre-term birth. so a very important piece for medicaid. med cay now pays for half of all births in the country. so it's directly applicable to medicaid, but of course for all kids as well. we'll be having a meeting

next week on -- with 41 states so far registered, with representatives to talk about the implications of the supreme court decision last week. what it means for states, what other options you have. christa is developing and we will launch about labor day a new website that will be what i first -- what i think about be the -- will be the first of several virtual centers of best practices, this website will obviously be aimed at health, it will have case studies from virtually every state, it will have listings of what your scope of practice laws are, state by state, what you allow medical practitioners to do or not do. we are doing some things, working with the state of maryland, we hope, on expanding dental practice, dental services, for example, because many of the medicaid kids aren't getting sufficient dental services. so we have those kinds of things underway. equally importantly and more to the point for today's presentation, another of my colleague's, steve leb heman, taught me 15 years ago when

he called the bank robbers of health care, and that was -- you may recall willy suggest i don't know, when asked why do you rob banks, when asked, he said that's where the money is, and in this case, the bank robbers of health care is why do you look at expensive patients, point is that's where the money is if you're worried about costs, but more importantly, that's where the needs are. when you think about 20 percent of the population driving 80 percent of the cost every year, the other side of this is that 80 percent of the population doesn't need much health care in any given year. focusing on the expensive patients, as all of our panelists did today is a very important piece of this. we sometimes bifurcate those folks in ways that don't make much sense. we certainly worry about unusual use of resources, excessive use of hospitalization. or nursing homes, emergency rooms. but we have only as a country in the past few years begun talking about how we also give these people better health and in the process, we require less health services and it's not just classic

prevention of lose weight, it's more important of how we take care of these people and as jeff and others have developed these models, it takes more than just a doctor. it takes more than just a hospital. increasingly we're understanding, particularly in medicaid populations but in others as well, that behavioral health is e-- very important part of taking care of folks in order to reduce costs. the governor knows because he's one of the few states that actually integrates physical and behavioral health for medicaid patients so it's critically important to take care of people as a total patient, not just the physical health care side. so we're beginning -- we have begun to solicit foundations and other funders for a center for health care analysis that will be available for all governors, and one of the first things we do and we'll have actually in hand soon is software that we can give you, allow to you use that can replicate what jeff has done on these hot -- on looking for patients. most of you