release of the vaccination, they may reformulate the vaccination strategy. rather than focusing on the broader category, the state has chosen to restrict its initial efforts to the sub-coyote groups reported. likewise, we are now restricting this in the private sectors to the providers most likely to serve the target population. .

a change in those estimates as a profoundly affect the route to the public health system. not only does the change in the available vaccine come back to scheduling of clinics. it impacts the plans for public information campaigns. any campaign encouraging standard vaccination when the vaccine supply is so limited, would likely result in patients becoming disillusioned because of their inability to receive vaccines. in addition, the inability to provide vaccinations will further undermine the credibility of the public health sector. needed campaigns must be timed to match the supply of vaccine. if more vaccine becomes available in late november, media campaigns aimed at encouraging a broad scale

vaccination have a much greater chance of success and patients a much better chance of being vaccinated. while vaccination efforts have begun in of alabamalabama, we ho discourage an alternative strategy. our success depends on the continued interest of the individuals in receiving evacuation's in december and january when the vaccines will become more available. if i want to thank is committed. without the support of this committee, we as a nation and alabama as a state would be far less able to respond. thank you for this opportunity to share our on going experience with h1n1. >> ms. mcconnell, would you introduce our next expert? >> thank you for the opportunity to introduce a person that i know well and consider a friend. the director of the st. paul

ramsey county department of public health since 1988. the labor, health, and human services education member. he is here to brief us on h1n1. rob directs and operation of large, full-service public health and defocusing on preventing communicable diseases, promoting the health of children, youths and their families, protecting the environment, reducing environmental health hazards, reducing chronic disease, and assuring emergency preparedness. he does this in many languages. one of the largest hospitals in ramsey county has on hand people to interpret up to 47 different languages. he also has reached out to many different cultures. he's a treasure to the local public association in minnesota, vice chair of the minnesota prevention blogger advisory committee. the active and serves on the committees of the greater united way. he's the school board member. the reason why i bring all this

up is he is not on the person who is an expert on public health and reaching out to the community, he is a person actively engaged in the community if and does hear from them directly firsthand when they are fearful of something and when they have questions. mr. chairman, i present to you rob -- >> thank you. ramsey county, minnesota has a diverse population, one of the first counties in the state of minnesota. the st. paul-ramsey public health department has developed a number of specialty clinics we operate for as tedious, family planning, and women's health, as well as a large family visiting program serving 1900 families a year. we have 320 staff to provide these services. we have been planning for

pandemic since the late 1990's. federal funding to support our planning came shortly after the 9/11 event and then the october 2001 anthrax event which i'm sure you are familiar with. the investment that the federal government has made in public health emergency planning and especially in a recent public health emergency response funding has been vital assistance to us in dealing with this current situation. i can assure you that local public health is well trained and ready to be the ground troops dealing with the h1n1 pandemic. in late april this year when h1n1 first reached our community one of the biggest task we face was getting accurate and timely information to our community about the threat of h1n1. we immediately began providing the mitigation information to residents of the county on how to avoid getting sick. wash your hands, cover your

costs, and stay home if you're sick, the same messages we gave in 1918 pandemic are still the most effective messages today as the h1n1 returned this fall. we continue these -- it is important we continue this message until we can vaccinate our residents. how to reach the many english limited people in our community. we initiated a service called emergency community health of reach. this nonprofit organization produces monthly health shows on our local public television in six different languages. they also have telephone message lines in 12 different languages and the website with information in those same languages. the second major effort at the local level was to assure that as many of the appropriate clinics in ramsey county as possible applied to receive h1n1 vaccine. we have large system clinic

among our 218 clinics, we also have 63 unaffiliated clinics, including three federally qualified health centers, health care for the homeless clinic, five school districts, and nine colleges with health services. and the h1n1 vaccine became available to us in small amounts are local public health department took on the responsibility of seeing that emergency medical service and other first responders not attached to hospitals received vaccines. one of the dilemmas was that the initial vaccine provided was by the state was the weekend live virus vaccine commonly called flu mist. this type of vaccine has some limitations such as the maximum age. we have also become a distributor of antiviral drugs. in minnesota they have established of that can help diagnose flu symptoms over the telephone and describe antiviral to those persons who can best use them. for persons uninsured or for

those whose insurance does not cover prescriptions the prescriptions are sent to our department. for the time, these people can come get the antiviral without cost. we are also the local stock pile of the anti-viral that will distribute to our local clinics as they need them. another responsibility for local public health is to be the' a story and distributor of personal protective equipment such as masks and 9n-95 respirators. how do we do all this at the local level? we set up our internet command system last spring and we initiated it four weeks ago. this is the formal system of managing emergencies to rations that we have trained and exercised for the past eight years. as of today, we have 135 of our 300 or so employees that have been assigned to some duties for the situation. the challenge for public health

is these folks have to give up during their regular work in order to meet the needs of the h1n1 pandemic. we have some concerns. the delays of the delivery of h1n1 vaccine are causing disruptions drop plans to vaccinate as many persons as possible, as quickly as possible there's an increasing number of illnesses and our community, and hospitalizations. we still have limited supplies of the vaccine. we know the credibility of the entire public health system is in question. due to the slow arrival of the h1n1 vaccine. the demand for this vaccine is high right now. it is low on arriving, so the demand may wane. we are anticipating 78 under doses of vaccine to focus on school children 9 and under, yet we have 20,000 children in this age range in schools in our county. our challenge is to distribute and vaccinate in a fair manner so that we cannot meet what will

be the high demand for what will be in children. another issue is the delay in delivery of seasonal flu vaccine. while this is not an immediate problem, it could become one, if we don't get adequate supplies in seasonal vaccine by december. minnesota has the highest rate of seasonal flu vaccine per person over 65 in this country. this will be more challenging to accomplish if the delays continue. we anticipate there will be a command system operations well into 2010. this will have a real impact on the delivery of our other important services. for example, we are planning to move many of our home visiting services from weekly visits to biweekly visits. we are also planning to reduce the frequency of our food, beverage, and lodging inspections. we are very concerned if that should we have another emergency such as a large-scale food borne out publioutbreak or tuberculost

our staff would have problems covering that there is a local and state funding has been impacted by poor economy. we have planned on limiting 5% of our staff to meet our 2010 budget goals. well as funding and is now and health care reform bill it is critical to ensuring a strong local public health infrastructure for the future. in summer, local public health says it is wearing many different hats. many of the jobs we are asked to do are familiar tasks, but some are not. local public health workers are putting in long hours and are deeply committed to serving our communities. they're well-trained, prepared, and willing to meet the many challenges we are facing off with the h1n1 flu pandemic. thank you. >> mr. chairman? >> one of the things that has come up in the testimony that i think is very important is how we direct our questions is the

timeline to develop the vaccine. they had to make a selection of the virus and then there are certain steps they go through. when you have a shortage, you want to know how long it's gonna take to get the vaccine. perhaps someone could explain a timeline. >> the way i want to proceed first is to provide an opportunity for both the majority and minority staff to asked the more technical and exacting questions and then we can move to any questions that the members might have. we will start with the ghadar de klerk for about 20 minutes. > -- -- with the majority cler for 20 minutes. >> good morning. i wanted to about the problems outlined in the state and local area. under the ajay just pandemic

influenza plan they wanted to develop specific domestic and try to incapacity to produce pandemic vaccine for the entire u.s. population of 300 million persons within six months of pandemic onset. while hhs have worked 24-7 to address the h1n1 pandemic, we are following -- falling short of this goal miserably. following the h1n1 flu outbreak last spring, the federal government contracted with five suppliers of seasonal flu vaccine to deliver to london 50 million doses of h1n1 vaccine to protect u.s. populations from the spreading the virus in the fall. initial government estimates indicated 160 million doses of the h1n1 vaccine would be available by october. based on information provided to it by the vaccine manufacturers, aged as later revised the estimate downward to roughly 40 million doses. by the end of october, october

29, cdt reported 24.8 million doses had been made available. short of the other estimates. ajay test data supplied to the committee staff indicate those were sufficient to cover all priority populations, but likely will not be available till january 2010. is that correct? >> there has been a steady downgrading of the projections for the number of vaccine doses that will be available. that number has continued to decrease through the summer and into september and october. as of today there are $32.3 million is available. at this point we have focused on going week to week in terms of what we are anticipating coming to us. what we have focused on a cdc is ensuring that we can receive the vaccine seven days a week, being provided by overnight shipping to facilitate the ordering by

states and other jurisdictions so that once it is off the production lines we can get a doctor's offices and to patients as quickly as possible. >> isn't that a concern that some of the high-risk persons such as printed women and young children may have to wait several months to get the vaccine? >> we are very frustrated by the status of vaccine delivery. as we said in the opening remarks, we are stuck with techniques which were very -- which we are confident in the safety of, but which takes too long. it used to be six-nine months, the initial estimate for vaccination becoming available after the emergence of a new strain. if you look at the previous pandemic and vaccine production, it has been really not possible to have a vaccine available for the first wave of the disease. we have a close even that lasts generally until may.

dr. lurie can discuss the work with manufacturers to try everything possible to get more vaccines without putting any corners. >> when do you anticipate there will be enough vaccine to cover the party populations? -- the priority at populations? >> at this point, from cdc standpoint, we're focusing on one week at a time what we are confident having. we already have been burned quite frankly by projections that have not come to pass. and our goal is to get the vaccine out as quickly as possible and to ensure that once it is available, it is used by the priority populations to the greatest extent possible. >> sure raises a question that everybody is interested in. -- she raises a question

everybody is interested in. i understand you are shy about raising predictions. nonetheless, you must have some observations, based on your experience with each of the manufacturers, that would lead you to have some estimates of what the future time lines would be. >> maybe i can jump in here if i can. we have been working extremely hard with each of the manufacturers to be sure that all of the stumbling blocks that we have any control of and that they have control of karlie out of the way. some of the problems that they encountered early on, in terms of growth and filling capacity, etc., seems it has been very well addressed. to be quite honest, as we know from history, flu is unpredictable. i think we are pretty hesitant about projecting forward more

than a week to week, largely because anything could happen. so, while i think at this point we feel more vaccine is coming out every week, at this point, creating sort of more expectation, i think wwould be more confusing than anything else. >> what have you learned on the site visits? why can't more vaccine be produced by the end of the year i? to the time line as well. >> on the site visits what we have done is a couple of things. i brought along a graphic which might help a little bit to explain things. but at this point the manufacturers really are where they are with their production

-- that is not a point be easy to see -- maybe we can pass this out to the committee. let's pass this out to the committee for now. but to say the manufacturers, i think, have made a lot of progress with their growth, which is the first step is really growing the virus. so that what this really tries to depict is the manufacturing process and where we have made investments. the stuff i know you are most interested in and down on the left-hand column in yellow. the first problem that everybody really wants to start with is the virus growth. the yield of the vaccine continues to decrease throughout the summer and into the early fall. all the manufacturers have told us now that they are through

those at least for now. again, something could happen that could stunt that virus growth. that is one of the reasons we are hesitant to predict. one of the things we did in the sight visits was to look at to the production challenges and to try to see if we could work together to figure out where there -- if there were other challenges in production we could help with parikh or help identify a contract manufacturer that was licensed in the united states. we have done those things. we have shifted all the vaccine manufacturing to the extent we can to multi those virus first because there faster to fill, with leaving the rest of leftover for the single dose syringes. we have worked with them to shift everything they can do to get the vaccine out as fast as they possibly can.

then we are tracking through the process step by step. to the degree that when a lot is ready to be released at a manufacturer, we have a truck waiting. it pulls up at the loading dock ready to accept that vaccine and bring it to the distribution sites. if we have been working through this every step of the process to get any delays out. that is what a sight visits have largely been about. >> a question about the contracts. [unintelligible] to produce this reject all under 51 million doses, kabbalah contracted the manufacturers to fill 117 million doses. why aren't they able to undo the full amount of doses -- able to do the full amount of doses? >> we need to make sure we have enough vaccine derived the time people want it and being careful stewards of society's resources.

the biggest issue press is to get the bulk vaccine produced. it takes four weeks to six weeks from when you have the bulk vaccine to do fill and finish. to put it in weyl's, thito testd for stability -- to put in vi les, to test it for sterility, and so on. we don't want to have a gap because of the delays in vaccine, the 117 million is taking us further into the year than we thought it would have. we will continue to issue additional task orders in time to fill and finish vaccines so there is no gap in the delivery. on the other hand, we don't want at the very end of this to be sitting with a lot of vaccine already in viles that cannot be used.

better to keep it in its bulk form so it can be used for example in the seasonal campaign next year or potentially available for the developing world. please be assured that we have a very steady stream of films and finished products coming out of the pipeline. we are buying it as fast as manufacturers can produce it. >> a question about the vaccine technology. everybody has alluded to the fact we're using 1950's era technology to produce a vaccine. european countries have already analyzed vaccine technology and are benefiting from the faster technology. it does not take as long to produce the seed strains, allows more reliable and the sterile methods of replicating the vaccine itself rather than chicken eggs. it has the added benefit helping people with egg allergies and

can prbe produced faster. they have invested a lot of money in it. six manufacturers have received contracts for this work. one vaccine manufacturer, novartis, is building a facility in north carolina. but this is three years away in the u.s. can't they get approval from the fda banned what actions can you take the expedito expedite? >> we are encouraged by the cell-based technology and other technologies that we have invested in from the basic science perspective through advanced development. the first cell based manufacturing and facility is now being built in north

carolina by novartis. we have provided substantial funding to help with that facility and so that we will have capacity there to manufacturers sell based vaccine when it is available for manufacturing. our understanding is that right now the manufacturing facility will first be available to manufacturers flu vaccine -- again, if all goes according to plan, in 2011. when the vaccine will be licensed is really an issue of when the company is ready with techniques, with manufacturing, and materials submitte are submd to fda. i cannot tell when that would happen. >> what impact would sell based manufacturing have on the time? >> we believe sell based technologies will get us vaccines faster, more reliably,

will avoid the problems with a base allergies. -- egg -based allergist. we need this manufacturing capacity in the united states. this cell based facility of the first one. it is going to get us may be shy of halfway to what our pandemic goal might be. in terms of capacity to make a vaccine for the entire united states. seoul what we are really excited about in the steps forward, we need to continue in cell based technologies in an additional manufacturing facility, an additional new technology to take as even a further into the 21st century, and to then take those technologies to scale, and large failescale manufacturing e united states. >> so there's not confusion about the relationship between

cell based technologies and other technologies that don't require the virus to grow, it is entirely conceivable that you could have a cell based technology that requires the virus to grow and it will grow very poorly in the cells. when you have to get the virus to grow, there is no guarantee that you will all of a sudden get away from all of the problems fromegg-based. probably more important than being quicker like three weeks or so or whatever, as the surge capacity of cell based, so you can get all of these vats of cells available and then start growing it. we feel the answer to these kinds of uncertainty that is to do the kinds of platforms that we are doing basic research, clinical research, and ordering with biotech companies to take

vaccine study from influenza into the 21st century by not requiring the virus to grow. there are so many of those different techniques. 1 for example is to take the dna that closed for the hemagglutinin, the important component, and inject it into an individual and have that person make a lot of immune response against the hemagglutinin parity don't even need the grvirus to grow anyway. you could make a limited amount. there are five or six platforms. unlimited technology. so based is the next step and it's important and we are investing a lot of money, but that is not the end game. the endgame is to get away from acquiring the virus to grow. >> thank you. >> will vaccines using either zobrist or any of the new technologies be more expensive? if so, how will this affect the seasonal and pandemic the flu

campaigns of federal and state level? >> that is a great question. i am not sure at this stage that i'm able to answer whether they will be more expensive. if certainly there's a lot of investment, research and development that goes into making and producing any vaccine. certainly, the more of it you make and the more of the you use, lower the price gets, because you have the efficiencies of scale >. >> new technology tend to be more expensive. as you scale up and get a lot going and get a predictability about how much you can order, the prices plummet. but right from the get go, if you're starting with a new technology that will maybe take 10% of 15% of the vaccine requirement, that technology will be more expensive initially and that ultimately would become much less expensive. >> had hhs invested solely in

bringing on and approving new technologies rather than focusing considerable resources on egg-based vaccine, but we have had the north and faster technology for the pandemic? >> hindsight is always a good thing. i don't have the hindsight of able to answer that question, i will admit. if things always takes longer than they should. i can remember, we first started talking about the need to get away from it egg based inlsee 90's. we started investing heavily in science at that time, largely under dr. bauchi's leadership to move to sell base and some of the newer technologies. -- dr. fauci. you have to have those technologies ready before you can invest in a manufacturing facility and take it to scale.

if we could have invested more. yes, we could continue to invest more in the advanced development of all of these new techniques and new vaccines. i believe we need to continue to do that. >> i will interrupt because i am torn that we will have some votes and about 10 minutes on the house floor. i would like to give the minority and opportunity proceed for as much time as we can. >> there are a couple of questions that would help lay the ground rules of some further questioning, like the time line and how much is available, so we can get projections. >> why don't you take 10 minutes with your staff. >> i will refer back to your chart. i was curious on the right-hand side, it looks like a pallet coming down from the sky. i could not connect that to what is going on. do we have to airdrop this isnn? [laughter] >> what this is really intended

to convey first of all is right now we are still dependent on growing vaccine in eggs. >> was that a palace of eggs? >> yes. we have had to maintain a steady supply of millions and millions of eggs. ghadar that contract in 2004. how many eggs do you need? >> are multiple eggs required? >> you can get at least two, sometimes three doses of vaccine per egg, but each virus grows at a different rate. for the h1n1, i think when people started with the first strains, they were getting out

.3 doses per behalegg. >> so they have been able to increase that capacity. >> you need millions and millions of eggs. >> do we have that now? >> we have been securing millions and millions of them and millions of chickens. i was responsible for many chicken farms, absolutely. >> if you are going to look at a time line and you need to increase the dosage, you start with? with the start wi>> you have to haves and the have to be fertilized eggs. >> it takes awhile to order them? >> we have a steady supply and steady order now. so that is not a handout. that is because of investments made in 2004.

then when a new strain comes along, what you have to do is isolate the virus, get the seed strains, and then it has to grow. >> is there an average time or a unique time? >> this virus was isolated in just days by the cdc in california. >> so they're constantly looking for mutation to this? >> yes, within our limited resources. >> so how do they grow enough to put into the eggs? \ >> cdc will isolate the virus, select a candidate strain that looks like it will be good for a vaccine, and then send that department institutions that will change it to a form that facilitates to make the vaccine. it took us literally days to get

that done after isolating the virus. we provided to our partners. the partners then provided openly to manufacturers, academic institutions, governments around the country and around the world. >> from the time to isolate the virus until you inoculate the eggs is how long? >> about 10 days or two weeks. >> it really varies because there are two ways -- you have to get the seed viruses and a reference tstrain. you have the viruses that are very good relative adapted to eggs. >> what is the longest? >> it could take several weeks if you don't get a good reference train or seed viruses. it could take days to a couple of weeks. if it takes a long time, it could take months. >> if you were going to get

100,000 vaccines, it would take two-four weeks to get ready to inoculate the xeggs? and then how long after that to incubate? >> if you have isolation within a few days, you get that, and it takes two weeks to get the seed viruses, then you grow it and give it to the different companies and they start adapting it to their system, if it hits the ground running and it's a good borrower, you could start making that right away and get yields within a couple of months. getting the yields for what you want, the whole process -- >> lets use 100,000 vaccines as a benchmark. that's how much you want to end up with. 100,000 viles. how long can we expect this

process to last? to take? it seems kind of nebulous. i cannot project for that if i need 100,000 vaccines at some point in time, when if what i expect those to be available? what is the delivery date? >> planning for pandemic always said six-nine month period from the day of virus is identified to the day a vaccine is ready to be given to patients. >> 100,000 is really a small amount of vaccine. >> just for the time line, what is realistic? >> if it is a fast-growing, you cannot that amount off and a couple of days. i think the important issue to understand is that on a regular flu year where you have a reasonably good growth or with no glitches, from the time to isolate the virus and make the

decision on what to put in the vaccine from the time you get it into the vile ranges from six months to eight months. >> we can expect the same for the h1n1? >> we hope that would be the case. there were three issues. i believe that was the question you ask from the beginning that you wanted to get to. if you look at the time frame, when you decide what you're going to do with seasonal vaccine, it usually makes the decision in january and then start the process. usually, if it's a reasonably good grower, you get what you need around the middle of the summer, you start getting it ready to send out in september, you get it down to the people who need it and then the floozies and does not really a few in earnest until the end of the fall or beginning of the winter and well into the winter. so now what you have is a process that started in april. right away the wiggle room for a

slow-growth, you have 1 foot on a banana peel there, because you have lost three months. on the other end of the spectrum, instead of having some cushion room for floozies and to start, the virus never left in the summer and was just waiting for the kids to come back to school at the end of august or beginning of september. -- flu season. instead of january, it happens in earnest the end of august or beginning of september. superimposed on that is a virus that does not grow well. then you have a triple whammy. his start late and you know that is when the virus appears. you have to pay flu waiting for you when the kids go back to school -- you have a flu waiting when the kids go back to school. that is the issue. >> so we have six-nine months, which, to me, if you don't have

a timeline and there's all of this, i guess, slush in the schedule, i am not sure we can properly manage it. instead of -- i want to make sure we are managing this, from our perspective, as the government, we took over general motors and a couple days, which took over the banking industry and a couple of weeks. so why can't we take over this process and getting to work right in a time line that is not 50% off, three months one way or the other? >> that is a good question and it's frustrating all of us. the thing that -- at this point in time, with this technology which is being used for which there was no choice but to use it because it was the only available technology, for this type of technology, as difficult as it is, you really cannot do anything when you have a virus

that is not going well, except trying to wiggle it around to get it to grow better. so you really cannot say that now we are definitely going to have this amount of doses. that is the reason dr. lurie has said it's very difficult now when you have such a fragile system, to make absolute definitive predictions. >> we are talking about american capacity, correct? we are relying on a worldwide production for this. >> correct. >> how much less control do we have over the world wide production of this? six-nine months for domestic capacity. does that include the ability for australia, which we contracted with and then the diverted their supplies for australia, not a surprise. we have limited capacity year and we have this sort of slush in the schedule, does that apply to worldwide? >> everybody has the same problem with growing this virus.

this is a global issue. if this is not something that is peculiar to the united states. >> would the gentleman yield? >> i wilyes. >> we have had a controversy involving thermerasol. to prepare dozes without it took considerably longer than it did to produce the same compound if you had this component. does that controversy, in your judgment, add appreciably to the time that it has taken to get this off the ground? >> i think a little, but not substantially. that is not the major issue. >> @ i if it takes so much longo

prepare doses that are not free of this component, then why is that not a significant impact? >> if you have multi dose viles, it facilitates the process rather than having to put single. i don't think that is the answer to the problem. the answer is fundamental terrible growth of the virus early on. >> this component is not involved in whether the virus grows or not. it is added at the end to the multi dosed it viles as a preservative. -- multi t-dose viles. >> if the growth time is slowed, then why do we have a pandemic? >> great question. there's a difference between howard gross in the laboratories

and how it spreads from person to person. one of the reasons this virus has spread so rapidly and affects young people more is that it's unfamiliar to us. there has not been a similar virus circulating widely in decades. that means it can spread rapidly among people who don't have immunity from having been exposed to similar viruses in the past. i>> so it's a strain that is unusual to our younger population that allows it to grow so freely among young children. what we call that group, the party population? is it children under 5 and pregnant women? >> five groups that our priority. health-care workers, caring for people with influenza. they need to be protected. the second is pregnant women at higher risk. the third is people who care for infants six months or under, because we don't give vaccines to infants that young, so we protect them by protecting the

people around them. the fourth is kids and young adults from six months at 24 years of age. then people with underlying health conditions. if they get the flu they would more likely become seriously ill. >> let me interrupt to say we have four minutes left on the clock to vote. 380 members have not voted yet. so what i would like to do is to get in one other person -- one another round of questions before we break to vote. [unintelligible] >> thank you, mr. chairman, for having this important hearing. i want to go back to the shortage issue. there have been a news media -- news media reports of people

standing in line for hours trying to get vaccinated only to be turned away. in los angeles county, for example, 5.5 million people fall into the priority category for getting vaccinated, but only 50,000 people were vaccinated in the first weeks after the county clinic opened. many were turned away because of the vaccine supplies have run short. public health experts have repeatedly told us that once people are turned away, it is very hard to get them back to be vaccinated. my question is, as the early supply shortage seriously damaged the goal of vaccinating all americans? where do you think the point balances between your public messaging intended to raise public awareness about the dangers of h1n1, which raises the demand for the vaccine and the current limited supply of the vaccine? >> thank you.

anytime someone comes to a doctor's office or goes to a vaccination site and there's not a vaccine available, the likelihood their return to that site is less than we wish it would be. if that is why we are so frustrated not have the amount of back in available when people want to get vaccinated. our goal has always been the vaccine should be available to anyone wants to be vaccinated, with priority groups. many people choose not to be vaccinated. that is their choice. we are currently at $32.3 million is available. for ordering and distribution. it is not nearly where we would like to be. what we can predict is demand for vaccine will be dependent on multiple factors, including how much disease is in a community, how high profile the disease is, and an extent to which the vaccine shortage tends to increase demand for vaccine. we are seeing unprecedented demand for seasonal flu vaccine even though it does not protect

you against h1n1 piercing also shortages of seasonal flu vaccinations. the seasonal flu distribution system is done differently than h1n1. 90% due to the market and who manufacturers can sell to. the fact that there's not vaccine currently in providers of this is when people want to get vaccinated mean some of those people in all likelihood will not to get vaccinated in the future. >> after the initial wave of vaccinations, what will be the strategy to reach the rest of the non-high priority populations? how are you communicating that message to the public at? -- the public? >> we have put $1.5 billion into state and localities for planning and administration of vaccines. for some states are working to

managed care organizations, some through vaccine clinics, some through private providers, some school vaccine clinics. we have examples of those working very well, some of them. we have left it up to each state to identify the strengths in their jurisdiction and then to support them in doing that. my colleague from alabama may have more to share. >> if the answer tthe answer tot populations, and alabama we are trying to match the target populations with the provider most likely to see the target populations. our plan to originally reach children in kindergarten through 12th grade was through school based vaccination clinics. we still hope to do that, but it has been pushed farther into the future. thirith pregnant women, we have reached out to the ob/gyn doctors and family practice

services and federally qualified health centers. we have done that. we also recognize there are going to be patience who don't have a primary care provider in one of those target populations. across our state we held statewide vaccination clinics through our county health department. if we will continue to do that. our strategy is as long as the vaccine is limited, we will have an underlying safety net of community that and public-health departments to serve the other people. once there is enough vaccine, whether that is late december or january, then it will be the challenge of reaching out to people who have self deferred and not come in and. in alabama we have said while we're trying to reach the target population, anyone who gets in line, we will vaccinate. once we turn away, they don't come back. that was the experience in 2004

during the last vaccination shortage. >> let me ask a question before we break. i and stand that the vaccine grows at the same speed [unintelligible] . whether it is free of thermerasol or not. but my understanding is that the filling and finishing took considerably longer with the ones free of that component. what -- let me call on the clerk to expand on that. i'm still not clear on whether there is any delay in delivery because of that problem. >> that was the point i was trying to make, mr. chairman, that it is easy to have it multi dose viles, which requires a

preservative, then it is to have a single small doses without that component. that phil-finished issue, the issue we are facing is much less a delay in fill-finish than in how the virus grows. that is why i said you might be able to cut some time off in filling and finishing. the fundamental problem is the virus not growing. >> we understand that. i'm trying to figure out how many additional problems we have. >> let me jump in. when it began to look early on in the fall and maybe even earlier than last, i cannot recall exactly the dates, that we're going to have this slow- growth and fewer doses of vaccine, we worked with the company's critically to say do everything you can to maximize the number of doses that get out there quickly. regardless of whether that is

multi dose ciles. -- viles. we asked them to fill as many as they could in multi dose. don't hold up the number of doses that we will be able to get out quickly because of the need to do the pre filled syringes. from that perspective, it had a little impact, but very little. >> we will recess and come back as soon as we can after the vote. >> after a break for a house vote, the members continue questioning witnesses for another hour. you can watch the hearing in its entirety by visiting our website. also, there are more programs on the h1n1 swine flu. including last week's testimony by health and human services secretary kathleen sebelius. you'll find all that and more at

c-span.org. >> patrick o'connor on the phone with us. house democratic leaders have signaled they want to begin debate on health-care legislation this saturday. what happened today to allow them to announce the schedule? >> viroqua committee announced they will have a meeting on friday at 2:00, that they will do the final rule that clears the way for the democratic leaders to bring the bill to the floor. your list is probably know that the democratic leadership posted a manager's amendment with the rules committee last night as a last-minute change to the bill. we are on the clock in gearing up for what looks to be a saturday afternoon or early saturday evening vote on this massive health care bill. >> how have the democratic leaders decided to address the concerns by summoning a caucus over the federal funds used for abortion, over whether the funds should be used to pay for abortions? >> there's a compromise still

being hashed out. the compromise deals with language more than any substantive changes to the bill or the initial language. if they're trying to reassure abortion opponents that none of the federal funds allocated in this bill either subsidies or that are used to the public plans would be used to fund abortions. for the most part, that is current federal law. what the initial offers wanted to do was to make sure that those current laws stay in place. you have democrats on both sides of the divide that are trying not to allow the abortion issue to ruin the overarching debate over health-care reform. it's a bunch of mostly moderate democrats meeting with party leaders today to try to figure out language if that would make both sides happy. really what they want to do, is like the senate has, to ensure that any federal dollars will not be used for abortion, which they will need to require private insurers, to decouple the money from splitting up

private premiums for whatever money they get from the federal their summit. then putting a prohibition on any of the federal dollars for being used to pay for abortions. >> the big question, will the compromise language satisfy enough moderate democrats to win their support for the overall? health care overall >> good question. at this time i would say yes. there will be a lot of folks and have it, namely michigan rep parts to pack. party leaders have gone around his back to try to work out a deal with folks they thought could get to yes. one person told me this is less about what it says in the end and that members are looking for either a way to rationalize their note or give themselves cover for yes. i think what they are trying to do is get enough guys in the room who they think can actually vote for the bill to make them happy enough so they can go back to their constituents and say this won't allow federal funding for abortion. the outside groups have already

blasted this amendment. it is not finished yet. i don't expect them to sign on once they figure out a compromise. >> how many democrats do they need to get past this? >> i don't know. a lot of people have asked me that. i get a sense they are close and the field is a lot better than the cap and trade bill did. before its passage. there were a lot of arms twisted on that one. there are only about seven or eight democrats that were in the meeting in steny hoyer's office earlier today, working on this issue. i imagine that they are probably representative of a slightly broader group, but i don't think the universe is huge. a lot of people know where they are on this thing, so they know if we're [unintelligible] i don't know what that universe looks like, but we're not talking 50 members. >> the house meets friday

occurred when we get the debate on saturday, how much time do you expect to be allowed for debate? >> i don't know for sure. maybe an hour for the rule. maybe an hour for the republican talk and then three hours of general debate on the bill itself. i don't think that is final, but a number of people told me they would do at least as much debate as they had when the republicans did their big change the medicare, the prescription drug bill in 2003. i think they realize optics are a big deal on this. republicans took a lot of heat for the way the medicaid vote went down. they want to make sure they do enough hours of debate in daylight when people are paying attention. i imagine -- i am expecting five hours of debate with a 1 hour clickable and one hour for the substitute. >> patrick o'connor, thank you for the update. >> thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2008]

>> "washington journal" is next with today's news and your phone calls. the house is the incessant at 10:00 eastern, today's agenda includes a bill that would extend unemployment benefits. . >> we will talk about afghanistan. representative

coffman and new york democratic rep eric massa. "washington journal" is next. host: good morning on this thursday, november 5. a three-hour program ahead focusing on the economy, health care, and the war in afghanistan. news the house of representatives hopes to go to a vote on health care legislation this coming saturday evening. we will take your telephone calls about the legislation as it is developing and factions opposing and supporting the health care legislation as it moves to the house floor for a vote on saturday. the phone lines --

as always, you can send your comments by e-mail and twitter. we have 20 minutes to talk to you about the likely health care vote on the floor of the house this saturday evening. "the hill" tells us in a front- page story -- house rules committee chairwoman expects the voting to either conclude by 6:00 p.m. saturday or start -- meaning the voting would be over around 7:00 p.m.. karen from "time" is on the line. the question is whether the leadership has the 218 votes. guest: i think they would not be moving forward if they didn't feel they had the vote. and certainly to keep the congress on a saturday night is an extraordinary thing indeed.

host: we keep hearing there are concerns from all points of view over abortion language and the coverage that might be available to buy into the system by people who are in the country illegally. what do you know about that? guest: they tried to deal with some of the concerns with what is called the manager amendment. after nancy pelosi put her melded bill out, hard to come -- team, i think, has been and pretty much nonstop consultation with members, making sure they were addressing as many of those concerns as possible. host: did tuesday's election results have anything to do with movements on this? guest: first of all, this is not exactly speedy. there are many months behind this. the original schedule they had set for themselves. i think if ever let -- election

results suggest anything, they are likely to make moderates a bit more cautious on moving forward on health care reform, particularly while they are still hearing qualms at home. i think the last thing they want to do is send them member's home for another one of these raucous recesses without having finished the bill. host: how about the senate? guest: of the senate is far more problematic. harry reid made it pretty clear tuesday it has now become an unlikely they are going to finish and get a bill at the president's desk by the end of the year which is of course everyone had wanted because the last thing they wanted is to have this bill, which as i said, missed so many dead lines going into the election. host: thank you for setting the stage. guest: thanks a lot. host: karen tumulty from

"time." this story -- one thing to note, today there will be two brand new members of house of representatives sworn in. it would bring the caucus to 258 with all 177 republicans likely to oppose the bill, ms. pelosi could afford to lose 40 democrats, at most. later on it says even if they tried to negotiate a compromise on abortion democratic leaders are wrestling with another thorny question, whether illegal immigrants will be allowed to buy coverage in a national insurance exchange. illegal immigrants could buy insurance and exchange but could not get federal aid to help defray the cost, the house bill says. the companion bill would set up its -- exchanges and all states and illegal immigrants would be barred even if they are able to buy the full cost.

a call from all night, maryland. tony on the democrats' line. caller: there is something i would like to say quickly. it is a big issue. i withdraw 67 cents from u.s. bank and $39.80 dollars for every day i was not able to pay the balance. of the bill went all the way to 287. i overdrew 67 cents. this is the problem. a big issue going on in this country with corporations, taking advantage of poor people. a public option needs to be part of the equation in order for costs to go down -- and obama was elected on that. he needs to push it forward. the democrats have the vote to do this and they need to push forward with a public option otherwise obama will suffer if he does not do that.

host: let me show you the headline from "roll call." democrats anxious for obama engagement. the story suggests they are looking for active involvement by the white house and getting members to vote for package -- passage. tallahassee. donald on our democrat line. go ahead. caller: good morning. host: you are on. go ahead, please. caller: i want the country who really say that there are true christians, and not to pretend, to say that we are christians and they claim we are christians but they are not christians but they are -- to actually prayed that this bill does pass that people who don't have health insurance, like myself, worked

every day, never ask a democrat or independent to give made nothing but an equal share that they come together because prayer is what is going to bring this thing together. this country will pray and ask that this bill be passed, the true christians, not those who claim to be of our brother judah but give them a bad name but they are thus synagogue of satan that president obama pass the bill for the people. host: silver spring, maryland. victor is on the republican line. what about the saturday vote on health led decision? caller: first of all, i am going to the rally today, a friend of mine, and we will politely and formally tell anybody that we run into -- congressmen,

congresswomen, that this is unconstitutional. you cannot be forced to buy something you don't want. that is unconstitutional. about saturday. i think it is absolutely ironic -- think of the date, november 7. that is the anniversary of the 1917 bolshevik revolution. how ironic that the vote is going to be held on that anniversary. host: will you tell people about the rally? caller: it is part of the tea party rally and that understand there will be a huge amount of people showing up. i have been listening to rush limbaugh and other talk shows and people have had it, they don't want any part of this socialist fiasco that nancy pelosi is bent on forcing on all of us. and we are just telling but

congressman, you vote for this, and guaranteed you will be gone in 2010. host: victor from silver spring. mary on the independent line. calling from long beach, california. caller: first i wanted to say i was really calling in on the unemployment extension beard that the bills should pass. i hope obama signs that. host: are you unemployed? caller: yes, i am. host: what do you think about health care? caller: when i first got unemployment and the offered nicole brown and it was very expensive. getting like the idea of how expensive it does. host: what do you think will happen saturday? caller: i have seen the staff of the bill that they had in the

u.s. senate and maybe they should try to go through it and revise it for the republicans and democrats need to come together and they need to stop dragging their foot on the things the united states people need. and this recession -- we are in a recession. host: next, and, watching us and a town called 84, pennsylvania. caller: i am totally against this vote. and i feel that this health care bill is going to do nothing to destroy innovation and health care in this country. and i'm wondering how much has c-span covered on 110 new bureaucracies created by this pelosi health care bill. my other question to you is, i'm

a little disappointed in c-span that you have not -- you know, if you covered it, i missed it -- but how much time did you spend on the democrats and obama taking over the student loans. there are no more private stood loans available -- the democrats and the government has taken it over. how much time have you spend on all of these czars, like we have a safe school czar who promoted a 13-year-old getting doodlsed by a 40-year-old. you can read it in his speeches. everything has been on health care as far as your discussions have been. and did you read "the wall street journal" yesterday, they will change the way the unions can unionize so that no votes no votes anymore.

there is so low -- -- so much this the administration is doing to destroy private industry that i am a little disappointed on the amount of time that has been spent on that and i hope everybody who is against this health care bill calls rep, called of their senators. this is -- when they caught -- started medicare, cbo was off by 10 times the amount that ended up costing. host: we have to jump in. a lot of people waiting to talk. tennessee. lacy calling on the democrats' line. caller: yes. host: what is your comments, please. caller: i think -- host: your tv volume is up. caller: my volume is up. my comment is i think mr. obama, he should be strong and go on in

there with the single payer plan and win, lose, or draw. i think he has been too weak on many other things. i personally am on medicare. i am percent disabled. i have no problems really with that. i have planned d and so on. we have been having government controlled health care for god knows how many years and it absolutely does not make any difference. why does these people need these other people. it appears to me, when, lows, or draw. at least show that you are trying, you know? host: in "the wall street journal" this report. as of wednesday house leaders did not appear to have the votes. michigan rep bart stupak has been withholding his support --

over abortion. house aides say as many as 40 members sided with him on the issue. the 52 this -- fiscally conservative blue dog democrats is divided, in part out of concern it could increase the federal government deficit over the long term. representative gerald colony, president of the 30--- 39 member freshman class, he said he told freshman at a weekly breakfast wednesday that passage of the health bill will help, not hurt, their 2010 prospects. it told me the lovers -- they will have to deliver to that democratic base. this saturday vote for the health-care the desolation. reno. tim callin g on the independent line. caller: last time you were on you were talking to representatives sessions.

and you read my e-mail to him, why don't we consider a different plan which it violated out briefly. the zero mandates to states, zero mandates to business. only cost the government 5% or 6% of gdp and very affordable for all of this citizen's -- the majority of the people use only $394 billion in health-care costs. host:tim, doesn't look like your idea of gaining traction. what you think about the vote this weekend? caller: susan, what i was going to ask you, on your health page, but there are citizens and videos. could you ask the web master if he could set aside sections for alternative plans?

no traction -- i am disappointed because i can't get it notice. host: or what master is listening and i think you can up load videos no matter what they say, including your alternative ideas. forestville, md.. republican my beard autocrat thank you for taking my call and thank you for c-span. i'm calling because i'm against is a vote. i am against this bill. i have been against it from the beginning and have been calling my congressmen and have been attending these town halls. i went to bomb march on washington on september 12 -- i went to the march on washington september 12. i can be on the capitol steps today, but i hope many people do turnout. i just feel that everybody that is represented in person, there are going to be tens of other people who are not able to be

there who will be represented by them. i'm just really against this plan. i tried to be -- i tried to make my representatives aware of this from the beginning. i just feel like the people in washington are not listening and is based on the calls you are getting four people supporting the public option, they say, look, we have the votes, just cram down these people's throats and that is just so not america. host: next is in bowling green, ky. the democrats' line appeared caller: -- the democrats' line. caller: whole lots -- on a lot to say. you can hear me? the ability of hatred that i see in the republican people -- it almost scared me.

i live behind the graveyard. i sit here by myself and i watch to be a lot. unfortunately too much. i can't see to walk or talk -- or drive, i need. but i do see and listen to you people all lot, too much. but i say hey -- hatred, so much, you sweet christians around here, you are not. you've got huge churches. you've got lots of people who want to get rid of people but you've got nobody with love for anybody it seems, except your pocket. i'm just one of nothing. have a good day. host: the aarp notice on "usa today" likely to back health care proposal, and board for democratic leaders. it said the announcements of the group is expected thursday.

it says here that steny hoyer, majority leader, we're counting. final call on this discussion -- we will have more later with a member of the house and senate. lakewood, washington. lawrence on the independent line. caller: i think it is a good thing it is happening. so much money spent in the government on medicare all because how much money it costs for insurance companies with everything. almost about 50% of income thrown into the system. if there is no reform that they're asking for not it will be the same amounts of money will keep increasing and it will put more money to people who don't give a crap about america's population. more money for the big man. when this in medicare gets

revamped and there is an actual market, it decreases the amount of cost. not only does it help people looking for health care but also it helps government for medicare so the plan is better utilize so people will have medicare can have some benefit without having its cost on people. host: how old are you? caller: 20 years old. host: are you feeling optimistic? caller: always. host: even though the concerns raised about people not caring about the youth in america. caller: that is okay. people my age are the use. whether or not they don't care they will be long gone by the time -- and then i can hear for the people behind me. host: lawrence, lakewood,

washington. the last caller on the open phones. it one article in front of "the washington times." democratic governors not all on board on health reform. host: we're going to talk about health care more later on. the next focus is on the u.s. economy and actions by the end of this week and what they signaled. we will be right back with krishna guha from "the financial times" who is chief economics correspondent. he has a front-page story on

this topic today. among this weekend on "book tv," it has been 20 years since the fall of the berlin wall and we will look back through two books, one of president kennedy, the construction, political fallout, and a book about president reagan, his call for wall to come down and the end of the cold war. then a 40 year mystery of two young black men murdered in mississippi and what it took to bring the klansman to justice.

and then a valuable tool in u.s. foreign policy is contractors. "q&a" sunday, the life and times of supreme court justice louis brandeis. >> this is a man who attacked 19 practices and attacked the courts with being not in touch with any reality -- by any standard, he was radical. >> a new biography of justice louis brandeis. >> "washington journal" continues. host: krishna guha returns this thursday morning. his front-page story in of "the financial times." what was unusual about the federal reserve meeting? a lot of speculation -- the cut

interest rates basically to 0 today. the question is how soon might they raise the rates in the future. this time they made the first change since march. they kept extended period language but for the first time this spelled out the conditions that lead them to that conclusion that said low levels of resource utilization -- to you and me, higher unemployment. subdued inflation trends. stable inflation expectations. what the fed is basically saying providing this actually happened, yes you will get interest rates staying near zero for a long time but implicitly saying, look, if unemployment

starts to fall more quickly than we thought, or if inflation expectations, inflation worries start to run away, then we will move quicker. host: you also make reference to fed doves and hawks. can you explain what they represent? guest: and the general jargon of central banking we talk about doves and hawks. hawks meeting people want to raise rates, tough on inflation, focusing very much on prices. being careful -- those to be careful not to tighten too much. focusing on unemployment. putting more convict on that. at the moment, there is quite a tussle with and the fed between these two camps. the hawks are saying, look, interest rates are nearly zero appeared the economy is growing

again we have been doing a lot of their extreme stuff in the last couple of years to keep everything afloat. we need to start thinking now about bringing this more back to normal because if we are late, this will end up causing too much inflation. the doves are saying, hang on a minute, and unemployment is virtually 10%, and it is going up, at least probably for the next several months. it surely does not make any sense tightening interest rates when we have unemployment, low utilization and manufacturing capacity and so forth. that is sort of the main nub of the debate appeared host: we welcome your questions or comments about the fate of the u.s. economy at all and whether keeping interest rates low is a good things in your eyes or whether you have concerns about asset bubbles or other issues. let me ask you about this

decision to have extended low interest rates. look at the benefit -- benefits and minuses for three cams, if you would. bank lending institutions. then lending to expand and providing more jobs. then over all for u.s. consumers. guest: low interest rates are very helpful for banks because it essentially banks structurally borrow short-term funds and lend them out at longer-term spirit that is the nature of their business. but they also can play the market's very deliberately threw their trading arms. what banks are doing at the moment is borrowing short-term funds at a cost of nearly zero and investing in things like 10- year treasuries, which still have a yield of about 3.5%. making a nice little turn. the same basic logic applies to their loans.

making a nice profit margin. one reason why banks are profitable at this moment despite a near death experience just a few months ago. for businesses, what we are finding is * a very good for the biggest firms in america in terms of financing. if you could go straight to the capital markets, fortune 500 firm, you could raise a very low-cost funds but if you are a small or medium-size business, you cannot go immediately to the market, you go to the banks. so banks are careful in their lending. so you see a two-tier system where the big guys get capital easily and the medium and small players can't. finally for consumers, basically it is bad news for savers, and deliberately so, because at a moment like this the fed wants people to be spending, or at least not to cut back on their

spending so quickly that they send the economy into a deep tailspin. host: the last part of the article, the decision by the federal open market committee to shave $25 billion offer of the plan to hundred billion dollar purchase of debt issued by fannie mae and freddie mac. these are mortgage-backed securities. since the mortgage markets was the genesis, what does this mean? guest: the linchpin of the said's unconventional efforts to support the economy has been large scale asset purchases. they have been buying overwhelmingly securities issued by fannie mae and freddie mac. in very simple reason. fannie mae and freddie mac supporting guaranteed loans, basically the only source of mortgage finance left because the private sector -- no

subprime loans left, no jumbo loans left. so the fed has been desperate throughout to that at least the middle market can still get financing through fannie and freddie. so it has been buying the securities issued. in doing so it has been making sure the cost of funds, mortgage rates, is moderate. that has been supporting the housing market. the decision been made yesterday is to shave $25 billion from one part of this program, which is buying their debt as opposed to the mortgage related securities. it is a technical issue and you can get into too much debt, but it is hard to buy as much as their debt as they wanted to, so you buy a little bit less. but if it over of some of the rings, the fed is by a lot more than $1.50 trillion of stock. so buying $25 billion less of something does not make a hole in the overall purchases. but i think it is interesting

that instead of taking the $25 billion and say buying into that less of this or more of that, just take it out. i think that is just another small sign the fed is taking these babies' deaths toward eventually exiting from its unconventional support. the baby steps. host: "the financial times close -- have the rules by which they issue mortgages been changed so they are not taking on as much risk? guest: 2 sets of issues. one is availability, can enough people get access to the lungs? there have been some changes. some people believe it should be brought about still further to support the housing market. the other is the riskiness of what fannie and freddie are doing. at a moment like this, the focus is keeping the funds flowing

beard in some sense -- flowing. in some sense, the time to worry about making these loans is the top of the market. most people think the housing market is around about bottomed out, giver take 5 percent for 10%. making the loans now is not necessarily it's terribly risky venture. -- not necessarily a terribly risky venture. at the end of the day the taxpayer is on the line for the whole lot. host: texas. leila of the democrats' line. caller: what i want to say the federal government sent stimulus money to the local governors and governors issued it to the mayors of the city's so people need to call their governors and find out how much stimulus

money they have and how much the mares are getting and how they are using this money. because you look around the city, a lot of time you see foreigners working and not american citizens. the other thing i wanted to say is i know that senator chris dodd and some other people working on rules that are going to govern the banks. i know they were talking about taking out credit defaults wop'' -- i think they are talking about customizing them. it did do that, that will create another loophole. our banks are global. " we gave them the money, did that money go to europe and asia and india and create jobs for people over there instead of creating jobs for americans? that is my concern. host: thank you so much. let us start with the

legislation coming out of senator chris dodd posset committee. pardon me for going to competition. "the wall street journal" have a front-page story. the regulatory plan on odds with the white house. if you read this reporting, it suggests the senators thinking is in a very different arts and from what we heard from barney frank potts committee and the white house. what is coming out from the committee? guest: as you say, this is from the competition so i am not accurately appraised of what they are referring to. credit card regulations, is specific set of issues that chris dodd is trying to get in to grips about credit-card reform. i think the journal piece is focused on the wider question of regulation. what is interesting there -- is there is not really a consensus on how to move this thing

forward. the administration came up with a detailed plan and put it to the hill. barney frank potts a committee started working on this. there are another -- barney frank's committee start working on this. there are another -- it number of things the disagreed with. it is not easy. it is very, very complicated. my big concern is we end up getting an insufficiently far reaching overhaul, because of that happens we are setting ourselves up for another crisis. host: banks being global, she is talking about tarp funds outside of the united states. guest: the truth is it happens but also happens the other way around. you have european banks with operations in the u.s. being indirectly supported by the bailout. so some of the u.s. bailout rest billing overseas and some of the

foreign one spill into the u.s. so net net it is not necessarily clear that the u.s. is losing out big time. one thing they were about as they do feel under pressure to act more nationally. the bank is here, in europe and the feel that sense if -- since they get aid from the government, they are politically accountable and should be funneling the money domestically. in isolation it may sound like a good idea. but a lot of people think the world is better served -- the u.s. and europe are competing. and considerably global banks from around the world are competing for office funds in europe. not necessarily a good thing having everyone's banks serving the national customers. host: her final point was on the stimulus package in job creation.

guest: i think the really interesting thing about the stimulus is most economists budget most private sector folks on wall street actually think the stimulus is making a material contribution to growth. of course temporary, but a material contribution. it is saving a significant amount of jobs. a lot of the models of just the white house may be was not so crazy to say 3.5%, the growth and q3, the three months was related to stimulus. but it is really hard to show this, follow the money and trail and identify how this is actually happening. as the caller says, the bunch of the money is going to states and local authorities. the reporting is really in exact. and it is frustratingly difficult for the taxpayer and

for the policy-makers to really understand exactly to what is happening to those dollars and cents. host: we are spending time with krishna guha from "the financial times." he has a front-page story. this question by twitter -- guest: that is a very, very sharp question. chairman bernanke -- the fed has a nice line. the famous prayer from st. augustine where he says, lord, make me chase, but not yet, because everybody knows a long haul the u.s. what the build up savings, households will have to save more. and indeed, households are saving more.

but if everyone tries to save a lot more at the same time what happens is that demand in the economy collapses and then people are put out of work and their incomes fall, so even though they were trying to save more they might end of not being able to save more. sort of a strange paradox at the moment is that you actually need to make sure we stabilize the economy and you get growth properly established before the savings rate goes up. you want the savings rate to rise through that process but so -- slowly. if we get the change we need to quit, it could be economically disastrous. host: paul, greenwood arkansas. caller: the key to recovery in the economy is jobs. the reason why our jobs are going overseas is because we don't have any kind of

government health care. bill kristol let it slip, that the military gets first-class health care and it is totally government control. if you can take the cost of health care off of those employers with the public option, and you need a strong one and probably at least the single payer, then the jobs will return because there are 25 million small businesses in this country and 15 million unemployed. think a minute. if you could take that load off of these employers who have been sending gis overseas, even a third of them could hire one person, that is 8 million jobs plus. what in the heck is the matter what is people listening to rush limbaugh will is being paid by insurance lobby to keep them

stupid, and just three kinds of people against the public option -- host: paul, i will answer a few of this point. i think we have another of your point. guest: the caller makes an important point, that health care costs are a burden on firms. very often the burden is actually passed on to the workers. in other words, one reason why the average always is -- wages for many did not improved very much over the past decade was the cost health care costs are going up, firms' contributions are going up so they were not paying people more. so sometimes the firm's action and the past on the cost of the employees and -- actually an up passing a low-cost to the employees. but it is certainly true that printed daily in some industries like the auto industry, the fact -- to the well-established

detroit firms have a very high standard but expensive health- care plans, has rendered them relatively uncompetitive compared to not just foreign producers but also new non- unionized firms in the u.s. there is certainly a between health care and employment. but also importantly, and wages. the one thing i would say of course, in fairness, in terms of balance here, is if costs are loaded up on some employers through mandates and so forth as part of the health reform, obviously that may increase the burden for some. it just as public options and so forth may reduce the burden for others. so we have to sort of look in quite a granular way about what sets the businesses are being helped or hurt by this. in fairness to the administration, i think they

wanted to be careful not to load up to many costs on the small businesses. host: the ap brand is -- the bank of england will pour 25 billion pounds or $41 billion into the economy and keep its rain interest rate at 0.5% for the eighth consecutive month. the banks decided thursday to expand its asset purchase program to 200 billion pounds. aim to increase the amount of money in the economy. it comes after last week's surprise news that britain remained in recession. that is a prelude to a question via twitter -- guest: the european union has a whole is grappling obviously

with all the same set of issues we are grappling here in the u.s. in terms of trying to overhaul financial regulation. there tends to be a bigger focus in europe on bankers' pay, and in a more prescriptive manner. most u.s. officials, if you talk to them privately, would say some of these bankers say schemes got out of hand, they were encouraging risk-taking, but this isn't really the center of it. this is about capital rules, regulations and institutions in the marketplace. the europeans are even more minded to think that a bigger part of the story was about the compensation. one area in which there is an emerging difference, the administration likes to play it down, but there is an emerging difference between europe and the u.s. is the european nations for instance want more standardized rules on how banks should pay their top employees

and star traders and so forth. the european nations want the standard benchmark, 40% to 60% of bonuses have to be deferred. the point is to give you slightly longer-term interest in what happened and to see -- before you pay out the bonus. the treasury and the fed have been more flexible approach. but don't want a standard 40% to 60% benchmark. but what the firms of cigarette the best way of doing it themselves. another area of differences over what we call leverage limits, but borrowing ratio. $10 of debt, $20 a day. the u.s. had these rules for banks, not non-bang financial firms. the u.s. wants these kinds of changes to come in.

they say -- europeans say, hang a minute, this wasn't really a big problem. some of the leveraged institutions were fine. they say the problem was more u.s. problems, why are we focusing on the simple leverage ratios. and this gets you down into some very -- hugely important and very complex terrain about bank capital regulations. there are different accounting rules and financial firms for the u.s. and europe. when you start reforming capital and regulation rules, it depends on how you define things like capital. you can't read this reform anyway that will help the europeans verses the u.s., it makes it very hard to agree.

host: akron, ohio. this is krishna guha. caller: two quick questions. first of all, green jobs -- obama. it is a pipe dream, realistic, and how much of an impact will that be? there is a movement afoot in china and opec, giving the u.s. dollar not tied to a barrel of oil. i am not sure the economic terms. it is the u.s. dollar off the international standard and move it to something else. how dangerous is that for the u.s. economy if that were to happen? guest: great questions. taking them in sequence. green jobs are not a mirage but we have to understand our likely

to come in place of something else. when we look at things like cap- and-trade legislation or more broadly, ways of capturing the economic cost of environmental degradation and so forth, imposing a tax or fee or payment into the economy, that is going to shift the balance of the economy. it is going to be bad for jobs in energy intensive sectors. and it is going to be good for jobs in the green industries. what tends to happen in these debates is people focused on just one side and not the other. the truth is, we are going to get both. they are going to have distributional consequences. you don't get something for nothing, so these costs may impact the measure of economic

activity. but the whole point of doing this is when you are just recording gdp, if you are getting a little extra gdp of the cost of trash and the environment i guess probably measured you can actually -- sort of and the long run. green jobs, there is potential but you have to waive this against the laws that will come in some of the other sides. in terms of the dollar, there is an enormous angst at the moment about the u.s. dollar, which has been sliding but not collapsing in any sense, but sliding since the bottoming out of the crisis. part of that is natural because in the middle of the crisis everyone wants to hold the world's safest and most liquid asset, u.s. government bills, and dollar assets in general. as panic subsided, people take the money out and put it elsewhere. but there is a wider sense of

dissatisfaction outside the u.s. of being so exposed to the dollar, so exposed to the u.s. -- you've got countries that have hundreds or even in some cases thousands of billions of dollars of assets tied up in dollar assets. so that means their wealth, if you like, is entirely tied up with the u.s. and then you see the u.s. running giant fiscal deficits, they worry whether the u.s. political class will ever be willing to take the tough decisions, tax increases, spending cuts, to get the public finances and balance. you see the fed during the interest rates and things they fear might lead to inflation down the track. and they say, why are we tied up with dollars? is there a better way? that is not the kind of shift

that takes place over a short period of time. i think it is more likely to come over a period of decades. but people are paying attention to the dollar. it is just this wild card in the pack right now. host: 10 minutes left with krishna guha. frank, democrats line. caller: back and the 1980's, i kind of remember things looked pretty good around here. we had a pretty good thing. but the thing is -- we had around 36,000 people, of 40,000 people inside that community here. then all of a sudden you get an influx of people. when you get an influx of people like that, doesn't that make the job industry suffer because if you don't have the job industries here to compensate for everybody who comes and then you start losing employment issues and then you have

employment jobs. some of the people making $15 an hour. i say back then that 1980's, things looking prospers and now we are looking at these times of years and things are starting to suffer, not equal out as much. what can we do to get this thing straightened out? guest: thank you very much for the question. i think the caller was calling attention to the link between immigration, if i'm correct, and the jobs market. it is a very complex issue. again, one that is often simplified by people on both sides of the aisle. obviously when immigrants come into a community, the work force expands, they are competing with indigenous people, people from that neighborhood for jobs. there is no question about that.

the distribution of the skills, if you like, and incoming population, it is often the law were skilled workers than the average in the community already so that tends to skew things a little distribution away. they may depress wages in the lower skilled areas. perversely that might be a benefit to those in the high skilled occupations who are not competing with low-skilled workers. it they are not only adding to the supply of workers but also adding four -- to demand for businesses and products. because they are earning wages and spending money. so, net net it is often a wash. what happens -- and to have a vibrant demographic, an expanding population, is often good, often attracts people to come to an area and set up and

encourages people to start businesses in that community. so you have to think of both sides -- additional supply of workers but also an additional demand. what happens in times of unemployment like today is obviously the tensions are exposed. in a normal economy that is functioning well, you should have full employment. the only affect on immigration should be on relative wages. but if there is insufficient demand in the economy, there are not enough jobs to go round and there is a trade-off between immigrant jobs and those who have been in the community for a long time. i think a long red -- or even in the short run, the primary is to get demand going again, to create demand and make sure businesses start hiring again, to make sure consumers are confident enough to start

spending again. and that demand will create the jobs that will ultimately be filled by both the immigrants and the people in established communities. host: john in holyoke, massachusetts. independent line. caller: there with me because i am nervous. and it is kind of strange i have been noticing all the news and c-span -- what i have been noticing is there is a consolidation of information, consolidation of banking. most of the people -- there has been a transfer of power from the people to corporations. i think it is getting to the point where people are not seeing the real point. it is all about life here. i noticed that information is being consolidated, the transfer of wealth from the people is being transferred to a special corporations and private interests. you have records -- i think this

is a way of different governments of controlling the masses and the wealth for -- i don't know, maybe there is going to be one type of the nomination that will be traveling all over the world. i've got one question. why is it that if we are giving money to the banks and all of these corporations, right? and we are the ones getting charged with interest rates. and the other thing. one question. how can the corporations get the flu shot before the public? i don't understand? every time it is supposed be helping us the corporations are getting over. this morning i just saw in the news, corporate companies ended up getting the flu shot before the public. guest: there are a number of points the caller raised. if i could gear in on one of them, the frustration that and

not -- a lot of the taxpayer efforts seem to be going to help the you rather than the many. in the first instance, this is true. in the following sense, taxpayer support, and particular for the financial sector, is necessary in the sense that if the financial system collapsed, trust me, we would all be in a lot of trouble. but there is no question in some sense there is a lot of leakage because the federal government comes in their role with its policies, the federal reserve sets interest rates to try to support the financial system, intervening in the markets. this is designed to save the

banks, designed to keep the institutions afloat and to get their way back to health. we have to do this because we don't know how the economy can function without a proper supply of credit. but there is no question that in the process the a employees, the senior employees of these firms and their shareholders are siphoning off some of the benefits created by government intervention pared that is most unfortunate. in some cases, it is downright tasteless when -- some bankers were sensible enough to understand the public's concern and some were not. weaken party like it is august, 2007. but i think this is a serious issue, and i think the banking community would do well to understand the public outrage on

this issue and the host: last call from palm bay, florida. caller: this starts off, for the last 30 to 60 years we have been robbing peter to pay paul and now we are charging this to our grandchildren and great- grandchildren. i have two quick questions. host: we'll have one minute left. short question and short answer, i'm afraid. caller: what to raising the interest rates a little bit to raise the dollar worth to keep the oil down be a wash for business and people, to bring the oil down, we need the energy to do business. and isn't the real problem with manufacturing jobs going back to businesses can always do something with taxes or pass along to their customers, hire lawyers or accountants to avoid them, but what and the environment movement came in, the paper company left, the

steel, and it hurt themselves because it takes carbon to bring it back then. but raised prices in america where you cannot buy american- built and now it is gone so far to hit cities and states to where michigan did all these environmental things, where it takes two to five years to open in manufacturing jobs but they bring in dcod, which they pay from taxpayer dollars and adult bring in enough to pay for them so all the businesses have to go out of businesses and give no or businesses tax breaks and excuse them from the environmental laws. host: gotta run. we are out of time. can you respond briefly? interest rates -- guest: very quickly. the affect of interest rates on the dollar is not trivial, in these two be taken into account. i do not think it should be based totally on the currency but it is -- on the green jobs,

the question is a level playing field. if environmental regulations brought speaking are applied in a fair manner and even manner, not just in the u.s. but globally, then we shouldn't have the loss of businesses from one place to another. .

>> he says it will generate chinese and mott american job. it would erect wind turbines in west texts he he saysno carrier

people to vote for a bill or against a bill. depending on where we're going. it's a lot of hard work but i love it. i tell people the thing i like the least about this job is

getting stuck at the airport for 2 1/2 hours trying get home. it's a wonderfu& opportunity and you know i come with i think a very blue collar perspective to this job and i think that helps me out a great deal. while have two years of community college but i also have a degree of common sense and in this institution sometimes that can help a great deal. host: your responsible to help whip or counsel votes. started out with a quote from the majority leader saying we're counting as the 18 bar looms for the healthcare vote on saturday. guest: i think we'll pass it. i think we're very close. a few issues yet to be ironed out but i think we're close. people that i've talked to, some that were leaning no, i think because of the extra work the speaker has done and taking trsq out with individuals has helped

a great deal. some of the things we've ironed out. congressman has issues about abortion in the bill. but at the opening day i think we have to pass this bill. i'm enthusiastically supporting this bill. we're losing 400 people a day. the dime of people that don't have healt$ insurance and 14 thousand are losing the health insurance they do ha+e a day. so i didn't come here to just vote, no. that's easiest thing to do is hit, no and sit back and watch. i - my parents lost their home when i grew up. my dad was ill and lost their home and my oldest sister was married and there was the deputy she riff. process server with 30 days to evict. i know what it did to our family and shortly before he died he said don't let this happen to another family. i'm hoping that when we cast be

just for him but for the thousand office people that have lost their homes and lost their lives that can't get insurance from their children because they have juvenile diabetes or whatever but you have to do it. it's not a question of should but must. host: you referenceed the abortion debate. congressman from michigan recently was on this show and we are also reading another area of contention besides abortion line is immigration and whether or not in the bill illegal immigrants should be allowed to buy into a pool and get any % subsidies doing that. which with your special perspective someone that worked in a hard industry hit by job losses, what's your thought on that? host: in the bill we have the language. when you go in you have to show your social security number. if you don't have it, they will

send that over to the social security administration and if it comes out without it you have to produce the documentation. i understand people's concerns in being able to purchase it if you're not a citizen of áhe united states. again, look i think we're a nation. people come here for a reason because where they came from it's very difficult for them, and look, we have clear language in the bill right now that says you must be a citizen in order to have legal status to participate in the bill in the insurance program. sr(t(r' i think every time we take a step forward somebody is trying push back and these are ways to is strakt us from what we have to do which is again, we have almost 40 plus million americans that don't have health insurance. we've got to get this bill done. immigration, abortion, whatever the issues are, at the end of the day we'll iron them out and my hope is saturday if we vote at six o'clock or four o'clock

we pass the bill. i can't think of p'ything more pressing right now than getting people back to work and getting them reasonable healthcare. >> call beginning with a call from wilmington delaware. caller: good morning. yes. i wanted to say to the representive you cannot purchase insurance if you do not have a social security number. >> that's cjqht under the current law. >> i worked in healthcare and i also worked as a temporary, nonbenefit employee and i hp" to purchase nongroup insurance. luckily, at the time i lived in the state of pennsv&vania and there were a lot of different things available but i have relatives in other state. onq is in new york right now and is on unemployment. it cost 9 to 1100 dollars a month for one individual to

purchase healthcare. and that's not even a really good policy, you know, so i hope that some of the people that $ave time or benefit jobs that they can run up to washington and think about the people who are working to two and three part time jobs to make ends meet. host: thanks. let's get a response from the congressman. guest: look. that's why we need a public option. in illinois, may tag left 1600 people without health insurance. they had two options. to have no insurance or go into cobra a highly expensive policy. if we get the exchange and i believe we'll have it, people will be able to go in, what i believe 5 percent of their income low or high to that matter and be able to purchase health insurance. at the end of the day what happens, a lot of the folks and

i've toured hospitals in my district and nine of them and 50% of the people that go through the emergency rooms and "t$ospitals in my district are people uninsured. it's a heavy duty cost to the hospitals so i support the public option and think it'll help people like you and others% to go in and buy quality insurance that they can have and another job provided employer healthcare you the not go with the public option and take your healthcare. host m host: indiana? caller: i'm one of the kind of peo(le i don't like government involve meant in my life. i believe the government has a limited role in america. keep our borders secure and keep the drinking water clean and make roads accessible. i'm antigovernment because i've

seen the cluster of ruin that this government has done. with good intentions. thev mean well, but for whatever reason they just don't get it done. this is my question to ask you and then i'll like to retort on that. i've heard through left and the right and middle, that down the road, it's going to be required - and i repeat, required. mandatory that all-americans will be required to carry government backed insurance. now what i'd like to know is, if that is true, and then i'd like to respond to that if you could? host: bruce we have to move on we have a lot of calls. guest: that's not true. for 85 percent of private insurance now they can keep it. there won't be mandates from the federal government of any kind and let me say this to you too. i understand the government sometimes does things that don't make sense to any of us, myself included but the veteran's

administration bill and medicare and medicaid are government programs. we're not perfect but that's whole run business by the government of the united states and for the veterans that go to out patient placements those are federal employees and i'll tell you. you ask veterans for the vast majority will tell you they will really be angry if we were tampering with the, v.a.. we do good things and sometimes to things i'll tell you, we mess this is a question of whether or not we're going to continue the status quo and we're not. as i said very early on, we have to move to a point where people can have quality insurance regardless of where you live and with pre-existing conditions and we're a better country than to watch people lose they're insurance and go without. host: earlier i showed a front

page story from the washington times with concerns about the shifting of a new population to medicaid roles and add together the unfunded mandates and responsibilities for payment privacy. >> we have to help those states. mine illinois is upside down in deficit spending and i met with the governor and he's con srned about that. but you know, again, i think what we have to remember is a lot of this is the strain puts on the state because their having their own financial problems and this is a recession we're coming out of. all be it way too slow from my perspective but we have to help our states and i think we can and once we get this bill through. look. this bill doesn't take effect until 2013. when we first had social security years ago. it wasn't the end all be all. they corrected it's a they went down the road and we can do that

as we see how the bill unfolds. i think we're going to be okay with our states. or governor is optimistic and it might just help 40,000 people will have health insurance that don't currently and that's huge drain on our hospitals. one rule in hospital in illinois to put this on perspective. three years back they had $400,000 in charity case work. the director said the follow year it went up to 1 point 3 million and monmouth illinois hospital, town is about 13 thousand will have 2 point 8 million in charity work. that's gone up to 4 hundred to "tr# anybody don't think we hava problem they need to go there. host: independent line? caller: i have a question - in fact two. michelle will wring the people

to you guys today. are you going to shut us out or let us? guest: i hope you come in. i have a mark up on things with transportation but r hope people go to every office. i believe every american can talk to every american in office. so no, i welcome people to come in. i may not always agree with what michelle back man does. but look, this is an institution that the people that send us here are really our bosss so i don't want tz shut anybody out. office and other offices and i welcome them coming and staying and saying what's on their mind. >> second question larry? you still there. sorry. have him any more. huntsville, alabama. sunny is on our democrats line.

caller: thanks for taking my call. i've been with you all morning listens and it's a great program with all of your guests. my primary question is, i - this issue is one of the biggest issues. i'm 61 years old. i'm a veteran and i have been following what's been going on politically all of my life. this is one of the biggest issues, and is the most miss information of anything i've seen. i support the healthcare reform. i think we need it. it's obvious we need it. i'm concerned especially looking at the senate proposals that what we're going to have is a watered down bill that basically benefits the insurance industrv more than the people of the country. i wonder, why when we began the negotiations that we took single payer off before any negotiation

have been a working situation. we already hp" a system in place. people already understand it. it seems to me, it would have been the no-brainer way to go. i could go on for hours but i know you have a lot of people that want to call but if you could address that aspect for me it would be enlightening and thanks for your hard work pushing this through. guest: i couldn't agree with you more. i'm a strong supporter of single payer and i think had we had done this, i think we could have had - a billion people complained. the bill that dennis and john conners introduced in the house has a total of about 18 pages to it. we could have done this a lot easier, but look.

candidly we didn't have votes and had to go in another direction. i'll tell you. there are things in this bill. no bill that comes out of this congress i've found in my three years of ber'g here is perfect but this bill comes along way. i got a glimpse of the republican bill. they're alternative is to cover only 3 million of the 40 million americans and and to let the insurance companies continue to deny people and at the end of the day it will cost this country 60 million. thanks for nothing. i don't want a plan like that and won't support a plan like that and if that's their version of healthcare reform they have to sharpen their pencils and try again. americans are smarter than that. what do you do with a child with juvenile diabetes. i had a woman that had 25 insurance companies she went to that would ensure her but not her family. if you don't cover pre-existing

conditions you don't have meaningful healthcare reform. host: houston? caller: good morni'g i really don't have a question for you. i just wanted to say i'm extremely proud of my i have heard that he stood on the house floor yesterday and gave a speech and invited every blue dog democrat to not committee political suicide. i think, it's standing u( for me as one of his voters in his district but it's also inviting my friends that live across the united states to also be representive, or rather by my congressman and that's all i had to say this morning. guest: whether your blue dog. with our party, we have you

know, the progressive caucus and blue dogs and a broad range of caucuses but i would say this. no matter what end of the spectrum you come from we all want health reform. what's the best way to do it is the question. i will tell you this. the easiest thi'g for any member of this institution is to vote, no and criticize the plan and that's perfectly fine, but i do think at the end of the day you have to have a' alternative. we've been way waiting for months for the other side to come up with something to have a reasonable debate on. we're to the stage where, how much longer can we continue to wait and when we did get it leaked out. we found only 3 million will be covered and cost us 60 billion to do it with no pre-existing conditions. i don't think it's political suicide. i think and i said this at a

town hall meeting if somebody told me my vote on saturday couldn'á come back, i would go home and sit back and get proud of the fact i was part of helping ordinary americans have% healthcare for themselves and their kids. i believe this will be the single most important vote i cast in congress. host: now sandra, independent line in massachusetts. caller: one question. 10,000 jobss. that so? and two, did the medical we have now fráz massachusettss is working. i heard that it was going to cost more if this bill goes through to us, and where are we going to get the money for it?

ours a lot lower in cost. thank you, could you please give me the information i need? >> second part if you have existing insurance policies you have as i understand and these can be in psalms and ou going wt it. massachusetts i don't think has to worry about this. gr+en the fact the states can stay in or out. i want to say i don't know about the 10,000 stimulus jobs. i certainly hope so. i met with the transportation committee i'm on that i serve on and he has a plan to put one million, one million pet to work if we in 90 days if we confront load to the highway need to do.that we desperately we've not to pivot off this once we get this done whether we pass it or not get people back to work in this countrv

i don't subscribe to anything like a job less recovery. someone said to me on the floor, the g.d.p is going up.% for an ordinary person on the verge of losing their job it's not g.d.p but job. we have to get this country moving and get people back to work. we have a highway reauthorization bill to retract with. a million people coming back to work in 90 days, come up with things that don't increase the budget defrcit. i don't know about the 10,000 but i hope that's true, but i'm also hoping the congress will pivot the next day and start working on proposals to get people back to work in the construction industry. we've got a lot of work to do this country quickly. hj'h we heard the president tell people as he's been out speaking, if you have a plan you can keep it. a doctor you like, stay with them. that caller has such.

can you tell her áhat her premiums will in the go up with her existing plan or her benefits will not beady finished? guest: i absolutely can. currently for people that have insurance and this is something that i think really, we miss in the whole debate. the current premium inc)ease for people having insurance that are paying for people that don't have it ranges depend on the estimates between $130 to $150 a month. not only can she keep it buá she should see a decrease in her policy because of adding the people into the exchange of the public option. look, we have to hold the insurance companies feet to the fire. we're asking them to do basic things in the bill. one, pay the claim if you say you are don't cancel a person if they have a claim. and the other thing is how about some good old fashioned competition. it seems with all the rhetoric we're hearing from the insurance

companies they will have the potential to sell their policies to 30 million addition people and i think they need to be held on federal antitryst regulations. if you're not doing anything wrong you don't have to worry about it. i'm not here to beat up on anybody but with the market the insurance companies have they should do well. with the congressman. next question from mary ann from chicago. caller: i have real good insurance and i'm okay with that, but i also want to have the public option for people that don't have insurance, and i don't understand why people get all upset when you tell them over and over again, you don't have to change and i think this bill will also protect me just i' case down the line, my

insurance couldn't keep me off for anything. so i just don't see the problem with people jumping up and down say about the government. every country needs the government for something and one more thing, everybody's talking about money and taxes. well, don't we send israel money every year? millions of dollars. nobody is saying anything about that. guest: everybody talks about the cost of this bill and i % don't know. i don't work for the cb o and they've scored this bill a couple of times. for 10-years, we're talking about insurancing 97 percent of americans for what we've seen on the war in iraq in 7 years. put that in perspective and i think that this country has a moral obligation to help it's own citizens out. second thing, for people like

yourself and i don't know if it's private or employer provided insurance. suppose you lose your job and we're in a recession and numbers are coming out tomorrow. i don't anticipate them being all that good on the unemployment. when they say 230 thousand people lost their jobs wlshgs do they go for insurance if you don't have a public option they ha+e two options. one is they can either try to get by without insurance or they can at the end of the day go back on the insurance company that will which aring charge them an arm and a leg for a policy and if you have anything other than the common cold or nose bleed they'll try not to pay it because of pre-existing conditions and i can't be a part of that. we had a woman before our committee that had a medical from there docáor and had surgery coming back and on thursday casq home to a letter from the same insurance company denying the claim.

now has a $1 $18,000 hospital all-americans this is a very important bill. there's been a lot of disinformation about this bill. our job is to sort what's fact and fiction and move on and have the courage to do what you believe is right and i hope we can do that on saturday. >> this legislation goes to the rules committee and on to the house the next day. what's the next 48 hours like for you as part of leadership? >> very busy. i'll be working with members. i tell you a lot of peop&e who were undecided before are leaning yes now and are coming into the yes column, so this is not going to be easy. you know, i don't think we'll see a landslide victory on the votes but we just have two n ne members coming in but at the end of the day, the democratic

party, i said yesterday this is the party of franklin roosevelt and john kennedy and party of medicare and social security. i want to be the party of healthcare reform. meaningful healthcare reform. that's who we are as democrats. i respect all my colleagues even those that won't vote yes. as somebody there that's negotiated union contracts for people. we've fought this bat for years and it's one i hope at the end of the day on saturday when i walk out of that door, you know when i go back to my district i hope people understand the reason, where i'm coming from is because i believe healthcare is a fundamental right for people and not a privilege. that's road i've taken here. >> thanks for being here. livq coverage of the floor debate on healthcare on c-span on saturday. we'll be right back. our next guest fju the first time in "washington journal" the youngest member of the united

states senate. we'll be right bp()y ♪ >> q & a. melvin newrosky. >> this man attacked the practices and the courts not in touch by reality by any standard. he was a radical. >> a new biography sunday night

on c-span. >> c-span's 2010 student cam contest is here. $50,000 in prices for middle and high school students. top prize. 5,000 dollars. create a 5 to 8 minute video on one of our country's biggest strengths or challenges we're facing. it should show varying points of good view. grab a camera and get started. go to student cam dot org for contest rules and information. >> "washington journal" continues. >> here's florida senator who is going to have an opportunity to cast a vote on healthcare. legislation this year. based on what senator reid announced. when do you think that might be? host: we'll have to see. we still don't know what the senate proposal will be. we had as you know the finance

committee reported out their bill but there was a bill from another committee and senator reid will work on the senate democrat proposal but it's not an open process. we're not sure what that will be buá hopefully will find out soon. host: healthcare is a big issue in florida because of retiring issues and somewhat of the center with the economy. the real estate bubble. what are constituents wanting done? guest: i hear a few different messages. of course we want to provide for more affordable healthcare and florida cares about healthcare access. nearly 18 million that don't have health insurance. they also tell me their concerned about the size of government and government spending and they're very concerned about the public option and what it's going to do to the size of government and their own individual healthcare plan. they're concerned even though

the president says you can keep your insurance they're not going to be able to keep it and saying if the government gets involved in the running of a health insurance company. i get a lot of concerns and people obviously want solutions to problems but in some ways they're more concerned that the solution might be too much government. >> you brought the actual one of the bills this morning, why? guest: we don't yet have the final senate bill and i think consolidated version. it looks like two phone books because it's on both sides but there's a lot in here. this is 1990 pages. speaker pelosi's bill is a program. we estimate that's about a half a million a page. there's a lot in there. a lot of taxes, new government programs and it occurs to me, i'm a new senator as you said,

i've been here since december and i'm used to florida where our government has to balance the budget. at thq end of the year they look at the receipts and taxes and expenditures and two have to meet. here in washington that's not the way things work. we pass bills that are 20% more than the bills we passed last year. it just came out we have a 1.4 trillijz dollar budget deficit more of the last four years of the bush administration combined, so i'm rep&ly concerned about how much government we have now and whether we can afford the government we have, let alone the government in congress want and there's a lot of government in the 1990 pages. host: as you think about the floor, what's a deal breaker for you? guest: for me it's taking a lot of money out of medicare. the proposal now in the house, and similar proposal was in the senate and we'll see what comes out finally is to take 1/2 million out of medicare,

healthcare for seniors you. f&orida. we have the second largest number of seniors in the country in florida and highest per capita. three million of them on medicare and this program, these pro(osals take a half a billion dollars out of healthcare for seniors. that makes no sense to me that we would pay for a new program taking money out of a program that's already in financial trouble. medicare in 7 to 8 years will run a deficit with more people taking out áhan people putting in. so it makes for being senator from florida, how could i justify voting for a bill that takes a 1/2 billion out of healthcare for seniors when that program already is in financial trouble. host: you've probably seen the story about the extent and dollar amounts in the 60 to 90 billion about abuse in the medicare system. how do you factor that?

guest: the first bill i file a buts. the ed medicare system an important program healthcare for seniors is rampant with problems but unfortunately florida is ground zero for that fraud. we have organized crime ripping off healthcare for seniors. sometimes as much as 20 million a pop. we don't do what the private sector doqáipú3 so my bill does three things. first it would put in place a chief healthcare fraud prevention officer. deputy secretary at the agency that add ministers healthcare who's only job would be to get rid of fraud and a buts. second, we'll to borrow something not or from the private sector. you go to best bye and buy a television or another vendor and walk outside, this happen to me here in washington and you get

an e-mail from your credit card company saying did you authorize that purchase? and you have to confirm to them that you did. they have a computer system set up. i live in floor dad abought a television. high expense item in washington and that doesn't conform with their computer model and that trans action is not processed until i validate it. my bill would take that system, from the credit card companies and borrow that model and set up a modeling program so if someone in miami florida sells the same wheelchair 100 times in one day and literally, we've had those problems maybe when the third transaction goes through the computer program would say look, we're not going to pay that claim until it's validated. i think we need to stop the fraud before it start as and the third thing it us and you would think and i think our viewers would think, we don't have

background checks on healthcare providers. we have convicted fe ljju signing up to provide healthcare to seniors and poor. we have to do something better to put those restrictions in place. i think that'll cut the fraud. host lost comment from our viewers on twitter. it says senator the five hundred billion is cut from waste and fraud. guest: respectfully i don't think it is. there are very extensive professions against waste that five billion is cut. 150 billion comes out of medicare cuts to the hospitals. 51 billion comes out of home healthcare, there's a 135 billion from medicare advantage. medicare advantage is a sort of premium type program in medicare and we have 915,000 florida citizens that subscribe to it. it provides more resources and

more options for seniors. thing like eye glasses and i know florida citizens like it. almost a million are on it. this proposal will cut 135 million from medicare advantage and that will impact seniors and i don't think that's a smart thing to do. host: one more twitter comment and then calls. james art said come on e senator, defending the sales medicare system might help you politically but the program is a disaster. guest: medicare does have problems and that's why i put this senate bill in place, but we've made a compact with our seniors. seniors pay into medicare it comes out of your wages everyú week or two. a per tenth end to pay. we can't go back on that covenant and not take care of healthcare. look, i'm the first guy here that wants to work on tryr'g

make government run better. a lot of folks in the united states congress want to create grand new plans and ideas. i get excited about fixing the programs we have and making them run efficiently but we can't abandon seniors and medicare. host: from pennsylvania. this is vir regina. caller: my last concern was the last man that basically to me, told an out right lie.% ron paul is not healthcare act because specific purpose is the individual by mr. obama's speech in september will be required to carry basic health insurance and carraying.c health insurance and cost out of the senior citizens we know right now it doesn't go where it's suppose to go. so thats with social security but also the charity that the care given by the hospitals.

you know, the figures are, hooper queen hospital in arizona. 000. on uncompensated care to illegal aliens. they need to do what i need. they give me a bill and pay on payments if you pick up the illegal alien and he needs care. give him his care and send him over the border. host: start reverse concern of coverage for illegals. guest: we're having a tough time covering american citizens so i don't think we have the host: should they be able to buy in if they cover it t$emselves. guest: i'm not sure you should prevent anyone from buying in. we take care of their childre'. they beat to go to public schools but we can't afford this program for american citizens as outlined in the 2000 papers and

i don't think we should look to expand it to i legal aliens. host: requiring people to buy insurance? guest: there's a mandate and there was a big exchange from george step november lhanopholo says a tax. if you do not purchase healthcare insurance you're going to be taxed 2.5 percent of your income and businesses that don't provide healthcare are taxed 8%. there's some 7 hundred billion dollars estimated of new taxs in this proposal, so it seems to me that there's something fundamentally wrong with the relationship of the government and individual if the government says it cares more about you than you care about yourself and will require you to bye health insurance even though you don't want to purchase it. host: next call from independent line from georgia.

caller: good morning. so i'm a libertarian. i don't subscribe to the republican philosophies. i have to address the cost of this. the government mandating costs as they do in medicare won't bring the cost of the services down. the only thing that brings cost down is, the only thing that ever brings cost down is a competitive environment so i had a big idea which i'm sure nobody will subscribe to but i'd like to throw it out there if we got the companies out of delivering medical insurance and the government out of it, and all the individuals would buy their health insurance, you could form, there has to be some government vomit. yo involvement and tax all the insurance companys the

same way they do the banks that support banks that go bad. in this case you use it to support the indy get and people that can't afford it or ha+e pre-existing conditions and elderly and all those folks can be taken care of out of that fund. host: senator? innovative ideas and not those that are necessarily run by the government. there's this idea of an exchange. senator energysi has put forth insurance companies would be told this is the policy for individuals. and you need to come in at a certain price and we'll divide the country up and say let the insurance companies compete. we've done something similar under a florida plan. there's innovative ways to provide access. you have cover this, have to have cat graphic care at 2

$50.00 a month. here's 40 million americans bid for it. that's great innovative idea. it's market driven without the government running the program. host: john, democrats line? caller: good morning. yeah, a couple of things i'd like to say. number one, it seems to me that the private health insurance companies have had their opportunity and blown it. personally, i'd be quite happy to let the government run an insurance company and see how they get on, we wouldn't have this problem if free enterprise could handle thq job well. there's only two people in washington that know what the real so&ution. one is ron paul and at the other end dennis gasenich. we have plenty of money to go on foreign adventures and build planes and bombs. et cetera. no one is going to attack us while we have those silos tuned

up so there's plenty of money to take care of our own and it's about time we do. i'll take your comments off there. thank you. host: military spending and not healthcare? guest: we're fighting two wars and that's expensive. our country was attacked. and i support our military. think we have to continue to defend the homeland and wars are expensive. we should do a better jzb in defense spending like in all the other areas of spending. look. democrats and republicans want to do something about healthcare and a ford built and want to cut waist, fraud and a buts. we have to take it step-by-step but there seems to be a lot of emotion to get this done quickly. it's mindful to remember the hippocratic oath for doctors. first do no harm. i'm afraid this will cut

medicare for seniors, two raise taxes and three, actually increase your cost of health insurance, the congressional budget office which is nonpartisan said this may increase your premium bias as much as 80 percent. that's not healthcare. host: margaret from texas republican line? caller: good morning. i admire what you're doing, but i don't know what's going to happen but i have a little story to tell you. i'm 76 years old and i'm in fairly good health. i don't take any prescription drugs but i have a daughter that had deteriorating bones and she's a wheelchair. i have a daughter that's totally blind, my daughter that's in the wheelchair, she takes lots of medicines, and if they take that medicare advantage away from her, i don't know what she'll she's um... an older woman in

her early 60's but she is in bad shape. my husband died a few years ago with alzheimer's and i've had a hard time and i draw medicare. i don't draw medicaid. try to live on my medicare but i don't know what me and my daughters are going to do if they cut on us where we can't see a doctor. you've got to help us. all you republicans out there, please, please! do what you can. i just don't know what we're going to do. thank you, sir for what you're doing. guest: thank you, margaret. my heart reaches out to you and your daughters. i get letters and calls like you is and i can't understand why we're trying solve healthcare by taking money out of healthcare that we've committed our

seniors. it makes no sense to me. maybe the folks the democrats that put this proposal think in a couple of years we'll go back we're in a situation where we have a 12 trillion dollar debt and this will all catch us some day. i'm going to fight to keep your host: this is bonny from the line. caller: i was listening to the lady before then, my comment, i don't trust anybody up there right now. um... because i'm 72, we're not going to get p raise this year, but they will probably raise our deductible and take that much more money out of our pocket. and why they don't open insurances across the state lines and tort reform.

if they don't do something with tort reform it's not going to work. and i just - to take away our medicare and advantage after we have workq" all of these years and in that bill you've got in front of you, how much tort is in that bill? ho host thanks for the call. sáop at this point because you've given a few issues. let's start with tort reform on that. guest: this proposal doesn't address tort reform. the president in his a dress to congress said he would do exploring on that. i can tell you, i know first hand that doctors practicing defensive medicine because they're afraid of lawsuit and high premiums for medical malpractice insurance is directly impacting the cost of healthcare. my wife and i have three sons and a baby on the way.

her doctor is in tall a see florida. we went and met with him and i talked to him about his medical malpractice insurance and he's pays $120 thousand a year in medical malpractice insurance. that's directly impacting our cost of healthcare. we need - republicans have a propose toll reduce the cost of practice of medicine. if everybody comes to the table like the president said we should, that's got to be part of the solution to get healthcare reform. host: cross line insurance sales? guess guess there' guest: there's no reason why you can't take your healthcare insurance when you leave your job or move to another state. it makes no sense. the way we regulate it state by state in this antitrust exception for insurance. not sure that makes sense either. we need to treat insurance like

any other business and make it host: jefferson, new york. veronica. your on the air. democrat line. caller: thank you for letting me speak. could you just give me a few minutes. i wa't to know why, the republicans have been in power for the 12 years up until 2006 when the democrats took over. you never lifted a finger or do anythi'g about healthcare and out of the senate is e proposal that is brought up is, no. even when you did the unemployment. i watch it. it was no, no, no. fighting them and i don't get it. the people of the united states need some type of help when it comes to healthcare. and it just seems like you just don't want to cooperate in any way. and it is very frightening thing

and you have people scared to death with the different things and today they're telling them to raid the congress and let them see the whites of your eyes. "táhis is ridiculous. this is absolutely ridiculous and i just want to know why, money is so important now but when bush was in, money was never a question. you call yourselves conservative but your spending more money increasing government and doing everything that your complaining about the democrats doing. host: thank you. guest: well, first of all i'm new. i'm not responsible for things that happened before i came but veronica said republicans didn't do anything about healthcare in the last few years. president bush pushed through the medicare partd the prescription drug benefit that's been wildly successful and actually came in under cost so i

respectfully disagree on that. and i' terms of the point about fighting things like unemployment insurance and we still voted for. propose for the viewers to know about to extend unemployment insurance in several state as wednesday is pow importanted it but our leader went to harry reid and said, we should have a way to pay for this. we should find a way, maybe take some stimulus money that hasn't been spent and pay for it, and the majority leader wouldn't let us have that amendment and debate those issues. i know it's not something most folks realize but the way things work here in congress, the majority of t$e democrat party dictates rules and we try to get things on our side and that's why it takes longer than expected. host: jeff, republican line. virginia. good morning. caller: morning. i'd like to ask a question. several months ago i had back surgqry done on my back.

i went to my pre and it cost i'd like to know what goes with the cost of that? if you people up on dc want to know what would solve the medical problem and democrats as well as republicans. i turn republican when reagan came in. a contract the people of the united states to work for the people. republicans and the democrats both, do not have no idea what is going on. i hear raising costs, lowering costs. bill is 19,000 and some odd bills. the deficit will last until my grandchildren are 60 yqp)s old and a job prospect is none. nobody up there is doing nothing except spending mjátk and spending money if you want to solve the medical problem in

this country, go regulate the cost of medicine where it takes five cents to make a pill and they charge $10.00 in a hospital. host: thanks jeff. guest: he covered a lot of ground but let me talk about cost. the truth is, we don't know what things cost in healthcare and there's no transparency in the prices that you pay. you know we've all gotten this bill that gets sent to us and if my wife is having a baby or there's a medical procedure showing $10,000 for this and you look at the bed pan cost $100 and a band-aid is $50. the reason why this is happening is because healthcare, hospitals and other providers of healthcare have to make ends meet in any way they can. i talk to the head of the florida hospital association yesterday and he told me basically look. medicare and medicaid don't pay the bills of the patients that come to see them. we take the money we make on

private insurance and subsidize medicare and medicaid patients healthcare.aying a shell game in we don't know what the cost of any particular procedure is. the healthcare providers try to get whatever they can on any particular item or service to make they're budgets and what we should do is post the prices of all of the different procedures from healthcare providers out in the open so people can comparison shop. if we did that i think costs host: holly ridge from north carolina. t line? caller: like your view on not giving illegal aliens any more freebies and entitlement p!uses and all that fraud. i want to ask about the, cb o for the healthcare bill. they had said something - i was watching on the houáq floor about 7 years of debt and they were putting that up with

10-years of income of collecting money. and i was wondering you could elaborate on that? guest: your referring to the congressional budget office scores saying how expensive a particular piece of legislation should be. this is scored a the a trillion, 60 billion dollars. and the way they do that is they go through the (roposal to figure out. i think it will cost a &ot more than that. they try to go through and figure out what's going to be created by new government programs. there's an apparently 111 new offices and bureaus and commission's created in this healthcare proposal so it become haves expensive. now to the point you said, how's it paid for in three years verses 7 years the way this bill works and way they getting to be receive sit neutral is there's a lot of taking in of taxes early before the actual programs start

working and getting and delivering healthcare services. those taxeák there's a- 5.4 percent on people that make more than 1/2 million a year. the original mandate tax and tax on businesses. those start right away. the benefits don't start until year three or four or five. that's how the smoke and mirrors to make this deficit neutral. ho host our papers are full of second day analysis of tuesdays elections when you see ahead line as this one, and baltimore sun this morning. what's your reaction. republican moderates to blame for the parties troubles. guest: i don't think that's true at all. i think what the people want is public servants that come here and be problem solvers.lutions what i think the election on tuesday said is the people in new jersey and virginia and new york, they've got a real concern that government officials, folks elected to office keeps

expanding the size of government and keeps spending their children's and grandchildren's money. i think folks are concerned about trillion dollar new programs and their concerned about incumbents in office pushing these. where the mayor in new york that eked out a win or chris, cristy in new york. which is a big deal from republicans or the governors raise in new york. host: thanks for being here. please come back. guest: thank you susan. host: one more seeing innoc se. meet formq) military members here to talk about the policy toward afghanistan and whether or not we should send more troops. first a news update from c-span radio. .

>> a group of senators are working with the white house on a climate change bill. democrat john kerry, republican nancy graham, an independent julie berman are working on a measure that could republicans -- lindsey graham, and independent joe lieberman are working on that measure that clear the whole senate. barbara boxer is considering a measure to move ahead on the bill without republican to the

patient and that could come as soon as today. -- the republican participation that vote could come as soon as today. aides said palestinian president mahmoud abbas has told allies that he will not run in general elections and will make that announcement in a speech later today but the aides say that the present receive calls earlier, israel's president and defense minister and the president of egypt and the king of jordan, all asking him to reconsider. those are the latest headlines on c-span radio. >> last thursday, house democrats introduced the health care bill. this week the bill comes to the house floor. follow the entire debate to life, without interruption or commentary, only on c-span, c- span radio, and at c-span.org, and find out more on c-span's health care hub.

>> this weekend on book tv, it has been 20 years since the fall of the berlin wall, and we will look back through two books but one on president kennedy at the political fallout, and a book on president reagan and his call for the will to fall out and the end of the cold war. on "after words," the 40-year mena -- 40-year industry. and allison stanger says that a valuable tool in foreign policy is private contractors. >> "washington journal" continues. host: in our final segment we'll talk about troops in afghanistan with two members of the house of representatives who bring to the discussion their own experience in the military. congressman eric massa is a

democrat from new york could tell people about your military experience. guest: good morning. i spent 24 years on active duty prior to coming to the united states congress. it has given me a tremendous focus to ensure that these decisions are made without politics, and in fact that we focus on getting it right. it has been a tremendous influence on my thought process as we ponder these significant topics. host: mike kaufman is a republican from colorado who also served in the military. guest: i served in the army and marine corps. i've had five overseas assignments in my career, four of which took me to the middle east, the last one to iraq. i served on the ground in a civil affairs capacity. host: both our guests are members of the house armed services committee.

let me start with you, congressman coffman, about your view on the appropriate decision on afghanistan. guest: we are waiting to see what the president will do. march 27, he said he wanted to fully resources were unchanged the strategy, and i think that is appropriate -- resources this war and change the strategy, and i think that is appropriate. i think it is in the security interest of the united states to make sure that we prevail in iraq and give the afghan government the capacity to do so. but i don't think we can forget 9/11, the fact that the give safe harbor to al qaeda -- the taliban gave safe harbor to al qaeda and they are not defeated but disburse. we cannot forget the fact that we under resource to this war over the last eight years and

had a failed strategy and we cannot forget that this is one theater of operation for pakistan. an unstable afghanistan contribute to an unstable pakistan, and with pakistan, with the issue of nuclear weapons. host: congressmen massa, your view. guest: the united states is not an imperial power. we invaded when the mission was clear, to identify, locate, capture and kill those who does harm or who would do less harm in the future, and admission is prevalent and continues through we are not and should not be in the business of creating an afghan national identity and expanding -- engaging in and this nation building. -- and this nation building. we have written checks for $300

billion in afghanistan. i cannot for the life of me identify what it is we bought. to prevail is undefined. to win is not associated with a particular outcome. if winning is creating a jeffersonian democracy and a kabul, certainly the elections of the last eight weeks and a farce that surrounded it proves that it is a fool's errand it is time to come home. the pakistani government know where the meeting al qaeda terrorists are and will not do anything about it. the only option is to invade pakistan. instead, we are giving them $1.7 billion a year. it is time to come home. we are not an imperial occupying power. host: we want to get calls for the two guests. before our first call, for both of you, reflect on two events in

afghanistan this week and how it affects your view of what should be done. first of all is a bill, bill's announced this week after we learned that -- abdullah abdullah's announced this week after we learned that he would not to dissipate in the runoff, holding a press conference where he called karzai's victory illegal and that they would not check corruption or fend off the taliban. the other one is the deaths of five british soldiers who apparently will and for traded -- infiltrated by afghan policeman, people that we are expanding money to train and we hope to be part of the security feature of afghanistan. guest: first of all, to the issue of a padilla -- for abdullah abdullah and the elections, i am glad that he did it out. he is not a pashtun. 45 percent of the population is pashtun. very rarely has afghanistan been

deferred, and only for short periods of time, by somebody who is not part of the pashtun ethnic group. our problems with the taliban are associated largely with the pashtuns. it is important to let karzai stay in office. at the same time, it is important for the administration to focus on the issue of governance. to the afghan people, it is not so much about whether or not the election is corrupt. what matters to the afghan people is whether or not there is a rule of law, whether or not the government has the capacity to establish a rule flocks -- a rule of law. so far it has not demonstrated the ability to do that. i would agree with eric -- if we cannot do something different, if we are going to model down

the middle and not resource this war and have an appropriate strategy, we will not prevail and we should get out. i hope that the president's plan not only focuses on resources, but focuses on a difference that it that makes sure -- fred strategy that makes sure that the government in afghanistan has the capacity to establish a rule law. as for the british soldiers were killed, having worked in iraq with the united states marine corps, that is no doubt a tragedy when that happens. we have to have an appropriate vetting of afghan security forces, and that will take a presence on the ground of u.s. forces to make sure that we build an afghan military that is certainly capable and that is not infiltrated. but there are going to be setbacks like this throughout this and never even if we do things right.

it is a tragedy, but unfortunately, counterinsurgency operations, it happens. host: mr. massa, and then cause. guest: our hearts go out to our british allies and those families who have lost loved ones in afghanistan and iraq. let us never diminish their sacrifices even when we disagree on the strategies and missions assigned to the personnel with american military -- personnel. american military members carry out the burdens and there is honor and integrity in doing so. i take exception with my esteemed colleague. when someone says "i am glad that karzai remains in power, that he is pashtun," i ask the fundamental question -- who are we as americans to have an opinion or input on the controlling factor as to who wins elections?

when that is followed up with the concept that elections are secondary to rule of law, and yet our on the ground military commander states that the no. 1 mission is to secure those elections, that is the exact example of a mission that should not be given to uniformed american personnel. in fact, it is a fool's errand. the afghan people lack a national identity we are trying to enforce upon them. we will never ever be successful in creating a jeffersonian a democracy that we then believe will serve our interests, be it pashtun or any other ethnic minority. the afghan people will not stand and fight and die for what we are asking american military personnel to stand and fight and die for. therefore, fundamentally, there is a disconnect between the strategy and the mission, and the overwhelming military presence in that region. it is time to come home. period.

host: i know you're going to respond, but our callers have questions. dennie on the democrats' line. caller: good morning. i'm glad we're having this conversation to the pri when i look at this entire adventure group and on, when this group of -- this adventure we went on, with this group of terrorists attacked us, it should have been handled as a legal matter rather than as a war matter. we have terrorists locked in prisons where the air doing nothing. -- where they are doing nothing. we spent billions of dollars lost many lives on a military adventure, and we still have not brought these people to justice in eight years. there is something very flawed but the entire concept of going to war -- and i think that came

about because of bush's ambitions and dick cheney's ambitions to invade iraq. i do not induce -- i do not think these people should have been given credit to go to a war footing. i think it should have been treated as a criminal matter from the beginning. host: mr. massa, t want to start? guest: salutations to liberia, an old stomping ground. one of the challenges we face in congress is inheriting a lot of baggage over the last eight years. i try very hard not to historically spent my time casting aspersions on any other administration. our mission is here and now in the future. i believe it is fundamentally the white and the necessity of the united states of america to deploy military forces to identify and locate, kill or capture, those who would do us

harm anywhere they may be. i'm not a pacifist. i'm not a group hug a kind of guy. i spent 24 years in the military, 8 the plains, and the vast majority of the time spent was in the middle east -- 8 the plains, and the vast majority of the time spent was in the middle east. but it is not in the national interest of the united states of america to deploy 100,000-plus military personnel as a permanent garrison in a foreign country that lacks a national identity and pour billions after billions of dollars into a government that is so corrupt that even they themselves cannot determine how to hold a corrupt election. that is where we are headed with our current policies, and that is why income saying here today -- i am saying here today is time to come home. guest: i think, first of all, we were attacked on 9/11 and over 2000 americans lost our lives,

and attack on american soil by a nation state that gave safe harbor to those who attacked us. in and shared their ideological views. that is an act of war for if ever there was one. they have long memories than we do. and the americans by and large have forgotten 9/11. if we give up in afghanistan, the same individuals who attacked us will reconstitute in the country. i do not think we can allow that to happen. i am not going to make excuses for the failed policies of this last administration in afghanistan i think it was deplorable that secretary of defense rumsfeld had this light footprint view in both iraq and afghanistan and it was a failed policy, a failed strategy. i was in western euphrates river valley with the united states marine corps when we did not have adequate resources there and we took casualties on

necessarily as a result of that and we did not move the political process forward. was only when we had adequate resources in that river valley that we were able to move the political process forward and gain the confidence of the civilian population to turn it against al qaeda. i think that we need to look at that same strategy for afghanistan. in iraq right now, we pulled out of the urban areas of the june 30 deadline and we were scheduled to be out of the country by december of 2011. we will not win the war in afghanistan. it will be the afghan people who win the war and we need to give them the capacity to do so and the security to be able to develop that capacity. host: next questioner, as from san diego, republican line, and this caller's name is susaie. we cannot hear you very well re.

caller: i'm sorry. i think everyone would love to have those boys, hundred i think about them every day and wary. but we are in a situation, can i just picked up and leave. we have other countries in there with us. is that not true? we are in a situation that we cannot just pull up and get out of there. i would like to see how you can do that gracefully. i agree with you that these people really don't have the capabilities to perform with the government the same way we can. but there has to be some way you can establish some kind of stability with the government. already we know the fellow in there is corrupt. but i would like to know just how you can do this without upsetting the apple cart.

and those boys -- i saw someone over there in your viewing them, and they are in harm's way. they cannot trust the people, as they go from one side to the other. guest: thank you for the call. first of all, we are not after establishing a jeffersonian democracy in afghanistan. afghanistan has had periods of stability. if you look at the history of the country from probably 1963 -- i'm sorry, 1933 to 1973, they entered stability in that period, and from 1963 to 1973, they were moving forward with democratic reforms. they unfortunately had a series of could talk -- coup de tats after that and there was a

soviet intervention in 1979. but they are certainly capable of governance. counterinsurgency warfare is tough. it is difficult. we certainly have matured our doctrine and learned a lot. learned a lot about it from our experiences in iraq and they are being applied to afghanistan. but you are very right in your point that what message does it stand, not simply to pakistan or the people who have been working with us and afghanistan, that the united states will simply walk out? and what about the leadership in nato, that the united states will simply walk out? this will be an extraordinary message to those who wish to destroy is that the united states is weak and will easily give up and walked out.

there is no question that we need a new strategy. that does not change the importance of the national security objectives involved here. what a great io victory, information-operations petric, for our enemies if we walked out. in bolton -- it would emboldened radical islamists with their objectives and in that region. guest: these are the exact same arguments that we heard throughout conflict in vietnam. we have lost at discount 911 u.s. military personnel fighting for a government that is so corrupt that it turns upon itself. yes, we can develop annexes strategy that tells -- an exit strategy that tells the world that our national security interests are in the united states of america.

but we can identify and localized and kill and capture them. we are not an occupying power. afghan governments that have some -- did have some stability over time, but those were under king, and we said to the king we wanted to create a democracy. if we are not trying to create a jeffersonian democracy, why did general mcchrystal said that his number one priority was to secure the elections, elections that were so far to lead that the primary parties involved -- so fraudulent that the primary reason often walk away from governance? karzai is so corrupt as to be absolutely discredited, and his entire government follows him with the afghan people will not stand up. there is an afghan at kennedy, it should come from within the country and not without compunction -- if there is asked and identity, to come from

within the country and not without the country. this is the united states of america, and afghanistan is not our 51st state. host: i have a detailed question for you -- when you include the casualty numbers, why did they not included the numbers of contractors? guest: that is a very good question. no one intends to be fe -- to leave that sacrifice of the table, but it is a very hard number to come by. the only ones at access to our published by the department of defense. any other number i use would be a guess and in my to disrespect or harm, and i do not mean that in anyway. we have thousands critically injured, and more hurtful in some matters, soldiers and marines were there and burden -- will bear and bird and the scars

of this conflict for their lives, along with tens of trillions of dollars. for those who protest and said the federal government should not build highways and infrastructure, why are we spending billions of dollars doing that in afghanistan only to see a corrupt government destroying it in there conflicts? it is time to tell them that we're coming home. host: mark from hon still, alabama, independent line. caller: i have been listening in and i wanted to make a comment. i served in the united states navy four years and went over to desert storm. -- for years and i went over to it doesn't storm. initially, i said we needed to stay. but i am at the point now where i do not see the long-term --

perhaps there will be a long- term benefit if we could help with the stability, but because of the corruption, because, as you just said, we should be added to this the -- should not be in the business of nation- building. i went over to haiti, the second time we intervened as a country, and we always fall short. the people of the native land -- they have to resolve their own issues first. sure, we of political aspirations dealing with them. people like to bring up 9/11, but what about vietnam, pearl harbor? people are always going to be after the united states, period. host: let's get a response and we will start with congressman coffman. guest: thank you for your

service to the united states may needed we have to look at what will happen if we simply get up and leave it and walked out of the country. i think the taliban will reestablish governance there, and al qaeda will be back in the country. they will have the ability to generate money off of the opium drug trade. they will derive all of that in the future and use it as a staging ground for terrorism and we will be back there again. the question is to be resolved it now while we are there? i believe we can. we have had a failed strategy and i think we can do a better job and combating the corruption in the afghan government. it certainly is an issue. the failed elections were an issue as well. i think the fact is that what

the afghan people are looking at is whether or not there is a government out of kabul that will establish a rule law -- rule of law in the country, that has the capacity to do so. also, we need a change in strategy that will reflect the political culture of the country and will reestablish the importance of tribal governments at the local level. i think there are a lot of things we can do differently. i would agree with eric that if we continue down the same path, it is the wrong path. but i believe that having served in iraq, having served in an area of the country that was al qaeda-controlled, and that through greater troop presence we went from simply having a company in the river valley to have a reinforced battalion,

that not only brought down the u.s. casualty rate, and we had our iraqi counterparts with us in these operating basis, but it bought the people who did not know who would be in charge tomorrow -- i am sure that the people of afghanistan are listening to comments today wondering what the u.s. commitment is, with the taliban will be in charge tomorrow -- people the confidence to allow the political process to move forward to give them the capacity to defend the country. host: let me take a call from shreveport and then i will come to you. shreveport, democrats line. caller: i'm a democrat now, but i will never be again.

my son is a lieutenant colonel and he has served in the military for 21 years. he is a proud american and he has been to iraq and just came home. am telling you what -- when we pull out -- we did this in vietnam. i am a 77-year-old woman and i will never forget how they treated our military when they came home but i am telling you what, if you don't send more soldiers there -- our soldiers in afghanistan, they are very sad. they know that this president we've got is not -- he is a weak man. he wants the money from the military to spend it here. guest: so weakness has nothing to do with sending americans to

defend a country that will not defend itself. strength has nothing to do with prominence in a corrupt foreign country -- permanence a corrupt foreign country that has no national identity. we have every right to let the afghan people and ask what their commitment is. we did not spend time wondering if the british would come or the french would go. we stood up and said that this is an asian first and foremost before asking anybody for help. -- this is a nation first and foremost before asking anybody for help. is it not up to them to stand and fight for themselves? why is it that we would this honor our military -- dishonor our military by sending them to do what a foreign government and military will not do for themselves? it is not a matter of strength or weakness. it is a matter of learning the

lessons that we should have learned all along. the united states has no reason or purpose to expand our military on overseas occupations when those nations will not stand in common with us. kabul is not seen as a central government. they have no authority at said the kabul area and they never will. it is a tribal nation organized along ethnic lines. the disgraceful corruption that is now spread and discrediting the government that we asked our american soldiers to fight and die for i think is the absolute most disrespectful thing we can do to our military, and i say that as someone who has spent my entire life prior to coming to the united states congress on active duty. i agree with my colleague the last eight years have been an absolute disaster. but i am not willing to put my name to another eight years failed policies. maybe if the afghan people realized that we will not stay forever, they will stand up and take charge of their own

futures. but as long as we have an indefinite commitment without a definition of what our strategy is, and these nebulous statements that we have to win and no one can define what victory is, we will be mired in the mud and the rest at a cost of lives and treasure that i think is unbearable. host: our two members -- guests are members of the armed services committee. republican line. caller: i wanted to ask a representative massa what you will do when these young men come hundred their parents probably cannot of the homes there living in. you cannot offer these boys jobs. at least they are over there and getting paid to try to make a better nation. we are 225 years old and we're not solve our problems. what is the difference between

bernie madoff, wall street, and tax assessors? congress and wall street and tax assessors of a suspension and to have been ripping off over 147 million -- have been ripping off over 147 million. guest: i think is a weak argument to say that we should maintain 100,000 military personnel in afghanistan being shot at any harm's way as a jobs program. i am in no way advocating the reduction of the size of the united states military. quite the contrary. we need every active duty military personnel we have, " we do not need -- we do not need them there. their jobs are safer and more secure in the united states. please know that in a bipartisan manner, with total transparency, and i know my colleague will agree with me, nothing to united states congress like an absolute

requirement to look after the needs -- nothing unites the united states congress like absolute requirement to the after the needs of our veterans. they have so many challenges facing them in a downturn economy and issues that are coming from iraq and afghanistan. i would like to turn the floor over t their -- to the floor over to eric. host: you are taking my job away from me. guest: i want to say one thing. this not about the people of afghanistan, does not for them. -- this is not for them. this is for the security interests of the united states. we need to establish the governments there that has the capacity to keep our enemies out of that region. that is why we are there.

we are not there for the afghan people. that is certainly a positive byproduct of being, but again, i think eric and i certainly agree that we did a different strategy to prevent -- we need a different strategy to prevail. i think eric wants to get out under any circumstances. but i think we need for resources for this war and a different strategy. -- full resources for this war and a different strategy. host: independent line. you there? let's go to james in texas. caller: i would like to congratulate the democrat there. a bit of fresh air that we have someone in congress like this democrat, not like this. over here that says we need our boys -- not like this idiot over to that says we need our boys

over there to be killed. they are just killers. i am a korean veteran and you were sent over there for the same reason, for nothing. i went over there waving flags and everything else and i came backe. you sat over there for a year and you have your feet frozen off and you want to send more boys over there. it is so ridiculous. we were ran out of vietnam because the american public got fed up with people like this republican over here. host: all right, thanks. we will let the republican have a chance to answer. guest: first of all, thank you for your service. currie was a difficult conflict and thank you for your service. -- kora was a difficult conflict and thank you for your service. we started of vietnamization

program that required the army of south vietnam to take the place american soldiers. the undaunted not collapse -- vietnam did not close until there was a sweep by democrats and the congress in 1974 that cut off all funding for south vietnam, which would include ammunition and fuel, at a time when the forces had withdrawn from south vietnam as they should have. be not collapsed -- the vietnam collapsed in 1975. we do not need to repeat the same mistakes here. i think we wait to see what the president has to say and how he changes the strategy and have the resources of this war -- how he resources this war. it is premature for us to say, prior to having the president come forward, that we ought to just up and leave afghanistan. i think we were attacked, i think we forget that gri.

it is in our national security interest. we do not want pakistan destabilized. pakistan is a different story because pakistan has nuclear weapons production -- has to clear weapons. for those to fall into the wrong hands would clearly be against all the national security interests of this country pick. host: is the amount of time the president is spending on the topic appropriate in your eyes? guest: i wish he would move faster. he is the commander-in-chief of our military and he seems to be focused on engineering a government takeover of our healthcare system. i wish to would focus on being commander-in-chief and deciding a time sensitive issue. general mcchrystal has said that really we have -- the report issued two months ago that we

have a year, a window in which to turn the situation around. it will take time once the decision is made to put troops in place. there are seasonal variations in our ability to conduct technical operations at the country. -- to conduct tactical operations in the country. i hope the president moves forward with a comprehensive strategy and that will encompass the region and the national security interests in the region, as well as governmance that reflects the political culture of the country and a fully researched war. guest: i find it interesting in a national debate that is sometimes characterized as the national takeover of the health- care system that the same individuals would take the responsibility of not only taking over the health care system but creating a health care system and afghanistan.

that is what we're about, nation building. why are we expanding lives and treasure securing elections and trying to create a jeffersonian democracy in a country that is fundamentally tribal in nature? yes, we were attacked, and we invaded and killed or captured every installation of the al qaeda terrorists and we drove the rest of them into exile and there was absolutely no proof whatsoever that the tribal powers and afghanistan today are willing or ready to accept al qaeda -- not even the taliban, who come public, is predicated the entire popp -- eradicated the entire poppy culture that is not funding the terrorists. to characterize it as up and leaving is simply not accurate. we need to tell the afghan people in all forms that we are not staying permanently, and as we told the iraqis -- there were

voices at the same time that said that you cannot given exit date, you cannot say you are going to leave. it is the exact same philosophy. we are not an imperial occupying power. after vietnam collapsed, there are forces in this country that signed give away free trade agreements with the very communist government that we fought so many years against. is that where we will be after spending thousands of lives and god knows how many billions of dollars? host: our last question is from texas. this is charles. caller: god bless you and c- span. to the new york fellow, we was attacked and hit them into a 90's time and time and time again. -- in the 1990's time and time and time again. it is all on the history channel and it is documented. it was treated as law

enforcement. we had osama bin laden, three or four times to get him, but retreated as law enforcement -- treated it as law enforcement you bring those troops home now, but when we are hit again, and we will be hit again damn it, the plan will be on your hands. -- blood will be on your hands. guest: no one is talking about treating this as law enforcement. it is the requirement of the united states to seek out those did or will the west -- will do us harm and to identify, till, or capture them. but that is different from expanding the entire operational capability of the u.s. military as a nation building power in a country that has no national identity. there is a huge difference between the two i don't share

your opinion that it is inevitable that we will be hit again. tens of millions of americans in uniform and outside of uniform, but the way, including some of the most brilliant law enforcement agencies and the world -- the fbi and even the united states postal inspection service -- are on watch and focused every single day to do everything humanly possible to make sure that that does that happen and we stand unified in that goal. -- does not happen and we stand unified in that goal. we need those resources here, died in afghanistan -- not in afghanistan. guest: i worried that there is a movement afoot among liberal democrats thatto look at it terrorism as a law enforcement issue and not an act of war. weakness invites aggression. if we are weak in this situation, if we do not fully resource this war and change the strategy of this war, as we did

in iraq in 2007, and if we simply walk away, we will walk away not only from our leadership in nato, but we will demonstrate the kind of weakness that again invites aggression. peace through strength ought to be the focus of this country. you have to have that the deterrent capability. i hope the president can devise a strategy that is different and achievable the victory, and that he will fully resource this war. host: eric massa, 24 years in the navy, mike coffman from the army and marine corps, both members of the armed services committee, thank you very much. we will say goodbye to the two congressmen, who have to get

back to capitol hill, and then we will have 15 minutes of open phones. >> last thursday, house democrats introduced the health care bill. this week, the bill comes to the house floor. follow the entire debate life, without interruption or commentary, only on c-span, c- span radio, anax c-span.org, and find out more on the health care hub.

>> "washington journal" continues. host: we are back with open phones, and you continue the debate about afghanistan, health care, or anything else on your mind. florida, arthur, you are on. caller: referring to the last segment, both of those congressmen gave me the opinion that we should bring these troops home, because we are not getting anywhere in either iraq or afghanistan. now, these two gentlemen are members of congress. if congress wants to bring the troops home, i don't see why they don't do it. they keep saying that our troops are -- the president said in his campaign that one of the first things he was going to do was

bring the 64 billion or whatever the number was of dollars that was going to iraq -- he was going to bring that home and bring the troops home from iraq. host: thanks, arthur. next up is chris from boston. caller: i think the last two people that were on are bought and paid for -- keeping troops in foreign countries to decrease unemployment rolls in the united states. they go to war because they receive contributions from the same industrial military companies that they say they oppose. they oppose war. but jack reed, who serves on one of the military commissions,

takes money first certain military housing and then boats to military housing to government contractors -- votes to for military housing to government contractors. obama does not want to stop war. he wants to end the united states. all these secret treaties his signing, like to regulate the internet, to take copyrighted material that people was on the internet and use that as a purpose to stop them from ever going on the internet again. host: chris, we will end at that point. mary is next, long beach, california, a republican line. caller: thank you for taking my call. i want it back to the three members of congress who are bold enough to vote to oppose

h.r.867, because they read the bill and put human rights before our corporate -- before their career. it has not been covered on c- span. it has to do with the cold storage report -- the adults don't report to investigate the crimes committed by israeli -- goldstone report to investigate the crimes committed by israelis against gaza. i'm a republican, but i agree with the representative massa about what is going on in afghanistan. host: thank you, mary. independent line. you got 10 minutes. caller: why don't we have -- host: once every 30 days. you are a regular color and we have heard about your concerns. next up is christine on the

democrats' line. caller: i want to get through when the new senator from florida was discussing health care reform and tort reform. the way i see it is that tort reform is government involvement. it goes to show you how republicans don't mind government involvement when it helps their campaign funders, the big corporations, but when it helps little people, they don't want anything to do with it. host: associated press just ran the store after a briefing with majority leader steny hoyer. he predicts that the house will pass historic health care legislation on saturday to extend coverage to tens of millions of uninsured americans and an insurance companies from turning people away. the maryland democrat said in an interview with wire service reporters on wednesday that house leaders will have the 218 votes needed to pass the bill, presuming a couple of final issues are resolved. he alleges that the vote will be

closed. he says that the language on abortion and the legal immigrants is still being worked out -- and illegal evidence is still being worked out. next call is from ohio, larry, republican line. larry, i can turn your tv volume up. turn it down, please. caller: yes, ma'am. can you hear me? host: yes. caller: i wanted to speak to this to do what no one to which the stock, but unfortunately i cannot get through. -- the two gentlemen who were just on, but unfortunately, i could not get through. we are fighting and ideology in the middle east but we cannot defeat an ideology. in world war ii, we fought the germans and japanese, but it took millions of troops and five years to do so but secondly, i

did not feel a seconnse of urgey about any of our problems. i think they are just hem- hawing around and not getting down to the heat of the meat, so to speak, and a publishing a solution to our problems. -- and accomplishing a solution to our problems. thirdly, i do not think we will ever leave that part of the country, because we have a foothold there, and it will give us an opportunity to protect israel and our interests as far as oil and, like i said, protecting israel. susan, i really appreciate the opportunity to speak to you and to speak to the public. i hope the public will sit back and try to analyze the things that are going on and not just be thinking about what the

government is going to do for us. host: larry, we have to run. maine, independent line. caller: i am grateful to be able to have this time expressing how i feel regarding this more, and it is a war, and to reiterate a little bit, we never should have gone into iraq. we should have gone right to afghanistan, but we were misled. but now we are in theiere. it is not to us to change the culture of that country. who do we think we are? i come from a military heritage. my dad fought in world war i. my brother was in the air force in world war ii. i now have a grandson in this situation in iraq. you know, we should pull our guys out. i do not think it is a disgrace

to pull out of the situation that we're not able to take care of. i do not think it is this race at all. i think it is a show of strength. -- i do not think it is a disgrace at all. i think it is a show of strength. host: next up is washington. caller: the democrat who is on brought a point that i was going to make. i think it is ironic that the republicans in congress are not against spending taxpayer funds on wars and intentionally killing and injuring people in foreign countries and building medical facilities to treat and care for both those we wounded and maimed why are those victims more important to some of those mostly republicans than americans here who need medical assistance? that seems so ironic to me. the other quick thing is that i

feel that health care should be every u.s. citizen's right, and to me, it fits right in with the declaration of independence, where it says that we are all endowed by our creator with certain unalienable rights, among them are life, 45,000 dying every year with no insurance, liberty, the pursuit of happiness. i think that affordable and accessible health care is right with the vision our founding fathers hoped for. i don't think that medical bankruptcy and poverty and homelessness have to be. host: nevada, he wore on, elizabeth. -- you are on, elizabeth. caller: i am a republican and i voted for bush the first time

and the second i did not. this time i voted for republicans thinking that was going to be changed. but i am a little bit embarrassed and disappointed with all these extreme, a very ignorant attitudes of our republican people. i do not know if the attitude is because of frustration, but we need to get together and show that we are doing something for our country, with health care and the war and the climate change. and participate in the senate. we pay taxes for them to be there. i feel that congress and also the senate -- they are not there. it is embarrassing, the way that they also -- i don't care who

the president is -- what kind of example that are giving for the kids to our country, calling him a liar. that is really embarrassing. i am not going to allow my kids to call me or anybody liars. host: next up is new york city, craig on the independent line. caller: hi, how are you doing? to get to the root of the arab- israeli conflict, one has to look at the history, and you have to go back to before 1948, you have to go back to the 1900's, when jews were purchasing land from the wealthiest. families -- dissed -- we althiest arab families, and you have to look at the fact that terrorism preceded occupation there was no occupation in the

1950's, prior to that. i was wondering if you had any comment on the recent reports on camera.org on at the reporting accuracy -- the accuracy on reporting on the middle east. host: we have about 30 seconds left and i will take a phone call from indianapolis to wrapup the program. caller: i want to talk about the senate bill, a belated thank you to the merchant mariners. it has passed the house of representatives three times in 10 years but never come to the floor for a vote. this will give our world war ii merchant mariners the recognition they deserve for their service in world war ii. it would also offer them a $100,000 a month payment from the department of veterans affairs for five years old as a redress for the grievance of not bein