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tv   Key Capitol Hill Hearings  CSPAN  August 31, 2016 2:03pm-4:04pm EDT

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another face tt probm and you cent a couryhat is in a fiscal and polic csi 's our leadership hin great troue to confrt is. therare deep sai bween the teitial leership and the u.s.edalovernmt, how doou unlock at how do younlk at polical problem is a mor chaenge, how do we get people focus on the zh -- vaccin. h tbeutront in ceer. it the solutn at matters this point. ers certain resignatio anskticism about this beuse we hav't seen the fu impacts t d t sface itooks le tbaknd we dot have a wle lot to fe op, gh we ve- we
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don't have vci, don't haveherapies, we have st but notidely disibuted rap tes d controllg mosqto as we'veeecabeuite diict, so i think at- that breeda rtn epcism resigtion that needs toe untered systemical by the messaging coming from our own leadership. >> we've -- you've talked in your work, steve, about national security and global health security for other diseases and we saw during ebola something quite remarkable in the united states, president obama sent the military in. i remember i was asked on pbs news hour what youhink oth and said iasery proud o amica a wlea secuty
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cocirelution, we havdo mir thin f aids. you see zika at a ahaving any kind of enocar ma serity tea i into irit it won't beidesprd t ute at but tk lileit ououapoa in thuned at a ppadns but so lkbo who a - a t glalesns sofoexpl iho's ragiplan ion aedor 2 lln s.olrshi ses ba oss unreime wt u ul ne i--llve weald enbout sgare soelus ltlbiabt atndowbo dfe or has someesnsro-za s
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leonfrbo? wl eve iatnt i ll,erriblfrhtinan eyetffmmia srmnd t f lel hystea. kas ffen lnab wentrglg d lirang andosy prataninonrsio withhycis d thhe falyemrsthey'rno movad d -toe th'rnoa bl memt, th'rnoa g icanth lad pas,e vet goeno atoi yet wre weeeheulmari rlt of ts cuing. e cthathe s --he clatn fruy w ofikas gbaengy
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the was rentecraon prtri a an ernc ty real cngth clat dth pveo y agn atho msus on arnosuicnt msus. he to me e set emtoe d iss eo wh ty en wh,e ve toakthca tt ds nowork iu. niol inre oinlobal test breinthe erng that t new phonsn one ad h arohe he he a stte a okg aewormal d currinseofhrtsnde ne tge uinhe adsh tt he th thwhe usanwi o joinstitutio a wh e ndg eye acceab a ady anavlae d t
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sck in licafits with congress. >>'moing to come bk th in a nu, evmoly tms of athe.sro isn iinuencinlein a ob hltserity probl anparticar i re th thunedtas with e rlheth orgizioan the li but wt th- tu tyono d, u have enolwi n just kaut yowe in we africfo ebola. yoveeein aica fo ylo fer,o a y'ra phicn, so lk ltl bit abouthfftsn or egnt women a tirabs, atreheears that they vealthe ars jtiie
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justified fears a wt should t pital do ce torionhi i' spent time ilan erica and i've lkeinhe eyes of ryooyoung pregnantom who are really terrifie speakings phicn' cocis, whaare yothki that? >>el fstf all, it doesn't ta bng physian to appciate d to have empathyorhaisoi thugthmis and the hearts of women who are pgnt thki about getng prean and in thr ous, famy mbs d veones when the ght bet sk or thers knn skhich is the case for man my
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countrs now in t aris but alsousstting to be domented in stfra zikairus infecon d aonas a penor anyone caunderstandha and i agrewi tony tt inkiccealis the tip of thiceberanmo data conguto phasize that. the head se t by may nobeo all that meets the efficient meuremencrer for saying it's mrocephy and ulstill brain damage, gnict ain damage, vionhein phaps to coition and we won't knofo sure how extensi that ma is untilheea tcome, d th's onlif we do aroiate studs. so that -- issn idic
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pgrs. it'soi tget musm -- mu rsceainly in the yrs ahd countes and cerin rtofheorld. again, if could justo one message. i real want to emphaze tha we know chth and im very concerneofhere the virus is going ne. when youooba tlast tor, zikvis rst docunt in colomb aer brazilutirst docen in ca vde. that's far frominny, sierra leone d leria. anin my opinion,otnoh atteiowas paid to --o e zikauteakn peer for
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the countritlf andhe the ruis going nt. it notnly imrtt to ask thquti b answer the be yocaatnyime in space. whe is the virus going next? the sse you can looback, udied for decades d blic hethchlsn rmof the trsmission of vis fro19 when they rsfod ithe zika forest t oblyeen arndefore at a long time onward in partoffra d iandhat i call ian hoppin then tfrench polynia,ahi anotrs but thatidn't come apparent att was gngn ench
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lysia unl azil because th h the pli inasucren az and very dtiuied and coliedesrchers and clicns in azil to ma t link withicceal so islanhoppin yoset island off the cot t mainnd ve close to where eba occurred. epidicndikan microcephaly. sone oth one and oy e heonanthas gin l ll. and sonul1st reportof zika.
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noon othe island buthe mala. poedoureport ces of zika i jy stillast beeninalized, so 52 days e rican strar asi, briln ra. since april there had eniv baesorith microceal icmes tmehat yoha to go back sevenr ghmohs fowh the za infectio obablyccurred, so itas oblylreadyasfall a ye a, ich to me means it que obably in ginnor siraeone, liberiaother
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plac. it's not going tben edec oreoe deba wn it'sot pandem. january thpaem, gr. ll it's not in enough con continents. 's world proemndoi toetor includingprd my opionn re parts o africa. >>el wjust finished th the azlyic rio olymcs andhe was aotf ncn going into t ompics att s going to ben plifyi eecan i fact, therwe aumr of hi-profi scholars o loiethwho anolympi commite to cancel or postpe
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e o olympics i fud sn e letter beuse i thout w qte iladse noth t olympics e er did brazil d aood jo did eyo go j, are le lyo e y plicatn and i would like to ask nybout siape. i spt meith thdean o eimecascol and the esenof t uveity. they werrely worri athat me becsef all the ndions with the mosqto werehe and ty expssed concer if anyone wants to dius whether brazilid eug whhew.h.o.eld braz d ough and what e possle efcts we and sondly,he wereikely to see the next e obe? >> is ry danro whether sobo d eugor not. whatoeenghean?
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thgs were very much t voanwhi untered the inn the person that wte that artlehasaid ty shou cceolpics becau fit all, was as yo might expect, peaki in januar d bruary which isummer ti ibrazil gu is the milef nter in bral so mquoes don't dippr but theyo down dramaticlynensity. atral d tir favor rewohings, one the we much less mosquito. i'm sure ty d good job of ntllg mosquito but mosqui nurallyucless at thti othe ye but the le mosquoes the le fectio a t w it acceleti iecon also diminies itself. so by the ti wgoto august and ju ibrilth coitns for major obrk
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were not the. th w fortunate for the condt otholympi, but i think e int that dan made a very good inofhere is it going ghnobeuse it's ceainly t gointoispe d m tching singapo vy cafully because y lk at the mbs in sgare it went from a handf tli 5 to 80 and now there's we or 10 cases. that's dfent than what we arsengn orida where th aggressive mosquito ntrol is noelinating -- i think need tkeep o eye on singape onother pces. >> slet me jusconclude a then wwi te our bre abt going back to th political part ofhis, ihink both steve a tony talked quite se about the imptae of
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blic healthmeen continncfu in the uned stateso thathethe next tbak arises and ty ys the lle ne and another ananotheand another that w don't have to tthe polical well to get mo mey th we epared and after all,henited at is one of e counies that pushed w.o. fm a continncfu. wh are t psptsitthis congssr t next for that to ppen? w timistic are we? >> ihi we can beeasonably tist tt the next admistti if itappens to be hilla cnt wl be mmted to working that. e deheroposal last week ago, monday,lllo those ne dends on how mu contied re ware seeing in the -- w muchoi and threathe i thenvonntbuit
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reir st determined pu to get this done ani in th ctalyn circles le hiarcltos, they' igd is optn and is a iority. i think that's a signal of this t of experienc tt 've ju gone tou a how usatg, embrassinit i t united states to i that positiowh wshould be leinin mh r robust and we-fand d re prictable way. yh, i mean, the unid states learspn blic health iwe understood around the world t ly are we pposedly very wellrere fopublic health emerncs t we also contribute interniolly and when t rld watches what happe wh ebola annowi t
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coressional inactionn zika the s.retaons at stake d w, of course, trere oposals and act wallti o -- actualits money that we used for oltoik i think there eery stng grndfohong that congress would take a biparsan position d act emergency continnc fund. withhat, i want to tha t panel. wl takebout aeninute break. weilco bk,e will reasmb the pel and the i'm going to bcaing onhe audience and parcurlthose o have resnsibility in ts ar, i would real like hear from you. okay, so tnkou >>oue welce. thanks. pplaus
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naib cveatns [iudible conveations
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[iudle conrsions]
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>> so out a n-minu bak ren e discussion oth zi virus canr.ntny sauci,e ll return? st menwhere will be joed onthers,iktoe
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nt pcef legislation en core returns next week. hoe back on tuesday septemr h alonwith the senate the senate he -sn2 ilthis break connu, lo athfbi antheir instation intoac io the state econystems fro th morni'sashington url. >> good mointoou wh l y to th. >>irst oall, there's been a t concern aboutotti for hainofhelection. a lot of this osov the suerittheisosure that e demoatic niol coite d enacked and othepolitical gazations in washingtonu.s. ielligence
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officials believ tt that came froruian intelligence cks and at did raise t -- the speerf russi tampering wi t electns. theussians arsowh crsing the line t mping those c ai aually ying to influencer disrt our democratic pcess. thwe of the democratic nvti tre was a gatheng of natnal security eerts i pe the aspenan annl event d eyut out letter th week ataid e concns that if reportsre correcanthe russians d is witthdemocratic tional committee, what els uldo they do? cod eyn some ways seek t ckntthe electis
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thsees andamr or disrupt the result now, this has beenn sue that electi sury folks ha be talking aboutoruite so time. it sorof comes y he er four yrswh a the vulnabities,hat are th ottions but atetr ally kd raised thstes and then a up oweeks ter secretar held curity johnson d coerence call stated eleioofcis in which waed this isomething we are conceedbo a here e steps, wwould keouo state, y stateleion officials to prote yr elti ste and also ofri fer cersecurity help ith wte vulnabitscs and so suesd tt the depament was lookg at naming eleio
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designatineltis pt of thcric infraruur that ul--hi mns that it cod provide- e eds -- fe cld providerotectn. three wes tethconference ca the f st t this rng ying tt ey had uncovered actual penettions o stateltion ver gistration databases, ey namethem in thflash er and published th on ou webse on mondabusource te uit arizona a illinois. in the case oflloihacker got in andctuallstole data on 200 -- upo 200,000 vote. th seems to movehess fromhe torical tth re.
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d'tetnowho was bend this. there are indications th these were foreign hackers. erarincations th se ofhe ip drses liedn thflh ert which views can adorheels havead pa aoctis with russian has,utt really ramped up thcoer abouthis -- abo th wle iss. .. g your response >> sure. we take ve seriolyny fort b a aorncluding tistates, especily
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nationat tt vebend the collecti oinrmion abt roury andffs the prospect oanfft inflncafirs in our cntry whetr it ielection o sothg else don'wa tcoen othe particarbuthoserehings weak very risland work hard to dersta s wca eqp the st of our governnt with options how tde with it. >> can y sculatehat th fbmeans en ty take it ve seriously? arey strongonfirmation what wa sin theyre lookingthis as a poible instancef stha e decr id. a foreiggovernnteeng to medd iouelti. >>os o the democtian reblican le.
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>> guestthis is not a rtan issue. iss meing thatug t beonrn whoev y a o the policasptrum. >>os afar as wha you we lkgbo, whatould soone possibly glean from those datases? >>ue: at is what mak th puzzling. ontsacth does t ke yo direcy to tpengit elti results. we canissshe t vulnerabilities are. thesere voter risatn database mt te registraonone cod say why y need to d ts? the pernainformation that goes beyond what you t onnesocial security nbe, drer len nbers, ther is ainofto t hacke tritionally ghwa t g in f cmon cyrcmil
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rpes, bogus elecon turns, thein of thingse haveeein sma other has. y is is bein taken mor seriouy tn ats s ts something thatrein adrsieor hacrso s, where vulnabits e and w g io e syst. itheorecay concvae that youanet inta regiraon dabasendtart leng the host: we fished r ne scsion btainabt e ited stepraredne b so the utestes rolin bizi iernational respseo blic hlt tpri a plihealth
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ergencs, awe dider effectively theba. to aonti but to mehe lessonf elaase were woefully unppad t tually did enga, d aemkae job,onolngnftis dias, meing we auay n withufcit litica wi a resoues as nybola mmissions said i wt e fst cal john luca st steppedowaseaof lel unl offit the rlhealthrgizatioand has aotf perience in tes ofotnly thglal respons but thenitedtates role
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with that. >> just the interfacen a way, if wt happenedemergency committe t recomnded sponseas an effect oth unitedtates. ther ioprtity in t governntto conver, and the opant flaw andreredness reecthe image of t uas anntnational leader of inuence the larger public enties. i dn't s this, the y leadship with e in my vi inot affect bwh -
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things that dn work in tes of thabut annecdotal percepon, inreed to see w is interfaced. one of the t oyo >> it always heful wh the whpls proactiveole in addressing sittions, the ndemic influenza or eba oureak, i hpful to the wod d at the unid at wod like to b y cled itorct. weo t it for the w t make move. i'ts if we ha respect r at t w does. d atoueeis spsibility not oy r e united stes buthe world. we do have a global lo at
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thgsotnlbeusof enghned self-ierest but what hapneinhe wor c afcts,ndhe sponsibility t addre tse thgs it is great tha t w tilynvolve d befe who s inlv. it is impornt to remi erody when the emergency coittee was pull tetr and made aeclaraon feua 1, the debate the u s in theenter of e ba about stngtheng the actity d pati of that emergency coite ing qck off the rk, mo ahoritaven tang a position.
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th declaration w a flecti in us policy. it was a refleioofheind active work ambassador coer and hers, presidenba's rees tcongress was feuary 8, .9 billion and i n't thinkhais cocidence, aeqstha wt rwd a few days te thdearationalidat a gimid and endoedoet ahead wiinuremphe,o t ahead ofhi a to ntributeo hepolations. zika ould bmo than
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ebaecse it is anou ighborhood in we africa so ere is a rtul respsibility. it ihere in washington. do you want to mpn he. t office for the us goveme a whoovnae thesbas, the ebola outbakwhinarticular e organiti wneeded to respond,he ino replacent, 5lurion pals. eyll cam to thsa
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colusion but there was not an alternive in strengthing emergency tbak it is globaleahaw inteatnahethegatns binding inationaagement and he te rtain measur aboutestrictingr not reriin trave. tial heah rulio ing nation coerio a fldi, mplyingnd enjed extern eluion using a us fl to lphe securit agdabut couldn't pp withtullaral lysing and someinrecommdefor al couniein theor. lotf the initiate awg atteiousurilncth
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are espeal gd at. questn o is an essential rtr in o interests wit fos suinat it. >> wted to a you, jmy and jn ca a d aboutho cae they have gone through a rockyerd, ander we-fded bu ao deoi an ection ocs r a n director genal. wh sulbe theriority of thdict gener? how cldher tnsrm the orniti, that it s ableo mobilizendinci betterhaitas been t
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past. eierf e of you. doou wt tjump in? uer thentnaon alth regulio uat i 05n opio ahoty and respsilies, anth ishe0tanfinal yearon the directoreneral conni erncy committee, adves whether thenternaon concn,nlshcadecide whetheto dla pliheth ergenc tta t advicor notakehedve of the
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ergency comtt. ve seari eernc unrgettae perien wh 200 patits with olfour mont ago isira lee, and in 201 with rega tthwh toeetingn ergency mein r ka andeconvening aft today. the director general t convene the emergencommitt. an declaring pli healt ergency. the ssily declaring public healthmeency, but ere is gnicant in a positive manner
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conveng emergency mmitte they cveen tim whout a blicealth commtee beg dear. conved r llow ve th niol ncn bein declared. and underappreciatedhenl e pson can connehe emernccommittee. >> sikg the iue of authority, andikit almt i thdirecteneral. for e mmittesingly.
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er a cckand balanc. eyad t get iwrg. and thhose risks, a clear feing abt theechanis liticapackage, cckan balancesf athoano in the actions but the ability to question t pnt form ofhe eaon of apatyanit is painfly thetaing, and the first is fanng, the meertas put lot of essure on the who, and wit
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the stutnal maates, a given the budge space for inecr genel's, solid fincl package. and in that caseits sustainable,o empsize. who termsf your mon ia pler and if yoare talkin oubo style or haiti yl t uted stas ll play a role in that. the elents to detmi suesof thefireon
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ai being pd willecsen thrganizion wiinn organization, wi accountabity and mecnisms and oversit,arof the fabr, d't tnkhe next possibility -- strenheng isirst oregulations a the committe waselcome but go action for a clean bill o heal t ce ck next ye, it is atreg plan for e recommendatis so it would the politil ll to suppor fos at aresstial.
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the legalramewo is gerly cepted and middle rengthing for interniol capacity >> introdu your self. >> worked on the impactf ebola, myquti, vacce is y d anthony fauci meiod this. fo ela hitn utheast as, 2013 as well, now talkingbout the guidancis present so there ia t
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effort goingn, why are integrated sto mag n only, yellow fever a tk out that -do you see more reectoanagement d fincing turnin to contl our ves? the aweis yes but i a nosu iwi be suesul it was proven toe extrel prletic, the best amef vect magement tt s ccessful isomethg ate a -- and accepblin today's ciy,ral d the 50when th got r of aids bmes that wouldote ceable. a mbatn of aggressive us
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of ddt and almt liristic gog toeople's homes d placesf rk to eaup stding water we know from wt goingn puer coand wh hon onloda how difficult iis wh you have clatth is se tpiloi cma t geriofhereeding of mouiess trely probletic paicar wn yoare deing with this u have to spray everyay becse they cyc wh e hating of the eg, d y c p tm on aggsse fo and on friday osard they e back t se level so its somethin y need to addre bui n' seet setng ealyttnable and at is whyoarhearin l o discussi about geneticly
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mofied mquitoe a thing at have prisbue haveo bearul because it eal a ccerned gro aut the pact on the envinmt. it is not sy iveoronols not easy, e of the thingshat do seem intuitivy obvious to thamic publiis the imrtce of cce diagsts and eatmen a what we have nic with ll fever andikand ebola is when epidemic hits we d't seem to havrely good pathwa,t is takina while and therere incentesgainsthaecause its episodic enen. instrys t ke to iest
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in ibeuse it is so esoc buteveral ebola pies taedbo aertions of prioritiesnd funding strms public-private pareripsnd thike toxemplify ely rearch opaogs atre rcatgut havnohit. >>e n' need to ientivize earlrear but advanced delopment of vacne e platform we e usin one t sevallaorms ware using a dna platform deloped for a vaccine agnst we nileohe vaccine rear ctedelod aer ni vci ain wt nile. weid a pha istudy,e uld
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nofind aompany to ptner thdvanced deloent. weave a good candite in as2 ials in the caribbn d only now tha ware getting coanies interestein developing a vci, becae e blicity we areetng with theunowe ve coans that are interesd gointhe distan wh s it ally is the incentiveo develop a vaccine that ghno have unirs ugend that gets back to ourilngsso makenvtmtsn developing vacces for things thatil not be a hot item for people t use. a lot of efforis goingnt veping that proach. >>an iava llow-up questi a g other pple in
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the room? >>'mirtor of the proam institute. i hava estionn terms of etr u could eborate a tt me on ethical isss -- the population mo at risk at the mont? >> not s sure you call ian etcaise but it is anss u have to take into consideratn s the rget of the ka vacne ia maof childbeari a. ifou he prnant woman who infected before she kwshe is infecd it might be tooat so the tgewod beimar tohe rubella vaccine. its a relively mild disease
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thelf-liting infectionnd don't cause anybody rmnd let somebo g iected ring egnc and you get the rubella anrome or the issue of danger to pregnant wenrhe ki oclicri y dis son hil flavor to it in th when you'rdeinwith thesenronmen there is teial of anodanbo related enhancen ifouav a cce that isubtil in s effacy anyou get infected y mightav enhancements rheth protti. we he enhaiton stereotype of ng firsts anhewhich tells usou hav to bcareful in the design urlicatrial and we have
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considerable dcuiodung the ol obreak, there is alys a ke-jerk reaiowhen you have an outbre a an inrventi, out a ge people becaus youave a moral imperave to do that as pod saying you ne to know iit works and if it is safend not ithat orde you haveo si alical trl to get thanswers quickly asou canithout putng peoplet sk. unke dg at vacne is gin to a persono protect em as oppod to someonwi andvcedisease who nes ug where t benefit ratio is much difrent when dealg th a sick person o ed interventi vsua compte ll pern who needs prevention.
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those etcaises come io vain develment. aing about rrent infections andf u could speak tohedethat the evus infecti mighte imctg the epidemiological tternse are seeing. >> the qstn you are ain relatedict or indirectly to wt sa aboutediate haemt. if you havbe exposed to a vis tt dgu zika, wes nile,apanesenphit, theorecally since there is th issue with deng b no
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othe demonstrad inctn. the ssibily of abo, meat enhancent even thgh there is no motratio if yowere infected withest ni or got vcinated wh yell feverouava lowev, you th g infected you mht have mo sio, it is theoreticay ssle getting ba tthe view, make sur y have t right contrs but yo look storicallybo pelende carul abo stieinhi y prospect o leesk t qstn, retroscte studies, they hav aknesses iertlbutiv eir weakneesreospecte seatnastyle say people o re vaccinad wityeow veor had west le vir
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don'have any me diffult coseitother ruses. i canay that it was do retrospectely. ba there. >>eoetown law studt. wh role do yopeei t precion healthniate thisas longitudinada analysis toorrobotehe likeho of hangeactions gin taccination has greater unkeho, er ia lot of funding toward t data
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analysisinvialand the decision to help itiiv gog rwd,o you e it panding into ts areof global health issu. and infectio. .. that you c dth a t bestay to get e swer t wh y're saying is to he a 10,000 person rdomizeonol beusyou can find o ect the answer if yodo ndiz control trial sometimes yoha tdoore flexible and do different nd a trial but igerathat's e standard of answinth esonhat you're askg. >> i want tori iste d
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dan into thicoerti and paicar gng to the political situation bauseim talkoday me during the bre and i llnvite tim to comment on ts as well because of t fact that the s been established a emerncfund thatasn't been funded d me of thetudents he id wouldn't this ba fund andhat would igr . whi don't invite eitr m stevtoefctn thostwo iseso kind of brinusul circleactohemptance of congress pacve fundi these kinds of problems. >> well, we have other precedents outdef pdec emergencies wch youav
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t idfus r priority purpos a y c -- you can etty -- pretty well lay out what the tgg condions are d at theepting requirementsrendo at there's a measure countalitynd tnsparency and how thatoney ius and it can b--t'the satisfy this seome clear quirementshat we areeeg er and oveagn so i don't beev-- mn,f u can get ov the firstump and get coress thinking long-ter about having rularly budte funds availae for is purpose,ot jusauorizin methinbut not fuinit icishat tim is going to ll us about, tn think you cabegin to acqui aecord
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performancana co o peormance will oy, tnk, begin to litimizyoself. thmost importanthi ith this has cdili on a birtisan basis that bse , you know thayoca motrate thathose dollars are beg put t ctically important uswi ocos ry important cases and ihi we've seen here, i mean, iwe ar--e e paying a huge pre by n having that and i think ataso broug foar we have x vcine cdidates. we are mthbendn ing ab to fully vehose foard. if whad had a contgey nd available in february, tony, where would wee da wld we be closer -ife lie the vaccine ishe ultimate luonor zika and weno
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'soi tta aroximately x number omohsets so -- that point, s month dey,ouan calculate t numberficphalicndou can gito demonsttehe cost of not having it as wl having putng in place the sortf poinrequiren atou donra to a sktic th this is beingut wthy cse so we've t the cost and delay bualso, tim, u' vy thoutful aboutheudtary pres e erprlems about precting funngoi fwa and how do we explaithe existence a funth habit beenrorly fded?
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wh a the phws to makin th wk? [inaudib] iwagog be a passi obm d it's mostly en unpropriated and youe exacy right th it's thoriz anoappropated. it f iueth arise during theoue audt ye wn -- it's a sucral obm at congrs gi dg iadvance. lo of thgs arise dinth court of a budget ye tt hasn't been and r,ut i veo y having bn auoredmo of thtime ither mocrat n reblican adminisatn' reesappropatn for . they just n'anhang been authorized mosofheim decraticr puican majories in e ngss don't
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put the moy ideier. i ink it's -there e me budget comicio tdo so but i inmo othtime it's t truckhul potil -- structura lical iueheyou have rrt eds, we are competg limid nds forow most of the timthey say iav toma pblems to deal with w d cat t anytng ase d dot ink it i any wareted to pubc heal. i mean, weon he adequa hrineepr us fund eitr d d'tave an adequate hhw raitrust fund jusdot veon for thgshawe can't immedte willaye are intope r, and i he thathayou
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gu a sinth t consouess is aringecse of ela and zikthat tre will be in tt arise dung e urse oa dget year or ev 1monthsfter the budget ye tt op rlldo nee to have netoece r so at thecatake immedte tion for setng as emerncyoreesibing da ju tnkheoness an e mistti aaywant to snd the mon f tir currtlidtiedeeds. >> we hath aumt made- [inaudible] a tt thisas ris from
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ina condarorhird oer priority to meinth i noregnized as higher prrity, i thk you' got an arme about why would wput money to setng thawe may t e. >> i py that youre correct there are obouy me budt gapes to b pyed. we've known th wne rricane reir foronr an pandicepair. we wt r emergency no yea moneandemocrats and republics can ba wth it has to osewi other cuts or not. u may meer the chris christie he hued bark obama cae christie came after offsets. this sms pital dewehtut there wn you cat immeaty idenfy whe
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thmoney is going for but i pr that u' correct tt senior people and senr gislats can be conscious atikand eba d whatever on- nyaythe next oblem wille. buit's not simply potian i mean, there have been yes ich the public heah op said, oh, no, nd the money for this also and vet ked r tbeudgeted foan knn contingency t. >> we have oneorquti and en'm goi tinvitehe panelists toayome closing rdanweill wrapp. so whyon i move tord the summary. n, youaven't had lot of oppounities topeak, why don't you reflect w za d e lesss arned om ebola, zika goinfoaran what you hope anexctill
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happ wh e currt ernccommittee yellow fer cling, ihi, e prleof getting betr technologies f vcis to avoid tus scarcities? >> all in sonds? i thinwe nee moreacne de w.h.o.'leaderipn astaundi thingapned over 8 milliopeleere vaccinated buth had to use one fifth the normal dose vci because eyav'tavenough athiti to give aullos . a fu dose willrotect for a lifeti. fifth dose 12 nt, a ye, we don't know how much lger. differenechnologietu o
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a new type of yeowev vaccin that's one example. anher toakself-cultu. kw that theor kwsnd e foodndrug adniration ows. that's wt nd. cae if yellow fever goes to asia for t fst te, it neveras11 tralers went wi ylofer,e worry about reing za -they ret ting and spreading llow fevern march orpril but w theyre biting. ift re in ia or othe part
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ofhe wor there's not enough tecology. special thenreeggs like influenza vaccine chlo, but maybe ten years ohe unedtaseg aow we venfluen vcine plant ici thinu. government was voedtony, make that pp. so that's what i s afaas ll feright n. the only oer comnto try to ke to s uup everythg thoprtunityou gave mto spk ou in closing, it's not just mter of what's next, which i've aayasd nynd many other op becauswh'sexis already out there. it already he. eba began in gin idemb 2013 but we didn'kn tl march o23 when cfied confird franc
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ity sh, 7,000 people dn' knowhait wasn m. itasn't recognized. we have en behind th ccatgngola. it hado p o fm the goveme oanla. now e joty of peop close 80% opelereacnated and e idemic has almt stpe aost. 'sll right o there thlast thing wld like to y iny view wvented wh i would like to call the epidicagofumans, so two ys agon capeown, aic
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rkg group tryingo cide on have we eer io a ne geog stage. and befo, d befe,nd i n'know all the befores b beforehe dinau. two days o, they think we are and he he idhat t t spificatont which wellnois950, it's e begiinofhe atomiage. ttsi, in mvi we can lkbout with capil bu thma a scientists dilast year a -anthey pposed the ulbe indtrial anthropaci a well tot anmay goack at least wn
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e ropeans ca to th continenanma, nymany miio opele die somethg lled the orb spike or o-r-b gbazaonplane trav, pid ple avel awhe aroundheor. urnization. >> clite chae. clima cnge fo se epidems, i ehazehe world panpidemics. wereotoi to ev lve it a wne tstand to it from aolic, teatnal responbity andctn in ofie now >> we e a wor tt epidiccod sead mo
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radlanev wh t aent with vacne a wprared steve as a natn and internationay? and ifotwhat do weeeto ? well,ir oal tnkou larry for lling l is geeroday, rely pria ts. th h bn ryaluabl i dot inwe arerered. thk are aa rning int. asonpoteout we are at a monthe t disionsav to btaken heise thingsre going to freezupn our own spseerwh ware talkg ouzika. a vulneblthatacne won't haenndprd areas li alaba olosia er yocasee clusters and n ha vy odreparaon the ulbeui sprea 've talkedbo tt at leaves us t dk bit about w a where
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weace seoupolitical problemsn the hillthose -- m n be possib to anscend afr e econ cycle but weave to tryeay ha ithcoming weeks to tr angepastho. we a sing some -- it a very fluid situationlolly wi respe to zika. me, e southeast asia, ngorevtshere at ho putoic rai sh fast-minto, the reing of t bod supy will gives a beer picture of at's going and we wi bin to e ecom cseences in terms tve trism ier of fas. we a very chn the debtf to, amy pope, tom fedan
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at a florida authorityha workedn pa or the last veral nt to putother a amework that has swnome very significantestsnd rydvse circumstances. >> ande veeen lky cae ora dn paicular miami have hhl futi health departnt sof it hped alace wherth didn'have any squitoonol authorities or fuin it could have beemu worse and mae sll will . to, nawords. >> soer bef jt ck to my last slide of erng infectious, i just want to put a pih to t audience whicis ry much like pacngo e chr cae beeve everybody in t rm elt is same w itoever forgethe portance oinvestment i research in glalealth. we do not live ia vacuum here
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and there are moveamg some in congress eential a portn ne bas ocotry, which meanshat if you looat that and say how much ney shouldoupe pereb y n rget about malia rear, v search, you can foet abo reah om rgg or reemergin fections. i want to put itit ld and clear,ubliclhe and anyon who listening of why it's so poanfous to ve an invement in global health d t ink in terms of preventionli f oselves cause whatffects theesof the world ll affect us and what affects uisoing t effectheesofheor. 'serdiicult as tim pointed ouso well to askor sothing at hasn't ppened yet wh y he lot of
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thgs that aralready haening. we jt needo t overha d beyond tt and realize that yohave to prepare fothgs th have not yet pped heisyore going tbe continlly in theame ho that you find yourlfn en you' csing aoutbre. thwot ing too is to tr d asanuteak, t outbreak aosalwaysins. yohave to behead of the oure. >> are we prar in the united stesarwe prere glally, i think u ard the answer is not t. soust rein for me te really, really gre pasure givi mheart lthanks for thaming coributions t ju in th rm t throughout theiliti ofte mre,
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anon behf of goarnto ivsi and the oei, wanto thank th oorni tnkouery much. ppus >> thank you. naib cversations
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>> you canat ts scsi on our webtes lls others t za rus it in th video brary cpan.or lateth aernoonredent obamwill give keotspch atheake tae mm o water anthe environment, joing m hry ried an cafornia senator diane feinei y c see tt at about 30asrnn sp2. dona tmpiv secon apprcho miatn,o the s. andefe his speech he's meinwi psinteña etanweilhave it live on-span amonwi yr actionyo pnealls and twts a starts at 9:00 p.m. eaern.
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re is more of ate ul ar about dald trp tig. >> goomornin >>oomornin tnkfo hange. >>hat do we ow exalybo thpotis this speh ll taken iza today by donald trum >>o we rlly don't ow much. he been little bitague leadg to th sech. we do kn hs into sti ca f tt wall. asf now we kw thate' gog cl réxi tpa for it altugh hes goin last nhte tweeted thate s intoeewith the pridt of méxi bore the spee so the ulalyse so cnges to th pic afr etg icyou ta about tms of compromi. we knoth he's into rely doue down ontrger forcement d tting crins out t cntry. stalk autrizona, wh the and eciclyhe wh'seethreaction mbe
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fromho iaronabt ear speech wl,rina is reblican ate. he uright w, noty a toolha out 5 in, comftae stattoe . has tndsementf erf e arpaio who iser ro ostopping ieg immigratioantaps rht int atase. w,rinalso has arong spicopatn mr. tmp s ikind of going cknd foh overhere wh op wh dootikhis policies at a d the moats trying to tap into tt de of thin, definily medesge but ov all is reblican sta with eorment oa sheff whiseay strong on illegal immigrion. >> the have been stories adg up to this sec you ntion anngolicies thra
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mr. trumtangosblonon miation and those mostre inreedn thathow arth wahi ts eech? >>hawe areatinfor today any kind quote, unquotsoftening om him s team saiit dinitel nogoing hpen but th reas we are loing for that because lt eke met th e spic advorbodnd they -- congutf at meeting sd few thingsat e int he wou say steng on histae icwathe strongeskind -imgration s en his sigtu cpan su touou very sonatt o point healled deportationsor so ftening will ba geal. llg work thaw abing domented immrant who are being to pay bk xe noheama uple of days ter th and said that's n tr. i was just to liting opinion
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omeoe. i'm justs strong asve ifnyf ose thgsom throh,has actuly a chge in s ance. h aut the meeting tha umwi have mexican' prident,ust mr. trp invited and what's othagda and image imgriowi topop agen b wt sean be scse wdot know vermuch. lly clinton was so vited. pant t psident of méxico iit tm th on id. w dn't hear anythg tila lt nigh so i know at the trump caai has bn working schelehis. 's a strategic schulg t justralwe cause it's clero izona than new york, he ce tthspch saying i met with thereside o méxicond we discontinued thi and mep withlans, denily psidential move. w w not by any means st directedt dona tmp
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d'tnow what ty'll be lkg out bedethat but iju kind saying leadg up untilhe election, our two countriearconnected. let'ta authings, assumingmmraon at least. athing elsee should kw ornything else iorntor ouviers to wat for fm ispeech? >> i thi we arju reall lookinfodeils togh so, you knowyocan talk aut the ll, you can ta aut gettg iminals oubut wh abt thes 11- mlion documeedmmigrant w a the country rhtow a really lookinfor what's happedo themecause he had evus said get them all out so we a curious or ife uld be wling to leso oth stay. >> eliza f u todayalng abouthspchy donald trump togh ms. coins, tnkou. >> thank y. >> wh the house and senate returning omhe summe
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breanext wk,n thuray at 8:00 p.m. eastern wi previ foureyssues faci cgrs this fal ferafu to go combat e zika vir. wen in erica todawant to maksu that theyave the ability to notet prean wh becausthe mosquitoes ravage egnt women. ..
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>> si'm readinso te
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trelan expiensz ficon andendon how mucti i get to read. generally it jt on the airpla. >>avyoulws been a ader. >>es sen ficti has be mfavorite, d the politicalhrle. ds hp you your work heren cgrs? >> it helpseunwind. ers lo read doinhe. there's l llanfor fu i'm breangutov. >> wl 'slws hard to find time to re. two bookbo dli wh the onynderin don't seem be like in era. restbution, and, whodles into the incentives that so many
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amicans veot wororot wk o hard. >> scandal of ne ihi a t y remeerim from wealth and positilyanit deals wi t feder rerve i maki the wealthier people better off, but e lies ov the last x ar i rtul he hurthe avege y. th'shy we have theto market boom,ndheverageuy isn't making tt chon and co bk aeconomy in, whicthaveragguys, income goingp every ye. bksikthat do th hp yoinou. >> yh, with more. i thinthey give me coidceiny arguments. and, me nfen i dismantlg mef e welfe ate and mo cfince, i thidea whave to doomhing with t feresve >>el i alws keo ad
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bos atreetn reign cotrs ere i'treling. i just came ba, om tp kea, ando read itois sharksrer f gerrya thller. set ther anfor kenya, rd out afcagain, icisn d voteana w e ll e bolter whichs e orof a loon lad a, ther scdalous life in kenya. >> book t.v. wants to knowhat you're arrestingth summe tweeusouaner and post it onur facoo pe.
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>> lk at mobilring cagirs androvidi vege for nonedal servic >>kawe'll get arted. i'm marilyn, i with th the alan f hlth reform. balofurocir setor cainnd, bunt, i likeo lce u to the briengn ghee hh st patien. chlenges andprising de. as wte new model tres gnict teion toho patientsith thgrte hethreee and who a so othe colit tit. weft hear the atha5% t populiois resnsle for abouha othhethre spenng dawe're intoe lkg outhe chlees of ri foth populio a erng ideas a mel ifoureatchin le on
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c-an today, or if yoaral foowg us this conversaon onwitter, wencoura tyo bm yr estion e shtag ihn.chi nd hi cos i'd li for tnkurarer ansuorr in, todas briefing t cmoeah fund whh s ne qui a bitf work, and espiay,edal lia ra w is myartner today. mical ldas vice-predent at the coonal fd d adit hethre deliverprogra yocasehefu by o in o cks daas you can seehe ll by'ses for l o speake. i'going tn it over to mecalinda and she'll help us understa ts p o cing, the challengesaniniting efctive ogms andhat's e rk a then she'going iroce the rest of our
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panel. so, medicalinda. tnkouery mu. d thanks to our partne a thalliance for health reform for today's befg. so i'm jusgog do a litt biof conct setng, an real tn nd it ero our panelis d pes day. as marlin mentne hlt syemparsand providers arineangly fus on the gh cospaents a wrer t 550, 5 w accou for 50%. expeitures the reason i is saty which we cldmproveeah tcesanlor costs care forurigdiest pie. cungn cost alone, witht considering thnes of this
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paent polaon, might t proplydeify those r which te vtions ghbe most eective or e policies needhae. sowh wpaned with john's hki,niversity, and coucd seesf analyses of nationasueys. the e o data briefs at are ing reased today. theye in t bk t room, wn u came in and e okat, you know, some of the mos of the populatn d e usansecondne looks at how well t stem is meenghe edofheopulation. who are ey? >> so, in termofhe, e anys that e ing released toy, the wayt s fined. they were adul w h three me ronic conditions and a nctional litioankan daviwi g io is a lileitore.
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itasffecting theirbity to carfothemselvesr peorroindaily tasks. ere are about 1 in0 llion u.s. adults, w qli ahi edv 's2 llion people. what we find i when you look at ts pution, they are much more ke, ey're more likely tn st alttoe older d,ow income and publ insurance. anal, to use aot of alca svices. so, this population isi, they are often filndhe are very expensi. they're using loofeah ca svis. , is, inhis chart it ao brgs home thpoint , addition to e needthere's a t of cts associated with em. an that when youomrehose withheunio-- witthe
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chroniqutis us the litaons compared to those wi multie chroc conditions, yosee mu hher level spending. wi tell u, in addition to eir increased totaco of cas,hey'relso higher out pkecosts. soven thgh thehave gat menes, they're greer costs r pop 350u lacg. while they ha hher ouat th te ll a sayings and gh needs we have fou a part of this analysis,hiis the sond brief, performanc they havgreateunt nee. anthen, in addition tir unt eds and these are higher, whetheyoreooking at tse, alone the tal 307 peacing. they are morlilyo po
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on n m ndsnd difficult to obtn sy accs the a spiali and report,r less likely trertoo mmicion wi tir over hower, they armore lelto rertaving a patient ceer mem home. sohat's the good news. >> one o t impornt pies you'll heaabout on t pel da wl stly come fromhe ct, is that, the a a mb of models and proam that exist. th exaffect stifily me the needs of thive sick,rail mitedopation. d ers quitbith w owbout the pgrs at rk. th is, based off aanalys, d is is e of many anales. there'severath have en blheanthere e a nuer
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pming proams. and th, part of what nd said tarti tsehawill most befit from the inteentions, a engaging tients, good iorti tenology, ancodition and soe kw someies that arneedo meet the needs o th pulioand there are evidence bas pgrams that are out er hover, trere some barrie tohexpled alof somof ese promisg ogmsnd wel ar about more of ts today, both omar davisnd therine hes. the first and mo impornt which manyf u probly know is theisaligenof finci inntesth just te twquk ameswhile ther arwi aouable care, and medicare advanta, value based ymt 're not seng that
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lubased payment t se value base coenti a wee t ei tt trickle do tthe frt lines of car 'rstill seeing some misalime a is t bein felt. secondanwe'll ar more abouth, tt os the financial incentur, ith alyscce to t pti, th uertakes thinvestnt. ithfrtle ovider neednvest,n the care maname program, but e sanggsgoo the per. anweo e a grte inre, on hh ed higco patienand a greater interest spreangnd scang these mols. at w iismptant to hear how it coulbeer mee
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the needofhe pients. there are nuerf other rriersndon oerne, that i will mentio i how a lof tseatient, have i adtion thang phyca health needsheha behaor hltnes d social service nee to meet, impre eioutcomes a lower the co of ca wprobably edreaterlex abilitto cover so othnon-meca seic. some of e rsalarand so, in differe stis. t erodcamake ito the doctors office, some at me or cmunityasedetng ward ts goal of yi to imove ouom a lower cost trereivfoundation that'serco tetr suorhethre ornitis,o opt eviden inrventions d m outh i am wki wh e hn.
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haford, and robe jns a tersonand thscan unti. therwas aserective published, athend ofuly th tked about this andha wee anng to , in forwd. >>o,hat's the troducon d w m gointo turit ov tthexperts, othe ne rst will bdoctorar vis, a she'll beolweby kathereayes,irtoof al and tn ctor per boin who is dict oga tcks anhe will give ua perspecte,f physiann ho bedetng >> karen.
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>>'moing fus on medicare neciiewi physical or cognitf impairment. most releso medicare with o or me limitations of actiti oday ving or pelehoerdying -dygs nod with twohis yr thki, that i'm goi to try to ses fit a, is populatn edbo medic services d ng-term receiv a spo. nearly all othe with physalmprmt vehronic nditio, o-ir he ree or me roc conditio. the cond shifti think we're us ttaing about how to sa mey in e medicare progra and,owo duce
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hospitalizatioorsef erncy rooms. wh iant to insert intoou thinking is e poan o heinpeletay atomas a go. t, also, the iorncof reducing or lang nursing home placementndchvi sang not just to mice but also medicaid d mily bunch ts. so the need for integratioof re between medalecve d ppt, and to put isn thbrder coexofot ok healthar she mentioned misalignntf incentives. th's truwhen y try to ingre medical,nd long-te care serviceani'gog she some policy ias. thfirst point that iant to make, is, that, this populatn, while it has a t charactestics, being low
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inme and, multip hlt problems ty e t synonomo wi dls. one-third of t medice beneficiary wi this, he incomes belotwe poverty and th are n cd front by dire th'she suboup th's the rdest hit. it's harde h wth you look at medicare spending, it is ice asigfor people with phical impaiments as those without. but you alsoeehas ue in th pulio who diid, with incom bow twe poverty. an 11,000 a year. the e also spending a high rctage otheir co out pkeonhirange of seic. almost halofhe incomesor
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those belotwe verty, not medicaid, goes for out of cket sts. e next point tt waedo ke is w high at sk thi polaons for nsi home placemt. followed people fo14 yea w starteouat the medare beneficiaries o veatom and th, over the4 ar periods 36% wou uin a rsg home. so verhigh rk r nursg melacement f thoseit dementia, d,3%orhose thwor moreimitations d evenho with mild cognite impairment, in nursing me on average, it tak aut fiv yes fo sebody, with demeiain uin a nursing ho.
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siyes th a.d. l. d, yearsor those with ld cognitivimirment. >> if you cod lay byin months, nursg home plament or pvent it, ne mont t nursg me caryocould save 112 billion in nsing he exnditures over yrs t l es to medicaid becse a t t out of pocket t 3ilonsangs over 14 ars, just by delaying rsing home plame bnine mons. in aition, doctor s look erynto medicaid and loinatlder mice beneficiars who wereot medicaidan over 14 yrs,
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in micd verage, 19% of os wh ysal impairment and high out opoet eens, more than0% of thei income, wind up spdi dn, intoedaid. agn,hat isrufothne poor. but evenn e veryighest incomero, oswith incom rehafo times poverty are at risk of spendindo io diid agn,f you could lower e spend wn rate th comes wit ghutf pocket costs with people forhycal and cognitf paver mea y ulsa 1 billi. it's time to thinkbo wt are some policsoti that' woulbring reogheand wod ove tter finanal protection agastho expens. to she thou, briefly,
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anveiew ofhe medicarhe om weound that covering targedomca benefit, unr dicareup to 20 hrs we, 0 r home and community based services und mice cod fand,y a mbinatn medice priums, 42 dla aon, and anncasinheayroll tax of 0.4% onmpyers a emoys. it psie to srtith a targeted bef, pring meautiocovere home d mmunitbased car atould eveenle organizations thatreilng tontegra medical and long-tm reerces toegin te financial acunbity fothe entire range o seices.
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rero these as intrad care orgizio. they m srtuts acuntable ca oanatns, that n sharen medicare saving buthey couldha, r dud dayed nsi he placement. ey wou he ienve to pridsuorto fily ca vers, and, care plans seon patient prisoneferens and inpeenasom hoit ahome. atrodeuprtor famy ca caregivers. so, this is quk erewf thisedarhelp ahome net,ndow it uld prote beerntrad re, at benefits, tt ulacue to indidls across the income
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sptr. but thma pointis thath cuent medica befits poli, poorlsued to neciariewi physil d cognivimpairment le than a third micare beneficiies, a hwinc heill inch abiliesnd the'anmptant nd pa befits to ilu he and community bad re to promotthe growth of teat care organations, that wld she sin from duced nuinho placement >>ha y. 'rgog to move e coersati wld cathene has, andoithe converti onwierhrts turn to
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kaerine. >> thank youermuch a thank u for cling knee today scsi. wouldike for the who e tamiliawi e licy cte is noprofitrganizioth was foedn00
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mihe, bake dacia and dole. anthhethroct, i'm th reoranoucod chairs are form sate majority leader dacial, a, fsk before g io y level of ta. i wod ke to telloubout thpresancomingp th li romndio our goal a the gl of my health proje, to idti prsi iue ipublic pocyin thereas of meca, mediidpuic and privathealth insuran a ng-term seic a spo. he neor ideve system refm. nuer of us, ther he en rmer hlth stashers, d,ne thg at is portant about coming up wiitpocyis
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coizg,hat folks need. and, thosereoly remmendations that, have certain level dail, ian remb sclearlsitting in thsetend having folks co ansahe's whaweeeto donds un staffer. but, yes, how do do th? how do we impleme that? >>owo tnk about imrsement? >>o our goaleriso try mep thoncrete coendation that's cahelp idagcy and congressional staffers. m going skip or, as a- dical linda has taedbout th, is is what we ow but e stmptant things that p.s.c. is focusi on bar iers, to reimburseme for successful mods of care. inhat, wreooking at medicare and medicd, in coming up with recommdaons to
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remove it anma it eaer for providers, tta aooat paen with hi ndsnd dermine whathey need and develop a carelabad on at thene rather than what is covered underheedar and mecaid pgrams. so, when the cte wn work on an issuee okt the currenresearch. then embarkn gnificant akolder engagement, we spend out a year to a ye-a-aalf meeting with providerrgizio, and, conser orgizio, d, he pns, and also wki wixpts in e eld, that have done research. cee have donthat we come up witpocyecmeatns, and ene o and vet those ai go back and ask t esons. did we get rht so when we he these recommendations put toth,
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d go ba to theears we know what t ps,nd continues, are, d e pial, d can tell them, that they veee vetted. wehetake another step, which is somethinghaisery ffulsometimes, it's recoizing, there a lt things, we cou a ce to a agreement on policy recommentions, if dn' ha twoy authe politic and, feral budget. so that's anothefierhat we run these sues throu. we tnk about wt igog ct,nd, we hava lot of these poliesoaed out and we have aeentwi cms, d we'reorngwi medicare d dicaid for get a sensef wh things argog st and en finlyin thiing about , tnkbout wt
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the currt vinment wh thaptite is for chge geinsomething done, inhe nearer we ao have lonte coentions. in the short-tm we try tfi thgshacod be done with thnext yr. , in lking aca for high needs, high statnts we broke isow e first rorwi be - loinateimbrs meant mel at serveuals, and 'll be loinat medaradntage, and monstrations such as the financial alignmt,nd loong at t pe proam cee mep with tho coendatis,hen we fir d initl concretemendmes to eacof tho, tug rsf does it makeense t really try to take t programs d art wi the duels, that
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arrelyea for two differenthings. addrs oopatnsan should we thinabt way to bud prra fm the ground up using somofhe exiin what we have leaedthug medicaredvantage. and through thpa pgram. so we'll bcongutith threse of recommendaonin september. one, are amendmentto exiing progms andsend will be a new amork foproviding receiv a by ne fmework i recognize ai bng hl afr,hathlast thing you nto hear, is he ia r ne program. ild on an existingtrtu. wee looking at t tee way ntcthat'sei imemte aow estates, the fera governme, d alla, to
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work together, to servdus. anwe make recommdaonto loprids, to teinto three y ntctitcman theta. finally, we ma se coentis, on approvin e ograms. anwe staed with duels, beusweere woied about howeere gog pay f it. the e t onlheth lated receesut l of pport. with medaiatea with the duels, we d iraructur the, and revenue soue ther help fset tseosts. thne phaseill begin, wl repo i april o 2017. some of thth'se have been okg nat rms ofur
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preliminy ndingsisooking t existing imrsen dels, atofts exily,s there to cov reiv, atre not today, consided medicarcore seic? , initiall se t even sws the things at wehod looking aar trio hsi relat receivesand, medic transportation so we'reoong at the dicare advante ogm d acunblcare. d,lso, lki aic cungn, theims,ndndhe ternative ymtod. and a w others. buwel issui aept eaier inheall that ls out what theyrendhen ne ye wll issue remmendaons. thank u.
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>>et tn isveto ctowling. y. perct well, ye tnks evyby for inti me here. m intoake yothrougmy joney whh ga aviiniairgini mmwethnirsy,hei joedhe facty, after trning, in internal dine d, tug iad this gured out. thhospital lel car the ch nt,nd tught we were doing a eajo as a safety-n hpil. yocaeehewa, flting t ehasis that atur place a itaed mangoucas. at wasy rst jo anas i d tt,his t turnedpse-wnecause i fod t thathe patnt

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