to 51 years old when a gunman opened fire during the premier of the lake as batman film. the president is expected to meet law enforcement's officials and make some remarks, which we plan to bring you today. from there he will go to san francisco with remarks to a convention in reno, nevada and fund-raisers in oregon. present a candidate mitt romney is also expected to speak to the of foreign wars tomorrow. >> republican house members allen west and michele bachmann spoke at the eagle forum's annual college summit. congressmen west talked about

the military and the threat of sequestration, the automatic defense cuts that take effect in january if congress does not further reduce the deficit. representing bachmann use a portion of her speech to accuse the obama administration of allowing an egyptian politician into the u.s. who allegedly has ties to a designated terrorist group. this is one hour, 10 minutes. >> i think this is the biggest and the best collegiate summit we have ever had. we have about 100 colleges represented here. my plan is to have all the speakers keep their speech to 15 minutes so that we can have 15 minutes of q&a. i want to bring interactive the best be interactive and bring you into it as much as possible. we have a rule of one press

questions. you can ask a question if you can -- one-breath questions. it is more fun if we have a lot of questions the questions will be short and the responses will be short. we want everybody here to be a part of the program. i am impressive that we have guides here in the best guys here in coats and ties. eagle forum has made a place for itself in -- on the american political scene. i hope you will like it and be part of an be active so that we can save our country from the people who are trying to change us into something that looks like europe. that is not what we want.

when we see a picture of the future, it is europe and that is not what we want. let's have a quick prayer. >> heavenly father, we recognize u.s. creator and lord this morning. we cannot help but be in awe when we look around our nation's capitol in all that we can accomplish. encourage the speakers to stand for truth where you have put them. amen. in jesus'name, >> i told you we would have our favorite members of congress and one of them has arrived. you can see that he was in the military because he arrived on

time. he has his master's degree in political science and a master in military arts and sciences. he served in the army for 22 years and was in operation desert storm. after retiring from the military, he was elected in 2008 to serve as a congressman in florida's 23rd district. he is on the small business committee and the republican study committee and he has made a name for himself. we are proud that he is here today. please welcome congressman allen west -- congressman allen west. [applause] >> someone passed a note that he was here.

>> i cut my announcement short because i thought he was here. we are hoping for meaningful interaction between students and speakers who are speaking. we are going to give away a fund prize. it is a camcorder that has a drive you can put in your computer and shared the of easily. we are going to give that out on friday to the student who has not only a quantity of social media at -- interactions, but mean folk interactions. he will be looking for your hashtags. the second contest we are going to have is for t-shirts. if you ask a question, you will get a ticket. every ticket will enter you into a drawing for neat prizes.

>> i hope you'll understood that because i did not understand a -- you understood that because i did not understand a word she said. we thank you for interacting on social media. we hope you will be active on social media. we know that obama has done a great thing with that. we want to be just as good and reach just as many people. i do not understand. they told me he was here. he must be with some of his fans outside. you are all happy and here on time. thank you for coming. i want you to socialize with the other students. you are an attractive bunch of students.

there are about 100 colleges representative -- represented. you are coming from all over the country. we have a spectacular website. i think is the -- it is the best in the movement. if you are on the list, you will get notices of alerts. yes, congressman west is here. i gave you a beautiful introduction a few minutes ago. everybody clapped, so we can clap again. [applause] thank you for coming. i said, being in the military, you are on time and i thank you. >> thank you. once again, it is truly a press -- pleasure and an honor to be here. phyllis schlafly has been on this battlefield for quite some time. i am unearned she will allow me

to be out there with her on the front lines. -- honored that she would allow me to be out there with her on the front lines. they want me to talk about military superiority. there is a line that i heard about the treaty coming up in senate. the best way to make sure you have a treaty is to make sure you have a strong navy. if you look at what is happening in our country with sequestration, it continues to be a vicious cycle. when you go to world war i, we budget the military after the war. what happened after world war i, we had world war ii. what happened at the world -- world war ii? we send people to a place called korea. the next thing you know, we get committed to a place in vietnam. but i was in desert shield and

desert storm, we saw deployment increase of 100 fold for our military. we have to understand that we cannot look at our military force -- as a bill payer for fiscal responsibility. we continue to do that after every single major combat operation. we believe that is the end of major conflict. john f. kennedy said the absence of war is not peace. i wish we would understand that. the world is truly more machiavellian that it is kantian. if you have not read kant, go back and read it. and read the press by machiavelli. -- the prince by machiavelli.

the reason i think you see all the craziness that is going on across the globe is because the united states of america is not portraying strength. yesterday, i sat down and talked with representatives from the three syrian movement. the talk about the united states coming to their aid. i asked a simple question. with what? we are sitting here arguing about what we are going to do with our military. we are going to send 200,000 men and women home. we are going to take our united states navy down to a level it has not been since 1915. we are going to take our united states air force in has not been at since we created the modern day united states air force. we do not have a credible

military threat right now. we have men and women who have been on five and six combat tours of duty. they are supposed to have a narrowly defined mission sets. we are supposed to believe they are being -- the soup de jour. what we have failed to do is look at the world broken down with the geographical aor, and look from the next 10-15 years. what is the bible direct we are going to face? and build -- what is being -- the viable threat we are going to face? it cannot be budget based. it has to be based on the threat

that is out there. when you look across the globe right now, when you look at the belligerence you see coming out of russia, when you look at the fact that china, with the trade imbalance that they have, their growing economy is not going toward improving the standard lot of living of the chinese citizens. the best standard of living of the chinese citizens. they are looking to increase their military capability. what are we doing with our navy? in the 1990's, we had five -60 naval war vessels. today, we only have 283. the-56 -- 560 naval vessels. go back to every civilization. everyone has understood -- this

is going to hurt my feeling saying this as an army guy. the means by which you really and to fully extend the power and dominance of a nation is through a navy. what are we doing to our? what are we doing to our maritime forces. that is the message you are sending out to the world right now. if you look at north korea, the actions they take is because china has so much of our debt. the president says, they are not really a threat. tell me why there missile site is being placed in the venezuelan? why is there such collusion between venezuela and iraq? look at what is going on in somalia. look at what is going on across northern africa. look at the new radical terrorist groups in nigeria. look at the situation in egypt.

there were those of us who said, who sells the leadership vacuum in egypt one year ago. -- who fills the leadership vacuum in each it? everybody said, you are an alarmist. the muslim brotherhood said they would not run a presidential candidate. they brand name and then to a candidate and that person won. all of the sudden, -- they ran a presidential candidate and that person won. not to mention what is happening with the failure of the united nations mandate 1701, which is supposed to preclude hezbollah from rearming. there are rockets and missiles in southern lebanon capable of striking every city in israel.

we know what hezbollah is doing in the gaza every day. and now you have a situation in syria. why? because we are not portraying strength. the world needs a strong america. it is not about us try to be a hegemon. is is about us understanding that we -- it is about as understanding that we are a beacon of freedom and democracy. when you talk to people in russia and the fact that we have turned our back on them, that is what they have problems with. is military superiority and important thing for united states? is it a key to peace? it absolutely is. you have to have a credible military. it is part of the national power you have. you have diplomatic power. and have economic power, which

when you look at our debt and deficit, the economic power is failing. you must have military power. what we need to be honing in on as constitutional conservatives -- i was listening to "washington journal" today and they were talking about mitt romney's tax returns. they are not talking about economic security our energy security or national security. we are on the cusp of having a hollow military and they are talking about mitt romney's tax returns. this is such a threatening position. let me bring it in historical context. when the united states of america first went into world war ii, pearl harbor happened.

the first unit sent to career was absolutely devastated. -- korea was absolutely devastated. we have a habit of not being prepared for the next major combat operation. here we are putting our men and women, the best and brightest amongst us, in a horrible situation. in 2003, when i deployed my battalion to iraq, we did not have enough body armor. we had some humvees that did not have doors. that is not a nation, the united states of america, projects power and strength. we have to have a strong military. we cannot look at the military and say, this 19.7% of our budget is going to be the bill payer while this other 62%, the interest on our debt, medicaid, medicare, social security, we will not touch it because we

have politicians that will not have the courage to tell the american people what needs to be fixed. the number one responsibility of the federal government is to provide for the common defense. it does not have to do with giving out food stamps. it has to do with protecting the american people. unfortunately, if you go back to look at food stamp spending from 2000 to until where we are today, we have gone to $2.8 billion. -- 20.8 billion dollars. but we will turn to our men and women in uniform and say you are not the money.

we have men and women on the tactical battlefield. the world is more machiavellian than it is -- than it is kantian. , and going to use the platform here to ask a question. i was glad to hear you use the word military superiority. as much as being strong, it is superiority. those words used to be in the republican national platform. will you help me put them back in the platform by telling your delegates what to do? >> you are absolutely right. there is a little known fact that a lot people are not paying attention to. if we're not careful, this could be the first election cycle will be visiting president and vice president and candidate for president and vice president

have never served in the military. i believe it's the first time in 77 years. how will you be able to articulate the preeminent responsibility for national security, military superiority -- it's not just about bullets and ammunition and guns. it's about a full spectrum of military operations. we have got to have people have served in the military. you had at 75% of the members to of -- members of congress to serve in the military and we are now down to less than 12%. that has a reflection on the priorities of this country. >> how do we balance maintaining our strength? >> you have to look at one of

the right and constitutional responsibilities of the federal government. i disagree with the president who says people are out there creating businesses and is not due to their own success constitute government success. when it starts to get to that point, you are saying we own you and we'll your resources. we have got to unleash the individual, and of little entrepreneurial spirit of the american citizen. america is about individual industrialism. you get investment, ingenuity and innovation. the federal government is -- the federal government should be individual cannot provide for when you start to look at it in that perspective then you understand what are the responsibilities of the federal government? the federal government in and of itself has gotten too big. it has become a bureaucratic

nanny state. we are starting to get away from the things that are necessary for the function of this government. if you read the book democracy in america, it talks about when congress gets the point where it can drive the public by using the public treasury, this is what you have. you have this exorbitant growth of the federal government. we are promising more and more largess to the american people. how does that work out? how did it work for greece or italy or ireland or spain? i know we are on c-span right now. this is the question you should always posed to liberals. where has what you believe in ever been successful in the world? [applause] >> who has got a mike?

>> thank you for being here. could you give us some insight, i believe it was last year, president obama had met with jewish leaders behind closed doors at the white house. could you give us some insight as far as what you think, whether or obama's support for israel is one of the biggest things? >> i don't speculate. as president of the united states of america, how many times has he been to israel? how many times has he been to give major speeches in islamic countries? in turkey and in cairo. i think that you see what the ramifications thereof.

that is what i look at, your actions. those actions have not let us to believe that israel is truthfully our greatest allies. there are some issues about the fact that israel is looking to have launched bases in azerbaijan. they need the bunker busting munitions, aerospace clearance. those are the kind of things that have to happen. once again we are not showing a strong supporter of israel, so therefore the other actors in that neighborhood are starting to rise up against them. >> thank you for being here. my question is on syria. some are saying our lack of involvement is showing that we don't really have power or influence in the middle east.

what do you see over future in syria and what could we possibly do? >> i will tell you this. if you recall the president when he came to making his announcement about the troop withdrawal from iraq, his opening line was, i have kept my campaign promise. general alston, the commanding general in iraq at the time, ask for 15,000 of a residual force. the next thing you know he is totally 0. now we have left a vacuum in iraq, and guess who is in syria? iran and the revolutionary guard. they were able to transit through. again, this is the shortsightedness of our foreign policy and national security policy which promoted what has happened in syria because iran is extending their regional heads. you have to be careful about what has happened in syria.

on one side you have bashar al- assad, you have iran supplying weapons. on the other side you do have freedom fighters. do we really know who they are, do we know there structure? what is the strongest political group in syria? that is the key question. the next thing is you have al qaeda operating there, and you have turkey seeking to become the next islamic hegemony. whose side you come in on? that is the question have to come in on -- that is the question you have to ask yourself. if you don't have a credible military presence, it will not be able to get their attention. my biggest concern is that if we get involved in syria, and it starts to resemble 198411 on -- 1984 in lebanon.

the next thing you know, while they are asleep in their barracks, a truck bomb rolls through because they are not allowed to have a magazine in the well of their m-16, and the terrorists saw that. what is the new, free syrian going to look like? i do not want to see the massacres that are going on. i do not want to see but zarrella shot stay in position. -- i do not want to see assad stay in position. >> glad to have you here. i did have a question about, as

we work towards maintaining u.s. military superiority, how do we ensure that that superiority is used to deal with keeping the security of the united states intact and not being used as a global police force for companies that have nothing to do with u.s. interests? >> that is where you have to have individuals with an understanding of three levels of workfare, strategic, operational, and tactical. they know what it means to employ the military. first we have to protect the sea lanes of commerce. the suez canal is a concern for me, when you look at what is happening in the straits of hormuz. we have to develop a full spectrum of energy resources here so we don't have to be so concerned about the straits of hormuz and we can take away that threat.

when you look at what is going on with china as well, the biggest threat is taiwan, and taiwan is looking to us to be able to provide some type of assistance. that is very important in the pacific rim as well as vietnam and the philippines. we have to sit down and look at this by geographic area. you start to look at what are the emerging threats you would have to contend with in the next 10 or 15 years in your capacity to contend with those threats. the 21st century battlefield is unlike any other battlefield we face. it is centered on non state that have no respect for international borders are what have you. you have to have a totally different type of mind-set. we need to move away from may forward deployed top of military.

kind of a cold war holdover, we need to go to a power projection type of military. the quick strike type of forces you can use, an expeditionary mind-set. that is what we have to start looking at. it really is a reworking of our strategic level posture of our military so that we can be flexible along the entire spectrum from low intensity to high intensity, if it ever comes to that. i don't believe anyone is willing to take on a militarily superior united states on the battlefield. be very careful. you can say that nigeria may not have any effect on the united states of america, but it

speaks to your values when you have a christian community of there being murdered. you have to understand the concerns that can have on the global markets as well. it is back to us having our own energy independence. i am not one that thinks we need to send the u.s. military all over to quell every single uprising or conflict, but i think as ronald reagan said, you cannot have peace through strength. >> the eagle forum has worked very hard to defeat the law of the sea treaty and looks like we may win that battle. would you like to comment on that? >> i am on the house of representatives side so we do not have -- we cannot see our sealanes and waterways to this

international organization. that very much concerns we. we have this international gun law coming up as well. i do not want to see us lose our relationship as far as being able to be a sovereign nation and being able to dictate what we do as far as operating on the open seas, and of course those waters that are close into our shoreline. i am hoping that the law is defeated in the senate. this is something that have been working on for quite some time. >> you don't think a bunch of bureaucrats in jamaica should make those decisions for us? >> i have to be careful about this because i am married to a jamaican. [laughter] and her cousin happens to be a member of their parliament. they may not let me go down on vacation.

i think we have to be a sovereign nation and we cannot allow other countries -- i am not messing with to make a. we cannot allow other countries to dictate our policies and make a subservient to their whims. >> i have a question. these young people sitting in front of you, the media has portrayed college campuses and their use of this nation as being totally behind the left and obama. what do you tell these young men and women who are excited and proud to be who they are and represent what they are? they can make the media understand there is a large conservative youth base that can put barack obama out of office in november. >> i would tell you that the whole nature of hope and change is going to become divide and

conquer. a lot of young people back in 2008 you are sitting at home and their mom and dad's basement and do not have a job, they feel the american dream is slipping away. what you all represent is the next generation of constitutional conservatives that understand that this is a republic and that the rule of law must be adhered to and we must maintain that individual sovereignty. it is hard on college campuses right now. i note it is. -- i note it is. continue to stand on principle with courage and conviction. what you believe then is the fundamental basis of this nation. go back and read the declaration and the u.s. constitution. that is who we are. it means that the gun man like myself born in the inner city of atlanta can grow up and have a 22-year military career in combat and be a member of the

u.s. house of representatives, and stand here before you with phyllis schlafly. part of our dna as americans is that we pass on to the next generation the blessing of liberty, freedom, and democracy. ron reagan talked about it. freedom is only one generation away from being lost. it is something we passed through in the bloodlines of this great nation. that is why i looked out upon the wall, and i have two daughters, 19 and 15. you are our future. the media does not want to admit that you exist. george soros just put a $5 million price tag on my head. the thing is this. use your social media. get your message out on youtube, facebook, twitter.

connect with others so that people know that there is another voice out there. we have to have the continue throughout all of our age groups, all of the demographics. this thing that you all believe in, this thing that eagle forum promotes, limited government, fiscal responsibility, free- market, traditional cultural values, strong national defense. that is what makes america great. >> wait for the mike. >> for those of us who are going into the military, what would you have to say to us? any advice or areas that we should be aware of? >> pay attention to your training, watch your step, and always take care of your teammates. that is it. are you going in through rotc?

which branch? >> marine corps. >> why not an army man? they have the cool uniforms. the chicks dig the uniforms. plus, you guys have great commercials. i commend you for that. in my family, i am the third or fourth generation of military servicemen. thank you for carrying on the desire to want to defend this great nation. the first thing you need to look for is your platoon sergeant and listen to him. he will make you a great second lieutenant, which means you will be a great captain. then listen to the first sergeant who will make sure you become a great maj. always take care of your marines.

>> i have a similar background, i grew up in the inner city and did junior rotc. my message to get out to the community in the inner city and preach the conservative message. how can i do that effectively and fight the liberals who may say it is cruel and unusual punishment? >> for whatever reason, our fellow americans who are liberals would rather see more people waited to government than being out there and being successful on their own. high school rotc set me on the path i am on today. i remember my for high school rotc instructors. i will never forget those men. they developed a sense of

leadership in me. why would anyone disagree with that? men and women who have served in combat, to go back into our high schools and inner-city center i to teach honor, integrity, and character and selfless service to our young people. that is what we have to understand. there are two different governing philosophies at war in the united states of america. one is that a constitutional republic and one is of a socialist, egalitarian, welfare and nanny state. the latter cannot be the way forward for this country. when i look at the inner cities, when you look at 14.4% unemployment in the black community, when you look at the fact that you have over 40% unemployment for black teenagers, my wife is a brilliant woman.

we have been married for 23 years. black families, kids with the mother and father in the home, 28%. something is going very wrong in this country, and that is the truth that has to get out. >> we are depending on you. [applause] >> he has met a great name for himself in congress and we are very proud of his service. our next speaker has arrived, congresswoman michele bachmann. before she entered politics, she was very busy as the mother of five children and she had 23 foster children in her home. i had six children, but i don't know if i could have dealt with 23 foster children. in her spare time, she was a tax litigation attorney.

she has become one of the real leaders of the conservative movement, demanding that we must repeal obamacare. she was first elected to the minnesota state senate where she was a big supporter of all of our views about the taxpayer bill of rights and education. then she was elected to congress in 2006. she is one of the recognized leaders of the conservative movement. she won the iowa primary and is a thrill to have congresswoman michele bachmann here today. [applause] >> thank you. good morning. any day is a good day when i can be in the same room with phyllis schlafly. i am thrilled to be here. she quite literally got me through all the years when i was a young mother at home. let me start off by saying if there is any advice i have for

all of you, it would be this. mary well. find someone that you love. marriage is forever. you will look at that person a lot of mornings across the breakfast table, so i think long and hard before you actually make that decision. but i am encouraging you, get married and have children and live life, in that order. phyllis has probably been one of the best examples of that, of a woman who really did it all, who lived live very well, who was a mother and wife but also worked her way for college. she worked and she tested ammunition. if anybody could do that, it would be phyllis schlafly. my point is, life is a long process, and we live in

segments. one thing i see too many people doing is saying i want to be president. there is nothing wrong with saying that, but get to that point of living your life, doing something. the best example was last week when our president went out and made the statement that if you build your own business, it isn't you that is responsible for your own success. he was infering that it was government that was the reason behind his success. this shows a window into his soul. it is why he truly doesn't get it about what america is about. i say that because i came from a family where my mom was a single mother. we just had nothing. i had to work my way through college and law school and for my post doctorate program. when my husband and i got married, we did not even on a car. we worked our way to college and graduate school together.

we lived on the cheek nonstop. all of our clothes came from garage sales. we did what americans do who have nothing. you work and you save and you put aside. what you put aside is called capital. that money you can take and try and invest and do something with. we took that money and started our own company. we on to clinics. we started our company and became successful and i became a tax lawyer. i spent a lot of time in the court room litigating tax cases. it was our sleepless nights, i work paying ourselves last, not taking sick time, not having vacation time. we built this. we thank god for it and we thank god for the customers and everything we have, but we know how the free market system works. you don't get that sense at all from the president that he has any clue how the american system

works. that is why his policies have been so profoundly dangerous, particularly for you and for your age. let me give you one statistic from the house budget committee. they said that by the year 2027 -- how many years from now is that? 15 years. calculate how old you will be in 15 years. you are absolutely gorgeous. don't take it for granted that you are thin, it doesn't last forever. if you are 20 years old right now, in 15 years, you are 35 years old. now consider what they said. by 2027, our economy will effectively shut down. that is not crazy michele bachmann. that is not right wing phyllis schlafly. that is your government saying

to you that in 15 years, our economy smothers and shuts down. why? debt accumulation. really? i came into congress in january 2007. our debt was a little over $8 to go in. now it is almost $16 to again. -- now it is almost $16 trillion. it took less than eight years to double. the reality is that it is your life that will change in the future if we don't get a grip on the spending. one of the key drivers in all of this is the president's health-care plan. that is why this captured the attention of the nation. the senate budget committee also determined that the unfunded net liability of the president's health-care plan will be $17 trillion over the

next 75 years. by way of comparison,, social security is $7 trillion. that has been the big driver that everyone is scared to death we will run have enough money for social security. if we don't have enough for social security, we will not have enough money for finding obamacare. that is why this is so important to you. it is your life and you are beginning and your future. i am glad you are here so we can discuss the issues and philosophy. when you leave here, we do not have a lot of time. we have 3.5 months to make this election count. over and over during the presidential election, i said all bark chips are on november 3 that is more true now than ever. i sat in the supreme court

chamber when john roberts read his defense from the bench. the individual mandate, the requirement that just because you breathe in america, you are forced to buy product or service that the government tells you must buy, it means they dictate the price of that service. that is what he ruled. he did that on the basis of the taxing authority, which was the flimsiest portion of that argument that he could. we can answer that question later on legal reasoning. the point is, now more than ever, we have 3.5 months to take our country back. we could spend 3.5 months sitting at seminars, but we don't have time. you need to find a candidate you believe then and what door

to door with them. you need to help with phone calls and getting out mail, whatever needs to be done to win these elections. we have to win the white house. we have to all band together to make it happen. we have to win three more united states senate seats. if we do, the republican vice president and cast the tie vote in the center repeal obamacare and then hold on to the house of representatives. i did make a distinct contribution to the presidential race. i made the appeal of -- the repeal obamacare my central issue. the american people are with us. 70% of the american people want the president's health-care plan either fully repealed or reform. mitt romney has said eyeball to eyeball to me multiple times, i

will repeal obamacare. we need to recognize that no matter who our nominee is, and i stand fully behind mitt romney, we have got to get behind him, even if he is maybe not everything we wanted, he is our guy. i know we can trust him on this issue. it is your future that will be decided in this election. the good news is, an economy can be turned around. the best example is jimmy carter and the disaster he made in the late 1970's. i worked for the jimmy carter campaign. i was in college. i was a democrat when i was in college. i worked on his campaign. he said he was a born-again christian, pro-life, and i worked for him. then i saw what a disaster his policies were. i had my own renaissance when i

was in college and i became a republican. i work for ronald reagan in 1980, and i never looked back. ronald reagan, in a very short time, showed the miracle and the power of the free market system. the economy came roaring back like we had never seen. it can happen again in your life, too. that is why if we do not win the white house, the senate, and the house, we cannot turn the economy around and repeal obamacare. now more than ever we need to have you in this upcoming election. if you have questions, i would be more than happy to take them, and thank you for allowing me to be here today. [applause] >> i am from iowa. we keep talking about repealing obamacare and then replacing it with what?

>> today we have a monopoly in all 50 states that the insurance companies enjoy in those states. of what to break that down and let every american by any health insurance policy they want, anywhere in america, with no minimum federal requirements. i want them to pay for that policy with their own tax-free money, and have true medical malpractice reform. that costs nothing and would drive down the cost of health care for everyone. that is just the beginning, but the answer is getting the federal government out of health care. it is the federal government intervention that has spiked up that cost of health care beyond any reasonable level. when government intervenes, the price goes up. for people your age, a health insurance policy should not cost more than about $30 a month.

you spend more than that on music downloads and coffee at starbucks. you can afford your own health insurance. you do not need your parents to carry you. you can afford $30 a month. but you are subsidizing other people's health care. there are going to you to pay for it. this is just redistribution of wealth through health care. there is a lot more we could say about that. >> you said you practiced law. what advice would you give to people who are about to go to law school? >> study hard.

my best advice to every one of you, i assume you are all leaders because you are here in this room. we teach our own children, leaders of our readers -- leaders are readers. read a wide range of books. i think it is good to go for a wide variety of sources. be very well read. there is a course of the presidential election, i love the debates more than anything. that was my favorite part of the entire process. the best preparation was a lifetime of learning, of reading, and of living. i go back to what i opened with today. live your life. do something with your life. get married, have children, start a business, engage in life. don't ever forget, this is not a dress rehearsal. this is it.

this is the main event. this is like. start living it right now. that does not mean just hedonism are engaging in license. that means get engaged now. you can literally start setting the stage for what the future will be if you get engaged in this election. study hard, and take a wide range of classes in law school. it may be the foundation for a different career. it may be a foundation for something else as well, but it is a great background. >> thank you so much for being here. i am from arizona. you are my congress crushed. >> that is so cool. my kids will not believe it. >> when and why did you decide

to run for congress? >> i was in the minnesota state senate at the time. i do people approach me and say i should really do it. i had no intention of running for the minnesota state senate. i just showed up for a republican endorsement convention. people said, you have got to do this, you have to run. i was a mess that day. i had a torn sweat shirt, i had jeans on. i said i will look like a freak if i run for senate. but they said someone has to challenge this guy. so i said i would put my name in. i got endorsed that day. my husband was not around. this was before cell phones. he came home and it was april fools' day.

he found out his wife was endorsed for senate in minnesota. what are you going to do? i had to run. i ended up being in the minnesota state senate. when people said i should run for congress, i actually got to ask my husband this time. we really prayed long and hard because it is a big deal to do something like that. both really believed that this was the right thing to do, so we did it. it is the cost and the sacrifice to your family, but i know that i was prepared for this fight and i had the will and back on for this spot. i have been grateful for the privilege. i represent wonderful people, and all i am doing is bringing their voice and sensibility to the halls of congress. i know it made an important contribution. quite honestly, this is what i

think about when i take my voting card and put it in the machine and push the button. i see your faces. i have 28 children invested in the future, and that is what i am working for. >> i go to southern methodist university in dallas, texas. i would argue i am your biggest supporter. >> please, no fighting. >> do you enjoy court ever get tired of being the liberals number one target? >> the last 48 hours, i have been their number one target again. the latest by that is going on, i sit on the intelligence committee. there are 19 of us and we deal with the nation's classified secrets. something that has been clear under the obama administration is that there has been influence from the brought -- from the muslim brotherhood. we are raising questions of the

inspector general to look into it. two weeks ago, the state department violated federal law. it granted a visa to a member of a foreign terrorist organization from egypt. we listened on our state department website. our state department broke federal law and granted a visa and brought a foreign terrorist into the united states. not only did they bring this terrorist into the united states, they took him to the white house. he had a meeting with the national security council. you do not get any higher than the national security council when dealing with the nation's classified secrets. what did this member of a terrorist organization request when he was in the white house two weeks ago in violation of federal law? he requested that we open up our u.s. prisons and released to the world the mastermind of the

1993 world trade center bombing. we members of congress are just asking a question. why did the state department do this? why is this an outrageous, unbelievable action on the part of the and ministration to allow influenced by the muslim brotherhood at the highest levels of power? why is this going on? we just want to know. for that, msnbc, cnn have been lighting actress in st. we are going after individual personalities and being mean to muslims. this is nothing about being mean to muslims. a lot of muslims are upset about radical terrorism, too. we believe the administration needs to keep the safety and security of the american people

#one. that is why i am in trouble now. every day i am in trouble for something. who cares? >> thank you so much for being here. i will make a couple of comments and then i want to ask a question. i grew up in private schools until a third grade and i went to public school. i feel like the education of our generation is deteriorating under the public-school system. i listen to david barton a couple of weeks ago and he talked about christian fundamental values that were placed in our founding fathers and how our first congress made a bible.

i wanted asked, as far as reforming the public schools and moving more toward privatization of schools, do we have anything going at this point? >> thank you for asking that question. phyllis has been one of the leaders in the united states on the education reform movement. she has been on this issue since the 1950's when she saw the problems come in to american public schools. we have a common bond and love for this issue. we home schooled and sent are volatile children to private christian school. but we are prevented by the state of minnesota from sending our foster children to private christian schools. a was concerned about what i saw on our public schools so as a mother i became involved. the federal government has essentially taken over the public-school classroom. what i said during the presidential race is, were i

president, was shut down the federal department of education. they have done nothing to add to the quality, high academic standards of america. they have only brought them down. the local public school classrooms must be directed by local parents and local teachers and faculty. that is where the emphasis needs to come. there are any number of excellent materials we can use to teach children academically, but i believe very strongly in the high quality of local public schools. bill clinton said american needs to get over its love affair with local control of public schools. we are seeing the end result of the federal government and what happens when they run our public schools. like so many other areas, we need to get the federal government out of running it. they just mess up everything. >> young people like to hear

and see how their actions are being represented in politics. he said that romney wants to repeal obamacare. how exactly is he going to do that? >> i think he is just going to sign the legislation. it will be up to the house and senate to pass the legislation for full-scale repealed. we just put it on his desk and he either sunset or he doesn't. i have no doubt that he will. i think he is a man of his word. this is a very sharp guy. he is an optimistic person. he has proven himself that he knows how to succeed in business. he gets that the public is very upset with obamacare and he will be in geared to the nation when he affixes his signature to that legislation. thank you for asking that question. >> i am from st. louis, missouri.

i want to personally thank you for taking those foster children in. how to our bring the conservative message back to -- >> it goes with the territory. that is where you have to have a titanium spine. when i was a courtroom lawyer, the one thing i found in my life is, in order to succeed, be the best prepared person in the room. that is what you do, be the best prepared person in the room. do your homework. one thing i learned as a program lawyer, i needed to know my opponent's case better than my opponent did. i need to know their case inside and out so that i can answer any question and poke holes in their argument. that served me very well during the course of the presidential debates.

i encourage you, be extremely well prepared. if you are going to work with the adoption or foster care, we are talking about human lives. we want the best possible outcome. the one thing we know is that a child does best in a home with a mom and dad, a stable environment. they don't have to have a lot of money, it is just a stable environment. that is what a child needs. i just put some legislation forward for foster children so they can at least stay in the same schools. [inaudible] i think this is our last question.

>> thank you for being here. in retelling amy about being well-prepared. what list of books would you suggest that we've read? >> everything phyllis schlafly has ever written. the 02 used bookstore and buy it. she is an absolute genius. you are looking at -- you do not know how privileged you are to be in the room with phyllis schlafly. this woman single-handedly moved the nation in the 1970's. no one else, no man in this country did what phyllis schlafly did. that accolade's would take hours to talk about this woman and what she has done for our country. she quite literally is a living legend. you can go to my web site, i think i have a list of books and

classics. mark stein has some great contemporary books. and culture has a lot of great books i would recommend. -- ann coulter. learn american history and heritage. when you know who you are, you fall in love with america. there is no other nation like america. make sure you read our founding documents, the declaration of independence, the constitution and bill of rights. read the federalist papers. began there. that is very easy to do. , office and i will give you more books to read. >> if you want a good lesson in how to deal with the press or professors and so forth, watch michele bachmann on tv.

she has no equal in being able to handle hostile questions. we saw that in the debates. we see that in all those interviews that you give. i wish romney would take lessons from her. you can take lessons by watching it. she is better than anybody else in the country in hamlin a hostile questions and making her point regardless. -- in handling of hostile questions. let's give michele bachmann a hand. [applause] >> i had an unfair advantage. when i grew up, i had three brothers and no sisters. that was unparalleled schooling. thank you, everyone. [applause] >> our next speaker is not here yet. let's stand up and take a seventh inning stretch.

>> rep michele bachmann along with others have accused a top aide to secretary of state hillary clinton of being part of a conspiracy by the muslim brotherhood to influence u.s. foreign policy. that aid has worked through mrs. clinton's since her husband's presidency and is the wife of former congressman anthony wiener. arizona senator, john mccain, ranking member of the armed services committee, spoke out about the accusation this week on the senate floor. >> rarely do i come to the floor of this body to discuss particular individuals, but i understand how painful and injury is it is when a person's character, reputation and

patriotism are attacked without concern for factor fairness. it is for that reason i come to the floor today to speak regarding the attacks recently on a fine and decent american. over the -- over the past decade, i have had the pleasure of knowing her during her long and dedicated service to hillary rodham clinton, both in the united states senate and at the department of state. i know are to be an intelligent, upstanding, loyal servant of our country and government who has devoted countless days of her life to advancing the ideals of the nation she loves and looking after its most precious interest. she has done so while maintaining her characteristic decency, warmth, and humor is a testament to bear even most arduous duties with poise and

confidence. simply, she represents what is best of america -- the daughter of emigrants who is risen based on her substantial personal merit and abiding committed to the american ideals she embodies. i am proud to know her and i am proud, even with some presumption, to color my friend. recently, it has been alleged that a muslim american is part of a nefarious conspiracy to harm dick united states in favor of the muslim brotherhood and other islamist causes. five members of congress wrote to the inspector general demanding he began an investigation into the

possibility that she and other american officials are using their influence to promote the cause of the muslim brotherhood within the u.s. government. the information offered to support these allegations is based on a report "the muslim brotherhood in america" produced by the center for security policy. i would like to point out i have worked with the center and its head is a longtime friend of mine. still, this report is scurrilous. to say the accusations are not substantiated by the evidence they offer is to be overly polite and diplomatic about it. it is far better and more accurate to talk straight. these accusations are nothing less than an unwarranted and

unfounded attacks on an honorable citizen, dedicated american and a loyal public servant. the letter alleges that three members of her family are connected to muslim brotherhood operatives or other organizations. never mind that one of these individual, her father, passed away two decades ago. the report offered not one instance of an action, decision, or public position that she is taken while at the state department or as a member of that senator clinton's staff that would lend credence to the charge she is promoting anti- american activities within our government. nor does either document offer any feet -- any evidence of the direct impact she may have had on one of the u.s. policies of which the authors of the letter and producers of the report find

fault. these sinister accusations based solely on a few unspecified and unsubstantiated associations of members of huma's family, none of which been shown to harbor threaten the united states in any way. these attacks have no logic, no basis, and no merit. and they need to stop. they need to stop now. ultimately, what is at stake in this matter is larger than the reputation of one person. this is about who we are as a nation and who we aspire to be. what makes america exceptional among the countries of the world is that we are bound together as citizens not by blood or class, not by sector or ethnicity, but by a set of intering, universal equal rights that are the foundations of our constitution, our laws, our citizenry, and our identity.

when anyone, not least a member of congress, want his speeches and egregious attacks against fellow american on the basis of nothing more than fear of who they are and ignorance of what they stand for, it defames the spirit of our nation and we all grow poorer because of it. our reputation, our character are the only things we leave behind when we wrote -- when we depart this earth. unjust acts that maligned a good name of a decent and honorable person is not only wrong, it is contrary to everything we hold dear as americans. some years ago, had the pleasure along with my friend, the senator from south carolina, when the gramm, a traveling overseas with our colleague, then senator hillary clinton. by her side, as always was huma. i saw firsthand the hard work

she did on behalf of the senator from new york, a service that continues to this day at the department of state and bears with it its significant personal sacrifice for huma abedin. i have every confidence in her loyalty to our country and everyone else should as well. all americans over a debt of gratitude for many years of superior public service. i hope these ugly and unfortunate attacks on her can be immediately brought to an end and put behind us before any further damage is done to a woman, an american of genuine patriotism and love of country. mr. president, i suggest [inaudible] >> president obama boarded air force one at andrews air force base this afternoon, adding to colorado to meet families bereaved after a mass shooting at a movie theater in a denver

suburb that killed at least 12 people and wounded 58. the victims who range in age from 6 to 58 years of age were shot to death in colorado or early friday when a gunman opened fire at the prayer of the latest "batman" film. the president is set to be with families of law enforcement officials during his visit. he is expected to make some remarks which we plan to bring you later today. from there, the president travels on to san francisco. he will begin a three day campaign swing along the west coast tomorrow, then up to the vfw convention in nevada and than it to fund-raising dates. mitt romney is also expected to speak to the veterans of foreign wars on tuesday. we will have live coverage of the president speaking to the veterans tomorrow on the c-span networks.

>> it was about those men and women who are almost notably injured in war, who, because of a huge advances that have been made in medical trauma treatment over the last 10 years, they are being saved. an incredible number of them are being saved. almost everybody who falls on the battlefield is being saved. i wanted to write about what life was like for these people. i started off with the question, having seen some people who were pretty, pretty gruesome the main -- gruesomely maimed, wouldn't it be better off if they were dead? don't they wish they were dead? >> david wood spoke with

veterans and their families, surgeons, combat medics, therapists, nurses, on the daily struggles for those severely wounded in medical -- military operations. more and more tonight on c- span's "q&a." ♪ >> watch "booktv" and "american history tv" as we explore the heritage and the literary culture of louisville, kentucky, the home of churchill downs, the louisville slugger, and its oldest bookstore. >> a lot of stores that have failed or owned by people that are interested in having a business, not because they have a love of books. they were business people. i think you really have to have

a gut attachment to books to care enough about them. your customers will like that. they come because they really care about books. >> watch for "booktv" and "american history tv" august 3 and 4. >> on friday, dr. delos cosgrove, the president and ceo of the cleveland clinic, discussed the upcoming changes in health care policy. he says the affordable care act makes great strides in providing access, but does not do enough to control costs. explains some of the ways the cleveland clinic is controlling costs -- he explains some of the ways the cleveland clinic is controlling costs. [applause] >> today's speaker is the head of one of america's most respected medical institutions, ohio's the cleveland clinic -- ohio's cleveland clinic.

it is a $6 billion health care system, comprised of the cleveland clinic, eight community hospitals, 18 family and ambulatory surgery centers, a hospital in florida, a center for brain health in nevada, a wellness and executive health center in toronto, and a hospital currently under construction in abu dhabi. his leadership has emphasized patient care and patient experience, including the re- organization of clinical services into patient-centered, organ- and disease-based institutes. he has launched major wellness initiatives for patients, employees, and communities. under his leadership, the cleveland clinic has consistently been named among america's 99 most ethical companies by the ethisphere institute. dr. cosgrove is a graduate of the university of virginia school of medicine and completed clinical training at massachusetts general hospital, boston children's hospital, and brook general hospital in london.

he was a surgeon in the u.s. air force and served in vietnam as the chief of u.s. air force casualty staging flight. he was awarded the bronze star and the republic of vietnam commendation medal. he joined the cleveland clinic in 1975 and was named chairman of the department of thoracic and cardiovascular surgery in 1989. under his leadership, the clinic's heart program was ranked number one in america by u.s. news & world report for ten years in a row. he performed more than 22,000 operations and earned an international reputation for expertise in all areas of cardiac surgery, especially valve repair. he has 30 patents for developing medical and clinical products used in surgical environments. his visionary thinking, medical and business expertise, and dedication have earned him numerous awards and honors. he is a member of both the cleveland medical hall of fame and the cleveland business hall

of fame. he topped inside business's "power 100" listing for northeast ohio and is highly ranked among modern healthcare's "100 most powerful physician executives." along with dr. cosgrove's many attributes, he is well known for his ability to provide high-quality care while holding costs down. he is also known for his concern that health-care reform might stifle medical innovation. we look forward to hearing his views on these and other issues affected by the supreme court's ruling on the affordable health care act. ladies and gentlemen, please join me in welcoming dr. cosgrove. [applause] >> thank you very much. that is the nicest introduction i have had today. [laughter] i would like to share with you some of the experience and some of the things that are going on

around the cleveland clinic, and how it reacts to the affordable care act. first of all, let me tell you a little bit about our organization. we are very innovative. we are 91 years old. we are not for profit. we have tried -- have a tripartheid mission. we are physician-led. we all are salaried. there are no financial incentives to do more or less. that is an important aspect of where we are. we all have one-year contracts. there is no tenure. each year, we have an annual, professional review, which is part of maintaining the quality of our organization. it is interesting to look at health care and see where we came from and how we are organized. the design that we currently have dates back to 1950. much of that relates to the hill-burton act, which

encouraged communities across the united states to develop hospitals and be responsible for the care of that community. since that time, health care has improved. longevity has extended. with that of we have seen diseases change, as well as -- with that, we have seen diseases and therapies chains. we are seeing chronic diseases. six of seven major causes of death in the united states are chronic diseases. it is no longer possible to have all of the technology within one hospital. no hospital can be all things to all people. what is the crisis we are currently dealing with that we have heard so much about in the united states? what does the affordable care act do and how does it address these things? there are three main things we are trying to address. the first is access. you heard about how the affordable care act put another 32 million people, who did not have insurance -- a they currently have insurance. this is a major step forward.

the other problems were around quality. quality is variable across the country. finally, cost, which was escalating. right now, with a $16 trillion obligation that the united states has, 50% of that is related to medicare. the health care bill will do little to affect that obligation. we probably will see increasing costs. how are we as an organization and how is health care as a new organization -- as an organization beginning to deal with these issues as we go forward? let's take them one at that time. we'll talk a little bit about how we as an organization begin to deal with these. first of all, access. insurance does not necessarily mean that you get to see your physician. one of the individuals in the audience came to me and said that coming here in washington, it is not difficult to see a physician.

there are a number of steps that you go through to try to see a physician. we have begun to try to address each of these. the first thing we did is we put in place nurse on-call. at 2:00 in the morning, when your top has a temperature of 103, you can get on the telephone -- when your child has a temperature of 103, you can get on the telephone and get advice from a nurse. last year, we answered 20,000 phone calls. this is a free service. we put together a call center. the call center now has an average of 40 seconds to answer the phone and only a 3% drop rate on your phone calls. when you call to make an appointment, each time, you are asked, would you like to come today. last year, we saw 1 million a

same-day appointments -- saw 1 million same-day appointments. 95% of them were made on a same- day basis. and there is the emergency room. people complain about the way its. we changed our method for how we see people in the emergency room. the average wait is now under 30 minutes from the door to see a doctor. all of our emergency rooms across our entire health care system. we have tried to begin to address the day-to-day needs of access. the second issue is quality. i would point out to you that quality is not one thing. it is three things. it is a clinical experience. it is a physical experience. and it is an emotional experience. the clinical experience, we have begun to address with the medical -- electronic medical record.

they begin to make your data available to you across the entire organization. you can move from outpatient facility to a community hospital to the main campus with your electronic medical record going with you all the time. , thate you see a doctor th information is available at that point. the other thing that we thought was incredibly important is to begin to have transparency. transparency comes in a lot of forms. starting some 30 years ago, we began to look at outcomes. we began to try and understand how you understood what outcomes were. each time we looked at those, we always found that there was an issue we could do better in. starting eight years ago, we said we would like each one of our institute's to put together and out comes -- institutes to put together an outcomes book and make it publicly available.

they are published and are available on our web site. it is part of transparency. we think that transparency is about what is going on in your care. that should be available to you at any point. we opened the medical charts. you can see your chart any time that you want in the hospital by simply asking for it. further, you should be able to know about your medical history and your medical record when you are not in a hospital. we have electronic medical records that are available to you over the internet. we have almost 500,000 people who now have access to those. interestingly, we now know that people who use this take better care of themselves. the diabetics know their blood glucose levels and they take better care. so, we encourage people to actively participate in their care along the way. further, we have begun to

understand complications within the hospitals and we have looked specifically and been very transparent, not only about the entire organization, but the individual departments and the individual physician's's outcomes. we post those publicly. interestingly, i would tell you there is no more competitive group of people then doctors. they do not like to see themselves on the bottom of the list. if you want to improve the quality of a physician, are you have to do is rank them -- all you have to do is rank them and make it public. we have had a lot of good experience with that. the physical part of coming to the hospital is also part of the experience. we have looked at everything as far as it is concerned. from the architecture, the lights -- we have increased the

glass to bring in more natural light. we have begun to bring art into the hospital. the speakers no longer spend all their time paging people. in the public spaces, they play classical music. it adds nothing to the cost, but greatly enhances the atmosphere of the facility. and we bring in art therapy, music therapy, and even, amazingly, we have dogs walking around our hospital. i laughingly say there is nothing better than a look from a lab. [laughter] we like to have the physical experience be a positive one as well. it helps with healing. the third and perhaps the most important aspect is the emotional aspect of being in the hospital. we are very concerned about this. anybody, of the 43,000 people who work for the cleveland clinic, can ruin the experience of the patient in the hospital.

i have had one of those experiences when a relative called me to the room, a relative of my wife, called me to the room and said -- very upset family. i wanted to know why they were so upset. the heart surgery had gone great. they were upset because, underneath the bed, there were dust bunnies. that ruined their entire experience. we brought all of our 43,000 people to gather and took them offline for three hours. we sat and around round tables like you have here with doctors, nurses, -- we sat them around round tables like you have here with doctors, nurses, staff, and we talked about the cleveland clinic experience. that has been a major factor in how these people are engaged. we no longer address them as staff and doctors. everyone is addressed as a caregiver. that has changed the atmosphere.

without really now find ourselves in the top 90th percentile in the country -- with that, we now find ourselves in the top 98% drop in the country in satisfaction -- the top 90 s percentile in the country in satisfaction. let's talk about cost. one of the important things we have to realize is that we have perverse incentives. one of the major things about reducing cost is employing physicians. all the physicians at the cleveland clinic are employed, myself included. i get a straight salary. it did not make any difference whether i did three heart operations a day or four. i got paid executives same amount. there was no incentive to do more -- i got paid exactly the same amount. there was no incentive to do more. our system encourages people to do more. in the trade, it is known as "eat what you kill."

a little strange. [laughter] nonetheless, the incentives are wrong. we need to begin to move to an incentive that does not incent you to do more. it incents you to take care of the patient and be paid for that. the involvement of the doctor has been proven that salaried doctors -- it reduces cost. the "dartmouth atlas" looked at the top organizations around the country. two that came out with the lowest massacre -- lois medicare cost for the mayo clinic and the cleveland clinic -- the lowest cost were the mayo clinic and the cleveland clinic. we involve our physicians and everything. we are physician-led. we involved in our purchasing decisions.

it all helps bring about lower costs. the other aspect of bringing about lower cost is integration of health care systems. we are completely integrated across our organization. so, that has allowed us to do a couple of very important things. first of all, we have reduced duplication of services. we have rationalized services. we have rationalized and consolidated pediatrics, trauma, rehabilitation, heart surgery, obstetrics. we have gone to places which to a bigger volume. as a result of doing bigger volumes, they do more. as a result of that, they get better quality and more efficiency. that certainly has been proven to be the case in multiple studies across the country. we also recognize now that health care is changing. where it is done is changing. the hospital is becoming less

and less the epicenter of care delivery. care delivery is going from inpatient to outpatient to home care. we now can see that every -- hip replacements and the replacements are done with 24- hour stays and many people going home the same day as they have had those procedures. it is simply the advance of care. it is also the advance and change in the types of diseases we are dealing with. more chronic diseases, less acute diseases. the acute and surgical diseases are taken care of more outpatient and inpatient. -- than inpatient. there is no incentive for us to take care of ourselves. we smoke. we have become obese. we do not exercise. we go to get health care and expect to get great care. let me give you a couple of

examples. 40% of premature deaths in the united states are secondary to three things. smoking, eating, and lack of exercise. take smoking for an example. the incidence of smoking is 20% and it is rising. it is associated with the majority of cases of cancer in the united states. we began a very aggressive approach to this. we started out by having no smoking allowed anywhere in our campus, are parking garages, anywhere that is property of the cleveland clinic. then we had smoking cessation for all of our employees, free. then we decided we would make a bold step and stop hiring smokers. by the way, it is legal. i checked. [laughter] one of the smart things i have

done. [laughter] and then we rolled out this program of smoking cessation into the community. it helped drive smoking cessation lost -- laws in public places in the state of ohio. the incidence of smoking in the county has gone from 28% to 15% in five years. you can make a difference. perhaps we have saved more lives by doing that than one would in a cardiac surgical career. the epidemic of obesity is terrifying. right now, 1/3 of the united states is overweight. 1/3 is obese. obesity is leading the epidemic of diabetes. right now, 10% of the cost of health care in the united states is secondary to obesity.

the projections are, in the next 10 years, that will go to 20%. we will not control the cost of health care in the united states unless we control the pandemic of obesity. so, again, we figured that we needed to begin to address this. we started out with food. we took the trans fats out of all of the foods we served in the hospital's. we made 40 changes in the as of the food that we serve. we took a candy bars and sugary drinks out of the bending machines. we turned it -- we took the candy bars and sugary drinks out of the vending machines. we turned to exercise. we have lost three and a 30,000 pounds. -- we have lost 330,000 pounds. it is a start.

this represents an effort that you can take out into the country. we need to begin to address these. let me just for a moment tell you a story. i think he will understand the reason for this story. 2 1/2 years ago, a 25-year-old opera singer was flown into the cleveland clinic in the dead of the night. she was end-stage lung disease. had she not had a lung transplant, she clearly would have died. she received a lung transplant, a double lung transplant, was extremely sick, was kept in a medically-induced coma for four weeks. she eventually recovered, left the hospital, came back to sing opera three months later for the

team that had looked after her. that summer, she married the man who had stood by her through this entire event. and then she began to get short of breath again. she came back to the cleveland clinic after extensive medical therapy and could not be sustained or improved on that therapy. she was placed on an artificial lung for three weeks, waiting for a second set of lungs. she received the second set of lungs and is now living in washington and singing opera again. i would like to have you meet charity tilleman-dick,. she is with us today. [applause]

charity, i think is here with her grandmother. her grandmother is -- tom was a congressman. last time she was here, he was speaking before this group. he was a congressman from california for 27 years. would you stand up? [applause] i introduced this to you because i think this is an example of american medicine at its very best. we need to address the three issues that i talked about -- access, quality, and cost -- if we are going to be able to continue to drive this sort of quality medicine in the united states and provide quality care

so people like charity can return and sing opera for us and contribute to our society. thank you very much for the privilege of talking you today and sharing some of our experiences. [applause] >> thank you. how has the cleveland clinic managed to reduce costs without sacrificing the outstanding care for which the chronic -- and it has long been known for -- for which the clinic has long been known for? >> the physicians understand about the things that they can do. for example, they came together around pacemakers, hips, knee replacements, purchasing. we reduced our purchasing by about $125 million in the last two years. >> what can be done about the

increasing number of doctors? who will take care of our growing population? >> the number of doctors is not actually decreasing. the problem is that we have never produced enough physicians in the united states to look after the demands. we have been a net importer of physicians. we're going to have a shortage of nurses bordering on 1 million. so, we're going to have to find other people to be the caregivers. physician's assistants are becoming increasingly used. that allows everybody to practice at the top of their licensure. technicians are coming in to replace much of the work that nurses have previously done. no need to have a nursing degree to take a blood pressure or temperature.

>> do pharmaceutical companies reward physicians to prescribe their medicines? if so, how? >> we have seen stories about that. i think that is being less and less an issue in the health care world. there used to be a lot of entertainment that went that way. that is almost completely gone, to the best of my knowledge. >> is the cleveland clinic more or less likely to hire employees as a result of the affordable care act? >> whoa. [laughter] i do not think we know yet how the affordable care act is going to affect us. we have not seen yet the implications in terms of the number of patients that we are going to see or -- and figure out how we're going to take care

of them. any help your organization, the major cost is people. it is about -- any health care organization, the major causes people. it is about 60% of the cost. we would like to do that in the most efficient way we can. we will have to wait and see what the demands require. >> tens of thousands of patients die each year from infections. how can we reduce that staggering toll? >> that is a question that has been brought to our attention. we have seen a 50seen -- seen a 50% reduction simply by bundling and using standard procedures. i think we are increasingly looking at the same thing. atul gawande was particularly effective in bringing checklists to medicine. interestingly, part of the other

major issue in the cost is the end of life. we think there is a lot that we can do to both make that a more civil and kind experience, and, at the same time, let people pass in a less costly way. so, we are looking at checklists. atul gawande and the cleveland clinic are now doing a research project, trying to develop those sort of end-of- life checklists that will remind people about where you are in the process. have you talked to the family about it? i might just say, parenthetically, if you do not mind, i think this is an important topic. i would encourage you all to think about this yourselves. i know many of you have had this experience. both positions and family, patients, are stressed at the end of life. the worst thing that can happen

is not to have a discussion about the difficulty that this represents for both people. i have found in my surgical career that if i would enter into the discussion with the family and say, i will do everything possible to keep your loved one alive if i think they can return to a useful member of society. at the end of that time, if i think we have come to a poll where i do not think that is going to happen, i will come to you -- come to a point, where i do not think that is going to happen, i will come to you and we will have a discussion. i will not keep it going. i have always been greeted by, thank you, doctor. i am greatly relieved that you had this discussion with me. if you look into that discussion and have that discussion, it would be good for your patient, good for you, and

for the doctor. >> are there growing risks from antibiotic-resistant bacteria? what needs to be done about this? >> and clearly over my head. -- i am clearly in over my head. increasingly, it is something that people are concerned about, getting resistant strains. we have seen this in tuberculosis and staph infections. i think it is important that antibiotics be used judiciously and that the pharmaceutical companies be encouraged and supported ans they develop increasing antibiotics to take care of those resistant strains. >> how can health insurance companies reduce their costs so

they can provide more services to their clientele? >> i have to plead total ignorance on that. i am not in the insurance business. >> prostate cancer is often in the news today with differing medical opinions as to what awaiting versus immediate medical treatment. what is your take? >> it is interesting. now we are beginning to understand the differences there are in prostate cancer. that has been done out of a study that is now almost 10 years old, donna the cleveland clinic, looking at the genetics -- done at the cleveland clinic, looking at the genetics of prostate cancer. some are very aggressive. some are not aggressive at all. by differentiating, we can begin to decide what is the most appropriate type of therapy. >> when omega three fatty acids were discovered to improve health, some pharmaceutical companies were concerned this would affect sales of certain drugs?

-- drugs. as this happen? -- has this happened? >> i am sure you are aware we have seen a 30% decrease in the incidence of cardiac death in the last 25 years. i think this is the result of several things. it is not just the coronary stents and coronary bypass surgery. it is the better awareness of taking care of yourself, increasing use of fish oils, etc., and better diet and exercise. i do not know that any of these drugs have been substantially decreased in their use. >> what do you think of steps such as mayor bloomberg proposed, capping beverage items or sales on certain items? >> first, i think you have to

salute mayor bloomberg in some of his stances. he was one of the first people to begin to take trans that out of foods. he raised our awareness -- trans fat out of foods. he raised our awareness. whether it is the solution to the obesity problem remains to be seen. i am not particularly optimistic about it. >> you said you no longer hire smokers. you hire folks who are chronically -- do you hire folks who are clinically obese? [laughter] >> the americans with disabilities act protect people who are obese. it under advisement, we do not discriminate against people who are obese. >> if a patient receives ^ the cleveland clinic leader sees a doctor who is not affiliated with the clinic, will the doctor have access to those records? >> we like to provide access to

the records, but without being involved in the electronic medical records, it is not possible to send the electronic medical record, but we can give the electronic medical record to the patient and the patient can take it to his referring doctor. if you get treated at the cleveland clinic and you get sick in los angeles, you have access to your records and you can take them with you. >> how serious an issue is non- compliance by patients, failing to take the correct dosage is? -- dosages? >> non-compliance is a big issue. we are trying to figure out how to address this. we realize that just making a phone call and st. "did you take your pill today" does not -- and saying "did you take your pills today" does not do it. we are involved in a discussion with time warner, who could integrate this into the

television. the physician could say to the patient, could you hold up your bottle of pills? did you take your pills today? the 13 -- the routine office visit, the phone call reminder, a skype-fashion reminder. i think that is the next step in the future. >> there have been 18,000 cases of whooping cough in the u.s. this year. what should be done to prevent or reduce further outbreaks? >> the concern about moving off is a major concern, mainly driven -- about coping cough -- about whooping cough is a major concern, mainly driven by mothers and fathers not getting their children immunized because of the fear of autism. i think that has been mainly

disproved. this will being caught -- this whooping cough epidemic would not have continued if we did not have the concern about immunization. >> copd is a leading -- second- leading cause of death in the u.s. do you plan to increase your research? >> my father died of copd. he was a smoker. i do not think i have ever seen someone with chronic obstructive pulmonary disease who has not been a smoker. the biggest thing we can do is begin to drive smoking out of the general public. this is a huge public concern, and we are not blind to get that improved until we do take -- we are not going to get that improved until we do take care of the major cause, which is really smoking.

>> how can health care institutions work better together to develop more innovative processes, technologies, or clinical capabilities? >> i am starting to feel like dr. oz here. [laughter] by collaboration. let me take this to a little higher level. we are starting to see now a tremendous change in hospitals across the country. the hospitals are coming together in systems, systems are collaborating. we are starting to see systems talk to systems. one little fact. 60% of hospitals in the united states are now part of a system. as we have systems come together, we start to get more standardization of care, more efficiency, and more collaboration going on. >> speaking of dr. oz, being a

popular tv figure, what more can the media do to educate and motivate the public on better health care practices? >> i think there is a tremendous need for the met -- for better medical education. there is going to be a big process of educating people about what the current health care act and tells -- act entails. few people recognize what is exactly in that bill and what the implications are, both through personal care and for the health of the nation. that is going to be a big education process for you all, too. i do not think you can do too much to emphasize the importance of people taking care of themselves, in terms of smoking and obesity. frankly, my major concern is the public's -- the public generally has not come to grips with the pandemic of obesity. just to put that in some sort of

perspective for you, if you look at the disability -- the total visibility of the employees at the cleveland clinic, and you take out -- the total disability of the employees at the cleveland clinic, and you take out cancer, 90% of those on permanent disability are morbidly obese. that is how big the problem is. >> a number of states have indicated they are not willing to expand medicaid as part of the affordable health care act. what will this do to the health care system, like the cleveland clinic? >> if we do not have medicaid patients covered, we are going to have more patients who are not -- they are not paying patients. currently, we are the largest medicaid provider in the state of ohio. and this is going to have just more patients without any reimbursement for us. that will cause the rest of us who buy insurance to have their premiums go up. >> how did your hospital in abu

dhabi, about -- abu dhabi come about? are you planning more hospitals in other countries? >> it is an interesting sort of history. when 9/11 happened, we were operating about -- on about 35 patients per month from the middle east. from that point, it went to about 5 in two weeks. my ceo predecessor said, why don't we meet them halfway and establish something in london? we tried to buy something, lease something. people began to realize that the cleveland clinic was willing to go offshore. we had inquiries of one type or another from 70 countries. we look at many of these. by far, the most attractive was of the body.

i think it is important that we -0- was -- was abu dhabi. i think it is important that we point out to you that we are not spending money in abu dhabi instead of ohio. the government is building a hospital, paying our salaries, and paying less in management -- paying us a management and consulting fee. we're using our capital to drive petrol dollars back to ohio. [laughter] if you look at what the world wants from the united states right now, they are not particularly interested in our steel, our refrigerators, our cars, but they do want our entertainment, are graduate education, and our health care. our facility is the first facility from the united states that has taken the challenge of going entirely overseas and

staffing the hospital, bringing the designed to the hospital, bringing protocols to the hospital, and taking responsibility for doing that. it is a great opportunity to begin to help design a health care delivery system for a country. >> given the success of the cleveland clinic and it being replicated in other countries, why aren't there more hospitals like yours in the united states? >> the cleveland clinic was started as a system that was looked at as very innovative and radical at the time that it was founded, which employed physicians. they were looked at as medical bolsheviks. that has not been the tradition. it is very difficult to change from the system that is currently -- that currently exists in most places to what we are. most of the physicians are very entrepreneurial.

what is happening across the united states is changing that enormously. right now, 60% of the doctors in the united states are employed. 75% of the medical graduates now are going to be employed instead of being self-employed. you are seeing hospitals coming together in systems, hospitals employee in physicians. -- hospitals employing physicians. you are beginning to see that change happen. it will not happen fast, but it is important, i think, for the long-term affordability, that it does happen. >> you talked about your staff being on salary. how serious are the concerns that physicians cannot afford to practice or do not find a pay compelling -- find the pay compelling? >> it is worthwhile talking

about how we pay and set salaries. we looked at the average salary of the academic medical center across the united states. we try to pay in the 90th percentile of that. pediatricians do not get paid the same as neurosurgeons do. we pay according to the specialty, the expertise of the individual within the specialty, and what the national standards for that specialty are. >> to what extent do medical malpractice lawsuits way on places like the cleveland clinic -- weigh on places like the cleveland clinic? is it getting better or worse? >> tort reform is not part of the affordable care act. it is an important thing that we're going to have to eventually deal with. in ohio, we have had a tort

reform -- have had tort reform and it has decreased the cost of malpractice significantly. it is estimated at about -- that about 4% of medical costs in the united states are the result of malpractice and trying to avoid it. >> what are the effects of medical tourism, where people go to other places to avoid the high costs of care in the u.s.? >> there has been a great deal made of people leaving to get care outside of the united states. the data looks at medical tourism principally to places like india and singapore. they always give the data about the numbers that go there. the vast, vast, vast majority of those are from southeast asia and the middle east and not from the united states. it is a trickle of people who

leave the united states for health care outside. it has almost negligible economic influence on health care costs in the united states. >> do the people who utilize your 24-hour call service have to have insurance? >> no. [laughter] other factorse beyond smoking and obesity that cause ill health like chemicals, air, and water quality? what are you doing about these? >> [sighs] [laughter] you guys are mean. there is no question that there are multiple other things that affect health care. those are the three really big ones. the thing that concerns me, quite frankly, is the epidemic of autism. autism, frankly, was something that was not seen when most of us were kids.

now it is one in 88 live births. the implications of that for society and for the economics are stunning. at the other end of life, the other thing that concerns us is alzheimer's disease. if you get to the '80s get to be 80 years old -- if you get to be 80 years old, the chance of having alzheimer's disease is 25%. it is one of the top seven causes of death in the united states. the implications of those two things at the beginning and end of life are stunning. until we begin to identify whether it is an environmental factor or just other factors and begin to deal with those, it is going to put a huge burden on the cost of health care, both in the united states and around the world. >> what recommendations do you have to get schools to change

their lunch menus and vending machines to healthier offerings? >> we are very fortunate at the cleveland clinic to have our chief wellness officer. he has reached out into the schools of cleveland. we have begun to actively help them improve the quality of their lunch meals. this has been a big effort that has gone on a long time. the other corollary of that is the epidemic of childhood obesity, which is directly related to school grades. we have done a great deal of research on that particular topic as well. the food issue in schools is acute. we are trying to deal with it locally. i think that this is going to have to be something that is taken up on a national issue, probably right here in washington. there are 30-some agencies here in washington that regulate food in one way or another at this

point. >> how will the affordable care act affect the medical innovation? >> i am a little concerned about beginning to look at the efficacy of a drug or a device when it is in practice to decide what you're going to pay for it. let me give you an example. if you develop a hard golf -- a heart valve, it takes about 10 years of work with animals and through the regulatory process to get that approved by the fda to be sold. if you're going to tell whether one is better than another, it will take another 10 years to understand that. i do not think there are very many venture capitalist who are willing to invest in a 20-year project. i am concerned, frankly, that beginning to fund things on that basis will drive a lot of the

innovation out of health care in the united states. you have to realize that health care and products that are developed here are sold all over the world and our major exports for the united states, whether it be pharmaceuticals, devices, or other things use in health care. that may well slow becasue, -- because, right now, we know that the regulatory process is a lot faster outside of the united states than its in the united states. we have to remember, on a bigger scale, you cannot do anything new without attendant risk. society has become so risk- averse. we will not see animation that has driven health care to the point -- see innovation that has driven health care to the public that has doubled life expectancy in the last 20 years. >> republicans in congress have

talked about any to repeal and replace obama's health care law. are there any aspects of the law that you would repeal? what would you replace them with? >> let me defer just a little bit on that. i think, more importantly, we have to say that -- the law does a couple of things very well, and some things, it does not do quite so well. we know it is not going to control cost. we're going to have to do that. it is probably going to be led by the private sector. the second -- one of the things about controlling costs, there is not a lot in this law about providing incentives to take care of yourself. i would like to see more incentive for people to do that. interestingly, just recently, we helped senator wyden and senator corker and to introduce a bill in the united states senate that was set up criteria for people

under medicare to begin to have financial incentives for meeting various milestones. keeping their weight under control, blood pressure, etc. we found that very small financial incentives drive significant behavior. by that, i mean, for example, we had 3000 diabetics at the cleveland clinic. only 15% of those were seeing a doctor regularly. we were shocked when we found that out. what we did is we put a series of incentives in place. now 50% of people with chronic disease are in chronic-disease management. with the well is that i talk to you about before, with those financial incentives -- the wellness that i talked to you about before, with those financial incentives, we have seen the cost curve flatten. >> which other health care facilities do you consider to be

innovative? have any other clinics had ideas that you find to be impressive? >> innovation can happen any place. we see it coming across all sorts of places. i do not think that you can look at health care and expect it to come from one organization. i think there are great things happening in multiple locations. the important thing is to go and find those and incorporate them boldly into your organization. i told everyone of our employees at the cleveland clinic that i would ask them to take one trip a year to go and learn something new someplace. i did not care where in the world they went. i thought we were turning loose a couple thousand spies to go out and find really good things. i think there are lots of places. we have to look for new ideas wherever we can find them. >> what is the impact of providing more home-based

medical care for elders? >> the thing that is driving home care is the fact that the diseases change. people now have chronic diseases that are not going to be looked at in the hospital and are looked after at home. the implication is that we have to build the system to do that. secondly, it is going to reduce the cost of looking after patients. they will be better cared for at home. i do not think anybody would rather be in the hospital than be at home. that is the direction we are trying to move. >> we are almost out of time. before asking the last question, we have a couple of housekeeping matters to take care of. first of all, i would like to remind you of a coming speakers. july 24, judy woodruff and gwenn ifill will discuss the complex issues in play in the run-up to the november 6 general election. on august 28, general james amos will discuss the role of

marines as america's crisis response force. on september 6, kathleen turner, iconic stage and film star and chair of planned parenthood. and on october 12, secretary arne duncan. i would like to present you with the national press club mug, to be used, of course, for low- calorie beverages. hospital food has been referred to as bland and uninspired. do you sample the food? >> i sample it every day at lunch. thank you very much for the opportunity to be here. [applause] thank you >> for coming -- >> thank you for coming. i would like to thank the

national press club staff for a rising today' -- for organizing today's event. if you want a transcript of the program, please check out our website, www.press.org. thank you. we are adjourned. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012] >> it was about those men and women who are almost mortally injured in the war. because of the huge advances made in medical trauma treatment over the last 10 years, now are being saved. an incredible number of them are being saved. almost everybody who falls on the battlefield is being saved. i wanted to write about what life was like for these people. i really started off with the question, having seen some people who were pretty

gruesomely maimed, wouldn't it be better off if they were dead? don't they wish that they were dead? >> in "beyond the battlefield," david wood spoke with veterans and their families, surgeons, a combat medics, therapists, and nurses, for the daily struggles of those severely wounded in military operations. learn more tonight on c-span's "q&a." >> we actually manufacture it. you can see -- your car can see and help you avoid accidents with pedestrians, with bicycles. can see the traf