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tv   Key Capitol Hill Hearings  CSPAN  August 30, 2016 4:32pm-6:33pm EDT

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but if you slap price controls you've got to like the price you have because you're not going to get a new one >> let me go on the negotiation issue. we have a system in which we are negotiating prices with healthcare party and it is the federal government contracts with health plans who negotiate prices, they are the drug companies. it's relatively effective but if you replace that with a single governmental negotiator , you have to have the ability to deny access to the market. in other words, the plan that negotiates where we won't cover you if we don't get a good deal, we are not going to cover you, go to your competitor, the government cannot do that. it cannot deny access to markets but it has very few tools to work with. they're very effective getting mechanism in the veterans administration to give the contracts to one company and have a national contract that gets very good prices but you have to be
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willing to do that, medicare could never pay that's a point about the rationing, right? people go to treatment if it's protected. >> plus, if you tell the other companythey're not going to be able to market medicare and pick up the part of the market medicare has , you're going to put them out of business. >> a large share of medicare often occurs in the last months of life. since this year medicare has been paying doctors and other clinicians for advanced care planning discussions, it's a limited move and this is still a sensitive topic. we remember the whole death panel discussion of several years ago. what do you guys think the government or cms or the government more broadly can do on this issue and if you'd like to touch on it, what do you think that the rest of us , and i'm talking about physicians, clinicians, families can do on this front? we can start with you yes they are and it's been a challenging year because for
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decades it's been a taboo topic. for the discussion of death and dying with dignity and many of our physicians, especially those that were trained 20, 30 years ago and are in the middle of their career have never been trained on how to have that discussion. and yet it's critically important. as you mentioned, i think some of the estimates are 50 percent of the health care expenses are spent in the last nine months of the patient's life and oftentimes , the interventions actually expedite end-of-life instead of expanding end-of-life so from a physician's perspective, one of the new tools has been the expansion of palliative care nurses and
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physicians and integrating them into the practice of medicine and making them available as a part of the care team. >> it's hard to think of a more discouraged destructive public debate in the last few years then the term death panels because we do need to confront the way that people feel good about, not afraid of the way we are talking about with the family because oftentimes the patient, not the physicians make decisions for themselves and the family has to be invited on this and the family has to understand what the patient wants. so that's something each of us can do with our families. we shouldn't put all of it on the physician and we need to recognize the inevitability
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that we all will die but i don't think any of us want to die in a hospital hooked up to a machine. most of us would prefer to die in comfort, at home and yet that's not how we do it. the net is the exception, not the rule so there's a lot of opportunity there to do a better job for ourselves and for the people we love. >> and on your question about whether there's a legislative care, i thinkthis is a big cultural issue . they have to all become much more comfortable with this conversation. and i'm not putting it on this but if you haven't read the morally good it does bring this conversation down to the level that we feel more comfortable about it but you know, the other thing is the way we do the discussion of this in public is wrong. we should talk about the right of the patients not to have unwanted medical treatment and that's a right that every patient should have and that right should be supported by intelligent conversation with your physician about the
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trade-offs, the risks, what can be done and what can't be done. and then there should be an opportunity to make those choices and right now that doesn't happen. right now those choices are made in the medical world and infrastructure without much regard for what the patients really want to do if they had the opportunity to understand the issue. >> mark as a writer who's lived in scotland and californiaand he wrote , the scott c death is imminent, the canadian seedis inevitable. california , it is optional . and doctors are trained to fight death, it's the enemy. they're going to lose in the end they're going to fight to the end and that's where i think we have a lot of this care that's doing very little marginal value and maybe prolonging someone's life a few months, maybe even a year but i don't think we think
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about the quality of that life and i agree, i think we got something where the panel agrees on this that people need to think about what kind of care they want. i think physicians need to be very honest with people about exactly what they can and cannot do and what the treatment will and will not give the person so they can choose, do i want to undergo this treatment to plan for the end and the become with my family? >> all right. we're in agreement. you raised this already but i'm going to jump in. long-term care. probably people in this audience know this but i can tell you as a reporter talked a lot that you would be shocked about how you do. medicare doesn't cover long-term care. medicaid does if you qualify but medicare does not and
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there is a gap there that affects a lot of people. around 8 million people need long-term care in 2000, it's going to grow to around 19 million people by 2050. i will ask the panel how we should tackle this issue both at the policy level, meaning what should be happening at the federal or state or other places , the government but also do you have any thoughts for the people in this audience or for others who might be watching how to address that issue in their own families? because it is something that affects many of us. >> it is the most glaring area of exposure that we left in our healthcare system for people, for families have to bear on their own and most of the care provided in the united states is provided by family caregivers. paid care is a relatively small proportion of what's going on and we really don't tally the consequence of that but it's very substantial. i think we have to tackle it on two dimensions.
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i think one is, what i can characterized as service delivery reform. were undergoing a substantial movement in the united states in the medicaid program, we call rebalancing which is transferring the resources that are available to support people who have functional limitations but we are really talking about people who have functional limitations they need help with in the home or the community. half of these people are under 65 so it's not just seniors. when we talk about long-term care we think about older people but many of these are services that people need to be able to function day today so while medicare may be a part of their life and they may be in and out of the physicians office a couple of times over the course of the year, day today they are living with this and they need that kind of support but we have to first of all i
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think do this rebalancing and getting away from an institutional focus which we had for so long and do more to support people in their jobs and in their lives. but i think the other big piece of this is financing. we do not have a way to finance those people other than the people who become eligible for medicaid.and private long-term care insurance does not fill the gap and it can't. we have to completely rethink the way we approach this whole thing and i would say one quick thing which is i think truly integrated plans and bringing more of both long-term services to support and fully integrate health plans essentially, we offer the opportunity to manage these kinds of needs in a much more effective way and really have a big impact on health care. >> basically, when you say fully integrated health plans you mean a plan that would also include a long-term care benefit? >> yes, exactly. >> i'm trying to keep things simple. >> when it comes to long-term care i think we all think that's a state of denial.
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it's a painful subject and one that is threatening not just us as individuals but to those people we love because we could end up being the caregiver or we could have our children, our spouse give up everything else in order to care for us so it's a very tough subject and i think i agree with larry. there's some hope in terms of more integrated approaches but given how much of this is dealt with within the family, it's not a matter of the medical system, it's a matter of are we prepared when people we love need the help and i think that's a tough issue and we should set up our employment laws so people can have family leave. we can set up support in the neighborhood to give people relief from being caregivers.
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there's a lot we could do. it's not all healthcare areas, and the medical sense, it's not even all about government area . >> i would add to that that there's also the opportunity for us to deploy new care delivery models as well. larry mentioned the movement from institutional based long-term care to home based. there's a lot of technology that can affect and be leveraged where someone could stay in their home yet be wirelessly connected to a health care provider and the ability to have care managers available as an adjunct to that family to help care for that individual at their home as opposed to an entire long-term care facility. >> now at risk of getting a little too wonky, forgive me everybody. i'm going to ask about payment models for providers. i ask this because although it is difficult, it's part of
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the system how there's a lot of data that shows how paid providers really quite closely affect the care they give, not to be too cynical but it turns out to be the fact. so federal regulators, cms have been trying to change how they pay hospitals and doctors and a lot has to do last year, i will spare you the acronym or it is expected to exonerate that on the physicians side. the idea to keep it simple is that if we pay healthcare providers for each thing they do which is the predominant model today i would say in medicare and elsewhere, they're just going to do a lot more of whatever that thing is . a fee for service use and that but the alternative means of paying, things like something called compensation which is at its most extreme sort of a paper member, per month no matter what care the
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person gets the providers get the same amount of money or other versions of that as rewards efficiency that can reward quality, there have been concerns about those models too, particularly if you look back to somewhat played out in the managed care industry in the 90s. what do you guys needs to be done here? is cms doing the right thing? are they going far enough, are they going to far? what do we need to do in terms of how decisions and other providers are paid to manage our system better? i think we should start with keith on the front lines. >> this was written for me, absolutely. take it from your point. there is no perfect reimbursement or payment mechanism. they all have failures. with that said, i'm a huge supporter of the momentum that cms as well as tmi which is managed medicare and medicaid innovations have begun to implement that high,
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either the clinical outcome which is also viewed as a quality indicator is paying more on the outcome value versus how many widgets or how many visits, how many units of service you can effectively provide. it is a step in the right direction but hannah mentioned decapitation as an example, that's a prepayment to the hospital were an integrated delivery system. , that has worked very well. it's about the mechanisms that are out there right now, anybody, a provider as a residue is something else's expense so you use the insurance company as an example, the insurance company revenues the premium, hospital every time they admit the patient, every time they see someone in the er or
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the ocd or promise a physician or a test or do a test , that is the expected plan. and there's a lack of incentives to go the extra mile in order to save expense because the person doing the work, i.e. in this case the physician is not economically rewarded for that extra work. quick case in point, if someone calls a physician at 5:00 on a friday afternoon, and if their patients and they may have just a heart failure and they're having difficulty breathing, the physician can go to the er and that's going to start, that is going to be an 11 or $12,000 encounter starting at the er, most likely in admission and then three days later a discharged back home. and it's easy for the physician to do that. with the right incentive, what application does is that physician stays another hour,
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mrs. jones comes in or mrs. jones, i'm going to send my clinical nurse to your home and it may be as simple as an adjustment to their medication that just kept them out of the hospital. but the physician then got paid because other capitation you can change the rules and you can invest in clinical resources and new ways to reimburse that then saves the system $12,000. it's really about how you align the right economic and clinical incentives to the benefit as a patient. the patient is better off being at home and not in the hospital there's a consensus in washington about this issue today. it has moved away from people service and moved toward capitation. you could also take about would you like your physician to be paid just a salary and not the incentive to over treat or under treat but the
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point i would make is no matter what system you deploy, i would want bonuses for rewards and decisions to do the best job regardless of how we pay them and we are just beginning to have the measurement systemin place to be able to do that. i think that's really important . >> and the next system they are planning to move to is the paid quality of care that they deliver. the problem is, how do you get those measures of quality care and part of this is going to be electronic medical records so that it monitors the outcomes of care and a lot of those outcomes are subjective to physicians taking time with the patient to discusstheir concerns , to talk about adherence to the treatmentplan . so this is a very difficult step, it's the way they should be paid and the fundamental problem is the one who's receiving the care, the one who really knows the
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value of it is not the one laying the bill. >> i think one of the best things to come out of the affordable care act was the cnmi and the opportunity to do a tremendous amount of experimentation and demonstrations around a variety of different payment methods to test what might really align the incentives properly and get the results. and then the discretion which we never had before to be able to add that out, to scale that out and in this country without having to go back to congress and passing a law so that i think going to change the pace of innovation in medicare to a substantial degree. >> i would like to add to this point, comment about the clinical quality measures while in perfect, or at least a step in the right direction right now and i will tell you because i get to watch it every single day, that these metrics and these outcomes are being measured, the
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decisions are payingattention and we have seen a significant improvement in clinical quality and outcomes as a result , >> we got a couple of minutes so i will ask, i've sort of covered stuff related to pay-for-performance and these kind of models and they do seem, they can be very challenging. i think john had something to answer their's. >> we've been talking about healthcare since the medical system was the answer but really, if you really want to save money in healthcare we be thinking about population health, we be thinking about smoking and illegal drug use, we be thinking about alcohol. those are what costs money. and those are where the big opportunities to save our and by the way, keep our kids healthy so we can rejigger reimbursements and benefits all we want in the healthcare system but unless we get
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serious about the population health stuff, we are not really going to change the course of what costs or the cost towards how well we do in keeping people healthy. >> how do you do that? how do you get people to take care of themselves and eat a good diet and not get diabetes? >> wear your seatbelt, all that. >> is there an answer? >> the economist will always say they are part of the cost so we move away from that with the affordable care act and sing the community ratings so you can't really wrist, you can adjust your premiums according to your health , your risk, your expected cost so people are insulated fromthe cost of their care . >> should people can't pay more for their coverage if they are obese or eating lots of steak and soda or. >> i don't know.
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>> that would be most of the population. [laughter] >> listen to your parents very carefully. >> i think this is where the audience gets to ask questions, right? >> mistake questions from all of you and they are your hands already saw see you in just a second, i'm the only one with a microphone tonight but there are plenty of cameras around, this will be recorded and up both on our website first thing tomorrow morning and in the next couple of weeks of on c-span and on c-span.org so if you will say your first and last name before your question if we want to quote you and we got a question right here. >> and doctor walter. the pediatrician and we have all communicated earlier on a panel discussion. two issues that you have not addressed as far as rising healthcare costs are number one, the administrative costs to deliver healthcare. if you look at the administrative costs for medicare, the 27 percent and compare that with someplace
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like canada, where it's about 15 percent in each year it has gone aggressively elevated. keep in mind that $.27 out of your dollar or healthcare is going to administrative costs. the second question i like to ask you all to comment on is that defensive medicine is being practiced in the united states, we are talking about liability concerns and malpractice concerns, if you think when a patientcomes in and i will give an example of this, how many patients are sent to the emergency room with a headache , when they get to the emergency room, the total cost by the time they get out is anywhere from two to $5000 or their ct scans, it's incredible the number of people that are going in there and you ask the doctors why they do it and one answer is liability concerns so if you could address that i would appreciate it. >> i like to start on the ministry question. >> one thing you have to bear in mind about administrative costs is the more you spend on administration to actually do things like putting electronic medical records or do quality and stuff like
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that, that's all very expensive but if it reduces the benefit dollars, the amount of money that you are spending on healthcare costs themselves, the equation result in a much higher percentage of total amount spent for administration so the more we move down this path of quality and improving quality and outcomes and measuring what we are doing and accountability for practice and performance, it's going to be a much higher percentage of that total dollar that we are spending for administration and i would be willing to bet that canada does not really have a lab or a system as we have right now built around quality. >> to the other component of what you talks, on defensive medicine, economists in general don't agree on much but health economists agree that the single force that's
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driving healthcare cost in the us is the technology, the technology is expensive and the more it does, the more powerful it is the more it can benefit other people so we have mris and all of these available and then combine that with the possibility of mac malpractice lawsuits and yes, there's a lot of unnecessary waste in the system. >> i think we could do more to protect physicians as we have better measures evolve here for physician care and i practice within the approved guidelines, examination being protected from lawsuits. if sometimes you have that outcome even when you practice well, that doesn't mean that we should allow suits against a physician. >> next question? >> hello, i'm quarter recently retired teacher and
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although we don't use the word capitation, what i'm hearing sounds like what's going on in the education profession in which teachers are getting more and more pressure to graduate students, to give them certain grades, etc. i am also thinking about lawyers for example, do we reward them if their clients don't go back to jail and don't commit crimes again? mypoint is for this outcome thing, the other half of the equation is the patient . how do you have a good outcome if the patient refuses to do part of your treatment?that's my worry about this capitation thing. could you address that? >> i will start if that's okay. great question. the patient family and if you want to call it member participation is critical
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ultimately to a successful outcome and often times patients compliance is more an issue of a lack of education and making sure that we provide not only education but also the resources and tools to be successful or it with that said you will never have 100 percent compliance and that's also into the metric as well, there's always going to be an error factor. >> to clarify exactly what capitation means, capitation means current per head so that's if you are a teacher, you were paid per student that you have in class so straight capitation payment would be a physician or healthcare plan is paid a certain amount of dollars to provide all the healthcare necessary for these particular pools of patients
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and they are paid according to the number of patients they have so there's not necessarily an outcome measure involved in a straight capitation system. >> but what you are talking about like pay-for-performance is also part of the kind of stuff that medicare is trying to do and the insurers are trying to do so the question was ongoing. >> next question? >> i have a question you haven't touched on and it's one that's become relevant over the last several years. could you address any of the panel members how burnout is affecting healthcare providers whether they are doctors or nurses? this is something that seems to be occurring and could be affecting the system going forward. there's a lot of things that have changed over time, some of those have had a negative effect on the people from providing care. one could move that the family care. >> you use the term burnout?
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so we need to change that and you're right, we have seen a number of positions leave, retire early, didn't want to put up with this and a lot of that is because we have become our own worst enemy by not providing the training, the resources and the tools for them to be successful. that means new investment in
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technology but also people. >> i wonder if some of this is a generational thing because i think you have a generation of physicians who were trained to trust their judgment, knowledge and assessment. they're very comfortable with it after a while. this whole system of putting in place accountability is based on x certainly imposed performances and then measuring their performance on that basis. i think that goes down better with a younger population but i think it's been very difficult for the physicians who have been practicing for longtime. >> next question. >> i would like you to continue the theme started right at the end of the panel. the idea was preventive medicine and to charge people, drunks,
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that people, charge them charge them or not for their healthcare, but for their insurance. i would answer my own question, there are are about three ways of doing that. one is to have competitive insurance. number two is to eliminate the restrictions against pre-existing conditions. in other words, the insurance company gives you a health evaluation and they charge you according to your actuarial costs. if they did that, with that not people to take better care of themselves. >> if i can comment on that, one area of complex complexity around that is that people can have conditions or things that happen to them that is based a lot on their genetics or they
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may be predisposed to things and then for other people, just have really bad habits and don't care , but you're kind of making an informed judgment about people on why they are the way they are and how they got there. because you've created it as a form of punishment, i think think it would be very hard people to accept a system that is built that way way where people feel that they are being punished. >> one of the things they did was change the individual market which used to be more like what you are describing where people paid more based on their pre-existing conditions. even though the apa pulled results on this are mixed, the aspect of people being able to buy insurance no matter what their pre-existing conditions is is a pretty popular aspect of the system. >> i think the point is that it is pooled risk. when you start to rate people,
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you really eliminated the pool of the whole concept. >> we do that with automobile insurance, people who have more accidents are paying more. there's the same in workers compensation insurance and that provide tremendous incentive to employers to make sure their workplaces are safe and keep the number of accidents down. i don't know the answer to this, but i do know with the community rating now, anybody who takes care of themselves and is healthy is subsidizing the less healthy people in the pool. >> i think this is a tricky issue but i do think it's answerable. do people who have to pay more because of some behavior stop
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that behavior? no. so if it doesn't and sent people to do the right thing, then maybe we should take another approach, and i think that's pretty clearly what's going on here in healthcare. people were not adopting perfect lifestyles as a result of experience ratings. in healthcare it does not produce any change. i think taking other approaches is a better way. >> that will actually conclude our program for this evening. all of the panelists will be at our reception where all of you are invited if you would like to speak further with our panelist tonight i want to thank the council at asu for co- presenting tonight's program. thank you so much. of course all of our panelist for being here and donating their time to us. thanks again, have a great night. [applause]
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[inaudible conversation] ,.
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[inaudible conversation] >> here's a look at our prime time schedule on the season that starting at 8:00 p.m. eastern on c-span. fbi director james comey on cyber security issues. on c-span2, it's book tv with books and authors who have written recent biography and memoirs. on c-span three, american history tv. we have a look at actuality in america. then in campaign 2016 coverage continues with live primary results from florida and arizona democratic congresswoman and former dnc chair debbie wasserman schultz and marco rubio face primary and we will bring updates. then to arizona where john mccain seeks the republican nomination for a sixth term in the u.s. senate.
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we will bring you his remarks as well as your phone calls, reactions and tweets. that's alternate on c-span. c-span washington journal, live every every day with news and policy issue. coming up wednesday morning, chief investigative correspondent for yahoo! news will discuss the fbi's investigation, suggesting that foreign hackers penetrated to state election databases and recent weeks. then they will talk up controversy of the recent hike in the cost of epipen's. then our spotlight in magazine, they will discuss the story, are we any state and transceiver which looks at the $1 billion that have been spent to protect u.s. and if it's made an impact. be sure to watch "washington journal" beginning live at seven am eastern wednesday morning. join the discussion. >> also tomorrow, the road to
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the white house average continues with five remarks from donald trump outlining his immigration plans. he speaks to voters and supporters in phoenix. we have a live at 9:00 p.m. eastern on c-span. >> with the house in senate returning from there senate break on thursday, will preview for key issues facing congress this fall. federal funding to combat the virus women in america today want to make sure they have the ability to not get pregnant. why? because the he does affect the pregnant women. today they turned on the very money that they argued for last may when they decided to gamble with the lives of children like this. >> the annual defense policy and programs bill all of these votes are very vital to the future of this nation and at a time of
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turmoil and a time of the greatest number of refugees we've seen since world war ii. >> gun violence and other issues. >> every republican and democrat wants to see less gun violence. >> we must continue to work for nonviolence and demand an end to senseless killings everywhere and the discussion of congress to john andrew, commissioner of the irs for high crimes and misdemeanors. we will review the expected congressional debate with the senior correspondent for the washington examiner. join us thursday night at 87 on c-span for congress this fall. >> now the defense department
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briefing on the recent publication by iranian vessels and what's being done to combat isis. the head of the u.s. central command said isis has been greatly degraded and the terrorist group has lost a significant amount of territory in iraq and syria. this is 45 minutes. >> morning everyone, i'm pleased to welcome general votel from central command to share his thoughts on what's going on within his combatant command. lots of issues to talk about and without any further ado we will let general votel begin and we do have to keep an eye on the clock because of our meetings here today. >> thank you peter, i appreciate it. for all of you, it's good to be here with us morning. i appreciate the opportunity to come and talk with you and provide you an update on u.s. military activities in the central command and the area of responsibility. to guiltily it relates to the
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ongoing fight in iraq and syria against terrorists organization isil. i've spent a good to do my time in the region since march. as you all know it is a strategically important part of the world. it's also a part the world that is dealing with a myriad of complex challenges including sectarianism, economic and political discouragement, ungoverned spaces and terrorism. during my travels i've met with many partners both government and military leaders. i will tell you the one thing has been very clear to me to set our partners value their relationship with the united states, they they value our leadership and they want to work together to accomplish objectives. we need to do what is necessary militarily to improve stability in the region. we are achieving good effect in a number of up areas. i will give you a few examples.
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maritime security is an area where both preparation and cooperation continue to achieve good effects. nearly 30% of the the energy vital to the global economy passes through the three men time regions in the area. our efforts, together with the efforts of our partners and allies help to ensure the free flow of commerce through these points and other parts of the world. in recent months we've seen an uptick in confrontations by iranian vessels. i've personally witness this behavior last month while on the uss new orleans. some of you were with me. we saw a missile ship and other ships that demonstrated aggressive behavior near our ship. in recent days we have witnessed more provocative activity by the navy vessels. that type of behavior is very concerning and we hope to see a
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rants naval forces act in a more professional manner. in contrast, i cannot say enough about the professionalism of our naval forces. they remain measured in their response and they kept a tense actuation from escalating. i was proud of our sailors and their leaders. our efforts in afghanistan continue to pay dividends. along with our coalition partners we have made tremendous investments in the country over the past 15 years. the afghans today are in the lead and they are taking the fight to the enemy to their sissies available security strategy. they are doing so while dealing with some tough challenges in places like province for example. they continue to demonstrate resiliency and they are proving capable of defending their sovereign spaces. meanwhile we advise and assist and train in afghanistan and those are proving effective
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against the isil affiliates in afghanistan and other areas. during a recent visit to afghanistan, i spent time with our train advise and assist teams in with the poor commanders leading the forces, across the board i was extremely impressed by their skill, their determination determination and their extraordinarily high level of resiliency. our recent combined operations against the islamic state resulted in the destruction of 25% of their forces. with president obama's decision decision to keep 8400 u.s. troops through 2017 and with the additional authorities that have allowed us to target the islamic state in the area and to accompany afghan forces, i am confident we will see them build on the momentum achieved today. of course we remain focused on the ongoing fight against isis in iraq and syria. as a result of our coalition military operations, the groups capabilities have been greatly degraded and dismantled in both
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countries and they've lost a significant amount of territory they once held. in just the last few weeks alone, isil lost a hold on the city and the border crossing from syria. also in other areas in iraq. forces defeated an attempt to counter attack by isil fighters in should body. this has served to cut off key lines of communication with isil while restricting the enemies ability to bring in more fighters. as you look across the whole battle space, you see isil is under more pressure now than any other time in the campaign. we are causing the enemy to have to look in multiple directions and they are struggling to respond to this pressure. generally speaking, i do believe our approach, which requires to work by with and through the indigenous forces is working. we are making forces progress against forces.
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challenges do remain in it as there is much work to defeat the enemy in both countries. we remain concerned about their external operations capability as well as their adaptive myth. as sec. carter has set on a number of occasions, defeating isil in iraq and syria is necessary but not sufficient. we need to work together across boundaries, the whole of the u.s. government and the international community to truly defeat this organization. perhaps even more important, we recognize the significant clinical challenges will also have to be addressed. to this end, we will make concerted effort to make sure we synchronize the political and humanitarian assistance plan with their ongoing military plans and operation. this has been one of my main areas of focus during my visits to iraq over the last five months. we are exploring ways that we may be able to work more closely with our interagency to support these efforts in recently liberated areas until the
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security environment improves and allows greater access to aid organizations. we have proven time and again that when we work together difficult challenges can be overcome. we remain confident that we will be successful in our shared divers. with that i would be happy to answer any of your questions. >> question about syria, today the turkish presidents said the u.s. should end its policy of what he calls supporting the kurdish forces at all cost. i was wondering if you could respond to that and whether or not it's possible to increase the air representation of the forces you are developing? >> i will just say, we rely on turkey and the syrian forces to help us in our right against
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isil. both of them are critical to it. turkey plays an extraordinarily important role with their access based in a variety of things they do in their operations along the border against isil are very important and welcome. at the same time, we also value the contributions of the democrat forces that have been a good partner to us in helping address the isil threat in the area. as we see the need to continue to work with both of these organizations as we move forward and address the principal threat which is the islamic state. can you say your second question again. >> are you trying to increase the number of arab fighters that you put into that. >> we certainly are. the syrian democratic forces which do include a variety of other elements that are all included in that really are proving to be the force that is
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most capable against isil in that part of the area and what we do see his other elements that want to align themselves with that. >> kurdish media has been flooded with worry about the u.s. reaction or the slow reaction and they feel like they been stepped on the back or betrayed by u.s. forces. are you seeing any battlefield precautions or doing this to work with the u.s. >> i'm not. we continue to enjoy strong support for the basing where we
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have our coalition aircraft and where we operate out of. turkey and they continue to provide that as we move forward. again, as we look at the operations along the border against isil and some of the border towns, that is extraordinarily welcome. i don't see any degradation to the support that we are getting right now. >> you worry about the endpoint of these coming together and are they going to be able to work together? >> as we dismantle and ultimately move in the direction of the feet of isil we will see these issues emerge but what we are focused on is getting all our partners focused on the
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fight against isil right now. >> i would like to ask you about yemen. they have reported targeting of civilian facilities how do you see this issue and what do you specifically believe is the american responsibility in civilian casualties in yemen caused by the saudi coalition given the fact that the u.s. military is providing hands-on support? >> i think it's well-established , the level of focus that we put on civilian casualties, it represents our values on how we conduct these operations but i think part of our responsibility is to
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continue to emphasize to all the parties involved their responsibility to operate in a manner that absolutely minimizes chances of civilian casualties. we continue to emphasize that all of those partners that are involved in that aspect of the conflict in yemen. >> you think the united states should withhold enabling support to the saudi coalition if civilians continue to be targeted? >> i think that's probably a topic for our policy leaders to address so i will leave that to. i think what our responsibility is to do is to continue to stay engaged with our partners, encourage them to operate in a manner that accomplishes our mission yet protects the civilians and doesn't add to a humanitarian situation on the ground.
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>> i wondered if you could walk us through the next stage of the anti- isis operation. i know the turks are in syria. do you want them to go west as opposed to heading south, and as , they want the kurds to move across. just walk us through what you would like to see? >> what we have seen with the turkish operation along the border, i think it's been very helpful to us and they are in the exact right thing that we need for the coalition and we need for the fight against isil. what i see moving forward is making sure that we keep all of our partners and all of our forces focused on isolate this point. i think think we have good momentum going against isil anything we need we need to continue to emphasize that aspect of it. we are very much in favor of what the turks are doing against
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isil. >> do you want them to move west? what if they move south for the kurds are? do you see that as problematic? >> will they as vice president bidens that lose support? >> we have made it clear that our support is support to all parties is contingent upon the focus on isil. that will be how we continue to do this. what we are trying to do is ensure that we keep all the focus on isil. it's not helpful if there is infighting among themselves point we don't want that and we are working to prevent that. it is most important for us and you the sdf and our turkish partners and other partners focused on isil. >> do the kurds have to face the euphrates mark.
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>> they are on the east side of the euphrates river at this time. they have lived up to their commitment to us. >> i think it's important to understand that when you look at the sdf, it's not just kurds. there has certainly been a kurdish element to that but there has been syrian arabs and others. i think what you see in this area are forces that are left in place to hold and provide security that are principally made up of forces that come from that particular area. so i think we should expect that will occur. what we have seen is the portion of the kurdish elements that have supported that have largely move back to the areas. >> can you actually accomplish your campaign plan if the kurds
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stay and do you believe the turks actually agree with the concept itself or do they see it, particularly for. [inaudible] >> i think that's probably a question you have to ask the turks to comment on. i think our responsibility is to make sure that as we work with our partners to make sure we are transparent back and forth and understand who is who in that, as i just responded here, there certainly are syrian arabs and others that are involved in that broader at sdf piece. to answer your basic question, yes i do think with the kurds staying in the area where we've asked them to stay, that does contribute to our forward momentum and continuing to move forward in our campaign plan. >> within syria, even with the kurds not moving. >> yes i do believe we can.
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>> 20% of the worlds oil goes through iran, have you given us a sense of why the iranians have those repeated actions last week ,. [inaudible] this change in their thinking in terms of more harassment from the united states and since the world oil immunity reacts to every hiccup over there, do you see the irs gc harassing commercial oil traffic over there? >> i don't think i can get inside the minds of the iranian regime to understand exactly what they are thinking in terms of their action and while we saw some activity here in the last couple weeks, that's not particularly new. we've seen that over time and as
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we've reported in the past, about 10% of the normal interactions that we have are things that we would consider to be unprofessional and unsafe and that's been a factor over time. i guess out this, iran's action in the golf are like anybody else. no one else does what they do in the iranian golf. they don't go out and drive fast boats toward military vessels in the same way that they do. nobody else does that. when i call on a rant to do is to be the professional force they claim to be. professional militaries and maritime forces don't operate in that way. we acknowledge all parties, all countries have the right to operate in international waters but they should do so in a responsible manner, and what we see with the iranians is not particularly responsible. it is provocative in some cases
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and unsafe and it can lead to situations where we may not be able to de-escalate in time before something happens. i'm very focused on this and i'm very proud of the way our forces operate in the way they conduct themselves. they are very professional and measured and i think we are applying our values and as we do this, i am concerned about those types of activities that are just plain unprofessional and aren't replicated by anyone else operating in the area. >> the oil community wants to feel there is some security there. are they trying to harass -- >> i don't have any sense that they're trying to harass any commercial activities. >> just to follow up on the question, there's a great landmark between the united states in iran in the past decade and it's been this nuclear court and since the
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accord was reached, we've seen a doubling of harassment of the u.s. navy ships, we've seen a number of ballistic missile launches, how did this nuclear agreement. [inaudible] >> i'm not sure i'm qualified to make that assessment lucas, but i would say that we haven't seen a significant change in their behavior just as we've been talking about here with the agreement. to me, that remains a concern. it's something we will have to continue to deal with in this part of the world and pay attention to. as regards to other capabilities that are beginning to add, it's certainly my responsibility to pay close attention and provide advice to the secretary on how we should be looking at that and dealing with that, ever going to have to do something there. we are paying very close
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attention to all that. >> when you found iranian address. [inaudible] >> you really have to talk to the iranian regime leadership about this. what i see is this is principally the regime leadership trying to exert their influence and authority in the region and they are trying to do it in provocative ways that are unsafe, unprofessional and really work against their objective in the long-term. i would want to emphasize that about 90% of of these unsafe, unprofessional activities we see come from the iranian navy vessels. they don't come from the general iranian navy, only a very small percentage of them do. in my view this is not about the iranian people, it's about the iranian regime and their desire
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to continue to do these types of things that stoke instability or attempt to stoke instability in the region. >> would be okay if i ask you about muzzle? you think iraqi forces are prepared to launch an offensive in muzzle sometime before the end of the year or sooner than that and what happen when you set up the combat air patrol? what you think the motivation work for the syrians and doing what they did and do you think, how close were they to american forces on the ground? >> first of all with respect to muzzle, i think is as the prime minister had said, it's in his intention to get through muzzle by the end of the year. my assessment is more that they are on track to achieve that objective. they own the timeline here for this and so we will continue to work very closely with them and ensure that we can support their operations when they are ready to go.
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i think we are receiving apace right where we hoped to be at this particular time. i think we are there with respect to that. with regard to what the aryan regime motivations might have been, i'm not sure i can speculate too much on that. whether it's there concern of maintaining some level of mine schemed medication back and forth, i don't know, i just be speculating on what their motivations be. >> how close did they get to american forces that were working with our partners there? >> i think there were several hundred meters away from the area in which we were. close enough to be concerned, but wasn't an immediate direct threat. >> there's been a perception
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over recent days that part of the reason. [inaudible] turkey failed to adequately coordinate with the united states and it would've been more welcome after the u.s. would've been able to get some the kurdish elements to move out of the way. did turkey jump the gun? >> i wouldn't say they jump the gun. i think as they went across i would highlight to you that we did support that operation and focused on isil. one of the things i think all military leaders try to do is look for opportunities in the move on those opportunities very quickly. i think based on opportunity, he moved quickly on that and we tried to support them as we did and we did support them when they began to focus on something
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other than isil than i think we had to withdraw on our support for the and so we are now trying to keep those elements separated and focus on the counter isil fight. [inaudible] >> not particularly. i think we saw some indications that they were doing that, but again it's an opportunity and we look for opportunities as well. it was focused on isil initially so we are glad that they moved in when they saw on opportunity against isil. >> two questions, one is can you provide an assessment of the forces inside multiple, a kind of ranges from this could be a huge fight to maybe this will melt away. what is your thinking post muzzle, and post- rocca. >> you're talking about the
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islamic state. >> yes. >> one of the effects we are creating is that isil is having to make hard decision because they are getting pressured in a variety of ways. certainly in both iraq and syria and a lot of locations we are continuing to target their leadership, we continue to target their revenue generation sources in both northern iraq and syria and i think we continue to keep them on the horns of a dilemma. they're having to make decisions. it's interesting to me when you look at the battle of mandate which took place over the course of 74 or 75 days, very difficult fight where there was extensive use of tunnels and they were fighting inside of buildings. by the way, the engine sdf exhibited great skill and concern for civilians on how they approach that and i think
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they took a very deliberate manner to that. when applied pressure there, they very quickly left the area. gordon, i think what you are seeing is a think we should expect that in some places, perhaps in some parts of modal they will feed the area to us or to the coalition, to the iraqis and in other areas it will fight harder to hold onto that. i think that's what we are going to see going forward. they are to have to make hard decisions about where they're going to concentrate their power and where they will have to let the coalition and our indigenous partners succeed and that's kind of what i see going forward. to the second party problem, or your question, i'm sorry, again as the secretary has said, going into these areas in addressing the core of isil in iraq and syria is very important but as
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we've learned about this enemy, 11 they are very connected so things that happen in iraq and syria resonate in other places and resonate in our capitals in europe and other places. the connected network. they are very vulnerable. we are seeing that. as we present them with lots of diplomas they're having to act to make difficult decisions but they are also very adaptive so we should expect that as we come out of the big operations they will continue to adapt and we will continue to deal with the next evolution of isil, whether they become more of a terrorist organization and return to more of their terrorist like roots, i think we are thinking very hard with the coalition and with our iraqi and our partners in syria, how we look at continuing to keep the pressure on isil after we complete these major operations.
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i don't want to give any impression when we finish in these areas were done, we are not. we we will continue to deal with them. >> thank you general, back to turkey and syria, i'm wondering if turkey will continue to move forward against isil or will retreat back across the border and just contain the problem rather than solving it and defeat isis but have you received any assurance from turkey that they will continue to fight? >> i haven't received any particular assurances, but i think what we have seen as we have seen them move west along the border and i think that is extraordinarily good news. that's very helpful to us and in our other partnering efforts with them we have seen them continue to support those operations and i think those are extraordinary positive so in
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this case, the matter and what i am seeing on the ground is that they have been very committed to the isil fight. they have said that and we will take them at their word for that [inaudible] >> again i won't get into the specific details of what each of the elements will do as part of the modal operation but i will tell you, as i mentioned, we have a very aggressive and a very interactive planning process going on that includes the isf and other entities in iraq and making sure that we have the right mix of forces to do this. in my recent discussions with
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the president, he continued to commit his pledge to continue to work with the government of iraqi forces in helping with this. we expect everyone to play a critical role in this operation and so far i think we are seeing that. we are seeing good interchanges between political and military elements to continue to address all the complex issues that have to be addressed in a large area like this. >> discussing iranian provocations, do you think they are indicative of a worsening u.s. iranian government relationship to the extent that there is a relationship and what is the fear there? is their fear of recalculation? what are your thoughts on that. >> again, we don't really have a military relationship with iran
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so i can't say of the relationship is getting worse or not. it is what it is and it's pretty much been the same. i think the big concern is miscalculation. i'm very confident in the measures that our mayor and time forces are taking. they in deliberate in the things that they are doing but ultimately we are going to protect ourselves. if that comes the situation. i am concerned about rogue commanders, rogue iranian commanders who are operating in a proactive manner and trying to test us because ultimately we will prevail here. i'm very, very confident of that and we certainly don't want that to come to pass and that's why i call on them to act in a professional manner that they espoused to act, especially in international waters. >> do you think the calls are getting closer. >> the what? >> have there been any close calls, in other words.
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>> i think these are all close calls. when you were with us and saw this we are talking seconds. this is very important work that our people do here and we are relying on our good young leaders in our young sailors to make good decisions and in every case that i have seen the have made good decisions but ultimately, if they continue to test us, we are going to respond and were going to protect ourselves and our partners. >> general, your spokesman told us recently captain david last week said you're expecting some very tough fighting in iraq and in syria as these battles continue to unfold and colonel robert said about a week or so ago as well, there are some very visible signs that the organization is weakening but they are preparing for some tough fights to come.
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i want to make sure i understood you correctly, when you say you think. [inaudible] do you expect a big tough fight there? >> i think it will be a tough fight. what i think they will do is they will have to make some decisions about portions of areas in which we are operating in in which they will not defend , they will not expend a lot of their efforts in order to focus on those things that are most important to them. i think in some areas we will be able to move perhaps a little it more quickly, but i do expect, based on what we've seen an experience, we are at a point where we are now really into the heart of the caliphate. we are moving into modal. we are moving toward rocco. these are important cities for us. as i've learned in my career and
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as i've encouraged my commanders here, we have to respect our enemy and he is going to defend what he has taken and held for a long period of time. we should expect that the rock hard and difficult fighting and extensive use of ied's and a mixture of civilians and forces in there. we will use civilians as -- they will use civilians as shields as we have seen them do. we will have to be more careful as we've seen them do that but in the end we will prevail through that. in some areas they will concentrate in. >> you think it can be done by the end of the year like the prime minister suggested are asked? the prime minister's objective to have that done by the end of the year and right now, we are
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supporting them with this in the timeline. my indication and my assessment is that we can meet the prime minister's objective if that's what he chooses to do. >> who is making decisions in this? is that the central leaders are commanders and is there any pattern to their meant that tells you what they value most in what they're going to hang onto hardest? >> i'm not sure i can answer your question about who's making the decisions. i'm certainly, this is a strong network, they do rely on guidance from their centralized leadership so i imagine there is some indication that there is
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direction coming. i remember what we saw from daddy to fight to the death. obviously they didn't so they didn't follow his direction. i do think there is direction coming from the centralized leadership but we have to respect our enemy and recognize that he has leadership of the lower-level and he has to make decisions about what they are doing. [inaudible] >> i think they will try to hang on to those areas that are revenue-generating areas and for the caliphate will be very important for them. certainly, iconic locations
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within either of those cities or locations are important to them. i think it's important to them to have a capital caliphate. as they define that, i think think they will probably identify areas that are perhaps more defendable or more important to them and they will continue to try to hold onto them. >> you made reference to the fight against isis will continue, it won't and and i'm trying to get more specifics about what does that look like? are you worried about the potential that they will do more terror attacks in europe in the last and expand the caliphate to other places like asia and secondly, can you tell us about the u.s. effort to get back hostages from afghanistan like katie holman? >> thank you. one of the things that we have
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seen some of these horrific ied vehicle or suicide attacks in baghdad in the past as we put pressure on that. fortunately we work very closely with the iraqi government to begin to address that and again we are making some progress. we haven't completely eliminated it but we have through our work together, enabled the iraqi forces to go after that and they are pursuing that. i think as we look in the wake of a big operation like modal, i think it is possible that we will see some of those type of terrorist attacks and they will try to go after vulnerable locations with vehicle borne iuds who continue to challenge the government and the forces that have taken them. i suspect that we, as we do in northern syria, we will see them with counterattacks and try to
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retake key locations for them. certainly as the physical caliphate disintegrates and as it comes apart, as we dismantle it, i think as i've indicated, they will return to more of their terrorist roots and direct support or inspire support outside of the core in iraq and syria. i think we should expect to see that and that is why as the secretary said, we've got to address with happening in iraq and syria, but that's not sufficient. we we have to look much broader at all of our efforts to address the threat that they pose trans regionally as well as in this particular area. >> and the hostages? >> certainly when americans are taken captive this becomes an immediate priority for us.
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we are paying extraordinarily close attention to that and we always do it i won't get into too many details with that but i am satisfied that we are doing everything we can at this juncture to understand who took them and to try to get them back. >> a few more questions. >> can you clarify. [inaudible] and did you have notice of the turks operation. you have any communications channel with no. [inaudible] you have any information about what happened. [inaudible] , who left the border area and how can they act under. [inaudible] >> i think the fact that we
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provided some air support to the operations indicates that there was some coordination beforehand. yes, it was not an extensive planning. for this, we were taking advantage of an opportunity that are triggers partners identified so largely because of the basing that turkey provides us for coalition aircraft, we were able to respond very quickly in that situation. yes, we were able to respond and do it in a timely manner for their operation. we are not necessarily directly talking to all of those partners, we do work through turkish partners to communicate to them and communicate what is happening so we try to use all mechanisms of communication back and forth with how we talk to the various partners. with respect to where, i think your last question is where the islamic state numbers went to, i
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think there's a variety of places they could have gone, they certainly could have gone further to the west or southwest for the l bob area, they they could've moved towards rocca, those are areas where there is presence of islamic state forces so my expectation is that they would've moved to areas where they could have received support from islamic state elements which might be those locations. >> and how do you think they can act. [inaudible] >> i think that is something we pay some attention to hear, but i don't know that we necessarily see any indications of that at this particular point. >> general are you concerned at all, were were you expressing concern with the advisors and
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sdf forces as they target the forces in these clashes, was there any concern about that embedded? >> we been coordinating with the forces for a long time. they know very well where we are so we may remind them, but frankly i think our coordination and our situational awareness with the turkish forces is good and that was not an immediate concern for me. i think we have had situational awareness with the turks. >> there was recently a two star general that was dismissed for. [inaudible] are you concerned with the vetting process with the generals who have access to information in your command. >> i don't know all the details of that particular situation. i think once we go through the prepared leaders is very efficient.
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>> thank you general. >> if i could just for a moment, i would like to make two points here as i close. not so fast. first, two points to emphasize, we do see momentum building in iraq and syria. as i've commented to several of you, this is really the biggest concern that i have as a commander and that's maintaining our momentum in the fight and the intent going forward is to continue to support our partners and maintain that momentum. that is a very key piece for me as the centcom commander. hour also point out we have extraordinarily good partners and we've talked about a variety of them here in this room but certainly in a large coalition, we have, we are very well supported. i spent a good amount of time in the region over the past five months and i've gotten out to see a lot of our partners and i'm very encouraged by the strength of our relationship and the willingness of our partners and allies to continue to do what is necessary to achieve our
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common objectives against the islamic state and i am confident that will be done and that will be the case going forward. thank you for the opportunity to speak with you. i look for to seeing you again. >> here's a look at our primetime schedule on the cspan network starting at 8:00 p.m. eastern on c-span, fbi director james comey on cyber security issues. on c-span2, it's book tv with books and authors who have written recent biographies and memoirs. on c-span three, american american history tv with a look at sexuality in america. then campaign 2016 coverage continues with life primary results from florida and arizona debbie wasserman schultz and marco rubio face i marry challenges and we will bring you speeches from both of those candidates. then out west to arizona where
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john mccain seeks the republican nomination for a term. we will bring you his remarks as well is phone calls, reactions and tweets. that's all tonight on c-span. >> c-span's "washington journal", live every day with news and policy issues that impact you. coming up wednesday morning, the chief investigative correspondent for yahoo! news will discuss the fbi investigation and how hackers penetrated two databases in recent weeks. then caitlin zero when will talk about the controversy of epi- pens. then our spotlight on magazine segment, they will discuss the
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magazine september story, are we any safer, which looks at the $1 trillion that's been spent to protect the u.s. and if it has made an impact. be sure to watch c-span "washington journal" beginning live at 70 stern on wednesday morning. join the discussion. >> three researchers and scholars on turkish politics and foreign affairs after the recent coup attempt in that country. they also looked at the various political factions in turkey and how they play into the nations short and long-term political future. it was held by the bard bipartisan policy center. this runs one hour. >> good morning everyone, welcome to today's discussion about turkey after the two, allied partner or something else i am pleased to be joined by two of my esteemed colleagues and world renowned. [inaudible] the purpose of today's event was to discuss what has been going on in turkey following the july
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attempt. we have had significant developments along turkey's southern border when it comes to syria as well so we be talking about that. before we launch into our discussion, i just want to lay a little bit of groundwork because i think what we will be talking about today didn't really start on july 15 or is a series of recent events as developments in a long line of evolution of turkish u.s. relations that arbitrarily speaking will date back to late may of 2013 when we saw protest breakout in istanbul that were subsequently put down in a rather oppressive manner which sparked what some have seen and we definitely at the bipartisan policy center have written about by turkey's ruling
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party and its leader and prime minister. at the same time, we have seen changes in turkey's domestic politics and changes in the form policy that have led some to question as we did in a paper last year whether turkey is increasingly an undependable ally and the main bone of contention has been syria policy where the united states and turkey appear to have long differed on what priorities in syria should be with the u.s. focusing on the defeat of isis and turkey alternating between focusing on removing the asad regime and limiting the ambitions of the syrian kurds in the form of a people's protection unit, the white pg. both of those trends when it comes to form policy differences and concerns about turkish
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domestic politics have obviously played out in the past couple of days and to discuss that with me, i'm pleased to have to my immediate left alan, most notably former senior professional staff member on the foreign affairs committee but also a fellow at the center for american progress. before i go any further i like to think the house foreign affairs committee and the chairman of the subcommittee for hosting us today. i would like you to talk about what happened on july 15 and how we got that situation the first place.
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[inaudible] >> all right, is this better? >> excellent. >> so before july 15, there was a number of people who thought the two was over and some extent it was right that it does seem to be over by the massive outpouring of opposition to the military when it tries to seize power on july 15 was very strong evidence that, i guess where the analysts including myself had erred in thinking that everyone in the military had gotten the message as well. there was certainly, it seems significant, we don't don't know what percentage of military
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leadership in turkey that may be, out out of sheer desperation, but one way or another came to the illusion erroneous, it turns out, that they would be able to succeed in toppling the government through military force. when that failed, well, first of all, there was a moment of intense crisis when the coup started and people didn't think this was a worst-case scenario that the best case scenario is no coup at all but even worse than a accessible coup would be a partial coup that forced the country into civil war and for a moment when that started it seemed like a frightening possibility. >> with that said, i guess, once that was over, once once the immediate threat to turkey's stability had passed, unfortunately the real crisis for u.s. turkish relations began and there was, i guess best case
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scenario it seemed like after the failed to, the turkish government immediately came to the conclusion that the movement had masterminded it and we might have hoped for a situation in which everyone proceeded calmly and the government tried to marshal the best available evidence to explain what actually happened and then provided evidence to the united states, if the evidence contained in conclusive proof of involvement in the coup, the united states would've extradited him and he would've received a fair trial in turkey and things could have proceeded in a just and calm manner. unfortunately it became clear very quickly that was not what was going to happen immediately after the coup, while the united states did, as early as the night of the coup they said it was on the side of the
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democratic government, they can condemned the coup itself but the turkish government immediately began launching accusations at the united states for have been complicit in the coup and subsequently when the united states pointed out that before he could be extradited we would need to see evidence of his ilk than they began using this as further evidence of our complicity in the two. this dynamic created an unhelpful situation that we find ourselves in now where again, what would of been handled at is a matter of legality and a sort of joint u.s. turkish effort to get to the bottom of what happened and solidified turkish democracy in the wake of this to directive event has now turned into an adversarial process where turkey is launching accusations at the united states and the united states, many people in washington have come
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to see extraditing glenn is almost a concession and i think the question for people in this room dealing with this in washington is how we can move this back to countries dealing with a dangerous situation in turkey but also deal with it in a healthy, bilateral manner. >> i guess a couple of questions stemming from that for you, first, it strikes me that if turkey really wanted us to extradite him, they seem to be going about it in all the wrong ways. this anti- americanism, this push to extradite without concern for the due process of the law, there's just sort of, i think the prime minister said, who needs evidence, that u.s. didn't need evidence after 9/11. all these sorts of statements that seem to misunderstand how
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the process works and then to antagonize the u.s., it seems to suggest they're not really serious about it or if they are, they don't know how to go about it. could you explain a little bit about why you think there is the diversions and also secondly, a lot of the anti- american rhetoric seems to be driven in turkey by the belief that the u.s. didn't come out quickly enough against the coup and doing enough to support the government against the coup. do you think that's true? could we have done more? >> as a take your second question first, when we came out against the coup, the coup started around 3:00 p.m. our time, little after and the white house statement came out at 7:02 p.m. i think by the time it came out,
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it seemed like the tide was turning against those who started the coup so in a conspiracy minded society, it was only inevitably going to feed conspiracy thinking. i don't for a minute think that anyone in the white house wanted the coup to succeed, but it would've been very useful i think to have come out immediately, as soon as it was obvious there was something going on in turkey and oppose it instead, unfortunately the first statement was made by secretary kerry when he came out from a meeting with. [inaudible] and just had been informed about it and he said he hoped for peace and continuity which, instead of just saying flat out, we are are against what's happening in the military to get back to the barracks, and the
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coup mate platters rounded up, i don't think the obama administration can be given an a+ on this one. i think that statement should have gotten out earlier, meanwhile russia and iran jumped in opposing the coup. i think no matter what, based on my experience with turkey, there would have been conspiracy theories about the united states involvement in it. i think the fact that we were probably a couple hours too late to the game for their fueled to their conspiracy. >> we want to oppose the cake to support turkish democracy yet we are extremely concerned about the fact that turkish democracy has really been eroding for at
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least the last three years and it has eroded rather significantly in just the aftermath of the coup. were talking about tens of thousands of people who have been detained or fired that presumably could of had no direct involvement in the coup, how do you balance that. on the one hand support the turkish government because they are democratically elected and on the other hand try to push them to rein in their authoritarian. >> it's a difficult balance there's no doubt. first of all we don't know how many of these people are guilty. we don't really know anything at this point. we know what the accusations are i think what caught people by surprise here is the fact that so many tens of thousands of civil servants, including judges, prosecutors and police were so rapidly rounded up and fired the next day. i think had it been confined to
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the military, even the extraordinary measures that were taken, i think that would've been understood here but i think there is reason to be very suspicious that so many people could have been involved in coup making. there's a history here, i understand it did not begin the moment after the coup, it really begins, they came out in 2010 against that you can say from february 2012 when there was a judicial effort to prosecute the head of turkish intelligence, but what we know, when the gloves were dropped and the
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shirts were off and it was irrevocable, he became an irrevocable fight when the judiciary went after ministers in december 2013. the judiciary was convinced and that there is goal was to topple his government. instead, i think that has really been what the fight was about so i think that has cast a shadow over the current government lames that they were behind the coup. by the way, i didn't fully answer your? extradition and i apologize for that. matter fact, i didn't answer it at all. i don't think turkey does itself any favors by politicizing this and demanding that they be
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extradited now and it's a full on process. i expect if he wants to appeal the process down the road and prove this is all a political witch hunt, he will be able to cite some of the statements in u.s. court. at the end of the day, i think this is primarily a decision of the u.s. courts and it will be done on legal grounds based on the quality of the evidence. they've not yet done it. they made an extradition request before the coup, they've not yet made one post too. they are supposedly preparing that and will send it to their minister when they do so. they said we will see, a poison the atmosphere the way they
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thought about it but at the end of the day this is primarily a judicial process that as i understand it, the secretary of state has to sign off on. by the way way the center for american progress where i work will have a paper issued soon that really has looked into this issue of how the extradition process works. >> in the meantime, maybe you could walk us through that process a little bit in the graphic that's on the table available for people to look at. >> the key point about the extradition process is that there is a political and legal component. for him to be extradited the political will has to be there and the legal evidence has to be there. so far, unfortunately unfortunately what has happened, in the absence of providing any legal evidence, turkey has gradually eroded the political will for this. :
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>> >> the standard at that point is probable cause the same that is required for a judge to issue an arrest warrant and. the real question of extradition will be what evidence he can provide with the faller -- followers of the military of the two that he personally gave himself and that would be the most difficult and he would not have that on the phone and
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as a matter of one year ago picture but even in the best case scenario with the evidence for but ultimately e.d. issue has been personal involvement and for this is another area there is a number of concessions that seems suspicious that how quickly they are confessing and at the same time most are published and the newspaper of those giving us concessions fit this will not help to convince the judge it is reliable evidence.
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the real disaster scenario est. situation where evidence exists that it could be a reliable but plausible evidence but no convincing evidence that would enable the court to extradite and the court has made it clear that they sincerely and rhetorically except the idea of the independent judiciary in the united states. fin part because of of exaggerated in this representative way to take america's response of habeas corpus rights after 9/11 to be more representative than is if you look at that historical record there are situations with the i.r.a..
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the british government was eager to have been extradited in was very close to margaret thatcher that was us source of extreme pressure asian and in that case they did write that extradition treaty and with as much political will as possible but a judge blocked that in that if that happens and then that could be a nightmare scenario for
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turkish relations. but then not meeting that immediately with the support of turkish democracy but then erdogan goes to russia so what is that meaning and why is that so concerning? or watches erdogan met with britain on august 9th and to follow the crisis if the turkey shutdown of the russian as 24 that turkey said was in the air space on november 24.
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and to slap a lot of sanctions on turkey. some very important trading partners with almost two-thirds of natural gas but there was accusations that erdogan was benefiting from the trade. but coupled with the letter that erdogan wrote that was never made public but the russians wanted to be contained with of apology and then there was deep regret to but i think the
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concern that had to a time when of deepening tension with the united states, turkey baby moving at of the western orbit and willis are coordinating with russia in syria? and flip and the of policy that has been so against that by coming to some sort of agreement and then moving toward the russian position might answers to both questions is no.
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but that is something that policy makers have to think about seriously without falling out when turkey said it would not go to shanghai coordination with fact economic group. so erdogan shows just enough seriousness through enemy russia that we should say with that predecessor empires. and for whom add a popular level there's very little trust on either side. and to put on into play if there is a dramatic change
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with nato in the west. >> is almost when erdogan went to russia to meet with pretend it almost seems so eager to point out how worried they should be to reassure people it seemed like they were telegraphing a little too hard. but yet we have that marked change uh turkey syria policy over the past couple of days last week we saw statements from the prime minister of turkey day wooded consider allowing assad to stay with the transition of power. >> base said that last fall with relations. >> as they leave their approach meant with russia but until reproached meant
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then they were afraid they would lead respond militarily. >> let's just talk in more detail what turkey is doing right now and syria may be one to talk through some of those geographical things spin mike we also have a handy reference map to look at while we discuss this because it gets remarkably detailed remarkably quickly. but there is the ongoing tension between the united states and turkey over the main political objectives and in syria with the united states and turkey they wanted assad to be gone the be in the united states and little more quickly but turkey over the past year to come to terms that the sod with say a power but as generally supporting the
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rebels some disagreement over who they would be this is where the turkish policy alliance with us and conflict between isis with that syria n affiliate's of the pkk that is currently fighting a civil war and for strategic reasons with the conflict it focuses very much on preventing the white pg for musing gain since syria to strengthen its position regionally against the government united states while sympathetic initially
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with the concerns was eager for turkey to find a political rather than military solution which at one point l. look like would be possible but then once i cisco mondesi in and captured everyone's attention than the focus became quite naturally to combat isis in syria and there was frustration at the lack of turkey's enthusiasm to partner with the united states as well as the recognition on the ground feel the political military after that seemed capable was the kurdish ypg. so the tensions that we see now is a continuation of the situation of a long-running tension of the united states and turkey actually managed situation batter as turkey
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sees the pkk as its threat and rushing to and sees isis says the main threat they're both fighting against each other but up and tell now and most recently the turkish operation across the border with cs aero here into northern syria with the fact that there has been any measure of coordination between the turkish forces that represents what is considered a success at this point. >> added say lobar for success? >> that is the measure of coordination to say the turks went into syria by themselves spending task for
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u.s. support and good i thought was interesting is the fact the white house was reluctant the church ask for support from those supporters on the ground the white house did not want to act on that idea out because the rebels of the elements of buckeye it to target u.s. commandos so we had a turkey that is a coordinating with us that is fighting alongside people that could do was harm that skirmishes with those forces of isis and openly flirting with russia and what does that say about the status of the u.s. turkish relations? been making for some time we could say it is the lowest point of u.s. turkish relations.
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>> but before the july 15 coup attempt, the white pg dispute between turkey and the u.s. was of biggest issue n our relationship. met now you could argue they flip? so maybe that coup attempt would lead justify from turkey's point of view with priorities set? but in each category the relationship the tension has grown greater with the difficulty has grown greater turkey, let me back up. if bob ypg move east of the ukraine as they are supposed to, and if turkey basically
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stays in the area across the border or adjust moves along the 98-kilometer area and no further along the syrian turkish border, think the situation could work. obviously the white pg is not totally withdrawn the great fear is that turkey will want to go further they may want to go win or go southwest well below the border to block any possibility of the kurds or the two parts of the kurdish linking up non-bank that is what the movie is about to
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it is about blocking the kurds from being able to link up to those of which they currently hold and if they do that to stand along the border it could worker preparing is good reason to be skeptical but then the air renown of the battlefield widens end of a chaos adds another layer of mayhem. >> so what are the u.s. policy options? we definitely still being of turkey as a country that we need that isn't necessarily lining up with our interest or objectives that we need

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