One thing is with all of the data that is now available for research, what we are seeing is and what is being seen by insurers, in fact that higher prices for the services does not indicate better outcomes. They are rebuilding or fixing knees and the more they do it, the more familiar with the better the out come and because they do of them. And often the price of that particular procedure is lower than it is for the guy who does one a week. If they do or two or three a day versus one a month, what we are seeing in terms of the outcomes is that often times the lower cost procedure is really producing better outcomes. The place for the network and cheaper. I think we also know that we have seen a lot of networks in the networks and the pricings are the lower in general and they expect my view that we dont know how to measure quality. A few things we do know and what i like to point out is who scores well on the care and fivestar system that is one of the systems that is leading the way on measures equality. Im not sure how well it does that, but to the extent it does, who comes highest on the achievement under that system, it tends to be the a chp companies that are the integrated System Companies like dianes company and kizer and group health. They do tend to perform better in that system. Before you jump in, you mentioned the system and the federal government is looking at new standards that are similar. Is that where we should be going . The federal government did hold up to quality initiatives for a couple of years and several different there and one of the main reasons is what they wanted to make sure that there was something else. There was a lot of work going on to align these things. I think we are primitive on being able to. I dont know if they know how to measure quality yet. I think we have a lot of work to do. Joel is right that the analogy to this discussion if you looked at the past, i think the evidence at the time suggested those plans were able to have lower cost and perform well on the stalt of the art quality measures at the time. The key phrase is at the time. The measures were not that good. The thing there is the narrowing of the networks. Not the defining feature. The narrowing of the Network Enabled them to do other things within the organizations. It will be a mistake given where we are in the process now to try to generalize about these plans. I ensure there will be exceptional ones that will provide low cost and high quality care. I am also sure there will be some that wont be as good. The challenge here is to try to set up a system that both identifies, informs, and monitors those that are falling on the part of the spectrum that we dont like. I think its going to be very challenging to try to generalize about anything about what these types of networks do. They will be local abilities to manage them well and they will have a series of other tools layers on top that will vary. You are not talking about just the network. There is a bunch of other things that occur related to the managing of the care and a bunch of other things that define the outcomes that you want. We will have to live with that and decide the extent to which we trust consumers to choose among est them and respect their choices versus limit their choices for various reasons. Okay. We are going to open up for a q ask and a. I want to remind those who are listening on the phone line or watching on cspan 2, email questions to questions all health. Org or tweet network adequacy. I want to remind everyone that we have two on the ground experts with us. We have diane holder. She is with the university of Pittsburgh Medical Center and can give us an on the ground perspective as well as alina pabin in michigan. We have on the ground expert who is will be joining in the conversation and you can direct your questions to anybody on the panel or just to the panel in general. When you ask your question, please identify yourself. I think the point is well taken with a difference depending on where they choose to go. Cutting off access to facilities is not going to work well with a consumer. If you have that treatment, it might prevent more treatment down the road. One of the things at the heart of the debate is what was adequate and you look the the outcomes and you want clinical outcomes that are an improvement in many regions and across the country. We suffer from deficits and the struggle gets to the heart of what michael said. How they get the right cost and quality. Certain minimal Access Points and it has to be balanced with both provider and insurance competition. I would add and so first let me say as i mentioned, my mother had a lymphoma and she was treated in pittsburgh and cancer is one of the most complicated areas because of this notion that you are not going to know beforehand where you go for the cancer care. When choosing a plan its unrealistic to have the Cancer Center they want. That may vary by the type of cancer. I am very, very wary of a situation in which we forced organizations to include particular providers in them because of what that would do for prices. I think and i might be wrong about this, i think that would be on the road towards some type of price regulation. To be in network is fine, but now we have to say what price you would charge. The concern is if we think there becomes a monopoly type provider. We have to think of a way to deal with that beyond a rule which is every network has to include this particular provider or type of provider. In areas that are big enough where they are competing, we might have a different approach in a place where we have different providers and all of the Network Development with regulation to make sure they have access to good cancer care and in a way that doesnt give a blank check to the organizations to say now you can charge whatever you want and do whatever you want. It is the case that they may in fact save money to make Treatment Choices and has yet to be shown that they do for a variety of reasons. Thats an academic discussion. I wanted to make the point that in and around the work we are doing, in and around the model, to michaels point, when a situation does arise where you havent decided where you want to go if something bad happens, there are formal and informal processes and i can think of one in particular where there was an informal process and they said i need to go where i can get the treatment and i need a way to get there. The long and the short of it, we made it happen and that person is alive today because of that. Thats the role of the regulator. When those situations come up. In terms of rewriting of the model, that will be filing quick appeals for emergencies and specialized care. Through formal or informal means. Consumers when faced with the challenges have an avenue to purr pursue. This seems like something they havent had in a long time to compel the hospitals in particular to do more and align their prices in response. We get a lot of hospitals who care about the Thread Counts for their bedsheets and you dont see anything reflected that gives them the ability to say wait a minute. If you want that, you can buy it. That doesnt include the fourstar hotel importance. People thought they would and to the earlier point, they voted with their feed not to. We can debate what they were over, the copanelists can demand on it and separate out the threat count from the cancer care. And i dont mean to say that, but it is a question about whether you want them to make those choices. We were having the discussions on how we create markets that work where information is not perfect and we wear about the out comes in a way that we dont for a bunch of other things. If you buy a third rate cell phone, im sorry. But bad health care, i feel differently about that. We will see and should allow consumers to make choices to get access to different facilities in the breath of their network. We have to have a lower bound and regulate the processes about that for information choice and the processes that were discussed. You mentioned that your issue is dallas is an ideal place to have these systems. There can be good competition. Some parts of the country it is one hospital. There is not the same leverage to drive price and quality. Its again another issue which you see on the pages of the press that is not connected is issues of antitrust. In combination will be aspects of consolidation. We have another briefing of how we want to allow integration. On the other hand we want competition amongst providers. Many i think are in the forefront of the minds of policy makers are overlapping. One of the themes is the extent to which we can end up with a system or competition works between assurers and providers to put that to the competition. This is where they had cms this year decided for 2015 it was going to put in place more strict Network Standards for those offered on the market places. They said they may look at time and distance requirements. What do you think about recognizing state by state differences . I love my friend, but im very leery and weary and concerned if the folks come up with a floor. I have regulators who would like a floor, but given the diversity of market places throughout the country, what i dont want to have is an extra or heavy push by the federal government to get into the business of something that states do very well. They know the market places and the distances. We do a good job. What we dont want to have is friends around here to put something in place. They are already working well. And better manage because we are right there. I would like to ask if the other panelists want to weigh in on the more or less work and what is going to happen with the federal government moving forward on some aspect. A quick comment, i think i agree with what ted is saying and we want the ability to do that and we certainly have cases where we dont have Network Providers and geographies because a Doctors Office doesnt exist in that area. It becomes complex for patient who is live in rural areas and where they access care and how expensive it is. As a plan, there is a way to develop measures and programs where you have a team between and those parts in the state. From my perspective we agree with the flexibility in allowing states to do that work. That was the qualitative standard and not a quantitative force. Thats important, but having said that, there wrinkles with a lot more low income and people coming into the market place. There is a second part of network adequacy, the essential Community Providers who serve that population. We did start with quantitative regulations and 20 of the Community Providers to make sure that the provider who is have the populations would be represent represented. I would be wary of where that goes. A question for mr. Nichol. Have the Medicare Advantage standards created five Different Levels based on the diversity of a community total population and density. Have those failed and recognized diversity among the states . Thats not a question i am well versed on. I have not seen much in terms of diversity, but i would have to get back to you on. Do you have something to mention before . To import them directly and the principals that are there. There those and the Medicare Advantage standards. I certainly will be skeptical of doing that at this point. That is where the rubber will meet the road. The Medicare Advantage example has one distinction, the existence of medicare. You have this market backdrop in the Medicare Advantage world and most people do. I opt to stay in the Medicare Program where as in the exchanges, you dont have the plan that you can pick. We are worried in the exchange population. If there is a market place where there is not a choice you would want. In the Medicare Advantage situation, medicare relieves a lot of pressure on the regulation of Medicare Advantage plans. Related to this loosely, they have recently come out with an accreditation of plans. How is that going to work . Is that going to work well . How does it fit in with what the other parties are doing . Its welcome in terms of what can be helpful and a love of the regulations and once the regulation is having the experience and trying something that worked on doing that. That was not my experience and looking at Different Things through and approaching the software and the regulations that are to be commended. I dont know a lot about those standards, but they look to me when i skim through them to be more processoriented and making insurers working the process of asking the right questions and having the answers on them. The strict bolt you wittom line which i think is good. I think you need to interpret the activity as a subset to inform people and provide information about the type of plans. The enormous venture and the range that is trying to inform people about the different plans and the different providers within the plans and when they are choosing a plan and when they are choosing a physician. You will see an amount of Venture Capital and private efforts to improve the way the marks work. We are at the very beginning of understanding how well all of those new tools that take advantage of data and sciences. We dont know how well we can translate the knowledge into the consumers many more important and how well they will be able to process the information and how that works through in the markets. You will see a lot of stuff being done by different organizations to help improve the markets. When people make comments, i cant handle that and how will i handle more. They are thes that create algo rhythms. They end up trusting and not the ones that say let me look through the data. They get on the thousands of pages of data. Most people will stay right on the surface page and say will you give me a recommendation based on the recommendation. I will start typing and you give me a match of a health plan and i say no, i will give you more information. The process and within a minute or two. They are running all of the data. Its not going to be the consumer looking at the data. Its going to be the intermediaries figuring out how to process it. And whoever gets the result like that, thats exactly how they are thinking about this. The one thing that they slip by is the new information that is personal. Its not which plan is better, but better for me. That requires information that is not just spitting stuff out, but combining it in ways that would be useful to individuals and again, because it involves information and all information agrigation requires value judgments to do that, it remains to be seen. That is the vision they would have. Joyce friedman. With apologies. I will ask a providerrelated question. There have been reports about providers not finding out which networks they are in or thinking they were in one network and finding out otherwise for mr. Nichol and anybody else, i was wondering if there were efforts being made in the model regs to make sure providers are adequately informed. Your question is more about providers not being informed than consumers figuring out that the provider is not there. Is that your i dont know that the model will spend a lot of time on that. Its more going to be looking at it from the perspective with insurance regulators and looking more from regulating insurers and making sure that they have plans that they file with us are adequate and we are looking at it from that perspective reaching out and saying you may think you are in this one, but you are not. Thats a step where its just not going to be in our wheel house to be going that far. In any of the comments you received from providers, did you hear about this . Was this something they were talking about . Thats not one that i have seen. The first thing i will double check on it. When i said what i said about the providers, i didnt mean to imply i am being unfair. I said i do believe the system needs to be fair. Not the least of which is fair, but also one way in which consumers do get a lot of information is from the providers. If they are not well informed from the networks and whats going on f they cant figure out what others are in the network, its hard for them to make referrals in a way that you would want. Its important for the well functioning of the market for providers to be informed. Apart from the most important part of the care, its important to have the information flow here. Just as consumers need to know which hospitals are in the network, the providers need to know. You have to work through the issues. There real issues that i do believe require important attention. Whey meant to imply, before the end of the day, we care about those at least largely. How the patients get treated will depend on if they are being treated fairly. In and of itself, a provider being in versus out of the network is not the ultimate goal. They will take heed. The Customer Service around those issues and the health care issues. One of the reasons is the employerbased system where everyone knows and im not making the choice and its not even accountability. One of the dimensions within the exchanges, i believe increasingly in the market through private exchanges, when they are responding to the retail level to sell the product rather than the employer on the wholesale level and Customer Service and all the issues are going to get much, much better. There is no other system in which the supply chain and the doctors and all of us that are part of the system have as many conflicts with the ultimate payer in the system. They are grown up in a way that is not customer friendly. As we move to a retailbased system, they will be the ones who treat the individual right. Diane . I think if you look at what makes health care potentially work better, its the ability for all the components to be informed and understand whats happening. If you say who are the important parts and in that system, that transparency and the provider has to be well informed and have to understand not just networks, but they are now increasing and the average patient is going to the average doctor saying what do doi with this coexperience. What should i do . Who is the better doctor for me to see . Patients have trusted doctors more than anything when it comes to health care. They make sure the provider systems are laz inform as they can be. How are we providing cost and quality . If you are my patient and im referring you the best place, what Systems Practice with the use of resources and things like that. At a plan level, thats difficult to measure. How do you define parameters and whats the best network in your specific area. Does it give you access to the care that the patient would need. How does it get consumed . We found that pcps are interested in their own performance. What about the plan back with the provider to make improvements. Its coming imminently. This is a question for the professor. When you say we should be fair to the providers, we should shield them from economic distress and thats what you mean, why is that a good idea . I do not mean we should shield them from economics. I do think there limits as to the amount of fiscal pressure we want in general because they need to be solvent, but as a general rule we do not need to protect them from fiscal distress. Much is about how we instill competition which in general is probably broadly speaking a good idea. You should be transparent in your dealings with them. You should not say you are in the network and it turns out you were in the network under those conditions or hold them to standards that they simply cant meet in a variety of ways. I believe in the market place being fair to providers will also be a Winning Strategy because at the end of the day, i believe the provider system and the hospitals and physicians are the place in which consumers experience the health care system. They need to function in a reasonable way. I think pressure is something that these networks will generate and create a distress on providers. I am not opposed to that, but stories you hear about people believing they were in contracts and then not. People being told one thing and then not. Broad ynl contract law feelings with folks. I think those things are important. Thats what i meant about being fair to providers. They need to know and those conditions should be upheld. I am flexible about what the criteria should be. But once they are set, they know what the contract is. Thats what i meant by being fair. What i said before, the goal is not to be fair to providers. What i meant is providers shouldnt have a foegz for the price of services are. I do believe there will be competition and lead to lower prices and thats probably a good thing . We have been talking about their providers and what they are in and not in. Who is in. What about the consumers. A recent report from the recent mckinley report based on an april Consumer Survey indicated that 26 of respondents indicated that they had enrolled in an aca plan and unaware of the network type they selected. There were questions about do consumers know what they are signing up for when they are signing up for it and two, once they are in, are they getting the right information and updated information about who is in and who they should see . Transparency and this is a broad question. Can we talk about the consumer end . It is a broad question. Michael put his finger on it earlier when he was talking about the decision at the point where you assume they will stay healthy and tend to buy down on the product. Thats what they do generally and have a different attitude if they do get sick. The people who are most cynical about whether there is going to be a change in networks or respond the same way to this over the next couple of years as they did in the 90s say that all we have seen is what people do in purchasing. I demand x and we will have the same thing as earlier. Again, its hard to educate people at the front end. Two things. One is transparency. You have to have as much as possible. You need these smokers in my view to make it work. You have to understand the detail. They help people sort things out and put it in certain terms. A lot will be run through the system and see how it will be in a world where we will have another thing. People will choose these things on the front end. We dont know as much about what happens when the rubber meets the road. We havent in wisconsin seen an up tick in complaints. I thought i had the that. This is new to many folks. This is the first time there has been a mandate to Purchase Health insurance. I think there is probably a certain percentage and i dont know if its a quarter like a result and the data indicates. They bought something and went through an agent or a navigator and somewhere and researched that Health Insurance and hoping that they got what they needed. They knew they had to have something. There might be some of that there. You had all the problems. Open enrollment that lasted forever. After a year of consumers purchasing Health Insurance through an exchange, they start Getting Better about it and asking questions. Maybe they start hearing it. They need to understand what benefits are available through that policy and how is it going to be . Im optimistic that consumers will be more informed as they play a greater role in the decisions and move forward. I agree completely with that and even in that optimistic view, there will be a subset of people that are not going to be able to make good choices. That has been true in every walk of life and every dimension. Its true in my family. I think part of the challenge for ted in the regulations is to try to figure out how we witness whey think is an obvious good which is having consumers to be engaged and make choices with protection against the at the times of protections. How do we manage a system in which we try to minimize the chance that someone ends up in a really bad situation. I think the other fall back processes to make sure that the one of the case is not unacceptable. They are watt you will have to deal with this. How 10 were making bad choices. Its not going to be that most of the people are able to make the Perfect Choice for anything. We have to minimize the downside if they dont make the choices they want to live with. That gives them an opportunity to learn and change overtime. Do that in a way that doesnt prevent the other reforms we care about to manage the system in terms of quality and affordability. I think consumers will have to learn to take more responsibility and even though thats easy to say when im sitting in front of you all, many of them will not. You a fan of the theory and that sort of thing . Absolutely. There is an enormous amount of work to make better choices. Some of that involves more intervention in the market and framing. I am an economist and believe in markets in a variety of ways, but particularly in health care there is a lot of limitations and a lot that can be learned in the new way in which you structure the choice. There is a lot of places where we can help people make choices while still giving them the opportunity if they want to do something different. A lot of evidence that markets dont work as well as say econ 101 would predict. The econ 101 and 102 models are sophisticated. With this understanding of econ 101, i think that will give us an out come that will have more people in situations they dont like than i would be comfortable with. I dont want to change this into a broad discussion, but i want to remind you and folks that then you have more of a catastrophic plan. That idea put consumers in charge and made better choices and caused them to be more curious about where the money was going. It was ultimately the first dollar out of their pocket. Lets not forget that that is out there as well. I agree that there is a percentage that is just not going have that available to them. Thats as much transparency and communication to help people make the decisions. Not just in your state, but how much are they stepping in. So far we have anecdotal communication, but can you give us a sense as to how many of your colleagues and other states are already being active here . Thats classified. We only talk about that in closed sessions. Im sure joel remember this is in his time in oregon. Commissioners and regulators in general care about their markets. When they see disturbances and disruptions and see things they have the authority to step in and do something about that, they will. In this very issue of networks and network adequacy, particularly and its not solely, but particularly in the more rural states, all of the rectangular states. There serious distances between you and anything. You go 60 miles to get a loaf of brd or a bag of flour to make the bread. Commissioners will have conversations saying look, this is unreasonable. Lets work through these things. Whether its that or an urban situation, very often they will be talking through the lieutenants to work them out and get the disruptions taken care of. Generally its very high up on many lists, but from day to day over the years, its something that they deal with regularly. I would say if you want to look at states where see more aggressive action on behalf of the commissioners, look at the west coast states. Washington, the commissioner struck out three or four Medicaid Programs because they were too narrow in networks. There was outcry from other people in that state. E eventually those plans got in. They had to figure out new regulations this year. The first set were rejected by all parties. Eventually he settled on a transparency strategy. Still not popular. Too much reporting now and consumers dont think theres enough, but thats where he settled out. In oregon, they are talking seriously about taking the Medicare Advantage standards in that state and theres an outcry from the insurers. And then california, you have the exchange and david jones and care regulated by a keizer guy. All of whom who have some stake in this. Those are places if you wanted to look at where some of the those are all people active in teds committee i think. Thats the other side to the prairie states where some of the same concepts are not very well received. States are doing a lot more besides just this thing. And i think one of the issues is to make sure that the strategy related to the topic were talking about today fits into the broader tragedy in the states and that varies across the states. So lets go ahead and wrap up. Im going to give each of you a 30 seconds to tell us, you have a bunch of reporters here in the room. Whats the one thing, the biggest thing you think they ought to be looking for. It can be what you hope is going to happen or youre worried about happening. Whats the one thing you think everybody in this room should keep their eye on moving forward. I think we should be clear when we differentiate value versus the other terminology. Can you pull the microphone up. We have to differentiate value and should not stand in the way or create unnecessary burdens from a regulatory point of view that gets in the way of progress and innovation. My two things, 15 seconds each, remember the tradeoffs dont get stuck on one aspect of the story and not the others. Its very easy to do. And understand that anecdotes wont prove the rule. Theres going to be bad things that would happen no matter what and finding anecdotes where it doesnt mean the system needs complete redesign. Ill just second what you said. Again, this is a hugely important issue. Its accelerating at a rate that we didnt anticipate. And thus the working group that we work on on this very issue is taking comments and considerations and letters from all parties to better address and move forward with the better model for states to adopt and implement. The issues are complex. There are tradeoffs. So its an area where i hope we let the states be the laboratories of democracy and experiment. One of the issues i would encourage the media to go into is look at the different states and what they are doing. I would just be wary of a premature kind of federal intervention that would limit the kind of experimentation we need to have on these issues. From my perspective, i think that find iing ways to report o quality and cost across the spectrum are going to be key. That means consumers and patients or physicians, so that both sides have access to the information they need. Great. This it con sclooucludes our se. Thanks to the reporters for joining us today. At the u. S. Capitol today, both the house and senate in for legislative business. The house coming back in in a few minutes at 4 00 eastern time working on more than a dozen bills today including one with steroid trafficking. The senate is in with speeches on isis and president obamas strategy earlier working also today on a pay equity bill. You can watch the senate live on cspan 2. And the House Rules Committee scheduled to meet for consideration of shortterm federal spending. Well have live coverage of that meeting. Thats scheduled for after the last vote in the house today. Also live. You can watch it streaming on cspan. Org. This week officials from the Obama Administration will testify on capitol hill before several committees to make the case for arming moderate rebels in syria. Defense secretary chuck hagel and general Martin Dempsey will be appearing before the Senate Armed Services committee. Well have live coverage tomorrow at 9 30 a. M. Eastern on cspan 3 and also tomorrow a hearing on the Ebola Outbreak in west africa and the International Response with witnesses including the head of the National Institute of allergy and Infectious Diseases and Health Workers who treat ed people infected with the virus. You can watch that joint hearing of the Senate HealthCommittee Live tomorrow at 2 30. Tonight on the communicators, California Democratic representative anna eshoo on communications and it Technology Talks about Net Neutrality and rules governing the internet. I spoke publicly about what i thought the fcc should do to be on firmer legal ground and point it to title two. And now we have had fast forward, we have had discussions at the committee about it. This is all about Net Neutrality, obviously. People in our country feel very, very strongly about the internet. Not only how they use it, but how they think about it and the access to it and that it be free and that it be open and that no one no isp or anyone should be able to interfere with that. Tonight at 8 00 eastern on the communicators on cspan 2. With live coverage of the u. S. House on cspan and the senate on cspan 2, here on cspan 3 we compliment that coverage by showing the most relevant congressional hearings and Public Affairs events. Then on weekends cspan 3 is home to American History tv with programs that tell our nations story including the civil wars 150th anniversary, american artifacts, touring museums to discover what ar if i ty facts reveal about the past, history book shelf with the best known history writers, the presidency looking at the policies of the commanders in chief, lectures in history with top College Professor ving into the past and real america featuring educational films from the 1930s through the 70s. Cspan 3 create d by the cable v industry and funded by your local cable or satellite provider. Watch us in hd, like us on facebook and follow us on twitter. Next some of the challenges facing iraq from a discussion hosted by the Wilson Center including the formation of iraqs government, the pressures facing kurds and the strength of isis. This is two hours. Good afternoon. I direct the Global Europe Program here at the Wilson Center and im delighted to welcome you all to this event on turkey, iraq and Kurdistan Regional government. For those of you who are not familiar with the Wilson Center, we have an overflow crowd of some 300 folks joining us today and overflow rooms as well. And also those of you who are watching us on cspan today, the Wilson Center chartered by congress as the official memorial to president Woodrow Wilson is the nations key Nonpartisan Forum for tackling global issues through independent research and open dialogue to inform actionable ideas for congress and the broader policy community. Certainly we will deal with one of those critical challenges for the u. S. , for the world today, the future of iraq, which has been put to the front lines and center stage with the recent surge of isis. Iraq is threatened by a new wave of violence and destruction, theres a large swath of that territory has turned into a conflict zone and uprising has shaken the political order. The Kurdistan Regional government initially managed to keep the conflict at bay in the territories it controls in northern iraq, but the recent isis advances into the region have also underscored the security environment in the country to which the krg is exposed. The developments also highlighted the delicate positions of ethnic and religious groups. Most notably christians. Thats what were going to focus on today. We have an Exceptional Panel of experts to address the future of iraq and the krg and the context of the Current Crisis and look at turkeys perspectives on krg energy issues, minorities and iraq in general. Let me thank our panelists for joining us here today. They will be introduced in a moment. A special thanks to our global fellow, a fellow with the Europe Program here, a senior scholar at the policy center and a professor at the university and a senior academic adviser to foreign minister. He has been the brain behind this event and we are extremely proud and pleased and thankful to have had him with us for the past few months. In fact, to have him with us at the Wilson Center on a regular basis and helping to strengthen our programming on turkey. The discussion will be moderated by professor, he completed his ph. D. At the taught at a number of distinguished universities, hes published extensively on relations. The issues and problems of politics and the countries, essential asian policies, politics and different issues and there are discipline. One of the books democracy in turkey, the impact of political conditionality was published in 2011. Let me also say that this event is coorganize d with the cente of strategic studies and our Sister Program here at the Wilson Program who is all the way in the back there. Before i turn the session over to our moderator, who in turn will provide introductions to the speakers, let me also thank my staff, in particular emily bus, who has been very helpful in bringing this event getting the logistics argued behind this large event. With that thank you very much. Good afternoon, ladies and gentlemen. Today one of the hot topics in International Politics we will discuss here, we will discuss the recent development in the triangle of turkey, iraq and kurdistan government. Today we are well distinguished speakers thats introduced here, but before giving the floor to the speakers, id like to raise some issues related to the topic today. Although official here is turkey, Kurdistan Regional government, we have to add syria. Basically because from the chemical attack in damascus, the problem has become part of regional struggle. Therefore, to combine both iraq and syria in a common conception chul framework today. Regarding the problem things should be discussed here in depth but they have come to the floor when the Islamic State has started to take over some in iraq and start to o threaten the region. The u. S. Has carried out more than 90 airstrikes against Islamic State. It seems that currently the u. S. Pushback the isis and of the bigger the question here is that whether the i. S. Has been containment. The answer is obviously not yet. Its gripped northern and eastern syria. Striking isis in iraq but not in se syria. From my perspective, the problems in iraq are more than brutality and linked to syria. For example, seems accepting this fact. The failure o of the credible fighting rebels left a big vacuum, which they have filled. This is what turkey has seen for the last few years actually. As you know, turkey has been left alone by the western states. Assad has happy to let it hurt moderate rebels in syria. I would like to rise here before giving to floor to the speakers is about the humanitarian disaster in iraq. Basically the brutality against american journalist james foley and the unacceptable disasters in iraq has a lot of people in america in part of the world. It has to do everything to stop this barbaric atrocities. But you have to realize that other local people too are under attack. Under the great threat of massacre by isis. On saturday, two days ago, they call called for emergence act to prevent a possible massacre. Which has been under siege by isis. With they are quite different from the peshmergas because they have wellequipped armed forces. Before giving the floor to the speakers, i would like to express my gratitude to the organizers of this very important meeting. Thank you very much. And im going to give the floor to the chairperson of middle east research and hes going to discuss basically the formation in iraq and iraqi crisis. The floor is yours. Thank you. Thank you very much. I want to thank the organizers and the institution for having us here and for creating this opportunity to update you all on the latest. Theres so much going on that life is never boring in iraq. Obviously, excitement of a different kind. There are many hot topics that have occupied various peoples minds, especially in the international community. This it may in. Collude the war against terror, the formation of government, the military airstrikes, and also possible u. S. Administrations change of policy in the region which may include going into se syria. But to ask iraqis, actually they are busy dealing with a series of neverending crises. Only one of which is the war against isis. And the least of which is the formation of government. They face crisis in the presence of a failed political process in baghdad. And a nonfunctioning state that is now divided and its on the brink of dissent grags. So update you on a whole range of issues, i think im going to leave a lot to the question and answer session, but maybe i should start by giving you the latest on the formation of government as you suggested. And then branch out from there. He was nominated by the president to form the next cabinet. He has until the 10th of september to win everybodys trust to sign all sorts of agreements with sunnis, fellow shias and kurds before going to the parliament and win the vote of confidence. Nothing is easy in iraq and this process will be a protracted one. Its by no means certain or guaranteed that e he will be able to meet the deadline. Theres obviously pressure from the United States and iran for obvious reasons that to form his government well before the deadline and to say the least, this will help remove probably by far the biggest obstacle for progress, and that is namely, mr. Maliki thims. This is at least in the view of the u. S. Administration, as you all know. In fact, the u. S. Administration has made it very explicit that any future military support is conditional on the removal of mr. Maliki. And in fact the kurds and many sunnis have made it conditional for their collaboration and efforts to on the removal of mr. Maliki. So Everybody Knows that. Mr. A baa day is in a hurry to form the government and hasnt been resting for the last week or ten days. Hes been working 24 7 around the clock trying to negotiate with everybody. Its really a difficult task for him. And he promised to form the government as soon as possible. He gave 72 hours to various plit u call leaders to nominate their ministe ministers, so his deadline is tomorrow. For him and for iraq as well as the international community, failure is not an option. It will be disastrous on stake holders and then again, failure is a real possibility. There are those who are working on making it fail. There are those who are actually making it difficult for him to Progress Given the type of conditions and preconditions that they put forward. But so far the negotiations have been going relatively well. And only yesterday the kurdish delegation finished their first round meeting with mr. A baa day and went back to meet the kurdish leaders and held a press conference saying that theres room for optimism, but we are not overoptimistic about the chances of him meeting all our conditions. So he has not had the chance to go down to the nittygritties and has been busy trying to bring the ceilings of the conditions down from everybody. The government is meant to be one of a national unity, mr. Abadi will need to bring irreconcilable interests together, basically, and satisfy everybody, which is an impossible. Task. And mr. Abadis brothers and sisters within the state of law as well as within the house of shia would be asked for the share of possessions as well as authority or there are by no means united, they are by no means easy or make it easy for mr. Abadi. And of course, mr. Abadis challenge is to bring the sunnis on board as well. So you would think that given that the sunnis are in the poorest state and they are power based have been occupied by isis and they are in desperate need of help, youd think they would be the weakest partners. But actually thats not correct because their hand is now stronger than ever. Everybody now strongly believes that defeating isis in iraq and liberating the major towns and cities of the sunni triangle will require active engagement of the sunnis on the ground. Everybody insists that the sunni political and tribal leaders must be embraced, rehabilitated and supported financially and militarily and this is where they may turn a a corner. So the sunnis on the other hand themselves would probably no longer accept sectarian rule by a shia majority. The kurds, on the other hand, have lost faith in iraq. They wish they did not have to go back to baghdad. But they are doing so out of necessity and out of lack of choice. The kurds could not comprehend how a Central Government could starve people in peshmerga from funds at the time of war against terror. How it can deny humanitarian and military help from arriving in kurdistan via the air when people are being slaughtered and religious minorities facing genocide and increasing number of displaced people with basic needs. Thats the refugees displaced from parts of iraq. In fact, only yesterday they decided to give salaries to people from mosul, but only those in baghdad now, he did not include the hundreds of thousands of those who are now in kurdistan region. So had it not been for the u. S. Airstrikes and international help, it would have been extremely difficult for the krg to stop isis and make progress as well as helping the internally displaced people who are now well over 600,000. In fact, if you include those from elsewhere, it includes 850,000 people. So imagine kurdistan being just under 5 million so the population of kurdistan suddenly increased by 15 while not having funds to pay their peoples salaries and while they are still withholding the budget. So in any case, the kurdish leaders have come around and have begun investing seriously in baghdads political process. They now have a president who was instrumental in stopping maliki from extending into a third time term. They are engaged in negotiations, but they have a long list of demands and preconditions for mr. Abadi. Some of which might be beyond his powers. They want gauarantees that they want guarantees not just from himself but from the house of shias as well as iran and u. S. And others who are putting pressure on them to come forward. They want guarantees that the next Prime Minister will not be like mr. Maliki. He would not be in a position to use the budget and peoples salary as a Political Tool to punish rivals. He should not be in a position to repeat policies on oil and gas and genuinely try to find Middle Grounds and arrangements. So the kurds want to make sure that really future Prime Ministers are not selective in the implementation of the constitution articles. Specifically to deal with article 140 with sin scerity. This is an article that relates to the disputed territories, which are now under kurdish control. After the withdrawal of the demoralized army of iraq in june. So in short, the kurds want greater sovereignty essentially within the boundaries of iraq. They want to retain decisionmaking powers over the economy, air space, International Relations as well as security. Otherwise, they see no reason to really reconstruct iraq for them to remain vulnerable. Kurdish politicians are under increasing pressure and demand from their own people to go independent and the increasing number of political leaders are becoming convinced that their future is not in an iraq that remains highly centralized and grossly dysfunctional. And finally, a few words about the isis. I dont need to tell you what isis has done and what its capable of. However, i would like to emphasize thattist cyst a real extent shl threat to us all, a real threat to the entire humanity and international community. Isis managed to grow and undermine two sovereign countries and now deeply entrenched in highly populated oil rich provinces, defeating isis will not be easy or quick. It requires a longterm strategy and international collaborations. It needs radical rethinking of methods and alliances. If the krg u. S. Clollaboration was a model to go by, then i suggest that u. S. Airstrikes a similar model needs to be adopted in iraq and syria. And. By that, i meant striking from above and then having on the ground their own people pushing isis out. So most importantly, as a final point, its not just United States and iraqis. Its the regional powers that need to change strategies, rethink their approach to iraq and the middle east. Iran, turkey, saudi arabia, the gulf countries, everybody who has a stake in the region, who has a say in the region, who have so far influenced iraq and events in those countries need to rethink before we even talk about winning against isis. Thank you very much. Thank you very much. So our next speaker is a professor of Political Science in the top university. Professor will take l the question of the perspective from turkey. So the floor is yours. Thank you, mr. President. I would like to discuss the Turkish Perceptions in iraq, but i also would like to first put it into the historical background a little bit without any long introduction. I remember last year we held another event here from turkey and the middle east and we were discussing a different context. I attended different meetings in d. C. The questions of turkeys relationship with iraq were completely different and today we are living in a new reality. In that sense, i u see major changes. This is agent the background to the transformation of turkeys policy on iraq and how it affected turkey as relationship with other actors including the United States. For some time before the recent crisis in iraq that started in june, turkey has been because of iraq policy and criticism was lar largely part of the broader criticism toward turkeys middle eastern policies and they have moved away from a Problem Solver in the region to becoming partly part of the problems. And then in that sense, we saw a lot of criticisms towards interacting with iraq and especially the Prime Minister maliki. And according to many, it was on the verge and based policy on the criticism of maliki and most of the critics pointed to two different trends in turkeys iraq policies first. Turkeys to defend the rights of the sunni groups and into the system and secondly turkeys relationship with the krg was another source of criticism. Turkey was looking at this relationship with the krg starting from 20072008 and that became essential in the middle eastern policies of turkey. It took another dimension which is a partnership in turkey and the kr grg. They moved in the direction of facilitating the export of the Oil Production to the turkish territory to International Markets and with these policies first, turkey was pursuing a sectarian agenda in the case of iraq and also in the border of middle eastern policies and turkey was undermining the stability and the territorial integrity of iraq. In general also contributing to broader instability in the region. The arguments that we heard from the turkish officials for the following and turkey always argue argued that it valued territorial integrity of iraq for its own National Security and Foreign Policy objectives. But turkey also underlined that for that e we needed to see the nation building process in the country. And this required careful interpretation of the issue of power sharing and this issue of revenue sharing and the policies of maliki in the second term. They are not helpful in that regard. Grounded in his ability to hand until a delicate manner the fragile structure of iraq. We have seen turkey on several occasions criticizing maliki and we even saw global exchanges between the turkish u Prime Minister trying to respond who follow a number of those occasions. But interestingly today, we have come to the table is upside down. Most of the International Actors including the american policymakers that used to criticize turkey are on the same page. We see the realignment of the positions and reinterpretation of the positions. Here we see the effect of the events of the last two months, three months, the advance of isis in mosul and also afterwards. And also we see the turkish policy about iraqi politics in the wake of the parliamentary elections earlier this year in april. Turkey has been advocating a policy that was in line with its previous policy of criticizing the way maliki has run the country and arguing for an alternative National Government rather than the majority government that the shiite groups including maliki were trying to establish in the new government. But the events of june and its afterwards of politics on a different page, as i said, but they also did undermine in some mistakes and they also strengthened in other respects turkeys policy on iraq, which i will discuss in the rest of my presentation. As i said, events since june have strengthened turkeyss position because they proved the value of turkeys previous position of criticizing the way iraq used to be governed. Also the american policy of ignoring warnings coming from turkey, coming from the kurds early on and also actors in the region. A long time not paying attention to the criticisms of malikis policies. We see some advantages of turkey from the recent crisis. Bu but especially in mosul and it also put turkish policy on a different delicate page. So in that sense, turkey has to tread very carefully they are doing on the ground. It has to do it behind the scenes without publicizing some of the moves in iraq. And in terms of the relationship with the kurds. Also the new in iraq led to new realignment on the ground. The actors are popping up and certain actors are vetoed such as kkk in the fight against isis and the advance into the krgcontrolled areas. Also the growing interest of the western actors including the United States into iraq. Could you speak into the microphone a little bit. The military operations in iraq to provide military assistance to krg. This is changing the parliament of krg, the integrity of iraq and this is also pushing turkey to rethink about policy which has defended so far. And since june have also created new humanitarian and security challenges for turkey. Turkey has been struggling with the flow from syria. A new wave of refugee flows from iraq in terms of the groups, but also inside iraq in the krgcontrolled areas providing immense amount of humanitarian assistance. These are new challenges about the security. Threats come with the humanitarian challenges. And then we see that turkey is also trying to play a role behind t saenhe scenes in baghd about what has been going on. Although it was not publicized much, i personally have been trying to argue in a recent piece i wrote that turkey played a very crucial role in the government process. Those who follow iraq sort of still mate in the process with the convention of the new parliament with the election of the new speaker of the parliament. They prefer so to speak a package deal. The process was not moving forward. It came up with the idea of moving step by step and i have seen a Turkish Foreign minister speaking to especially the sunni leaders speaker of the parliament, former speaker of the parliament to convince him for the process of selection of the new speaker of the parliament and also elect the new president and also in the phase of government formation. So this was an essential contribution in terms of untuing the knot in baghdad policies. In order to achieve the territory u integrity of iraq, the solution has to come from the political processes. Theres an urgent security challenge because of the rise of isis. The advance of isis at the end of the day is based on some social political realities. It should not ruse to a security challenge. It should be understood within the broader social political die mentions for which the political processes in baghdad to continue and also think about base for national con citylation in the next stage. In that sense, the new government has to be based on power sharing, revenue sharing and also somehow interpretation of the issue of federalism in which we can discuss. I see turkey welcoming the new Prime Minister designate. He has a good chance to build coalitions, but turkey sees that it will be a lot of challenges before he has to build a coalition he hasnt managed to have food control 37 he has to talk to sunni groups and we see a major risk in iraq. They have been increasing in a unified leadership to represent although they have different channels to talk to the sunni leadership. Turkey sees that it is really difficult to identify the leaders. This is important. Again, the negotiations between the kurdish leadership and mr. Aba abadi are ongoing. This is part of the process that turkey supports. In the shortterm, another challenge will be the issue of budget, which was also mentioned. All these challenges will have to be addressed while they are also fighting isis. This political transition will be a very delicate matter. In the medium to longterm, the issue will be to rethink, how to redesign the countrys political institutions. Then another major challenge is the future of the disputed territories. This will have to be tackled maybe not as part of the government formation process, but in the next steps this issue will come up. And before i a few words about the krg. As i mentioned at the beginning of my presentation, the turkish relationship has been one of the Success Stories of turkey. Turkey has transformed its own policy views of krg from adversity into an incorporated one. Now especially with the turkish policy on the oil exports from the region, you see that the pipeline that was criticized by the United States on to now has become the lifeline for the krg. This makes the autonomy possible. Before it advanced into the areas we have seen, the leadership talking about independence, but later with the recent course of events, the position has been more in favor of the determination of the Kurdish People in iraq within a unified iraq. It doesnt necessarily need to translate into independence. Turkey has been defending, but of course, well be better off. This has been more or less the main turkeys policy on the krg. Here i would like to stop and we can discuss. Thank you. May i just we have a lot of electronics in the room. If i could ask you to turn off your blackberries and cell phones, that would help with getting interference here with the microphones. So thank you for that. Thank you very much for this very comprehensive analysis of the key politics. And now we will discuss the place of the most vulnerable people. I will provide my own perspective. So i will try to provide to you a snapshot of whats going on in iraq. We have three distinguished president s and the general perspective. So my duty is to let you know whats going on in iraqi crisis situation, whatever you call. I have been a close follower in Foreign Policy since the past 20 years. Im a little bit older than actually i seem. In 1990s the issue was half of turkeys iraq policy. The other half was the kurdish fear of independence. So the whole turkish policy was limited to northern part of iraq. It was not going to forget about. But things have changed. And we had one of the wise es president s of the United States invaded iraq and e he said two things. Im going to change the regional landscape. Im not quite sure about the first one the democratization of iraq, but he changed the whole landscape. That had Immediate Impact on Foreign Policy. There was this new party government. While they found this crisis, that was the first year. So they need to change policy and they need to go beyond the northern iraq. So that meant that it lost its significance in the iraqi policy since the factor has been replaced in the new era as part of turkeys iraq policy. While also looking at the figures in iraq, in 19d 90s we have been told that there are 5 to 7 million, but in these days, we have been told that there are 700,000 to 3 million. Its a significant projected numbers gives an idea of the change of the factory in turkish Foreign Policy. While significance in the wider middle eastern perspective, nobody has talked about arab spring. But it is an ongoing process. And in this process, i recognize two important. One is empowerment of actors. And the second is sort of close porder. But this empowerment has a relationship with some military power. Of course, we all know Islamic State, but here there are some groups, minorities who has not been turned to nonstate actors. So the major difference is the absence of military strength. So one of those. So whats going to be to those kind of entities in this process of arab spring. This is another important issue and problem we need a little to think about. Lets move into iraqi context. So there are three kind of ter it toirs in iraq. The one is the krg territory area. The other is whats called the disputed territories. So part of those disputed tr toirs. So the area was under control of iraqi Central Government up on to Islamic State expansion to northern iraq. So at that time, kurds were opposing it. But now there is kurdish control. So the question here if iraq falls apart, whats going to happen . We are talking about a minority group. What comes closer to my mind is the pyd. It is the kind of diverse in northern syria, but still they have constellations that may count geographically. But it is absent in the case. So whats going to happen. They have to live with the kurds. Its not up to them to decide whether they are going to live within the kurds and the bigger iraqi state or they are going to live within the future kurdish state. To some extent. Another difference, they are middle class urban people. And they dont have a tribal organization. There are some families, but not like the kurdish presence in northern iraq. There are ideological differences. They have also been assimilated to the kurds. So the picture is not very much promising. So they are either going to live with the kurds, with lack of kurdish understanding of a guarantee guaranteed peaceful existence or another option is to live facing with Islamic State with absence of military power to defend themselves. And if we are lucky, we are going to have an Iraqi Government and then the Central Government and krg disputed territory. This is the optimist scenario. So the turkish policy is also getting complicated. Turkey and krg is becoming closer in their interdependence. But this closeness has not been reflected to krg relations. It may have an impact positive, but so far i did not recognize a positive impact. It did not lead to have some kind of selfconfidence. They are getting closer, we are going to have in a better situation. They rather blame turkey to sell to krg for oil. Turkish krg even increased the differences within the group. While turkey is in a position to help them since this has been official by policymakers and a new government promised to them to first you help yourself and then we will be able to help you. And this edition, reading between the lines, besides the addition is a kind of first constellation. But it is a kind of challenge and thing to do. Sectarian relations and all off are over there. But some kind of reconciliation is a must. What really matters to them is some cultural rights. The democracy has changed. So theyre suffering as a middle class, but now they have to deal with a new social public, and turkish immigration. So what sounds as the optimum that can provide the best to them is a kind of agreement that is going to provide them some kind of, you know, governance right, with some veto powers. That will go beyond the course of the friendship, okay, we are brothers, and these kind of things, but they need a kind of guarantee, and a sort of veto power and governor rights to feel better. And then in that case, you know, the turkish krg and Iraqi Government and turkey, they have to have constructive interaction for taking care of their future challenges. But again, you know, going back to what i started, this is a very volatile geography. Very much an Islamic State. So it is very interesting to follow them with regard to the military powers, while some other entities have been empowered enough, the actors, the kind of entities of position, and having additional suffering to the time. You know, we dont require an expert to say that things will be uglier in the future. So its just, you know, a matter of time to see whether they will have a reconciliation, a new kind of working towards a better arrangement of a future, and how turkey is going to help the external actors to facilitate this process. And how it is going to help the iraqis, as the panel talked about in this geography. I would be happy to answer your questions. This is it for now. Thank you. Thank you very much. Before asking your question, please indicate your name and your affiliation, and please, again, indicate the person, the speakers to whom you are asking your question. Microphone . Yes . Thanks. Im barbara slate from the atlantic council. Can you hear . Okay. I want to address my comments to the kurdish speaker. Can you imagine under any circumstances, that the krg will give up kirkuk . What could the baghdad government possibly promise in return . And do you anticipate that there will be i mean, how can you have any kind of referendum under the current circumstances considering the instability . Thank you. I think that i can see two or three fragments, or question within a question. From the last one. Whoever is in control, if its done properly under the kind of legislation that is recognized by a legitimate and constitution, and the question of giving up, i dont think the kurds see it as giving up. Because for them, its kind of regaining control over a territory that the kurdish authorities consider kurdistani territory, come back to the kurds, to protect the people. So lets forget about how it was regained. But i do not think that the kurdish leadership as well as people are contemplating a scenario where they would kind of with the control of the kirkuk to the iraqi army. If its not for the fact that they consider it the right to govern this area, as far as handing it back over to a government that has not yet demonstrated the ability to protect the people and provide security and rule of law, the negotiation with baghdad will be a tough one. And it will be baghdad has always seen kirkuk as the leverage that will lead to inevitable kurdish independence, if the kurds have it. But now, the negotiations with baghdad is bigger than kirkuk, because just over one city is about making iraq work. If iraq works again, the kurds will sign up, too. But the idea is that there has to be a new mechanism, a new arrangements with baghdad, whereby the status quo can be maintained amicably with guarantees from both sides. So this has to be negotiated properly. Its no good to say that in the past, the Iraqi Government used to say that the time span for the article is over, now the article is dead. In other words, dont even talk about having kirkuk. Now, with the way things happened, and the events of june 2014, the reality changed. Suddenly its baghdad that is the article that is alive, and the kurds face death. But neither would be correct constitutionally. They would have to come up with an amicable arrangement where they can actually implement all three components of article number 14 as soon as possible. Otherwise this is a stalemate that could be a recipe for disaster. Could you just remind us of what those three elements are . Oh. One is reconciliation. Ill give it a try. But there has to be the three stages of reconciliation, compensation and referendum. And then theres an element that the president has to demarcate the area, and there are some who know the three elements. It ends with the word referendum that has to be done to decide the fate. But it cannot be done until the Population Center is in place. And theres a compensation element as well. So all of these can happen under the kurdish control. It does not have to be baghdad that does that. What has changed is baghdad controlled it, and the kurds demanded it, now its the other way around. Thank you. I wanted to ask the sorry. I have two questions for saban. I know you said that turkey still prefers a unified iraq. But theres been a lot of confusion recently, because we heard from a spokesperson for the akb party that a kurdish state is no longer a cause for instability. Thats what he said in an interview with my publicatiopub. So my question is, if, like, push comes to shove, will they accept an independent kurdistan . And you mentioned something you said iraqi federalism. You said that should happen. And what do you mean exactly by that . I know the kurds are calling for a con federation, which means more power to the local authorities. And we just saw joe biden writing an article in the Washington Post mentioning a functioning federalism. And he also referred to not having National Guard for every region. Is that something turkey also wants to see, more power for local governments like the Kurdistan Regional government . Thank you. Thank you. About the first question, u actually, i was in d. C. For another conference and there was another question about him. I know what he said. It wasnt an official policy whatsoever. What he meant should be put in the context of the revolution, and the policy, visavis krg. As you recall initially, when the formation of the federal unit in the krg area started after the invasion. At that time turkey perceived it as a threat to its own National Security, its own stability. But after 2005, 2006, there was a very bitter period between turkey and krg that was critical