>> and now former president bill clinton's book presentation from the neocon historical society. >> good evening ladies and gentlemen. my name is sunny, and on behalf of all my colleagues, i'd like to welcome you to the new york historical society or what some will have a memorable evening of conversation. tonight's conversation will reach across the generations. we use that term when the old are interviewed by the young. and we'll focus on something of interest to everyone in this room, collective future. the american dream is a fossil concept. of late, the talkers being derailed, people are worried about their jobs, they are worried about the economy. they are worried that we have lost our competitive edge. and they're concerned that the american safety nets are fraying, and not be there for them when they retire. my good friend president clinton has written a new book that addresses these concerns. in "back to work" the present rights, and i quote, i came of age believing that no matter what happened i would always be able to support myself. it became a crucial part of my identity. it drove me to spend a good portion of my adult life trying to give others the same chance. president clinton goes on to say, it's heartbreaking to see so many people trapped in a web of idleness, debt and out. we have to change that. we've got to get america back in the future business. president clinton, dedicated public servant, will be joined on stage tonight by one of our brightest, youngest citizens, also a champion of public service, chelsea clinton. chelsea clinton is a graduate of stanford, has earned a masters from columbia columbia and is currently pursuing a doctorate at oxford. she's also working with the clinton foundation and the clinton global initiative. her recent professional and academic work as focus on improving access to health care with citizens around the world, on equal rights, and on education for children. ladies and gentlemen, please join me in welcoming president clinton, and chelsea clinton. [applause] [applause] >> thank you. before we begin, i should acknowledge the fact that i'm currently not an unbiased interviewer. i am unapologetically and profoundly biased towards my father. we don't always agree, but i certainly always learn from them. whether in conversation or in the pleasure of reading many drafts of his book, and then finally in a hard copy for myself. last week. so i think it would be a good place to start a bit where stunning left off, saying that she wrote this book largely because you were worried that for many of us the american dream had become opaque and for others it had been lost. so i think it would be helpful to hear why at this point in time you were compelled to write this book. it is brief. it is filled but it is action oriented. >> well, i first was inclined to do it after the 2010th elections because i went out, i don't know, more than 130 events. and i wasn't particularly surprised about the outcome for the reasons i state in the book. people tend to hire democrats when things are messed up. think about it. so they hired us to fix things. they didn't feel fixed on election day. they also, the american people are always somehow deeply ambivalent about the role of government, and they have been from the beginning. keep in mind, we were born in reaction to unaccountable government power. i just had my picture taken with the stamp act. [laughter] and posed by the british government under king george, and it's the first time i think the stamp act has ever left the parliamentary archives in london. it's here for an exhibit that will be here at the new york historical society through april. so we always wanted, we didn't want to much government but we want enough. and was enough and not too much of course i is a source of constant debate. and so all this stuff happened. what bothered me was the election was almost completely fact free. and i think that's not good for us. and then i started thinking about the last 30 years in american politics and how sort of anti-government paradigm had led us into one blind alley after another, arguing only about whether we should always be against more taxes and always be against more regulations, and government would always mess up. instead of going to the end and working backwards, how do we build a country that is a country that promotes shared prosperity and new jobs and new opportunities and broad-based educational opportunities for people in the 21st century. and then walking back from that, how do you get that? if you look around the world, at the most successful countries, they have both a strong economy and a smart and effective government, and they work together. so that's what propelled me to write this. and i've been saving all these articles that i have gotten out of newspapers, blog sites, magazines since 2007. since the recession started. about the economy and about other things. and all the books i read it nfib decided i should just try to distill it and say here's the political and economic history of america for the last 30 years. here's what we should do now what i think we should do now. what i was think about. it would be a good thing if every american who cared could have a slim volume with enough facts in it that would prove the case about how we got where we are. and i could make the argument about what i thought we should do when forward. >> one of the things that you could articulate in the book is what come in your estimation, is just the right amount of government and what the role of government should be. one thing you don't articulate in the book is what you the role of the private sector be and what do you think is just the right amount of engagement and action, particularly at moments like these by the private sector. and serving from my edification i would like to hear your answer the former and the latter together so that there's sort of a clear and coherent vision of what should be rendered unto government and what should be rendered unto the press center. >> well, i think in general the private sector should do the work of the country. basically private sector is better at competition, building businesses, hiring people, creating jobs. the government should set the rules, the boundaries, how do you get, how do we have clean air, how do we have safe and clean water, how do we have safe food, how do we produce energy in a way that maximizes the positive impact to preserve the environment, and should do it anyway that leaves the largest number of how questions to the private sector if possible and still get the good results. when i was president we had 43 million more americans breathing cleaner, and we had the metal law which favors transparency, but we tried to set up a system where the private sector was in televised to meet these objectives at the lowest possible cost in the shortest amount of time. and so, but it changes over time. we privatize some of our management of nuclear stockpile, non-bomb making materials. over time there would be more and more functions that government used to do that might be probably done by the private sector, just as the government should do things that help us to get into new areas of economic opportunity or deal with new problems that are broadly shared that the market will not solve. but i'll just give you one example of something that was done in 1980, that is probably more relevant today than it has been in decades. in 1980 with a bipartisan majority, the congress passed a law that president carter signed which provided for federally funded research to universities that results in commercially valuable findings to be licensed to the private sector, determined by the university. because it was recognized that the private sector would be able to make the most of the commercial development, and that most colleges could run their own businesses. shouldn't be starting businesses and doing it. that tech transfer system has worked pretty well for 30 years, and one of the things that i argued in my book is that all the colleges in the country that are doing this, and i have a young cousin who does this work at texas a&m university. i love talking to him. >> who does get a shout out in the book. >> what? yet. what the heck, i have to take care of my family. [laughter] >> but the back -- best tech transfer program is probably mit, because they never take any money. they only take stock in the new company. they will give a professor a year off to work in the company, but the professor must promise after a year, to bring in a professional business person to run the company. and they've got a lot of other things. anyway, it works really well. and they're some of the models, but in general i think this question chelsea asked is something we always ought to be constantly asking ourselves. should this be privatize, should it not? that if you have a doctrinaire position each way, you might wind up with a bad decision. i'll give you another example. the united states is virtually the only big country that does almost all of its large infrastructure with 100% public funding. other countries don't do that. so the president actually has asked the congress to adopt infrastructure bank proposal that has bipartisan support in the senate to have the government siege in infrastructure bank with a relatively modest amount of money, let's take 10, $15 billion. and i suggest in the book ways to get. and then allow banks to sell bonds to allow american citizens to invest in it, and also to take money from overseas interests, and from pension fund, but also from sovereign wealth funds, from governments all over the world because these infrastructure projects yield a very high rate of return. and i think we have been to hide them. wished me the only country in the world that is afraid to take private sector money to build our infrastructure, and i don't mean just roads and bridges but i'm talking about a decent electrical grid, faster broadband connections all over the country. it should body that south korea's broadband download speeds are four times ours. and so having good government policy doesn't preclude something is being done by and with the private sector. >> one government policy that you discuss in a few different places in your book and that no your personally advocating for is the extension of the 1603 green tax credit, which is particularly jermaine to the title of the book, "back to work," because you articulate in your book, roughly a billion dollars has been invested in a new coal-fired power plant, yields about 187 jobs, and a billion dollars invested in building retrofits yield somewhere in the order of seven-8000 new jobs. so maybe you could talk a little bit about green tax credit and why it is set to sunset in 2011, sort of hearkening back to the first part of your book, a little history, and how those of us in this room could try to help change that dynamic for 2012. >> when president and the congress were debating after the 2010 elections, whether the bush tax cuts would be extended, because of the recession and whether it be a bad idea to raise anybody's taxes in this down economy, one of the things the republicans said is tax cuts are always wonderful in a down economy, but spending cuts don't hurt at all, which is self-evidently crazy. there's really no different from a macroeconomic point of view as our friends in the u.k. are finding out. and he went for an austerity response to the current circumstance. one of the things they wanted to get rid of was the 1603 tax credit, and they said it was a spending program. this is a kind of argument that ought to be held in a seminary over some obscure provision of scripture. [laughter] in my opinion. but you be the judge. the republicans and without to get rid of 1603, it's a spending program, it's not a tax cut. and it is that it isn't. when the congress did things like loan guarantees for new energy companies, at the infamous solyndra loan guarantee, was actually adopted during the bush administration, signed by president bush and supported at the time i almost all the republicans on the energy committee. and it's hard sometimes to pick winners and losers. that's not what 1603 does. 1603 recognizes that a lot of people building solar and wind installations are startup companies, so if you give them the 30% tax credit that you would ordinary give someone for building this defector, it will be worthless to them because i have no income to claim the credit against. so what 1603 does is basically give them the cash equivalent of the tax credit if they are startups. now, if you just don't like solar and wind energy and you want to keep the oil depletion allowance or any of the other tax credits for traditional energy, you can make that argument, but very significant number of the new solar and wind projects have used 1603. so, my argument is it out to be extended because we've got thousands of more facilities in solar and wind power which are becoming more economical every time. the price drops about 30% for solar and wind every time you double capacity. and so in particular has had significant technological advances in the last three years. ironically one of the reasons solyndra went down, because the technology, other technologies got cheaper faster than anybody figured. and took them out of a competitive mix. so i like the 1603 and i think it should be continued because i think we should be supporting startups as well as existing companies. and a very significant percentage of americans jobs over the last winners have come from small businesses that were five years old or younger. so this is the kind of thing i think, you know, my iq is we should say where do we want to go in this country? we want to build shared prosperity and be competitive, and then back up from that essay how do we get there, what's the government's post-do, what's the private sector supposed to do? i think if you do that instead of saying government, no government, you come out and say this is a heckuva good deal and we ought to keep doing it. >> since you mentioned the end of 2010 i wanted to give you an opportunity to sort of repeat something that you said to me earlier, which is the one part of your book we feel like you did the resident a bum rap was run run the debt ceiling debate. that's been in the coverage a lot. >> i was with a upset. i do know what is the white house or the congress that resisted raising the debt ceiling in 2010 after we've lost the election spent when we still had the majority. >> when we suddenly to get because i knew congress was meeting and i knew if we waited until january the republicans would drive a very hard bargain. and so i said in a very kind of muted way that for reasons that were still unclear to me, this didn't happen, and gene sperling actually sent me an e-mail and said, who worked for me, unscrew plus a honest person he said oh, we tried. you know, we didn't make a big deal out of it because the main subject was what the bush era tax cuts going to be extended. but it shows you, i'm trying to force myself to say once a day, either i don't know or i was wrong. [laughter] because i think it would be therapeutic if everybody in washington do that. [laughter] so i want to be as good as them. so here's something i was wrong about. is raising the debt ceiling simply ratified the decision congress has already made to spend money. and since the budget is the only thing that the senate votes on that is not subject to a filibuster, i thought that raise the debt ceiling vote was not subject to the filibuster. and i was wrong. so gene sperling sent me a message and said senator mcconnell said he was going to filibuster and thus we agreed right in on their budget. they would run on. so turns out he couldn't raise the debt ceiling and i was wrong. it didn't hurt too bad. [laughter] >> and that's when we we get less ideological politics that people find errors they make and fess up. >> moving a bit out of washington, one of the things that you frequently in the book is to cite examples of where you think this sort of appropriate partnership and shared responsibility between government and the private sector is working at the state level. maybe you could talk at it about your theory of that and also show some of the examples, particularly from your time as governor of arkansas, sort of what worked then and also what has continue to work and not work subsequently in arkansas. >> well, first i think we americans are used to people at the state and local level hustling business, trying to say businesses, trying to extend business, trying to locate businesses there, and it is largely a bipartisan activity undertaken perhaps with varying levels of exuberance by elected officials, but one reason i was able to stay governor for a dozen years and never got bored with the job and loved it the whole economic develop an aspect of it. and the interesting thing is that in most every state in the country, although it is got more partisan nonsense 2010, but i think that will settle down, it's largely a bipartisan activity. and so i try to cite some areas in the book, for example, to give you one just practical example, there's a long section in the book about what i would like to see done to clear the mortgage debt more quickly. and i guess i should back up and say, these kinds of financial crashes take historically five to 10 years to get over. and if you have a mortgage component to it, push it out towards 10 years. we should be trying to beat the clock. we can't do it, in my opinion, even if we adopt the president's jobs plan. i think there's a lot of good ideas in there, and they will give us one and half, 2 million jobs according to the economic analyses, but if you want to return to full deployment economy, if you want to have 240,000 jobs a month, i think we average 2,127,000 a month for ages, you have to flush this date -- flush this debt and get bank lending going again. so kenneth rogoff at harvard recommends, some people say well, but if we lowered the mortgage rates, if we bring the mortgage debt to the value of a house, then the people who hold the mortgages will lose money. who's going to compensate them? and what's going to be? rogoff has suggested that the banks are the people who ultimately hold the mortgages, instead of writing them down, just cut them in half by taking an ownership position in the house so that when the house is ultimately sold, the people who issued the mortgage will share in the profit, and you get the same practical result that you know longer have a dead -- a bad debt on the boat and the home phone has a mortgage that he or she can be. and i said in the book, i know this will work because when i was governor in the late '70s and early '80s and our farmers got in trouble, we had been hundreds of small state chartered banks who didn't want to foreclose on the farmers. they knew they were just had a couple bad years, and they couldn't pay their farm loans off, and he didn't want to take possession of these farms. so we allow the banks, we change the law. the banks take ownership position in the form and then give the pharma an absolute buyback right to take his form back, full title ii once they could pay off the farm loan. that's the sort of practical thing you see done at the state level. the republican governor of south dakota, i will never forget, called me on the phone and said, he said this is unbelievable. i wish i would have thought about it. cindy the law. i said i will, but, you know, that your neighbor in north dakota, which was more republican in south dakota, is the only place in the country that has a state-owned bank and they been doing this since the great depression. that's how i got the idea. [laughter] but you get the idea. doesn't matter whether we were right or wrong. the point is we're sitting there talking about how to keep farmers on their land. how to avoid putting our banks in trouble. nobody gave a thought, and even after the beginning of all this hyper partisan error in the '80s when i represented the governors with the republicans and negotiating a welfare reform bill with the reagan white house in 87 and 88, and i went to the signing with president reagan on the white house lawn, and i had a rebuttal can counterpart any democrat counterpart, we worked with the committees, we worked with the democratic chairman and the republican minority leader, and we work with the white house and was never a lack of politics in the whole time. we're always talk of how this would work, how would it affect poor people, what would we do. then when the first president bush was in office, i represent the democrats ended with his national education goals and i got invited to the state of union address with my republican counterpart. we stayed up all night at the university of virginia writing these goals. all we talked about what would work. we need that again. every time an election rolls around, turn that we still disagreed with each other enough to have a heckuva good election, but when the election wasn't going on we actually thought we're supposed to go to work for you. god forbid, right? so that's, i could give you lots of other examples of things, these kind of economic strategies that have been developed. andrew cuomo just did i think a great thing, organized new york into 10 regions and got the legislature set aside some money, and the regions are competing with this to get this cash. i think $200 million or something, and they haven't decided how much they're going to divide. all the regions have to come up with regional development plans, and new york is a very diverse state. so i went the other day up to albany to meet with the thousands of people that represent these regions are coming up with these plans, and i am telling you, even the regions that don't get the money are going to be way ahead because they're doing something that have never had to do before. a talk at what they want to do and how they're going to do it. instead of having some idle political debate. so that's the kind of thing that i think chelsea is referring to. i think. the federal government ought to be doing this. we ought to be, do you want to give the chinese and the germans the whole solar market? even though we have greater capacity just in domestic demand, and much better venture capital than they do get and the price is dropping precipitously. and if you don't, what should we do about it? what should the government to? what you the private sector to? the same thing when building retrofits. governor cuomo just signed a great deal in new york called, i think it's called on bill accounting, but here's the bottom line. if you retrofit your home or your office building, you can get it financed that way and then you can pay off only from your utility savings because it will just add it to your utility bill. so it is a just say yes system. and it will create 10 or 12,000 jobs in new york to put billions of dollars into this economy within a matter of months as soon as it is fully implemented. those are the kinds of things i think we have to be more of. >> in having conversations like these, writing books are advocating, do you think this is sort of the niche that civil society should fill in this conversation, having discussed sort of what the role of the public sector is, the role of the private sector is? you clearly have a unique meaning capability, but i think a lot of us can make the source of contributions, yes? >> yes, but i would like to explain. a nongovernmental organization in america has largely done two things in the modern era. one goes all the way back to before we became a country. the first ngo in the united states is the volunteer fire department, benjamin franklin organize in philadelphia before the constitution was ratified. and he was doing old-fashioned ngo work, 18th century style. that is, is always going going to be a gap between what the private sector will produce and the government can provide. we didn't have enough government to afford a fire department and they were not enough fires to make it profitable to make it a private business. on the other hand, if it was your building you thought there were enough fires. so we organized the volunteer fire department. one of the morning television shows i did today, the today show, after i left they had what is fast becoming the biggest them in america, did you see it? this family with 18 children, about to be 19, about to be 20, 19 about the between. that guy is a conservative republican who was in the arkansas legislature in my last year's present, the first time i met him. 11 years ago. but we're talking to his kids because one of his kids is proud of the fact that he was a volunteer fireman in the little town where they live, where i established the fire department as governor because we set up 700 fire department. i was in rural arkansas. we have the highest fire in the country. the point is that's in ngo deal or the gap between what the private sector can produce and the public sector can provide. the news additional and improved role for ngos is to basically hopefully working with public institutions and with private institutions for appropriate, to figure how to do things faster, cheaper, better. because unlike business you don't have to turn a profit every quarter. and unlike the government you don't have to be embarrassed if you fail. and as you can take a bad story, you can say i tried to do this, it didn't work, we're going to do it another way. and so, that's what you do with schools. you go in there and you try to figure out how to take otherwise statistically disadvantaged kids and who they are just as smart as everybody else, they can when things just like everybody else. and having the chess tournaments and organize the way you organize will increase their learning level. so i think that what we did with cgi american west a version of the letter. we tried to bring people together to think about what we could all do to create jobs. and i think there are a lot of things, there's some other examples where private foundations are creating employment directly in partnerships with public and private groups. like in san diego which is now the genomics center of activity in america, as the largest number of nobel prize-winning scientist at any time in the country, they have the university of california san diego. they have qualcomm and 700 i.t. companies. at all these, other things, they have the craig venter's foundation and the other foundations that are investing in all of them work together on a common plan. that actually works in the modern world. cooperation works in real life, conflict works in politics and news coverage. it does. i'm not being cutesy here. it does. i'm as guilty as the next person person. spent i don't know if that is a conflict. >> but anyway, you get the idea. we need to ngo to fill the gap. the robin hood foundation funds both kind of ngos. the harlem children's zone does both kind of work. so there are differences, but you get the picture. there's a real important role for ngos here because they take a lot of heat off businesses who have to turn a profit, they take a lot of heat off government who want to try certain things but may be scared of getting too much eat if it failed. spent dates are the laboratory of democracy and the 18th century -- >> and cities are, too, now. that's the difference between now and when the framers wrote the constitution is the cities are just as much laboratories and states are. look at all this thing, this deal michael bloomberg it putting up $109 to build a whole new university labs are degenerate high-tech jobs. in al qaeda who's going to get the contract. >> as a standard of all -- >> the point is, it's a heck of an idea. it's the way the world should work. i think it's wonderful. los angeles just announced vast new consortium to have major buildings have both greater energy efficiency and putting up more solar power, and how they're going to finance it and it's going to be the biggest commercial retrofit project the country has yet undertaken. they figured out how to do it. full disclosure. my foundations climate change initiative worked with him, but always did was provide technical help and support. they figured out how to finance it. so the city can do a lot of these things but the congress at least should not make decisions which makes those things more difficult. they should be empowering that and rewarding it and incentivizing it. >> and it's an election day today, not in new york city but certainly in many cities across the country. mayors are being elected, or reelected in san francisco, baltimore, philadelphia, houston, phoenix. and yet i don't think questions like this have been very central to the coverage in advance of even those local elections. so albeit what you said earlier is credible having been a governor certainly that people expect governors and mayors to possible business, that seems to not be central to the discourse around the the local elections. how do we make that more fundamental? and i know you are racing around the country trying to do that, since you not a scalable resource, although almost an inexhaustible one, how do we think about that dynamic? >> i already got his i was wrong, now i can say i don't know. [laughter] but i got some ideas about it. when i was a governor, i really worked hard in the national governors association and all these regional associations and educational associations, and there were a lot of things we did when i was governor where arkansas was the first state doing. we were the first state to require counselors for kids in elementary schools. i was proud of that, but i was always more proud when we were the second state to do something. because it should that we were not too proud to learn, that we were out there on the edge of learning. and one of the real problems is education and in health care. so i will just use because they both bear on the economy, is that a lot of the challenges america faces, for example, in providing health care at lower cost and higher quality so we can afford to be competitive in other areas it all of those charges have been met by somebody somewhere, but the ideas don't trumpet almost every child in american education has been met by somebody somewhere. the ideas don't travel. part of that is the complication where you have in the public sector a monopoly on revenues and customers, and in the private sector where the status quo has more power, more resources and more lobbyists than the future does. but one of the big challenge is that i tried to talk a little about in the book, which admittedly not having an answer to, is just to do that. how do you make these ideas travel? outeat an example, just ask yourself how many of you knew this, what city in america has the highest energy efficiency standards for new buildings? answer, and the oil capital of america, houston, texas. spent which is why it is so important who is elected mayor. >> why? because the then mayor who did it, did it, bill white, was deputy secretary of energy when i was president to give been my friend a very long time, and i knew he knew a ton about oil and gas but he also want to build a modern energy economy. he gets elected mayor of houston. the first thing he did was retrofit every home of the 20% of houstonians who are homeowners with a low income. and then he had the highest new building standards in terms of energy efficiency of any city in north america except for vancouver, canada. he was reelected with over 80% of the vote. and yet the idea still doesn't travel very well. although they do travel better than you would think among cities. but we need to think about that in the united states because a lot of the stuff can bubble up from the bottom up. if you look at this that i wrote a lot about in my book, i mentioned the next american economy by william a host and. we need to figure out how to more of the that and then how people learn from each other on the basis of this year. >> when they want to ask about is something not in the book but came out yesterday. the census bureau announced a new draft methodology for how we calculate and process poverty in the united states. and it's sort of early hypotheses out of that the paradigm, or that we have 49 million americans living in poverty, our highest absolute number ever. and more elderly americans living in poverty than previously assessed, largely because of higher out of pocket health care expenses. because although the vast majority of older americans are covered under medicare, medicare only covers 80% of in hospital expenses. ostensibly although still somewhat challenging given absolute numbers of children living in poverty is actually lower than has been previously determined. largely because of chip and supplemental supplemental program. free school breakfasts. as you think about that new emergency data, how does that impact both what you diagnosed as challenges in the book, chiefly around social security, sustainability and medicare sustainability, and also your recommended prescriptions. >> well, first the childhood poverty numbers are still appalling, but they are smaller. the children's health insurance program, that's what chick's, started when i was president, and expanded beginning i think in 2007, we had a fight naked, i think i'm attending kids can get health insurance under it. and they will be maintained, and that number will be expanded to some health care reform bill is implemented. that plus nutritional supplements like school lunch program does lower the percentage of people who are in poverty in fact. what happened to the seniors is that even though the social security checks go up more than the real cost of living exclusive of health care goes up for seniors, because health care has gone up so much that it's really affecting older people who are on medicare, but as chelsea pointed out, 20% of their hospital stays, for example, are not covered. if you are really poor and old you get medicaid, too. so what's happened is, especially since the states are busted right now and are lobbying against raising the eligibility levels for medicaid, what's happening is this money is going up, the amount of money you have to pay out of pocket is going up, and the number of older people who qualify for both medicare and medicaid is not going up to make the difference up. so what -- >> the states are not commensurately changing their medicaid parameters? >> yes, and because of their budget problems that cut. for example, in 2007, 2009, gdp is going to 7.5% of most people worry about going broke. health insurance profits went up 50%. 5 million americans lost their health insurance and three and a half million of them went on medicaid. so ironically the private sector drove three and a half million people to the public sector. all the time bashing the public sector. the states did have the money to pay their medicaid mix, and the federal government debts increase. so what do i draw from that? i draw from that the conclusion that one of the best things about the so-called simpson-bowles commission, the bipartisan budget commission, is that it recommends not only savings in the social security program, but modest 200 billion over a decade. it sounds like a lot of money to you and me but to the government it is not. but they recommend the program redesign in a way that channels more income to lower income seniors so that if we don't fix the health care gap problem, at least those people will have enough money to be lifted out of poverty again. and it can be done and still save money. >> one of the things that you say you believe in the book but don't go into detail is that the united states could actually move the 17.8% of our gdp on health care spending is on .% of our gdp on health care which is what france and switzerland approximately spent on health care. that would save us about $187 billion a year. how would we do that? >> that would save the federal budget 187. it would save you $850 billion. that is, if we, for every year the pew charitable trust does an analysis of health outcomes in wealthy countries, and they generally conclude that america's -- america ranks the 30th in the overall health care. that's not fair. too low. but what is true is that germany and france are normally ranked at the very top. and it is true they get better health outcomes for spending less money. and it's also true that even if you had, you gave us more credit for being, for example, being the longest breast cancer survivor rates in the world and being great at heart surgery, i'd like someone else will be giving this talk -- >> thank you. >> you still have to face the fact that we are not getting what we pay for. and it's being driven primarily by the way we finance health care and fee-for-service. josie used to work for mckinsey so i will give your title discount. about three years ago -- >> i didn't get the credits i will get the mckinsey credit. >> midteens the issued a three volume study trying to analyze the differences between what we spend for health care in america and what are other rich countries spend, and they essentially concluded that the biggest deal was fee-for-service medicine instead of paying overall enrollment plan, which dartmouth and other people say has led to about 40% of the american people getting health care that's likely to be more expensive than they should get and not being the optimum care. second was the way we finance it with private insurance companies which adds massive amounts to the administered cost of not just the insurer, the company, but also the insured. and if you have insurance on the job, then it's more paperwork for the medical providers, for the employers, and for the insurance companies and cells. it's about a $200 billion item that we wouldn't pay if we had the administrative cost of any other country. and the third thing was we pay more for medicine for anybody else, but if we bargained for for medicine bought, if we could do that, that's about 75, 80% of the difference. and then there is the biggest chunk left, about $150 billion is because we have higher rates of diabetes than any other country in the world with its intended consequences which is what childhood obesity is the number one public health from in the country, in my opinion. then there's a thousand other little things that make up about 5%. >> so given that we're almost out of time, if you wanted to ensure, if people left here with one call to action over one fact that would help lead to more fact-based debates as we move to more from this election day looking toward the next election day, next november, what would it be? >> well, if i could only say one thing i was the everyone should at least be involved where they live in trying to spit state and local initiatives that does, that to bring government and the private sector and ngos together to do what we did at the cgi america meeting. start with where you are. look, this is still the biggest economy on earth. as much as i worried about the retirement of baby boomers, and i'm the oldest one of them, i worry about them. you should feel good about this. 10 years ago as i was about to leave the presidency, my then hometown of little rock, arkansas, had a terrible turn of the rate that the oldest part of the city, and a little, all african-american community next-door was which was leveled where i had done worked 20 years. so i went down, i had a dinner with 20 people. i ate barbecued back when i could do that. i ate barbecue with 20 people i went to high school with. besides me, only two others had finished college. besides me, only to have been made more than $50,000 a year. but their number one goal in their retirement was they're going to imperil their ability to raise their children should get one you give up on america, you just remember that. it's still basically a good country. people make rational decisions based on what they know. now, in spite of all of that, our average workforce age is still younger than europe and japan. canada may be a little younger than us, but not much. we, it's easy to start a small business here than almost any other place. we still have these laboratory support for r&d than most countries don't have. we have a lot of indigenous streaks here. we have a better sophisticated venture capital networks and other things. and we know what we need to do. there's plenty of money after to bring the economy back when you figure out how to unleash the money, unleash the money in corporate treasury and in banks. so i'm not pessimistic, but they are doing this kabuki dance in washington now over the simple things we have been debating since we were told in 1981 the government is the problem. it is an. i mean, it may be but it's not the only problem and it's got to be part of the solution. so my view is, if i could say one thing, it would be you know, bloom where you're planted. start and come up doing, find something to support in your community and in the state here and use that as evidence, try to change, break the logjam in washington. because there's not a single, one of the most important points of this book is i go through all these other countries that are now ahead of us in certain indices, faster broadband downloads become a more modern infrastructure, higher percentage of young people with college degrees, less income inequality, faster job growth, lower unemployment. there is not a single example on planet earth of a successful country that got their on an antigovernment strategy which is the most important thing you can ever do is never taxed somebody in build clinton's income group never again. never ever, ever. not want to cover 33 oecd countries, we rank 31st in a percentage of national income going tax. mexico and chile are lower than we are. we ranked 25th in the% of national income spending because of all this money we had to come up to avoid the calamitous consequences of the financial collapse. so, i want you to change national policy, but we have to somehow find a way to break the psychology. and i find, i'm happier if i have something to look forward to in the mornings i don't just gripe all time. and so, you ask me one thing you can do, make something good happen. go hire somebody. i have a friend, a company called acxiom which is the largest mass mailing company in the country. if you get "sports illustrated" every month, you got it from them. and most of the magazines. on november 1, they challenged every company in the united states and 50 or more employees to hire one more person. they said if everybody, even wal-mart just tired one more person, everybody with 50 or more people could afford to do it, there would be another million people working within a month and it would change the psychology of america. just do something. and then you will be able to tell the members of congress what you did and ask them to follow suit. >> thank you all very much. i hope you will do that. and by the book. thank you. [applause] >> thank you. [applause] [applause] >> for more information on president clinton's book, trenton, go to the website. >> and now onto screen is eli saslow who is a staff writer with the "washington post." he's written a new book. it's called "ten letters: the stories americans tell their president." what are the 10 letters? >> so, the 10 letters are 10 of the letters that come into president obama every day. and really they are reflection of the mail that comes across the country. republicans and democrats, fourth graders, grandmothers. it's this really democratic election every night that comes into him that he then read and usually writes back one or two letters a day. >> how are the letters delivered to him? are they carefully edited? or is it pretty, can they be pretty frank with him as was because they can be frank with him but getting dollars to his death really requires an army. mail used to be handled inside the white house before the anthrax scare and then they moved it outside to the sort of secret office building in downtown d.c. were 1500 volunteers and 100 full-time staffers work every day, sort of take these 20,000 letters and categorizes them by topic, either positive, or the negative, and they make -- he sees just about five positive, five negative lives. this point to start out dear moron, or there are others that are very positive. >> how did you get access to his mailbox and he receives about 20,000 letters a day? >> he does, 20,000 letters a day. i worked for the "washington post" and i'd written a longer piece about the letters. the white house can be tough on access. the letters on of the very few things they like talking about because they believe it shows he is connected to the country and listening to interest with the letters really reveal is what's going on in the country and oftentimes it's heartbreaking brutal stuff that doesn't necessary reflect him well. but they're willing to show me everything because i think they want to show he has written. >> and how me dizzy respond to? >> he usually responds to one or two a night. some of these he response to really