working faster and it will get the i.t. communicating faster while we wait on the interoperable standard. with that i rest my case. >> mr. chairman i naturally very sympathetic to the policy goals that have been articulated by senator coburn and in fact i have repeatedly said one of my great passions in this house on a tea is to make sure that it's interoperable and not obsolescence before it begins. also, it is a wonderful combination of senator colburn and pete stark which shows we can all work together. where i am as i've been notified by the judiciary committee that they feel that our voting on this is outside of the scope of the health committee and belongs in the judiciary committee. what i have here is a letter from senator kohl asking the antitrust subcommittee be consulted on any proposals with the health care reform that create the antitrust exemptions or alter the applications of the antitrust law so they want the colburn amendment referred to them and not dealt with in this committee and we have looked at the co

answering emails and using health i.t. effectively, using nurse practitioners, allied health professionals, implementing wellness programs whatever it takes for their beneficiaries to get better health outcomes and lower costs. this is part of most of the healthcare reform proposals that are being considered right now. and again, focuses on accountablity for costs across diverse practices and it's designed to be compatible with other reforms things like paying for health i.t. or care coordination, bundled payments, things that are considered part of healthcare reform can help move in this direction of getting to what we really want, accountability and payment based on better outcomes and lower costs. and this can be done through multistakeholder collaborations as well. there are a number of these going on around the country. i'll mention those briefly in just a second. but the idea is as patrick was saying there's some things that are best to collaborate on and other areas that are best to compete on.

and the definition of meaningful use of health i.t.s putting a big emphasis of getting demonstrated impact on performance measures and on quality of care. having some ability to compare these benchmark trends to impact over time. so either having a controlled group or having a benchmark prediction that can be tracked against an actual performance of this accountable care collaboration. having a savings threshold above which savings is shared and then again having a quality and efficiency component as well. so these kinds of steps are being done now. they are being considered in legislation related to medicare that would give medicare, i think, a much-needed ability to get important quality and cost measures quickly for their beneficiaries so that the impact of reforms like these can be evaluated much more quickly and i think it can potentially be an important part of achieving meaningful healthcare reform. thank you all very much. [applause] >> thank you, mark, for sharing your perspective. now, it's my pleasure to introduce uwe reinha

it is their health i.t. carper go rabid then as keeping all the health i.t.cars, we will have the record of this retreat and an updated file on i.t. but they will carry their own card. they also have the option of doing it through local health or some other mechanism that we don't know will come to market now, but what it does come instead of putting this large burden in the middle of the healthcare center, it creates in uses technology with which to utilize things that are already proven out there. and so we enabled that. if used correctly the patient's savings on this could be billions and billions of dollars every year. it would also give us better and more timely information. one of the biggest problems we have as physicians to care for multiple patient's to see multiple doctors is getting the information from the other doctor. it will be right there in your card. the legislation would provide a charter for treating member owned, independent health record bank accounts that are operated in a cooperative institution for the medical information wedded here

already made investments and health i.t., that's information technology, electronic medical records that will reduce medical errors, save lives, save money, and still ensure privacy. we also need to invest in prevention, in wells in programs to help americans liver longer and healthier lives. [applause] but the real cost savings will come from changing the incentives of a system that automatically equates expensive care with better care. we've got to move from addressing -- we've got to address flaws that increase profits but don't actually increase the quality of care for patients. we have to ask why places like kiss jer health systems in rural pennsylvania or inor mountain health in salt lake city can offer high quality care at costs well below average but other places in america can't. we need to identify the best

we think we should take advantage of all the i.t. that's out there. number two, medical savings accounts. we believe that the market should be put into action so that people can save money and be incentivized to put some of that money in their pocket if they don't spend it by the end of theay. number three, we don't believe that health care decisions should be made by insurance companies, h.m.o.'s or washington bureaucrats. number four, we believe there should be less frivolous lawsuits. we certainly want to protect the tort laws in america but we conet want frivolous lawsuits. number five, we believe the patient-doctor relationship should be preserved and that we should not have a british, canadian or german-style centralized government planning where the doctor-patient relationship is destroyed and, mr. speaker, i yield back. thank you. . the speaker pro tempore: the gentleman from kansas. >> mr. speaker, i ask unanimous consent to address the house for one minute.

as a i.t. professionals, we can't imagine and build solutions that make our lives easier, more convenient, more productive, and prosperous while using emerging technologies and cutting edge tools. in fact, we are already seeing women establishing green technology firms. others advise on optimal usage of the social networking and social media, and even more becoming independent consultants. women who succeed ian i.t. have clarity of purpose and a strong sense of self worth. i imagine many of you of his room share the same qualities. i know our two q of speakers do. as we began this conference, i encourage you to talk to other attendees about the work life balance issues and share your personal experiences, how you overcame challenges or how an inspiring mentor and courage you to follow your path. let us and engage in a dialogue of how we as women in technology can shape the information technology industry with our approach to innovation. more importantly, we should work together to set the cours

having capacity to measure performance in terms of quality and cost of care and are trying to help i.t. and the definition of meaningful use being discussed now but puts an emphasis on demonstrated impact on performance measures an ad on quality of care. having some ability to compare these benchmark trends to impact over time having a control group our benchmark prediction track and against actual performance of this account a bowl care corporation, a savings one and then having a quality and efficiency component as also the steps are being done now. they are considered in legislation related to medicare that when given a much-needed ability to get import quality cost measures for their beneficiaries so that the impact can be evaluated much more quickly and it potentially important part of achieving meaningful health-care reform. thank you all very much. remarks on the financial markets from the chairman of the financial accounting standard board here from the national press club this is about an hour. >> i am a reporter with usa today and i am president of the national press club. th

the other issue that concerns me has to do with i.t. security weaknesses. how many improvement in data protection do you believe the irs will be able to make with the $90 million that you're requesting for i.t. security? give us your assessment of the vulnerability and whether that is in fact a sufficient amount to address the problem? >> yeah, so when i came in, everyone all they talked about was modernization, i believe if you're going to run a big technology portfolio you need to worry about current systems, updating those, making sure there's the right security and infrastructu infrastructure, you need to worry about data security then you have to worry about your new systems. so one of things this budget reflects is me rebalancing the portfolio so we're not focused on modernization, that we care a lot about security and data. there's 90 million in there, in the budget request to upgrade security posture and infrastructure, it's incredibly important. i think knock on wood, we haven't had a major data breach. there's always going to be a spectrum of weak

our i.t.capability has improved dramatically since september september 11th and we can always use as could any entity more resources in that regard in. we had to in the wake of september 11th to address the threat of attacks that seem to be eminent at that time for my transfer almost 2,000 agents from the criminal side of the house to counter terrorism and over the years since then to the extent we have had a budget enhancement increases mostly on the national security signed. we have not had an opportunity to backfill those agencies that have come from the criminal side albio many of them have been doing narcotics cases and smaller white-collar criminal cases but as we face the mortgage from crisis the investigations into corporations we have made requests to congress and the congress has been providing those resources. i'm going to testify in a couple days before the senate appropriations committee and will continue the dialogue as to obtaining those additional resources. >> thank you very m

i would say the implementation of health i.t. will be a significant enhancement factor for providers who often don't want to be isolated but with health i.t., can be in frequent consultation with specialists and colleagues in various parts of the country and various parts of the state so they are not in isolated practices. so there are a number of features that are not only in this discussion draft, but in the bills that you previously passed that i think really help to address the workforce issue. >> thank you very much. >> thank you. >> i yield back. >> thank you. we now go to mr. burgess. >> thank you, mr. chairman. ma dm secretary i'm in the broom closet behind the kid's table which is where they keep me on this committee. during your -- and welcome to our committee this morning. during your confirmation hearing before the senate, i believe the statement was made, you said if confirmed i'll not only be an eager partner to work with congress, but that i understand bipartisanship. is that a reasonable fact similar lee of the te

there will have an opportunity to get in a health care career or i.t. career or an entirely different area, but to make sure there are capabilities that they will achieve and the hubble to it the education and training. if they have to be mobile, they will get the opportunity and there will be a job at the end of the day. >> getting back to the auto industry, general motors has just filed for bankruptcy. chrysler is in bankruptcy. one area where there is potential large job losses is the cutbacks and the dealerships that chrysler and gm have announced. last week i was in a hearing with a number of senators really grilling executives from chrysler and gm about the dealership closings. they plan to close about tutsis and dealers, terminate their franchise agreements, -- will they be pushed to ease back on the leadership closings or at least extend the timetable for the dealers to get rid of their inventory? >> it is a very pressing situation. people are losing their jobs, no doubt about it. those kinds of decisions will have to be made between chrysler an

i think that's true for i.t. as well. >> great. now a couple of questions on access.one is on the -- what -- i'm going to turn this over to you, uwe. what should we do about undocumented workers? and how does that figure into your formula going forward? >> well, actually if we had only undocumented workers, uninsured, we could probably handle that the way we've always handled the uninsured because to put in a law that says every undocumented worker has full rights, you could do it. germany does it and somehow they manage. so they do actually by law have full health benefit rights what's they're inside the border but it would send a signal for people to come and i don't think there's bipartisan support for that at all. [laughter] >> so i think we would just have to just leave that them -- deal with them and then pay dish money and handle it through the back door or have neighborhood health centers for them. i do believe this nation would know how to handle that if we have everyone who is legally here covered, this would not be an unmanageable problem, though. >> great.

i.t. all loveless are basing our estimates on a really splendid paper and health affairs play jack hadley, and who are the others, you probably know them by heart i shouldn't put you on the spot, but they were a bunch of urban institute crowds basically employees and this is a super study the way they did it and everyone uses it as a benchmark and they started out singing if you took fully private insured people in 2008 and looked what was spent on their name, it was $3,900. and if you took similar, the same demographic makeup, similar people who were uninsured, we spent, what, something like 18 -- 1700. so about 43%. so what if we argue we are not rationing that is just a joke. that is rationing unless you say the whole difference was waste we must have already been rationing. so basically what jack hadley and colleagues to basically say we have to top this off. if we insure than they behave like the others 3900, and i think that in the end because some people were uninsured the whole yea

i want it to be like the i.t. revolution. everyone becoming a programmer. only in this case, it's everyone becoming a green innovater. what i.t. was to the 1980's and 1990's, e.t., ecological technology, will be today. this will give us the opportunity to move forward into the next several decades and give our children and grandchildren the competitive edge to compete in a world economy. with that, madam chairman, i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from california. mr. waxman: i'm pleased to yield to the majority leader one minute so that he may speak on this amendment and the legislation that's before us. the speaker pro tempore: the gentleman from maryland is recognized for one minute. mr. hoyer: i thank the gentleman for yielding. mark this day, june 26, 2009, my colleagues we have an opportunity to serve in a historic session of the congress of the united states. we have an opportunity to take action that will make a major difference in the security and independence and environment of our glo

if this is is an i.t. savings in the system, we are for health i.t. if there is a transparency savings in the system, we are for it. i think all of those things will ultimately save money, whether the majority can convince the c.b.o. to score those or not is something we will be interested in seeing. but we will have a significantly lower price tag thand there are four or five different places to go and efficiencies in the system and competitive marketplace are two that nobody is really talking about to the extent they deserve to be talked about. >> people are talking about [inaudible] is that on the table? >> it is certainly not part of our plan. and i can't tell whether it is part of the democrats' plan. mr. mccain talked about it. mr. obama said he would never if go there and angle he is there. mr. rangel said it was not be part of their plan and now i think it is. i don't think it is necessary to tax that benefit. i think it is helpful to give employees more knowledge of how it is used. we have a marketplace now but it is not the kind of competiti

education early on that when they are in college if they are taught how to do development or taught i.t. degette the secure fundamentals as a part of that as chris was saying and then once they graduate and go into the workforce that we have mechanisms that give them career paths so they can have a full career. they are not stuck as though you're the security guy, your ags 12, right? for those of you and the federal government, you know what that means. there's unlimited ends. you can go through the political ranks as a security professional. i think back when chris and i were both prosecutors in the mid-90s we had this problem where you would see investigative agents in particular who would develop considerable expertise in doing cyber, investigations and then they would be rotated out. they would be doing some sort of paper fraud or something else and some of them said the enough of this. i'm going to the private sector where my skills are in demand. that's changed substantially throughout the federal government but we've got to go farther to make sure we develop the career path and t

what we have now is a collection of people that did not grow up with i.t. now people grow up and by the time they've taken their driver's test, they've been around cars forever. there's an entire community educating them about driving when they are very young. that's where the recommendations and so forth people have been doing it for a long time. we do need to step this up to another leaf. underif in fact this is a national homeland security problem, we need to treat it that way. it is not a mystery and what we node to do, we need to execute. looking at how to make the item more%$y se tick. 15 years later, we have more problems with identity left tell me why you think we haven't made progress on this fundamental issue in 15 years and what we need to do going forward all of these technologies were developed with the notion that everybody was benign. we have a goal of driving completely out of the networks we have excited that technology has evolved. social security has become a secret. when i was a kid, we printed them on our checks. i think those kind of t

when they are in college when they are taught i.t. that they get the securities fund of that. >> so they are not unlimited. oh, you are the security guide or g 12. back when chris and i were both line prosecutors. you had this problem where you co-would see investigative agents some of them said enough of this. we have to go farther and make sure we develop that work path. you can't really understand this field unless you stay and play in it. no that's not just true in the law enforcement field but the energy fold. i think we need to make this cool for kids so it seems like something they want to do. it is something there would be congressional interest on. we were having this conversation in the waiting room before. i found it fascinating getting kids involved. we teach spanish, french and language to kids. why not teach code as another language. there are models we could follow. we found they tipped to stay in the government when we give them good work. that's probably the best money we've spent so far on cyber security. i think we

for about a decade now there has been no increases to i.t. within the brother of congress and yet most of the use -- within the library of congress and yet most of the users are library of congress i.r.s. this was the highest priority of our brairn of congress, mr. billington. this investment will ensure the millions of people who access the library through its web site will be able to find what is it is that they're looking for. similarly, within g.p.o., we funded the final increment for updating g.p.o.'s -- government printing office's -- web site to ensure government publications can be easily accessed and searched. also, the bill provides the final increment of funding to complete the merger of the library of congress police into the capitol police. this project was initiated by senator bennett when he was chairman of the subcommittee and has been promoted by each of the successive chairs and ranking members to improve security of the capitol complex. finally, there is a directive in the bill for a report by the government accountability

it tracks federal i.t. investments. politico reports that some republicans believe a handful of democrats may have taken a career ending bode by supporting the energy bill -- ending vote by supporting on the energy bill. chief justice john roberts says that justice this will rehear a case on corporate funded campaign ads after failing to reach a decision on whether a documentary about hillary clinton violated those laws. it could reshape the way american political campaigns are run ahead of the 2010 midterm and 2012 presidential elections. republican leaders say norm coleman's challenge has been worth the money. since election day, republican senators and the rnc have given hundreds of thousands of dollars more. the government experts vote today on whether michael and other combination cold medicines should be pulled from the market. the fda has assembled experts to discuss and vote on ways to prevent overdosing. the pain relieving. the reducing ingredient in tylenol and others medications. those are some of the latest

s to the pernicious incentives i.t.we are against them and would be difficult to design a system where an executive compensation reflects whether that executive actually helped the company in the long term rather than simply made it look good in the short term. this would be easier for those who have company wide decision making since we could give them restricted stock in the entire company those who led it to the success or failure of a single unit it would be far more difficult and i yield back. >> the gentleman from illinois for two minutes. >> thank you, mr. chairman. i'm disappointed some federal officials are moving in directions of government determined pay not just for senior executives in the united states companies but for their secretaries and the janitor. i think that is a slippery slope or worse. don't get me wrong, financial criminals must be brought to justice. but most important risky behavior in the financial service industry must be addressed and i think we can do that with smart and more effective fi

i.t. we have all seen the famous line what he said to his mother on the deathbed. he looked at her as she was about to take her last breath and said i forgive you. what i'm hoping is my grandchildren don't say that to me when the time comes but when i read the excerpts of the book in "the new york times" magazine i realized how revealing it is about the way in which families of a certain kind live together and how you come to terms with the fact these extraordinary people you grew up with have reached the end of the line and it sounds to me something worth reading so i will. >> to see more summer reading lists and other program information visit our web site at booktv.org. >>> up next on book tv, "after words," an hourlong discussion between a guest host and the author of a new book. this week author eduardo galeano talks about his book mirrors, stories of almost everyone. he also discusses open veins of latin america which venezuelan president chavez came to president obama during the summit during the americas of april. he's interviewed by john dinges journalism

we still haven't done a good job in terms of broad band expansion, whether it's health i.t. information or just people being able to have the ability to have these new protchalkts have not reached rural america. and i know something about it because i was on the energy and commerce committee and we worked a lot on the telecom subcommittee and know that's something that will help enpower so many of our citizenry. if they have acsession it cuts down on other incidentles. sand going back to green jobs, cutting our dependency on foreign oil. making sure we can retool and retrain workers. and hopefully those jobs will stay in america and be a sustaining crotch of new jobs that will help -- crop of new jobs to help people say in the middle class. >> on behalf of the los angeles times and steve of the cleveland plain dealer thanks for joining us on "newsmakers". >> thank you. >> as we continue the kferings, let me follow conversation, let me follow up to your question on california. what are you sensing and what role does labor have in >> the administration is really retsents. that

that includes computers, the internet, satellites, most of the rest of the i.t. revolution that finally exploded in the late '90s in a tech bubble but also much else. civilian aircraft, advanced machine tools, pharmaceuticals, biotechnology, and a lot more. the crucial role of the state in economic development should be kept in mind when we read these days dire warnings about government intervention in the financial system after private management has once again driven it to ruins. at this time an unusually severe crisis and one that harms the rich, not just the poor so it merits concern. it's also worth recalling that large state intervention of the economy is nothing new. on the contrary, it's always been a central factor in economic development. there's no time to review it here. but the history is quite instructive. these state-guided modes of economic development require considerable deceit in a society where the public can't be controlled by force. so people can't be told that the advanced economy relies heavily on the principle that the population pays the

when they're in college, if they're taught how to do i.t., they get the security fundamentals. once they graduate and go into the workforce they get mechanisms that have career paths. you are not stuck as a security guy. you can go up to the political ranks as a security professional. back when we were both prosecutors in the middle 1990's, you'd have this problem where you see investigative agents who would develop considerable expertise in doing cyber crime investigation and then they would be rotated out. they would be doing paper fraud. some of them said, and enough of this. i will go to the private sector were my skills are in demand. that has changed throughout the federal government. we have to provide that training. lots of other people have thought about that. >> the career path is important. one of the agencies that he mentioned, the fbi, cyber is one of their top priorities. you'd do a little bit of cyber, you do something else, and you do it again. you cannot really understand this field of the sea stay in it. the developments are too fast to go away. it is true acr

first, the purchase of health i.t. equipment. and we looked forward to standards for intraoperablity. [applause] and we thank you for the investment in comparative effectiveness research to enhance quality medical care. [applause] in your budget, you used realistic numbers about the cost of treating medicare patients and you charted a course to replace the senseless medicare physician payment formula and you're the first president to do it and we thank you for that. [cheers and applause] you've recognized that medical liability concerns contribute to rising health care costs and we appreciate your interest addressing this problem. it is critical to the physicians of this country. [applause] friends, i've had the opportunity to meet president obama at the white house and i can attest to his willingness to listen and to engage. his focus on heather care reform and the polite of the uninsured -- health care reform and the plight of the uninsured takes a courageous spirited and wise judgment and we're grateful for hits leadership. so

that does not count some of the long-term savings we think will come about from reform from medical i.t, for example. so that stuff is not score will in congressional jargon. the congressional budget office will not count that as savings. so we are saving -- we are setting that aside. we think it will come, but suffer from that, we put $950 billion on the table. taking us almost all the way to covering the full cost of health care reform. in the weeks and months ahead, i look forward to working with congress to make up the difference so that health care reform is fully paid for in a real, accountable way. let me add that this does not count longer term savings. i just want to repeat that. by insisting the reforms we are introducing our deficit-neutral over the next decade, and by making the reforms that will help slow the growth rate of health care costs over the coming decades, ending the curve, we can look forward to faster economic growth, higher living standards and falling instead of rising budget deficits. let me wrap up by saying this -- and that people are cynical whether we can

health i.t. is important as well was mentioned. i think a public plan option is the way to go and i'll ask dr. hacker about that in a second, dealing with catastrophic costs clearly that's something we have to deal with it, there's no doubt about it. and i could go on and on. i do want to pick up on the regional and geographic disparities question. i'm from iowa which may not surprise why i want to pick up on that. iowa as maybe everyone on the panel, maybe everyone not is consistently ranked at or near the top in terms of outcomes and deficiency, quality of service, all the rest. we're among the best if not the best. yet iowa and not just iowa but there are a number of states that rank high in terms of outcomes but rank low in terms of reimbursement rates. i want to ask any of you here to offer any remarks that you might with respect to the current bill and whether it really gets at that issue or not. and what we might be able to do to really remedy some of those geographic disparity that is we see. in particular, i think mr. poll

. >> i.t. to get a little bit by the federal government. >> mabey from sponsors? >> government funding. >> the viewers? >> how is c-span funded? 30 years ago america's cable companies created c-span as a public service. in private business initiative, no government mandate, no government money. >>> author akaka bradley graham joined washington journal to describe donald rumsfeld. this is one albert. >> host: bradley graham covered the pentagon for the "washington post" for many years and now a book that goes on sale today on donald rumsfeld, "by his own rules: the ambitions, successes and ultimate failures of donald rumsfeld." how did donald rumsfeld viewed the role of government official of public service? >> guest: he was a very interesting public service from a very young age, he was inspired in college senior year when adamle stevenson came to talk to his courage reading class at princeton urging of the students to put their work in public service and not long after that rumsfeld ran for congress and became the youngest republican member of congress in the 196

we are very blessed and louisiana that there were donors then gave us more i.t.and that gives us the opportunity with the flipping of a switch to move it around and that is absolutely incredible opportunity, but that is aware of our country so the capacity of technology is critical. >> if you could take that down and you when and with the same issue. >> and i seen that york has some serious gaps in the very highly urbanized area, new york, new jersey, pennsylvania? >> that is, correct. >> and then is that kentucky gripes west virginia. >> delaware. >> know, further out. >> kentucky, north dakota, arizona, wyoming. >> but on the eastern seaboard and the reason that i raise this issue at this hearing in the beginning of this season is that the predictions i have seen and the feeling about this season it is the storms have been so intense in the gulf coast. there is some sense that this is the east coast time and i just need to reinforce that and other people and minorities have not had a storm and a longtime. but there are some significant study is that show what w

some organizations, some of the i.t. organizations do but follow up with the actions just aren't getting accomplished to the extent government organizations have agreed to do. >> and talking with a lot of the agencies of other issues, we are often told we have a process by which we can't offer sole source contracts. we have to bid every contract out, yet you mentioned kbr contract for certain activities. could that contract have been bid out? is there a process the department of defense has to go through if they don't get contract at, there is a jna that has to be issued. why are they able to still have these contracts sole sourced >> mr. flecha is an excellent question. it has been some years the department of defense tried to have a leader contract in which there would be -- later version which there would be three competitors, and they i think the talk about that goes back at least two years. they are now slowly phasing and the successor arrangement that would have competition among the companies but it is still not i

similar to robert though, i.t.bably spend a year or two on research, filling those crates from office depot and but chronologically, chronological writing is the easy way out i think and i often take it. even as you are writing and 800 word book, the structure is the same as a good joke, with a foreshadowing an finally at the end everything becomes clear and chronologically that works particularly with the presidential box, where every second of the presidents' day is recorded and everyone who was contact with him, it is the high point of their lives so if you go to them 30 years later they remember what happened, but basically i write before there is anything easier to be done. [laughter] those hours from 5:00 28:00 9:00. >> i do the same. >> that is the first thing you do in the morning, before you have to do something else. i think the best, one of the most important things that i learned it, and i took a film writing, it was a weekend-- one of those thelma riding weekends in new york city and that was really im

i will assume that you looked at the april 21st report of the special i.t. for t.a.r.p. >> yes, sir. >> i think you did a good job of laying out the problems of transparency oversight. do you have any thoughts about these recommendations and how to implement them? and if you covered them before, i apologize. >> i had begun in my first week in the treasury to meet with the inspector general. i meet with him every week, if not more often. our staff at the treasury meets with him also and his staff. we are, i think, all intent on making sure these programs are very well controlled. and that there's as much transparency as practical given the need for these program to be quite broad. i know the inspector general shares those perspectives. so we are respectful of his findings and we take them very seriously and we're working with him to find practical ways of dealing with those concerns. >> and there's another issue, potential issue. i know the regulators are doing a great deal to avoid an issue. that is a reapplication to t.a.r.p. for an institution that might p

the sexy parts of the market were the equity market and things like that because it started with the i.t bumper go credit and debt which had been quite sleepy the previous decade with regard to blackwater, so you didn't have the high status, labels attached to that area of activity. so that was one problem. another problem was that actually not having lots of journalist apparro for the credit world suited the bankers just fine. i nothing there was deliberate by the bankers, let's fight but we were doing but it was one of those situations that suited everyone rather well. the bankers became like the financial preselect, who spoke financial latin. the conservation just sat there. the congregation by and large were happy to-- as long as they bus everyone from time to time and the funny to priests felt no need to talk about anything but financial let in. there was a feeling that this is all complicated. let me get, the. of course, politicians didn't have much incentive either come up because it was a contest the credit boom, so everyone was going along in and join the party. there's also the

it means health i.t., it means prevention. all these things are the starting point, i think, for reform and i've said very clearly, if any bill arrives from congress that is not controlling cost, that's not a bill i can support. it's going to have to control costs. it's going to have to be paid for. so there's been a lot of talk about well, $1 trillion price tag. what i've said is, if we're going to spend that much money then it's going to be largely funded through reallocating dollars that are already in the health care system but aren't being spent well. if we're spending $177 billion over 10 years to subsidize insurance companies under medicare advantage when there's no showing that people are healthier using that program than the regular medicare program, well, that's not a good deal for taxpayers and we're going to take that money and use it to provide better carat a cheaper cost to the american people. so that's point number one. number two, while we are in the process of dealing with the cost issue, i think it's also wi

and it covered health i.t. and the way that that can save costs in health. and just yesterday i got a book from senator daschle, information cure, solving the health care crisis systematically through integrated health care management. i read that last night. it has a lot of good points in it. some of which we have not put in the bill yet, particularly dealing within ing aggregating information. it reaped benefits. we have found some common threads there. but we have neverin aggregateed that so somebody might have something similar that is affecting them. each of the registers that we have are separate registers. but there is the possibility of integrating that information and aggregating it and coming up with new solutions for prevention and that's would cut costs. but i'm afraid we'll be on a much more limited basis raising expectations for people while we raise cost instead of lower costs. so i was hopeful and i'm still hopeful that we will take the time to get it right. but the bill we're marking up today is a bill that we were kind of excluded from havi

health i.t., electronic medical records. i think the republican party would agree we need to go in that direction. to equalize the tax treatment of a health care benefit. those who work for an employer gets a very nice tax exclusion that covers outstanding health care and many cases it includes prescription drug benefit but if somebody isn't working for a larger employer or is the sole proprietor or certainly if they are out of work, they have to go into the individual market, pay higher rates because they don't have the delusion affect the would have on a lot of lives covered, and they get no tax break. that's not fair so we clearly need to equalize that. there are just so many things that hopefully we will have time in the show to talk about, because we, too, we are not in the party of no, we clearly understand that our system could be better, should be better. is the greatest system in the world. most people are happy with health care and we certainly don't want to throw the baby out with the bathwater. >> host: question

to be honest is a similar problem as we have in the late 1990's with i.t. jobs. >> perhaps you can color code your report in the futures mckinsey the dream jobs. >> thank you. >> ms. klobuchar for five minutes. >> thank you. good to see you again, commissioner hall. i think when we were talking last month at this hearing you had went through the statistics and increases and indicated that we would continue to see this on employment and one of the things i want to clarify on congressman braley questions is the fact i think since the start of the recession we lost something like 7 million people have lost their jobs. when will you marked the start of this recession, this economic crisis? >> obviously the mbr was chosen by the start of the recession that also coincided with the first payroll job loss. so that's been a pretty good indicator for the recession. >> so december 07 was an entire year before president obama took office; is that correct? >> that is correct. >> we are at 9.4% unemployment rate. just we talked about last month these are real people who'

of bipartisan health care reform there is an emphasis on getting better information for using health i.t. to developing better evidence on what works for a particular patients of what kind of policies work best for decision making. those are important policy steps but in themselves are not going to be enough. they are enablers and not going to be enough and so all of this emphasis hearing today on reforming payments to providers and moving toward paying for what we really want, better health, lower-cost as opposed to fee-for-service is also extremely important. a third key element is consumers and involving patients to been a reform and we talked about that as well. i've heard about that in the last presentation and you can think of the reforms being considered on coverage sitting in the school as well. insurance market reforms make sure everyone has access to a range of choices and competition among health plans based on each patient better and not by selecting healthier individuals. we talk about the insurance market reforms. tax reforms and things like having the health insurance excl