president obama has called this the most important event this year and afghanistan. why do we say that even though this election is undoubtedly a very difficult event? holding an election in a wartime situation is always difficult. holding one with the enemy has said they will try to disrupt it makes it even more difficult. holding it under historic conditions that have been alluded to, they can go on forever about how this relates to the history of the country. it is even more daunting. . . a national reintegration amnesty program, improving the governance at the sub-central level which barney and others alluded to, sepideh particularly mentioned it, all of these are vitally important in a counterinsurgency effort but until an election legitimizes the government, whoever wins, we have had to focus on that. as all of you recall if you have followed afghanistan when we came into office the country faced a constitutional crisis over how to deal with the fact that with the aiding and abetting of the international community the afghan constitution, the one rinna helped draft, was be going -- not going to be carried out. imagine what would happen in the united states if people announced that the election would be delayed indefinitely. well, that's what we inherited. the opposition says who is going to be legitimate? who's going to rule? we spent most of the spring helping the afghan government seeing -- it threw to the august 20 date coming up next week. so this election matters and we will see what happens. my -- i will be leaving the day after tomorrow for afghanistan and pakistan in reverse order. pakistan first, then afghanistan then i'll fly to istanbul where the turks are hosting a friends of democratic pakistan meeting and the president's asked me to be on the scene during the elections. but i do want to emphasize that we have an extremely strock -- strong team in the american embassy and in the military command. ambassador eikenberry is superb and as the former commander of the forces in afghanistan has a unique ability to integrate civilian and military issues. his deputy was our gaffer -- ambassador in to -- two of the world's largest american embassies, egypt and the philippines. the number three person, who was already mentioned, tony wayne was a former assistant secretary of state and just came directly from buenos aires as ambassador. the number four person is a former ambassador as well as -- and we have an additional election unit out there headed by ambassador tim carney. on the united nations side, kai runs you asuperb operation and his senior deputy is an american. peter gathbrathe served as our first american ambassador to croatia and was the deputy in east timor so he has long u.n. experience. and on the military side, admiral mullen and general petraeus pure and simple sent the first team in. stan and david are the two best people now available in the united states army and as vikram importantly said and i want to draw your attention to this, the best counterpropaganda is to reduce civilian casualties and the rules of engagement have changed in a way which has produced a visible as a result -- result on the ground. if there's been less news coverage of that issue lately it's because there's been less of that terrible problem to deal with. so in closing, in closing my opening remarks, i want to be very clear. we know the difference of input and out putt and what you are seeing here is input. agriculture. pule of law. counternarcotics. the illicit financing. that's what we're doing. the payoff is still to come. we have to produce results and we understand that. and we're not here today to tell you we're winning or we're losing. we're not here today to say we're optimistic or pessimistic. we're here to tell you that we're in this fight in a different way with a determination to succeed under the direct personal supervision of the president as -- and secretary of state and the rest of the cabinet. and so i want to close with that and turn it back over to john and, john, thanks again for the center for american progress doing this today. >> thank you, richard. >> i want to come back to the election but i am going to ask a few questions and then we're going to open things up againing with the press. i want to come back to the elections but i want to pick up perhaps where you left off and ask a larger strategic question which is that, and let me begin by noting that when the president announced the policy after the 60-day review he laid out what appeared to be i think in the minds of many people a very narrow objective. which was to disrupt, dismantle and defeat al qaeda in pakistan and afghanistan and to prevent their return to either country in the future. but actually to execute against that very narrow definition of what the project was all about, you need a broad strengthening of the governmental capacity and security forces in afghanistan. you need a stronger, more committed partner in pakistan. i think this team reflects that. and reflects a much larger strategy than what is embedded in that very narrow definition that the president"pñ used on march 27. i think probably ambassador eikenberry's budget request that was recently reported reflects that again. so in that context, for, from the perspective of the mediterranean -- american people, how do you define clear objectives of what you are trying to succeed with as out putts against the -- how do you measure success against that broader array of problems and inputs? >> a very key question which john, you are alluding to is of course if our objective is to defeat, destroy, dismantle al qaeda an they're primarily in pakistan why are we doing so much in afghanistan? it's a legitimate question. it was addressed directly by hillary clinton in her july 15 speech at the council on foreign relations here in washington. and it's a relatively simple connection but it needs to be very explicitly stated. al qaeda and the taliban, or to be more precise the talibans, because pakistan taliban and afghan taliban have some connections but they are also separate in many ways and it's very elusive to analyze the inner connections. and by the way in the aftermath of mehsud's apparent death there's all sorts of reports that you've all read in the papers of inphyting and there's going to be some major readjustment coming up. we don't know what it is. we have many theories, but the connections are clear. if afghanistan is first ill re -- is fertile recruiting territory for the taliban it gives more terrain from which to operate. unless the taliban were to renounce explicitly al qaeda they are basically fighting in support of one another, so they are allidse. in secretary clinton's speech and i would draw your attention to this, she laid out the fact that if -- that we would support the reintegration into afghan society of any people fighting with the taliban who renounce al qaeda and lay down their weapons and reintegrate peacefully but on your key point, the question we're always asked, i think it needs to be stated very clearly that if you abandon the struggle in afghanistan, you will suffer against al qaeda as well. but we have to be clear on what our national interests are here. >> i guess what i'm asking is can we settle for a reconciliation process, a weak state, and continued intervention, destruction of al qaeda forces in pakistan? as we've seen just this last week. >> i think that you say a weak state -- >> is that a, an acceptable end state? >> i think we have to be reasonable about afghanistan. as barney said at the outset, it's the poorest nation in the world outside of africa. it's been torn apart by 30 years of war. we're going to help rebuild it. the military part of this struggle with american troops is not an open-ended event. but our assistance, our civilian assistance is going to continue for a long time. i can't give you dates. and we will help strengthen the government. that has to be part of our mandate. the specific goal you asked, john, is really -- it's really hard for me to address in specific terms but i would say this about defining success in afghanistan and pakistan. in the simplest sense the supreme court test for another issue, we'll know it when we see it. ok. >> let me -- rinna gave a, i think, very great backdrop to the election. let me ask you a question about that. i think some observers believe it's not the taliban or insurgency that's so strong but the government of afghanistan that's so weak and there's a lot being built into -- you quoted the president being the -- with respect to the election this year. do we have any expectation that this national election that includes provincial elections will change the weakness of the government going forward? >> couldn't be a more important issue. i asked the ambassador particularly to focus on that issue and without going into too many details let me say that after the post election phase is completed and i stress that we aren't going to know on the evening of august 20 who won, cnn is not going to call this election -- >> well, we may, but we still -- they may but we still won't know. >> so all 41 candidates may call it. but the process will take a while. the ballots have to be brought into kabul to be counted. hundreds and hundreds of observers out there. i think something like 600 or 800 journalists have already registered to cover it from around the world, including i think some of you in this room. we -- after this process has determined a winner and there will be disputes. they aren't american elections. we only picked a senator from minnesota just a few weeks ago after a rath elengthy delay and so after this is settled, we will be looking to the government and when i say we i want to echo what jane marriott said. we means the international community. this has been one of the main topics that i've discussed with my 24, 25 counterparts. we will be asking the government to reinvigorate or invigorate if it's a different president, the leader -- leadership in these fields that you have heard today. the reason we start with agriculture is that that was the -- we start our presentations with agriculture today. we started our efforts with agriculture because that was the least controversial program. and astonishingly, the u.s. government was spending -- spending more moneyer add i indicating poppy crops than building up agriculture. it made no sense to us. by reversing that, we were able to jump-start the issue. but many issues -- anti-corruption, etc., are deferred. we're going to be trying very hard to help the afghanistanans. i want to go back to something sepideh said. another thing we discovered when we came into office is less than 10% of american assistance wand -- was going through the government. it was going to contractors. if any of you are in this room, be warned, we're going to try to cut the contracts down. we just have to because of the way -- because of the way they work. they're not flexible. they undermine the very government we're trying to strengthen. an example, we found a $30 million contract for women's programs that was going to be given out to somebody, to some n.g.o. or some consultant and we just cancelled the contract and turned the money over to the embassy for an ambassador's fund on women's programs. that way we can increase our flexibility and respond to this hugely important issue. and secretary clinton's women's advisor, your old colleague milanda deer, went out there with ashley bommer and they had a fantastic trip. these programs will be implemented. we have about 20 of them. only discussed a few today. after the election, because with whoever is elected. we have to try to strengthen the government bearing in mind all the inherent problems. the biggest single problem we're going to face, i'm going to be very honest with you, is going to be strengthening the police. no question. unfortunately we didn't have our police team here today and it's a whole active issue but the police in any -- whole different issue but the police in any counterinsurgency, guerrilla wars, i spent a lot of my life working in these areas, you can't do it unless the police take over a key role in security after the military forces do the clearing. this point was made quite well in an article i don't entirely agree with in last weekend's wall street journal. i didn't agree with everything in it but the emphasis on police was correct. so we have a vast array of programs which have been deferred by the delay in the election which we hope to emphasize as the military pushes forward and disrupts the taliban. that in turn going back to your first question, john, that in turn we know will weaken the links between taliban and al qaeda and together with the dramatic events in pakistan in the last week and a half which are enormously important, but we don't exactly know how, we just they they're important, are the direction we're trying to go. >> al: vexing question in my mind is the role of iran in the region. we had cooperation earlier from inan the now putting tremendous diplomatic and other pressure on them. do we need support from iran and afghanistan to succeed? what's the tradeoff? maybe another way of asking that question is what's the greater threat to national security if you can opine on that. what's going on in iran or in afghanistan or pakistan? >> i can't opine which is the greater threat because a nuclear iran would be a very great threat not only to us but to everyone. nor do i work on iran. but i do want to make very clear that while i don't have an iranian count part, the -- counterpart, the -- we recognize geography and its realities and anyone in this room who's been to herat, as ashley bommer and i have on a trip as -- and many of you know that herat is in a kind of cultural economic orbit with political influence from iran, iran has a legitimate role to play in the resolution of the afghan issue. but whether they will play it or not depends on a lot of other critical factors and that's really about all i'd like to say on that issue now. but we are completely aware of the iranian factor and they went and i would also draw your attention to one other fact. on april 17 in tokyo at the pakistan pledging conference, the iranians came and pledged $330 million in an international conference to pakistan. so they are a factor and to pretend they're not as was often done in the past doesn't make much sense and you pointed out that i -- a critical point that in bonn were -- where rinna was, they did help stand up the current government. >> my other yeah -- question was on the geography between pakistan and india. is it critical that the united states try to play a role? that's on really problematic with respect to the indians in terms of defusing tensions between india and pakistan. is that outside 9 postal -- the portfolio of this group? >> it is outside the portfolio of my job. on the other hand, i am in constant touch with the indians. i met with the indians continually. the new ambassador in washington and i have had dinner recently and she and i are in close touch. i go to indio whenever the schedule permits. i stress we're completely transparent. the secretary of state and my close colleague assistant secretary for south asia, central asian affairs bob blake and i were in india recently and the indians are a major factor in the region. they're the dominant power. improveb -- improving u.s.-indian relations ha been a continual goal of the last three u.s.strations, all which i think have been successful in that regard, starting with president clinton's trip in 2000. i will keep the indians fully informed and i have an indian counterpart who i keep fully informed in india. >> ok. going to open it up. [unaudible question] >> i'm not going to stand so i don't block the cameras. >> please identify yourself. >> martha raddatz from abc news. ambassador holebook i know you want to talk about the civilian side of this. >> but you don't? >> but the security is so intergind. tell me how that is affecting what you're trying to do, what kind of a hindrance that is, what hads to happen in order for you to succeed and as part of that i want to sigh that a lot of people i talk to, civilians in afghanistan complain that they really can't go outside the wire in certain areas because of the security. >> you mean the americans? >> yes. >> let me start with the second question because we're really changing that, martha. when's the last time you were in kabul? >> about a month or so ago. >> all right. so you may have noticed then, you say the wire. the first thing that the new team did was cut wire down symbolically around the compound. they used to need permission. they used to drive in an armored car from the embassy across the street to the a.i.d. compound. they had to drive. that's all being changed. they have changed the curfew regulations, extended the curfew from midnight to 2:00 a.m. you no longer need 72 hours prior permission to leave the compound. you can leave on -- you don't need permission at all. . you just notify people where you're going. it made no sense to any of us when we came in. we send people over there and put them under restraints they can't work. now we have to protect them but we're doing it to gib them much more discorrection. -- discretion. we have also guaranteed any person who goes to afghanistan for the united states government that if his or her spouse wishes to work in the mission, we will guarantee them a job. so far the first time, we have tandem couples in significant numbers starting with ambassador eikenberry himself. and so on that point we agree with you completely. it was a self-denying situation and i will continue to talk about it with the security officers and ambassador eikenberry. on your first point, i of course -- of course security is the underlying component. that's why i mentioned the police. without security you can build a school, you can build a bridge, and one grenade, one mine sets it off. so we understand the did, completely the integration of the two. but as you've seen and this is refered in a lot of reporting been done lately including the washington post piece on page 3 this morning by karen de young and her colleague, we are trying to integrate the civilian and military. general petraeus and i and our whole teams have had two full-day sessions on this to integrate. if i go into details i'm going to take up a lot of time for smug already know but of course you can't could civilian growth unless you have security. it's obvious. what? >> [inaudible question] >> i think that general mcchrystal and secretary gates, and general petraeus have addressed the troop question very fully and i think there's a process underway the integrity of which i think we must respect. >> beth mendelsohn with voice of america, the afghanistan service. if one of the candidates doesn't get 50% and this goes into a second round and things get complicated there, what are the constitutional laws that are in place? can karzai call the loya jirga? and also if it goes the way some of the things did in iran, what is the united states prepared to do in these circumstances? >> rinna? >> i'd like barney to comment on this as well. if there is a security situation then there are stipulations where a loya jirga can be called. but i'd like barney to speak in more detail about this as well. >> well, i'm not sure what your question is about. according to the constitution if no one gets more than 50% of the vote, then a second round has to be held within two weeks of the date of announce mentd of the result. perhaps your question is what is -- if there is civil conflict and it is not possible to do that. we of course do not want to address hypothetical questionsb3 like that. there is an international presence in afghan government that is our partner and if such an unfortunate scenario sha rise there are policies and institutions on the rise to address it. >> thank you, mr. ambassador. sky news. the british and u.s. troops as well as the nato troops will be watching this very closely within their own compound. what message does this administration and do you, mr. ambassador, want to project to the troops in-country right now in >> you mean what message do we want to address to the u.s. and allied troops? >> yes. >> um -- >> in edgerrin james tv the election -- >> well, every trip we make out there we always meet with the troops and talk with them -- them about why they're there to find out how they feel at the lowest levels, particularly on the front lines which are really dangerous. and i think the troops really do -- they don't love it out there. they're carrying 120 pounds of equipment on their back in 120 degree heat and i'm not making those numbers up. and it is an extraordinary thing to see. but they know why they're there. they know exactly going back to john podesta's opening question, they under the causal connection between their presence and 9/11. they under their mission. and they are now more and more trained for the integrated civilian military. otto, you may have noticed that otto mentioned in his agriculture presentation. national guard units from texas , nebraska, several states have agricultural development teams which they are very proud of in uniform. the military is supporting these programs. vikram discussed the initiative on counterpropaganda. i stress nobody likes to be out there. it's very tough work. but i felt that they really understood it. >> let's go to this side of the room. start with karen. karen? >> karen dion with the washington post. i'd like to go back to the question of iran. barney rubin said we were in regular consultations with all major neighborhoods who have a stake in afghanistan and i want -- wondered what that meant in terms of iran and also if you could give us an up to date assessment of iranian activities in afghanistan, particularly the provision of weapons, training, and advice to insurgents. >> well, karen, in regard to all neighbors and regular contact. barney did not mean to include iran. we don't have any direct contacts with them on this. but you can judge for yourself by their statements, and -- what was the second part of your question? sorry. >> are they training? >> oh, are the iranians training? we get conflicting reports on that. vikram, do you want to address that? >> there's certainly -- you know, i didn't comment on it. i wouldn't want to get any -- the most current information i don't have. certainly the iranians have in the past troy -- provided some arms to certain groups inside afghanistanity i do not think it's been viewed from a defense perspective as a substantial effort or a substantial threat. i do not have the most recent information more you, however. >> i think for the benefit of people who don't follow this issue closely i'd add one very publicly known but underexamined fact. iran has arguably the highest -- the largest problem as a percentage of adult population of drug addiction in the world and those drugs are coming across the afghan border. it is a major concern to them. they've admitted to a very high number. don't hold me to this but i think five million. it may be higher. and there is obviously a very high imperative on this. you also will note that in the declaration that president obama and. medvedev gave during the moscow trip there was a specific paragraph on the russian concern with the drug trade in afghanistan and its effect on russia, with a particular emphasis on precursor chemicals. so i mention this because if you look -- barney dade -- said earlier about strategic parallelism but not fully integrated policies -- there are these issues which every other country in the region and all the way through to europe and this includes another afghan neighbor, china, all share and this is one of them. >> yeah, hi. simon denny from reuters here. i wanted to pick up on something ashley and vikram are talking about, propaganda. the taliban are going around telling people in afghanistan that the russians were here for 10 years, the americans have been here for seven, you know, stick around, we're going to be on the winning side and it's changing that perception of who the winning side is going to be which is crucial to getting the villagers to actually support your goals. and i just wondered, you know, i understand that the military commitment can't be open-ended, that the goals have to be realistic but can you really tell the afghan people you're here, the military's here until you provide security, development, and democracy and not just at a presidential level but democracy at a local too. is that commitment still there from the international community to do that? >> great question. barney and rinna, would you comment? >> well, first, you accurately describe the message from the taliban. the situation, however, is quite different. the soviet invasion of afghanistan was condemned by virtually the entire world community and the -- it was one of the major factors actually isolating the soviet union. the operation in afghanistan of which the u.s. is a part and it plays a leading role is perhaps the most fully multilateral operation in history which commands the support of at least officially if not unofficially as i mentioned, of virtually every government and every international organization. i don't think it's crass to say that we are committed to waging a war in afghanistan until afghanistan is a perfect democracy which would seem to be what you implied, nor would we make did, nor would we expect people to believe such an unrealistic commitment but i believe we are committed and it is realistic to ask believe -- people to believe that we are committed to fight there until we are security from terrorist attacks launched from there and until the region is free from the danger of nuclear terror and other forms of danger that would be extremely dangerous. >> rinna? >> one of the first places i went when i returned to afghanistan in 2002 right after the taliban fell, overnight you could see that there was a tremendous level of enthusiasm for this process from the afghan population. the afghan population does want this process to succeed. they need to see a commitment and i do believe the changes that this administration has brought about is certainly something that is increasing confidence among the afghan people. afghanistanans are pragmatic, realistic. they just want to be confident that they are going to have a partner in this process and i think that's something that this administration is showing and demonstrating. >> why don't we go to the front? >> my name is wande, i'm with the south asia voice of america and my question is about the legitimacy of the election. only earlier this week i think it was the british ambassador to afghanistan who said there will be a very low turnout and also the security yisheds -- issues. who is going to decide the result of elections to be legitimized? the concern is here, in afghanistan they're watching the situation in iran and other groups. >> no, this is obviously a central issue. who will decide the legitimacy of the election? there are thousands of observers, international an -- and domestic. there's going to be enormous media including the voice of america. i gave you an interview yesterday about all this. but you know, my own answer is it ends up being the media, frankly. not an answer that john podesta probably thinks is the right one but the truth is that all of what happens in any distant place is in the end reduced to the simple headlines of media. and you take the three most obvious recent examples, iran, kenya, and zimbabwe. no one knows what actually happened there. what you know is what you think you know, thanks to the media. in all three cases, by the way. i think they covered it quite accurately and i know something about those countries. so i will leab it to you to report. we're going to do the best we can along the lines we've discussed earlier. as everyone here has said, nobody is looking for a level of perfection in an election to which we are ourselves don't always achieve, to put it mildly. and the -- so we're just going to do the best we can. this election was called for under the constitution. it shouldn't have been delayed. it was. we have put an enormous amount of effort into it, we being the international community. >> the leading commission will be the body that ultimately decides what the result is and the point is that it will be about the media and the international election observers and government staff statements in behaving responsibly, not speculating too much and allowing the i.e.c. to take forward its work, allowing the electoral commission to address and adjudicate on complaints, are the best way to come -- your mike was down. could you state the front end of your answer? >> yeah. the front end was ultimately the afghan electoral authorities, the independent election commission will have the say on the election and making sure we don't speculate too much on the legitimacy. >> and there -- will there be challenges to the election? there are in every other democracy. i think we should assume those. >> it's generally recognized that afghanistan is unwinnable as long as the taliban and al qaeda have privileged areas in the areas on the afghan border. i'm just wondering why fattah did not come up this morning. >> we did talk about fattah, but there were no questions. i agree with you on the larger framework. i prefer to use the word "succeed" rather than "win" because this war isn't going to end on the battleship missouri or as you alone in this room can attest, in geneva, because you were alt that famous conference. the issue of pakistan and the sanctuaries is central to success. that's why president obama took these two countries and hillary clinton and asked for a separate organization which you see here before you. just for a point of reference on how different it is, up to january 20, afghanistan and pakistan were not only in the south asia bureau, but they had different deputy assistant secretaries in charge of them. so the integration -- there was no integration until you got up about three levels. now we have a single desk and everyone on this podium and any colleagues here works in both countries. and with all the other countries. now to your question. this is an enormously important issue. the end of mehsud as we all know is a very big deal and as i said earlier we don't know how it's going to play out but we know that the reports you've been reading in the press of disarray among his people, of other factions maneuvering, al qaeda has to decide what to do because mehsud was sort of like an independent subsidiary of yadier -- al qaeda, focused on pakistan, but some of the other groups in the area were focused on afghanistan. everyone is thrark around. there are -- thrashing around. there are unconfirmed reports of a shoot-out during the leadership meeting. this is very good news for all of us. equally important, arnaud, the pakistani people are converging on a consensus on the importance of this. i think this will pave the way for redoubled efforts. i know we're running out of time but i'd like to ask vali, who is really one of the great experts on this, he lived in pakistan for years and has a network of friends that there -- that is extraordinary, to add additional comments that this. >> it's no longer enough to just think of this as a sanctuary contributing to fattah. fattah is still a very important locale for afghan taliban as well as pakistan taliban. the zone of taliban operation rups much farther east and south and north. and what we are seeing is that to bring pakistani and afghan and american interests into alignment to deal with what is now a much broader regional problem, so what we're seeing is the pakistanis have engaged and the ultimate conclusion of this fight against the pakistani taliban will have to have a resolution of the fattah problem. so we are seeing much more of the hammer and anvil approach and in ard to succeed we'll have to maintain that kind of a relationship and cooperation with pakistan. >> robert, last question. >> good morning. i'm bob dreyfuss from the nation magazine. do you think when you are involved in all this do you have in mind that there's a domestic political clock here in which americans could look at this and as you said know it when they see it and decide that this isn't succeeding? and also do you think that al qaeda's comments about negotiating with the taliban leadership were helpful and constructive? >> whose comments? >> the u.n. did, kaida. >> oh, yeah. >> that we should start talking to the top leadership of the taliban rather than trying to peel away the local people? >> on the second question i haven't seen the full text. in the contempt -- context i saw them in they seemed to be consistent with our positions and those of everyone else. on your first question, i can't answer your question. no one can. but i can tell you that we all feel the impatience and pressure of the american public and the congress, which legitimately wants to see progress. that's an absolutely legitimate thing and we have spent a great deal of time talking to members of congress and reaching out to groups, never in this configuration, this is unique for us, but to talk about this and so far it seems to me that people understand how critically important is this is. do we need to show progress in of course. we can't make these investments without making some demonstration that they have results. that's why i said earlier i don't want to confuse input and out putt. we've answered your questions about what's going on on the ground but we're very mindful of the fact we need to show that all these programs talked about today, frankly unveiled in this context for the first time, have to produce results. make john can invite us back in a year and you can hold us to act. i'll leave that to him. that is an open invitation. let me close by noting that when richard began his remarks he noted he was aught our launch event for the center for american progress. he said he hadn't been invited back. i reminded himj#u we had invite him back many times nor private consultations but it's sometimes dangerous to give him a microphone. but the real reason was we were waiting for a tremendous encore event and i want to thank he -- him and his colleagues for presenting the many components going into the strategy here. it's a very challenging context in which to work and we loork -- look forward to seeing what happens next week during the elections. you have a standing invitation to come back and report on how we're operating against the metrics and objectives that you laid out today. so thank you very much for being here. thank you, john. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . >> up next on c-span arks report on this year's defense spending bill and the white house holds a reception for the newest member of the supreme court, justice sonia sotomayor. later, congressman kevin brady holds a town hall meeting in live gsston, texas. -- livingston, texas. on tomorrow morning's "washington journal," tony of g.m. will talk about their new 230-mile-per-gallon car. we'll talk to greg ballard and discuss health care with "new york times" correspondent jackie calmes. "washington journal" is live alt 7:00 a.m. eastern. then at the brookings institution, a look at the economy and fram stimulus six months after the stimulus plan was passed. you can watch it live starting at 10:00 a.m. eastern here on c-span. >> british voters are expected to good to the polls in national elections next spring. this weekend conservative party tory government would change current domestic policies. british politics sunday night on c-span. >> now a discussion on the defense department budget for fiscal year 2010. today the center for strategic and budgetary assessments released their report on defense spending. this is 20 minutes. >> want to welcome every to the extra for strategic and budgetary assessments. i'm jim thomas. today we're pleased to release three publications. the first is the analysis of the fiscal year 2010 defense budget requests. the second is a backgrounder on classified funding in the f.y. 10 budget request. and the third is a report on the impact of wars in iranl -- iraq and afghanistan on the u.s. military's plans, programs, and budgets. as you automatic already know this is a very important budget year for d.o.d. war funding is heading in a new direction as the focus shifts from iraq to afghanistan. personnel and o. and m costs are continuing to climb, including under the strain of rising health care and equipment reset costs and a number of programs have already this combrear been proposed for termination or reduction. all this is obviously happening at a time of record federal deficits as well as during a severe recession. tough decisions lie ahead for the department of dave lewis and for the congress. further increases in defense spending are not likely. there's a need to rebls -- rebalance forces to address critical security challenges, including continuing to confront radical, violent extremism, rising powers, as well as the specter of either further proliferation or the use of weapons of mass destruction. i'm pleased to citrus this morning todd harrison, who is our fellow for budget studies here at csba. he brings a wealth of budgetary programming and engineering expertise to the topics we have before us. he'll offer a presentation on the fy 10 budget and then following the briefing we'd be happy to take any questions you may have. if i could ask everyone two things. one, if you would please hold your quiz until the end of the briefing and secondly in the "q.&.a." if you would please identify yourself and your organization before asking your question. at the. with that i'll turn it over to todd. >> good morning. i'm todd harrison and i'd like to start by going through this briefing we have prepared today, give you an overview of what's in the three reports we're releasing today and focusing mostly on what's in the f.y. 2010 defense budget request. looking at an overview of the defense budget request, a total of $668 billion is requested for the department of defense of the that includes $538 billion in the base defense budget. within that there's $4 million in mandatory funding and then $130 million for the wars in iraq and afghanistan. the base budget is actually up 3.% this year in real terms, so adjusting for inflation. this makes it the highest level in base defense funding since world war ii. the plan for the future the administration shows in the budget going out to fy 14 shows it will remain funded at this high level in the years to come although it does slow the rate of growth. it will only be growing just enough to keep up with inflation. so what this means is that president obama's plan for the base defense budget over the coming years puts him on track to spend more on defense in a single four-year term than any other president since world war ii. and i want to start by highlighting some differences in this budget from previous years. so despite a lot of the attention that's been given to the program cuts and term incidentally -- terminations that secretary gates announced back in april, funding for procurement is actually up this year in the budget. up almost 5% in real terms. pesm costs and o and m costs are also up. research and development funding is down slightly although r and d funding does remain near a historical high. for the first time, one of the significant differences in this budget is for the first time it includes funding for a full year of the wars in iraq and afghanistan with the budget. now, it's not included in the base dave lewis budget. it's a separate part of the budget but it is included and it shows projections for future years of funding. we'll talk about that in more detail in a few minutes. the budget also moves some items that were previously funded through supplemental appropriations, the wash funding, back into base items. these were items the administration deemed were not directly related to the war, including some funds for procurement of modernization and for increasing the size of the army and marine corps.én that is part of the increase -- reason for the increase in the base budget this year. another difference is that this budget does not include a future year defense plan detailed going out into the future. the reats -- reason for this is the quadrennial defense review is currently in progress and that will drive some changes in next year's budget so they didn't feel it would be valid to pro t.c.u. the future year defense plan at this point in time. also this budget includes for the first time a spreapt section called term inages, reductions, and savings. and what this is, is the administration went through the entire federal budget looking for areas they could cut spending. they identified a total of $17 billion in the federal budget across all agencies in the federal government. 16 of these programs and about half the total dollar amount, $8.8 billion, came from d.o.d. programs in particular. so you can see on the slide here a list of these programs ranked in order. in order of dollar amount for savings. the top of the list is the f- 2 program, not continuing to prosecute cure anymore aircraft alt a savings of $3 billion if the program had continued at its level of funding from last year. a number of the proposals do appear to be going through congress without many problem but there are a few that have encountered some resistance. the presidential helicopter, the president has asked to end that program and relook at requirements and start a new program in the following year. the house preapted -- appropriated money for that and a veto has been threatened over the presidential helicopter. the joint fighter, that's a second engine for the fighter jet that would be basically used to reduce technical risk if something goes wrong with the primary engine but also to drive down costs by having some competition between two engine providers. the pentagon has asked to reduce funding for that. the house and senate are both considering aadding funding back for that and a veto has been threatened over that as well. the c-17, the current administration wants it to end at the current number in the pipeline and not procure my more. i believe the house appropriators are putting in funding for three additional aircraft. the white house has not threatened a veto over this item. one program that was cut in this budget that was not included by the administration in this list of savings is kinetic energy interceptors, a missile defense program. basically it's a rocket with a very high acceleration and can impact a missile sooner in its flight. that program had experienced some technical challenges as well as cost. issues and the administration has proposed pulling the funding for that and ending the program. that would be a savings of about $500 million in the f.y. 10 budget and the house appropriators have included funding for this item as well in -- and the white house has strongly urged them to reconsider that. looking at the funding for the wars, to date about $944 billion has been appropriated for the wars in iraq and afghanistan and that's through the end of fy 09. this budget requested another $130 billion for fy 10. that is down slightly. part of that is due to items included in war funding in the past having been moved to the base budget. what is significant this year is fund r for the first time for operations in afghanistan will exceed the cost of operations in iraq. the remaining $4 billion is not allocated between the two operations. what is concerning though is looking out in the future years of funding. the administration included a wedge in the budget, $50 billion for fy 11 out into the future and if you look at the funding currently for afghanistan and iraq in fy 10, that is, each of those operations on their own exceed the $50 billion projection and looking forward right now we're still in the process of building up additional troops in afghanistan. by the end of this year the number of troops in afghanistan are already planned to be double the number that were there last year, in november -- december wait to -- 2008. so as you add more troops you would expect the budget to increase, not decrease as this budget shows. so this means the administration will have to likely come back in their next budget and raise the projected funding for future years in these operations. all right. so military personnel funding. $136 billion is included in this budget. that's up significantly from funding in the past. part of that is due as i mentioned before to some of the personnel cost that had been funded in supplemental appropriations for the increase in the size of the army and marine corps. that's now being put in the base budget. the total amount for increasing the force by 92,000 troops is about $14 billion a year going forward. so that's now, the full cost of that is included in the base budget. this budget also haments the reduction in the size of the navy and air force that had been planned. it's going to keep them at about their current level. it also gives 2.9% across the board pay increase for members of the military and congress is actually considering increag -- increasing that to 3.4%. to give some perspective, inflation right now is projected to be about 1.5% for 2010. the bureau of labor statistics projects that the average wage increase next year willing about 2% or a little less so this is well above the pay increases that people are seeing in the overall economy. part of the reason for increasing personnel costs is actually health care related. health care totals about $47 billion in the defense budget for 2010. it's about a 10th of the total defense budget and at the rate it's currently increasing, military health care costs will nearly double every 10 years. so if you put this in the perspective of future funding is expected to remain essentially flat for d.o.d. in future years and health care spending is growing that means it will be necessarily crowding out other areas of the budget. part of the reason for the increases in health car costs for the military are, well, first of all, increased benefits that have been enacted by congress such as tricare for life, tricare for is he -- reserve impts. also there is increased usage of the system. currently there are 9.3 million americans covered under the military health care system. that includes active duty, retirees and dependents. . if you look back, and has been increasing over time. if you go back to 1990, costs are high and -- higher now adjusted for inflation than they were then, even though the size of the force has been reduced by one-third. part of the reason is that operations and maintenance depends on a cost of operating equipment and training as well as the cost of maintaining infrastructure and all the bases that dod maintains around the world. the lagging pace of procurements of the past two decades has meant that equipment the military uses is aging and that makes it more costly to maintain. it is not just the weapon systems. it makes operating costs much more expensive. the base realignment and closure commission they release their findings several years ago is continuing. bases are being closed and realign. some savings are expected for that in the future, but we are not at the point where we are seeing savings. it still cost $7.5 billion to fund those closures in this year's budget. if you look at weapons systems funding, there are two different stories. if you look and the research and development side, bunning is down slightly from last year, but it is still nearer a historic high. if you compare it to previous years, the previous peak was back in 1987 a level of $61 billion adjusted for inflation. compared to $79 billion in this year's budget is a high level of development funding. procurements funding is going up this year, but at the same time, is still far below its previous peak. the previous peak was in 1985 at about $175 billion. procurement is relatively low from historic standards. development costs are relatively high. this represents a longer-term trend in defense funding. the ratio of procurements dollars to research and development dollars has been falling. back in the 1980's, dod used to spend $3 in procurements for every dollar in research and development funding. now we are spending $1.40 for every dollar. this means we are spending more on developing increasingly complex weapons systems, and not able to fund the procurement of the systems in sufficient quantities. that has led to part of the backlog in procurement we have seen over recent years. classified funding accounts for nearly $36 billion in this budget. that is 17% of all acquisition funding, including research and development and procurement. we are near the highs level of classified funding we have seen since 1987, about 80% of all classified funding is through the air force, although not all that money stays with the air force. part of the air force funding is believed to go to fund other programs. in terms of classified programs, there has been a mixed record of success. there are notable ones. the b-2 bomber ran into budget problems and earned the nickname billion dollar bomber. congress was not willing to continue funding in so it stopped short of what they intended to procure. the other end is a recent program called the future imagery architecture. they ran to problems with a satellite component of that program and had to cancel it. it is reportedly at 8 $4 billion loss to the government that they canceled that after spending that much money. there is a mixed record of success for classified programs. it does make up a significant part of the budget. another thing in part of this year's budget process is the unfunded priorities. every year since 1995 they've been asked to submit these lists of unfunded priorities. this is a wish list, but they put together a list of items that did not make it into their budget, things they wanted to include the they were not high enough priority to make it into the funding. this year the secretary of defense did something a little different. he asked services to review their submissions with him before submitting them to congress. if you look back, there's a reason for this. in previous years the total amount of funding requested has been growing each year. it had gone to a peak of nearly $36 billion in fiscal year 2008. after the secretary asked that people review their unfunded priorities with him we saw an order of magnitude decrease. you see the total is less than $4 billion compared to almost $36 billion a couple of years ago. the air force makes up about half of this request at $1.9 billion. if you look at what is in their unfunded priorities, it includes funding for shortfalls, post-production support activities for the f-22, a couple of classified items at a cost of $331 million. the army's largest item includes something called force provider, a containerized base camp system that provides climate control facilities for troops when they deploy overseas. the marine corps included a number of small items, $23 million for combat vehicle repair facility. navy included funding for a ship depot maintenance. these items are ready partially funded in the base budget. the navy said with additional funding they could do more depot level maintenance. special operations command includes the highest priority item for modification of additional aircraft. in conclusion, the 2010 defense budget request represents the highest level of base defense funding we have seen since world war two. it is 4% higher than the previous peak in defense funding back in 1985 when you adjust for inflation. it slows the rate of growth. in future years we expect will only see defense budgets that are just keeping up with inflation, maintaining the same level of funding into the future. in context of what is going on in overall federal budget, the federal budget situation is significantly worse than it was eight years ago at this time. eight years ago it projected a five year surplus from 2002 to 2006 of two trillion dollars. it turned out that over that same time we ran a deficit of 1.5 trillion dollars. the budget situation has got a lot worse. right now cbo is estimated 2010- 2014, they are projecting a four 0.4 trillion dollars deficit. that is a significant issue in the federal budget. it has a lot of people concerned. if you continue out this funding for 10 years, assuming defense funding states about the same level and deficits continue under current budget policy, in 10 years the interest payments on the national debt will exceed defense funding, for the first time in modern history. this means that further increases in defense spending seemed highly unlikely that we will be able to do that. that means that underlying trends in the defense budget will constrain how defense money is spent. if history is any indicator, will continue to see personnel, healthcare, and peacetime operating cost increase. acquisitions that have already been insufficiently funded to keep pace with systems that are becoming obsolete are also likely to continue to experience cost growth, as we have seen in the past. this will lead to some really hard decisions in the department of defense. pressure will mount to scale back some of the modernization plans. the sooner action is taken to correct some of these budgetary issues, the less painful these decisions will be. >> coming up on c-span, the white house hold a reception for the newest member of the supreme court, justice sonia sotomayor. then congressman kevin brady hold healthcare town hall meeting in livingston, texas. followed by another white house event honoring recipients of the presidential medal of freedom. on tomorrow morning's "washington journal," of talk about the 230 mile per hour gallon car. we'll find out how the recession is affecting in the analysis -- indianapolis. "washington journal" is live at 7:00 eastern. then at the brookings it institution, a look at the economy and federal stimulus. six months after the stimulus plan was passed. you can watch it live starting at 10:00 a.m. eastern here on c- span. >> british voters are expected to go to the polls in national elections next bring. this weekend, conservative party leader david karen on have a tory government would change current domestic policies. british politics, sunday night on c-span. >> at the supreme court on saturday, sonia sotomayor was sworn in as an associate supreme court justice. following a 68-31 senate confirmation vote, she replaces justice david souter, who retired this summer after nearly 19 years on the high court. chief justice john roberts officiates at the ceremony. >> midmorning, and welcome to the court. judge sotomayor will be invested as a member of the court on september 8 in a special session of the court. we are administering the oath this morning, simply so that she can begin work as an associate justice without delay. now i would like to indicate missus up sotomayor, her mother, and her brother, dr. sotomayor to come forward. >> judge sotomayor, are you prepared to take the oath? >> i am. >> please raise your right hand and repeat after me. >> i, sonia sotomayor, do solemnly swear that i will administer justice without respect to persons and do equal right to the poor and to the ridge and that i will faithfully and m partially discharge and perform all the duties incumbent upon me as associate justice of the supreme court of the united states, under the constitution and laws of the united states, so help me god. >> congratulations, and welcome to court. [applause] >> the white house held a reception today for judge sonia sotomayor. the president, first lady, and patrick leahy it were present for this event. this is 20 minutes. >> ladies and gentlemen, senator patrick lei and first lady, michelle obama. -- senator patrick leahy. [applause] [applause] [applause] >> all right, good morning everybody. and welcome to the white house. i am glad all of you could be with us today as we honor the newest member of our highest court who i am proud to address for the first time as the justice sonia sotomayor. [applause] we are also honored to be joined by justice sotomayor's new colleagues. we have justice ginsberg who is here as well as justice stevens. [applause] i just want to thank both for being here today and your extraordinary service on the court. i know you will be giving justice sotomayor some good tips. i also want to thank everyone who has worked so hard to bring us to this day. i want to especially thank our judiciary committee chairman, patrick leahy. [applause] as well as our senate majority leader, harry reid, for their outstanding work. [applause] for their outstanding work to complete this process before the august recess. i want to thank senator schumer, senator gillebrand. i want to thank all the members of congress who have taken the time to join us at this white house event. i want to acknowledge all the groups who organized and mobilized in support of these efforts from the very beginning. your work was absolutely critical to our success and i appreciate all you have done. pat yourselves on the back. [applause] two members of congress i especially want to acknowledge our senator bob menendez who worked so hard on the senate side. [applause] and congresswoman nidia vasquez, who is the share of the congressional spanish caucus. [applause] and i think we all want to take a moment to recognize the woman who truly made this day possible, just as sotomayor's motherjustice sotomayor's mother. [applause] mrs. sotomayor is here with her husband and brother and other members of their family. we are thrilled they could join us today. i don't normally do this but let me also just thank my extraordinary white house staff who helped to usher this through. we are very proud of them. [applause] of course we are here not just to celebrate our extraordinary new supreme court justice and all those who have been a part of her journey to this day, we are here to also celebrate an extraordinary moment for our nation. we celebrate the impact justice sotomayor has already had on people who have been inspired by her lifestyle. we celebrate the greatness of a country in which such a story is possible. we celebrate how, with their overwhelming vote to confirm jstice sotomayor , united states senate toward down yet one more barrier and affirm our belief that in america the doors of opportunity must be open to all. with that vote, the senate looked beyond the old divisions and embraced excellence. they recognized justice sotomayor's intellect and independence of mind. and her devotion to protecting our core constitutional rights and liberties. justice william brennan said in order for government to ensure those rights, government officials must be attentive to the realities at stake in the decisions they make. they must understand the pulse of life beneath the official version of events. justice so tommyre or understands those realities because she has witnessed them firsthand. sonia sotomayor understands these realities. we give people a chance to live out their dreams come out work that she has done with devotion and with an unyielding commitment to give back to this country that has given her so much. she understands these things because she has lived these things, because her life is one of those only in america stories, raised by a single mother in the south bronx determined to give her every opportunity to succeed, propelled by the talent and hard work that would earn her scholarships by the best schools in the country, driven by the belief that it does not matter where you come from or what challenges life throws your way, no dream is beyond reach in the united states of america. with the depth and experience, justice sotomayor understands how the law actually unfolds in our lives. its impact on how we work and raise our families, or whether we have the opportunities we need to live the lives we imagine. that understanding is vital for the work of a supreme court justice, as justice stevens and justice ginsburg will testify. the work of applying principles set forth at our founding to the cases of controversies in our time. our founders did not presume to know exactly how the times would change, what new questions history would set before us. instead, they sought to articulate ideals that would be timeless, ones that would accommodate the changing circumstances of our lives and preserve our most sacred rights and freedoms. when justice sotomayor put her hand on the bible and took that oath, we took yet another step towards realizing those ideals. we came another step closer to a more perfect union we all seek. because while this is justice sotomayor's achievement, the result of her ability this moment is not just about her, it is about every child who will grow up thinking if sonia sotomayor can make it, then maybe i can, too. [applause] [applause] [applause] it is about every mother or father who looks at the sacrifice as justice sotomayor's mother made and the successes she and her brother have had, and thinks i may now have much in my own life, but i if i work hard enough maybe my kids can have more. it is about everyone facing challenges in their lives who thinks of justice sotomayor's story and thinks if she could do it, then i can, too. her rise from humble beginnings to the heights of achievement is another symbol of that faith. faith that the american dream still endures, faith that equal justice is not just an inscription. this is a great day for america. i know that all of us here are honored to have been a part of it. with that, i would like to introduce the newest member of the united states supreme court, justice sonia sotomayor. [applause] [applause] [applause] [applause] >> no words cannot equally express what i am feeling. no speech can fully capture my joy in this moment. nothing can convey the depth of gratitude i feel to the countless family members, starting with mom and my brother, and the many friends and colleagues, so many of you who are here today who helped me reached this moment. none of this would have happened without all of you. mr. president, i had the most heartfelt appreciation for the trust you have placed in me by nominating me. i want to convey my thanks to the judiciary committee, led by chairperson leahy for conducting a respectful and timely hearing, and to all members of the senate for approving the president's selection. i am so grateful to all of you for this extraordinary opportunity. i am most grateful to this country. i stand here today knowing that my confirmation as an associate justice of the supreme court would never have been possible without the opportunities presented to me by this nation. more than two centuries ago in a constitution that contained fewer than 5000 words, our founders set forth their vision for this new land. their task was to form a more perfect union, to establish justice and security blessings of liberty for themselves and their posterity. over the years, the ideals at the heart of that document have endured as subsequent generations have expanded those freedoms to more americans. our constitution has survived domestic and international problems, including a civil war, at two world wars and the catastrophe of 9/11. it draws together people of all races, faiths and backgrounds from all across this country, who carry its values in our heart. it is this nation's faith in a more perfect union that allows a puerto rican girl from the bronx to stand here now. [applause] [applause] [applause] [applause] >> i am struck again today by the wonder of my own life and the life we in america are so privileged to lead. in reflecting on my life experiences, i am thinking also today of the judicial oath of office i first took almost two decades ago, and i reiterated this past weekend. to judge without respect to what a person looks like, where they come from, or whether they are rich or poor, and to treat all persons as equal under the law. that is what our system of justice requires, and it is the foundation of the american people's faith in the rule of law, and is it why i am so passionate about the law. i am deeply humbled by the responsibility of upholding our laws and safeguarding the freedoms set forth in our constitution. i asked not just my family and friends, but i ask all americans to wish me divine guidance and wisdom in administering my new office. i thank president obama and the united states senate for the tremendous honor and privilege they have granted me. thank you. [applause] [applause] [applause] [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] [no audio] [applause] >> amar night, we will rely coverage of the net routes nation conference from pittsburg. this is an annual event for progressive political activist, and the first night of coverage includes an appearance by former president bill clinton. you can watch it here on c-span beginning at 8:00 p.m. eastern time. >> radio talk show executive brian jennings on the new fairness doctrine, why it is a bad idea, and alternatives to censorship. he is interviewed by monica crowley on c-span2's book tv weekend. >> this fall, inner america's highest court, from the grand public places to those accessible only by the nine justices. coming up for sunday in october, on c-span. >> now texas rep kevin brady host a town hall meeting to discuss proposed health-care legislation and take questions from constituents. lawmakers across the country are holding similar meetings this month. from memorial medical center in livingston, texas, this is one hour. >> good afternoon, everybody. i want to thank all of you for coming out here. we really appreciate this. i also want to thank you for bearing with us. this is about the largest room we have in the hospital, so this is as good as we could do. out of respect for everyone's time, i want to get started with this health care discussion today with congressman kevin brady. kevin gray was elected to a seventh term representing the eighth district in congress -- kevin brady. it runs up the i-45 corridor to trinity county and then east over to the weak yen of border and down to orange county. he is a member of the house ways and means committee that writes many of the tax policies impacting healthcare in america. he also has jurisdiction over much of the medicare program. he served as deputy whip. congressman brady has become very active on health-care issues during his last three years, having launched a grass- roots effort called a " bit the ideas to improve health care." this is an ongoing conversation between rep brady and doctors, nurses, hospitals, and everyday texans throughout southeast texas to find out how they would improve health care in america. they do not pay any federal income tax whatsoever. in the states of america, people in those tax brackets, more than 50% of their income will go to their state income tax. think about that for a minute. for those people, the tipping point is the federal government and state government will have a greater claim over their earnings. that is a tipping point for every hour you work, every risky make. the government will have a greater claim over your wages and earnings than you will. that is a tipping point we cannot go to in this country. if you look at the bottom line of this health care plan, simple questions. will lower health-care costs, because that is one of the biggest concerns we have in america. the congressional budget office takes a look at our plans. they say no, it will not lower health-care costs. it will increase costs, just as it did in massachusetts as it drove healthcare costs up. will it break even or will it add to our deficit? the answer is, it will add tons of money to our growing and scary and dangerous deficits today. they say quarter of a trillion dollars more to the deficit in the first five years. let me make a point. this is the way this health plan works. for the first four years, nothing much happens except the tax increases, which is how government works. it goes up just like this. when they say over the first teen years we will only run this far into the deficit, they are really being misleading, because what it looks like is an adjustable rate mortgage, or one of those credit cards with zero interest for so long. the question is not how much does it cost america at the beginning, it is how much does it cost when it's fully into gear. at that point, those estimates are a solo, that in my view, we will create another medicare very have overpromise. it has nearly bankrupt the health care our seniors depend on. it is an unfunded liability stretching out generations that will never be able to be paid for. we are looking at adding another entitlement or health care plan we cannot afford either. that should worry us, especially since looked at all the money we have gone into debt here the last few months. it is scary. we are heading toward a doubling and tripling of our national debt, just before july -- you might not have noticed it, but the congressional budget office is required to take america's spending habits and to project it out over the years to see where we are headed. it is sort of like shooting for the moon. you get off course at the beginning, it can go while in a big way. they took our spending and deficits and budgets and looked out in the future until 2080. they literally could not find a scenario where we balance the budget during that time. think about that. a child born today could go nearly their whole life and never see a balanced budget in america again, and yet we are going to add another plan that cannot afford. ought to make us nervous. i offered one and a congressman from nevada offered another man and you might be interested in. i offered an amendment that said members of congress had to certify they have read the bill before they vote on it. they told us that was a bad idea for lawmakers to have to read the bill. it is true. he may have watched it on c-span at night. the in hell are offered an amendment that said if this public health -- dean heller offered an amendment that said if this health plan is so good, the members of congress should have to enroll in it with their families. that got defeated, too, because they said it is important that members of congress have choices when it comes to health care. . >> we have republicans and those who have worked on health care for a number of years have put together proposals. there are five of them in all. one offered by the head of our ways and means on the republican side, dave camp. representative paul ryan, congressman john shadegg and tom pryce, they go from mild steps to bold reform. i don't think we'll be able to offer them. 70-vote margin in the house and filibuster-proof in the senate, every republican can vote against this plan and still wouldn't stop it. if we get a chance, if the american public speaks out in august and says we want to hear other ideas on health care, i think rather than going back to the 1950's and 1960's, why don't we come up with a 21st century care in america. coverage is key. the people -- we have a lot of people without insurance. some of them qualify for government plans. some are here illegally. some are college kids who think they are invince i believe. let's focus on the truly uninsured, who can't afford the health care. someone is changing jobs, in between jobs, because of recession and other times, because americans don't work for the same company four years in a row. and those with pre-existing illnesses, people who have cancer, stroke, chronic disease. that's what we ought to focus on. let's focus on the truly uninsured. let's create incentives for small businesses so they can afford health coverage. let's create for those who want to be mobile in america, let's give them the worker backpack, an option they can chews what is right for their family, get the same tax benefits and support as businesses get and put it in a backpack and take it from job to job or like my wife worked at a local bank and she's home raising our boys and will be going back to work so we can afford college, everything to go through life. let's create options so people can take their health care with them. for the pre-existing, people with illnesses, you could expand these state pools to cover those with those illnesses and that's in that plan and part of the republican plan. i think a better way, rather than take those who health care costs we know are going to be higher and isolate them together where the pool gets closely, why don't we insist insurance companies cover those with pre-existing illnesses and then let's have an independent board that watches them and let the insurance companies swap dollars to cover that care. in effect, what you change is insurance companies don't profit by who they exclude, they profit howell they cover those they have. and everyone that they have. and i think there are great ideas on coverage. affordability. you ask anyone in america what concerns them most, it's just health care is too expensive. let's squeeze frivolous dollars. two of them quickly to mind, frivolous lawsuits, the lawyers who sue our doctors and hospitals and everyone at the drop of a dime to drive up costs. dollars get off into defensive medicine or the frivolous lawsuits. let's do lawsuit reform fee federal level. the legislature did it in 2001. we saw the doctors just bleeding our state. they put in limitations and what happened? we have a backlog of doctors waiting to come into texas. not just in wealthy areas, but in the rural areas. a great example is how i was tracking the texas medical center in houston before tort reform. they had one pediatric neurosurgeon, one baby brain doctor for five million people in this region. today, because of reforms on lawsuits, we now have almost six. and they don't discover houston throughout available for communities like ours in the rural areas. lawsuit abuse has to be stopped if we're go to go get the most affordable care. that red tape i talked about, we can't keep diverting $3 out of $10 into a bureaucratic system. that needs to go into patient care. the other plan really doesn't do much to help us. research, i worry that other countries are figuring out how to get ahead of us in trading the lifesaving breakthroughs, new medicines, treatments and surgeries. so we have to up and make permanent our research and development tax credit. as i have gone through the town hall meetings realized that ought to stand for responsibility as well. i'm not sure we can ever reform health care in america until we tie people's behaviors to their health care costs. especially for young people. but for a lot of americans. the two questions we ask, what's the co-payment and our deductible. for us to get quality care, we have to ask much more than that. i want to give people incentives that go along with their lifestyles, the choices they make. we see great examples. there is one down here just north of orange, texas, where a paper mill and steel worker unions work together and came up with a plan that is so basic and so remarkable, but it's tied to your dollars actually are your health care dollars. safeway. you read about the big company that decided that our health care costs are going through the roof. they created incentives for their workers and dramatically lowered obesity and chronic illnesses and lowered their health care costs by giving incentives, reward workers with dollars, lower costs for doing that, for exercising and for taking their doctors' orders in between the time they say you. they have a stake in it. safeway can't do more of that because federal law and state law prevents them for doing that. so research and responsibility have got to be the key. and part of that, and some in the medical community may not like this, but if we want informed consumers, we're going to have to pull back that curtain of mystery on medical pricing. why can't we go on-line and compare the drug prices of every pharmacy. why can't we go online to figure out what are the test costs in your clinic or the infection shon rates. why can't we bavekly be more engaged in our health care. we have to transition to that. that is getting more bang for your buck. and there are a number of ways we can do that. government really creates a fractured health care system. over the years we paid physicians and others, hospitals, sort of check the box, do this, get paid. so doctors who want to keep the care going in between doctor visits focuses on the patient. it's hard for them to do. why don't we change the way we do things in health care so we reward doctors, hospitals, other priors for aligning towards the patient, instead of having today doctors versus hospitals versus insurance versus lawyers versus regulators, why don't we align all of them toward the patient and reward quality health care on the health of that patient, not on what boxes get checked. there is so much we can do on efficiency that isn't in that bill today that makes common sense. i'm hopeful we get a chance to sit down up in washington to be able to come up with a better idea on the government-run plan. a lot of that depends on august and how you speak out as americans. with that, david, can i stop and let's start taking questions and comments. yes, sir. >> you brought up prescription prices. one of the things, this does not bring up and all my friends who are against it are surprised that -- i don't take the position of being against this, we need to clean up the act in the first place. in 2001, new zealand began a campaign to make to direct to consumer pharmaceutical advertising illegal. every night we are deluged with what is a $4 billion campaign by the u.s. pharmaceutical industry. they outlawed it. as it stands now, the united states is the only country in the world that permits direct to consumer advertising of pharmaceutical products. 80% of the doctors or more are against it. why do we have it? i am a retired government anewt. i pay $356 a month to blue cross and in their cleverly worded contract, i get limited results. and my seven prescriptions i pay for, my doctor appointment, i end up averaging $1,000 a month out of my pocket for this same great insurance product that the congressional people have, i suspect. last year, wall greens according to a statement i have, they paid almost $12,000 to the pharmaceutical companies on me, my behalf. multiply that times everybody you see standing in line at wall greens. why, and i know you have a business background, why do we have to continue to sustain $4 billion in overhead pricing for pharmaceutical products? if you want to stop and lower the costs, let's do that first. why do we have to see hospitals, herman, anderson, every night in the houston news, advertise. why do hospitals advertise? the huntsville paper, i saw saw a month ago, full page advertisement of the hospital administrator sitting at her desk, who pays for that and why? i further asked the question when last thanksgiving my son was visiting from out of state and got bitten thanksgiving afternoon and wept to the emergency room. he soaked his hand in a solution for 30 minutes. do you know how much that cost? can you guess? >> $1,500. and they didn't wince. i don't know what this hospital charges. i have a next door neighbor who is an attorney -- >> we have so many questions -- can we focus on the first one. great point. >> after watching tv, i'm convinced i have new illnesses just from watching the advertising that goes on. really, it's so vague. and the side effects. don't get us going on that, ok. you know, i do think we spend too much on advertising. i do think, though, that given a choice between less information to consumers and more information i always -- i just always choose more information. i wish they would do less. i would like every dollar they can pumped into research and development and next breakthrough drug. part of the problem we have is that america bears the cost of research for all these breakthrough drugs. the bulk of it here in the united states and when we sell to other countries, they have price controls and other things that limit that. and it comes back on you and me to pay for that. that needs to be addressed. but i have to tell you, i really worry about this plan from the standpoint of the goal is a national health care plan, single-payer health care system. as people often say, let's get the profits out of health care. i tell you, a lot of the best parts of health care, including the new innovation comes from people knowing that they can actually have the profit if they come up with that new drug or new medicine or new surgery or treat patients or come up with a better way for doing that. i want to limit the cost of medicines. the increases are dramatic. we need to use moreen erics and need to buy medicines from around the world if we can do it safely. this is my only point to you. i want to be careful they don't go overboard and sort of shut down that r and d valve that ends up in that lifesaving breakthrough. don't you think there is a way to do that? >> yes, sir. >> i have a friend out heir page by page on the things that are in that note and i passed off one to your press secretary today. i think there is a manifesto in this thing for the overcoming of freedom in america. and we have some things that are listed in here that say we have to give up some of our private and financial information. we are going to be told some things we can and can't do as far as businesses are concerned. we have to pay to put people into health care. they are wanting to take care. the people pushing this thing are not looking at health care alone. and i believe we are looking at a manifesto, a.k.a., hugo chavez and castro. [applause] >> i think there was a lot in that point, ken. thanks for being here. i think the goal of this plan is very simple, a government-run health care plan, one payer for everyone in america. and the president has been very clear about that in the past. the leaders -- >> he lies a lot. >> on this point, he wants that. and congressman barney frank said the other day -- he said whether you call it a public option or you can call it a co-op, at the end of the day, both will lead to a national health care system. and what seems so odd is that here in the country where we're looking for an american model, not an english or canadian model, why are we taking those 1900's examples of health care instead of creating a 21 century model for us. david, why don't you point out to people. >> the doctor had a question. >> you made a question about the pharmaceuticals. if you look at how they develop drugs. research and development is less than 25% of the cost of the drug. more than that, a good deal more than is spent on the marketing of the drug. the rest of the cost of the pill you pay for is what they decide how much they want to make on that medicine. there's nothing wrong with profit, but profit earing is bad. you can cut back the profits a great deal and still have a healthy bottom line and allow for resevere and development. you are subsidizing all the drugs everywhere else. that's the reason we can pay half the costs of a pill in canada as we do for the same drug here is coming off the same conveyor belt. made here and shipped to canada and yet we can't go and buy our medicines there. if i give a prescription to someone in my practice and ask them to go to canada to get it filled, i'm guilty, i could be put in jail with the same consequences as selling cocaine in the office. there is something wrong with that basic concept. medicare and most insurance companies for that matter are bureaucratic to the point we can't use them now. this is going to make medicare look like child's play. and this is so inefficient by its very concept that it's not going to be workable. and like you say, why are we going to base our future of health care on plans we know don't work very well? in britain they are offering tax incentives now for people to go buy private insurance because it's bankrupting their country. the only way -- they can control costs is to deny access. so above a certain age you don't get reenal transplants or reenal dyalisis. we are talking about age 65. we aren't talking about the extreme elderly. not all ration is bad, just based on outcomes. but we don't have those numbers for most things, really. that's not available anywhere in the world. people are gathering that information now. i'm a nurelingist. every couple months, i have a new practice on what's the best available evidence of a treatment for a given disease. we haven't gotten through 5% of the nureling call diagnoses yet. spread that out, we don't have the information to make those kind of rationing decisions at this point and be rational and correct in it. we're just going to make decisions based on the costs. and there's good cost benefit ratios and may save you money to do things that aren't allowed right now. i can tell you that the reasons that insurance companies and medicare have now decided to pay for sleep apnea diagnosis and treatment is medical costs have gone down 50%. if you want to make these decisions, that's the information you need, but it's not there yet. >> doctor, i think for me, we have two young boys, family going up, mom's on medicare, i want my family to make those decisions about those treatments. i don't want the government making those decisions for me. and i don't want to lose control of that. and most people i talk to, that's what worries them the most. yes, ma'am. >> i'm a pediatrician and since i work with kids i'm very simple. if i had a child who did something right and came up with a new plan, i would go back and fix the one. i have been working with the medicaid product for a long time and there are a lot of things that could be corrected. all the money was embezzled. this is very complicated and make me question why i gave up my life and family for years to achieve my goals so i could pay more taxes. i would have been better off staying as nurse. i would rather quit now take my unemployment and sit home and watch tv. >> we can't afford to have you do that. a lot of doctors say if you want to make improvements, fix medicare first and medicaid. >> the veterans have given so much. and the veteran health care is in horrible shape. again, i only work with parents and children but the sense of entitlement these people have, they don't want to pay, they want everything given to they them. they want to come up with an idea and tax a 50% more because they want to start a new business. it's going to flip. there is going to be a small minority making money to support everybody else. i'm going to quit and get on the other side. >> yes. diane. did you have your hand up? francis? >> relate particularically, what are the odds of defeating this? >> the question is what are the odds of defeating this bill, she used monstrosity. >> it all depends on you. there has been such a headlong rush to get this bill to the president's desk. we were fighting hard to get you a chance to see this bill before it got voted on. now in august, i can tell you in the time i have been in congress, this is the first time i have seen the american public actually get a chance to change the course and direction of a bill. i think if americans speak out on this legislation before lawmakers go back at labor day, we have a chance to stop this and say wait a minute, go back to the drawing board, both parties, come up with real reforms that this country can support, because there are great ideas out there. it depends on town hall meetings like this in texas and every state, every community across the nation. it's all really key. >> i called my congressman -- who do we call? [laughter] >> i mean, we know where you stand. how do we change the minds of other guys? >> in america, there is absolutely no shortcuts in democracy. those who believe the most and the longest prevail. i think in august, i think three things, speak out in your own district, not just to me, but to our senator as well. i know they feel the same way. but speak out. secondly, reach out to your friends and family and co-workers who are in the other congressional districts and encourage to get to town hall meetings themselves. pick up the phone, e mail and ask them to question their lawmakers about the bill. and then finally, don't quit. don't quit speaking out and reaching out until this is done and a new opportunity is made available. there are some great solutions. this doesn't have to be it. >> should we go to washington enmasse? >> it would be better to drive over with a neighbor who is in another district or friend or family in another district and talk to another member of congress, because at the end of the day, members of congress represent their communities, their neighborhoods. that's who they want to hear from. again, the white house, i think thinks all these town hall meetings are organized. you know, i'm republican, we can't organize anything these days, it seems like. truth is, what motivates people isn't party these days, it's their beliefs and their beliefs that there is a better answer than this. and that's why i think they are underestimating it in a big way. it may seem basic like you would tell your children, but it's really up to you guys. we're going to keep fighting on this bill, but that's how you can magnify yourselves. seems basic, but it will work. >> i was on the internet and there are democrats that go to town hall meetings and own constituents are telling them to vote no and they have the arrogance to say they are going to vote yes despite what their constituents say. there is one representative who said because of the powers that be, he said he could not name his superior, but told to leave the town hall meeting and was still going to vote yes. they have democrat constituents asking their representatives to vote no but yet the representative going to go back and vote yes despite what they say. if there are a party-line going on there and if they are going to be in line with obama and the democrats of congress, then they are going to vote yes despite what their constituents say. >> don't give up until they represent their districts. there's a long time between now and after labor day and beyond when we'll have a vote on this bill. and in the last two weeks, you've changed the tone of this debate in america in a dramatic way. so don't underestimate your own power as voters. don't do that. because in the day, it's not just about a year and a half from now, it is their representation every day. so stay after them. that's my point. in every district, in every state. >> who wants to go to washington? >> i'll go with you. >> let's take some more. yes, sir. >> as far as government-funded health care system, the tribe does have a government-funded health service. it's underfunded. about half of -- we are working on a 50% budget shortfall. with that, we have to go every year, because we have catastrophic coverage that actually causes our funds to deplete. but in the middle of the year we have to go through priority one where we can only go see the doctor if it's a life or death situation. that's a government-funded health care system. we live through that right now. you talking about people waiting to go to the doctor in canada, it's happening right now. our health costs are so high because we have 50% diabetes eates rates, our insurance rates are $1,100 per month per employee. if we don't provide health insurance, they are stuck somewhere else. some of our catastrophic illnesses have put us in a range where we almost can't get insurance. >> you're not thinking this is the answer. we have to find an answer. >> when you say a government-funded health care system, you are talking about raising the cost of affordability of health care. we provide insurance for our employees, but now because we do have severe cases -- one or two employees cause our rates to go through the roof. we asked for 10 private companies to look at our whole portfolio and only one was able to respond. >> in your clinic, you do good work. >> the government-funded system, we are proud. but we have people not going to the doctor and our life expect answer si is very low. so there has been a change but it's still underfunded and that's what we have to live with. >> thank you. good to see you. yes, ma'am. >> i understand that the rationing of medicare was going to be immediately upon passage of the bill. and you know, where is it listed what rationing they're talking about? >> i don't see that happening under this. what i do see is in the long run, rationing of health care across the country for everyone who's in this public plan and others in government-run plan period. the reason is we already have this in america today in the medicare system. we ration our doctors' services through the reimbursement. when we have this commission, this government commission that is supposed to decide how much we reimburse doctors, but they don't say dr. specter, how much more this year are you paying for staff, how much more is your rent and expenses so we can do your cost of living, they estimate how much money should be spent on dock -- doctors' services. it's lower than that, they cut them, even though there is no way they can offer seniors a 20% cut to them. when a government entity takes a budget number and if you go above that, we already have rationed health care today in medicare. that's one of the reasons why it's hard to find doctors to see seniors all the time. most people don't want to see that across the country as well. that's one of the fears. >> >> are there any people in washington that have an orange thought in their head that just don't repeat the party line. is there any chance of getting nancy pelosi out of the speakership? [cheers and applause] >> did you have to bought -- were you told by nancy pelosi to vote at 9:00 to vote on that bill? >> we have a young woman back here. >> most of the people in my subdivision are retired. what kind of advice would you give me to tell them not to be so afraid of this plan? [laughter] >> you know, i heard a gentleman from england saturday. we had a town hall meeting and he had been in the health care system over there and had come to america. was applying for all his visas and all of that and wouldn't go back for that health care system . but he reminded us of a comment, a statement from thomas jefferson from long ago who said people afraid of its government is tyranny. a government afraid of its people is democracy, you know. and i'm not talking physically fearful, but respectful of what americans want for health care. tell your neighbors there is no question we can do a lot of good things to improve health care, but this plan, the more you look at it, the more carefully you look at it, this isn't the plan for us going forward. and encourage them to speak out to reach out. i really think there is no more important time. for all of us, this is health care and this is our families' lives on the line. we have to get it right the first time. not rush it through and say we will fix it someday. it won't work that way. we know it won't work that way. and what worries me, too, the things we keep discovering in this bill, for example, there's a provision here that shuts down physician-owned hospitals that are under construction in america. in texas, that means 40 of our physician-owned hospitals will be shut down. 15,000 health workers will go without jobs. hidden in the middle of this bill. thank you, david. we're going to stay here so we can answer questions. get on my e news letter. we need to hear from you. david, thank you very much. [applause] >> we do appreciate your patience. >> various political groups have been running national ads on health care. here are some ads that the democratic and republican national committees are running. >> trillions for rushed government bailouts and takeovers, banks, the ought oover industry. and they'll have to pay. the next big ticket item, risky experiment with our health care. barack obama's experiment hasn't healed our economy. his new experiment risks their future and our health. the republican national committee is responsible for the content of this advertising. >> what's the cost of not reforming our health care system. premiums rising faster than your pay check. insurance companies dictating. denying you coverage. the cost of doing nothing means out-of-pocket expenses, some leading republicans playing politics have vowed to kill reform. tell republicans the cost of doing nothing on health care is just too high. the democratic national committee is responsible for the content of this advertising. [captions copyright national cable satellite corp. 2009] captioned by the national captioning institute --www.ncicap.org-- >> coming up on c-span, the white house honors recipients of the presidential medal of freedom. then an american enterprise institute panel discusses the obama administration foreign trade policy and richard holbrooke talks about the situation in afghanistan and pakistan. >> on tomorrow morning's "washington journal," gm will talk about their 230 gallon car. we'll find out how the recession is affecting their economy and discuss health care with jackie calmes. "washington journal" is live at 7:00 a.m. eastern. then at the brookings institution, a look at the economy and federal stimulus, six months after the stimulus plan was passed. you can watch it live starting at 10:00 a.m. eastern here on c-span. >> how is c-span funded? >> donations? >> federal funds. >> private contributions. >> honestly, i don't know. >> i would say from commercials. >> advertisements? >> something from the government? >> 30 years ago, america's cable companies created c-span as a public service, a private business initiative, no government mandate, no government money. >> at the white house today, president obama honored 16 individuals with the presidential medal of freedom, america's highest civilian award. recipients this year include massachusetts senator ted kennedy and former supreme court justice sandra day o'connor. this is 35 minutes. ♪ >> ladies and gentlemen the president of the united states and first lady michelle obama. [cheers and applause] >> thank you. please be seated. there are many honors and privileges to be put upon the occupants of this house, but few mean as much to me as the chance to award america's highest civilian medal, to the recipients here today. this is a chance for me and for the united states of america to say thank you to some of the finest citizens of this country and of all countries. the men and women we honor today led very different lives and pursued very different careers. they are pioneers in science and medicine and gifted artists and athletes. they have made their mark in the courtroom, in the community and in congress. and what units them is a belief that most -- forgive to those who are not americans but most american of beliefs. that our lives of what we make of them. no barriers of race, gender or physical infirmity can restrain the human spirit and the truest test of a person's life is what we do for one another. the recipients of the medal of freedom would not set out to win this or any other award. they did not set out in pursuit of glory, fame or riches. rather they set out guided by passion, committed to hard work, aided by persistence, often with few advantages but with gifts god give them. let them stand as an example here in the united states and around the world of what we can achieve in our own lives. let he them stand as an example of the difference we can make in the lives of others. that each of their stories stands as an example of a life well lived. one of the last things sue comben ask go her sister to make a promise. that she would prevent other families from breast cancer. what began as $200 and list of friends has become a global race for the cure, a campaign that has easted the pain and saved the lives of millions around the world. nancy thought about the promise she had made and whether one person could make a difference. and nancy's live is the difference. while an intern came across a patient in a coma without no name or address, homeless man found by firefighters suffering from tushtush. in the days that followed, the physician known as dr. joe, searched for clues about the patient's life in the squallor of miami's highways. dr. greer found a health concern, a clinic that now offers care to over 4,000 poor and homeless patients. a life that might be distilled into a question that he asks all of us, if we don't fight injustice, who will. the professor was a brilliant man and immediate oak kerr student when he lost his ball and and fell down a flight of stairs. he was told he had a few years to live. he chose to live with new purpose and happily in the four decades since he has become one of the world's leading scientists. his work in theoretical physician sicks, which i will not attempt to explain here has advanced. his books have advanced its cause of science itself. from his wheelchair he has led us on a journey. and he has stired our imagination and shown us the power of the human spirit here on earth. >> jack kemp led the beautiful buffalo bills to two championships. he had been booed, cheered, cut, sold and traded. makes me feel better. a conservative their, a republican leader and a defender of civil rights, he was that rare patriot who put country over party, never forgetting what he learned on the gridiron that it takes all of us working together to achieve a common goal, a life which we can all draw lessons, democrat and republican alike. after purchasing a $8 racqet, billee jean king was declared the best tennis player in the world. we don't honor her 12 grand slam titles, 101 doubles titles and 67 singles titles -- pretty good, we honor what she calls all of the off-the-court stuff, what she did to broaden the reach of the game, to change how women athletes and women everywhere view thements themselves and give everyone regardless of gender or sexual ownertation, including my two daughters, a chance to compete both on the court and in life. and as she once said, she should never underestimate the human spirit, nor should we underestimate billee jean king's spirit. born and raised in jim crow, alabama, preaching in his blood, the renched joseph lawry is a giant of civil rights leaders. it was just king, lonch -- lowery that led the movement that was to follow. the founder of the movement, he served as president. he served as one year but wound up serving for 20, one-year terms. throughout his life, some have called him crazy. but one of my favorite sermons that i heard he once delivered he said there is good crazy and bad crazy and sometimes you need a little bit of that good crazy to make the world a better place. born just a generation past the battle of little big horn, a grandson of a scout for general cufter himself, dr. joseph medicine crow was the first member of his tribe to attend college and earn a master's. he served in world war ii. wearing war paint beneath his uniform and say credit feather. joseph medicine crow completed the four battlefield deeds that made him the last crow war chief. historian, educator and patriot, a good man, dr. medicine crow's life respects not only the warrior spirit of the crow people but america's highest ideals. his name was harry milk and he was here to recruit us to join a movement and change a nation. for much of his early life he silenced himself. in the prime of his life he was silenced. in the brief time he spoke and ran and led, his voice stirred the aspirations of millions of people. he would become one of the first openly gay americans elected to public office and his message of hope, hope unashamed, unafraid could not ever be silenced. it was harvey who said it best, we got to give him hope. when a young sandra day graduated from stanford law school near the top of her class in two years instead of the usual three, she was offered just one job in the private sector. her perspective employer asked her howell she typed and told her there might be work for her as a legal secretary. now, i cannot know how she would have fared as a legal secretary, but she made a mighty fine justice of the united states supreme court. a judge and arizona legislator, cancer survivor, child in the texas plains, she is like the pilgrim in the poem, forged a new trail and built a bridge behind her for all young women to follow. it's been said that sydney poitier doesn't just make movies but makes milestones of america's progress. on screen and behind the camera, in films such as "guess who's coming to dinner, "uptown saturday night," which he became the first african american to win for best actor, he not only entertained, but enlightened, shifted attitudes, broadening hearts to bring us closer together. a child of a tomato farmer, he once called his driving purpose to make himself a better person. he did. and he made us all a little bit better along the way. did he lores knows the diversity that comes from a difficult name. i can relate. [laughter] known to the world by the name that has lit up broadway, her career had an improbable start. accompanying a nervous classmate, she auditioned herself and impressed them who would make them fa famous in anita in "west side story." she revealed that still rare ability to overcome when she recovered from a car accident that ended her life. she ended up retaking the stage and took a tony from "kiss from a spiderwoman". the only girl in the family of four brothers, mary robin son learned early on to make sure all voices are heard. as a crusader for women in ireland, she was the first woman elected president of the country of ireland. when she traveled abroad as president, she would place a light in the window that would draw people of irish decent to pass by. as an advocate, she has not only shown the light on human suffering but illuminated a better future for our world. after graduating from the university of chicago school of medicine in 1948 janet riley got married and gave birth to four sons, making medicine a hobby and making family her priority. it was not until she was almost 40 that she took up serious medical research and not until almost a decade later examining small photos, that leukemia are notable for changes. cancer is genetic and how we fight the disease. all of us have been touched in some way by cancer, including my family. what began as a hobby became a life's work for janet. the glint in the eye and the lilt of the voice are familiar to us all, but the signature quality of desmond tutu is readiness to take unpopular stands without fear. perhaps that explains what led the arch as he is known to preach among tear gas and rally against apartheid. when south africa needed a heart big enough to forgive its since, he was called on once more. tribune of the downtropical depressionen, voice of the oppressed, can'tor of our conscience, he poses that sense ofen rossity, that spirit of humanity that south africa know about. a young economics professor was struck by the disconnect between the theories he was teaching in class and the reality of the familiarin outside. determined to help, he left the classroom for a village and discovered that just $27 would free vendors from death. offering himself as a guarantor, he withdrew a loan, paid off their debts and founded a bank that has disbursed over $8 billion, lifting millions of people from poverty with loans. muhammad was just trying to help a village but he managed to change the world. there's a story that ted kennedy sometimes tells. it's about a boy who sees an old man tossing a starfish back into the sea. there are so many, asks the boy. what difference can your efforts possibly make? the old man studies the starfish in his hand and tosses it to safety saying, it makes a difference to that one. for nearly half a century, ted kennedy has been walking that beach, making a difference for that sold year fighting for freedom, that refugee looking for a way home, that senior searching for dignity, that worker looking for a job, that family reaching for the american dream. the life of senator edward m. keppedy has made a difference for us all. these are the 2009 recipients of the medal of freedom. and in a moment when citizens in doubt too often prevail, when our obligations to one another are too often forgotten and the road ahead can seem too long or too hard, these extraordinary men and women, these agents of change remind us that excellence is not beyond our abilities, that hope lies around the corner and that justice can still be won in the forgotten corners of this room. they remind us that we each have it within our powers to fulfill dreams, advance the dreams of others and remake the world for our children. it is now my distinct and extraordinary honor to ask each of them to come forward to receive their award as a military aide reads their citation. [applause] >> nancy brinker has transformed the nation's approach to breast cancer. when her sister was diagnosed, most breast cancer victims didn't know about it. she promised to challenge the norm. she found susan gfrpblt comben and it supports research and community awareness programs across the united states and around the world. nancy brings her unique passion and determination have been a blessing to all those whose lives have been touched by breast cancer. [applause] >> pedro jose guerrer, junior. dr. pedro greer junior has devoted his career to promoting medical services for the uninsured. he followed his passion for helping others through medical school and founded the health helping others through medical school and founded the health