cdc -- and this is a guess -- but i would say probably 75% of cdc's funding is not reactive but it is proactive. and i think one of the things senator coburn is saying so well, and i'm thinking about myself, we fund the nih and the cdc and we put a tremendous amount of money in dod because we have a controlled group of people upon which you can do research, making determinations all the time on best practices that somehow never get through this clearing hois to get promoted. they kind of get stirred around and we add more money to them. rather than think of this as a negative approach, it's kind of saying -- and i'll be the first to say i don't know all those best practices, either, but maybe it's time we look at what we know before we put more money to find out what we already do know and put incentives before pieing more money on top of the other. probably for every dollar spent in reaction, they spend $3 in proactive research in preventing things around the world. >> i find myself with both of these distinguished senators. when this bill came up, and i looked at it, i was very crit

cdc is the center for disease control and prevention. and to get through this and pull this together under one regime. and that's why just to say we're doing it in some other area, a lot of those again are discretionary. they're not funded. that's why i argued for a mandatory program. >> and i take your argument in face value. and, in fact, let's move all the rest of the programs to the cdc so we have one source, one place to do it, one management team we can hod accountable that gives us metrics and say we spent this money, what did we get. instead of saying here's hrsa, here's this, here's this, and here's cdc. why not put it all in one place? why have competing programs doing exactly the same thing? what is the sense of that? why not put it international one place? >> if you're going to do this, pull everything else out that's doing the same thing and put it in cdc. if prevention is going to be a focus, let's have somebody responsible for it, hold them accountable and see what the money does for us. >> one is your amendment talks abou

cdc can't do all this alone. and in summary, right, we spend $2.2 trillion nationally in this country for -- on health care. we spend approximately 4% of that in prevention and public health. this, if anything, is not enough, senator harkins, effort notwithstanding, we should did at least this. that's why i support the amendment. >> let me just say, let me just people know, we're going to -- we have a good debate on this generally already. we'll go to the senator in a minute and then number nine as well. this is -- there's two or three defining moments in this debate. this is one of them. the agenda will come with coverage issues. there are play or pay issues. we have big issues. i don't minimize the other qualities we have and workplace. they're very, very important. but i think, again, coming to the point where we've all made the conclusion, properly so, that prevention is going to be critical. if we don't get this part right, make the necessary investments, then bending that curve is going to be nothing more t

the hemingy communities program that's granted through the cdc, duplicates that. the transportation enhancement grants at the department of transportation, we're duplicating that. the safe routes to school program, we're duplicating that. the rural development program, senator burr mentioned that, the rural housing aprogram, we're duplicating that. identical grants, going to do the same thing as those programs are. we're duplicating it. the weed and seed program. same thing. we'll have a crossover and a dupe election there. and the department of energy efficiency and conservation block grant. we have duplication. so, again, philosophically i'm opposed to us spending this money this way if we're going to spend 8 billion, let's go spend 8 billion on real spre vengs. let's enroll people in a precourse and get them the things they need. the let's spend 8 billion every year on caring for people with a comprehensive exam that don't have it today. let's go back to what you were just talking about with the murkowski amendment. let's put that money there where we're going

we are giving cdc a lot to do in this bill on top of their heavy workload. as an even have enough funding to evaluate their own programs but the title of this requires them to by employers wellness programs and a set of trading more than 15 a programs we should modernize current programs. we should evaluate and improve our federal programs before we spend tax taxpayer dollars in aid to ensure those programs are not duplicative. this title requires incentives to develop recommendations relating to prevention specifically employer sponsored -- programs. i'm concerned these recommendations will become requirements and employers must have the flexibility to provide effective on this programs and in good job of this right now and should be allowed to continue to innovate. government mandates will make that difficult if not impossible but employers are not the ones who must bear the burden of multiple federal requirements even with the stimulus funds for political leaders in 19 states are still struggling to negotiate budgets. according to a recent report by the n

of that, 16 billion is not spent at the cdc or nih. there's not one metric that measures what we're doing now, whether or not it's successful. we have 16 billion out there, supposedly on prevention. some of it is doing good stuff, but we don't know. so now we're writing a bill and not knowing whether what we're doing today works and we're adding money to it. what i would propose, and whatever we end up doing, we'll come ahead with metrics and it's got to be transparent about what it does. you know, we don't have any metrics on the u.s. prevention task force, whether or not they've been successful or not. we've not independently measured the money we spent here. what has it done? >> we just send money out there and say this sounds like a good idea. some gup told us it would be a good idea and we never go back and measure it. when you look at this $5 billion and you have 47 million people uninsured and we'll measure chronic disease and give them a wellness program that's $100 person per year. it will be hard to manage chronic disease for

already have multiple agencies doing the same thing right now in the $16 billion outside of nih and cdc that we're spending every year doing exactly the same thing. first of all, we can save a ton on overhead. we can make the dollars be spent much more efficiently. so i was thinking about this evening trying to get my staff together. we'll look at all these areas that you've addressed in here and see if we can't come up with something. i'm just asking would you consider it. if you won't, i won't spend the time on it. >> if those three entities are all targeting the same target group, population -- >> why y don't you work at it. >> or we could do this with the intention that a refinement of the bill out of the intention of the bill is to eliminate those duplications and bring them to one central source so that we do that. there's lots of ways we can do that. my problem is is, even though you get this cross-agency council, the fact is there's turf protection that goes on in administrations. and bureaucracies. and unless we specify what we want to do, we're not going to get there. >> i jus

we have our cdc director, and we have some extraordinary members of congress here on stage, senator doddourbon, senator harkin, representative waxman, rep christiansen, and rep platz, all who did a big part to move this legislation forward. [applause] i want to thank all of them. there are three members of congress that i have to especially thank, representative waxman, representative dodd, -- senator dodd, and most importantly, senator ted kennedy who cannot be here today. [applause] and the legislation i am signing today represents a change that has been decades in the making. since the middle of the last century, we have known about the deadly effects of tobacco products. more than 400,000 americans now die of tobacco related illnesses each year, making it the leading cause of preventable deaths in the united states. more than 8 million americans suffer from at least one serious illness caused by smoking. these health problems caused us all more than $100 billion a year. what is even worse are the effects on our children. one out of every five children in our country are now current s

- if you people from the campaign -- [applause] we have the commissioner, hamburg, tom frieden, the cdc director,r and just some extraordinary members of congress here that are on stage, sen. todd, lautenberg, rep. waxman, dingle, platts, who did extraordinary work in getting this to move forward. i want to thank all of them but there are three i have to thank, waxman, sen. dodd, [laughter] >> and most importantly, sen. ted kennedy, who cannot be here today. this legislation represents change decades in the making. since the middle of last century we have known about the deadly effects of tobacco products. 400,000 die every year, making this the legal will cause of preventable death in the united states. nearly 8 million merit -- million americans suffer from something caused by smoking, and this costs us over $100 billion a year. even worse is the effect on our children. one out of every five children are current smokers by the time they leave high school. every day over 1000 children become smokers, much of this began before the 18th birthday. i was one of those teenagers and i know h

and there was an hbo movie years ago that they did the whole thing of when the young guy worked for cdc, alan aleda plays in it. but going on to other things. everybody's talking about obama doing this and doing that but we're rushing into everything. and they want the government to pay for everything. and nobody seems to realize that the government is your money. you know. you're going to pay for it eventually. and i jist don't understand why the american public doesn't understand that government is spending your money. host: more about the story of the supreme court nominee quiting an all-women's club. says the club bills itself as a women's answer to the 130-year-old all male bo heemion club in california to which chief justice earl warren belong ds before he joined the court and long before the federal judiciary adopted a code of conduct. president obama made reference to supreme court nominee sonya sode mire last night at the radio and television correspondents dinner here in washington, d.c. he threw out a few jokes. one of them was at the expense of his supreme court nominee. thi

so i think that -- i was alarmed by the recent cdc study that says we have an increase now in teen pregnancies again having had a decrease the last years that is not good news. we know that 40% of births right now are testing parents -- to single parents. so there's a lot of common ground and work to be done and i think a lot of the assets to do that are in the department of health and human services and i look forward to working with you and congressman delauro and others because i think this is an area where some focus, collaborative attention can play huge dividends and the long run. >> i appreciate that and i think congressman delauro and i and others would love to sit down and hash this out. one other topic i would like to touch upon i think when we have these discussions about health care there's always an issue we never talk about and that's the issue of stress and a lot of it see it now and the congressional districts because the economic situation we are dealing with. and the issue of stress leads to i think, we know increased illness and, you know, these people losing their jobs, los

the cdc said that if we do nothing we reduce smoking to 15.9% by 2016. and the congressional budget office under h.r. 1256 said if we pass the kennedy bill the rate would be 17.8%. as a matter of fact, i miscalculated when i put the chart together and it's actually 2% higher. meaning we do 4% better if we do nothing. you see my point is this: exactly what i said at the beginning, the authors of the bill said the purpose is to reduce the risk of death and disease. and to reduce youth smoking. i would tell you that a caveat to that should be that we should reduce smoking. and clearly the centers for disease control and prevention says if you do nothing, it goes to this point; and the congressional budget office after looking at the bill suggests it's 2 scrierks o% or f we pass the bill. now, why is that? how could it possibly be higher if you pass legislation that's supposed to fix it? well, mr. president, it's for that reason: because of what h.r. 1256 does. it is not a public health bill. it is a bill that locks in the most risky products and grandfather

bill fahey of the cdc, a revocation attacks in equity, provides the ultimate social justice. this is something we will come back to again and again as we talk about the lessons of this program. the most important about eradication distinguishes it from the other things we do in international health, it requires getting the populations that everyone else mrs.. you have to keep going if you're to eradicate the disease. most things, the millennium development goals, much of what we have done so far, 80%. with 30% of children, not only, my third reason why eradicating polio, not just to get their, put these kids on the map, being to scale with the areas where we need, interventions -- these are 2 examples of we have been doing while we have been eradicating polio, whether it has been helping to eliminate measles or fighting pandemic flew. the polio eradication initiative, it is a partnership first and foremost on the right hand side, you have the private sector partners who are part -- the left-hand side, the eradication initiative. on the right hand side, the political bodies an

i think there are certainly in my age studies that can lead to that and the cdc is looking at areas we can improve quality the part of it is learning from the folks running the health systems that have been identified as delivering high-quality care to lower-cost. we have some improvements currently proposed in the budget and medicare demonstration projects. one of the areas we know is very erratic, what happens to a patient when you get released from the hospital? right now 20% are readmitted and a lot of evidence leads to the fact that is because of lack of follow-up care, which is very expensive and certainly not good for the patient, so we are trying to expand best practices in that area looking at bundled payments so providers are more concerned with ultimate outcome and not with contact with patients. we think that would be an effective strategy and driving and encouraging voluntary collaboration with symbol practice doctors so they have more coordinated care strategy, cetron and to take what we think is working and encourage others to follow the practice and use some of the medi

the fda, cdc must have the authority and expectation to share actionable information with public health partners to the extent necessary to protect the public's health program will conclude with a final comment about the importance of ensuring the fda with the state and local partners to have adequate resources to meet their responsibilities for which they are charged in this bill. no one would argue the fda is currently underfunded, overworked and overwhelmed state and local food capacity must me robust in order to maintain an effective food safety system. consistent funding must be dedicated explicitly to sustain the food safety program at fda as well as the state and local partners to work with them to keep the food supply safe. americans will each 1 billion biel's today i cannot think of a better investment than one that would keep every single one of those meals safe. >> good afternoon mr. chairman pallone and members of the subcommittee i am pleased to do to the fresh produce industry has been a leading proponent of strong federal oversight of food safety. my name is tom stenzel i

. >> secondly the epidemic continues to rage in the african-american community according to the cdc and the blacks account for about 34% of population the account for half, 49% of people who get hiv and aids. i'm pleased to note while we continue negative but testing and treatment activities among african-americans i am concerned the program and by quote the heightened national response to hiv/aids crisis and the african-american community has been scaled to mobilize to conduct the hiv/aids testing activities, for and the initiative. madam secretary can you review the situation and see what needs to be done on this testing activity? >> is i will. >> thank you, mr. chairman. >> thank you, mr. chairman. we all agree it is enormously expensive to undertake health care if we have government program it's expensive for families and which leaves a wife got two questions. one is the administration considering taxing health care benefits to pay for the expansion of health care and second, is the administration considering allowing those who are not an employer based plans. for health care with a

coordinating committee with similar purposes that includes all of the agencies under the umbrella of hhs, nih, cdc, hrq, and others as well as the more relevant agencies that are also on senator harkin's council, the va, the department of defense, epa, department of education and department of labor. this interagency coordinating committee does not include the department of transportation. the department of housing and urban development, the department of homeland security. prevention should be about health care, points that i will will make and touch on. the other thing is, the health council inappropriately defines health promotion roles of non-federal entities, whereas this council has a laser-like focus on making federal programs work more effectively. i understand that none of the public health council's findings are binding, but americans might find it troubling that a federal board of bureaucrats would tell state and local governments, community schools, work sites, families and businesses what they should be doing to promote prevention. we've already clearly outlined here that the private

disparities issue, we mentioned language and also training of health professionals and research at cdc without having any consideration, research, instruction in the health profession and language i think we'd be missing a big part of the needs our communities face. for instance, there was an operation that was going to be had in the county down from my district, and persons happened to speak, and the doctor was checking to see if he was following and there was no communication between the two, and the wrong leg that wasn't supposed to be amp pew tated, so the man ended up missing two legs. these are just reported incidences. there's over 7,000 reported. how many more are there that have not been reported? so this is critical. >> the office of minority health, what would you like to see in terms of that particular office other than just more money? >> there are several agencies in health and human services that don't have an office of minority health. cms? fda? so we want to see it expanded. it's always been that they have been allowed a budget up to 5 percent of the budget of the agen

but a chemical we are all exposed to upwards of more than 90% of us have bpa in our body because the cdc has a by monitoring program so we're all expose but we don't know exactly how although it is often at -- and all of the bottles and our babies are exposed somehow perhaps leaching and from the bottles that have until recently bpa. because there hundreds of studies and depending on what studies to use you can say it causes harm or it does not. the discussion is not so much does it cause harm in animals by which animals doesn't cause harm in and out was that important to extrapolate that to humans? industry shows no effects and have paid for a number of exercises where they put the literature and they say there is no effect. there have been a couple of federally funded -- federally funded the thames will that have mixed results. some included there could be something here and some said there are not. but this is the chemical we need? given that we cannot show their safe and there are hundreds of studies and of those paid for government at university 90% show the effect on very low doses

can perhaps by themselves, with some identification in gaps and disparities it can be everything from cdcto medical school, things like that. second is commissioner of insurance i know that there is 50 states and territories and i also know that when i asked the question about antitrust and its role in health costs and other costs in this country, the issue of reimbursements from the federal government to the cost of medical services and doctors being able to afford protecting themselves through insurance premiums what impact would there be if there were antitrust, if we brought the insurance companies under the federal antitrust law we as the other corporations are? >> and you know i could get my answer in writing if you want but it's still on my mind. i'm not an expert in these areas but it seems like the insurance companies are one player in a lot of these arguments we have about costs and stuff like that. >> well, chris mann, i am not quite sure what the system is your describing for the future but i can tell you that oftentimes there is prohibition that currently exists with companie

enhanced and needs to be improved and needs to be focused on and he is coming to this job as a new cdc lead we are that agenda at the forefront of his priorities and it's one that i share. >> why are we facing such a crisis in public health workforce today? i know part of it is that we need more graduates from public health programs, but i think the other part of it is that we may not have the right incentives for the graduates we do have to enter public service? >> well, i think the whole incentive system in health care is one that is on the table for review as we look at the reform agenda. how we not only attract more students to medicine in the first place, but how we attract more of the students to the appropriate shortages. >> but do you think that the scholarship alone repayment provisions in the draft bill will help incentive to the public graduates to the public work snors. >> i don't think there's any question that those strategies have been proven to be enormously effective. students unfortunately today, are emerging with mountains of debt and often, public health officials a

and now i'm pleased to present the next bigger, my classmate and my colleague and the cochair of the cdc health, congressman danny davis of chicago. thank you very much. i'm pleased to be here with all of the members of the tri-caucus. i want to commend the leadership of our individual caucuses for bringing us together and having us to work so effectively. for more than 40 years, we have seen the growth and development of community, rural, migrant and family health centers. i maintain that these have proven themselves to be the most efficient, most effective and most comprehensive approach to provide health care to large numbers of low income people throughout america. as a matter of fact, they are the best thing that had happened to health care probably since the indians discovered cornflakes. >> these centers currently service more than 18 million, mostly low income people throughout america. they are linked and connected with secondary hospitals, with tertiary care centers, and provide enormous training opportunities for individuals to work, especially in primary care. it is our posit

national intelligence, i thought this was the primary responsibility of health and human services, the cdc, that they were the experts but it turned out there was a pretty strong role for the intelligence community in keeping an eye on that situation as it developed and it is still developing. for one thing, it was up to us to check whether some of the information that was being reported by different countries was in fact a record not and that is a fairly familiar function for the intelligence community. another piece of it was the predictive analysis using epidemiological models, looking at history, trying to project what might be. as this virus developed. so, i found in the intelligence committee we played a non-traditional but very important role in trying to inform the u.s. response to the u.s. response to the h1n1 flew phenomenon, which we don't know the final story of yet us so, this business of standing the environment, looking for threats and opportunities trying to project trends is sort of the day-to-day business that we do. the second broad area that we pursue it is, when the un

at cdc is $104 million and all that these days just on tobacco. and smoking. comprehensive school health, cbc provides $54 million to all the schools in the u.s. oral health for kids and current funding of $12 million a year and i to go through, there's a whole lot of others and give you some idea what of the amount of money that we put into prevention. now the other thing is the community transformation grants. those of go by the wayside also. but the trust for america's health last year issued a finding title prevention for health care american investment yield significant savings and their studies showed that a return of $5 and $0.60 for every $1 investment in community-based prevention and cited in number of different communities around the u.s. that have done certain things and then they tried how much will the health expenditures were in those communities before and after and that is how they came up with this and the amount of savings that they showed only took into account the clinical safety, it did not show added productivity more people working in n

azar can you go to the question of the cdc and first explain to the viewing audience with that is and why different results occurred depending upon the decision which is made. >> the alternating current system is the primary transmission grid we have right now and it's completely interconnected so when you put an electronic on that grid it's going to go through the path of least resistance and we with models you can predict where it went to go but you can on direct it, it goes, the electron goes where it wants to go. on a d.c. line -- >> that means direct current. >> thank you. you have a lot of control over it, the electron was in one direction. you know for instance when you drop an electron on one end of a dc line you know where it is clinton and up, on the other side of the line where as a ac great if you look drop the electron you are not sure what pat is going to take. the only thing you know is you are pulling power of certain locations, so it is a very, they are two very different models. >> for the purpose of the discussion today how does that instruct this discussion in term

eradication is i believe so important is i think that's put in the work here of doctor bill of the cdc is that eradication attack in equities and provides the ultimate in social justice. i think this is something we'll come back to again and again as we talk about some of the lessons from this program. but what i think is most important about eradication, interesting wishes so much of the other things we do in international health is that it requires getting to the populations that everyone else misses, where the road stop for every initiative you have to keep going if you are to eradicate a disease. it's the ultimate indicator that you are actually reaching children and achieving the goals that we set out to. most things, as you know, in the pursuit of the millennium development goals must of what we have done so far is been given more thing to the 70, 80% of children. what this talk is mainly going to be about is what have we learned about trying to reach the other 20, 30% of children. and not only been bringing me to the third reason about eradicating polio. the third reason is not

but then they would say, no we can't because cdc gave it a good evaluation?i mean -- >> well, actually, if hipaa prohibits it already, they cannot even try it. >> huh? >> if hipaa prohibits it, they cannot try it. >> well, say it is not prohibited, but they are doing it. say they are doing something that is not prohibited. >> how about does not mandate? >> mr. chairman, mandate. >> how is this bearing on the earlier discussion about the 20% limitation on the variance, premium differential for a wellness program? one of the concerns that i think we had about expanding the 20% was that it be limited before it is allowed to be expanded to programs that the secretary has approved so that we know that it is not a phony effort to just run up the score so that there is some quality control before we allow that boundary to go from 20% to 50%. one would think that in that calculation, one would want the benefit of this, and that would be an appropriate place for it, and i think that one of the places that we might end up is that you get the hipaa 20% irrespective, bec