Transcripts For CSPAN2 Key Capitol Hill Hearings 20240622

I mean, i had Ruthven Stella meet me outside. I did not have time for doug great, great people. I can tell you a lot of stories. Let melet me get to it so that you can ask questions. I am thrilled to be traveling with johnson in john sununu. I wish some of you would write in the car. We talk about every policy and we will the fair. It is so much fun command he is so smart,smart, smarter than i am, but i like to have smart people around. One more round of applause. [applause] so i dont thinki dont think you have heard this before. Let me tell you a little story. I grew up in a little town outside of pittsburgh. My father. Male on his back. His father was a coal miner. My mothers mother lived with us. She spoke broken and limited english. My mother she is very opinionated and really not like me. I am shy. Just a terrific woman not educated because that is not what they did. And it is one little thing i think about what my mother could have been. It was a place where theyre were not any republicans. They were all democrats but i tell you who they were, they were reagan democrats. Godfearing the common sense, and they were the ones that did all the work. They worked in a steel mills there was onetheyre was one guy that lived on a street that were a white shirt. I never saw white shirt. A result bluecollar and conservative love america. I left thati left that little town after high school and went to ohio state. I was theyre for about a month ago very concerned about some things. I decided that i needed to have a meeting with the president of the university because my uncle always said you start at the top. I kept calling and they would not let me in. Finally they did and i went in to see the president. He was an impressive guy tall baritone voice, a beautiful office, beautiful rugs, desk, furniture. He says to me what is on your mind. I tell him. I have been hear for about 30 days and am undecided as to what i want to be. I look at this office in your assistant, maybe this is the job for me. What exactly do you do . And so he told me about his fundraising because that is what president s to. Academics. Then he said, tomorrow going to fly to washington have a meeting with pres. Next and. I said, sir, there said, sir theyre are a number of things i would like to talk to him about also. Can i go with you. He said no. I said, well, if i go back to my dorm room and write a letter would you give it to the president. Thethe man had never seen before and he said, i guess i could do that. I went back to my dorm room, my best writing sketched a letter to the president and signed it sincerely john kaysix. If you would like to discuss this let me no and i will come see you. A couple weeks later ii went down to my mailbox and is a letter from the White House Office of the president. Pretty cool. I open it up, go upstairs and call home. My mother answers. I said come on, the pres. Of the United States would like to have a meeting with me in the oval office. My mother is shouting honey, pick up the phone there something wrong with johnny. True story. So i go home and this meeting is going to be in december. Im home for firstquarter break. They give me a ticket for driving to the airport. I get out of the car. Johnny, when you get down that they are going to let un but it will be okay. I got on the plane, flew down, go through the gate and am sitting rest of the oval office on this little city. The guythe guy walks up and says, you will get five minutes alone with the president. What do you think . What you think . A tell you what im thinking, i got a knew jacket, new shirt, new kind and knew pants, i didnt come in for five lousy minutes. [laughter] so i said, the door and theres the oval office. You know present the United States. I walk in. We shake hands take a few pictures. Pictures. Pictures. I sit down at his desk and spent 20 minutes alone with the president. In 18 yearold firstquarter freshman. The bad news is i spent 18 years in congress, and if you add up all the time i spent in the oval office, i peeked out the age of 18 and should have moved to the seacoast. But it really has been folks the story of my life and i cant am grateful to the lord that i have had opportunities and blessings. Look, i am a flawed man trying to do the best that i can. I ran for the state senate in a tough year against an incumbent. And i did not rely on the party organization. I relied on ladies like this and this no ax to grind normalgrind, normal folks. The weekend before the election this that i was a nice young man but i was going to get slaughtered. I went to the state senate and learned how to work with the other party because i was a republican. The house was democrat and i no it is more important to pursue policies and politics. I was 26. I spent four years. On Election Night my mother and father were theyre. My mother said, johnny, what are you doing now. I ran for congress with reagan. I met reagan and 76. I was involved in the convention and 76. I was a big reagan guy. When i say that i knew reagan and work directly with them at that convention how could you not be inspired by Ronald Reagan . I knew him as Ronald Reagan, not whatreagan not what i read in the history books because i had a chance to be with him. I ran with the reagan agenda and no one wanted to appear with him because the economy was terrible which was great because i get to spend more time with them. That year i was the only republican to defeat an incumbent democrat in america. Going to washington now. The 1st six years i served on the defense committee. My 1st foray i was one of the people who found the hammers and the screwdrivers that cost tens of thousands of dollars. Ii tell you a funny story. I took these hammers and screwdrivers that this retiring colonel gave me from a little operation columbus. My chairmanmy chairman was a guy who had his leg blown off in world war ii a great patriot, great man, democrat i go down theyre and say i got the stuff in the console is money and he looks at it and looks at me and says your mama dont have any more like you at home does she. This was a different change for embassy. We reformed that process improved it. Many miles to go but i was on the fence for 18 years. It was incredible because i service or the greatest minds. I get to sit across the table from Barry Goldwater john stennis, john tower. While. Sam nunn incredible people. I learned a lot. Six years and i got on the Budget Community and wrote my 1st budget and 89. The vote on my budget is 405 no and 30 yes. What would you think . Yeah. So i went back. My. My staff was depressed because they wrote this with me. Are you kidding me . We get 29 other people that think we ought to run the country. This is fantastic. We really gathered momentum. In 94 reelected a class of republicans who just did not give with about there own reelection. They didthey did not care about politics. They came to reform welfare and balance the budget. After ten long years i was one of the chief architects of balancing the federal budget the 1st time since man walked on the moon and we have not done it sounds. We pay down the largest amount of publicly held debt and the economy is doing great. I left washington. I was a giant Television Star on fox news. You remember how great i was i also worked at Lehman Brothers and traveled all of the country learning a lot about business which is critical in terms of understanding what motivates ceos and boards of directors so i left. Then i felt a calling because i believe. I dont know why were here. We can work a little golf and from time to time. We did face a bad situation. 20 percent of the operating budget in the whole lost 350,000 jobs. It was pretty bad. What from 8 billion in the whole to 2 billion in the black cut taxes by 5 billion up 350,000 jobs credit is rocksolid and if you have Mental Illness drug addicted, the working poor artistic, developmentally disabled a member of the Minority Community you are in our family. No one gets left behind. I was rewarded. I had 28 percent approval rating. You have to get up every day and work hard to be that bad i won 86 at an 88 counties including cuyahoga. I get 51 percent of union households, 60 percent of women in the 2nd highest margin of victory in modern ohio political history and it happened for two reasons. Creating jobs, opportunity and people feel included. The most important thing we need to do why in job creation is our highest moral it is our highest moral goal. Gettinggoal. Getting people work is what it is about. This economy has had terrible growth so we have to get the economy going and balance our budget. I have done it before we will do it again. Secondly, as people feel that things are Getting Better every american has to be invited in. No one can feel as though they are out. I am a believer that this country is great that because of the people at the top but the people at the foundation which is why i have tried to do all my life yesterday was an interesting day. Because of that i made a decision to announce house running for president. It took a little bit away, but that was okay because his son was happy. Thats my story and im sticking to it. Speaker, you get to pick the folks. How was that . [applause] [applause] the lady in orange. [laughter] not sure i like being called a big pumpkin. I dont even no the speaker. [laughter] okay. It is a pleasure to have you here today. My question and one of my concerns obviously with what is going on at has happened in our recruiting stations how do you feel about our military being able to protect themselves in recruiting stations and on us soil . First of all people who are in the stations should be armed there to be able to do there job. [applause] so in my state even today we were closing four of them down, assessing all the armories but i want our recruiters to be able to be effective and to be able to protect cells and others. Tickets to a bigger question a couple of things i would tell you. The military has run down over the last decade not just recently. There are too many bureaucrats that are running things inside the pentagon. When you havewhen you have all these people doing all the stuff things dont get done in the government. If you are bloated whether you are a business or government it just doesnt work and is one of the reasons why privatized Economic Development in ohio is doing it through the government we cannot move at the speed of business and the same is true inside the pentagon. It needs an entire makeover. Then wethen we need to make sure we are buying the weapon systems we need to rebuild our navy, strengthen our army we will be able to battle this problem. In order to do this summer what we have to do should involve the private sector. After september 11 i got a phone call to go meet with the former secretaries of defense of the pentagon. I have no idea why but i went to the meeting. I began to learn that we were actually not doing well on the technology front. I suggested that we think some of the best minds from the Silicon Valley because it was working out theyre. By the way i brought these two guys. When i met them for dinner in california they came to the meeting in a volkswagen with inline skates tied to the roof. You may have heard of the company. Its called google. We took some of the best and brightest people. Rumsfeld from time to time with convene a meeting and take these people for the work they were doing to solve the technology problems. We need to do more of that the less paranoid and use more common sense when it comes to solving problems because bureaucrats can trip over one another and not get the job done. When it comes to people like isis it is either pay me now or pay me a heck of a lot later. I have been saying we should have a coalition of people that we will go theyre and begin to destroy that organization. I think we need to do it. [applause] people say well the polls are good for putting boots on the ground. When do leaders have to do this . When they do this they dont have any followers. This is something that has to be dealt with. We can rallywe can rally the support of the public. We need good intelligence, human intelligence. Snowdon not to be locked up for a thousand years. Even in my state i get intelligence briefings. I give credit to rand paul for saying we should have a balance. We have to have the security but we dont want the government looking and everything i do. I thinki think we can strike a balance and be prepared. I want to tell you i no that this stuff is unnerving, scary. We have been through the civil war racial violence, depression world wars, september 11. Cant we just feel good . Can we start to enjoy being americans . I think wei think we can. Youre never going to stop everything, but we can stop a lot of it. When it comes to recruiting stations they are just one piece of this. Rebuild our defense so that our allies respect us. Meanwhile we say. No more red lines. All we do is tell people we are weak. One other thing theyre is no religion that i am fire with not on the face of this earth in the history of mankind that says that for you to go to paradise yugoslavia and kill somebody that you never met. Ill tell you something. I think we have to leave the world and making it clear that is just complete apostasy and it is unacceptable to humankind. And that is a part of the message that we need to have said loudly across this we will. We have to fight for decency and im an optimist, glass halffull guy on most things were going to be fine. America is going to be fine command i can do my best, but you have to do yours because this whole thing is not built from appear down. Is built from hear to the top. We work for you. [applause] we will call her the flag lady. We have one in ohio. My name is brenda bouchard. I have been a caregiver for ten years. My husband has younger onset alzheimers. My 89 yearold mother lives of me. She has alzheimers as well. One in fiveone in five medicare dollars is spent on caring for someone with alzheimers disease. The projections are 2050 thank you. [applause] by 2050 the projections are by 205,028,000,000 baby boomers we will have alzheimers. I no firsthand the pain. Do you know it. I no firsthand the financial burden this carries to families as well as our country. What we will you do to make sure that this devastating disease gets the attention it deserves and also the potential bankruptcy to Medicare Medicaid . Let me suggest a couple things. When i was in congress and are balancing budgets because i dont think you just gone everything. You have to figure out how to make things work better. Some things have to go because its like a garage sale. Most of what you have just needs to be signed up. Newt gingrich has just written an oped piece. Ii am close to knew and very happy with what he had to say. John and i were theyre we will be doubled the funding for the National Institutes of health. There are some organizations i would not double. Ill be doing it the other way but we need to do this research, this basic basicresearch, this basic research at the National Institutes of health is absolutely critical, and i think it is bipartisan. Support for this is growing. Number two i think we need real incentives so that people begin to buy longterm care. Right now it is expensive. I have it, wife and i have it. We bought it years ago but there is very little incentive command we need to think about a way in which people can afford this because in your case it would be a situation where you would have someone there you are a caregiver yourself and no what difference it makes to have someone in the house. But right now you no what it costs, too much. We need to incentivize the purchase of longterm care. The other thing i would tell you always said if you need to go into a nursing home thats fine. If you want to stay in your home home in your own home you should be able to do that as well. We also treated caregivers fairly. When i came and they were almost a part of ohio and people wanted me to dump them out. I didnt want them to lose theyre health care. Recently since they can get on the exchange they now can get theyre health care and are protected because you do not want to hurt the caregivers. It is a gift. Thethe lord gives you a gift to care for people. So i think it is research. I think it is longterm care i think it is breakthroughs that we need to have the medicine to make sure our caregivers are respected in society. But i dont know how to cure alzheimers. You no what theyre is some kid right now who may not be getting a good education could be ben carson. Ben carson again someone who can rise because thomas aquinas, the old catholic theologian said the science and faith are connected. We have got to explore. Theyreexplore. Their given the brains to fix these things command that is what i have to do. I give you a hug because that is hard. The quicker we can get to it the better. I will do what i can do. Thank you. [applause] let me just say one more thing because i want you to here this. This. I get criticized because i took ohio money from washington to ohio to treat the mentally ill drug addicted and the working poor. Somebody says stop moralizing. I am not going to hoist myself on my own petard. I just do the best i can. The reason i brought that money back its called expanding medicaid. Because of this now we can treat the drug addicted in our prisons and we can treat them and in turn them over to the community, and the recidivism rate is 10 percent. The national recidivism rate is almost 50 percent. Why would i not want to treat them . Final have this money we will have the resources to do it. Bipolar and schizophrenics said in our prisons. 20 of. 20 percent of my prison population are bipolar or schizophrenic. Were supposed to lock them up. We treat them. You can be bipolar and functional most normally. The way we function, if thats normal. The function as well as you possibly can. I do believe in these programs do not have to be exploded to deliver the services. It is made a difference in our state and people criticize me for it. God bless them. I am really glad that this because there are peoples lives who have been saved as a result. Im sorry. I want to tell you that. [applause] hi. I am a volunteer your name is what . Annie. I am a volunteer with the league of conservation voters. Voters. What are your plans for addressing Climate Change in the state of New Hampshire . How about the world . Okay. First of all i believe we are supposed to be good stewards of the environment and appreciate the fact that you are involved in something. But we dont want to worship the environment. Wewe live here and have to manage it. Ask the speaker here. They have a beautiful farm. They care about that land is much as anybody. Sometimes people come up with radical ideas about the environment lending itself to worshiping. I dont worship the environment, but i respected and protected. We spend a lot of money on lake erie because we dont want that to be destroyed. I also thought for some people in my own party over the issue of renewables. I assume you like wind and solar as long as the wind farm is not where you are. I get it. I understand it. The kennedys like wind. They like that thing on the ocean. What we call that . So anyway i think it is a mix of all of that. When it comes to call we will be digging we had to clean it and then burn it. I think we have to be respectful of it young lady. If we dont go the extra mile that we may be doing something that cannot be improved. But i dont want to be crazy i dont want you not to get a job because they had done things that are extreme. Like many other things in life, he requires balance. Respected, protected, dont worship it do it, do some things to move us forward. Battery technology. Welcome to New Hampshire i have not had a chance to speak with you. With a Student Loans forgiveness for the baby boom generation for the offspring. One that is paying off his Student Loans but back in the day we had the National Defence loan do you have any proposals . Not a free lunch but forgiveness with Community Service to offset that. I dont know yet what we do about those. First lets get to the roots of that. My kids are 15. Here is that we have done in the state and what we should think about nationally. We do not give any aid to a college or university of less the student completes the course or graduates space no more a giving money so they dont graduate that creates it incentive read the universities to guide our students through it a shorter time. Second, we do have a Great Community College System that allows you to be in a position to cut costs for the first couple years before you go to university. Third we have a program that should be aggressively expanded that is called College Credit plus some students can take College Courses in high school to get credit for Higher Education summer cuddy coming close schiedam to cut off an entire year. But now when i have done is i have a handful of business people. I paid did not select them. With the cost drivers and Community Colleges. With parking lots and parking garages. Ohio state least those to a private company that by half a billion dollars this happened two years ago. Why is ohios state running parking garages . We have to look at the nonacademic as baghdad many of the leaders at these institutions they say do we will implement it. But it is tough to be a president. To get everybody together. And nobody will pay this kind of money i met a girl pregnant up 200,000 worth of debt and two years worth of scholarship it was 60,000 per year 240,000 aftertax dollars. Part of it is to control that cost the ayatollah diversitys if you dont get your act together Online Education aid will take you down. I think that is part of it. We do have some loan forgiveness and it got stripped out. I cannot make a promise all of a sudden we will write it off to a Going Forward read judy to reduce the cost but you did Say Something to make sense. You do some Community Service, maybe that is the way to work that out. That is an interesting idea. I want to make a promise we will take care that. We will balance the budget add the chicken in every pot but that is a good suggestion. You said dont ask me. [laughter] that were doing as much as recant Going Forward but we have to be concerned about what we have right now. Are you related to mario . That is my brother. [laughter] i am joking. Talk about the free handouts the people on foot stems has almost doubled and i heard the number of children going from 18 through 22 for those who work and stand there with their handout. It is thus did not to help people who need help is a lesson in to help people those that need to help themselves. We have 11 and 1 2 million in ohio we had 130,000 people on a generally the fell 132,000 after a 11. 5 million creates perspective. Here is what we are doing with welfare. This is an amazing thing when you go to get medical care and you dont know what is going on but the best procedure is to have the shepard to leave us to the dust through but if you go to the Welfare Department on food stamps or general relief it could have four or five caseworkers they will have one case worker for somebody who is on welfare you as the county department will not do what i say because we will do this then to get businesses in the welfare office. We have businesses located in the welfare office. So we have a 90 retention from the welfare line so there is a lot of things you have to do plus to have the skills education and plus k12 that works. We live at lake will be gone. And in many cases we have to give them the skills of from. The president can be a cheerleader to hold people accountable but the fixing of the education and welfare system must be done where we live it has to reflect our values. One of the things that would like to toolhouse is to empower people like you hear it in the New Hampshire to design your own program. And i think every county is little different so we should have our own program to hold people accountable the you cannot trade them for underwater basket weaving. So is an ohio we know the in demand jobs to determine what is the future job needs . We have so many programs. I will give you one more. You have a couple kids and the workout walmart. But you want to do better samir asking the businesses to come together to play of mine a curriculum you can take your own speed complete that you are guaranteed an interview now you have a skill if you become a medical scoter you can make 41,000 per year i am told. But what is amazing is do you know most of those people on general deave in ohio . You can only be on it three years most not stay on its that long. They go into the underground economy somewhere. It is not a simple answer but we want you to be trained for a job that exists to hold you accountable. That is where were going right now. [applause] i am a newlywed millenials so i a cared deeply about our fiscal issues i know you are a huge advocate of the balanced Budget Amendment so how will you get us there . What changes do you make. How to eat an elephant . One bytes at a time we need a balanced Budget Amendment because congress will never live up to their responsibility for cry was in congress we dont have a balanced budget requirement in ohio or New Hampshire people would figure out a way to avoid responsibility then with congress you come home and blame somebody else. The way that you do this is overtime. Because that is all we need to do but everything undergoes the scrutiny with no favoritism you cannot start to play games but then what you do do you need the program shouldnt be empowering the states . Can we fix it to make it work . And for the big entitlement programs how is it done in such a way instead of people repaying each other apart . Because if you dont it will not work because they show that through people are better so they have to build the team. I have written in 16 budgets i thought i was done. [laughter] but i will until they put me in the ground. Then there is another test if it is in the yellow pages why is government doing it . You dont have to. Gradual and creative and tried to innovate there was an Amazon Kindle it cost a lot of money now they pay you to take one. [laughter] one last thing if we can reduce that overhang i saw it happen the minute they won the majority in 1985 things started to get better because there was a sense the mess would have figured out. And it did until they went back to their spending ways. If i am president that will not happen. [applause] i am also a millennial concerned about the budget because were also burning fossil fuels over 30 years if we continue on this road we will reach 2 degrees celsius that would be catastrophic by the year 2015. We hear a lot in the Republican Party that jobs and the economy cannot cut fossil fuels but keep the jobs but in the Renewable Energy Community Employee is more than the fuel fossil fuel economyeml now you have methane issues of the delta where those to make sure the water is clean. That is another important part. And i vetoed the one bill because it would damage to the streams and tributaries. Sovietbacked to the issue of balance. But but they want to change things i have to of 15 yearold sandro wife. You think i am in charge . I am for gender equity but i dont have a say. But i respect what you say. You know, how you are a believer, so in my. Dont ever become cynical or glossed. Believe fight for what he believed in and be respectful you are the next leader. Will you commit commit to the . Again be the best answer i can i will give the best that i can for the environment. [applause]. Bin 2018 the obamacare plan it imposes the excise tax for some health plans. I think obamacare should go. [applause] people say because you are for Medicaid Expansion you are for obamacare but so did reagan in. But it does not control Health Care Costs and drives up the cost of health care problem. So we ought to incentivize the primary care doctors to have Insurance Companies come together to provide quality medicine not quantity medicine. Today if you go to the hospital they could give you than test but you only need to but they give you ted because somebody else pays so we want to take this nationally absolutely it could be dead it is scaled but we want Insurance Companies and the hospitals and managedcare companies and the primary care doctor working together so as the prices come down they both win and the patient is healthier. I will explain specifically. Our Childrens Hospital in columbus has made an agreement with an Insurance Company around the issue of as much. Oh lot of kids have asthma the issue is how can you be healthy without being hospitalized . The have significantly cut the number of hospital admissions that means they me and they make less money so the Insurance Company has more money because day have less claims but now they share that benefit. That is the way it ought to work treat for Quality Drive to lower prices and let everybody shared and we end up healthier fundamentally that is how we should do that and obamacare does not touch that. [applause] you have been persistent. I am known for that. Pleded is your position on the Citizens United and their courageous amount of money for campaign . It is not a good system when it is the fact billionaires for president every time we change it is worse we have to figure out what we want to do for if i lose i played the system if i when i think it is good. [laughter] but we need to be careful what we do and i will not get into a Campaign Finance reform right now. John mccain is a there will be times to address that i have some thoughts but i want to make sure they are accurate. Of my friends said last night john kasich knows so many things why does he say he doesnt know . Because i dont want to give you an answer that is not legitimate some people run for president they cannot do what they say can smile to it what ikea and if i am not sure i will tell you and we will get to it later. Of villages have you down to the white house. [laughter] thank you very much. [applause] [inaudible conversations] but what it is is amazing about uber white ago gold now it is a word in the dictionary. Who wears that . My wife. Hello. Have vice seen you before . Hold on. Thank you. Your refusal to commit to cutting carbon. No, no, no. There we go. Everything is great. Can i get a picture . Thank you. Is an all girls school. The link to. Let them know that they screen the candidates. We are excited about that. Thank you so much. [inaudible conversations] the 8q. My husband is since cincinnati. Are they close . It is very similar. I dont know about that. I dont think so. Thank you very much. Part of the problem because you can get to the lower ones without any problem. That is another thing because people use the loan for things. The number was extraordinarily high. That is what i was told. Why dont you lower your prices . But that mentality has to change. Really better earned incometax credits is unbelievable that it is the gateway to welfare. Check that if you are entitled to that. There is two things. That is interesting. We are not managing anything right. We have to manage it. I am no fran of the other gentlemen. But sometimes if you explain the purpose they will do a lot better then theyre doing. Absolutely. Great job. Thank you. Thank you very much. Of course,. There is a lot of ideas. [inaudible conversations] i am so glad i did not go there. It is a great school they have a lot of fun. I hear you. Thank you. That is all i can do. I can just do one. What about the border . We have to do that. If it is interesting it did not come up which is amazing. [inaudible conversations] in the year of the selfie. You guys will have to be and make sure we get it done. Tsa we dont want to do that. I have been there. Can i get a picture with you . Did you get it . Thank you. I just do my thing. Over and over again people like it or they dont that is when i got into the race because i think i could win. If it does great, if it doesnt then that aint bad. This is blocked by a blocked in peoples homes to take their questions in a town hall meeting. You have to ask the people i think there is a good connection but i dont have a narrow group i ask questions and answer them but when you have National Security experience balancing the federal budget if it is basically on its back it is so big and unique hand on top of that then they put them all together. It is too early to talk revenue is gone into is not. Why is this a unique path for you . It is into. But it is me. I have an update to say about that other then we will see. I will not say how it works for others provide a broader fortuneteller per girl but am i confident i could win . Yes or would not be running. I have far record that is unique among a pretty poor girl i have not heard you articulate. What are you looking for . Given the town hall i have been talking about health care and department of defense to balance the budget, up but we will take a lot of love we do in ohio to washington. It is the history to tell you what you can do but i dont think people say you did not tell me but if you are i needed to pay attention. If i am not connecting. May be a better question is what are your priorities. To balance the budget to rebuild the fence to send a clear signal ever ready as part of the american dream. That is what matters to me. The reason why the record is important because anybody can promise anything but who delivers. People like it dont like politicians but talk from what you have done or intended to do creates a credibility. One more. I have already said this. Id like john mccain he is the great war hero does the president of our freshman class maybe someday he will be for me. Were sitting here at the Agusta Museum of history and a decision was made to do a Permanent Military a display to honor jimmy had when i did research on the book by went over 9,000 Carnegie Medal recipients and of a the 3500 recipients since the civil war it turns out he is the only person ever to have heard both awards. He was very humble. When i interviewed people who knew him and i did the book, people knew him well. What about the Carnegie Medal . They did not know anything about it. Wallace of them will tell you i did not deserve this. It is of a piece of humility and he employed has been in that category. President wilson moved to agusta as a child at this and a oneyearold to live in another house. But his first memory is in november 1860 when he was four years old standing on the front gate somebody came by in every to say Abraham Lincoln has just been elected president and there will be a war. Where theyre so excited . We think it is remarkable his first memory is about another president and then another war, said the civil for which wilson would have to leave the country a through world war i. [inaudible conversations] good afternoon. Today we will spend the next hour and half talking about advancing medical innovation for a healthier america how to excel a rate that to the future. To be a Global Leader of medical innovation and for decades for girl tens of millions of americans have the effective treatments. With parkinsons disease leukemia, we have 10,000 known diseases that have been defined that have signs and symptoms but of those 2,000 we only have 500 treatments. We have a lot you do. Approximately 1. 5 trillion however if you look at those investments they have not resulted in a commensurate level of progress in discovery and development. Expensive and wing the developments of a process slows down the advancement of madison and that access to new and effective treatments. We hear the statistics which tractor but a new drug takes almost 2 billion of investment and about 10 years for that drug to reach the marketplace. For those who are facing a lifethreatening disease that may be in a Clinical Trial waiting for a drug that is too long a the clock is ticking way to slow paper broke and to play a vital role to work with the private sector in the Discovery Development delivery is does the to be modernized. We have the investments with treatments and though lightning speed with which new applications and devices and Information Technology is advanced. The government does that add lot of different ways but the fda is the Regulatory Agency that oversees the safety of medical products and devices before the American People for careers as a former member of congress we are very aware of the role of government. It can neither incentivizing antics of a rate or it can stifle Industry Growth to a back those advances which can be made possible. The easiest way is we cannot rely to day on technologies of the 1900 to end the fda structure was put in place when the world changing so fast it is on the cutting edge of new technologies including medical science and Information Technology. Fundamentally we have to modernize to bring up to date the way they are developed and delivered and it is time to act now and we will talk proposed Global Implications and competitiveness but you do have millions of patients out there waiting for cures better on the shelf ready to go. The legislative branch plays a fundamental role in removing barriers for approach to strip them away that fosters that dynamism and creativity and innovation to excel raped that development of defective products for gross senator alexander chairman of the Health Committee has given his own voice to events United States leadership with medical innovation in to improve the competitiveness across the globe or around the world. In january, seven months ago the chairman released a report to identify opportunities for meaningful reform with the development process. Later the chairman alexander and the our Ranking Member very lost in working together in a bipartisan way to identify those policies to improve the development of medical products for america protractor through a new effort fda advancing medical innovation restate path to support legislative efforts were safe and effective medical products for patients that brings us here. It is my pleasure to introduce chairman alexander was in constant discussion with the stakeholders over the last several months. For selected 2002 and in january 2015 he became chairman of the Health Committee where he laid out very early picks a new child left behind and for purposes today to bring more cures also serving as chairman has the Water Appropriations Committee guess there is day tennessee mafia as the governor to it the ever popular elected as the United States senator to become the Third Largest auto producer in america please join me to welcome the senator alexander. [applause] they give for being here. I was permanently retired from politics for the second time when he dropped around to see me one sunday afternoon that said i could win a seat that Fred Thompson was vacating the only cure for politics is embalming fluid. [laughter] so then i end up in the United States senate and the bill was majority leader and a terrific leader and by had that chance thanks to his leadership to be on this committee that is the Senate Finance Health Committee that has the jurisdiction. So i am delighted to be here with you and him the specially. I will tell you one other story which will explain why i plan to speak just for a few minutes then listen for the rest of the time. Senator warner used to tell the story when he was first in the Senate Sitting there wondering what to do one of the older senators put his arm around him to say dont worry you will get the hang of it. All you have to do to be a senator is stand up and Start Talking eventually youll think of something to say. I hope to do disapprove that [laughter] i am a recovering governor so i have an outburst of executive leadership i try to impose on the senate that is not that easy but to have 30 percent of all the jurisdictions i wanted to do something useful. So we had three big prairies to fix no child left behind and thanks to Ruth Patty Murray the senior democrat we could form a Bipartisan Working Group to get the bill through 81 70 last week which is pretty remarkable given that complexity of the issue and the difficulties. [applause] but we are results oriented. Second common it simplified federal rules and regulations to govern Higher Education there is wellintentioned rules put the institutions are struggling with the red tape we have a variety of bipartisan efforts to deal with that. A the third area that we identified earlier this year the real approach to the same bipartisan way is to try to space federal policies in such a way that we are able to move discoveries through the entire process of innovation , regulation and investment into the medicine cabinet more rapidly. The house of representatives has a similar goal and passed a bill called 21st century cures i was going to tennessee with obama earlier this year to announce the Community College initiative. I told him about the three goals he said he is interested in Precision Medicine. And as a result i went to the white house when he made his announcement and i said we will take that and incorporate that with our work on innovation by medical research and while we argue about Everything Else we will work in a bipartisan way to pass this. He thought that was a good ideas were have been working with secretary baroque and it is fair to say i think this trade will get to the station. The house already passed a bill we are working on a similar bill the press is interested in what we do and the timing is such an order to get everything we want to come it will be thanksgiving or the end of the year before we finish the Committee Work but that is not a delay because the senator could not put it on the floor anyway but with the support it has now and is expected to have by the end of the year i expect legislation that could be considered by the congress in the Election Year that people could take pride in. But bill frist has said it affects virtually every american so members of our committee that include elizabeth warren, baldwin warren, baldwin, Liberty Sanders and rand paul and others we have a diverse committee. [laughter] were all interested. We see the importance. We want to do the right thing. How to we know what to do . The big disconnect is between those of us who are elected and everybody else who knows what you do and how you get the two together. One person i thought of immediately and is billed for a style did not know anyone who understood both research and the United States Senate Better than bill frist. I am sure there is somebody who knows the Senate Better or Biomedical Research and nobody knows both. I asked to review the your leave help us design how to go about this and he said yes and he came up with the idea to work with the policy center. So all the parallel tracks are going and this is the house side track as we confer very carefully about your recommendations. I have a specific request to make of those who were working on this i will listen to the panel because i want to devote more time to learning but take those recommendations you have made to boil them down specifically that we can send to the legislative council. You have a lot of experience doing that with america competes 10 years ago which was a request i made of the National Academy of sciences with others to give a specific recommendations how to make the country more competitive. Attends pacific in priority order we got back 20 and then with the leadership we passed that with 70 cosponsors and eventually it got done. Not all of it the first year but most ideas failed for lack of the idea. So we need specific recommendations for what to do with the commission raising. Another example is a i ask the chancellor to give a specific recommendation about how to simplify it Higher Education. They gave us than in prior you order we will include as many of those as possible in the reauthorization of Higher Education to waste money on red tape as we could be hiring better professors or giving scholarships to students. That is what i would like to ask you to do. Here are 10 specific things you should do in the Senate Legislation to meet the objective to space federal policies so we can get it cures and treatments and other discoveries through the whole process into the medicine cabinet more rapidly and a lower cost. That is what we look for. We did stumble into Electronic Medical records. It is the project the government has been involved in it worked when it was giving a 30 billion nobody complained but now the money is gone and the system is in the ditches and there is a lot of complaining to the doctors and hospitals about the next page because the system isnt working with a variety of problems. That is essential because for example, dr. Collins to sequence human genomes to get that together and Precision Medicine does not work very well with doctors cannot point and click to use that information as they make the diagnosis or to translate information and. It is important we can do a better job for patients in the United States. As part of this the fivers six tapes steps to improve the Electronic Health records that they look forward to. That is the goal i am working with the secretary on that if we come up with those things that she can do by executive order so much the better it is easier and cheaper for requires legislation we have a train trying to cash out of the station. The queue for what you have done, i am delighted to be working with the Bipartisan Policy Center especially with bill and bart with whom i respect and ill look forward to your comments this afternoon and to receiving, if you can take those recommendations and boil them down to what we can look at and send as many as possible to draft and include in our bill. Thank you very much. [applause] i have a the bart gordon day he mentioned earlier i had the good fortune to be on panels making recommendations and i can tell you when you put your time in with a good recommendation and it goes on the shelf is very discouraging the you know how much fun it is to put that together then you see that with reforms. I am doing better listening to Lamar Alexander wright then. We have the opportunity to watch first and the governor work with their roadie legislature buddy came forth with infrastructure and investments and industrial recruitment he will have a good partner in the house. Newt. When i think of her think of a story of the little engine that could. I think i can. That is her she just plows on maybe having a world record of a number of hearings across the district to come forward with the major bipartisan vote in the house. Tell us what is going on with few. [applause] i am so happy to be here they dont ask us to come over from the house very often. It is a treat for us. I was happy to hear your reflections on these issues because as some of you know as the chairman and i talking about all those hearings we had hearings and round tables and white paper and worked for about 18 months trying to and many have attended a multiple of the hearings but to have this effort because they found many areas where we can make treatments to bring the jurors to patients. But this is similar to new the consensus that we found in the house and i think what it shows is that there really is so large amount of consensus of what we need to do through the regulatory process but also the resources we need to bring to bear to expedite Biomedical Research at the nih and then to approve to the fda. Hospice and medical Research Field as experts from all different backgrounds and sectors agreed about the meaningful improvements that we can make. And today a report was released i have not read it in detail but the executive summary offers a lot of the same proposals that echoes a lot of what we heard in that house and acted on in h. R. Six 01 to highlight a few of the similarities in this report compared to the house investigation. It is the report the recommendation to include the patients perspective throughout the process. H. R. Six has severed several provisions that echoed echo of policy and there are several of the strength of Publicprivate Partnership that we highlighted. Further there was a recommendation to a accelerate the development of antibiotics it is a provision that has been a controversial since it passed the house but when crafted in a careful way handinhand with the agency giving Technical Assistance assistance, this is something important to deal with those cases of antibiotic resistance. This was also included i could go on but i will not. I am under the house rules today but i think we can find a great deal of this consensus. I do want to talk about the importance of new resources for the flagship medical institutions. Fred and i went all around the country. I was then samprass commanded michigan he was in denver all over the country and biomedical institutions whether the fda or nih nih, theyre working on multiple priorities in a stifling budget climate and they need the ability to carry out the we are circling right now. Wants to give you an example we were having a bipartisan roundtable and the energy and commerce curve. And collins turned to be and whispered if we had full funding for the nih and not under the budget i, we would have had a vaccine by now. I said you have to tell the whole group. He put it on the record. Because of the Budget Constraints many programs were put it but that in this case really with all the relationships we have going on we need to research the innovation progress was to be no repast 21st century teachers in the beginning of the month, 344 70. You cannot pass the eternal with that by the way. We were gratified but we hope this bill will just be a resource to the senate as they embark upon a very important investigation this fall. I am discouraged to me it the senate Health Committee and the by part the policy center adds the momentum to the conversation and. We had a genuine opportunity to make up the line dash up dates in reforms and after the last century a river kumble medical discovery, we wanted to make sure the 21st century that day accelerate to meet the challenges of the time. And now but then it begins fiscal year 2016. That is october 1st. We are glad to be here and of any resource we can be we are thrilled the senate is taking this step and were thrilled to be here with this update. Thank you very much. [applause] seven faq representative. I am glad you made it all over here we had a little shower coming and i serve as the director of Health Innovation and on behalf of the group thankyou for coming in today. We will spend some time going through the report. And we are delighted to hear from the cochairs and if i could ask you to come to the table with the advisory county members then i will take a few minutes to introduce each of them. You were able to reach with a senator for is to open and today as a nationally recognized health and long transplant surgeon also senator majority leader. On his left this is congressman gordon former congressman who served as chairman of the house but i am delighted to introduce you just flew in from los angeles a position and scientists and has for diabetes and cancer published over scientific papers having patents on the Ground Breaking advancements then final the to introduce the to have a unified voice with more than 3,303,000,000 people those who are sick or have disabilities and have been a strong supporter for medical evaluation and the third member serves as the senior fellow director of policy at the Brookings Institution could not be with us today in person. I will move over here to get into the discussion. With the executive summary and i wonder if you could tell folks is the room of a broad brush for those of you that are here with the final finishing touches it is easily digestible. We have four areas. And to come through the process the first is to improve the medical development process. And to increase in a generation of realworld evidence it is accessible to dave it is hard to get into the fda. Ha you take advantage but also with drugs but looking at surveillance it is critical but the approval of those new indications into the Clinical Trials and the dissemination of scientific information with that clinical Decision Making that business understood generally but one at a five are getting awfully both their peace. It is lifesaving this because the way the approval process is set up with a Clinical Trial process but it it has been shown scientifically should not be given to patients in need. The fda does not regulate the practice of medicine nothing prohibits them from prescribing of love off label. And you will come to that with every discussion is the best we are the most innovative but there are good things happening around the world that need to be assimilated into our database. We addressed though whole issue of the inter opera ability to have improved with information and technology we do have all the is different standards out there but this is the foundation to not only improve the process also the broad aspects including getting it into the field and the strategy is to empower the patient that we did not have 10 years ago. Is in their report on page 14 blessed is who is responsible for what the death in charge of regulating congressional action needed to improve fire regulatory clarity where you put Different Things together who is responsible to regulate that . It is the ability to combine their drugs and the especially that began 15 years ago that opens up the coronary artery or insulin delivery instead of the injection with their transdermal patch for the treatment of early parkinsons disease. There is a tall lack of the between center delineation between responsibilities. To be clear on that clinical investigator to be the conflicting feed bought feedback to slow down the field as people try to rectify. To give a the pathway for approval many believe there is decisions made the Center Receives no user fees. That is part of the process that becomes very confusing there is no incentive for a timely review. Regarding the authority associated with the Laboratory Developed test the lgbt is very confusing we dont have experience directly but as the best diagnostic test to feel what is good or bad who is responsible . Also calling for a clarification to help technology with Clinical Software what we carry on our eye phones the coz the medical device with the Regulatory Framework it slows down innovation but we have a lot more to do. With the adults stem cells is exploding as all of us age the virginia try a to improve then that antiquated system with the stem cells and other therapies to hold the most promise to hold many of of todays untreatable diseases with the recognition of the ornate wood dash unique beecher with similar therapies. It was all embryonic and they were locked down but we are very beyond that. With the appropriate Oversight Framework with precision in madison not what we talk about is strengthen the ability to carry out the mission we have a summit the great people as they were quickly outdated framework and then to spend helmeted is important. We have a number of recommendations how do you hire people today . With the office of Personnel Management to hire and fire that happens is the legislative branch. But that holds humanresources also to prove the effectiveness of the Publicprivate Partnership and finally we have bay section and to improve access that there is river say Government Role and the it drove said drug company could make money but there is a Huge Population in and. They have made an obligation and. Battues the use of and erratics. But how can we . We go people are dying but also to cure or treat and again special attention to the use of antibiotics. And you can talk more about that. I went way too long but those of the four sections read the report and we will talk more. Thank you senator. And is a lot of recommendations in the executive summary. What is on a the web site is the combination of things that we hope the senate will move forward and wine to go for reduce the use of realworld evidence then a number of new idea is not in the 21st century legislation so go to the web site. We will run through the topic areas and one that is very important to us is about competitiveness of american companies. I remember representative cornyn could you talk about that and how they improve our competitiveness. I will just speak up. The senator is excited about this report. [laughter] i think for good reason. The following senator alexander model i will Say Something anyway. When we Work Together before we found after world war ii ruth the United States pretty much read led the world in all economic areas the reassemble formula to invest in education and invested in research or new ideas, improved ideas and new services and half of the gdp resulted from our investment in that research. Then comes in the rest of the world is increasing investment. They read the book. They figured it out. In the area of our anti research and development 2007 through 2012 hour share of the of World Investment went from 50 percent down at 44 at the same time asia went from 16 at 23 . So we have to get our competitiveness back and we talk about putting more money into the pot and that is one aspect but if we could get more use of the money were spending you get the same results. A couple of areas that i think are important is a great resource deadend our report we give a specific recommendations. If you see the government in the areas it is a market driver. Another thane the i think is important is this is looking at interrupter a inch rubber ability at with mutual acceptance on a variety of international standards. We just passed fast track here it comes and dpp and there is an unique opportunities whether through the agreement itself or through the vehicle to have these discussions to find out how we have harmonization and mutual exceptions to reduce the cost to bring drugs to market . Right now it dates to billion dollars to get a new drug on the market. Surely we can do better than that. Dr. Patrick you have a long history to develop been implemented ways to battle cancer. Dell whole topic of precision that is in is very interesting and a passion for you. Can you talk about advancements in this area and the implications for the up fda . How do they need to involve . I think the issue of Precision Medicine is an opportunity. The right to as a professor to leave to study the particle protein drug for lung cancer and but as the age the reason weve lost though war on cancer rigo down the wrong assumption but to explain and Precision Medicine can save us but not the urgency of what we need to do. We had always assumed as a nation and society that cancer was a single clone the the rise of horrible clone and it grows and you would kill it so we had been going down this path of the single drug of chemotherapy Radiation Therapy and it makes sense if it was a single clone to try to kill it to put you through a horrible process. And hope you come down at the end alive with the clone dead and your body alive. If that were true we would have cared cancer today. And amazing assumption was made by a simple mathematical calculation that in retrospect that cancer cells grew but it turns out now and there are 10,000 clones and also a turns out as the savior to produce 10,000 cancer cells per day your party has a protective mechanism to actually have them grow. So there are 10,000 clones only through next Generation Sequencing and genome sequencing. Then the a. D. It to use that you with a dose of cancer has failed but the killer cells will float around killing 10 of though white to sell just sitting there today