would think that -- but on the other hand, if it is to people who just live together, they don't have a common estate. i don't want people to think that when i say the word benefits that this is like welfare or food stamps or something like that. it is like saying, a married couple can file a joint tax return. they can save money on taxes. that is one of the main so- called benefits. it is true that social security has a survivor's benefit for a spouse. this decision means that legally married same-sex couples are treated like legally married opposite sex couples. when one person dies, the other spouse can receive benefit under social security. host: a caller on our republican line. caller: are we really free from religion and the constitution? all our problems are about that

religious stuff. i want to thank ted turner and a guy in fall city actually i vented cable tv. i guess he is a neighbor. this religious stuff, we start >> the said two provisions. respecting an establishment religion. the government cannot establish an official religion and say everyone has to go along. anybody can worship as they please. that has done a decent job of

holding to that line. no official government religion. this is not based on just religious view this. they decide how far states can go in regulating abortion and what authority the president has under executive orders. >> the second case is going to be argued in the fall. it is a big political power question whether he can make temporary recess appointments. that has been the case since world war rome into. -- world war ii. >> will they take all recess

appointments? >> all recess appointments. any time either say the senate is out of session for two weeks or whatever the president can make a recess appointment. there is no recess. they said they are not really on a recess. they say when one session of congress ends and another begins. that would make it hard to fill any positions. >> this is a day issue coming down the road. >> there have been a whole series of fight. a years ago they hinted out we're goingt said to stand behind a woman's right to choose abortion but states

may regulate the practice of abortion. a lot of these republican-led state say we want to impose more regulations and restrictions. we are not banning all abortions but we want to regulate it. the course got to decide how for the states can go. it has a mandatory ultrasound test for all women speaking for abortion. the state has appealed. i think is very likely the court will take one of these to see how far they can go. >> if you want to read more on the current term, one of his stories this morning is set like this. justice.qual thank you. >> good to be with you. willmorrow, nina olson talk about the targeting of tax exempt groups in her midyear

report to congress. octobers at the deadline for help insurance exchanges. they discuss government- sponsored broadcast. this is live at 7:00 a.m. eastern here on c-span. now a discussion on the obama administration's decision to begin providing military assistance to syrian rebels. hosted by the washington institute for middle east policy. this is about half -- one hour and a half. >> good afternoon. welcome to the washington institute. i am very pleased to welcome all of you to the special policy form luncheon debate. we do not often do debates. this is a debate among serious

people on serious topics. you will not see the gloves on and blood flying. it is an important issue to talk about u.s. policy toward syria. an audience that is watching on c-span knows very well be issues that are at stake, the humanitarian issues that are at stake, the political and military and strategic issues. there is a broad consensus about the urgency of the situation in syria. there is considerable debate about the -- what the united states should the leading in order to affect the situation on the ground. have beeninstitute

actively engaged in trying to present a rod range of information to the policymaking community. in addition to our speaker today, i want to draw attention to everyone here and our viewing audience at the institute website which includes data from first-hand visits to the region borderingte staff, all countries, detailed reports. today we are brought together with two of the most awful and insightful observers of the situation in syria. today's discussion is really

about what america should do. the springboard is an article. the current issue of foreign beler.s by andrew taylor basedthe author of a book on his eight years living in syria. the article that he has written is titled "serious collapse and how washington can stop it. though he offers analysis of the situation in syria and a set of very specific prescriptions for what the united states should do on its own in concert with partners and allies in order to stop the carnage and the violence and bring about a

resolution of the conflict. speaking today as well is professor mark lynch -- marc lynch. this is not the first time he has spoken at the institute. he is a professor at george washington university. ofis the prodigious author frequentnd a contributor to foreign-policy among many others. if you are wondering if we can find a coherent alternative view about what the united states should do, then i suggest reviewing a series of foreign- policy. we have today to very smart, very well respected and consulted experts.

i will not go into the details of the consultations. the articles we will be hearing today very much reflect the arguments that are on the table. we have had a change with the president announcement of of the gaining of direct u.s. military support to beat the whopper in any to the armed opposition. i think it is still sufficed us to say the overall strategy remains unclear. what the object is are, what they ought to be and whether we are bringing to bear the resources to meet those object does. i think today's debate remains very timely and very much appropriate. with that i will turn the podium first over to enter and then over to marc and then over

to you for your questions and comments. >> just one more word. if i could please ask everyone to silence your cell phones. it turned them off if you can, silence if you must. >> thank you for that introduction. angst to the washington institute and all of my colleagues here and -- in all of the capacity for helping with today's event. thanks to all of you for coming out. particular thanks to mr. lynch for accepting the invitation to discuss an issue that i think both of us believe is a crisis of the first order and one we have been talking about behind closed doors for the better part of two years. wet has followed the debate have seen inside at the u.s. government or heard about that come out of policymaking

circles about the difficulties in coming up with policy descriptions to deal with this crisis. bit of thanks goes to president obama himself for his recent decision to recognize the agents has used chemical in syria and the decision to increase military support. --nc. we are in an error era of policy flux. we do not know the details and i believe this is where a lot of the debate will be going forward. the article that he discussed about serious collapse was based on a recent trip i made with my colleague and good friend jeff white to syria border regions. i think the one thing that came away from that trip, and this

details our trip, one thing that the syriais that that i lived in for so long in the one i had been writing on for quite some time, the one that you know very well through jarecki board indirect -- through direct or indirect --eraction is chairing noble cherynnobling. now i think it is a threat to the regional security architecture and is likely to suck in not only a lot more of the regional powers but also threatens to stuff -- second other international powers as well. this opens that major challenges. i am afraid of this.

.his is the very sad truth simple. fairly this is not a question of if we get involved in syria but when, how, and at what cost. important attention has to be paid to outcomes in goals. and theot be able to crisis. i becoming more involved, believe we can shape and outcome in keeping with our interests and contain it as much as possible within the syrian borders. ws foreign affairs piece follo a lot of president obama's recent thoughts been charlie

rose's interview. what i want to say here is that i think the president very clearly outlines what u.s. interest were. he articulated the humanitarian interests. this is the first part of my piece. , depending000 killed on the numbers, just this month in syria. they say this is bosnia on steroids. comes on thearker second anniversary or just before the second anniversary of president obama saying the president had to step aside.

the death tolls inside of syria are worth -- worse than they were at the height of the conflict. there are considerable regional interest that the president outlined that are now at risk. this is something that really have not entered the policy considerations previously. had been talking about the humanitarian situation. --have the basis from and from iranian influence. this was so massive. the countries are simply unable to do this. those of you have been there i think have noted that the

refugee camp in jordan represents the country's fourth- largest city. you can go into the camp. there is very little security. outside is another matter. oft is another major area the spillover. then the president outlined the direct interests. this has the use of chemical agents in this situation. accordingncentrations to u.s. government officials. this is also a major concern and also threatens to take this crisis and all of the displacement that has been generated it and be supercharged that situation and send them running over the border or into neighboring

governments for cover and to stay out of these areas with the chemical agents could be used. that we expect will continue without a check on president assad and have him going up the escalation chain. i think the biggest take away that i had from the trip and what did think a lot of my fellow share is that the division of the country into these three general areas that i , in each one of these areas we see not just u.s. designated terrorist organizations resident, we see them ascended and eight key part of each area's ability to go politically within those areas. you saw hezbollah recently. you see the role of in terms of

power as well as soft power reaching out to the syrian population and then we have the local variant of the pkk. why is this all matter to mostcans americans do not want intervene inside of syria. there are different responses about what an intervention might look like. generally there is a lot of skepticism. there is the recent iraq involvement or afghanistan, finances, and so one. i think the biggest strategic threat emerging out of all of this really took me back to my original discussions with policymakers when i came to

washington five years ago. that is location, location, location. thethe force two years of obama administration, we engaged the regime not because we like him, not because his behavior was particularly good, but based on the idea that syria was very important and not only signing a bute treaty with israel also because of serious geographic location. it does not have a lot of oil. apple were very friendly. -- people were very friendly. we did not have a lot of u.s. interest to be fair. we had a lot of interest in the countries that surround it serious, israel, jordan, iraq, turkey.

i try to think a little bit about this. i kept on hearing every time we would talk about those who said we should not get more involved in syria would say "look what happened in lebanon here: lebanon caught on fire and burned down several times. those from their knowing exactly what i am talking about. in the end it is not really threaten things. i think the analogy that immediately came to mind was that for all the terrific things that happened in lebanon, lebanon is the small house on the end of the block. this is something everybody here can relate to. the block is the regional security architecture, the founder and that have divided the middle east for almost 100 years.

lebanon was stabilized and the secretary lebanon was stabilizee secretary dimension was contained by the involvement of the to and houses and a much more stable syria with much different demographics. it was attainable. that hassettlement never really been fully implemented and was not terribly successful but brought relative peace to the country. it is a way of splitting the baby down the middle. syria is the rowhouse in the middle of the block. that we see inside of syria is that what happens there does not stay there. it is not like they guess that whatever happens there stays there. the potential for spillover is so great and has accelerated over the last you month whether it is the refugees or the involvement of hezbollah, if you

would have told me a couple year ago that in a short time you will have have hezbollah rocket fire for an hour or mother needs tower. you have to be crazy. few seen it in a last months. those of you have been tracking the involvement of hezbollah inside the country. i do not think what is happening in syria will just stay in syria. it is less and less attainable. not in of itself threatens only serious neighbors but the security architecture as well in the region. ok? right now the refugees can be the destabilization of different border areas of syria. northern jordan immediately comes to mind. it is true. hings do not often burned down immediately. over time and given that we do

not have a solution to this the potentialk for this to spread is much greater. it deserves greater u.s. attention. my prescription is in the paper. these are ones i discussed with marc many times. these are not unknown to most of you. there are four parts. one is that the first that's all of this is that we need to enforce the chemical weapons use a red line with president assad. it gets down to american credibility. you should enforce these lines. the choices of not doing so reverberate beyond this crisis and will affect how we are perceived in the region and beyond. that is a big concern of many of those in the military.

most importantly, if we do not enforce that redline, there's every indication that president assad is moving up the escalation changin. surfacea service to missiles are already the third most used against the civilian population in the history of the world. verse adolf hitler. then the asad regime. the use on civilian populations, whether the enemy or not is there. unless we determine him from doing that, he will keep using them and that will cause more people to to run over the borders. it will potentially destabilize them. continue this we need to set up safe havens. many of you have seen that i have written about this before. these areas would be adjacent to turkey and jordan at first and could be enforced using

missile batteries or aircraft. these are not the only options. there are many courses of actions that we have discussed over the last year or so that very to more direct action with u.s. aircraft flying over those areas. the risks go up. it is much more expensive. next i believe that if we decided that president assad has to go and that is part of the solution we need to work with the opposition in order to achieve that militarily and politically. the reason i want him to go is not because he is a bad guy. the reason why he has to go is that he lost his chance to reform his country. and to deal with the

demographic wave that is now overcoming that regime. the asad regime has proved very rigid over time. it has been unable to reform other to open up banks and insurance companies. they have been unable to deal withc1 insurance companies. they have been unable to deal with the big elephant in the room. all the armed fighters have beards and black hair hair and very little gray. what you are seeing is authoritarian karma. there was a massive crackdown inside of syria. hard currency dried-up. contracted. everyone just stayed home and have a lot of children. that syria wase among the most 20 in the planet.

one just stayed home and have a lot of children. during that time that syria was among the most 20 in the planet. that is why many people inside of syria were actually pushing him to reform. the system cannot reform. they need to go in order to bring a true transition from a trickle form of government to something with the demographics. that is true stabilization. to do that we need to work with the syrian opposition in border regions of syria from turkey and jordan and beyond as well as into the sacred areas depending on if they are developed and when and over what time. there are a lot of details about that in my paper. i advocate diplomacy. i do not think we should throw it away. i think it is something we should always keep open. i do not think at this point the process see

will yield either talks or anything that would lead to a true transition that would deal with the difficult situation. isat i see of the end of this a serious that remained divided, regime controlled with various borders and -- in many of these areas. at the end of this process we to bring those pieces back together. that is a very distant goal at this point. i think it is worth trying to keep syria together, i do not think in the current form it is possible. at long last these were huddled around the regime. they might feel more confident and safe.

to have them leave the scene. that might give them the guarantees they would like in an terms of they did not feel as many minorities had told me that a transition would mean having their heads chopped.. i can understand that. incident started with diplomacy and without the syrian people, i think we should start with the syrian people and then end with diplomacy. hopefully the human security council but if not we would have to have some sort of diplomatic process. there are a number of other actors that might be able to step in and help us negotiate a peaceful and hopefully stable and to this crisis. with that i will conclude and handed over to marc.

thank you. [applause] >> i would like to thank all of you for coming out here on an extremely hot ride a afternoon. i would like to thank rob for inviting me back here. he does not usually host debates but every time i come here i and defend the middle of one. they have alluded to the many workshops and discussions we have been involved with. one of the things that is most impressive about andrew and a number of other people i see around in this room is that they have been focused on trying to solve problems in syria. they are trying to find workable solutions. that is what we all need to be working on. authors to not choose their own titles.

i get to choose the titles on those articles but on foreign -- i fully and completely agree with the main. serious collapsing. strategic void, everything but she described more or less goes along with my understanding of what is happening and syria. or on the moral imperative to try to ameliorate and solve the problems there or on the reality of a war and a civil war that will stretch on for a long time. or quick fixasy

to the problems of syria. our disagreement primarily lies in the subhead which adds how washington can stop it. i do not think washington can't stop it. i think washington can do some things. thethe end of the day, magnitude is well beyond the ability of the united states to control or decisively and. i want to be very clear. around ahe debate is certain set of limits. the words nobody is talking about boots on the ground. my point is that even with boots on the ground, 100 50,000 troops occupying damascus we cannot stop this. we could solve

this problem. we could overthrow assad, no question. then we have to solve the problem of a collapsed state, a shattered society and a repatriation of what has been left a heinz. i think any serious discussion has to begin with what syria is going to look like at the end of this game as well as right now. f only the president would do ais, if only he would create safe area. if only he would only mean it when he says this must go. we need to understand that our arguments are taking place at

the margins. politicalffect the situation. the magnitude of what is happening in syria is well beyond the ability of any minor fix or even a major fix coming from washington. it is absolutely and completely true that the president strategy for syria has not solve the problems of syria. parts of the strategy have been useful. parts of them have simply been good ideas that have not worked out. when you have a situation with 100,000 dead and millions displaced, the spreading like wildfire throughout the region, it is not a policy you would i often hearoff. that everything that the

critics pretended what happened has happened anyway. serious and absolute disaster. american troops are caught in the relentless pressure to expand our commitments to go deeper, stay longer, have a surge of troops. people talk of the slippery slope. you cannot do this. you have to think about what happened when step one does not work. about thethink various policies. i think three of the four of what he puts forward, i'm happy with all four of his. enforcing theust deterrence on unconventional weapons. i think there has to be a firm

and clear line between any kind of direct military intervention. there are a whole range of things we can consider the likely efficacy. i believe these come uncomfortably close to the line. crosses thetrikes line. once we have crossed that line unless you can give me a clear story by which the conflict ads, then i think we're on slippery slope that leads to exactly what everyone says they they are not talking about, relentless education. once you are in, you are in. you cannot say that did not work. those of you who remember about will circa july 2011 remember that the same people

who argued originally there were never talking about boots on the ground, they started talking about it. we do need to be extremely cognizant not just of step one but of step 2, 3, 4, and five. let me talk about some of those steps in my general sense of how this is playing out in what we can and cannot do. generally speaking, the argument about arguing the rebels that has dominated this for quite a while has largely been a red herring. a root something over a year ago. i said i suspected this is where we were going to go. why were we going to go there? it would be a way of showing we were doing something without actually getting ourselves directly committed to military intervention. that is what happens. you cannot do anything that looks that bad. you will definitely not the all in. you find something in the

middle. it will not solve the problem but it might help. i am surprised it took so long. i not think it matters very much. there was a point at which it matters. that was between november and march when you were seeing a debate taking place inside the syrian opposition and across the region about whether to shift from a useful uprising to a militarized insurgency. there were very real reasons to avoid the militarization of the conflict. because of the assadition that aside -- had a difficult time dealing with the moral challenge where it was a peaceful uprising in the arab spring spirit against a brutal authoritarian regime. it'll people inside of syria that there might be a safe, useful and better alternatives

of the asad regime. they might have a safe future. they might be able to prevent the spread of the secretary and fear, the collapse of these states and the unleashing of addictive old dynamics and logix. unfortunately, because assad proved she was willing to carry out unspeakable brutality against the syrian people and cynically use the strategy of brutality in order to push the opposition into a militarized he wanted to help me fight on that ground where he was much more confident of winning. he was right. i think this has been a disaster for the syrian resolution. almost everything that was been validated.

i think there are very few fence sitters left in syria. i think they are absolutely terrified at the victory of what is increasingly seen as an insurgency. i think we now have a strategic stalemate which is very much at the extent of the syrian people. i see very little possibility of either side reestablishing a viable state. i expect there to be at least if andears of civil war when, whether or if he walls, whether he survives. gone far logic has too far to the overturned -- to be overturned at this part. the reality is that the

militarization from an uprising into an insurgency has been a political disaster. it is one which he courted and thoughts. it has brought serious to where it is now. that was a year and a half ago when this debate mattered. now it is not really matter. it is fully militarized. this is now a multi-sited complex internationalize insurgency in which we are debating about how in the modality behind which we will support an insurgency. what it comes down to now is trying to figure out whether the kinds of steps that entry was talking about are likely to help this insurgency not when but let there different ways supporting that insurgency are

more or less likely to produce results that are likely to serve american interests. those interests have been defined as trying to find some kind of lyrical transition which preserves rudimentary functioning remains and find some way of preventing what seems to be a cycle of state failure and breakdown. it could eat that the steps being discussed here would accomplish that. -- could be that the steps being discussed here would accomplish that. serious just as unique as every other case. they studied this kind of

external support. usually goes to the weaker side. it tends to make wars longer and bloodier. stateds to create fai the weaker side. it tends to make wars longer and bloodier. it tends to create state failure in the entrenchment of political economies, those people that benefits from those associated with insurgency and make it less likely that you would have a democratic or stable regime when the war finally ends. they could be that syria is different. i would feel more comfortable if point me to a single case in the history of the world were such a strategy has worked. if that could happen, it is

frustrating that we have not been able to find one. we can talk about some of these that are immediately save it. you have to go back and make it in a radically different case, i am not convinced. the logic of arming rebels, even everything i said, it the logic of this has and fully, this has been fully adjudicated. you know the basic logic of why we have moved toward trying to arm the rebels. armingic is if we start the syrian rebels a couple of things will happen. we will stabilize the battlefield and prevent the rebels from losing. namell enable them to what they seem to think is the military advantage. support aof us who diplomatic endgame that will be

more likely to get an acceptable game if they were able to bargain from a position of strength, there is a broad recognition that there are these jihadist groups. than thestronger groups we would like to support. they might be able to repeal this. we further the battle against assad and weaken the jihadist to alarm us. s who alarm us. it gives us a greater influence over postwar syria. we will win the gratitude, the political support and basically have a role in post-assad syria after the rebels have arms one or negotiated a transition.

this sounds good. i have heard it expressed extremely well by many people. not convinced that .ny step in the causal change the argument that this would permit -- make a significant difference this -- significant difference i do not think it is right. serious afloat and weapons weapons. weapons have been flowing for the asked -- last year and a half. the u.s. would be entering into a crowded market of weapons. it is not like it was 1.5 years ago where you have first movers advantage and you can make a strategic qualitative difference. now you become one player in a crowded field of potential armors. one, of course you will

strengthen them if you give them more or better weapons. this is a change in the margins, not a change in type. this would matter the mills -- if we were only use the only supplier of weapons or were at least able to direct the flow of weapons from our allies in turkey, jordan, etc.. it unifies the flow of weapons into a unified opposition that would then have oversight over a unified military force. none of those apply. we do not agree on the goals. based in more time competing with each other.

there is a dysfunction of the opposition. it is something over here while the funding is over here. they are flowing in from the saudi's. all this does is help to increase the fragmentation separation. there's internal battling between what is a loose amalgam of local forces with fluid membership. they trying to do the centralization of political leadership.

the bottom-line is the arming of the rebels of has been going on for a long time and a must we can get control we will be adding to it rather than qualitatively changing it. we can radically change this. the other external backers are essentially maxed out. they have given every inc. they can. if we add to the mix we will then shift to create a balance favorable to the opposition. respond bysimply increasing their age and you have an excellent torry latter. i suppose this is in the."

weapon. i see no evidence that they are. third, i simply do not believe that we will drive away jihadist by coming more involved in the conflict. they love being there even more. ght usill continue to fi and they will use our the onesnt as to why receiving our weapons are not authentic representatives. the idea that they will step back and say we had a good run but now the americans are funding the moderate rebels seems exceedingly unlikely. the united states has been deeply and correctly worried that of the weapons will flow to these jihadist groups.

now we're told that the cia has decided they have identified the guys and they can provide guns to them. i find this ridiculous. insurgencys do things. that is what they do. that there is some bad jihadist spent most of them are opportunist and they are fighting because they have better weapons, and we have better weapons they will come to our site. key part in the causal chain is logically insane. once we have attracted these opportunist to our side with dstter weapons in the wins shifts, why would it opportunist switch back?

we know this does not exist. the idea that the provision of weapons is going to somehow marginalize and isolates and remove the jihadist presence in syria strikes me as deeply implausible. particularly because the insertion of more guns and moving up the ask the torry latter means that the fighting is going to get bloodier. it is going to get nastier. all the pressures will increase and escalate. there might be some examples out there in the world, people this from the blood flows. more ideas will become more attractive as the fighting escalated and as the state collapse accelerates.

i believe there are some good rebels. beacon place our bets on them and they will then deliver on our behalf. give guns to a particular general and they we say we do not like what you did to that community, we are not going to support you anymore, you will probably say ok. we will get our guns from someplace else. one of the key things i hear one of the things that has changed with the change in qatar and the saudi's are now taking the lead in this is a good innings, the saudi's are now taking the lead in the arming of the opposition. let me just throw this out there.

if you're counting on saudi arabia to deliver an anti- non-ary in an on -- islamist opposition, i do not believe that. what would the rebels figure that? they will be good at deflecting political pressure for washington to do more. it'll be pretty pretty good for the flecked and for us to show leadership by doing what they want us to do. it will give don carey some shifts in diplomacy and is will strengthen our proxies to others. all of these will be good for a month or so and then we will be right back to where we were, having arguments about when and whether to begin no-fly zones and the like. there are useful things we can do. we should be doing much more to oppositione political and channel more aid through the political leadership of the

opposition, both military and nonmilitary. we should be doing more. we have been trying to knock heads with our allies. maybe this will give us a more leverage over the saudi's and others to fall in line. we should be doing those things. i'm not going to stand up. promise you that this is the magic solution that will solve this problem. i think this is a very depressing way to end this but i shall. great. thank you both very much. i now have the great pleasure to be a provocateur and devils advocate against both of your positions. i would like to at least begin to focus on the higher strategic level about what the objectives are rather than the

tactical implementation level. let me ask each of you this question. you mentionedw, in your opening remark that we have three parts of syria effectively with three different u.s. terrorist organizations whiting each other. the question that was addressed in today's post an op-ed is a very good question. isn't this a great blessing? three terrorist organizations killing each other? there will be fewer terrorist in the world. in the meantime, let's protect the jordanians. let's make sure it does not overflow the borders. isn't that a reasonable strategy? on the total other side, the

iranians are all there. hezbollah is all in. are we going to lose? do we really want them to win here? shouldn't the fundamental prime directive to use star trek they do to ensure that not win and do whatever is necessary to make sure that the terrible calamity does not happen? is not the first time i have had this discussion. it has a certain coldhearted calculus to it. the sworn enemies of the united states. they have killed americans over the years. doesn't this sound great?

that would all work until it doesn't work. that conflictl becomes uncontainable within the current boundaries of that arena. i argued that earlier. i think it becomes difficult to contain that. what you end up doing is androying a country expanding politically extremism among the three different areas. i do not think that is something in our interest. making this more dangerous, we are looking at turkey, jordan, israel, lebanon and iraq.

i do not feel comfortable or safe at all and don't think that this kind of battle with these kinds of groups taking place is going in centered around an area where we have the largest stockpile of chemical weapons in the middle east. i realize most assessments are that they are in regime hands. we cannot guarantee that going cannot guarantee that, going forward. shells can be fired from artillery pieces. this is not stuff that can easily be kept under lock and key, over time. there are a number of downside risks. under the regional security architecture, you have that. that supercharges it, and sends it, in many ways, global. that is a reason president obama outlined it as a direct threat will stop -- threat. there are many reasons it was a

direct threat. as the conflict expands, what i am worried about -- it is feasible that going forward, we could have boundaries in place sense, but in a de facto sense, it will be part of the greater syria that many people talk about what probably do not really want. that in itself, the destabilization of the northern provinces of jordan, in its self, i think, is a threat, and that area being politically filled with extremists. dealing with the point mark made -- i think i say it in the article directly. if not, i will say it here. this is, in most ways, a political operation using military means, because we are

shaping a rapidly changing environment. itself, likeof mark said, makes this much more complicated and hard. one thing i would add to that is that, of the four steps i outlined -- all of these do not have to go in order, and we do not have to do all of them at the same time. the great challenge of leadership, going forward in the region -- i guess i learned this lesson a bit from, i hate to say it, the iranians, and watching our adversaries battle with us. they are very good at looking at the full dashboard of options, turning this knob and throwing this switch. they are very good at that. obviously, they do not have public pressure to go up the escalation change. in the end, they can do what they want. often, we get locked into a situation where we believe we have to go all-in.

i do not think that is what is going to win it in syria, necessarily. there are a lot of unknowns, here. it is going to be a much more complicated situation. a very senior security intelligence official, who i respect very much, as many of you know -- he said to jeff white and i, and a military base in the end of the day, when we were all thinking about this crisis -- he said, this is the most complicated challenge that israel has ever faced. this is a country that has faced a lot of challenges. he said, i did not say it was the just. i set it was the most complicated. and we are nowhere close to the end of it. i do not think it is just the united states. our allies,uch as israel,

think along similar lines. >> good questions. i want to emphasize that i agree with a lot of andrew's recommendations. good and useful politics-first approach to this, with military actions and arming in support of the political objectives. i recommend that. i did not mean to say that you did not. others, not so much, but i think that is important. i do not agree with your question to andrew or to me. i do not agree with lead it out and let them fight it out, hezbollah and al qaeda are killing each other. they are not simply killing each other. they are killing thousands of syrians and doing all of the other things we have been talking about. it is also not a zero-sum game. , paper idea that you could kill all the bad guys is

silly. theare exacerbating radicalization process elsewhere. this is not zero-sum. one of the most worrying things about what has been happening is the way that this is turning into very much a regionwide and even international-wives sex terry and campaign, this sunni sectarian campaign, this sunni jihad, like we saw in bosnia and others, using media, using mosques, using religious networks to mobilize people and to get them to provide money to come and fight. it is not just jihadist doing these things. it is the mainstream, the ones we are working with. think about it like little kernels of popcorn. some of them might come over and

die in syria, but more and more of them are popping all over the region. that there is a fixed number of these guys you can kill is just wrong. , are we reallyde going to let iran man? this gets to the nub of the question of overall strategic goals. we have not decided, as a government, as a policy community. i think people really disagree. is syria a civil war which needs to be solved, or is it a front in a regional war against iran that needs to be one? -- won? these are different things. the steps that might need to be taken to find a transition in syria are not the ones you would take if what you want to do is to bleed iran and fight it out, and the like. understanding what that strategic objective is is going to be difficult. it gets back to the point i was

making before. i think we do not agree with our allies. the jordanians and the turks probably want to solve the problem, which is threatening to overwhelm their countries. would probably be happy to keep fighting. to them, the strategy you are describing makes perfect sense. what do we think? i think we have not really articulated it. let's open the floor to your questions. we will start with tom. then, we will go in the far back. when you get the microphone, make sure you identify yourself will stop that would be great. fascinating discussion, sort of like the war itself. there will not be a winner for a while. there was a similar discussion at a conference in houston. when you get that far outside

the beltway, you hear different ways of looking at this. one of the speakers presented this argument. , far fromngements being security architecture, have ban on artificial overlay imposed by outsiders, that have prevented the inevitable sorting out that ought to have taken place after the collapse of the ottoman empire in the 1920's. the colonials prevented it from happening, and cold war constraints stopped it from happening. it is happening now, and we should step out of the way until there is a winner. i take it you do not agree with that. >> i do not agree with it. i think the reason why i see it as a major concern is because a lot of things have happened since the boundaries were drawn. nations, imperfect as they are often times, were built.

armies were raised. the case of syria, i think this is really important. produced bought and the largest stockpile of chemical weapons in the middle east. the breakup of syria, i think, threatens a lot of that other architecture. downsides of this breaking down are, i believe, so great on so many different levels that it would create a political and military chaos. it would actually probably lead we aregreat armageddon probably trying to avoid. that is the reason i would like to keep it contained within syria. it is pretty straightforward. that might not all occur. there might be some areas of lead out. the reason i wrote this -- of bleed out. ing of syriaernobyl

as a threat to u.s. interests on a number of levels. that architecture is 100 years old, for better or for worse. i think letting everybody get it out of their systems is not wise. we might not be able to control everything. mark is right. thatnk you all know subheading is just the way it goes when you publish something. as much as we can shape that, i think that is very important for our assets in the region. >> in the far back. >> thank you. my name is edward joseph, with johns hopkins. i agree with the previous questioner. i would like to take up the challenge to give you an example of where arming insurgents made a decisive difference. of course, that is bosnia, 1995.

actually, beginning 1994. the arming, and i would underscore the training, of andts in particular, bosnian forces, were the key determinant, not nato airstrikes. it was the improvement in capacity of the ground forces that made the difference on the ground that wrought the serbs to the negotiating table seriously at dayton and made that agreement possible. of course, there were many differences. am sure you are familiar with, elizabeth -- she and i have written an article differencess the and similarities between bosnia and sya. to get to -- this is andrew's point that syria has over five times the population, meaning you have to have on the order of 500,000 to 600,000

casualties to have the same relative impact you had in bosnia. markestion to andrew is, has made -- >> we are going to have to hold it there. >> may i ask a question quickly? if intervening is futile, do you agree? can you address that point? >> stop. stop. >> ok. bosnia. i am glad you mentioned bosnia and did not confuse it with kosovo, like some columnists. yes, you are right. what tipped the balance in bosnia was the arming of the croatian military, and their conventional victory against serbian forces. what did not tip the balance was the creation of safe areas,

which grew to be unenforceable, airstrikes which proved to make little difference to the resolution of the conflict. it was only the full-scale arming and victory of the croatian army that did the trick. i am not sure who you envision playing the role of the croatian army in this scenario. but it was not the arming of bosnian insurgents. it was the arming of conventional military, which won a conventional military victory. at the end of that conventional military victory, there was the dayton process, in which we took milosevic and legitimated him in power, made him a key part of the solution, and he only shows up in the hague many years later. agreeing tolved was the partition of the country, and legitimating the role of the architect of the massacres, being willing to wine, dine, and drink whiskey with the guy,

and not seek international justice. and basically having that be a major through international peacekeeping operation, with the overt acceptance of russia and the neighbors. if you are willing to go all the 's role envision assad similar to milosevic tom up finding someone to play the role of the croatian army, avoiding international justice, and giving bashar that role, that is a plausible path, but i am not sure it is the one most people have in mind. it is a good thought experiment to work through, i am notur it has the lessons that some people might think. >> a couple of questions over here. >> thank you. . daily newspaper a quick question to mark. was the president precipitous in saying that assad must go, painting himself into a corner

with diplomacy? is geneva 2 dead, for all practical purposes? thank you. >> andrew, once you start, you can get in your last comment during the question. >> arming the rebels. i do not think it is a futile exercise. however, as you noticed, the recent announcement was to arm the supreme military council, which is essentially the armed affiliate of the syrian opposition coalition. that organization was created around the same time, secretly, off in the wings. we have a paper coming out from the washington institute that tracks a little bit of this. overall, the smc includes defectors from the syrian military, people i have met. the problem is, in my opinion,

given we have seen gross extremism in the opposition ranks, is, in the smc are a who are closerrs and in terms of common cause with extremists than the u.s. government. the weapons that are provided by those channels could we -- could leak out. they could leak out through other channels. a lot of things happen when you move weapons through a check point. people in lebanon told me how that used to work. is a very,of weapons very common one. that is my first. this is also very important. this is also where i take issue with the administration. wasy opinion, geneva 2

dead when the team that was negotiating this in geneva took what was not a bad text, and took it to st. petersburg, and met with putin, and change the language that said all of this has to be agreed on by mutual consent. it seemed like a diplomatic way to get this through, and it was. but it made it unenforceable. you have to get assad to agree to go himself, which he is not going to do. at the time, it was seen as a check i the opposition on the regime calculations in this process. i think it gives this process, if we continue with it -- gives assad that lease on life, and he will continue. i have covered 2 syrian elections in my life, and it was not wasn't. and they were begging me to

vote, with blood from my thumb. there is a that was, less than zero chance that anybody else will win if he runs in 2014, or if they oversee that transition. it will take a lot more than that, or some american center that runs the elections. i agree that a true transition means we move it from this little cabal of people to a group of people that represent the demographic differences inside of the country, and those have changed over time. getting there is tough. i do not see the meeting happening soon, because it seems like the united states and russia are still at odds, which would keep it from happening. >> was the president to precipitous? click -- -- too precipitous? .> yes

there was pressure at the time to take a forceful position that assad must go. i wrote a piece, "expellus assadum," the idea that this was a magical phrase that would make this go. it created a set of expectations which could not be met. i think that on all sides -- most of us, i think, miscalculated assad's ability to survive. that as longn was as it was a peaceful uprising being butchered, assad could not survive because of the moral force of nonviolent protest, what this would do to the syrian middleground. once it turned into a military confrontation, my estimate of his likely survival went way up. people who wanted early military intervention also

misjudged. the idea that at first sight of a nato jet, assad would run for the hills was clearly not right. a descriptive statement, assad must go. that is a reasonable analytic judgment. as a declarative statement by the president, it probably should not have been made. , stanley, and then the way back. >> thank you for a terrific discussion. andrew, i have a question about chemical weapons and the so- called red line that has allegedly been crossed. greataq war, there was a deal of evidence presented to congress and the united nations, resented to the public, of iraqi weapons of mass distraction. in this case, we have a declaration by the president. we do not have anything

presented to congress, classified or unclassified. we have the head of eu diplomacy saying that their analysis is that the rebels used chemical weapons. what is the evidence? why hasn't the administration presented it? >> in the front. >> this is a good book aims to that question. "the art of war, said, know your enemy and know yourself. american people be willing to support whatever is necessary? whatu not have to view the american people would support now? >> i do not know if that is a question to me or not. in the back. >> i want to get mark and andrew to answer each other.

tell us what happens when mission creep happens, like mark was talking about. what happens if we do not follow the issue, and the syrian war continues to get out of hand, and no-fly zones are not enough? and mark, if you could let us know -- answer andrew's main concern, which is what happens when this becomes much more regional. >> why don't we start from that? this is going to be the final round of questions. gentlemen? mona asked me a question. like i said, i expect this to be a long-term war which is increasingly international and shapes the entire region. i have no illusions about that. ie question from before --

think arab states are more resilient than we often think they are. i think when a rock was at its worst. a lot of people thought something similar would happen, and it did not. i am shocked, in some ways, that the kurds have not left iraq yet. resilience to the and power of that supposedly fragile state structure. lebanon,ngly -- with i feel like lebanon and syria are so interrelated that i actually think there is a very high chance -- i am surprised there has not been more spillover from syria into lebanon, more fighting in lebanon than we have already seen, and unfortunately, i suspect that will happen, especially now that has a lot is involved. i think jordan is ok. jordan, for better or for worse, has long experienced flows of refugees, endemic security

threats. we should support them, but i am not as worried about jordan. turkey will also pretty much be ok. i am worried about iraq. iraq has its own internal issues. maliki's creeping authoritarianism. all that stuff is constant. flows of weapons back and forth is deeply worrying, and does introduce a factor. i do not know how responsive to your question that is. the spread of the many ways this might play out, that is the one that worries me most, the spillover into iraq. >> it is a good question. the obama administration, from my understanding of internal deliberations and some that leaked out to the press, was

concerned because of the slamdunk we had on iraq, and the embarrassment that comes from that, and the miscalculation that came from that, and so on. they were very cautious about that from the beginning. they really wanted to make sure. the assessments of the united states are shared by the uk and france. the arab allies, i am not sure. israel, i think, also share that assessment. it might be based on something slightly different, simply because i heard from israeli circles earlier. it was not only based on accounts and interviews with those inside of the country. bringing involved in out doctors who were treating those patients, individuals who had been exposed to those agents, and i believe corpses as well. i am not sure on the last detail. they tested those individuals and those bodies, and found they

were exposed to low doses of sarah and -- of sarin. there is probably more evidence, given there would be other ways to go about it. think obama's language, with a high degree of certainty -- i think that was the language he used. the fact that this came out of the white house is not insignificant, given how hesitant they were for this slamdunk to recur, so to speak. what happens with mission creep? i think what happens there is leadership. i know that is a really casual thing to say. i am not saying this from a partisan standpoint, because i am from the same party as the president. you look at what happens. you look at what is happening inside of the country. you turn one knob off and turn another knob up, instead of automatically going up the escalation chain.

your political opponents often pound you for being a wimp. that is the way democracy often works. in this case, given the complexities of it, i think the president is going to have to find a way to navigate all of that. the american public is cautious. they are cautious now, given the way they believe it is affecting them and it has been articulated by the leadership. part of leadership is framing the issues and the risks accordingly, so that when an increase in those risks to the country occur, the american public is ready for it, and ready to do what is necessary. right now, we do not know what those are. in the of this to go on, neighborhood where we have 65% of world oil reserves and 65% -- risks can reserves -- spread. i grew up in a community where

oil was discovered in the 19th century. the lesson we learned in history class was, the important part of oil is not the supply, necessarily. it is the price. that is another way this could affect everyday americans, beyond, for example, this spilling out and affecting our regional allies, such as israel, and i believe it will, or other allies, such as jordan. we would have to respond accordingly. i outlined in this piece what i believe are assertive and measured steps. not aggressive steps, but assertive ones i think can shape this conflict. >> thank you. i wanted to echo the last comment. my own view, for what it is polls-- i find all these about america's interest in engaging irrelevant, in the sense that if the leadership of

the united states has not explained to the american people whether it is important or not, one certainly should not expect average voters to think it is important. the real poll will be when and if the leadership says it is important. then, we will be able to judge whether people think it is important, but we are not there yet, and we may not be there. that, i think, is the end result of this debate. we still do not really know what the overall strategy is, although we have a reasonable consensus on what to do, even in the absence of a strategy, which is really fascinating. on that note, thank you for joining us today. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]

>> monday night, we will show you what southwest airlines ceo gary kelly has to say about air travel in this country, as he takes questions from an audience at the university of denver. then, we will open our phone lines, and ask what advice you would give the federal government that you think would improve air travel in the u.s.. we recently asked the same question at ronald reagan national airport, just outside washington, d.c., and this is what people had to say. >> i think one of the things they could do is have more tsa agent -- agents at peak travel times. the lines are increasingly longer. i think moreng is, of the security, the prescreen security -- i am a prescreened security traveler, that even those lines are as long as the other lines now.

i think more agents, getting people through faster, make traveling a better proposition. >> what bothers me most is when people get stuck on the tarmac for a long time, due to delays for whatever reason. it would be good to be able to bring those people back in. six hours, eight hours on the tarmac -- it is a little long for people with health issues and small children, things like that. >> the government needs to bite the bullet and get the next generation air traffic control system built, and allow these airplanes to get between places as efficiently as possible, with the most efficient use of fuel and the resources we have to manage airplanes in the air. >> what role do you think the government could play in doing that? how would they go about making that happen? >> the biggest issue is, the government he's pulling the trigger on getting that done.

that is the sequester and all the bureaucracy in the faa. i think the time for delay on this has come and gone, because we are wasting precious time and precious fuel. we are making people spend a lot more time in the air than they really have to, at the end of the day. this would be an improvement for everyone. the government needs to make sure the airlines pay their fair share and step up, because they are going to get huge benefits from fuel savings. it seems fair they should also have to participate more fully in that system. >> and we will get your thoughts on the same question monday night, following remarks from the southwest airlines ceo gary kelly, starting at 8:00 p.m. eastern, here on c-span. entrepreneurs who invent and market mobile medical devices testify before a house small business subcommittee. new yorkman is

representative chris collins. this hearing is an hour and 20 minutes. >> good morning. start over again. good morning. i call the meeting to order. i want to welcome all of our witnesses, and thank you all for being here. i think this will be a fun hearing to showcase entrepreneurship at its best. we are meeting to learn more about american small businesses and how they are changing healthcare through innovations in mobile medical applications, or apps. according to a pew center report, a majority of adults in the united states now own a smart phone. our overall economy is still weak, but the app economy seems to be thriving. some studies have found that mobile devices and their apps are responsible for creating over 500,000 jobs, and global

revenue exceeded $20 billion last year. apps that can help individuals monitor their health are becoming more prevalent and popular. worldwide, an estimated 500 million smart phones will be using a medical map -- medical 70% of top app developers are small businesses. entrepreneurs have pioneered apps for purposes as buried as tracking ms. routines, to reading digital images of a patient. these are groundbreaking medical apps to help empower consumers to make better healthcare decisions, allow patients to access critical health data in real time, and drive physicians to diagnose or monitor patient conditions. they may reduce hospital readmissions and cut the cost of managing chronic diseases. to help get these products to the public, small businesses have to navigate a complex web

of challenges, project financing, marketing, taxes, and regulations. we are eager to learn more about these innovations, as well as the challenges all of you faced each day in bringing your apps to market. the format is a little different. each witness will be allocated the customary five minutes. when they do testify, they are actually going to be demonstrating their apps for us on the two screens. we have screens on either side which will help visually. we appreciate the participation of all our witnesses, and we do look forward to your testimony. i yield to the ranking member for her remarks. >> thank you, mr. chairman. you are right. mobile medical apps are a really exciting area of innovations that have tremendous promise for american small businesses, healthcare providers, and patients across the country.

applications on smart phones, tablets, and web platforms can dramatically improve the practice in medicine. we see inefficiencies, confusion, and disorganization that cost money and lives. these can help put more haitian data in the hands of doctors, so they can make more informed decisions more efficiently, wherever they are. for patients, applications can cut through the fog of overlapping medical instructions and prescription schedules, providing reminders, and helping people to stay on track. this is not just a matter of convenience, and it is not a cool looking new toy. medical errors kill as many as 98,000 people a year, including over 7000 from medication errors. that is more than die every year in car accidents, rest cancer, or aids. bringing all of the medical information together, putting it

literally into the hands of that patient and their doctors, could help avoid these deadly errors. i am particularly excited about what applications can do for the disadvantaged and the elderly population, the most vulnerable with chronic conditions, who have a hard time sorting through all their medications without help. if anyone has ever taken care of someone with a chronic disease, or even recovering from a serious illness, you know how confusing and difficult that can be, and how handy and easy to use application that provides reminders and trucks treatment could be. i want to be sure that these exciting advances in mobile medicine do not leave behind those people that may not be able to afford a smart phone. on top of all those great benefits to these apps, delivering less costly, more efficient care makes our nation healthier. this is a field where small business can really lead the way. i think that is a really

exciting and really american prospect. u.s. small businesses, remaking our world with their innovation and ingenuity. it is estimated the mobile technology industry will grow to be valued at roughly 20 $5 billion, and account for an estimated 500,000 jobs. the development of mobile medical apps has steadily increased, with roughly 27,000 unique apps currently on the market, and about 500 new ones being launched every month. when you say, is there an app for that -- there will be. small businesses are critical to the mobile medical industry. venture capital investments reached more than $900 million. in 2013, it is expected to exceed one million -- $1 billion. the ability to receive such investment is highly dependent

on the regulatory front. that is why it is important for us to understand how they bring their apps to the market, and ensure the process does not hinder their growth, which is why i am glad you are holding this hearing today. we want to be part of a solution to this. thank you, and i yield back. >> if subcommittee members have an opening statement prepared, i will ask that they submit those to the record. i will explain the timing lights to our witnesses. you each have five minutes. the light will start as green. when you have one minute remaining, the light will turn yellow. finally, it will turn red at the end of your five minutes. i would ask you adhere to those time limits if at all possible. portella is the chief executive officer for a company based in texas. he brings groundbreaking technology to market.

this allows users to access clinical patient data anytime, anywhere, expediting decision- making. airstrip was the first app approved by the fda for the app store. welcome. you have five minutes to present your testimony. we look forward to your demonstration. >> it is an honor to be part of this committee at such an exciting time. this is probably the biggest transformation ever. the model is changing from hospital-centric to patient- centric. 160 million americans suffer at least one chronic disease. what we have to do is to be able to figure out a way to manage those patients with the challenges at hand. the challenge today is that we have a shortage of caregivers, and a patient population that

is increasing by millions under the affordable care act. physicians are becoming mobile professionals. the data has to be available to them, data that is clinically relevant, so they can make informed decisions, rather than going to their desktop computers to be able to get that data. mobilityo make sure becomes a key element to support the new model. is patentl device protected, fda cleared. acently, we received certification from the dod for security. these were never viewed as barriers to entry for us. they are what make us unique. they are also what allow us to impact a number of lives. one out of every five a beast born in the u.s. are monitored by doctors, looking at these babies before they are born,

using airstrip solutions. we have documented cases that moms that deliver from high-risk pregnancies -- those babies would not be alive today, were it not for quality diagnostic modeling. have a number of patients with heart disease, and i want to use that were our demonstration. it takes about 90 minutes for a patient with a heart attack, with full blockage, to go from the emergency department into the lab, so they can clear the artery. the reason it takes 90 minutes is that usually cardiologists are on call, not in the emergency department at all times. they are the ones who need to approve the decision. what we do with our product is, now the cardiologists can access that data immediately, when the patient is in the ambulance, not when they come to

the emergency department. they can make a decision before the patient comes in. they can have the care coordination team ready to take care of that patient. we are reducing the time for intervention to more than half, 30 minutes in some cases. there is a firefighter in new york who was able to go back to work after a full blockage after three weeks, and he was on national tv. the reality is that we are producing better heart and muscle as a result of timed intervention, but also better quality of life. also, physicians are able to monitor patients as they go home, also in the intensive care units. you can look at documented data i the nurses, the rates, the pressures, the respiration rates, the laboratory results, medications administered. also, you can look at their own and you can look at the

life patient monitor. this is something that can be done remotely, and it is diagnostic quality. we are taking this to home monitoring for cardiac patients in underserved communities, rural healthcare. you will be able to monitor that remotely. we are taking this to chronic diabetes and others. today, we are not representing large companies, but we are representing hundreds of thousands of patients that are alive because of doctors and nurses that were able to take care of those patients using our products. the partnership with the federal government, for us, is what drove our innovation process. the fda made as relevant. the dod made our patient data secure. together, we improve the quality of care. what we really want to urge as part of this committee is for

the fda to provide guidance on the regulation on diagnostic quality medical device mobility. , there is more security that is attached to this. is encouraginge medical device manufacturers to offer inferior solutions and give those to the customers without the rubber clearance, which is hurting us as a small business, but is also hurting you and i as patients. of being consequence the first one, taking the lead in the industry, is that we are one of the only companies paying the medical device tax introduced as part of the affordable care act, when those companies are not paying for the tax on mobile device applications. thank you for the opportunity. >> thank you, and i am sure we will have questions at the end

of this. the chiefuest is medical officer for a company in grand rapids, michigan. he was the western michigan entrepreneur of the year in 2004, and received his bachelor 's degree computer science from the university of michigan. designed to improve health outcomes and lower costs by motivating patients with chronic conditions to adhere to medication schedules. you have five minutes to present your testimony and demonstrate your app. >> chairman collins, ranking member, and members of the subcommittee, i am the ceo of ideomed. company michigan-based launched by spectrum health, with a national focus on disease. i am also here as a member of a trade association that assists companies in aligning with regulations to build effective

solutions. chronic conditions such as heart failure and diabetes are the untamed front of healthcare, with a trillion dollar impact to our economy. much of this could be affected if individuals manage their health on a daily basis. we engage patients in assisted management through mobile technology and human behavior science. to make the managing of one's health a breeze. this represents a new breed of health application. it does not dispense medical advice. it extends the reach of the clinician and inspires the patient to take control of their own health. his is a winning combination. we sell this platform directly to insurers, such as managed medicaid providers. they deploy it to the subsets of their populations with a most severe chronic conditions. as we will now demonstrate on abreeze engages.

which asee the version hypothetical patient with severe asthma would use. this is a friend on his shoulder that provides alerts at appropriate times, leading alex to quickly record his dose. for instance, he records his dose of advair. if he misses a dose, his mother and case manager received alerts. they received alerts whether they are across town or across the country. alex can also record symptoms and custom triggers that fit his life. for example, his neighbors long- haired cat, which can induce asthma attacks. this allows alex to see how asthma maps to his world. as he successfully completes medication, he is rewarded with digital creatures, called breeze wings -- breezlings.

the child earns these over time. it can also be tailored family rewards, such as a visit to the park. these are based on gamification science. alex is not alone on this journey. on the website, his care team can monitor his daily interactions, as well as establish medication will schedules, set incentives, and view trends. it provides control and confidence regarding his asthma. providesre team, it committed peace of mind. early in the development of the platform, there were skeptics who questioned the potential of mobile engagement. were misgivings about the ability to engage children, and worries that the need for wireless connectivity would be restricting.

our deployments suggest those concerns were unfounded. emergency room visits noticeably declined. we also expanded our aim. byersion has been used congestive heart failure patients for over six months, with a sustained daily engagement rate of over 80%. engagement rates across medicaid asthma initiatives have similar numbers. we continue to expand our portfolio to other conditions, including diabetes, cancer journeys, and more. we started three years ago with spectrum health and a determination to make a difference. we have blossomed from a startup with no office to a booming business with 32 expert team members with diverse skill sets, and a national product line. our initial product was a sleeve device that slid onto one asthma inhaler. it became clear that the mobile technology landscape was rapidly offering alternative approaches.

we found the cost to achieve fda device approval would be prohibitive, so we leveraged the insights we had gained, and the mobile-based app was born. we want to build solutions that are the highest caliber's for our users and safeguard their data. we have been able to turn assumptions upside down, and to empower individuals to steward their health with the connectedness of a broader team. we look to a future of touching lives, and peer a head the still-emerging fda mobile health guidelines. we welcome timely and right- sized governance. these are historic times of change in american healthcare. we are proud to be an engine of transformation to a new era of patient engagement. >> i would like to yield to the ranking member for her introduction of our next witness. >> thank you, mr. chairman. it is my pleasure to introduce

dr. chriss burrell, executive vice president for medical humetrix, a small woman-owned business in delmar, california. humetrix, dr. the founder of 2 startup companies. he is here on the half of the app alliance, meeting the needs of developers as creators, innovators, and entrepreneurs. >> thank you. chairman collins, ranking hahn, thank you for the opportunity to appear before you today. it is an honor and a pleasure. my name is chris burrow. i am at humetrix.

appre a member of the developers alliance and appear today on their behalf. -- and haveded in pioneered medical technology over 15 years, with numerous applications that allow consumers to engage with the world in new and innovative ways. despite significant regress in electronic health record adoption, essential health information is still not readily accessible to patients in the provider-centric system. by enabling patients to access their own health information at the point of care, with an easy to use mobile application, our app is free of many of the challenges encountered by the current system to system health insurance exchange. our technology is based on the federal blue button in michigan.

i have the icon on my lapel. give patients access to their health information, using an easy to identify symbol that could be adopted and used by anyone holding valuable patients and data.the blue button. humetrix recognizes the transformative potential of blue button data and built on the efforts by creating the blue button app for ios devices and android devices. it has easy and reliable access as maintained by both public and private maintainers. for medicare, it transforms the beneficiary of level currently produced by the blue button record into a user-friendly health record that can be accessed on a mobile device and exchanged by patients and providers at the point of care. this comprehensive health record can be viewed directly on a smartphone or tablet. it holds the patient's key health information such as problems, medications, and a

detailed history of all of their healthcare encounters, including inpatient and outpatient visits, labs and procedures. i will demonstrate our technology. on the screen is my ipad. i will launch the blue button app. the first thing i have to do is enter a password. it is a password-protected app. that way if i lose my iphone, no the else can get into it. data is held at high-level encryption on the device. in order to download the medicare record, the only thing a patient has to do is go to my medicare.gov and fill out a brief questionnaire and get a username and password. once they have acquired that, they simply enter in the username and the password here into the app. they say that. now they are ready to download the record.

all they have to do is hit that download record. here's the record. it is laid out beautifully. we have the diagnoses and showing the conditions that the patient has.for any one of those, the patient can do a quick it tells you what the partly latin term may mean. it is not so easy. if you are not conversant in english, it is even harder. you can also see all of the medications. all of the medications that are paid for under part d. that is quite transformative. here they all are. for any medicine, you can do a easy lookup for drug information. that will give you basic information. it comes from the national library of medicine. it tells you how to take the drug and what to watch out for and any side effects. here you can check them.if you see one, you can enter "yes."

basically, you have your whole medical record under your fingertips wherever you want it. when you see your physician, we have a companion note. you could push the record over to the device. we generate a qr code. the physician can scan your smartphone with this code. the record is now shown on the positions device.-- physician's device. all the physician needs is an ipad and our technology. everything the patient has entered will be shown.little exclamation points, saying whether the patient is or isn't taking that medication -- it shows whether the patient is or isn't taking that medication. well, my time is up. i'm delighted to have been here. i want to say thank you to everyone.our one ask is, we are trying to get the word

out. patient education is key. provider education is key.we are working with private and public stakeholders to do just that. thank you very much. >> thank you, dr. burrow. our next witness is a doctoral candidate and systems engineering at the university in buffalo new york. she owns a bachelors degree in materials science and engineering for purdue and a masters degree degree in business administration from the university of buffalo. she and her colleagues are joining her today. second.they received prize in general electric's hospital quest competition for their app. it produces patient and caregiver choice.it adds those to the discharge process. it supports timely communication between the hospital and community care teams. hospital readmission is reduced, saving society money.

welcome. five minutes to present your testimony. >> distinguished members, thank you for an invitation to participate in today's hearing. i'm honored to present a fellow graduate students from the university of buffalo, department of industrial and systems engineering. i want to briefly discuss how our group of young entrepreneurs are translating our individual health care and technology research into a global solution that will make hospital discharge -- discharge more discharge planning is a critical step in acute patient care. inherent complexity of existing processes often result in undesirable outcomes for the patient and the health care system. annually, nearly one in five are readmitted to a hospital within 30 days of their initial discharge.a cost of more than $17 billion. despite recent efforts to make improvements in these areas, readmission rates has been -- in the competition, it provided

-- readmission rates have remained constant. the competition provided the catalyst for our group to develop a better solution for the discharge planning. it will fundamentally redefine the process. solutions like ours can have a significant impact on healthcare they can connect fragmented care processes and improve continuity of care.it will improve cost of care. and the early stages, there is a difficult road ahead. there is difficulty and obtaining funding and support we must product. confront complex technical issues, such as interoperability. this will ensure healthcare providers can choose a solution that benefits the needs of their patients, and not just health technology systems. we seek to reduce readmission rates by facilitating communications among patients and their family and their

informal caregivers and living continuity of care with immunity-based providers. i am going to give -- i will take the next few minutes to get a brief overview of our cap. -- i will give you a brief overview of our app. there are some unique teachers it provides. -- features it provides. this is demonstrated with an example of an eight-year-old patient hospitalized for congestive heart failure. there is an informal caregiver to help with the recovery. the discharge roadmap is designed to facilitate the discharge process, allowing you to begin much earlier. using the applet, john, jane, and the doctor can be assured that everything is adequately considered in the process. bringing together a plan is a difficult undertaking. using a systematic roach and using the tools in the app -- using a systematic approach and using the tools in the app, it

can be categorized into three main functionalities. education, assessment, and referral. john would experience the educational component. he could review several short modules explaining his diagnosis. the same material is available to jane so she can learn the best ways to assist her father in improving his care. as john completes progress in this area, the results of his short quiz provides -- provided for him and his doctor. after learning about the diagnosis, john and jane can both assess what his abilities are to manage his care post hospitalization.

john stopped her will also look at their own assignment and will give a prioritized summary of the results of the assessment. it will allow them to have areas where there is inconsistency and answers. -- in answers. once they determine the needs, such as home care, there is evidence of results of what would happen if you follow through with those suggestions. john and jane can also review local service providers and indicate their preferences as to who they would prefer the peripherals. -- preferences. it isn't important to know what her schedule and constraints are it is important to know what her schedule and constraints are. finally, a referral feature shows continued he of care --

continuity of care. combined, we believe education, assessment, and referral components are redefining the discharge process. we are honored to have shared them with you today. thank you. >> thank you one and all. as we move forward with technology, i think we will be relying more and more on entrepreneurs to come up with solutions for a variety of reasons and in some cases to make money and in other cases to pursue your continued education. in each of your cases, you have given us a great look at the merits of entrepreneurs and

technology and where we might go and where we are going. all of the snow health care costs are the number one concern. can individuals afford it? they are facing those issues now as we move forward into a new world. anything that we can do to reduce the overall costs, i think the solution is starting to take control of their own lives. the old model was if you had insurance, you went to the doctor. you did not know exactly what it cost and seven else pay for it and you went home. today it is a very different model. i think what you are showing us is the next stage of the patient taking control. we have got an aging population. the baby boomers of which i am one, many of us retiring each day and the store you are sharing of an 80-year-old man with his daughter helping out -- i want to know where their son was.

[laughter] it is always the daughter. that is the world we live in. parents are living longer because of advances, but in many cases there is some kind of chronic medication. we are always worried about readmissions to hospital. my first question -- we do not have all of the regulations out but what you have done -- why don't we start with mr. burrow. you mentioned if you lose your cell phone, someone will not be able to get into your information. i know we are all concerned about privacy and who has access to our medical information. maybe you can explain what you are doing. >> thank you. it is a very important question. the way we have designed these apps is that you as the patient should be able to access your own records.

you acquire the credentials to do so from the data holder. for example, medicare. you would go to the medicare website and comply with the requirements of that data holder. once you have done that, as you do in banking and in other aspects, you acquire a username and password. it is secured and encrypted. the download takes place in a secure fashion. the record once it is on your phone, it is encrypted and stored there. if you lose your phone, the only data that could be acquired maliciously would be a file of encrypted 1's and 0's. it is virtually impossible to break. your data is secure. losing a phone would not be a problem. no one would have the password to get in. >> thank you.

>> well, as i mentioned before, we have received the certification for security. it is our position as were going through the process that we clearly recognize the risk for cyber attacks out there that are beyond what private citizens would have seen. basically the way the dod handles the security with the certification is that they have a number of engineers looking for hackers on a regular asis. every time they find them -- on a regular basis. what we need to do as vendors is immediately identified how we are going to mitigate those vulnerabilities. in some cases they are category ones. every month there are new vulnerabilities that could brink break into the patient data.

at some point we get closer to a medical device and eventually managing those devices. if you are vulnerable to hackers, the fcc standard primarily direct the security to the application level, but they do not did on the operating system level so much. the dod requirement prevents hackers from coming. what i recommend is that we look at what the dod is doing and

bring in some of that certification process into the air. >> thank you. -- into the private sector. >> thank you. i'm assuming that would apply not just to kids, but how does your app manage privacy? >> the privacy and protection is something we take very seriously. we have an approach that is similar to those with the encryption at the technology level. also above and beyond that, the people process it is an the application and is an important element. the data is self-reported data. the marital -- it can monitor their data. they would have to consent to sharing the data in that fashion. it would need the people's approval and the technology protection. >> thank you.

how does your app handle the privacy issues? we are still the development process. >> we have no official solution yet, but it is definitely a concern from the start of perspective. there are standards we need to ascertain to and navigate that standard system and how to determine the proper solution. it is certainly one of those barriers that we need to overcome and understand better. >> i welcome any other questions. at this point, i will yield to discussion. >> thank you, mr. chairman. you touched on interoperability. i was listening to everyone's presentations. it was all extremely interesting and exciting. it is where we need to be in terms of quality healthcare.

obviously the doctor who has been treating the patient for a kidney problem would have to be able to talk to the cardiologist who is treating the heart problem and -- to all the witnesses, is this a problem, interoperability? what do it need do in congress to help with the interoperability of all of these applications in healthcare? >> so, what we view on this is that interoperability is key. we would need to talk with everybody. there are several different types of standards. no unified or agreed-upon standard of how these different technologies can communicate with each other. we see the communication as enabling.

if we can do that, we can eliminate the need for redundant testing. really what we are looking for is as to what is the best approach. doing it a different solution for each software or could there be a unified agreement that we could communicate via one method? >> thank you. >> i do have about 20 years experience in this area of interoperability. it is a huge problem. we are not lacking the standards. the standards need to be enforced. we need to protect the data and preserve some of the advantages that they have. i'm talking primarily about the large vendors. yet to look at front and and backend. the back and will take 10 years

backend will take 10 years. we're dealing dealing with at the suit of care all the time and trying to capture the data. there is a very small subset of the data. the real data you'd have to get from interfacing to each of those vendors and there are different ways of doing it. all of us are trying to comply with that. we are in a new world.

>> i would agree with him in regards to the standards that are out there. the mobile application vendors can be integrated if the other side -- it is a flexible lilting a building block. there are multiple players and systems that could ensure the data that they build a flexible piece.

>> thank you for the question. our national strategy is built on three different approaches. there's a system and system exchange. we have heard a little bit about that. there is this other idea, the idea that everyone has access to a medical record that they can carry, if you will, on their mobile device. that will help solve the interoperability problem that is out there. we have come together on the private and government side for standards that we believe will be important going forward to mediate the patient model.

you can get the data easily. every citizen should have the ability to get their data. >> thank you. i think that is something we should look at some more. interoperability is key. i look that in many areas. i have more, but i will save it for the next round. >> we would like to recognize the gentleman from missouri for five minutes. >> thank you. i guess this means i should put my phone away. thank you for being here today.

last week i was disappointed and frustrated by the lack of information of the testimony of the witnesses. i admire what you are doing. i hope that you keep it up. it will make this a better world. very quickly, what regulations are in ways that you have to deal with everyday in regards to barriers that are put in front of you that you you have to overcome that we can have an impact on? what do you see as some problems? >> again, i think i am one of those where the vendors really adhere to the proposed

regulation. when it comes to saving lives, when it comes to moving into moving outside the four walls of the hospital, we want more innovation and quality and security. the reality is we deal with it on a day-to-day basis. we submit new products and enhancements to the existing ones. we feel that process is improving significantly. we want to make sure that right now we are actively complying with the requirements that are not out there yet. we would like the fda to recognize what we're trying to to do as a leader in the industry. we want to be able to go across the board and really regulate so everyone has to comply. >> you guys are on the cutting-

edge. >> we understand the regulations such as hip and the protection of privacy. -- key regulations such as hippa and the protection of privacy. we look forward to those government since and the clarity. we have anticipated and speculated what it might be. we have tried to be proactive and build a solution that would align well with the fda guidelines. we welcome those guidelines. >> dr. burrow.

>> i think the ones that would affect us the most is hippa. the encryption with the one time key where you push the record to the. oh -- to the doctor, the metrics has no way of touching your data. you download the data and you own it. metrics are not part of it. we do not store it. that is the one we are thinking most about. we support the approach will be fox a bowl and will ensure patient safety. right now, i'm not a regulatory expert. i do not have anything additional to add to the comments. >> from the very early stages,

certainly navigating that regulatory system and understanding what your options are and how you need to comply, that is really the point we are at. we need the right levels of security to comply with the regulations. >> very good. 30 seconds. measure the success of what you do. that will be important. is there a measure meant that you have able to establish? -- is there a measurement that you have been able to establish? >> yes. sorry. definitely in today's economy, no vendor can bring their systems to the market without a clear line of clinical and

financial. we evaluate the value at every step of the where else the customers would go away. if we took the cardiac patient that i explained before, you reduce when they come in and they do not need to activate it. you save it $7,500 and you reduce the length of stay in the icu icu because better quality in your heart muscles mean less time. and then, also, that is about .85 day stay reduction. the readmissions for cardiac patients under the affordable care act, two of the three conditions that will be penalized are cardiac conditions

and we are seeing a decrease of 25% on cardiac admissions which is a problem. you can continue down each service line. of stud tricks, patient monitoring, what is the benefit we bring to the table? >> my time is up. i ask the indulgence of the chair to continue. >> no problem, we would like to hear the continuation of the witness. >> is interesting to hear that you have the cost-benefit analysis brought to the table to fully develop it. is that what you have experienced? >> it is. as a shared in the testimony, we faced skepticism about the power of mobile apps to engaged, so we laid out a very careful journey to build more and more proof points. we started with health outcome measures in light of the most significant, the reduction in emergency room visits.

all outcomes have been positive. we are collecting cost data working with multiple insurance companies to have hard cost data to map to the outcome. likewise, we continue to scale and scope and size of our clinical trial so they will will have more and more relevance. we look at improved health and cost backed by black-and-white aided. >> for instance, can you give me some data that showed how many lives it would save, the amount of money saved by lessening the amount of time in the hospital in recuperative care? >> we have hard data on the reduction of emergency room visits for a select measured population. >> give me one. >> we had a study of medicaid asthma patients, 26 individuals

that had 12 collective er visits prior to the six months in the study. during the six months, it was reduced to zero. >> really? >> we can project it. it's a staggering cost savings in the world of clinicians and insurers, there is a high bar of diligence for proving such claims, but the early health outcomes would suggest that the cost savings would be very significant. >> we are early on and we have not collected data to directly answer your question, however, many studies have shown that having a complete comprehensive list of medications prescribed is crucial in preventing the adverse drug reactions cited by the ranking member, namely as many as 7000 of them desperate year are from adverse drug reactions.

we are intrigued going beyond that obvious point to collect data, but we have not yet done so. >> we appreciate your testimony. i guess you are still in the development stages? and you have some data to anticipate savings? >> more anecdotal evidence at this point. we anticipate a reduction in readmission rates so there will be cost savings from that, but we have been looking more at the intangible cost at this point, the benefits of better having the understanding of the care process by both patients and their caregiver. by having a better understanding, there will be intangible cost to the health care system and a more longer- term perspective. >> i appreciate the chairs indulgence, that was very informative. >> i just have a general

question as we go through this. three out of the four of you are in business and we talked about roi. it's intriguing as entrepreneurs come forward ultimately to say how you make money on what it is you're doing. i thought it was an interesting comment made that as he is developing, here's already subject to the medical device tax of obamacare because it is not based on profits but revenue. i'm just curious because i'm already hearing one of you is focused on selling to an insurance company. some of you may be focused on consumers. there may be different ways to get to market. part of an entrepreneurs job is, after you have invented this great app, how do you get it out there and get customers? i would be interested to hear

your different financial models to the extent you would like to share. >> if we look at what has happened over the last few years, we have significant growth in the last three years, but definitely, we are starting to see a significant impact from the beginning of the affordable care act. definitely, i think the model could eventually work because you are reducing the reimbursement and putting more money on the uninsured patients that eventually will come back in the system and increase admissions to the system. starting in april, sequestration created a huge problem. in new york at north shore medical center, these cancer patients are rejecting 16,000 of them because they cannot afford to keep those patients in the

system. we are starting to see through all healthcare organizations, the effect that they are starting to look on their operating expenses. they are looking more at how to manage the affordable care act as a caveman, but was really for sequestration. what happens is we are partners to those healthcare organizations and we are here to make an impact to the quality of care. we always look at the model of service and we partner with them and look at risk. what we're doing doing now is evaluating our prices and make sure that we clearly measure the benefit that we bring to them so that at no point they are losing money. that is our approach. >> we do sell to insurance companies. specifically, we sell population licenses. we provide licenses to cover a broad swath of their population

and they focus on the subset with the most severe conditions and we work together to roll it out to those populations. the savings that they realize is that er visits are reduced in they go directly to the insurance company's bottom line. we are a return on investment proposition. it reduces costs significantly. we do sell to health systems, accountable care organizations, also to hospital systems that may be focusing on reducing medicare readmissions or aligning with meaningful use guidelines. we have a number of potential sales candidates within the health ecosystem, but insurance companies realize the most direct cost benefit from the

purchase. >> thank you. >> hours are currently available in the itunes store and play store. individuals can use our apps. it is free to download. we have a nominal charge when the user to download and process the medicare record, which is a few dollars for five records or a few dollars more for 25. we give a credit every time a patient pushes that record to a doctor ran the shares it. they get credited back. if they use it frequently to share, the cost is really nominal. we believe that medicare and cms should consider policies to allow reimbursements for this type of technology. we would of course be happy to talk with cms. we think having every medicare

beneficiary have access to past procedures, lists, all their doctors is a self-evident good, so we would be happy to discuss that with them further. >> what is it called? >> my blue blood and -- my blue button. thanks for asking. >> thank you for getting the word out. quick i know you are still in the development, but have you thought the financial piece yet? >> it is one of the big questions we are tackling at the moment. our goal is to have the most people be able to use the app, there are several options to best position our product to be able to do that. i think the panel here for giving us some interesting insight into their models and how they are working though. >> we're joined by mr. kaufman from colorado.

we certainly welcome any questions you may have for this very dynamic and appropriate panel in this technological age. >> thank you all for testifying before congress today. i just had a veterans committee hearing scheduled at the very same time, so i left utterly to come over here in the interest of what you are doing. i wonder if all of you can just say what the and state is. in terms of questions we all have surrounding healthcare, quality, access, cost. and how what you do influences those three critical areas that are so important to the american people. >> of course, you are mentioning quality, access, and cost. i think in our testimony, we are addressing those three areas.

we are a big proponent of the fda regulating medical device mobility. as we are moving, as i said before, to a patient-centric model, we have fewer physicians taking care of my patients today. it is very important that the data that they get is diagnostic quality and then they get it in a real-time basis. the real-time basis is also very important. that is how it relates to quality. i think the area of costs, also, is very important. as i mentioned before, we are partnering with a number of healthcare organizations like dignity, ardent,, to really help us figuring out what the model should be moving forward.

we talked about sequestration affecting many of the healthcare organizations. as far as cost, we are putting models in place with them. in some cases, we are going on a risksharing basis to be able to work with them. as far as access, we talked about the challenge. the fact that there are a number of standards for healthcare information exchange, standards that are not enforced by the government and the vendors are not complying. even though their standards, like we mentioned before there are certain areas of h 7 where there are varieties in that language and then all of the vendors decide to put 99% of their day-to-day around and one percent following the standard. the federal government really needs to take a hard look into this and force all of us to collaborate. we are not realizing that as we

move into an outcomes-based reverse mint model, no longer fee-for-service, as we have the issue with a shortage of healers and patients increasing, we're not going to be able able to sustain this model without innovation and without vendors collaborating. we are all going to be responsible for the system collapsing if we do not act. >> our model is built with the desire to make a difference in quality, access, and cost, so i appreciate the question. the insurance company today of a fixed-price provider, essentially, manages the population including severe chronic medicines and often does it or case managers.

they reach out occasionally through telephone calls to try to connect with those patients. we work directly with his case managers across the nation and they are incredible individuals. they care and they can make a difference if they can just connect with, for example, the severe asthmatic. through the noble occasion, we give that case manager the opportunity to be present every day of the life, a connected way that is right there in the child's life that goes back to the case manager website i can provide incentives, motivation, insight. we increased the scale and the reach of the case manager and in turn provides access to the solution deployed from urban detroit to rural kentucky for patients who would otherwise not have access to a daily stewardship of their condition. we have targeted insurance companies because our belief is that if we lower the cost for insurers, it plays a significant role in lowering the cost of our

nation's health care and lowering the cost of everyone's access. >> unanimous consent for one more minute? >> absolutely. this is very interesting. >> thank you for the question, congressman kaufman. given that you are just at the va committee, i should mention, our app gives every veteran the opportunity to download their record. how are we trying to help? veterans often gets care both at the va and in the private community. by giving the veteran the ability to download their record which is output from the stove when they see a physician in the community, they can now see the record that our app is delivering, either on the patient's own smartphone, or it allows them to transfer the record with an optical code to

the physicians computer. this is a key problem for the va. faxes are from the mode of communication. by offering this, this is an important way to affect quality of care and cost for the veterans administration. we are on the va website as a partner. veterans can go there and link to download an application. >> as industrial engineers, these are concepts very near and dear to us. what we set out to do was really to reduce the costs of redundancy or a revert to care. we wanted to improve the quality perception and the understanding of what the care process is and not only what the steps are but why you should be doing them. what we hope to do through the assessment portion of obama's understand not only only what the level of comprehension is the one or the other constraints that are in this individuals situation that could prevent

them from enacting this level of care prescribed. if there are conditions where they are working adults, but there are clearly scheduling conflicts that need to be considered. if we can take us all into account in the beginning, we can hopefully create a more attainable care plan preventing all of these adverse events and effect coming up once the plans are not working out as they were intended. >> thank you, mr. chairman. >> do you have follow-up questions? >> i do. i was just thinking when you recall -- talking about cardiac patients, i was thinking about my own father who was a county supervisor in the 1960's in los angeles.

his heart doctor came to him one day and said, how would you like to save one life at a? i fathers like, great. marty registered to vote. how does it work? >> we have discovered that if we can get to them in the first hour, we have a chance of saving their lives. his idea was to train firefighters to be allowed to inject the drugs where they were instead of waiting until transported to the hospital. my dad thought it was a great idea. at that point, it took legislation because, obviously, a nonmedical person was not allowed to administer these drugs. it was passed by the california

state assembly and legislature and our governor at the time was ronald reagan. he was going to veto the legislation because at that point, the ama was against it. nurses were against it. you are taking something in their jurisdiction and giving it to these firemen. let me talk to governor reagan before you veto. so he flew up to sacramento and wanted to give one last opportunity to understand what it's about. let me ask you one question. with these mobile paramedic devices, would they be allowed to cross jurisdictional lines? or would they just be assigned to certain cities? the point is they are ready base hospital.

whoever closest is dispatched to the heart attack victim. ronald reagan said, i'm going to sign this. my dad said, what changed your >> his own father in beverly your mind? >> his own father in beverly hills had a heart attack and his mom called an ambulance in the 1960's. it came from los angeles and it stopped at the beverly hills property line and turned around and went back without relaying the information to anyone else and his own father died in beverly hills. sitting here today, this is great political satisfaction for someone like me, whose new around here, to think 45 years later, something that my dad championed, the paramedic program, and here we are 45

years later. of course, that was government. very exciting to hear small business people talk about it, and i think we are on the verge of something automatic and life- changing, life-saving, as one my dad championed which became czar paramedic program. -- which became our paramedic program. the latest pew center research said 56% of u.s. adults own a smartphone. but that still leaves a lot of people in this country, 45 million people, who will not be able to access your applications because they do not have a smartphone. my district that i represent is a poor minority district and a lot of those people cannot afford a smartphone.

how do we embrace this, help you to succeed? try to support you? how do we not leave behind 45 million americans who, by the way, are probably the ones who have the medical conditions that would exactly need this kind of help with their healthcare in general, to save money and be more efficient. how did we not leave them behind? >> a lot of important points that you made. but i would like to address first is, of course, what a vision he had. what we need to look at is, many times we learn a lot from what happens on the military side. we worry, of course, what we're going to do in rural communities, but many things we're doing today comes from the

military. we look from the model and the theater of operations prior to coming to us from the military health system. i deploy systems in every military base throughout the world. if you look at the theater of operations, the battlefield, that is were a model like this would have a significant impact. you have a medic who is not a physician but they need to be able to take action right there. if you can really provide the access of the doctor can make a position. if they have to perform a procedure, now they're going to be able to have those doctors working with those medics to be able to save those soldiers. that scenario we we can start immediately. we have the right regulations and then really bring those models into the air, supporting

underserved communities. now, the issue about people opposing an idea like that, because they did not want firefighters to make that decision, we go back to what we were saying the battlefield. you can have someone remotely helping an emergency where something like that has to happen. as far as this group helping us, how we could have more adoption on cellular phones and smartphones, we are the silent partner of the patient. i am more about the physicians being able to get access to the data for all of the patients anywhere anytime. anything that can support caregivers to be able to do care coordination through mobile technology, i think that is the area where we need the most healthy and reimbursement from medicare and medicaid is very important. >> thanks for the question.

it's true not everyone has a smartphone, although that is changing rapidly. in communities that have this advantage individuals where economics may not be there, we have been amazed at how many people, particularly of the younger generation, do in fact have a smartphone. more people use smartphones to access the internet venues apc. this is extraordinary. we have gone through an amazing inflection point. individuals who accompany their mother to the hospital with a smartphone with records on a smartphone, this is an extraordinary thing for individuals who may not be able to answer those questions. who are your doctors? what are your medicines? and even individuals who do not speak english, they have the record right there to show to the doctor and this is really,

really something. we think that this kind of technology is very important for the communities you're referencing. >> we have seen the proliferation of mobile technologies that is exploding even as it has already reached the inflection point and it continues to go up and up. a solution like ours can run on a smartphone but also on a tablet, anywhere that there is wireless where we have supported the application. often, the insurance company will provide the device to the population, whether it is to children with severe asthma, senior citizens with heart conditions. the expected cost savings are so significant, the cost of device paling in comparison. we also designed a solution so doesn't require pervasive internet. it only requires occasional. we have scenarios were users who do not have access to everyday internet go to a library, a

school setting, a local restaurant and upload the data. there is a variety of approaches we have used. in terms of what could help, looking to the future, i would underscore that bandwidth is beautiful indignation with great band is a strong nation today. -- a beautiful nation with great bandwidth is a strong nation today. >> there are still a lot of people who do not have smartphones. even when you look at the aarp, i'm a member -- i'm not embarrassed. they advertise for the jitterbug. our senior population is not embracing. the young people are, clearly, but the seniors and those who are disadvantaged are really considering it a luxury they

cannot afford. i hope we can figure out a way to not mean that many americans behind as we embrace the technology. thank you, mr. chairman. i yield back. >> i want to thank all of our witnesses for their participation today. what we are seeing is entrepreneurship at its best. we do rely on small businesses. 60% of employees today, 80% of new jobs created in america is the entrepreneurship we see here and it is alive and well. bringing solutions to problems people did not know they had, but as you demonstrated today, the solutions are somewhat common sense, but their only common sense after you discover them. as you present them, parents are

saying, of course, i would like to be able to monitor my child's behavior whether they are diabetic, have asthma, comfort of mine, or all of us with aging parents, we want to be able to know what they are doing. they go to different pharmacies, different doctors. we all worry about that. when you have done today has helped describe where this is going. anytime you are on the cutting edge, which we are are today, there will be bumps in the road, but i think your testimony was good. it was very informative to all of us. thank you for your time. i would like to ask unanimous consent that members have five legislative days to submit same it's -- statements and supporting materials for the record. the hearing is now adjourned. [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute]

>> the former hewlett-packard ceo will speak monday at the national press club here in washington. she is chairman of the group called good 360. they help companies donate items to charity. -- join us live for her remarks at 1:00 p.m. eastern here on c-span. the supreme court ended its current term last week. at this week, we'll bring you

supreme court oral arguments of be closely-watched cases from it. tomorrow, the oral argument in holder, dealing with the voting rights act. listen to it in its entirety here at 10:00 p.m. on c-span. it is criminal to me i had to authorize my budget people, my financial people, to write a $450 million to expand our contract with the russians to continue to carry our cruise to the international space station for 2016 and 2017 because we have not yet brought about the american capability of our program. we are not halfway to where the president has asked us to be. is to try to persuade the congress that the plan is good and that we will be efficient

users of the taxpayers money. i have not been successful in that but i am working on it. as i have killed every member of congress with whom i have talked, $821 million in the budget is vital if we are to make the 2017 date. what newt gingrich said is true, so that americans are transported on american spacecraft. 8:00 on c-night at span's una. a.q and nsa datan the collection program. a newhaffer interviews york times journalist who broke news regarding the program through leaks from edward snowden. from the international studies, this is one hour.

here is bob schieffer. >> to i very much. thank you for coming. i had a feeling we would have a big turnout for this one. we try to stay on the news and we are very much on today. mark has had his name in the paper a lot lately. he is the winner of 230 .ulitzers he wrote a book about vice president cheney. as one of theosen books of the year, works for the washington post, time magazine. he had the first story about edward snowden. old friend david sanger. he were to the times for 30 years. he is probably -- he has probably worked at one place longer than anybody on this

panel but me, which is really good. he has to go books but the obama administration. the most recent is confront and conceal. you had some information in that book that had not been known before your book came out. you have some experience in that kind of thing. and of course, the acknowledged expert on cyber war and cybersecurity. he has been in and out of government for most of his career and has a phd from the university of chicago. a very long resume for all of these gentlemen, but we will stop to their. you and tot to ask start off the threshold question. why did the washington post think it should publish this? >> i will speak for myself. i think it does represent the

post view on this. why wouldn't we? which theituation in congress passed a law which everybody gets to read that said very little that determines are quite opaque and the executive makes a secret, highly classified interpretation of what that's a law says. then it makes a program and goes to court. the court works only in highly classified ways and with no other parties present. the court makes a secret rolling . all that this is drawing a boundary around, where should the limited be between intelligence gathering and privacy and civil liberties? that is a conversation we have not had an opportunity to debate and the general public.

on sort of foundational questions like that of power, you're talking about the mutual transparency of citizens and the government that is supposed to serve them. i think there were lots of things in this material that and theo be researched confirmation of that comes from the fact there has been an extended >> did you have any concerns that national security would be damaged? >> yes, i did. there have been quite a few times when i saw a really hard balance to be struck and when i have had conversations with government about their concerns. i will tell you how i started the first conversation. and i said i will not hand you this document i have, but here is the date, the title, and author and i know you can find

it. and before we start talking i want you to know everything from slides 21-27, we're not even thinking about. >> is this the way he presented it to the post? >> when i came to the post i have a similar conversation. i said you are going to make your own decisions. i worked there for 21 years. i came back to them on contract with the story. i said you will make your own decisions about what you are willing to publish, and this is a part i would not myself be willing to purchase -- published. >> is this different in any way from when you did your book, because you talk about and we learned about some of the cyber war ability the united states

has. did you go to the same process? >> very similar process. there were a couple of differences. ultimately a similar thing. the way they handled this was extremely responsible. in the stories we published in the times and olympic games, codename for a cyber offensive against iran. the overall journalistic impetus was very similar to what you just heard. that in both cases of where the u.s. government draws the line between personal privacy and doing the kind of surveillance

leading to defense and where the government draws the line on the use of offensive weapon, it is all done in secret. in many cases you have to ask the question, how much of this needs to be secret because it is keeping operational detail secrets, which i thing we all understand we need to do that, and how much of this are fundamental issues that need to get debated by the u.s. public and perhaps by a broader public? i think the responsible way to do it is exactly as bart handled it, which is to go to the government and say this is what i have, the key elements will get published, the questions are if there are security concerns that would endanger someone. we're willing to sit down and hear that and make the case. i took some things right off the table that i knew i could not

even get into a conversation with, and in other cases there were responsible people in the u.s. government who made the case. i found that usually once you get involved in the conversation, you can narrow the subject matter pretty quickly if you are dealing with relatively reasonable people. they are not simply going to say well, we're not going to discuss it. that raises a more fundamental question, which is the who elected us question? why is it the press gets to go do this? that comes to an understanding that i think many people in the united states have about what the role of media is, and it is disputed by others. i do not think there are any absolutes here.

the fact of the matter is almost everything in the realm you write about when you are writing about national security is classified in some form. i do not think you can write about iran's nuclear weapons program or dealings with china without running into something that is classified somewhere. i have documents. i have a story that was assembled over the course of a year and a half. in bart's case he has specific documents. >> you have seen these cases before inside and outside the what do you think of this story? >> one of the things i am wondering, i just went through my five-year review and i thought why did i bother because

it will be in the times? there is no doubt that people in the community are a little depressed. but we will rebuild. in this case i agree, i think more transparency would be a good thing. if they had given some more more information on the program to begin with, it would have been easier to manage the public reaction. at the same time i am all for more transparency. i hope the debate does not lead us into a silly compromise where we set up a new advisory board or put in additional constraints. i think that would be a mistake. >> let me ask you. some of the claims that snowden has made, that he could listen in on any phone call, even the president if he had the number, i have had people on the record and off the record saying he vastly overstated his ability.

do you think he did? >> i love those shows where it immediately it pops up. come on, folks. technically it is possible to target someone and get their phone calls, but there are many legal constraints. you really have to work with the legal constraints to know how difficult it is. there is operational difficulties, legal issues. it is not like the movies. i think he was overselling. he had a product. he was in hong kong like he was dangling. i think he was overselling.

>> i am not a lawyer or advocate and i'm printing only what is true and can verify. i would not be so sure he is wrong about this. what he is right about for sure is the legal constraints are either lines of code or policy. les and regulations and supervisory change, which given the whole thing is a secret, can be changed that any time. his principal point is that there has been built up, without our knowledge, are remarkably powerful surveillance apparatus that did go through every american household. and that the main constraint on it now is what the code says or what the policies are, which can be changed. and we know is that when government accumulates power over time, they find one more reason why you might want to use this.

over time you tend to have a 1- way valve in which there is more use made of powerful tools for reasons that are stated in good faith. i honestly believe that change the boundaries. >> how could it be that someone can go to work in a situation like this, work there are only-- work there only three months and somehow get away -- we know he got away with some stuff. that does not seem right to me. it seems to me that is not a good situation. how can that be? >> i really want to defend the guys at the fort, but it sounds like there was a little glitch. [laughter] just to move a little bit aside, if you're looking at simple things you can do to make your networks more secure is restrict

administrator privileges. an administrator can do pretty much whatever they want. he was an administrator. >> is this basically that he is the i.t. guy? is that basically what his job was? >> someone i know described him as the help desk. >> there is a lot of stuff trivializing him or his credentials. he worked at the hawaii large sub-branch of the threat operation center run by the nsa. he was the administrator of a very substantial portion of that system, and in charge of defending it. he was there to watch out for

incoming cyber attacks on the system, and he also administered a lot of the rules, regulations and firewalls that prevented inside people and out from getting places they were not supposed to. >> is there any suggestion, and i know this is your source, but is there any suggestion that he took the job for the sole reason he had his mind made up that the thing needed to be exposed and got in there and got this job so he could do that? >> he spent a lot more years working in the intelligence community. he never told me he took the job in order to carry out his plan, but it is looking more and more like that based on the external evidence. >> what do we make of the fact that once he does this and he goes to russia and all of tha?

this is not your standard of whistle-blower. >> there are a lot of people that argue he is not a whistle- blower at all. whether or not he is probably comes down to the first question you asked, what kind of person he is and so forth. i think this has come in with interesting context at a moment when there is a new president in china. the return of our previous president in russia. both who had just met president obama within the past week and a half. both of whom showed a particular willingness to stand up and say, this is not my problem, and

perhaps enjoy how much angst this was causing the united states. in the case of the chinese, i think they just wanted the problem of their plates. the prospect of a year or two year or however long the extradition process took, i think they believed would be a fairly lengthy process that would erode the relationship at a time when the president has other problems with the united states that he wants to deal with. i think they decided they would take a day or two of heat for letting him come to hong kong, but then it was someone else's problem. that someone else turned out to be vladimir putin. >> do you think it might have been that they had already gotten everything they needed from him? we read all of these stories -- is it possible they could have

drained the computers he had without him even knowing it? >> i do know a little bit about it. he was not at the center of it. did they -- did he have access to good data? yes. did this come as a surprise to the chinese or russians? nope. i think when he got there this attracted a lot of public interest and started a big debate but was not a surprise to foreign intelligence services. >> he has said and given a good reason to believe that he is in possession of materials that could do extraordinary damage to collections by exposing things that foreign targets do not know in practice. he is not interested in talking all that out in public record. he is interesting in fostering the debate. there is speculation about

whether the chinese drained his laptop or whether the russians are doing so now. i would make a fairly substantial bet against. i know more about the precautions he took in anticipating that issue. >> do you all think he has done any harm to the national security? >> it is a very hard thing to judge from the outside. you will always get insiders saying any revelation of any of these types of programs or techniques does harm. then you hear the point that jim did, which is most of this was probably not a surprise for the russians or chinese.

in the case that i wrote about, since the virus had gone out in 2010 and the iranians already have the code and knew someone had been attacking their systems and did not think it was the swiss. then the question is, are these programs classified because you are keeping adversaries from knowing about it? that is a very important question to go answer. when i looked over the documents published in the guardian published, for some of them the first question that came to my mind was, why was the document classified at all? let me give you an example. one of the most interesting that got published was one we have written about but not seen, called presidential decision directive no. 20. it was basically the decision

directive that lays out the conditions under which the united states would make use of defensive cyber or offensive cyber. and each paragraph is confidential, secret. the entire document was listed as classified. i read through this and i am almost certain that when the document was signed there were declassified briefings for us. i went back over my notes. there were some interesting, smaller things in the documents but most of the things we have been briefed on. i went back to the white house and said, can someone give me the justification for why this

document was classified? the answer i got back was in short was because it was interested -- the interest of the united states to classify it. so many of these do raise a fundamental question, which is, would the government find itself in less of a difficult position today if it had said to the world yes, we have a central repository in which all phone call data is poured into and we hold on to it for five years? any terrorist went to the movies thinks we can go back and trace a call in 20 seconds. no one really wants to engage in that debate inside the u.s. government or do not want to engage in a publicly with all of us. >> can i ask something? it should not open and close the

conversation whether something would improve the debate and whether something might be damaging or actually could do some damage to the national security as one could reasonably plan it. john f. kennedy's great speech was not that we are willing to pay no price. there are trade-offs. the constitution begins with fundamental guiding principles about what we're here for. one of them is secure the common defense. there are other issues here and balances to be had. sometimes they're easy, sometimes they're hard. i do not dismiss the security risk that are involved in having this debate. even when a country or terrorist organization has good reason to think, you can compare it to the

elevator cameras we all know are there every day but we do not all behave all the time as though we would like to have our photograph. you forget about it. you stop worrying about it. by calling attention, there is a chance your dissuading people from going there. it is very clear in the description of the program, which gets information from nine of the largest silicon valley communications providers, it is explicit in the documents and in the markings, the most highly- classified portions of the document was the listing of the nine companies -- microsoft, google -- that is the number-one secret in there. when i've had conversations about government officials about what we were going to print and

what we were not, i said, if the harm you envision consists of private companies taking a reputation or market loss because the american people do not like what they're doing, that is why we're going to publish it. that is a very high stake that would make you want to publish the information. >> what can we do, jim? you have a better fix on this than probably any of us here. i remember when i was talking to you before the presidential debate, and you told me some of the things we can do. it is amazing. there are differences in the capability and using the capability, which is one of the questions that comes up here. tell us about what kind of capabilities we have here. >> that is a tough one. it is fair to say after

september 11 there was a great effort to integrate intelligence and expand collection ability. one thing that was most useful was, you captured a cellphone in afghanistan. you look at the cellphone and there are numbers. interesting that one of them was in the west. who was that person in the u.s. talking to? at that point you're trying to stop. you need to know this. to do that you will have to get what is essentially like your phone bill. that is what they're collecting. so a lot of it is the ability to collect and combine things captured on the battlefield. that is where the edge comes from now. this is not new. there was the echelon debate in

1990's where the european suddenly became excited because they thought there was a global system to collect traffic. they did a big investigation on the european commission. they concluded it is really not so bad as we think. i think that is where we will end up here. there are trade-offs that we need to debate. more transparency would be useful, but we need the collection capability. >> i told him we were going to fight all night. >> there is a legitimate problem you're identified. you had an intelligence legal framework in which you could spy on the guys overseas, and you could get warrants to spy on known bad guys, but when you got to the scene, which is what you

care a lot about, you had barriers in order to get through. but what you've just described is not really what the programs we're learning about now are doing. if you pick up pocket litter in afghanistan and it has a 35 phone numbers and 17 e-mail addresses, that is where you can go out and get individual warrants by going to the court and saying this was in so and so's pocket. you can do that. you have to show only that the information you want is relevant to an authorized national security investigation. that is a very low bar every time. what they're using these programs for is what people convention recalled data mining. they are looking for unknown

suspects. by finding hidden relationships among people. so if you start with one contact, suppose it is a terrorist contact. you say, who is in touch with that person, then who is in touch with all those people? it is an exponential growth in the number of people you are surveiling that way. six degrees of separation idea, which is that once you hit six degrees of separation from you and anyone else in the room, it encompasses the whole planet. >> this is such an old technique. they used to teach you how to do this using mail, envelops. of course you want to find the guys you do not know about. you have one person you know. you want to say, what is the network he is involved in? you have to look at people that are not known, not suspect that

you could not get a warrant on. i think the administration is a little miffed because they feel like they went out of their way to do this in a constitutionally-safe manner but this goes back to a least the 19th century. they were teaching it to children when i was a boy. [laughter] >> i am in agreement with him that it has been used a lot. the mistake i think the u.s. government may have made along the way was judgment that what was declassified when it had to do with mail and classify what has to do with email. it does raise the question that the race back in the days when the story was written in 2005 so that the warrant -- with the question of wiretapping. you ask the question, why could

the government not have described the outline of the program? they leave themselves open to the same kind of exposure and debate and argument about whether or not it really needs to be classified. when you go back and look at some of these cases, i would argue even wikileaks, the amount of damage that was said to be done was not as much as the damage actually done. >> the more you know about this, the more it creeps you out. the programs are collecting all of the data involving telephone calls and internet communications -- chat, email, video, voice over ip. >> when you talk about the data

and you say e-mail, that means they are getting the message? >> they are not getting the content. they're not reading the email. they are looking who you send it to and when. there is a lot more than this. digital networking information includes device identifiers, locations. if you gave me the choice right now based on current data management techniques, here is the choice, i will subject myself either to one month of having someone read all of my e- mails and listen to all my phone calls or one month of all my meta data, i would take the content in the second.

the infringement on our privacy would be much less. with the meta data, you know who someone is talking to and when and where they are. they are getting all of your information. they can tell whether you are negotiating a secret business deal, whether you are having an extramarital affair, whether you're thinking of leaving your job, whether you're not come out with your sexual preference. they have now taken all the information they would need to do that, and they are holding it. >> that does not make any sense. and there is a limited number of analysts, and they can only look at so much. priority number one is not your sex life. priority number one is terrorism, proliferation, a couple of countries we have bad relationships with. there are not that many

analysts. no one is reading your stuff. you are a good target for foreign intelligence agencies. is china, russia looking at your e-mail? would not surprise me in the least. nsa looking at your e-mail? no. that is the difference. it is not a perfect world. what it is is a place where we have these trade-offs. it creeps you out to have people looking at your data. it creeps me out to find unattended luggage in o'hare airport. did you like boston? >> when you collect these phone numbers and connect them and decide we need them, is there a capability on what i used to whereon tape or is that som

recorded that you can play back? >> an e-mail would be there but what a telephone conversation be there? >> when they analyzed the data, we were talking to and from where and what device, they call that the surface analysis. they use it for leeds to go get the content underneath the surface. once they decide you are a person of interest, then prospectively they can collect your communications in real time or go back and get terabytes of old communications stored on servers. >> would conversations be stored? >> once they start becoming interested in you, then they can slice and dice it your conversations going forward. i do not believe there is

present evidence that they are either capable of or that they are collecting communications content so they can play it back later. >> he did not reveal one dark secret, and i guess we should be appreciative of that. the nsa kept talking about something called the bit bucket. there is too much information. all intelligence agencies suffer from this now. it is easy to collect, hard to analyze. they just park it. there are not enough people to read all of this stuff.

the content has to be, and one thing that has improved is the ability of focus on persons of interest. >> it is not hard. adding a few lines of code to a vast computing capability. >> i want to go to you all for questions. i was very interested in one thing you wrote. you talked about some of the myths. you said we're not in the cyber war with china right now. why did you say that? >> the chinese probably could not wait to get this guy out of hong kong. the russians probably thinking of a way to ship him off somewhere. these are great power falls. --ionage is great war.

espionage is not war. great powers engaged in espionage. it is not enforced. not even coercive. the chinese take advantage of weaknesses. that is not warfare. it is not a cold war. they are the second largest economy in the world. >> can i expand on that briefly? jim is right on the espionage side. president obama has gone to some lengths to differentiate traditional espionage from intellectual property.

we are on the verge of a cold war. that is because the cyber issue has now moved to the center of the relationship and it's made far more complex by all of the issues that jim raises. china is the world's second- largest economy, a very major trading partner and lender to the united states. that constrains us from doing things that we did to the old soviet union during the cold war but does not necessarily mean we're not headed into a cold war, it just means a much more complicated version of it. >> questions. right here. tell us your name. >> congratulations, jim, you kept your clearance. >> it was a close-run thing.

>> the question i would ask, you and i are certainly old enough to remember richard nixon. there was a time under which kennedy and johnson, a lot of the practices engaged in what-- would have been acceptable or least they were kept quiet. one of the things that strikes me about this is we have been at this war for 12-13 years and there have certainly been a lot of statements along the lines. that would indicate this kind of thing was beginning to coalesce and come together. i realize this guy and has said -- this guy has set off a firestorm but is there a lot waiting around that someone finally coalesced and came together or something through a brand new discovery? >> are using this has to do with other things? >> i am not sure the press has done a great job of doing what you're doing right now.

one of the jobs of the press is the idea is that there would be a watchdog. people have read the petrie act and have heard the stuff around. we have not had the press. do you think the press has failed to some extent? >> the press always fails. i think by and large the press has done a pretty good job. a lot of people did not want to go through 9/11 again. i am not one who thinks edward snowden is a great hero. sometimes sources are good people, and sometimes there

other kinds of people. i have real questions. i said on television a couple of sundays ago that people like martin luther king jr. and rosa parks were my heros, but they stayed around and did not run off to china. i think if edward snowden had a case to make, i do not think he made his case by his behavior. i think the post acted very responsibly. i also think that we need to know more about what is going on here.

>> i really liked the framing of the question about whether there was intelligence failure by the press. it is a fair question because we're happy to say if there is intelligence failure it they are unable to predict every feature event. i do not think that is a fair standard to hold them to. did we fail to understand and present as these things were happening? sure, we did. in my case was not for lack of trying. in my last book cheney devoted 2.5 chapters to the surveillance programs. what i broke my sword on was exactly what was the nsa doing that the justice department

thought was such a big problem that there was very nearly mass resignation in march 2004. i could not figure it out. whether edward snowden it is a hero or whistle-blower, what he has done is enable a public debate in which we all get to participate in deciding how much power one government has. >> i would say this, this is taking place at a time when we are undergoing a cultural change in the country. and with the coming of the social media -- people of the younger generation now put on facebook things that people my age would not have discussed in mixed company. people have the idea of privacy. -- a different idea of what

privacy is now. they do not believe much of anything that the government tells them anymore. i think that has to do with more than just the government running this program it has been running in. i think that has to do with a lot of things. >> on any given day i figure i am lucky if i understand 2% to 3% of what is going on around me in the u.s. government. if you go back over the past

four, five years, the article i mentioned, if you go back to our coverage of the renewal debate. if you go back to the olympic games and use of offensive weapons and other weapons, and there are many other reporters who have broken very big stories along the way, i think there has been of very steady drumbeat. the only way you get these stories is by beginning to pull on the strength and hope that a little more of it unravels. we all go back to the old ronald reagan trust.

they cannot give us the information that helps us to verify because that is somehow classified. it is very difficult to know exactly what the government has done. you have these people that are supposed to be on the oversight committees. maybe they are right, maybe that is wrong, but that makes it very difficult to cover. here comes the microphone. >> i cannot help but think of dr. strangelove's doomsday machine. but what good is this program if no one knows a bit about it? i think the most important thing here is i am 31. i voted for obama in 2008. definitely did not vote for him in 2012. this is the context of this

story, my generation has a very hard time believing traditional news outlets, politicians themselves. a degradation of public trust. for me personally and pretty much everyone i know. this is what needs to be talked about more in the media. how are we going to repair this? what are your thoughts on that? >> it is interesting you bring that up. sometimes defined it as legitimacy, if you accept the authority of congress, and you say they are the press and say i can trust them. i am still working through this. i will give you the initial hypophysis.

that the internet has had -- we saw this with a printing press. new information available. they could read the bible and say i do not see any divine right here. we are going through the political effects of the internet. it is degrading the legitimacy of existing institutions. this could take a long time to work through. >> the other part of it is with the coming of the internet, most people whether they agreed with the editorial policy of the newspaper, they generally accepted what was on the news pages as the basic facts, because they generally accepted that mainstream media did a

certain vetting. that basically we did not print or broadcast anything until we had gone through some trouble to find out it is true. now you are overwhelmed with information from every corner. some of which is true and a great deal of which bears no resemblance to the truth. i can think that is one reason it is so difficult now and people have such questions about whether something is true or not. i think that is part of it. >> you mentioned dr. strangelove. in the 2008 report, we have that quote in it. we can talk about nuclear weapons, why can't we talk about the cyber stuff? >> a two-part question. since the isp service providers were acknowledged in the article, and so much data is available, was there in the--

any impact when this was made known to the public? was there any perceived impact based on the public demise of trust? the second part of question is, does my bill go up or down because of the use of my data? >> your bill has gone up and up, but it does not get charged. you never see it. the bill you are paying is the revelation you are giving to an enormous $30 billion plus industry of people you have never heard of, like flurry. it is the advertisement that works, marketing people. although it is true that ideas

of privacy are now and people postings on facebook, we're not losing privacy primarily because of things we reveal. we are losing it because of things that are being done without our ability to understand. you click on terms of service. you cannot say something that is factually untrue. i have recently been taking a look at what is happening behind your back, purely on the commercial side when you tap on angry birds. >> do you think we are safer now after 9/11? >> [inaudible] >> there was an emergency

appropriation for hundreds of millions of dollars to get bigger pots to put the data in and bigger computers to sift through it. there is some tax dollars. >> do you think we are safer now than we were on 9/11? >> i am happy because i went to a hacker conference and got a bumper sticker and it said the nsa, free backup service. you are getting some value. [laughter] if you compare how it was a bitter lesson but compare how things were to the 1990's and people were well-intentioned and trying hard and how they where now, we're better off. there are problems. there is no other way to do national level surveillance. i was in a huge exercise where we did not use communication

surveillance and tried to track terrorists and we could not find them. you put all the pieces together. nsa has their stuff. all three agencies are talking. are we safe? i leave that to you guys. >> lloyd hand had a question. >> comment and a question. i agree that a free and robust press as a synonym for a free society like ours. may it always be that way. on the other hand, i agree with what you said earlier about martin luther king and others who engage in civil disobedience took their medicine. they did not run off. last night i heard on pierce morgan, and they were talking

about greenwald. he said when the law says you knowingly publish classified information, that is a felony. did you know that you were publishing classified information? >> well, an entirely different kind of conversation. >> of course i knew i was publishing classified information. i put the stamps in the paper. there have been available series of prosecution for many years now, since 1917, as you know, in the espionage act under which a person who publishes information relating to the national defense, even if it is not classified and does not have a stamp on it, there are x number of active divisions in the army down the line that is relative to the national defence.

there have been available series under which you could prosecute the report or newspaper for publishing that. there has yet to be any administration that thought that that would be the right call to make in terms of how we organize the society, and if they did, then we would have an opportunity to test the constitutionality of the interpretation of the law that would apply it to first amendment protected activities. i am not a lawyer, and i am not at all cavalier about this, but it is true what david said that if you're going to cover foreign affairs or national security or defense, it is very difficult to write almost any story that could not be interpreted as breaching the lines of us of the espionage act. >> likewise, the point was made that they could and have always been able to make that choice.

a quick comment and question is, it is true that snowden precipitated this debate. my question was, was it a necessary way to precipitate debate, and it is important to keep in mind that all of these programs were legal. there was not an illegal aspect about it. congress enacted these laws and it is unfortunate that the congress did not go to the briefings or they would have learned more about it. >> i think one of the things that there should be more attention to is this congressional oversight. the fact that is it not true that when they have the most recent briefing for the congress they unfortunately had it on friday afternoon and they all left town because they had to

get back home. i think that is one thing that deserves a lot more publicity. >> in terms of oversight, this is extraordinarily complex stuff. the way congress works and the way in fact senior executives work is every branch of government, you need a staff to advise you on it. it is a very small minority of members of congress who have staff with clearances to get the briefings. if you are not on the intelligence community and certain appropriations subcommittees, you do not have that. probably one in 10. that is one thing. is this illegal? according to every interpretation of the law that has happened so far, what is happening is legal. there are lots of things that could be legal depended on what the law was, that we as a society might like to debate.

right now -- we know now and did not know until now, the court has radically reinterpreted some of the features of the patriot act. section 215, business records. we get only use this a few times a year to use this to get business records. it used to be the interpretation that the facility for which you collected business records was a phone number or e-mail address, and now it is all of them. now it is the entirety of the call date today at the big companies. no one knew that they did that. i am quite sure if lawyers read that opinion, that there will be very significant disagreement in the legal community about whether it is constitutional, but that cannot be tested right now. >> a very quick point.

you raised the question was, do you need these kinds of revelations in order to have the debate? history suggests you probably do. jim mentioned we manage to have a good debate about nuclear weapons, even though everything about nuclear weapons is classified. how we use them and where you keep them and so on and so on. we had a 25-year long debate that ended up in the cuban missile crisis 25 years ago for the conditions against when we would use the case of nuclear weapons. in the case of offensive cyber, it has been the same thing. you have needed revelations in order for there to be a debate. so far a very small debate about whether or not we need to use this new class of weapon.

as the stories departs, you would not have the debate unless people can stop and say, there was a law that was written when the only metadata you could look at was an address on the outside of an envelope still apply in an era where you were walking around with a cell phone and someone could figure out exactly where you are. the nature of the data is so much richer today that applying the law that was written 30-40 years ago may not make sense anymore. >> we have to end it there. thank you all very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]

>> tomorrow on "washington nina olson will talk about tax exempt groups. followed by npr health policy correspondent julie rovner. and ross johnson, former senior executive with radio free europe . "washington journal" live at 7:00 a.m. here on c-span. they had a tremendous role. we were talking about martha and the things she gave to george. every year was

huge, and he thought so. it was every winter of the eight long years of the revolutionary war. she hated it. it was dangerous. the roads were dangerous. she was a prime object of hostagetaking. to troop morel. he felt that very strongly. the troops tonize arrive. they would cook for the soldiers and sew for them and nurse them. they would put on great entertainment for the soldiers. the washington's genius was keeping army together. washington would say he not have done it without martha. he begged her to come to camp every year. the troops adored her. >> we continue our conversation on first ladies.

from martha washington to emotional obama -- michelle obama. >> our guest is representative michael mccaul of texas. the homeland security committee chair. thank you for being with us this week. let me introduce our two reporters will be questioning the chairman. the reporter on homeland security and intelligence issues politico." we will start with immigration. we'll start with you. >> i want to ask you the broad question and also a specific question. the broader question is speaker bo