campaign. the core policy for the united states and afghanistan -- is a core policy, i mean, what is the primary purpose for the united states military in afghanistan? core policy in afghanistan as stated by senior generals, secretaries of state, secretaries of defense, both presidents -- i have gone through and read the unclassified testimony to both the house armed services, senate armed services, from 2002 all the way up to the present. when commanding general's, under secretaries of defense, whomever, were asked by senators or congressmen, what are we doing in afghanistan? why are we there? the answer is always the destruction of al qaeda. period.

period. the destruction of al qaeda. this is a very, very limited core policy aim. since 2002, the united states has sought to use a maximalist operational method called armed nationbuilding which is the same as counterinsurgency. to achieve this limited core policy aim. i ask myself why. i think it is because of this rocksolid belief that war can always be made to work. you see why this narrative is so important and so dangerous? the war in this view can always be made to work as long as the tactics are tweaked and the better general is brought into place.

it has also become very hard to break out of this idea that the only way to achieve our limited core policy is by nationbuilding. and this moral commitment. with that, how are we ever going to be able to stand back and look at this objectively and ask, what is the right approach or the right strategy for the united states to have taken in afghanistan? in my view, strategy has not worked. in iraq, in afghanistan, and let's look at the cost very quickly. you have to look at both of these together. first with iraq. ambassador dobbin mentioned some of the better things that have come out of the war in afghanistan. let me set that within another set of figures.

with iraq, after 8.8 years of war, 4480 six americans killed, thousands more with life- changing wounds. depending on which estimate you want to take, close to 3 trillion american dollars spent. close to a quarter of a million iraqis killed. that many more are seriously wounded or close to a million displaced from their homes, very few have returned. we replaced one strong-arm later with another. this one is allied closely with our regional adversary, iran. then we look at afghanistan. close to 2200 americans killed. that many more seriously wounded. posted $1 trillion spent. tens of thousands of afghans killed. i've asked myself this hypothetical, just to try to set in context what these wars have costs relative to what we have achieved. if the united states and gone into iraq like it did in 2003 and in afghanistan in 2002, and then left, would the cost of the war been any worse than what

actually happened between 2003- 2011 in iraq and still ongoing in afghanistan. a famous british strategist said in the 1930's, the object of war is a better state of peace. with this data i laid out, how can we say that american war is worth it in afghanistan and iraq? not to say that we have not achieved tactical success. i can point to success in my own cavalries out in 2006, can others. in all of this, tactical success is supposed to lead up to something. with that, i will close by posing a derivative question to be one of what went wrong in afghanistan and i will ask this

peace that this decade of two costly wars in iraq and afghanistan? where is it, this better piece that was supposed to have been produced? [applause] >> thank you so much to our speakers. i will begin with a question. just for the panel. you can decide who wants to go first. do you think the lesson is not that we should be relearning the lessons of counterinsurgency and nationbuilding and knowing how best to set up reconstruction operations and development programs, maybe the lesson is to avoid the sorts of conflicts? we have the finest military the world, we can make these choices. we have routinely found

ourselves in these situations. would anybody like to -- this is a strategy question, not tactical. you can answer from your seats. >> i think it tends to be somewhat situationally dependent. punitive strikes can dissuade -- or the threat of punitive strikes not followed up by any further intervention can dissuade, punish or deter governments perpetrating certain act. punitive strikes cannot stop genocide. we can't stop nuclear proliferation. they can't stop civil wars.

they can't stop terrorists. pure punitive strikes as a way of punishing regimes you don't like have limited utility. if you are not going to take responsibility for shaping the post-conflict environments in ways that improve it over the pre-conflict environment and you are likely to have at most, a very short-lived success. john asked, what would afghanistan have been like if we left? i think the answer is easy. it would have been like it was in the early 1990's. when millions of afghans fled afghanistan. the level of conflict was much higher than at any point in the last 10 years areas you would have returned to a sectarian conflict between people from uzbekistan. the taliban would have become the dominant force in the country.

although probably not controlling all of it. the taliban remains today, allied with al qaeda, close links with al qaeda. al qaeda would have been able to reestablish itself. the united dates would not be doing drone strikes. it would not have any place to ace those assets. i think it is easy to say what would have happened in afghanistan if we had simply conducted our punitive attack on taliban. routed them, and then left the country. >> are those emissions we should

be fighting back out -- fighting? >> one should not take for my talk and isolationist view. maybe we should be involved in this kind of things. what we should ask ourselves at the beginning is, what will the cost of military intervention be? what is the likelihood of success? and have an honest discussion of what it will cost and in so applying military force in the process of doing that, which produces actions, reactions, counter actions, will the process of using military force has been worth it in the first place when we talked about this decision, whether or not to go in? i also think that, there has come to be almost this rule that says when the united states intervenes militarily for whatever reason, the rule says it has to stay and fix it.

i think that is a dangerous proposition. if that is the case, it seems to me that it commits the united states to perpetual, never- ending wars of nationbuilding like we have done in iraq and are continuing to do in afghanistan. >> i tend to view coin a little like nuclear weapons. something that we need to have as part of the arsenal, but given its cost, we should not be out using it all that often. with regard to the early bird in the afghan war, we also look at the early period in iraq. we seriously under-balled the cost. inking you could engage in this and trying to build a more stable, new administration in countries like that and do some modest reconstruction.

with a light footprint. you can't do that. i think iraq and afghanistan are clear lessons of that argument. these sorts of interventions are incredibly expensive and costly in terms of lives as well. it is incumbent to have that honest discussion up front as opposed to trying to go in with the small footprint, trying to convince the american people that you can do this on the cheap, if there is an enduring lesson from both of these endeavors, it can't be done on the cheap. you have to have an honest discussion about the cost.

all that said, i don't think we should look at a nationbuilding skill set and say, because these things are expensive, because we hope we will never have to fight another land war in asia again, we should just not train, not develop that capacity. it is an important capacity to have. there is a danger, particularly among the civilian agencies and our government, a narrative taking hold that the civilian surge in both iraq and afghanistan worked brilliantly. the truth is far from that. it needs to be honest. a lessons learned process. a capacity that is further build up and refined. one i hope we will never have to use, but we have there if necessary. >> could i just add -- i agree entirely with both the speakers that we need an honest debate before we engage in these interventions, but a well informed debate. and an effort to accurately predict the likely costs.

if we had done that before we went into iraq, we would not have invaded. the american people would never have sanction the invasion of iraq if they had any idea of what it was likely to cost and chief areas if we had that kind of -- cost and achieve. if we had that kind of debate in 2001, we would've gone into afghanistan, anyway. we would not have been wrong to do so. it is also not true that these operations are always costly. we did not lose a single person in haiti, or a single soldier or airman in kosovo. or bosnia. about 20 international interventions since 1989, eckstein of which produced which g peace.-- 16 of produced enduring peace. most of those took no casualties and spent their little money. >> sometimes we make too much of this notion of special skills required to do these kinds of operations. especially at the small unit level. a well-trained military unit can do these kinds of operations.

with this ongoing focus on lessons learned, figuring out what we did wrong tactically, it takes the important attention away from what is most important in these kinds of wars. it is not the tactics of doing them. this idea of special skills. it is what ambassador dobbins said. at the beginning of these wars come the strategy and the policy that puts them and lace in the first place. that is what iraq and afghanistan has turned on. not whether or not the army didn't have the right manual in 2003 than in 2006. >> we will open up the questions to the audience. ask in the form of a question

and give your name and credentials. gentleman in the back. >> my name is [indiscernible] i am currently a 2013 fellow in the south asia program. my doctoral research was on afghanistan. i agree that there have been a lot of problems. i will put this in the form of a question. there was a dire lack of understanding, the link just between tribes, power bases, and how karzai is utilizing different tribal bases, tribal families, groups to maintain himself. it is not a bad thing in itself that he is trying to do, maintain power in the country. any leader would want to do

that. it is the same dynamic overall. i find that the united states entirely misunderstood afghan society, which does not work. it has been the case in the 1920s, when they tried to implement drastic reforms, and disaffected a large section of the population which resulted in a war as well. this was the case again. culturally sensitive approaches are more appropriate rather than implementing [indiscernible] actions or models. more importantly, what would happen in the future? things have gone wrong, what would happen in the future? it fall into a civil war, like you said ? design good for society or neighboring nations?

>> country-specific context, different values, different norms? is that something that you also noticed in your research of these various countries? adapting international standards, gender equality, economic and military policies? >> i think some understanding of local cultures is very important, but again, just going back to the study of 20 different -- the purpose of that study was to determine what kind of local cultural and ethnic factors influence the outcome is in these 20 different interventions and levels of success. and it was homogeneity of the society, all of those things. we found out most of those things had no correlation with outcomes, that the things that had the most correlation with outcomes were, first of all, whether the intervention took place on the basis of a peace agreement and peacekeeping or whether it took place on the basis of invasion.

that was one of the two dominant differentiators, if you will. the other two factors were basically, one, could you convert neighboring countries from malign to benign policies? if neighboring countries would stop supporting contesting factions, stop feeding the conflict, put convergent pressures on indigenous actors to come together rather than fight, you almost always succeed. so geopolitics was more important cultural sensitivity. it was getting the neighboring

countries to stop feeding the conflict and began adopting benign, helpful policies. the second was co-opting the patronage networks in the country into collaboration. it would still be patronage networks. there would still secret, that would still extract wealth from the society, but it would not kill each other to do it. in some societies, these are organized tribally, by religion, in some cases geographically, other sectarian or religious affiliations to find a patronage networks, but if you get the patronage networks to stop killing each other and enter into some sort of collaboration, again, you almost always produce peace, and that almost always leads to some degree of economic growth and improvement of the life of citizens. >> i agree with what ambassador dobbins just said.

that is the point i make in these wars like iraq and afghanistan, there really turned like in the american military, this whole notion of cultural understanding? it has almost become almost weaponized. if you understand the local culture and all that in falls, and somehow at that level you will be successful and produce a better or good war. but these were still not turn on those kinds of things. they turn on the issues the ambassador just mentioned. for the united states, within all that, we should be asking whether it is in our interest at the beginning of it to intervene in those very things in the first place. >> just to dovetail with that, taking a realistic approach of u.s. interests, wouldn't it be best for terrorists to have haven in failed states?

failed governments? we would not want terrorists to congregate and pakistan or malaysia or germany. we would want somalia, yemen, afghanistan. should we be changing our approach? >> no. [laughter] no, you want terrorists to congregate in areas where the affected governments can suppress their activity. you don't want them to be left free to organize. and he dealt with them to use the state, diplomatic pouches, the banking system freely. the reason is better to have al qaeda in pakistan and afghanistan is because in pakistan, they're not allied with the pakistani government. the pakistani government, while the supporting the taliban, it is not supporting al qaeda.

it is prepared to give us targets that we can strike with drones, it is willing to pick out the al qaeda people. so what you dealt what ought, the problem with afghanistan, before al qaeda had aircraft three aircraft from the that states, they had hijacked the whole country and government, called afghanistan, and that is not what you want to replicate. >> anyone else? >> building on that, i totally agree. but then taking the whole surge debate in afghanistan, the

argument advanced by the military was you had to build up an afghan state that was strong enough, a government strong enough with security forces strong enough to resist the return of al qaeda operatives from pakistan into afghanistan. and if we did not surge and pour in the resources, the significant elements of the cut would go back into afghanistan. i think what we have seen is that is a little bit of a fallacy. al qaeda might be doing completely irrational things, but at their core there are rational actors. if the cost of doing business in afghanistan is incrementally higher than it is in pakistan, they will not come back in large numbers. if the government takes action against them and provides us with intelligence, certainly for those who were still around, pakistan has been a more respectable place for them to operate and afghanistan. to keep the cost up in afghanistan did not require 100,000 u.s. troops. a couple of special operations task forces, coupled with other sorts of assets, could probably have made the cost of doing business in afghanistan incrementally greater than

pakistan, dissuading significant numbers of them from crossing over the border. >> we can stop doing counterinsurgency in afghanistan and start doing counter- terrorism as long as the afghan government does counterinsurgency. it is not that counterinsurgency does not work in afghanistan, it is just too expensive to do. a million dollars per american is too much. we need to do it more cheaply. >> the afghans can figure out which parts of the three make sense to tackle first, with american support, as opposed to was doing it entirely for them. >> real quickly, why did it take us, what, from 2002 until today, 11, 12 years to figure that out? >> you did not have an afghan government in 2002 that could have done that. >> for the next question, i want to recommend that it is concise. the gentleman in the back? >> gordon johnson. my only experience and your arena is working the marshall

plan, which is a very different situation. my question is you have not talked about perhaps the biggest difficulty we have created for ourselves in setting a deadline when we would leave. if we are going to go in, the calculation it should seem to require support of the local people. if vietnam is the lesson for leaving the local people, we leave any people would support, will be before we showed. bush had a terrible time with the democrats saying you have to get out, you have to get out. and in a sense, how can you negotiate with the taliban if he tell them you are leaving in 2014, when the only thing they care about is when i you going to leave. so if you going to get the support of the local people, we cannot set a deadline to leave,

but if we don't set a deadline to leave, how we take care of the american people? it goes back again to vietnam and the minister in williamsburg who asked lyndon johnson, tell me, what are we there? is it not there for a requirement to not only get the support of the local people, we have to explain to the american people better the job of why we are there in order not to give them a deadline to get out. but the deadline to get out, seems to me, has been one of our biggest mistakes. >> so the deadline and also speaking to two audiences.

>> i don't comment on a couple of those things. compared to vietnam, at least in a moral way, the american people are not connected to these wars. they were during the vietnam war because there was a draft. personally, i don't think the draft is the answer. i think a less more ambitious foreign-policy and a foreign policy that is premised on the notion of limits to what american military power can accomplish, i think that is the answer. i don't think over these last 10 years of war the american people have been morally connected to these two wars like a war with regard to vietnam. the other point about time and how long these kinds of wars take, you are right, and original strategy is to use nation-building and counterinsurgency, if that is to achieve the policy aim, irrational strategy would say and come out front and be honest about it that if we're going to apply our nation building to keep al qaeda at bay in afghanistan, then it is going to

take a long time and it is not going to take 18 months or eight years or 18 years. we're talking about a multi generally shingle effort. then my point in my talk all along is if we're doing strategy right, the way i explained, especially with regard to afghanistan, we have this limited corps policy aim which is the destruction of al qaeda, which was pretty much accomplished by early 2002. why did we need to put into place this huge operational framework that committed us to a decade of war, trillions in blood and treasure, to achieve that limited corps policy? that is why i think our strategy from the beginning has been botched. >> first of all, we are not leaving afghanistan. the president has not committed to withdraw but drawdown.

he will leave some residual troop presence there after 2015 and beyond in order to support, enable, train afghan forces. in 2002, afghanistan had no army or police force. the day at has an army of three of 50,000 men, as a police force of about 250,000 men, and by regional standards they're not bad. it is a question of for they can with a minimal american commitment of trading and financial support continue to resist the taliban. but unlike vietnam, pakistan is not going to invade afghanistan. in vietnam, the u.s. left, but the south vietnamese government did not fall. then we cut off all financial and military assistance and it fell, but it fell largely because north vietnam invaded, not because the indigenous insurgency overthrew them. that is not going to happen in afghanistan. >> we can all agree it is a high likelihood we are not leaving afghanistan.

pardon some afghans, though, for being a little confused on this one a white house official raises the possibility of zero troop option, and options are put forth of maybe just a few hundred troops post-2014. that ambiguity that exists here in the policy debate gets multiplied several fold over as it echoes across the world. the way that you build public support is that you talk about these wars. political leaders are not talking about afghanistan. look at the 2012 campaign. neither obama nor romney said much about the war. if you want to build public support for it, you at least have to say, bush talked about iraq and a lot, but remember the early days post 9/11, we were all told to go shopping is the best thing to do to help support the effort, the fight against terrorism. but just with regard to the deadline, the specific question,

if you want to mount up a full 1 comprehensive counterinsurgency campaign, yes, a deadline does not make sense. it is counterproductive. but let's say the president, a young president who is skeptical of a counterinsurgency strategy, does not really want to surge, but kind of feels boxed in by his military commanders who cannot really give him much of another option, but recognizes that to get to the point where you get the afghans belong the counterinsurgency fight themselves, the need to create a little white space, you need to beat back the taliban, and then you could move to a security force assistance mission. then perhaps a deadline make sense and you say, all right, military, you want to fight this, i will let you do that because what it's going to do over the short term is beat back the insurgents, and then i can push you to shift the focus of the mission perhaps faster than you might otherwise want to get to a point where we have fewer american boots on the ground.

look at that way, then a deadline becomes perhaps more rational. >> wow, so many to choose from. ben freeman in the far back? oh, the gentleman behind him? sorry. >> ben freeman from cato. i agree that counter-terrorism does not necessarily require conference are to see, but once

we're doing counterinsurgency, it seems in the united states there is one model. it seems like in the history of counterinsurgency, not just in the u.s. but around the world, there are a lot of different models, many of which require co-opting insurgents. but in pakistan, where there are regions of the country, or even india, where they have had a fair amount of autonomy and have rebels or would-be rebels. it seemed like we have done in these two wars is not necessarily always consistent with state building and to the extent we have been successful, it often requires it co-opting insurgents by buying them off or long them to have a big part of the country said they did not become uncertain the first place. afghanistan, i am not an expert, but it appears particularly ill suited for a traditional monopolization of violence, build out the central state type of model. it seems like that makes us a revolutionary power because we

are overthrowing local authority structures, arguably creating resistance to the central state. when the ambassador mentioned these 20 countries, 20 efforts, 20 state building efforts, is there one model of success? might there be one strategy for bosnia that is different from the right strategy for afghanistan, assuming we are there? >> first of all, the best way of marginalizing extremist groups and insurgency is to support the insurgents, not to counter them, if you can afford to do that. because there is no insurgent in the world who would rather have the american support and al qaeda's if they have that choice. so we have muslim insurgency is in bosnia, kosovo, we support it and insists the in afghanistan in 2001. we supported muslim insurgents in iraq, and the iraq awakening by co-opting the iraqi insurgents, the sunni insurgents and offering them protection.

yes, that is certainly a viable tactic. there are cases in which you cannot afford to do that, or the insurgents will not come over. we offered the taliban the option of handing over bin laden after the 9/11 attacks, in which case we promised not to attack them, not to invade their country, not to overthrow them, and refused. that option did not work in that case. more generally, i expect john and i will disagree somewhat on the utility. successful counter insurgency requires a variety of different tactical and strategic approaches. you have to put a lot of different things in place to have success. obviously, is differentiated from society to society, the situation to situation to some

degree. but the successful counterinsurgency practices tend to run in packs, they tend to coalesce. when they do coalesce, they usually succeed. and bad practices usually lead to failure if they are pursued continuously. >> a couple of quick pence, to ben and what the ambassador said. you cannot find a historical case where american-stop counterinsurgency, field manual three-24, which is the same as state building, the lines of an effort within the field manual are about building local governments, national governments, the economy, infrastructure, military forces, all kinds of things.

you cannot find a case in history where armed nations -- this kind of policy carried out by foreign occupying power has worked. the united states lost in vietnam because it failed the strategy, nor can use this kind of counterinsurgency to explain or use it as the main positive factor as to why violence dropped interact by the end of 2007. the premise, to the question, there are different ways of countering insurgency. and i agree with the ambassador there should be a variety of tasks or math it's the united states has when it decides to use military force to counter insurgency. the problem with american

counterinsurgency today, as it was laid out in the field manual 3-24, which became elevated to the level of strategy, policymakers using the language, there really is not any variety. there is only one way to go about doing it. that is sort of the operational methods. this is what they're talking about. for the american military and 2009, when there was a legitimate, when there was an attempt at a strategic debate in afghanistan, there really was not a debate at all. this is one of the main points he brings out in his excellent book, "little america." and there was not a debate because there was only one way to go about achieving the corps policy aim, which was american conference of urgency, promised on the idea that general petraeus and the surge force made it work in iraq. this is the problem we have. its strategy is going to look at the world, maybe we want to use military force to counter an insurgency or do with instability or whatever, at least the way it is now we don't have a variety of methods. we only have one. and it is called american conference, a.k.a., armed nation-building.

>> insertions were using effective coverage receipt techniques in el salvador in the 1980's, columbia more recently. by and large, the kind of techniques and tactics described in the american field manual were consistent with those campaigns. they were not conducted donnelly by americans, but they were supported and advised by americans. >> the gentleman who initially stood up the first time? >> hi, bob shadler. thank you very much. you demonstrate impressively, informed, highly intelligent, but i would like to ask you to address a different framework.

we the people were onboard for the first afghan war because of three very obvious, specific things -- 9/11, the termination of bin laden and his associates who were responsible for 9/11, and, as we mentioned, the taliban government refused to give them up. so the mission of the first afghan war, i would suggest, was to kill or capture bin laden and his closest associates. that war ended when he left afghanistan and/or we realized he left. the second war began immediately afterwards and was too diffuse or embarrassment of having utterly failed. >> so all of this about counterinsurgency and phone usage in afghanistan and girls learning to read were not why we the people went into afghanistan, and we would be just as happy barely being able to spell afghanistan and having

only a few specialists know where it is. but it was that purpose, and once that purpose was lost because he left, we were fumbling around. so building up a central government or improving life there was not something we the people signed on for. it was to kill or capture bid laden, and the government continues to avoid embarrassment by staying there. >> we did not invade germany to get hitler. we did not invade japan to make a prosperous democracy. and a major export power. but we did both of those things very consciously in the aftermath of the war because we did not want either of those countries to return, in one case, nazism, and the other case military is them.

the reason we stayed on in afghanistan was so the taliban would not returned, so i cut would not return, and its and alisa we would have a base to attack. >> they're not on the level of nazi germany, we're not implying? >> you will always go into a war to stop something. you never going to war for positive outcome. ego went to war to stop aggression, to stop genocide, to stop something. once you have stopped, you are left with, what do we do now? the answer is you want to make sure it's better the war than before. otherwise, what is the point? >> right now we are at the point where we will be engaging the taliban and reconciliation, which was not necessarily one of the options when we invaded germany.

>> that was one of our mistakes. >> there are some really big differences between world war ii and afghanistan. the overall global threat that was there in world war ii with fascism and nazism, did is also an historical example where strategy made sense and where you had unconditional surrender as the policy objective, and in a very elaborate and well thought-through and generally well-executed by all the allies the u.s., great britain, and others -- to achieve that policy aim. i think with afghanistan, absolutely we were right to go in and hammer al qaeda and taliban for their support of al qaeda. and then, i agree with a lot of the points that you made. we achieved our objective fairly

quickly. by 2002, relatively speaking there were only a handful of al qaeda fighters left. now we're back to the basic question of strategy, what does it take to keep after that corps policy objective? and whether or not we needed to stay and fix and billed to achieve it. >> we also have to understand the cost of staying, fixing, and building in 2002, 2003 was exponentially less than they were in 2009-2010. and had we committed more resources than we did, but nothing on the order of what we have done today, we would not be having this discussion today. had washington listen to people like ambassador dobbins, among others, and more properly resources some basic state building, basic training of afghan security forces, basic peacekeeping efforts in major cities -- mind you, back then, much of the burden would have been distributed among nato partners and others. it would be a far different discussion. but when you get to 2009, it may not be there are two afghan

wars, it is more like there are three. the initial 2001, then the period of the rift that goes from 2002, late 2002 to early 2009, and then the decision to sort of recommit. by that point, the cost of getting there was so much greater. and that is when they are really needed to be, in my view, a more substantive argument over, well, yes, it would be great to have a functioning afghan state, you do not want un-government spaces because of what that potentially yields with bad actors in those areas, but the cost-benefit analysis, which probably could have been easily calculated in 2002 and come out positive, by 2009, the cost, at least to me, seemed to be far too great. >> sadly, with that, we have gone substantially over time. i would like to thank all of the

speakers on the dais with me. thank you very much. lunch reception will be held on the second level of the conference center, by the staircase. thank you so much for coming. [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute]

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what changed that day was the course that naval warfare would take. >> this weekend, the history of the unions first ironclad in the the final fate of two of its crew. sunday at 7:00 p.m. eastern on c-span3's american street tv. tv.istory >> they had a very political marriage, much like john and abigail. she would lobby in the house of congress. she was always very careful to say, my husband believes this and my husband advocates that. she herself was doing the pitch. one of her husband's opponent said he hoped that if james were ever elected president,

she would take up housekeeping like a normal woman. and she said, if james and i are ever elected, i will neither keep house nor make butter. >> monday night, one of the most politically active and influential first ladies, sarah polk. we will also look at her successors and take your questions and comments by phone, facebook, and twitter. "first ladies" live monday night at 9:00 eastern on c-span and c-span3, c-span radio and c- span.org. a reporter for, u.s. news and world report looks at the march jobs numbers. then a discussion about the state of the pipeline system in the u.s. then the director of the institute of health talks about funding for an initiative called rain research through advanced innovative nerd technologies. "washington journal" is next.

>> dear mr. president, it is clear that our current health care system hinges not only on our current economic situation but on the daily lives of every american. first, let's take a look at the fact. 15.7% of americans are uninsured. even though we spend $2.5 trillion each year on healthcare. , werary to popular belief do not have the best healthcare system in the world. we are ranked 37. affordablees the care act, also known as obamacare. it is designed to lower costs and ensure more people. , it wasthe arguing signed into law in march 2010. >> that afternoon. earlier today, the supreme court upheld the constitutionality of the affordable care act. the name of the healthcare reform with past two years ago. if you are one of the 30 million

americans who don't yet have health insurance, starting in 2014, this law will offer you an array of quality, affordable, private health insurance plans to choose from. >> what is his plan for medicare? >> this was included in his healthcare law and that is where you hear romney, other republicans talk constantly about this $716 billion in cuts. those are reduced payments to providers and medicare plans that president obama used and included to bring the rates down. he does a lot of other things to change the medicare program. he is just trying to change the system from within. >> one of the current issues that we're spending a a great deal of time on right now is a medicaid expansion that was supposed to be in the affordable care act. essentially what medicaid expansion would do would make

medicaid a non-categorical grant. ,nstead of having to be aged blind, or disabled and meet this criteria, it would be available for anybody up to 100 38% of property. poor really a way to get people of all varieties access to health care coverage that they would not otherwise be able important an as issue as it is, it is surprising that most americans don't understand it area we went down to franklin, tennessee to see what people had to say. iti had no idea even what really means. we are all supposed to have insurance whether you can afford it or not. >> i don't think he has done a good job explaining exactly what is in the plan. i don't think they really know what's in the planet. i don't think we're going to know until it goes into effect. >> from immoral then point -- a

moral standpoint, we should take advantage of helping those who can't help themselves. mr. obama,t heard to make any statement about the nuts and bolts of the entire healthcare is him. >> we just got married. you're not a dependent anymore after you get married. we were not sure about health insurance. >> the information is very accessible, if you just google search the affordable care act. i am diabetic, i don't know how it will affect her benefit me. >> i believe it. part of the country's will is the ability to take care of its people. >> i just recently had a friend of mine who got a sore on his foot. because he couldn't go to a clinic or anything like that, he almost lost his leg. and he ended up having to go to the emergency room. at his inexcusable, as far as i am concerned. >> even though the bill has

good intentions, it certainly won't fix everything. there is always room for revision. >> here is the danger, when the federal level takes a position where they can tell someone whether they purchase a product or service. where does it stop? the federal government can tell us that we must buy healthcare, today also tell us that we we must buy a certain kind of car or certain kind of product or service? >> employers will have a strong incentive to avoid hiring particularly low-wage workers. if they hire a low wage worker and end up in the new subsidized system, insurance company will pay a fine. not so if they hire a higher wage worker. disincentivesuge to hire the kind of people that are most in need of jobs. ask the way that happens now, each healthcare provider will shop for you. oryou go to rite aid

walmart or wherever, you will buy the lowest cost you can find. do that with an x-ray. -- can't do that with an x-ray. in terms of health care i am a licensed independent insurance agent, licensed in the healthcare field is one of the areas that work with. i think the system certainly has some flaws in it. need changing, need fixing. ofre are some good aspects the affordable care act that address some of those issues. i don't think the affordable care act is a surly cares or addresses all of the problems within the healthcare system. >> it is clear that above numbers and money, what it really boils down to is the people and their well-being. we went up to ohio and talk to a cardiac nurse at a hospital for

low income patients. >> healthcare is important because that is what keeps us alive. keeps us healthy, safe. the most important issue, patient safety. hospitals are now worried about productivity because they are not making enough money. they need more patience because they need to do more money. that they push patients on us, trying to hurry us to do it they need to do to get them better so we can push them back out the door. it is costing the patient's -- it could cost them their life. patients are admitted, they are discharged before they should be. ,hey are being readmitted which insurance companies say that if you are readmitted for the same thing in 30 days, they will not pay for it. i am a big patient advocate. i went to school to take care of my patients. to the best of my ability. allthcare is so bad, it is about numbers, not about the

patient's. how can we give that one-on-one care and make you and your loved one feel special and everything is being taken away from us ? you don't have the right drugs to cover the sick patients. we don't have enough staff because the hospital needs to make money. something needs to be done about patient safety. issueis clear that this affects everyone, no matter where they are. it is critical that the success of our nation. there mr. president, the matter what side of fence people are on, our health care system is at a turning point. we need to make sure the public is educated and ready. that way, as americans we can move forward. >> you can find this video and all the other winning documentaries at studentcam.org. a reporter for, u.s. news & world report looks at the march