Your back, you scratch mine and we spend the money. But as a consequence were borrowing a Million Dollars a minute. I think we need to be very aware of where we are situated as a country. I think we need to be very aware of the consequences of continuing to borrow a Million Dollars a minute. I think as we go forward we have to understand what the founders intended for our country. We need to understand where our richness, where our greatness came from. Were the richest, greatest, most humanitarian country ever known in the history of man. In 2014 alone we gave away privately, through charity, nearly 3 400 billion. That doesnt happen in cuba, they dont make wealth. If you want to know why we won the cold war, we beat russia and all of communism because the engine of capitalism defeated the engine of communism. Because we produce great wealth is why we were able to defeat the soviet union. If you dont know how wealth is created and you dont realize where wealth come from, if we dont realize it comes from freedom and small government, low taxes and less regulation, were going to lose it. I think this is an important election in the sense that we need to understand that the problems coming from both parties. We need to understand how Foreign Policy fits in to debt. We need to understand that there can be no unlimited spending for anything. And that we are not stronger as a nation if were trying to project power from bankruptcy court. I do think that the number one threat to our National Security is our debt. I want a Strong Military. Like we said, kellys dad was in the air force for 20 years. My dad was in for five years. Her brother went to the air force academy. Shes got three in the navy right now, her nef if yphewneph. You dont have a Strong Military by simply saying, oh, were going to spend a trillion dollars more. We currently spend 600 billion in the military. Is it enough . We can debate that. But to put it in perspective, we spend as much on our military, 600 billion, as russia, plus china, plus the next eight countries. Theres a secretary of navy under reagan, john lehman, he was the youngest secretary of navy, and he was an advocate of a bigger navy. He advocated and he was one of the spokesmen for romney. I agreed what he said, we probably have to modernize and enlarge and build more ships and have more capacity. But he said, do you know what, the way we pay for it, and romney i dont think ever said this, the way you pay for it is get rid of bureaucracy at the pentagon. Like anything else the military is like any other government. Too much bureaucracy grows. He didnt say to add on the cost, he said you have to find ways to conserve even in the pentagons budget. Im big on auditing the fed. You got to also audit the pentagon. Sometimes it takes a while to get things done in washington. Ive been working for five years to get a vote, which included sitting down with harry reid by the fire in his office 20 tim times that never worked. But i tried. But i finally am getting a vote. Its going to happen next tuesday, and if youre interested in having the fed audited, i think all of government needs to be audited, but were trying to get the fed audited, if you are interested call your senators, i dont think its exactly clear where everybody stands on it, but they all need to be called. This passed in the house overwhelmingly in a bipartisan fashion. Every republican and 100 democrats voted for this in the house. But were struggling in the senate and if it were held tomorrow it would probably lose. We have ten or 15 republicans were losing, we get about threefourths of the republicans and we dont have Many Democrats signed on at all. But if people will call, i think we have a chance. They have enormous power and we need to know what theyre doing. As we move forward in this primary, and were getting close, as you make your decision, you have to decide are you happy with the status quo. Are you wanting someone who will simply govern over the status quo. Do you think we can survive the status quo where we worry a Million Dollars a minute. My prediction is virtually everyone on the republican side will continue the status quo. The democrats as well. Because everybody has their sort of sacred cow that they want to spend money on and theyre not aware of the problem enough to say, weve got to turn, weve got to correct our ways. I want to be the candidate who will change the direction of the country. I want to be the candidate who will give you back your freedom. Give you back your liberty. Make government so small that it doesnt get in our way. So small you can barely see it. So small that what it does are the essential functions of our country and thats to defend our country, preserve justice, thats who i want to be and i hope you want to join that movement. Thank you very much. Thank you. Thank you. Thank you. Thank you. And now were happy to take some questions as long as theyre easy questions. Senator . Yes. Yes, sir. In light of the relatively [ inaudible ] what role do you perceive for the United Nations in maintaining world peace . Im not real excited about giving up sovereignty to international groups. I think if you dont like what im doing, you unelect me. If someone at the u. N. You dont like what theyre doing, you dont have a chance to unelect them. So, when we set up our country, we didnt really set up a country where we were supposed to give power to them. Im not against having an International Body where we have a body thats able to us and and we have a place of i guess worldwide diplomacy that comes together in one area. But i am concerned about giving up autonomy from us to them without it being approved by your congress. I think that Congress Needs to take more of an active role. We sort of outsource things, you know, sort of outsource it to the u. N. , the u. N. Is going to take care of it, and i dont think theyve done necessarily a great job. Im also not a big believer of sort of u. N. Wars. Korea was fought under the United Nations. Im not sending any of our young men and women to fight with the u. N. Emblem on their helmet. It will be an American Flag or not at all. Senator, you and the other candidates have had a protracted length of time in this campaign which has required a lot of money to get a job that pays a few hundred thousand. Lots of corporations are supporting these campaigns and probably getting more than simply good favor. Im afraid influence is being bought. The canadian process, the british method, where do you stand on that . I like the way you describe it as a protracted process. I think my wife would agree with that. Its a protracted process, thats for sure. I think money is influencing government and in a bad way. I think influence is being bought. And i think influence is being peddled in government. The first thing i would say on it is the reason people purchase government is because government has too much power to affect your daily life. If you had a government like what the Founding Fathers envisioned that was very small, no one would want to buy it. No one would want to purchase politicians to get their way. If government wasnt involved in your business or involved in your daily life and did very little other than defend the country, people would actually be more interested in being a state representative than being a u. S. Congressman. In fact, in the early days of the republic many people it was much more esteemed to be in the state legislature which ill see from some of the state reps here, but than it was to be in the u. S. Congress. But i agree with you that money is as the system exists is overly influencing the situation and people are bought and sold. We have had trouble figuring out how to fix it because we do also have respect for speech in our country, and so theres been the opposition of can you restrict . We allowed some Campaign Restrictions in the 70s and they have been allowed to have some limits but now people are going around the limiting through all these other groups. What i would say is this, and i think this would pass the Supreme Court test, some of the others have not passed. What i propose is that if you do business with government, that in the contract you sign to do business with government, there should be restrictions. So, lets say i ask you to build a billion dollars worth of tanks. Thats a big contract. We may well need the tanks or boats or ships or whatever we need, we may well need them, but thats an enormous amount of money or 5 billion or 10 billion, a huge amount of money. I think voluntarily you should agree to a contract that says you will not Lobby Congress and you will not contribute to congress. Lets make it really highbrow. Were still going to need armaments and well spend money on occasion for things but lets not let you have influence on the thing and come back and lobby for it. The only way it would work, though, politically to ever pass Something Like that is, big corporations do contracting. Big unions do a lot of work for government. If both big unions and big corporations had the same contractual thing. So, if youre the union that has 20 Million People working for the federal government or working for something, youd probably have to sign the same agreement that the union is not going to be giving contributions or lobbying as well. It has to be equal between union and business. Yes. We have dismantled our maritime commerce. And today flags carrying or ships carrying American Flags are practically invisible. The commerce this country was built on has diminishedappr apprecbly because were no longer a maritime nation, what would you do to turn it around . Hem me out. What do you think is the reason taxes. On building ships. Taxes on imports, exports, taxes on the ports. The greedy people who are working and changing the rules and changing the laws. Its you know, its rather obvious whats transpired. Im for a tax system that will be much lower and simpler than what we have. Currently the corporate business tax is 35 . I would have 14. 5 . I would also have 14. 5 for individuals. It would be very simple. Youd fill it out on one card. Wed get rid of 70,000 pages of tax code and that may well help in the maritime industry as well. Im also for lowering the regulatory burden. No president should be allowed to just heap a regulation on an industry. It should have to go through congress. In fact, i have legislation which is called the reins act which says if any president is going to do it and it will affect the economy, it has to be come back and passed by congress. I think theres things we could to bring it back. When i get a question like that where i dont know the exact answer for the maritime industry, im open to saying what do we do. If youre an expert, we get you in the administration and we figure out what it is that we do. But if its taxes and the regulation thats the problem, im for lowering the burden on both. The young lady back here. Say again. I saw the movie the big short recently the 2008 financial crisis. When i walked out of that movie my feeling was it was the lack of government oversight and the lack of government regulation that put us in that problem. When people complain about government oversight, the s. E. C. Was missing in action, glass steagall was repealed and the bankers on wall street who will tell you theyre assuming the risk so why should they be penalized, we were all left holding the bag. I mean, i want dodd frank made stronger and not weaker. I dont want my tax dollars to bail out the Banking Industry ever again. I think there does need to be more oversight and regulation particularly of government banks which i think were a big part of this. The Federal Reserve i think was the key progenitor of the problem we almost had in 2008. It didnt just happen in 2007 and 8. It built for quite a while. If you look at the average home price for 1930 it is doing this and 2003, 2005, 2007, its going almost straight up. Thats absurd. And it never happens in capitalism. Never happens in unregulated free markets. Because what happens in capitalism is interest which is the price of money should fluctuate like the price of bread. And so it sends a signal. So, if im building houses in exeter and theyre ten House Builders in 2003 and then there are 20 of us in 2004, and then there are 30 of us in 2005, and everybodys buildi ining houses everybodys competing for the money to borrow to build houses and homeowners to own them. What should happen to the price of the money . The price of the money should rise. And as the price of the money rises, Interest Rates rises, what should happen . Slows the economy down. This is the cycle of the economy that happens naturally under capitalism. Interest rates are the most Important Information that is disseminated throughout the entire economy. As a physician i liken it to insulin. When you eat a meal, your blood sugar rises and insulin rises after it and you get a cyclical effect. In medicine we call it homeostay s homeostasis, its an important debate, was this too much government or too little government. Was this too much manipulation of government on Interest Rates or too little. Now i would agree with you to a certain extent on glass steagall and things that allowed the the reason i agree, though, is not just as a simple regulation that when you allow banks to do investment banking, but you tell the taxpayer that were responsible for them being bailed out, that is a problem. The whole concept of too big to fail is a problem. Its still there. We passed dodd frank but it hasnt fixed the problem. But heres the counterintuitive part of dodd frank, we added a lot of regulations, but it was only on the big banks, and we need to make sure theyre safer so they dont fail and drag us all down. The Bank Regulators are now applying the big banks to the small banks. So if you have a Small Community bank in exeter, they may be struggling with all the regulations and its more expensive for a single bank to comply with regulations than it is jpmorgan. So what happens . The big banks swoop in and buy the small banks and all of a sudden the problem we were trying to fix counterintuitively the big banks are still getting bigger. I think one thing we should do to Something Like glass steagall. I wouldnt do it the old way. What i would do is if you have a big bank i will tell you we have taxpayer shoontion, fdic insures your deposits. What i would say is that were going to insure your deposits but well only do it if you have a division of your bank. So, you will only get it, and then maybe if youre a depositor at a big bank, if you dont have insurance, i wont deposit with you, okay, well have to separate our banks. Its a way of doing glass steagall. But i think theres a way of more strictly structuring it. There also needs to be a plan of bankruptcy for big banks. So when the big bank comes up tomorrow and everybody scares you to death heres the thing, the people say they have to bail out the big banks are the same people that didnt predict the big banks would have a problem and the same people that didnt think it was a problem having zero Interest Rates for ten years and these same people tell you, oh, you got to bail out the big bank and heres the middleclass we get all stuck with the bill. But if you have a gas station in exeter or a restaurant, you go bankrupt, nobody is going to bail out you, so its an unfair system. Its complicated exactly what the answer is, but i do agree with you that some form and i dont think weve i dont think were there yet. I think something more has to be done about too big to fail. I think it still exists. The problem is some of our regulations i think have made the banks even bigger. Not on purpose, but as an inadvertent result of some of the regulations. But i do agree with you more has to be done and im still trying to figure out with others if we can try to get something done about it. Yes . Banks are more dangerous than standing armies so give people the power to create money out of thin air and they control the world. How do you take that power away . Government issue for currency for debts foreign and domestic . Originally when the constitution was written, they said that it had to be of gold and silver. Thats all they mention. They do mention it explicitly in the constitution. We kind of got away from that and we have a Paper Currency. For a while the Paper Currency was exchangeable with gold and silver. And then for a while we said, well, the kunkssy currency is the full faith and credit of the federal government. As a government becomes less and less transparent and less and less honest with its books, it becomes more and more worrisome. The joke i have now is that once upon a time your dollar was backed by gold. Now your dollars backed by used car loans and bad home loans. Theres some truth to this. In 2008 when we had this big crisis, the fed bought 4 trillion worth of assets and assets are good, right . Assets are like bad home loans, thats an asset. Some people argue that the price of houses or home mortgages that the fed owns may not have been mark to market. They may not yet have gone to their bottom value. There is some danger that we still live in a real estate bubble. Weve come back in many ways people are building again. It seems to be more healthy. But we still have virtually zero Interest Rates and we have all of this stuff the fed owns. The fed owns so much stuff, trillions and trillions of dollars, theyre afraid to sell it. Theyre afraid to tank the Real Estate Market again. Theyre afraid to sell it because then we know what its actual value is at that point in time. So, i am with you. Some have argued that what we should allow is legalizing competition. Other currencies. And i think theres a possibility some of that occurs over time. I dont know if i have the ultimate answer other than that im very concerned about the fiat currency that we have now and whether or not we live in somewhat of an illusion of wealth that could come crumbling down in a dramatic fashion like what was about to happen in 2008 and some ways 2008 a lot of people still did suffer through that for several years. Yes . In the middle east and were getting a satanic spread of terrorism around the planet. The saudi celebrated the new year by executing the shia which could put us on the verge of world war. You mentioned this in your debate, thank you for that. This mention of russia. Youre the sponsor of the bill to declassify the 28 pages which talks about the saudis. Can we put an end to this terrorism which they have been sponsoring. Will you do what senator vevelle did with the pentagon papers so we can stop the financing of terrorism . What shes referring to is after 9 11 there was an inquiry by congress. Bob graham was a democrat senator from florida and he led the inquiry. Hes got a great book. If you want to know whats in most of the missing 28 pages his book Intelligence Matters was screened by the cia and the government and everything and he wrote a lot of stuff that he could find from public sources. He was allowed to reveal. He will tell you there was a link between saudi arabia and 9 11. Can it absolutely be proven it was our governmetheir governmen theres suspicion. There was financing that looked suspicious as well. But when we think about the middle east, saudi arabia is ostensibly our ally. Theyve gotten rich off of us buying all their oil. But its important we understand whats going on over there. The syrian civil war, the government is allied with the shiites. They are asly llied with the shiites, iran and iraq. The rebels are allied with the gulf sheikhdoms. In the civil war saudi arabia, qatar and the u. S. Poured tons and tons of weapons, many of which wound up in the hands of isis. Saudi arabias now executed a shiite cleric that was calling for, you know, elections or overthrow, whatever he was calling, but he had not committed terrorism. He was a protester in their country. And they executed him recently. And they have a shiite minority within saudi arabia, but there is some danger of that erupting and overflowing. But what i would say as commander in chief is saudi arabia buys all kind of arms from us. It has to be approved by the president who buys arms from us. I would only sell arms under people who are going to behave and do the right thing. I would have said you dont put arms into that civil war and you dont put them in in indiscriminately and if you do the floor of the congress ive introduced the legislation to bring it forward, but i would suggest to people who want to know about the 28 missing pages, where they blotted out everything, if you read Intelligence Matters youll get a lot of the gist of the 28 pages. I will continue to advocate for it. I probably wont read it on the floor but i will continue to advocate for a bill that does it. And i will tell you, read the yeah, read Intelligence Matters because bob graham went through a lot of what happened. It is important to learn from the past and the other thing i would say about 9 11 what still makes me mad as a senator no one was ever fired. Not one person was ever fired. All right. Yes . [ inaudible question ] can people hear me . Just on the same issue, i think it should be put in very simple terms. Senator bob graham said very clearly that if the 28 pages had been released, then isis would not exist. That the people who ran 9 11 and murdered 3,000 of our citizens would not be running free today to continue the mass murderous policy they are purveying as you see in the middle east. That considered, what possible excuse could you make for not using your authority as a senator to read the 28 pages into the record . And you have the authority. We dont need a bill, which as you admitted earlier is not going to do anywhere because harry reid is not going to do anything. You can read it into the record. And i tell you this, and i mean this with full respect, senator, that every member of congress who refuses to release this information and in so doing to bring an end to this mass murder, which was responsible for our own citizens being killed and is threatening millions of people in the middle east, every single one of those people who was killed by isis and who was killed by the saudis on 9 11, their blood will be on your hands and on the hands of any member of congress who refuses to release it im the wrong target because im your biggest ally. I introduced the bill to repeal it read it into the record then youre not really listening because im not your target. Im your ally i know you are but if you dont know who your friends are you wont get anywhere. Let me finish. Let me finish. Let me finish. But the only other thing i would say with the saudis, this was a big thing is two of the and the reason why this is all important also is that our reaction to 9 11 was to ask all of you to give up some liberty. It was asked of you to let us collect all your phone records and look at all of your private belongings and records in order to try to stop terrorism. But a lot of 9 11 was failure to do the stuff that normal cia and fbi should be doing. Two of the people from saudi arabia lived in san diego for a year with an fbi informant. With an fbi informant. We caught people trying to fly planes and not land them, also from saudi arabia. Also from france. But the thing is, is that we didnt do any of that and in the end we said, nobody made mistakes, or people made mistakes but no one will be fired. Said to the American People you need to give up your liberty and youll be safe next time. They say we dont have enough fbi agents, id hire more, but i wont look at all your phone records. If we need more fbi agents lets spend the money to do it. Lets do targeted investigations. The brothers in boston, we were tipped off by the russians. He flew back to checkch cechnya. Im a big advocate of privacy but if im the judge and you call me at midnight, im a yes to look at his records. If you want to look at the people he called. Im a yes. If any of them look suspicious, im a yes. If you ask me can we look at everybodys records in boston, im a no. Thats the difference. Im not against going after terrorists and looking at them individually, lets do it specifically. Lets have more agents looking at specific threats and not get overwhelmed by all the data that really just confuses and overwhelms us with information. Ive got time for one or two more. Right back here. I would like to thank you for coming to the town of exeter which is really refreshing considering last nights very uneventful visit by the clintons. Second of all, i just and i know you talk a lot about this. But really, id like you to talk a little bit about the information bill that was introduced into the senate in october and was written into law by president obama in december and how you as a primary opposition of bills or of the state of cybersecurity that we are in and our nation plans to have concrete plans to counter this kind of right. Yeah, the questions about cybersecurity. And they passed the cybersecurity actually as part of the big spending bill. It finally got put into the big spending bill. Is that your question, its about the cybersecurity bill. My concern about collection of information is whether or not theres due process in the collection of your information. And with the sharing of information, i dont have a problem with sharing of information. But i do have a problem if the data that goes along with it has a lot of very personal information about individuals. I think that there is a way and i think there already is a way of sharing information that if theres a certain type of virus or worm that is being worked into code and theres a technique for doing that, by all means people ought to share ways to combat that and i think there are ways of doing it. One reason i dont trust the government with more of the information in the way that they set up the bill was that the government hadnt been very good at protecting information, you know, the office of Personnel Management allowed access to 21 million names including all my personal information to a hacker which means theyre not doing a very good job of protecting their own. Business is pretty good at it because they react very quickly and theyre nimble and theyll lose money if people steal their stuff. Target has had a problem. Others have had a problem. But business is pretty nimble and i think i trust business more than government with the nimble nature. But i do think there can be sharing of information. But i thought there was not enough safeguards and lack of privacy in the way the bill was put together. I got time for one more here. Congress gives money to planned parenthood. I understand planned parenthood donates money to hillarys campaign. Do you have a problem with that . A little. But it gets back a little bit to Campaign Finance reform. If theyre getting government money, should they be allowed to have any contributions. Maybe that should be part of if youre going to take a government grant you sign a line that says were not going to make a political contribution. Not just a limit. No political contributions. They would say the money is separated. The problem is its really hard to separate and say none of this is going for abortion. This is going for this. They also tell you that 97 of their things that they do are not abortion. Well, but if you look at it in monetary terms its, like, 90 of what they do is abortion because theyre counting, like, you know, a pregnancy strip or getting some Birth Control pills as a procedure in all of their vast numbers of things they do. If you look at surgical procedures they do, 100 what they do is abortion. What i will do, its a controversial issue, i dont think government money should go to them at all. You could defund them if you were willing to use the leverage of the purse. Our leadership in washington says you cant defund them because you cant get to 60 votes. But thats not really true. Spending expires at the end of every year. That bill they passed in december, you let all spending expire. The second it all expires, now everything that you want spending for requires 60 votes affirmatively. So, you can shift the balance simply by letting spending expi expire. Holding your ground and saying we want government to open up as soon as possible. The last time we did it even the democrats said we got to pay our soldiers. We got to get the military the money to continue to exist, within two days they passed that. A couple days later people are, we got to pay people their Social Security and medicare. They passed that. But when it comes to the more emotional stuff, all right, lets keep passing the stuff we agree on and well get to the stuff we disagree on, maybe it will take 60 votes to get to the disagreeable stuff. But its also how you get rid of waste in government. We spent 43 million on a natural gas gas station in afghanistan last year. You want somebody to go to jail for something, whoever got the money for that should probably be in jail. They say the estimated cost would be about 500,000 in our country. Cost 43 million. No one will ever use it. Do you think there are very few cars in afghanistan and there are no cars that run on natural gas. Imagine trying to have a business in exeter and youre going to build a natural gas gas station that may be part of the future, but if you build it right now, nobody is going to use it. 43 million. They spent 800,000 in afghanistan last year for a televised cricket league. They dont have televisions in afghanistan, okay . And what business is it of ours to borrow money from china to send it to afghanistan. We spend 100,000 on studying japanese quail im not kidding to see if they are more sexually promiscuous on cocaine. I think we could just stipulate yes, you know . Thanks, everybody, nfor coming tonight, thank you. Hey, everyone. Thank you so much for coming out. There are blue cards on your seats and theres volunteers wo walking around. Its a movement and a movement takes people. Please put your name on that xa card and help us all out. Thank you very much. Cspan takes you on the road to the white house, best access to the candidates at town hall meetings, speeches, rallies, and meetandgreets. Were taking your comments on twitter, facebook, and by phone. And always, every Campaign Event we cover is available on our website, cspan. Org. Cspans road to the white house coverage continues all this week with candidates Holding Town Hall meetings in new hampshire. Today and thursday, jeb bush and Carly Fiorina meet with supporters in meredith. See jeb bush live today at 6 30 p. M. Eastern and carly fever rena live tomorrow at 6 30 eastern on cspan 2. And then on friday Ohio Governor john kasich visits exeter to meet voters there. See him there live at 5 00 p. M. Eastern on cspan. New hampshire holds the nations first president ial primary on tuesday, february 9th. Heres a look at some of our featured programs this weekend on American History tv on cspan3. Next tuesday, president obama will deliver his last state of the Union Address to a joint session of congress. This saturday and sunday, beginning at 1 00 p. M. Eastern, well feature four state of the Union Speeches by former president s during their last year in office. On saturday its president jimmy carter followed by president Ronald Reagan and on sunday president george h. W. Bushs final state of the union followed by president bill clinton. Also saturday morning at 10 30, a playwright and star of the Broadway Musical hamilton accepts the George Washington book prize special achievement award. And sunday morning at 10 00 on road to the white house rewind, well look back to the 1984 president ial campaign and a debate between eight Democratic Candidates in iowa. But whom we elect to replace that man has to have the trust and confidence of the American People, and it has to be on matters spoken in public and in private. Private promises and public statements for the American People being the same and it has to be for all our people. For our complete weekend schedule, go to cspan. Org. Next a News Conference on whats being done to prevent concussion in youth sports. We hear from several in the medical field including a pediatric neuropsychologist and a representative of medstars National Rehabilitation network. Held at the National Press club. H this is an hour. Is it 10 00 . Good morning, everybody, and welcome to the National Press clubs Morning Newsmaker Program here in washington, d. C. Todays topic is preventing youth sports concussion and what washington, d. C. , is doing about it. One of the first major metro areas in the region to provide a grant for research, education, and monitoring of concussions in youth sports. And were also here to talk about other youth sports injury. This newsmaker panel will offer an examination of data, trends in concussion research, state policies and whether or not the u. S. Department of education should adopt federal compliance mandates. Every state in the union has a concussionrelated law on the books. And a sports and youth Injury Program regulation on the books. Enforcement is the issue and come pligpliance is the issue a thats what the doctors here this morning and the sports data person is going to be talking to us about. My name is mike smith, and i serve on the National PressClub Newsmaker committee and the committee is chaired by Jamie Horowitz and our staff facilitatoe eoe eor is joanne b. I also own my own Public Affairs job called green smith Public Affairs in reston, virginia, and ive been a member of the National Press club for about 25 years. I tweet as smittypa and our is dcconcussions. This is being broadcast live on cspan and Available Online as well at press. Org and youll find Additional Information under our National Press club site, the website www. Press. Org. And in the record newsletter following the newsmaker. Various press releases have been put on the wire about Health Research under way here in washington, d. C. About one year ago washingtons department of health provided a grant to Childrens National medical, medstar and the agency for student Health Research also operating with injure free as their Technology Platform to collect data and information from parents, students, teachers and coaches and to provide education about concussion as well as diagnostic and initial screening questions to help student athletes. This newsmaker will referring to a monitoring, education and training funding and it will be implemented on the playgrounds of the d. C. Parks and rec department. The will smith movie concussion documenting the life and times of pathology, has returned attention to the issue of football and concussions. On cbc sports theres an item we saw on the Cable Network about youth sports cte injury a young athlete named keck and the student had suffered from cte imwas found. So its not just nfl players. The movie noted that the first autopsy which helped identify cte in a pittsburgh Football Player indicated a player might be hit ten of thousands of times by the time they go from peewee to high school and college and pro football. The actuarial tables show that 28 of nfl players might suffer from brain trauma and injury. But well not limit this discussion to football or even concussion in youth sports. Were talking about injury across the board and theres a lot going on with youth soccer and not allowing headers in the early parts of Young Athletes careers. Societys really becoming aware of this issue and so is congress and so are the states, and ill just mention a few things that have happened in the last few weeks on the hill and in the state houses that will allow us to provide for a policy discussion as well as a Technology Platform discussion. Its interesting as a member of the press club to see that we have education beat reporters, we have technology, sports, and weve had the health and medical. So, this issue traverses a lot of different beats. We want to draw a bit on the recent news on the hill and initiatives to help curb this Public Health issue which fred upton said reaches epidemic proportions as a Public Health issue. Three days before christmas congressman fred upton called for a congressional investigation of concussions. He announced a broad review for his statement before the house energy and commerce committee. He announced the committee will commence a broad review of the injuries beginning in the new year through his oversights on investigations, health and commerce. And this will include medical experts, professionals, nih, military, collegiate sports and the scientific and Research Community and other stakeholders. Upton said we often hear about concussions in the context of Service Members and athletes but this program goes well beyond the battlefield and the gridiron its a matter of Public Health as they are prevalent across all ages and population. Unfortunately theres a lot we dont know about head trauma, how it affects different subsets of the population, the short and longterm effects and other criticals critical to developing effective diagnostics and treatments. There are promising efforts under way and Congress Wants to better understand that. We have an opportunity to improve our understanding and better care for our kids and families. Another congressional kaw culls that has begun to take action on this matter is the congressional youth sports caucus. There actually is a congressional youth sports caucus and two of the chairs work to develop health, safety and fun and physical activity among players and sports leaders and parents. What weve learned just in talking together is that this is really a partnership between educators, schools, parents, coaches, and student athletes. So, what is this caucus doing around the issue of concussion . Were finding out in the new year that the caucus plans to meet and continue discussions on youth sports injury as well. And finally id like to go to the state house and in this case richmond. On the state level just on the 15th of december last year, the Virginia Commission on youth conducted a study providing a dozen recommendations to the Governor Terry mcauliffe and Virginia Department of education secretary ann houlton some of them centered on concussion. The first of which is requesting the department of health and the department of education Work Together to assess the feasibility of conducting regional information training on updated concussion guidelines and concussion awareness. They previously conducted the trainings after the adoption in 2011 of guidelines for policies on discussions in student athletes, so the departments are encouraged and in the state of virginia the ucenters for diseae control guidelines and other nationally recognized resources for presenting information to our communities. The information presented should focus on identification of concussion, the use of smartphone applications, and shortterm and longterm Health Effects of concussions and safety precautions. Its interesting that the commission on youth in virginia is asking for smartphone applications, things that can be used right on site and injure free is going to talk a little bit about that, the use of big data, cloudbased technology and the ability to bring it right down to your smartphone on the playing field. So, now let me introduce our guest speakers and panelists here at the newsmaker and what well do is have each of them speak for a few minutes and then well have a roundtable discussion. Dr. Gerard gioia is the division chief of neuropsychology and the director of the safe concussion outcome recovery and Education Program at Childrens NationalHealth System. He is a professor at gws medical school and directs the Developmental Disabilities research center. He treats persons and families with brain injuries with dual areas of interest. Hes been the Principal Investigator of several multisite cdcfunded Research Studies y ies with a focus on T Development of methods and tools for the evaluation and executive function and post concussion. Hes developed several smartphone apps and hell be talking a lot about the d. C. Grant and what were doing to develop this current application. And they have cognitive tests for post concussion symptom scales for children and parents. He works close with cdc on the headsup concussion programs as contributordimn author to the t kit. Hes beenen active participant in the International Concussion and sport Group Consensus meeting and the American Academy of neurology sport concussion guideline author panel. Hes a teen psychologist for the nfls baltimore ravens. Though he just told me hes a giants fan so theres your first scoop. He consults with the local and National Governing of Concussion Management and is on the medical Advisory Committee for usa football and the National Advisory board of the positive coaching alinels. Dr. Michael yokalson is medical director at the medstar National Rehabilitation hospital in washington. Hes a highly trained and qualified and Board Certified neurologist and psychiatrist. He served as the medical director of the Brain Injuries Program and associate medical directest Neurology Program at m medstar. Hes a graduate of g. W. Universitys medicine and Health Science schools and completed his training at the National Capital consortium. He served as a staff physician at the navy a. He currently serves on the board of directors for the Brain Injury Association of washington and is an professor of clinical rehabilitation medicine at georgetown and holds a position with the Rand Corporation studying traumatic brain injury in Service Members returning from deployment. He also serves on the fdas scientific Advisory Board for orphan products grant program. He has received numerous awards including the outstanding educator award in physical med sin and rehab at georgetown. Hes recognized as one of the top docs in washington at medstar. Charlie wong flew from san diego and made it okay through ohare yesterday. Charlie is executive director of the agency for student Health Research and founder of the injure free platform for monitoring and educating and engaging all stakeholders in concussion and other youth sports injury prevention. Its the cloudbased analytics system. He graduated from Marietta College where he played four years of ncaa football and he played two years of ncaa lacrosse. He studied at San Diego State and earning his charlie is a former Elementary School classroom teacher. He was the Athletic Director at the San Diego Jewish kad mee whe academy. Charlithee was Athletic Director at the san diego ymca and he coached football and baseball and softball there. He founded the agency for student Health Research which developed this injure free app. When it comes to traumatic brain injury, theres an app for that. Were going to find out about that. Its one year since washington, d. C. Provided its grant. In around march, the study work and i guess acquisition of data and information got under way. Were at about the nine month mark of starting to bring in surveys, information from parents, patients, students and dr. Gioia is here to tell us how that is going and give us a little more on the issue of youth sports injury. Dr. Gioia. Thank you, mike. Thank you all for coming to hear about this important issue here. Were talking today about not only concussion and its affect on kids but ultimately what we can do as a society to both prevent and at the very least to minimize the effect on kids and families. And were going to talk about the District Of Columbias legislation that was passed several years ago that is really attempting to put prevention and Early Intervention into place. I think its important to recognize that any good policy has to be based on Good Research evidence. On data that allows us to make the best kinds of decisions that we can. And what we know in the field of mild traumatic brain injury or concussion is that the research right now for our youth populations is really minimal. In fact, the institute of medicines report in 2013 identified that we were lacking in terms of our ultimate knowledge of this injury in kids. Most of our research has been at the collegiate and professional level or in a more narrow group of High School MaleFootball Players. So our ability to make good policy decisions for younger kids and for girls involved in sports is not based on good Scientific Evidence at this point. But nevertheless, we, back there 2009, recognized that we needed to do something. The state of washington, there was a youngster who unfortunately sustained two blows to the head in an eighth grade football game. Unbeknownst to his coaches or parents. Unfortunately, suffered a permanent brain injury. As a result, the state of washington and one of my good friends and colleagues dr. Stan herring and the Brain Injury Association wanted to put out a good educational platform and program for coaches and for parents. They did that on a voluntary basis. What they found was that when they went out to educate the public, there was at best a modest interest in the issue. They then brought it to the state house. And they recognized that they were going to have to length la legislate this process. Quite amazingly, over the next five years, every state and the district have put a somewhat similar law into place. But i will say that the District Of Columbia has really distinguished itself in its policy and its legislation in that it, number one, included not Just High School sports, which about twothirds of our laws at this point still only focus on, but also included youth sports, that is kids age 5, 6, 7, 8. It included private schools, not just public schools. It also included what we need to be doing to help kids after the injury occurs. In particular, how we return somebody to school that is where a youngster goes to work every day. And so its quite the comprehensive program. But i will also say that even more uniquely they put their money where their mouth was. They have funded Childrens NationalHealth System and med star and provide us the opportunity to bring charlie and injure free in to educate and train coaches and parents to be sure that we are getting to school nurses, to really lay the foundation for making our kids safer. But again, this is our best guess at this point in terms of what we can do. You are going to hear a little bit about some of the data that we have been collecting and the work that charlie has been doggedly doing to put a structure in place that will tie together our schools, our families, our medical systems and our youth sports systems. And i like to think of that as the four corners of a childs life, being able to make sure that when an injury occurs, it affects all four corners. That information needs to be well disseminated, well communicated and coordinated so that that youngster is getting the best treatment that they can. But again, the law was built to try to identify this problem. Typically by a nonmedical person. That is the coach, who may see something happen. And so our efforts in this first year of this project has really been focused on how do we give coaches and parents information to recognize the injury, to know that number one, if a blow to the head or to the body jerks that individual in such a way but with number two brings along a change in that youngsters function as identified by going through a list of signs and symptoms, then that youngster has to be pulled out of harms way. They need to be evaluated by a medical professional. And they cannot return to that field of risk, if you will, until they have been cleared by a medical professional to say that that brain has recovered and is able to handle the return. Those are the three core principals of this law. Educating, removing and making sure that we only return when ready. So im going to stop here and be happy to take some questions. We will hear from dr. Yochelson on some of the activities weve been doing in our grant. But again, i want to give just a strong, strong positive message to the d. C. Government for really making this happen and also for the department of health and facilitating it. Thank you. Michael . Thank you very much. Thank you very much for having us and allowing us to discuss this very important topic. I wanted to start a little bit by talking about my clinical practice or our clinical practice in med star and certainly at childrens, because i think it highlights the impact. We are seeing new concussion patients every single day. So throughout the med star Sports Medicine network, throughout washington, d. C. And baltimore, we have Sports Medicine and brain injury physicians throughout the region, similarly through the score program, childrens has their program in d. C. , Northern Virginia and maryland. And every single day were seeing new concussion patients. And i think that that really highlights the importance of this. And these are student athletes, these are adult weekend warriors, these are college athletes, these are professional athletes that we are seeing. In my personal practice as a brain injury specialist, i also see the longterm affects. So i am seeing patients who have the signs and symptoms of chronic traumatic enreceive lopty or prolonged post concussion syndrome. These are things that the only way we can prevent is to understand, to identify and to get the players out of harms way. And so its through this d. C. Department of health grant that we were able to begin this work. And its extremely early stages of this work. Theres much more to go on. But i just wanted to talk a little bit about a few numbers. So through this program that we have been working on over the past year and certainly hope to continue in the future, we had a total of 29 events. These events included awareness events, direct training, clinician Refresher Training and training the trainer sessions. And we touched over 6,000 people during those 29 trainings. One of the things that we also did is we did some pre and post training evaluation. We wanted to understand what did people know before they even came to our awareness events or our training sessions. And what we found is that there is truly a lack of understanding of the laws. In fact, theres a lack of understanding that even exists as it relates to concussion training. Overall, it was about 40 of people realized that there were laws. Again, the people that we were assessing are parents, coaches, athletic trainers, nurses and guidance counselors. Certainly, some had a better understanding with the athletic trainers scoring at 100 awareness of the laws, thankfully. But parents, it was only 31 of parents admitted to even recognizing that there was a law related to concussions for student athletes. This is really an indication that this program is a critical program. And what we have found in our efforts doing this is that it is a challenge for us to really get out in front of everybody and do the extensive awareness and training that everybody needs. Because were utilizing our own resources that are there also to care for these patients to go out and do this training. So we are a collectively a limited resource. And thats where the use of applications on smart phones, computers and whatever, really is a critical piece of this entire program. So certainly, you will hear more from charlie about that. And what this can bring to the program. But i think its also important, particularly as the concussion movie is out there and so parents, students, everybody is hearing about this, to recognize that this is actually a real entity. In terms of the research, much more Research Needs to be done. We are truly in the infancy of understanding how can we prevent concussion, how can we prevent cte, what does it take to develop that . We know that it occurs by recurrent concussions. We also know that you actually dont need a direct blow to the head to get a concussion. But what we dont know is, how many concussions you have to have, how severe, how frequent are the concussions in order to develop this and are there other factors, are there genetic factors . We suspect they are. We dont know what they are. There are certainly a lot of work that needs to be done on the buy logic side, on the genetic side. Theres a lot of work that needs to be done in terms of understanding the screening. Were using impact testing very often in the schools, in the colleges, and even in the professional teams to do baseline and postconcussion evaluations. Is that the right tool . How do you use that tool appropriately and effectively . So much more research is needed. I think with the program that d. C. Department of health has funded, were on the right track. But it cant stop now. It has to continue. These numbers show that. The numbers of concussions that were seeing show that. And so i appreciate the opportunity for all of you to come. Well be happy to take more questions. And i will turn it over to charlie. Good morning. Thank you, michael. Thank you, mike, and thank everyone for being here. It really is a great honer to be here and working with med star and childrens, peshespecially through the initiatives set forth. One of the things we heard from dr. Gioia was the need for more research and certainly the understanding about the issues at hand. As a former coach, as an Athletic Director, i understood the Administrative Burden thats in play here for schools. Paperwork, six, seven, eight pages for a return to play for concussions. For me it was, how can we use modern technology in real time notifications being compliant to apr amplify the efforts of doctors and researchers like the two gentlemen with us today so that we can affect a larger and broader area . But doing that in a coordinated effort. That was how to put something together that was able to meet those goals. The throughout washington, d. C. As we deploy, the idea is that were going to be able to provide the same level of care for any child who may suffer from potential injury or any other injury other than head injuries. So that would include anyone at the parks and rec facility in the public sector, at private institutions, youth club organizations, schools, pe classrooms, cafeterias, locker rooms, wherever these head injuries may be occurring, also on the football field, on the lacrosse field, in the soccer field, whatever it may be. And then as that information comes in, were able to study the effect of that concussion Education Training thats being deployed. The cdcs heads up Education Training and return to play protocols are being put into place so we can now electronically distribute all of the necessary requirements, the signs andni symptoms of recognition for parents, but then also for students, coaches, to complete that training process. Were also doing making it available for administrators at those leave hes to those levels to make sure the populations are going through the trainings as in accordance with the concussion act. So this regional effort is something that we want to be able to amplify on a larger scale. But the idea here is that national statistics, National Numbers and the rates of concussions happening are fantastic. We want to know how we can affect local policy. Here in washington, we have been able to look at the effect that this concussion Education Training has on reducing the number of concussions occurring. And then continue to work with those laws, continue to work with the policies in place, let the data speak towards what actions need to be taken and how were able to reduce the numbers. Again, its a great honor. Were excited at the agency for student Health Research. Were looking forward to continuing to work with childrens and with med star moving forward. Excited for what the future can hold. Thank you very much. Thank you. Well take a few questions. Id like to start off with one for the doctors, which is, do you think well look back in five years and say, we just didnt know what we didnt know . It just seems theres also a rise in our ability to collect information, analyze, compare. You talked about more studies. You talked about on the field experiences. It seems that the media cycle has caught up with concussion in the last few months. But the media cycles pass. Do you think maybe in five years we will have a better handle on whats going on . Well, i think the first thing we have to recognize is the brain is the most complex organ in the body. Neuroscience has advanced dramatically over the last decade. I think in five years, we will clearly look back and say, we now know so much more than we did five years ago, in the same way that we are looking back now five years ago and saying, our understanding of this injury, even our awareness of this injury has changed dramatically. I do think though the challenge is going to be making sure we dont get ahead of ourselves with that. And whereas in all of my active work with the cdc, our efforts have been to promote awareness. We also have to make sure that we dont kind of overstep where the evidence is, where the Research Really is taking us. Because were making a lot of assumptions right now about this injury, some of which dont really apply. So its always that careful ulto how to we protect that child to be sure they are having the best experience. In clinic i see kids who are in the performing arts who fall off the stage. We see kids who are just kids and they are injured falling down or in Motor Vehicle collisions. We want to make sure that the brain health of children for all reasons is taken care of. And i do think that in five years, again, with funding that we can prioritize toward our youth, we will have a better understanding i dont think it will be the complete answer. But we will have a better understanding of some of these issues that will help us guide protection and ultimately clinical manage money. Michael, do you have a thought on it . I do agree. I certainly think that in five years we will be much farther along than we are today. But i dont think that we will have all of the answers in five years. I think were probably decades off, unfortunately, from a really full understanding. But in order to gain that understanding, you need the research. So two things. One is that if you look at research in the area of concussion and brain injury, it is advancing exponentially. If you look at the number of studies in that field, ten years ago compared to now, it is dramatically increasing. And will continue to increase. However, we need the data. We need those numbers. So its actually through apps such as injure free and similar ways to collect the data. Its almost impossible to collect sufficient data without that in this day and age. Charlie, that goes to a question i had for you around Data Collection and analytics and big data nowadays with the cloud and the ability to really store and compare analytics. You are starting to see states that are doing well. And are seeing trends between districts in sports and counties and School Systems. So theres a chance to create a little Competition Among our states and counties as to how theyre doing. Tell me if you would, you mentioned minnesota, washington state, a few that are doing well at concussion education and prevention. Sure. We see a lot of different trends. Its something that as dr. Gioia pointed out, since 2009, all 50 states, including washington, d. C. Enacted some sort of concussion law, many of them models after the law in washington state. Up until 2014, last state came on board. So those the legislation put in place there was set to be a standard. I think now many of the states are revisiting those standards and looking at again how they can encompass not Just High School athletes but also addressing the youth sports markets that are outside of the education world, but also then middle schools, Elementary Schools. As we mentioned, kids falling off the performing arts stage, along that nature. As we begin to address, its a larger issue. So there are a number of states that are trying to take active measures right now. The university inner Scholastic League is the governing body for High School Sports in texas. They are making a concerted effort to collect information from their High School Athletic population on what information can we gather, how can we find medical researchers who will study this and then help us make the decisions. As a coach, as a former coach and Athletic Director, we never wanted to be the ones making those decisions. We wanted that advice coming from those that have the degrees to support the decisions being made. Its a community effort, much like we are seeing here in washington, d. C. , addressing total population. But many different stakeholders involved. Were seeing the states begin to revisit the laws now. The movie concussion was really heartbreaking. I think will smith is up for a golden globe for his performa e performance. Frank gifford had cte we found out around the holidays. Do you think the nfl has been more responsive now on head trauma and injury and the targeting and some of the penalties associated with the penalties meaning the sports scoring penalties related to head to head contact with these helmets and hits . Michael . I certainly that they are much more receptive now than previously. I think that they are certainly looking at and understanding the data that we do have as well. We do have to be careful about overinterpreting the information that we have. I think we do recognize that recurrent concussions are a serious problem. But again, we see thousands of Football Players who have had recurrent concussions over the course of careers, many of whom dont develop it. We really need more data. But certainly they understand that we do need to look very carefully at the penalties and how we can protect the players, particularly if thats the primary cause of the later sequelae of the injury. Let me say that the nfl was pushed into self examination. But they have also put money toward the nih, giving 30 million to study this problem. But i think going beyond football what has happened is it is now really asking all sporting organizations to examine what theyre doing to really look at that risk reward balance and to make sure that how we are teaching kids in particular to play the game, how we are teaching ajf officials t manage the game and then not unimportantly and probably maybe even number one, how we are trying to modify the culture, particularly parents and their focus and sometimes over focus on sports and the outcome of the game to really put injury prevention into perspective. So that the goal of the game is not always at the youth level, you know, to dominate your opponent. It is actually to do the best you can with hopefully the outcome of winning the game, but to take safety into perspective and to make sure that we are really managing this carefully. So i think this whole conversation, whether it starts with a concussion movie, what the nfl has done, what u. S. Soccer has put in place is looking broadly and widely and really many other National Governing bodies, u. S. Lacrosse, usa hockey, have been examining themselves, usa rugby. And i think its a good move going forward. What we ultimately need, quite honestly, from the perspective not just myself but really a Research Consortium that i work with, is we need a National Registry. We actually need you know the possibility of using injure free to register kids into a system, be able to identify their injury and be able to say, what is the denominator of the problem, meaning the kids that are out there playing, whats really the numer ator of the problem and be able to say, what is the percent likelihood that this particular sport is going to create this particular kind of injury situation. And then back it up to say, how can we prevent it, how can we make sure we are maximizing reward over risk. Benefit over cost. But we dont have that national database, that National Registry to make those decisions. Thats what we need to do. If we put into place in every state a system such as charlies to say, all whatever tens or hundreds of thousands it of these athletes are now playing from the age of 5 through the age of 18, and we are providing education to the coaches and parents, physicians, to schools and we now recognize and record the injuries that they have, we now can be able to say, this is happening in this way with this sport under these conditions. We can modify them in ways to reduce that risk. But weve got to have a fundamental database in order to let that happen. Can i follow up on that point, if you dont mind . In your opinion, why isnt there a federal reporting standard . Is it a lack of will . I was asked a similar question by tom goldman a couple weeks ago. And i said, its about priorities and about funding. And the priorities have really been, you know, to look at the professionals, to look at the collegiates. The ncaa has a wonderful grant going on, the care grant. Has multiple universities involved. They are developing data systems that are going to really help them to understand injuries, not just head injuries but all kinds of injuries. We need the same thing for youth. But again, the advocacy of that has been missing. I dont think its will in the sense of people believing that children are any less important. But i dont think we have had the voice behind this to really make it happen. Along with that, we havent had the organized body like the ncaa. Thats why were putting together this what we call the four Corners Consortium for youth sports and youth brain health to try to garner that organizational system so that we can put it in place. You mentioned this Congressional Committee thats looking into this in 2016. As they take months to look into it, hundreds of thousands of youth are still in sports. Is time ticking away . Do we have time to wait . We dont have time ever to wait for a youngster to be injured. Again, as i said, we want our best policy to be based on our best evidence. We have some interim tasks in between that. But we have to move the priorities toward our youth. You know that fred uptons committee on house energy and commerce was the one for 21st century cures. That was passed last year in the house which largely went to medical devices and other kinds of breakthroughs was the subclap t chapter. Concussion wasnt included in that. Maybe fred and the folks on that committee are trying to bring that into the fold of 21st century. Charlie, do you have thought snz. Absolutely. To follow that, we are seeing School Districts themselves or organized bodies, the National Governing bodies are taking these actions. Without that pressure, without that funding, theyre finding ways to make these changes happen. It isnt universal. Theyre doing what they can for their populations. Many of the School Districts that we work with on a larger level are taking these types of actions to create environments like jerry is describing where they are collecting information. A lot of this is driven from a Liability Protection standpoint. At the same point, its very much a lets get at much information as we can. Put it in the hands of medical researchers, of caregivers who have the credentials to oversee this population and then put the changes into place. What they can do with that data and how they can identify. Concussions may not be the number one injury for all athletic sports in the country. There may be field conditions. There may be foot issues. There may be warming up techniques that need to be modified. Certainly, thats the driver. Thats what were seeing from these School Districts and youth organizations involved throughout the country, that theyre taking steps on their own without that support, without that funding mandate behind that. I had one other question. Helmets, 475 helmets with sensors in them. Sensors measure the impact. But they dont say whats going on in the brain. The brain exists in its own liquid, i guess, has its own surroundings. Its not measured internally. Its an external. I have a question on helmets and whether sensors can help. Michael, if you could start. So i believe that its highly likely that they can help. At this point in time, the challenge with the sensors is that we dont know what the thresholds are. So we need to have a lot more research around that. And then there are different ways of measuring even with the sensors whether you are measuring a Rotational Force versus an impact. Those may have different factors as well in terms of the likelihood of developing a concussion. I do think that theres Great Potential for sensors. I think right now the clinical use of sensors or the use of sensors in Standard Practice is premature. And i think gives a false sense of security versus an appropriate diagnostic tool. I will tell you about a study were doing at wake forest that is looking at youth football in which we have sensors in the helmets. But what were doing is we are evaluating the function of children ahead of the season. We are actually doing very specialized mri and very specialized eeg scans of their brain. And then were doing that at the end of the season. And we are tieing together the biomechanical information that we learn from the sensors with that functional and brain outcome. Now, were doing that longitudinally over a number of years to see what are the affects of this basically, the forces. I agree 100 with what michael said. Sensors at this point are not ready for clinical prime time. They are still a research tool. And there has been a lot of study by some of my colleagues really at the professional, at the collegiate level trying to understand the science of sensors. How you place them, how they register information, screening out the false information from the real information, what we call the signal noise ratio. Think about putting a sensor not just in a helmet but on a head on a 5yearold out there playing whatever sport versus a 25yearold in a helmet. Its a very different situation. So a sensor is not a sensor is not a sensor. The biomechanical information that it has the potential of offering us tied to brain function and really cognitive and physical function i think is going to play an important role. I dont mean to hog everything. Can i ask you, dr. Yochelson, it sounds like what you are talking about in the d. C. Area is flooding the zone with information and measuring and whatnot. Very simply, what is your goal . Again, the goal is really to understand in a variety of different ways what is going to lead to clinical problems in the present and in the future for any individual. And so without data, whether you are talking about sensors, whether you are talking about number of concussions and frequency of concussions, right now we really need sort of use of data that we have or the information that we have to guide our clinical decisions. As a clinician, i need the research, i need these numbers to then come back and say, okay, based on what has happened to you as an individual student athlete, this is what you should do. Should you go back into the game . Should you go back to school . Are there any medications thats another thing too we havent touched on at all. Are there other treatments particularly if there are any b genetic predispositions. Are there ways we can protect against or treat a concussion once its occurred . Were far from understanding that. But its a possibility. Is your goal to prevent concussions or save lives or both . Well, i would say its certainly both. I think that ideally, the prevention is what you want to do first. But you are never, ever going to prevent 100 of concussions. You also want to understand how you prevent the chronic longterm affects and save lives. Let me add that in addition to what michael is talking about, our goal is to maximize the three core principals of law. Number one, to maximize the recognition of a suspected injury to the brain. Number two, to then act on that and remove that player from risk. And then number three, to make sure that they are allowed that appropriate recovery so that theyre not going back into harms way when that brain is still in a vulnerable state. Again, my good friend stan herring has said, you know, when you go out to dinner tonight, whether it be one of your parents, your spouse, your friends and they start to sweat profusely and they start to grab their chest and breathe heavily, you are not a cardiologist, but you are not going to sit there and let them do that. You are going to do what we have all been trained to do. Call 911. Because you want somebody to look at this individual. Thats what we want for concussion is the 911 of concussion. We recognize the conditions for when we remove somebody from a highly risky situation. So weve got to educate folks, because we know that there are not medical professionals on the side line at most sports for kids under 18. And so we need to prepare the systems and the responsible individuals for making that 911 call. So to speak. The question on policy is one about compliance and whether that requires a mandate or not. We dont know yet. The states have the laws on the books. Some are more progressive. Sadly, it often takes an injury and a parent and a lobbyist to make these things happen. Can you talk more about this app, this technology, and how it would be applied. A kid gets a hard hit. Who brings up this app . How does it get the information to get put into the app . Also, how do the doctors come into this . How does this get tracked from recognizing to treating . Absolutely. Again, to follow the points about the grant and the program itself was put into place, the first portion of this is the distribution of concussion Education Training, making sure that coaches, parents and students are going through whats required for them for participation. Either as a coach, an employee, a staff member, a volunteer or as a parent and a child before participation. Awareness, signs and those things. Thats being satisfied through a number of different platforms that have been uploaded. Were not building those Education Trainings. Those are being done by medical professionals and cdc and we deploy that. Register thats been accomplished. Administrators then are able to check off, run through a list so that a coach before a game can actually bring up on his or her smart phone a list of students if they have gone through the required trainings, their names will be in black. If they are not, their names are in red. They will know who has been cleared to play. If theres one of those children are participating, there is a suspected concussion, again, a coach, no medical professional on the side line, a coach, a parent, someone who has been trained to use the application or who has been authorized to access by the participating organization is able to bring up a simple Injury Report process. Dropdown menus asking basic information. We are asking them to enter signs or symptoms they may have of whats going on in front of them. At that point then that information is available for the administrators at the organization, the parents, the coach of the particular team, anybody else who has been authorized. Part of the process is to alert for the doctors and medical professionals at med star and for childrens to be able to have access to that information so that if a parent needs to come in for a suspected concussion evaluation, they can see will pull up that information with that parent access, with that parent authorization. They will be able to provide an evaluation and designate they have a concussion, no, they do not. That medical clearance process, they go into the standard return to play protocols that are outlined for the recovery process. At which point at some point hopefully they recover and then those medical professionals are going to be able to make that designation inside the platform. That name is going to go from red to black. Again, the coach can bring it up on the side line, you are cleared, no you are not, for that participation. Any coach coaching a sport would have authorization to this app . It depends on the organization. When we talk about soccer or anyone one of the high schools here, it depends on how that administration deploys their app. If they want the coaches to be able to have that access for Injury Reporting, for read only access. Its very customizable. We may want to talk about how you are going to be tieing the concussion recognition and response app into this. There are really two he willele of how we make that information available. Charlie built a system for athletic trainers, Team Physicians to be able to go through and do their assessment, their clinical medically educated clinical assessment. But again, probably 90 of the time we dont have a person on the sideline. We go through what we developed with our cdc materials, which is the concussion recognition and response app for parents and coaches that were going to tie into the system that allows them to go through and literally identify the incident and record that information to give them just a simple yes, take the kid off the field, no it doesnt appear like they need to be off the field right now. Give them guidance with what we have trained them ahead of time to understand. I dont know about you, but if im taught something one day, three weeks later, im going to be asking myself, how am i going to remember what im looking for . Theres an app for that to remind you of the questions you ask. You can record that information, have that registered in the system and made available now as you pull that youngster off the field and go to the medical professional now to decide whether it is or is not diagnosed. When we looked at ecosystem that exists in this process, theres a lot of information gaps. It was about collecting as much information as we can from whoever is on site. Giving them the right tools to be able to do that. Then passing that information and allowing a medical professional in to review that to help with the process, like dr. Yochelson was saying. We want them to look through all of the information they can and make the right decision. Its that connected Care Community that were trying to create here by allowing these types of pieces of evaluations to be accessible by authorized administrators. Theres specific evaluations, standard concussion Assessment Tool for athletic trainers. But in theres no athletic trainer, the cir would be available for parents and coaches to go through and go through some type of recognition process. You wouldnt be able to go into the app store and download this app no matter who you are . It would have to be through an authorized person or School System would authorize to you have access . Its not a stand alone. Its part of an ecosystem thats deployed by the governing organization in washington. Its been made available for every youth sport and youth Athletic Organization across the board. All schools, elementary, middle school or high school as well. Its available for those organizations. We are deploying it right now we start our department of parks and rec deployment next week. Its rolling out throughout washington, d. C. As we speak. What about virginia and maryland . Yeah. We actually have some have talked with the virginia board of education on friday. With ann holton. They are talking about which states might be most appropriate and letting those education departments the doe, the department of eds are the gov n governing authority. We are talking with the maryland state youth soccer association. We wait for those pushes to come. Organizations that are forward thinking that are being pro active working with researchers here at med star and children and taking the guidance and putting their best foot forward for their families. This is happening right now in d. C. Schools . When do you think it will be completed for all schools or all schools who want to participate . Our goal is by the start of next school year. Many of the i mentioned department of parks and recreation. That can occur at any time. That will continue to occur throughout the year of 2016. When it comes to the school year, we will get as many as we can before summer. Certainly, by football season coming up in 2016, we want to get as much as we can covered. Injure free is in la jolla, california. You have a lot of good scientists and doctors available to you there as well. I think you told me before the event that yusa soccer and lacrosse are taking bold steps as well. Ta he is its not just football. They are starting to work on data analysis. With the type of populations involved, much of the focus has been football. At the professional adult level or high collegiate level. I have two daughters. What about female athletes . We want a standard level of care for all students or youth participants in athletics and thats being accomplished. We are working with a lot of the National Govern he wering bodies who are proactive. Usa rugby is one were talking about. U. S. Driving, they are talking about updating their concussion education requirements. Some of the sports that might no, sir necessa necessarily think about but some that need extra support, that dont have the manpower or funding to pull a massive concussion Education Training program, we want to provide them technology thats going to allow them to amplify the efforts and take some of the best minds in the country here on this issue and amplify their efforts as broad as we can. The purpose of technology so theres not always the Human Element involved. I want to thank our speakers and presenters here today. For this informative session. We will see what the house energy and commerce committee, the youth sports caucus and state capitols do with concussion as we move forward. A couple of resources on the website childrensnational. Or. The concussion Awareness Training program is at the site. Injurefree. Com and med star. Were excited to on press. Org with coverage today. We want to thank cspan, cbs news for covering today. Were adjourned. Thank you. Cspans road to the white house continues this week. Today and thursday, jeb bush and Carly Fiorina meet with supporters. See jeb bush live today at 6 30 p. M. Eastern and carly fw carly live. On friday, john kasich visits to meet with voters. See him live at 5 15 p. M. Eastern. The first primary is tuesday, february 9th. Cspan takes you on the road to the white house and into the classroom. This year, our student cam documentary contest asks students to tell us what issues they want to hear from the candidates. Follow cspans road to the white house coverage and get all the details about our student cam contest at cspan. Org. Book tv has 48 hours of nonfiction books and authors every weekend on cspan2. Here are programs to watch this weekend. Saturday at 7 00 eastern, book tv is at the university of wisconsin with william p. Jones to discuss his book the march on washington. This was a movement that was really going to the core of many peoples beliefs about what this nation should be. And it did change a lot of minds. But it also steeled a lot of people to their position of hate and their commitment to inequality. Then at 10 00 p. M. Eastern, afterwards with fox news could have correspondent who looks at the life of dick cheney. No one on the right has attracted more vitriol from the left, more intense vitriol from the left than dick cheney with the possible exception of the man he served in the white house, george w. Bush, or richard nixon. On sunday, Molly Crabapple talks about her journalism, political art and her latest book, drawing blood. I started out writing personal essays. I only actually i think had five published pieces when i got the book deal. People really liked them. I had this delusional fantasy that since i had written a 2,000 word essay that writing 1,000 book would be like writing 52 essays. Watch book tv every weekend on cspan2. Television for serious readers. Earlier today, a house rules subcommittee met to examine a proposal to change the budget process that would fund the government every two years. Several members who are both for and against the proposal testified. Including republican reed rib e ribble. This is a little more than two hours. Good morning. The subcommittee will come to order. I appreciate folks joining us today. This is our first subcommittee meeting. I would like to thank my good friend mr. Hastings for his support of this hearing. I would like to thank on his staff our subcommittee staff Ranking Member staff director, molly larson and mr. Cody for his help on the ruleles committ and janet rossy. This hearing before the subcommittee will examine 16 hr1610, the enhanced oversight act of 2015 introduced from my good friend from wisconsin, mr. Ribble. It has been a topic of reform almost since the establishment of the congressional budget act in 1974. An act that i will make note was in the original jurisdiction of this rules committee that created the Budget Committee in 1974 and granted that authority. The question before us today is can moving from an annual to biannual process help us spend more weissly. We have distinguished members of congress from both sides of the issue prepared to testify on our current process and help us learn more about how to become more efficient and effective. I know many of you the members here are cosponsors of the bill. Some are very strong supporters of an annual budget process instead. I look forward to hearing both sides today. I would like to recognize the gentleman from florida, mr. Hastings, for any comments he may have. Thank you. I would like to echo your sentiment with regard to staff and their helping us to prepare for convening this subcommittee hearing on budgeting and enhanced oversight of 2015. Mr. Chairman, im very open minded on this subject. I have remarks that i will make that will counter that sentiment. I have strong convictions were going in the right direction. As i spoke with you yesterday, if time permits, hopefully we will hear other voices outside of our congress on the subject. While im certainly not opposed to congress debating the merits of this and do not believe it is necessarily a bad idea, i do think however that its disadvantages may outweigh its advantages and that it will not work with a budget as complex and as fraught with partisanship quite frankly as ours. I think thats your objective to try to take that partisan sting out of the budget process. I dont see how we can completely transform the federal budget process in this matter without first trying out a few test cases. If we really are serious about biannual budgets, we ought to identify a few federal programs we can test this out on for a few budget cycles before imposing it on the entire federal structure. The problem with our annual budget and appropriations debate and we have some appropriators here that im sure will weigh in. If you recall in another hearing, i asked chairman rogers of the appropriations chair his thoughts on this. He kind of favored the biannual budget but wanted it one year appropriations process. But rather, our debate is not the time line but rather the political leadership, smoothing out a few procedures here and there is not going to magically make our budget debates any easier. I suspect there is a correlation between interest in biannual budgets and the level of partisanship here in the house of representatives. If this body really wanted to, we could agree on a budget in one week or one day. But the budget is an intensely political process. And thats not going to change if we do it every year or every other year. Even in the off years, we would still be required to make necessary changes or consider supplemental spending and argue over authorizations and other revisions. If my friends on the other side are truly committed to working with democrats and the president to assure a smooth budget process, they would do so rather than tieing our hands and convoluted budgetary procedures. If ensuring a smooth process means that my republican friends are not going to try to eliminate medicare or pass tax cuts for the wealthiest americans or threaten to default on our national dealt, then by all means lets pass these reform bills. But we all know the reality of the situation. And that is, nothing is going to happen. Making the federal budget biannual will not stop the political debates, or will not reduce our workload and will ultimately result in a huge transfer of power to the executive branch. I happen to be one who continues to argue that congress has allowed too much of congresss responsibilities to be placed in the executive branch. Which by necessity will have they will have greater leeway with the purse strings. We ought to be about the business of finding ways in the federal budget to create jobs, support struggling americans and ensure that were not leaving those with the least among us to fend for themselves. More states in these few stats have moved away from biannual budgets than towards it. Currently, there are 19 states that have some sort of twoyear budget. Much less than the 44 states with biannual budget cycles in the year 1940. In comparison, only three states have switched from annual to biannual budgeting. Now seven of the ten biggest states have annual cycles. Its clear that so many states have abandoned biannual budgeting over the last decade. Therefore, i think that its fair to say that you cannot responsibly implement a meaningful budget two to three years in advance. Mr. Chairman, i certainly thank you for holding this hearing today. I look forward to hearing from our distinguished panel of witnesses. I thank my friend from florida. I would like to invite our panel up. Today we have the gentleman from oklahoma, tom cole, the author of our bill, reed ribble, dr. Price and our friend from oregon, kurt schrader. Our order of testimony, since were considering the ribble, i wanted to start with mr. Ribble. Then i wanted to go to our distinguished friend from North Carolina and then on to our rules committee colleague and mr. Schrader. With that i recognize mr. Ribble. Thank you, mr. Chairman. I want to thank the Ranking Member as well, for his comments. Any time you try to do something significant, it comes with challenges. Those that might oppose it, that might be concerned about it. Any time you try to challenge the status quo, its going to come with some anxiety around here. I believe that biannual budgeting reform has 233 cosponsored supporting it because the current budget process simply has not worked. And its only gotten worse. Since congressional budget act was enacted in 1974, congress has never passed both a budget resolution and all of its appropriation bills on time in the same year. Never. Not even once. It gets worse in election years. Ranking member hastings talked about politics. In the 40 year history of the current budget process only one time has congress enacted a budget resolution on time in an election year. That was in 1976, two years after the 74 budget act was signed into law. In the last 17 years, congress has failed to even pass a budget in election years 77 of the time. These 233 cosponsored include a majority of the majority. 75 of republicans in the house have been cosponsors. It includes a majority of the Budget Committee, a majority of committee. It includes onethird of the democratic party. Its truly a bipartisan effort whose time has come. Because congress failure to complete its work we are forced to rely on continuing resolutions and omnibus Appropriations Bills that are hastily passed usually without improvements to programs that could come from effective oversight. Given four decades of failure, let me feel why biannual budgeting should be part of the solution. It will provide greater certainty by moving the budget decisions further away from electionyear politics greatly enhancing the support this effort. Second having a budget for two years will reduce the need for frequent stop gap measures like continuing resolutions pcrs arent just bad government, theyre missed opportunities for congress to put its stamp on the executive branch and how it operates. With all due respect, mr. Hastings, this does not give the president more hpower. It gives them more confidence and certainty that the congress will actually do its work. What executive doesnt want certainty in their funding . Third, moving to a biannual process would free up more time on the house floor to tackle mandatory spending and tax policy and other essential work. The 2016 congressional calendar has only 12 workweeks from may through september. In essence the only thing congress will do next summer is appropriations. Biannual budgeting opens the door for congress to do all of its work. Fourth, not only will biannual budgeting tilt congress focused oversight, it will also reduce the use it or lose it mentality that wastes precious taxpayer dollars at the end of every fiscal year. Nearly 20 of all federal spending occurs in the last few weeks of the year and nearly a 35 billion increase in spending occurs in the last week alone. Thats a spike in the last week. I realize that biannual proposal put forth some will favor the status quo, thats the case here, theres a certain comfort with what you know even when you know what you have doesnt work. No organization on the planet embraces the status quo quite like the congress of the united states. We should not let the perfect become the enemy of the good for should we let comfort with the status quo become a barrier for fixing a broken system. You all need to know that i dont argue that its a panacea because it is not. It just simply isnt. But those that offer some critiques to it i think are worthy of a response. First critics argue that politics is to blame, not biannual budgeting process. That opinions not without merit. Mr. Hastings, you mentioned it in your comments. But thats a critique of congress as a whole, not of biannual budgeting. It is poll siitics that have kes from budgeting in election years. It improves the outlook and steers the process away from politics rather than toward it. Members of both parties can and should Work Together more often as they have done with this legislation that have been cosponsored for the last three congresses with congressman schrader and myself. Lets not let politics get in the way of this bipartisan effort. Secondly, critics argue that we need comprehensive budget reform instead. And i get that. But its been said around here that comprehensive reform is merely code language for not in my lifetime. Weve tried to do comprehensive immigration reform. Comprehensive tax reform. Comprehensive Health Care Reform and here we are with none of them being done. And i think comprehensive budget reform will fall into that same paradigm. We should not let the idea that we want to go all the way with a reform prevent us from going part of the way with a reform. We should take the first step so that we can begin the journey of comprehensive reform. Rather than saying we must take the entire journey in one step. We can get that done that way. In conclusion, i believe that biannual budgeting is an idea whose time has come. The house is seeking to work its will, mr. Chairman. I would like you to know that this bill has so much bipartisan support from virtually every caucus in the congress whether its the progressive caucus, congressional black caucus, House Freedom caucus, republican study committee, and it has vast support from outside groups as well. With that said, i know that any bill could use some tweaking and maybe improving. I want everyone to know that im eager and ready to work with anybody who wants to improve this bill as it moves forward but time is of the essence. And i encourage you to promptly move to a markup and continue this important work. That a bipartisan majority of meshes on this committee, on this bill, once again, i thank you for giving me the opportunity to testify here today. I look forward and ill be happy to answer any questions. Thank you, mr. Ribble. Mr. Price . Thank you, mr. Chairman. Good morning, colleagues. I appreciate the chance to testify today and would ask that my entire statement be put in the record. Without objection. I first testified about this subject biannual budgeting more than 15 years ago before this very committee. Our nations fiscal situation was quite different. The enactment of multiyear budget agreements coupled with a growing economy had produced several years of balanced budgets and allowed us to pay down more than 400 billion of the national debt. Since then to say the least things have changed. Weve had trillions of dollars in lost tax revenues, two unpaid for wars and a response to the Great Recession and most recently five years of extremely partisan and largely dysfunctional congressional budget poll six, so its understandable that the idea of biannual budgeting would, again, hold some appeal for members in search of solutions to our current woes. But this is truly a case in which the remedy could be a good deal worse than the disease. Now, im the first to agree that the congressional budget and appropriation processes have eroded significantly in recent years. Mr. Ribble is quite right about that. But biannual budgeting would do nothing to address the underlying causes of the dysfunction and would likely make matters worse by weakening congressional oversight of the executive, jacking even more decisions up to the leadership of both parties, and increasing our reliance on supplemental Appropriations Bills considered outside the regular order. Now, i want to stress that my opposition to biannual budgets does extend to the multiyear budget agreements such as the twoyear plan passed by Congress Just a few months ago. It lifted the misguided sequester caps for two fiscal years and allowed appropriators to write realistic funding bills that could be stitched into an omnibus measure. Now, that wasnt ideal, but the end result was far better than the likely alternatives of a Government Shutdown or a yearlong continuing resolution. However, this has led to some confusion with some describing the twoyear budget agreement as a de facto biannual budget. Thats not true. This ignores the fact that a budget resolution is not just a statement of discretionary funding levels. It also provides an opportunity to lay out fiscal goals, to set mandatory spending and revenue targets to activate the reconciliation process and to address budget enforcement procedures. So, my support for the twoyear budget agreement doesnt equal support for biannual budgeting and the agreement does not obviate the need for annual budget resolutions and annual Appropriations Bills. Proponents claim it would free up congress to conduct oversight in the off years. Thats a very ironic claim because the most careful and effective oversight congress conducts is through the annual appropriations process. When an agencys performance and needs are reviewed program by program, line by line, offyear oversight would be less not more effective because it would be further removed from actual funding decisions, and thus reduce congress leverage. Supporters have noted president bush, bill clinton Ronald Reagan all favored biannual appropriations. Does that surprise anyone . If this suggests that biannual budgeting is not a partisan issue, it should warn us that its certainly an institutional issue. It should be obvious why president s would support a free pass every other year. From an appropriations process that could make or break their agenda. They also support the line item veto. They also support a ban on earmarks. They support measures aimed at weakening congress authority visavis the executive branch. Now, as a senior appropriator im naturally sensitive to charges that opponents of biannual budgets are merely defenders of Appropriations Committee turf. I would suggest that the annual work of appropriations serves the entire institution. It serves our place in the constitutional balance of power, and that doesnt matter what the division of Party Control is or who the president is. The appropriations process has to be held accountable to congress and the country, but it does serve the entire institution. What about this accountability . I think biannual budgeting will do more harm than good. Faced with outdated and unworkable funding levels for individual programs in the second year of a biannual appropriations, whats the whats the federal agency going to do . Theyre going to seek reprogramming, reallocation of their budget requests. Who grants those . Theyre granted or denied solely by the appropriations subcommittee and Ranking Member without debate, without amendments, without votes and without public scrutiny. Offyear budget problems that could not be handled through reprogramming would necessitate numerous supplemental Appropriations Bills. In fact, the whole purpose of a biannual budget could be undermined by the proliferation of supplementals in the off years. Perversely we would have replaced the democratic process of annual appropriations with supplemental bills that are sporadic, rushed, and heavily controlled by leadership. Finally, let me switch hats for a moment and as a former house Budget Committee member articulate some additional concerns that were identified during the Budget Committees hearing on this legislation. First the bill as currently proposed would make a number of changes unet ared to biannual budgeting that could weaken transparency in overall budget process. One provision would consolidate the budget functions and show increasing or decreases in spending that it would